Review of the benefits and ROI of real-time indoor location tracking and sensing technology in senior care communities.

As the world changes, so do customer opinions and expectations of your service, particularly when residents' health and wellness are in flux or your service operations, and the bottom-line comes under pressure.  Simultaneously, shifts within an industry can accelerate much-needed growth in how a business runs and markets to its customers. It's the same reason why we've seen companies across the sector accelerate their adoption of new technology, applying quick and innovative solutions to meet oncoming challenges. However, there's a lot of new technology available, and it's hard to imagine where to start, what questions to ask, and how to quantify each technology's ROI potential to ensure an 'all hands' adoption.

This document provides comprehensive benefits and ROI information of one of the most exciting technologies poised to benefit the senior care industry, real-time indoor location tracking systems. The document also includes information on how real-time location systems work, reviews potential privacy concerns for the industry, compares technologies and recommends a stand-out solution with a transformative ROI.

The information in this document is confirmed by industry and academia and is available for reference at the bottom.

Introduction

Like GPS technology used in popular map applications, real-time location systems (RTLS) are now capable of tracking assets and people's indoor location. With small mobile tags attached to what to track and small fixed anchors strategically placed throughout the building, a system can provide approximate position data of every mobile tag. In distinction from GPS, this generates significantly more precise and accurate location data needed for tracking in indoor environments. In the past few years, many industries have installed RTLS systems at scale, including manufacturing, e-commerce, construction, and, more importantly, hospitals, 80% of whom report ROI within the first 18 months.

In fact, Hospitals have been leading RTLS implementation in the United States, commonly using the technology to track mobile equipment throughout their buildings. As hospitals expand RTLS coverage to monitor patients and staff, they create an established framework for senior care to follow. Like hospitals, senior care facilities maintain a pervasive set of mobile equipment while needing to care for residents with a wide variety of needs, shared characteristics that have made RTLS an early success in hospitals. Moreover, the senior care industry benefits from extended and more stable relationships with their residents, providing a more sustainable and welcomed reception for broad RTLS use. Simultaneously, resident-facing staff serving senior care lose out on up to 50% of their time on non-care related activities. These help to highlight notable areas of care and operational improvement through a wide breadth of RTLS opportunities.

COVID-19

The value of RTLS in managing spread of COVID-19 is apparent. When positive COVID-19 cases occur, RTLS provides a list of people the infected person has been in contact with for tracing/quarantine protocol and recent areas the person visited that need disinfection.

Primary RTLS applications within senior care

Below is a detailed review of four of the most exciting applications for real-time location systems within senior care ー equipment location, resident safety, resident happiness, and staff tracking.

1) Mobile equipment and asset location tracking

Although most consider direct resident care to be the predominant discipline of work within senior care communities, non-care activities such as documenting, searching for, fussing with, and transporting equipment consume a significant portion of non-care staff time. Furthermore, equipment purchasing, rental, and maintenance decisions are more often made according to a perceived need.

Where senior care communities run into problems with equipment

As wheelchairs, walkers, monitors, pumps, and other mobile equipment are moved and shared about a community, they become prone to human error, most commonly loss, hoarding, misuse, and theft, creating a couple of problems:

1. It distorts the view senior care operators have of their equipment use, condition, and inventory. Hospitals regularly experience the same problem and often purchase significantly more mobile equipment than needed.
2. It creates costly disruptions in staff workflows, diverting more staff time into non-care activities and bubbling up frustrations having tremendous effects on resident health and safety, especially when the need for missing equipment is urgent. 

Benefit and ROI of RTLS with equipment

RTLS enables senior care communities to better distribute and keep on top of their moving equipment and assets. This ability increases overall equipment use by 20%, helps staff more quickly locate needed items, directs more staff time back into resident care activities, and, in turn, significantly increases staff productivity and efficacy of healthcare processes. Real-time tracking also diminishes capital expenses associated with loss and theft, as theft alone is currently estimated to cost upwards of $3.9 billion annually in U.S. healthcare.

More substantially, communities gain objective insight into their equipment inventories and use patterns. On average, in hospital settings, RTLS highlights an equipment excess of 10 - 20% more than required, enabling facilities to save significant amounts in equipment rentals and purchasing. Equipment use data can also help facilities more accurately determine their equipment condition, reducing maintenance and repairs by as much as 80% through more informed decision-making.

Implementation of RTLS in hospital settings currently provides the most accurate indication of the potential ROI impact in senior care communities. The following table provides a tidy summary of the most established benefits.

2) Resident safety and security

In communities such as independent living, assisted/supportive living, skilled care, memory care, adult daycare, and behavioural health, there is a critical need to accurately locate people in duress with immediacy. To provide the greatest means of safety and protection, providing emergency response and reducing unauthorized wandering must be a smooth, immediate, and error-free process.

Wireless emergency call buttons (nurse-call)

Wireless call buttons with integrated RTLS outperform traditional hard-wired nurse-call systems. Unlike the fixed location pull stations, these are carried on-person as ergonomic and discrete bracelets, badges, pendants, or embedded in a shoe. Wireless buttons are more accessible to residents and notify staff of the resident's precise location, increasing staff performance and resident safety.

Automate supervision and wander management

While at any point in time, staff can look at a map of the community and see every person's location, the modern RTLS system also automates time-intensive supervision tasks by proactive alerting to hazardous situations. For example, if a resident is approaching an area they shouldn't be in or have not been active for a specified time, the system will alert so staff can intervene before accidents have a chance to happen (geofencing).

Advanced wondering rules designated for the individual needs of each resident ensures their well-being.

Resident elopement

Elopement is considered a type of unsupervised wandering. It is a specific example of assisted living or nursing home staff failing to meet two central expectations of care: supervision and security. The result is the serious endangerment of residents.

Residents who have eloped are at risk of suffering a fall when walking over uneven or unfamiliar territory. Additionally, they are at risk of suffering injuries or death due to wandering into traffic or bodies of water, exposure to inclement weather, or conflict with others.

Wandering in care homes has been becoming an increasing epidemic, especially with Alzheimer's residents. The Alzheimer's Association estimates that 60% of Alzheimer's patients will wander.

Elopements cause 10% of the lawsuits against nursing homes. 79% of these lawsuits involve a resident's death, which typically results in an out-of-court settlement exceeding $600,000.

Falls

Falls are the leading cause of death due to injury among the elderly.  About 30% of the elderly population over the age of 65 falls each year. At 80 years, this rate goes up to 50%. Fall rates among institution residents are much higher than among community-dwellers.  Getting help quickly after an immobilizing fall improves the chance of survival by 80% and increases the likelihood of a return to independent living.

Modern RTLS provides the certainty required for emergencies and is ideal for senior living communities, long-term stay communities, assisted living centers, and nursing homes. RTLS helps better protect seniors without increased staff-hours. With the underpinning of sophisticated location awareness, the following benefits of RTLS include:

RTLS is a life saver in assisted living and long-term care communities.

3) Resident happiness

Safety, security, and quality of life of residents are three of the primary factors families assess when considering senior care placement for their loved ones. As customer expectations on service continue to progress and residents' needs become increasingly varied, RTLS and modern assisted living technology are poised to provide new options for senior care providers to stand out from the crowd.

The focus of resident care

To ensure the quality of life is as high as possible, most senior care providers focus on promoting resident socialization within their environment - which research backs as the most reliable indicator of resident well-being. To ensure safety and security, the bulk of social interaction is usually maintained to routine activities and gatherings guided by senior care staff, such as meals, physical activities, in-house events, and individual check-ins. Staff also spend time facilitating prosocial behavior between residents.

Current senior care frameworks

Even still, physical and social activity remains a prevailing concern across the senior care industry. Commonly under-financed and understaffed, senior care communities compulsively spread personnel very thin, limiting the amount of time they can dedicate to each resident. Perhaps this helps us understand why across the industry, most senior care residents only receive care about 5% of the time and spend the majority of their days isolated in their rooms. Also, staffing hours are often divvied up between residents based on subjective staff evaluations, which tend to favor personal staff preferences rather than residents who may be needing it most.

Promoting a resident-focused philosophy of care

Residents are like any other people in America ー choice, control, privacy, dignity, and most importantly, autonomy regularly represents the vital quality of life aspects integral to the American ethos. These qualities are particularly influential for those dependent on assisted living and long-term care. Less independent individuals regularly report internal losses in identity, self-esteem, and intrinsic values and motivations. However, when empowered to maintain greater charge of their daily routines and choices, dependent individuals tend to report much stronger maintenance of their sense of independence and self-worth. This empowerment is particularly important to residents feeling "at home" in a senior care center, positively stimulating more adaptive cognitive functioning and prosocial behavior patterns, even as resident care needs evolve.

Benefit and ROI of RTLS with residents

RTLS provides an immediate impact to residents, enabling senior care providers to track and quickly find residents when needed, reducing search and response time by over 50%. Long-term facilities gain a more accurate understanding of how their residents spend their time. Location tracking data provides senior care facility operators with objective insight to guide staff in spending their own time, identifying which residents need the most attention week-to-week, and recognizing fluctuations in residents’ physical and private psychological well-being.

By the same accord, as staff gain greater clarity and confidence in resident behavior and safety, it provides the opportunity for residents to more freely move about and interact with their social environment, promoting feelings of independence and autonomy. At the heart of the solution, continual resident monitoring ensures independent residents can stay independent, and assisted living residents can extend their ability to live without long-term care as long as possible.

Tracking tags also enable senior care providers to transition away from reactive and scheduled care routines to needs-based care, whereby residents can use the tags to signal their location and need in real-time. While RTLS use with patients and residents in healthcare is still emerging, the following table provides a tidy summary of the most established assisted living technology benefits.

4) Staff and personnel location tracking

Senior care communities are highly regulated, with firm staffing mandates that, in theory, shape their division of labor. In reality, tight margins and under-staffed positions often challenge operators to make the most of the staff they employ to adequately meet their residents' growing care requirements while finding some balance in working conditions to attract new talent. Ultimately, a senior care provider's ability to effectively sell and market a quality service is more often influenced by its staff's workload than any other variable.

Where senior care staff spend their time

While studies across countries show a wide variation in assisted care staffing, some commonality exists in how specific groups of personnel spend their time. Perhaps most surprising is the amount of time staff engage in non-value added activities. When observed, resident aides give up almost 35% of their time to non-value-added activities, while RNs and LPNs forfeit as much as 50% of their time carrying out duties that could otherwise be safely delegated to less-skilled staff. Moreover, research suggests personnel are generally not effective in recognizing these non-value activities themselves, instead regularly over-reporting the time it takes to complete a given task by 2 - 3 times, particularly on larger jobs.

Research also shows that resident care is limited by the staff’s ability to quickly locate particular personnel and care providers when needed. Furthermore, resident aides, who spend more time with and typically have the most intimate knowledge of residents, show to be much less effective in communicating and sharing pertinent information with other personnel.

Benefit and ROI of RTLS with staff

Rather than relying on staff self-assessments, supplying tracking tags to personnel enables senior care facility operators to understand how their people spend their time more accurately. In doing so, operators can provide more pointed feedback that helps ensure more skilled workers make the best use of their hours and abilities while less-skilled workers fill in the gaps. Tracking can often help highlight needs for additional training and coaching with particular employees, creating a more supportive working environment. As struggling employees become more regularly identified and engaged in job-related training specific to their needs, this yields improved perceived culture and talent acquisition.

More broadly, an evidence-based catalog of how staff spends their time simplifies decision-making related to staff hiring needs, incentives and praise, promotions, and dismissals. Furthermore, as data is collected from the real world, the technology offers immense potential to automate administrative tasks, like employee recorded timestamps associated with specific duties and residents.

Proof of hours worked

There is a need for employees to prove their hours worked to get paid. Many reports are often incomplete or inaccurate, causing unnecessary administration, expense, and friction between staff and employers. With an RTLS a report showing when the employee attended the site, how much time they spent in areas designated to their work, and when they left are recorded automatically.

Electronic Visit Verification (EVV)

A recently passed bill, the 21st Century Cures Act, directs state agencies to implement EVV systems for Medicare reimbursement. Personal care service agencies must have an EVV solution in place or risk having their Medicaid claims denied. Providers have to collect correct, compliant EVV information at the point of care, such as date, time, location, type of service, and other information. They must then relay that information to the organization that requires the data for compliance. An integrated RTLS system records EVV information automatically as staff attend to their normal procedures, and makes it available to authorized recipients via the Cloud.

While RTLS use with healthcare staff is still emerging, the following table provides a summary of the most established benefits.

Considerations

Potential privacy concerns in senior care

Like any technology that captures data from the real world, worries understandably arise about the kind of information being gathered, especially when the information pertains to people and their habits. This fear of personal data aggregation can be seen most prominently reflected in tech giants such as Facebook, Google, and Amazon, who have recently come under regulatory scrutiny over their use of user data.

At the heart of privacy concerns is generally a lack of understanding.

• It is reasonable for an employer to monitor when the employee arrives, when they leave, and how much time they spent in areas allocated to their tasks.

Correspondingly …

• It is not acceptable for an employer to monitor an employee's activity outside the work parameters.
• The indoor location tracking technology recommended in this document cannot track location outside the community it is installed in because it does not use a smartphone or common network.

Based on existing research on real-time location systems deployment in hospitals, a phased implementation approach starting with tracking equipment and assets ensures the smoothest onboarding. This incremental approach allows staff and residents to become familiar with the technology and see and accept its utility in their work first-hand. As the first phase of implementation becomes ingrained in staff’s daily routines, senior care providers can feel confident in expanding the technology to staff and residents at a pace all stakeholders are comfortable with.

Real-time location system technologies

Americans spend about 90% of their time indoors, and yet most of the benefits from location systems currently come from GPS based apps, like Google Maps, that are generally limited to our outdoor tracking. While indoor tracking systems are a lot newer, the technology in this area has changed extensively in just the last few years, making it essential for purchasers to consider what is best for their community. On the one hand, while early generation indoor tracking technologies, such as RFID, offer a practiced and developed solution, they are complex, bulky and very expensive making them far less competitive than modern systems. Simultaneously, consumer-focused systems that use existing staff and resident smartphones are generally not practical for senior care communities. The phones are bulky, complex to use, independently controlled, require daily charging, lack sensor data, and unfit for tracking equipment and assets.

Indoor real-time location systems generally consist of two components ー attachable mobile tags worn by the subject of interest and small devices called anchors strategically placed throughout the building. As subjects move throughout a building, the tag's identification number, time, and relative location to the anchors are regularly transmitted to the Cloud. For locating people the mobile tag is generally a small and discrete bracelet, pendant, or ID badge, which the person carries on them. Locating equipment would use a similar tag but in a hardened case and include a slightly larger battery.

Previously reserved for the technically savvy, real-time indoor location systems are now practical and cost-effective. 

Below is a breakdown of common configurations of indoor RTLS.

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