VERY Key Metrics – Ignore At Your Own Peril

Tel-Tron powers the systems technology at roughly 1,000 retirement communities, improving the quality of life for over 100,000 residents. We work with over 200 senior living clients and have a very long-term understanding of the good, bad and ugly of senior housing management.  I’ve been tempted to start a blog series on things I would do if I owned a senior living company or community.   Given the challenges we’ve helped folks through this week,  that temptation is growing harder and harder to resist.

Let’s consider this post the prologue to that series, which will provide a behind-the-scenes, outsider’s, perspective on some very fundamental changes senior living executives could implement that would change everything for them.  Here is an example.

Visual Management of Staff Response to Resident Emergencies

Here are a few snapshots from a daily dashboard – available to any Tel-Tron user – from Auditrak.com.  Check out these statistics and see if you agree with my recommendations.  This is a real-life 80 unit assisted living community, with a fairly aged population.  The staffing levels are similar to sister communities of similar size, but the needs here are apparently greater than the staff can handle effectively without intervention.

Take a look at the activity level for just the last 24 hours on this real-life emergency call system.  What we see is a disaster. If I were the Executive Director of this community, this would have my undivided attention.  What I see is that in the last 24 hours, there have been 74 emergency calls, most of which originated from a resident pushing their wireless necklace pendant.  The balance were from pull cords in the bedroom, with only a small number of alarms originating from a pull station in the bathroom.

Daily Activity Snapshot

THE AVERAGE RESPONSE TIME IS 42 MINUTES!!!!  The longest alarm took 6 hours.  One has to assume that the 6 hour alarm has some explanation, but the average is 42 minutes.  In fact, a resident living at this community would be far better served by calling 911, rather than using the emergency call system installed in the community.  What, I ask you, other than poor training, indifference, lack of understanding could cause the people responsible for caring for these residents to think this average is acceptable.

Let’s look at a Chart 2, also for the last 24 hours, which will show us the call distribution by hour for the last 24 hours.  What we see is that the average number of calls per hour is approximately 4.  There appears to be a peak before the dinner hour, and again between 10pm and midnight.  Even still, these peaks only represent 7-9 calls an hour.  Not a very heavy workload by any measure.

Chart 2

Next, let’s take a look at some performance gauges that this community has set for itself, using their own targets, in the three areas relative to staff response.

Performance Gauges

We already discussed the average response time.  Notice their own internal target is 5 minutes, with 8 minutes being allowed.  The longest response time has been discussed already, too.  The last metric, % of responses outside their target threshold, 72%.  An overwhelming majority of their resident emergencies are taking staff longer than 5 minutes to respond.  I know.  Not every alarm is an emergency.   However, there is no way to know the real alarms from the non-emergency alarms until staff responds.  It is imperative to treat each alarm as the real thing, or else when there is a real alarm it will be a disaster.  Worse yet, an avoidable one brought on by complacency.

Last chart.  This one is about profitability, which may make hiring more (or better) staff a reality for this community.  This is a chart that shows the top users of the emergency call system.  Take a look.

Frequent Users (and abusers)

Remember, there were 74 emergency calls in the last 24 hours.  These 7 residents alone accounted for 71% of the calls placed over that period.  They should be paying more than others.  Whoever is in room 218, if this is continuous over time, should be paying even more than the other 6.  They are using the emergency call system 3X as often as the person who is number 3 on the list.  Assuming each alarm takes 5-10 minutes of staff time, this single resident is getting 1-3 hours of staff time  – daily – that other residents aren’t receiving.  I’d charge for that somehow.

Surely there are a number of factors that go into determining how much a resident pays for assisted living services.  The amount of staff time consumed by excessive use of the call system should be among them.

These are just a few examples of the kind of data that is available on the Auditrak.com service.  These 4 charts are on a daily dashboard that is emailed to executive directors (if they request it), making review of the numbers almost effortless.  Failing to review these numbers – which is apparently the case at this community – results in poor performance across the board.  My guess is that their resident surveys aren’t that great either.

All Senior Living Communities Are The Same!

Exhibit ASeriously.  Take a look at the web sites for the top senior living providers and see if you can spot the differences between them.  I’ve posted a few screen shots from a few just to prove the point.  Look at the mission statement graphic.  Is there a senior living company in existence that doesn’t claim to do ALL of those same things?

  • Friendly/Caring Staff
  • Beautiful Rooms
  • Great Food Service
  • Fun Activities and Social InteractionExhibit B
  • Regular Laundry Services
  • Transportation as Needed
  • 24 hour emergency response system
  • Etc., Etc., Etc.

So it is reasonable to assume all senior living communities are the same based on what they “claim” to be able to provide.  Deeper understanding isn’t necessary.  The only method to choose one from another would be whichever is cheapest.  Make sense?  It’s only where you will likely live the rest of your life.

To a person, my clients would say that is a ridiculous assertion.  And they would be right.

Having been in literally hundreds of retirement communities all over the United Exhibit CStates I can say with certainty that while the list of offerings is similar, all senior living communities are NOT the same.

In about 100 ways that don’t show up well on paper, I could easily describe the difference between a run-down old building, with criminal care givers, operated by a fly-by-night company and a well run, thoughtfully built and superbly managed senior living community – maybe even operated by a equally high quality corporate owner.  Every senior living executive knows instinctively that not all senior living companies, or communities, are created equal.  Far from it!

So help me with this.  Some of those same senior living executives – decision makers –believe that there is equality between all emergency call system providers simply because they claim to offer similar services.  For example, most of us claim to provide:

Does not the same logic apply to our industry and theirs?  You can’t have it both ways.  Isn’t it the design, manufacture and delivery of products and services that makes ALL the difference?  Of course.  There seems to be a strong desire for the flexibility that comes from buying commodity products – multiple sources, hyper-competitive pricing, etc.  But just pretending that a market is commoditized doesn’t make it true.  It does, however, alter your perceptions – incorrectly and potentially dangerously.

If you are using a commodity-based mentality to judge a non-commodity product/service you will make two mistakes.  1) You will assume the low price companies are decent quality and just being competitive.  Wrong.  They are inexpensive because they are cheap and poorly made.  2)  You will assume the high price companies are not better than the low price guys, they are just out of touch with current market prices.  Wrong again.

Being the Designer and Manufacturer Matters

Making A Difference

Delivering On The Promise 78 Times and Counting

In about 100 ways that don’t show up well on paper, I could describe the difference between a cheap PC based system, integrated with generic wireless components made by someone else, delivered by a clueless bunch of software guys, and a highly specialized emergency call system, made in America by a company that has invented nearly every feature of modern life safety systems, delivered and supported by the most experienced and committed emergency call professionals in the world.

So, no.  Not all senior living communities are the same. Neither are emergency call companies.

How Long Should Emergency Call Systems Last?

Forever.  Not really, but that is probably the only answer any buyer wants to hear.  These are technically advanced systems, so a multi-decade expectation is probably not realistic anymore.  That kind of thinking is a throwback from the days that emergency call systems were nothing more than a light bulb and a switch.

“It’s just not right that after just buying your systems 12 years ago we should have to spend money to upgrade them to the latest and greatest.  The whole emergency call industry has us bent over a barrel.  We have to have these systems, and you force us to upgrade them.”  — Actual conversation with the CEO of a major senior living provider and long term client.  His expectations are common, but not realistic.

So what is a realistic time frame?  And what should senior living operators expect for an End of Life process.  This article will attempt to answer those to questions and others.  I am running a risk here by shattering the dream of some buyers who genuinely think emergency call systems should last for 20+ years (and never need service).  However, candid discussion, and setting realistic expectations is how Tel-Tron has been in business for 65 years and why we still have our first ever senior living customer as a client.  Here it goes:

Product Life Cycle

Senior living operators should expect to get 10 years of performance out of an emergency call system.**  I star this statement because their are many mitigating circumstances that will extend this time period.  But let’s assume for sake of this discussion that no changes or upgrades are made to the system at all during its life.  Why only 10 years?  It isn’t the hardware.

Using rugged design philosophy, level III manufacturing techniques, and high quality components (all of which Tel-Tron does) will result in a system that will function in a perfect, temperature controlled, never touched by a human being environment  for 20-30 years.  We just replaced an old Tel-Tron system at Shellpoint Village that had been installed and working for over 25 years.  It is not the hardware that gives out and requires replacement.

Sure, sometimes components become obsolete and a replacement needs to be sourced. And, occasionally new technology is invented and wipes out an entire design methodology.  This makes continued manufacturing difficult, but won’t cause the system you already purchased to suddenly quit.  Just because they invented high definition TV doesn’t mean your old set will all of a sudden quit working.  That’s Murphy’s law, which is out of human control.  But these and other issues do relate to the primary reason products become obsolete and manufacturers issue “End of Life” notices.  Manufacture-ability and Supportability.

MicroScan System - Introduced in 1982

Manufacture-ability – If new components or technology is invented, the cost of continuing to manufacture the old way eventually becomes prohibitive.  For example, in an older Tel-Tron product we used an EEPROM chip that was less than $1 each.  Today, that same component is $25.  In other cases, it isn’t a matter of expense.  The part is simply unavailable.

Supportability – Take the EEPROM chip example above.  At some point, Tel-Tron was forced to design a new circuit board using a different EEPROM chip, and was required to write new firmware to support the new EEPROM chip.  At the same time we made a few other improvements and released a new product version.  At that instant, we were now supporting two versions of the same product.  In the product design world, that is called legacy product support.  The problem is that while the two products do the same thing (and because we’re good, the new one is also backwards compatible), repair of the old version is not feasible.  Over the course of a decade this process can repeat itself several times and at some point, it is simply too costly to maintain multiple versions of the same product.  This same level of complexity ripples throughout the organization.

Technical support, installation, customer service – even sales – all need to stay aware of product versions and capabilities.  When the weight of maintaining an multi-version, outdated product line is heavier than designing a new platform from scratch, End of Life announcement can’t be far away. Senior living operators deal with this issue all the time in their business.  The product in their world is the physical plant (the building) itself.  How many times have operators looking to grow their business had to make the build/buy decision.  It’s the same concept.

Think of the complexity of owning a senior living building that was built in multiple phases, expansions and refurbishments, over the course of 20 years.  Different electrical systems, wiring standards, wall construction, fire supression systems, hallway widths, etc.  The list is endless.  Every once in a while the decision is made to demo the building and start over.  It doesn’t happen often, but it happens.  Or maybe, like in the case of the Tel-Tron building, entire system are replaced.  We needed a new HVAC unit.  It was so difficult to retrofit to the old ductwork, we ripped out all the ceilings and replaced everything.  Sometimes a new platform is required. Their is no way to avoid an occasional End Of Life event.

Instead, we should focus on how long a product should last from time of purchase until End Of Life, and how the transition handled.  These two areas are a matter of corporate policy and reflect the character of the organization and its leadership.  And…a subject for a future blog post.

Throw out that PC based system and get in the CLOUD!

Once upon a time, senior living communities paid someone to be at the front desk 24 hours a day.  They did this because the emergency call system consisted of a panel of lights and buzzers mounted on the wall.  If a resident needed help, a light would turn on and a buzzer would sound.  Someone had to be within earshot of this panel at all times, or calls for help would go unanswered.  Once they heard it, though, alerting the care givers that someone needed help was another inefficient and labor intensive task.

When Tel-Tron introduced pocket paging to the wireless emergency system call industry (100 years ago…) both problems were solved.  Care givers wore pagers and were alerted right away when a resident needed help.  This eliminated the need for panels of lights and buzzers, and the need to pay someone to watch them 24 hours a day.  This was a transformation of the way senior living providers operated their buildings and provided care to their residents.  Really, it would be hard to imagine not having pagers or some other mobile staff device today.

Portion of Auditrak Dashboard

What does this have to do with cloud computing?  Everything.  When Tel-Tron introduced Auditrak.com, another senior living transformation began.  With the release of the ethernet gateway for our CompanionOne product line, Tel-Tron’s nurse call system has completed it’s migration to the cloud.  What is the cloud and how does it help senior living, you ask?  Let me explain. (click here for the wikipedia definition)

In the pocket paging example above, people were slaves to the front desk, because that is where the alarm panel was located.  The “data” they needed to respond to resident emergencies was accessible from only one place – the front desk.  The same is true on PC based system today.

System programming information, resident usage metrics, audit trail reports, maintenance notifications, resident check-in data, even changing resident pendant codes is all located, stored and managed from the personal computer located on-site.  You have limited or no access to that data or functionality from outside the building.  You have limited or no way to keep all of that data backed up on a real time basis.  You have limited or no way to integrate that system with other systems located outside of the facility, such as your accounting, or resident management software.

Worst of all…..Once you buy a computer based system, you are saddled with never ending upgrades, maintenance contracts, having to replace the computer itself every couple years, your staff uses the computer to play games or surf the web (see previous blog about that particular nightmare), Microsoft changes operating systems routinely, loss of functionality during a power outage…  Really, the list of downside risks to a PC based system are endless.  What’s the answer?

Enter the cloud!  Instead of your entire emergency call system being controlled and run by a software program on a local PC, host all of that functionality in the cloud (on the internet).

Your on-site system includes all of the devices in the resident rooms, all of the mobile devices used by the staff, one or more alarm consoles, the wireless or hardwired monitoring infrastructure.  But the activity data, programming information, reporting software, charting and graphing software, trend analysis, and system monitoring is “hosted” offsite.  You access this site through an internet browser like Internet Explorer, Firefox, Google Chrome and Apple’s Safari.  Which means you do NOT buy a dedicated PC for the emergency call system.  You use any PC (or iphone, blackberry, ipad, etc) you want, from anywhere you want, whenever you want.

  • There is no software to upgrade on site, ever.  The hosted software is always current.
  • You don’t have to keep back-up disks, or tapes on site.  Your data is always on line and backed-up continuously.
  • You don’t have to worry about your staff breaking the computer, surfing the web, or otherwise messing up the PC.  Because THERE ISN”T ONE.  I know this is a mental leap.  But it is literally transformational to the industry.  Senior living CTO’s, IT managers, even maintenance people are loving the fact that their systems no longer are PC based or dependent.

Sample Report of All Alarms with a "Resident Wait Time" of more than 10 minutes

In addition, once your secure data is in the cloud, you don’t need to run reports any longer.  Establish operating parameters and reports will be automatically sent to you (or anyone else) whenever something occurs outside those parameters.  Two small examples:  Many Executive Directors get a report emailed to them every morning listing any emergency call where the resident’s wait time was longer than 10 minutes.  Regional Operations Directors have this same report sent to them monthly for all communities in their territory.  Regional Maintenance Directors get a weekly report automatically emailed to them of all system trouble items that have occurred, and not resolved in the appropriate time.  I know, that was three examples, but the possibilities are endless.

Last one..any notification can be sent via email, or text message.  Some Operations Vice Presidents want to know right away if there is an elopement activity such as a window alarm, or “screen removed” alarm in an memory impaired section.  Elopement is a big deal these days and an early heads-up is helpful.

I know this is a lot to take in and understand, but having your emergency call systems data hosted and managed in the internet cloud, means a whole lot less headache for on-site staff related to computers, and an almost limitless opportunity for growth and integration in the future.  Just as pagers changed the industry in the late 80s, cloud computing will change senior living over the next few years.  Just browse on over to Auditrak.com and you’ll see what I mean.

I didn’t talk specifically about this, but having a single hosted location for systems data and management is exponentially more valuable if a senior living operator has multiple sites.

One day we’ll look back and say…”Remember when we used to have a PC run our emergency call systems.  How did we ever survive?”

Enough Already. The PC has to go!

Dig hole in sand....Insert head!

All you have to do is read words in this picture, which was taken by one of our salespeople when touring a community that just installed a new emergency call system from a competitor.  WOW!  I cannot believe that someone would actually write that memo – clearly aware of the implications of not obeying – and think that just writing a note makes everything OK.

IT’S NOT OK!   You are tasked with making sure that a resident’s call for help gets answered.  And for lots of reasons, including this one, a personal computer is a completely inappropriate engine for an nurse call system.  In case you can’t read the picture, here is what it says.

“Please do not use this computer to go onto the internet.  This computer runs our nurse call system and is vitally important.  Thanks, Jane.”

Jane – Rather than writing a memo, you should have thrown that system out and replaced it with one that is not computer based.  Can any of you think of a single system that is a life safety device that runs on a Windows computer?  Please leave a comment to this post if you can.

Defibrillators? No.  Airplane Avionics?  No.  Dialysis Equipment? No.  Automobile Electronics?  No.

When you hear about someone who is on “life support,” do you think it would be wise to have that equipment run by a Windows computer?  No way.  So why is it OK to put the lives of senior living residents in the temperamental control of a Windows personal computer?  Short answer….It isn’t!  They freeze up.  They need rebooting.  Software needs updating.  They aren’t battery backed up for longer than a few minutes.  Really the list is endless.

Staff can close the program.  Staff can turn them off (on purpose, or on accident).  And, as in the case captured in this picture, staff can browse the internet while calls for help go unanswered.  It simply isn’t necessary.

On an enterprise quality nurse call system, the main servers, switches, routers and gateways use embedded systems, industrial microcontrollers, sophisticated power supplies, elaborate supervision and battery back-up methodologies.  There are design tolerances measured in sub-1% range.  User GUIs are browser based and access data on the system, but do not control the system.  Visit Auditrak.com, for an example of a killer call system GUI that resides in the cloud.

As I looked at the picture in the beginning of this article, I was so frustrated at the lack of seriousness with which Jane took her role as caregiver.  In fairness, Jane probably did not select that system.  Someone at her corporate office, who doesn’t have to respond to an emergency call – ever – probably picked it as a result of their beauraucratic purchasing system.  Still…the kind of compromise and accommodation Jane is forced into is simply not necessary.  There are other options.

Wireless Network….Heal Thy Self!

Every time I hear someone say “wireless emergency call systems are pretty much all the same” it makes my want to pull my hair out.  While it is true that many systems have a similar mission, there are very few similarities in how the mission gets

Click here for a tutorial

 accomplished.  Here is a HUGE, IMPORTANT, SIGNIFICANT, FUNDAMENTAL, MEANINGFUL  example.  Enough emphasis?

On most wireless networks used for emergency call systems, if one access point (transceiver) fails, YOU LOSE EVERY OTHER RECEIVER DOWN LINE.  That’s because signals “hop” from one transceiver to the next all the way back to the computer.  Any break in the chain and the call for help goes unanswered.  GOOD ENOUGH for email, surfing the web, etc.  BAD IDEA when the data being transmitted is a person’s call for help.

That is why Tel-Tron never designed an emergency call system using the point-to-point wireless networking scheme described above.  In 2008, we released our version of a wireless network using what is called a “Self Healing, Wireless Mesh Network.” Translation:  If any access point fails, the downline access points can automatically reroute.  The network self-heals.  And, since all Tel-Tron systems are fully supervised, the system will alarm and display which access point has failed.  As of this writing, no other company is offering this level of wireless network service.  (No other company designs and manufactures their own wireless products…..but that is a post for another time.)  For a neat flash based tutorial on this topic, please click here.

Even the chip manufacturer was impressed, and published a “Customer Success Story” on our implementation. Check it out.

I suppose a rough analogy is the difference between run-flat tires and standard tires.  With a standard tire, if you get a flat your trip is over until you change the tire.  With a run-flat tire, if you get a flat, you are notified, but your trip is uninterrupted.  That kind of safety and redundancy seems like a great idea if you were a woman driving alone at night through a sketchy part of town on your way home.  Or, if you were a senior living resident who was counting on your call for help getting answered.

There are hundreds of differences like this between wireless nurse call system providers.  So, no, emergency call systems are not all “pretty much the same.”

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Never Miss a Staff Rounds Check Again!

Many senior living operators have a problem.  There staff is supposed to be checking on certain residents on a regular basis, but there is no way to prove that it was actually done.   A quick software upgrade to your Tel-Tron emergency call system and you can guarantee that you will never miss a room check again.

Simply install a “staff check-in” device in each area where the staff is supposed to show up.  Tell the software how often a staff person is supposed to be in that area (hourly, daily, weekly, etc.).  If the staff check-in device is not used in the time window you set-up, an alert will be displayed on the system, alerting management and staff that a check-in has been missed.

For example….Let’s suppose that you are supposed to be doing 2 hour room checks in your dimentia units.  First, you install a “staff-check” button in each unit.  Then, you tell the system (through the software) that each unit should have a staff visit every two hours.  Now, let’s pretend that it has been two hours and no one has pressed the “staff-check” device in Mrs. Smith’s room.  You will get an alarm on your system – pagers, console, text message – whatever — that says “Two Hour Check Missed – Mrs. Smith, Room 1.”  The only way to clear that alert is to actually go to Room 1 and press the staff-check button.

No one likes to talk about it, but every manager knows that FORCED COMPLIANCE with policies and procedures is the best way to make sure the appropriate actions are taken.   With “Staff Check-In” activated in your community, you can be sure that all of your rounds are being completed.

(You can use this for building rounds at night, too.  Put a staff-check button in hallways, libraries, laundry rooms, or anywhere you want your staff to be on a regular basis.  Then tell the system how often they should be there and you can be SURE that your staff did what they were supposed to do).

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