Technology Makes Top Ten Senior Living Trends for 2011

From Senior Housing News comes this article about technology. Click here for full article.

I highlighted things that stuck out for me.  One thing they failed to mention was the safety piece.  The barriers to entry into this “senior monitoring business” are very low.  With many companies, safety is a marketing buzz word.  I like the mention here of industry standards and the economic value of such, however, the life safety benefit of standards is the real deal.

Technology – Monitoring Networks, Apps, Devices and Systems Integrators

Ladies and Gentlemen, start your monitoring …..Through gadgets, apps, networks and the cloud! During 2010, a trickle of vendors released new monitoring systems and delivery options. The flood gates are going to bust open as the economy heals and companies are looking to invest and expand into high growth markets. Look for continued announcements and product offerings from old and new technology companies as well as acquisitions and roll ups of related products and services for the senior care market. Some products will be “me too” products that will provide additional market choices but few, real new features. Who will win? We’re betting on well designed products that are simple without feature overload at reasonable prices.

One of the areas that will start to accelerate in 2011 is systems integrators working in local markets to deploy various monitoring systems that employ industry standards  ***See UL2560 article here *** . If vendors work within established standards, the costs for deployment and support have a higher probability of being adopted faster than those that are built upon proprietary technology. These systems integrators will need to provide better service than the Geek Squad but also know about concepts on senior living design and general contracting besides the technical nature of deployment of these networks. What are we forgetting? The most important features: selling and servicing seniors and their children. How many local GC’s are ready for this? If you said very little, you’re probably being generous. The costs of a design and tech make-over may make your stomach turn at first but if amortized over an additional 5 years in the home versus assisted or skilled care, it will seem like a bargain.  In a society of instant gratification, that will be a hard sell.

So what about safety?  It seems most folks are interested in the fire alarm.  When it comes to the “wireless nurse call” system, a standard of mediocrity exists.  If the “emergency call system”  is ever used to save a life, shouldn’t it be designed to do just that. . . . in all conditions?   If a component fails, the power goes out for several hours, the annunciator panel becomes disabled, etc., it should still be capable of saving a life.  See Tel-Tron’s website for the real deal solution.

A National Standard for Emergency Call Systems (It’s on the way!)

In any Assisted or Independent Living community, the emergency call system is a significant link in the delivery of Life Safety for the residents. When help is needed, the expectation is that the emergency call system will reliably summon that help.

Despite this importance, however, emergency call systems are often treated pretty casually. Many think the various systems available on the market are all alike; they are not. Many assume that any system on the market must meet a nationally recognized standard; not so – there is no such standard – not today.

Nurse call systems for hospitals and nursing homes have had the ANSI/UL 1069 standard for many years. There are significant differences between application of nurse call and emergency call systems, however; applying a standard for nurse call to a residential property, such as Assisted Living or Independent Living, simply does not work well.

The standard for Assisted and Independent Living is coming, though. After almost seven years of work, a final draft of ANSI/UL 2560 has been posted on an internal UL web site for comment by members of the panel that will vote upon its adoption and other stake holders. Depending on the comments received, it will most likely be voted upon and adopted in early 2011.

 

The new 2560 standard covers hard wired and wireless emergency call systems. It requires minimum coverage of fixed call stations, allows portable devices (pendants) and specifies the maximum time from when an alarm is placed until it is reported. Generally, calls can be canceled only at the point from which they originated. (With certain exceptions, the call cannot be canceled from the desk.) All devices must be self testing and troubles must be reported within specified times. The standard requires backup power and obligates the manufacturer to state how long the backup power will last. It also requires that a battery powered device report a low battery and will continue to work for at least seven days after the low battery report.

The standard is very inclusive in terms of requirements. It provides no special advantage for any one manufacturer; most current manufacturers should be able to comply with only minor revisions to their products, if any. The standard also provides for future innovation by covering only the core life safety system. Ancillary features which were not envisioned by the standard can be added to the system provided they do not interfere with the operation of the core system.

This all started back in 2003 when Tel-Tron and a handful of other manufacturers formed the Emergency Call Systems Association (ECSA). The intent was to publish a consensus standard that would detail the minimum standards for an emergency call system. With no staff and no budget, the attempt never really got off the ground.

Then, in 2005, the National Electrical Manufacturers Association (NEMA) picked up the ball. NEMA’s “Health Care Communications Group” expanded its role and became the “Health Care Communications and Emergency Call Systems Group.” Many of the companies from the by then disbanded ECSA were represented and the effort for a national standard resumed. A task group was formed to draft a standard and both NEMA and UL agreed to provide staff support.

 

Like all ANSI standards, 2560 represents a consensus of manufacturers, users, regulatory agencies, and National Recognized Testing Laboratories (NRTLs) and other stake holders. By rule, and to avoid building standards around parochial interests, manufacturers are a small minority of representation on a Standards Technical Panel (STP). In the case of this standard, the STP consists of 17 members, only 5 of whom are product manufacturers.

A white paper on the proposed standard has been prepared by NEMA and is available here http://www.nema.org/stds/sbp1.cfm. (The document is free, but NEMA is not immune from bureaucracy, so you need to create an account to download it.) In some areas, the white paper was predictive, and there are some discrepancies between it and the draft standard, but it still provides a good overview of the standard.

Once the standard has been adopted, it will take some time for manufactures to demonstrate compliance to an NRTL and become “listed.” Our industry is moving towards the time when owners, developers, and managers of Senior Living communities will have a trusted third-party evaluation of the emergency call systems they are considering for purchase.

Tel-Tron has always been dedicated to lifting the reputation and quality of our industry. A national standard is one way to do that. Our Brian Dawson was founder and president of the original ECSA. Brian is also a member of the Hospital Communications and Emergency Call Systems Group at NEMA. I chair the Technical Committee of that group, was a member of the task group that created the original draft of the standard, and wrote the NEMA white paper. I am also a member of the UL1069 STP (to which this standard has been assigned) and chair the task group charged with handling ANSI/UL 2560.

As the senior living industry continues to mature, the time for this standard has come. Resident safety is too important a topic – from both the humanity and legal points of view – to take a chance on a product that cannot meet minimum standards. Most manufacturers and suppliers of emergency call systems provide quality and reliable products. There are exceptions, however, and this new 2560 standard will allow communities to purchase compliant products with confidence.

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.

Why 312 MHz Kicks Butt for Senior Living Emergency Call Systems

When it comes to resident life safety, why would you take a chance having your wireless emergency call fail due to radio interference or being blocked by common building materials? Activate a Tel-Tron pendant or wireless pull cord and rest assured, your emergency call will get through, and help is on the way.  Unlike many of our competitors who use 2.4 GHz technology, Tel-Tron uses 312 MHz which is absolutely the best technology for penetrating building materials and is essentially free of interference from other transmitters operating at the same frequency.

Recently, I was surfing the web on my laptop at my son’s apartment as dinner was being prepared.  I noticed every time the microwave oven was being used in the kitchen my internet connection stalled.  In case you don’t know, the 2.4 GHz frequency spectrum is littered with intentional and unintentional transmitters – 802.11 Wi-Fi, Bluetooth, Zigbee, microwave ovens, security cameras, cordless phones, baby monitors, etc. I couldn’t help but wonder how in the world some of our competitors could offer emergency call transmitters based on 2.4 GHz with all that potential interference out there. So-called, “Wi-Fi pollution” is an especially well-known problem in high-density areas such as large resident complexes with many Wi-Fi access points (see http://en.wikipedia.org/wiki/Electromagnetic_interference_at_2.4_GHz).

In stark contrast, Tel-Tron wireless emergency call transmitters (pendants, wall-mounted call stations, etc.) operate at 312 MHz; far, far away from all that 2.4 GHz pollution.  Except for just a few garage door openers on the market (which operate very infrequently and are not likely to be near your residents), there is no comparable 312 MHz pollution.

And then there’s the issue of penetration. With all other things being equal, as frequency increases, range decreases.  This is most evident inside buildings, because higher-frequency radio waves are more vulnerable to absorption by building materials (such as drywall and concrete), and because higher frequencies are more directional (less apt to bend around corners).  Take a look at the engineering data graphic below that shows how much better lower frequencies penetrate reinforced concrete.  Sound waves share this transmission characteristic with radio waves: think how easily you can hear your neighbor’s low-frequency bass boom through your walls, but not the higher-frequency instruments or vocals.

Q: “Wait a minute Buddy … don’t some Tel-Tron products also utilize 2.4 GHz wireless technology?”

A: Yes we do, but not for resident emergency calls!  Rather, we embrace 2.4 GHz for our wireless high-speed network backbone whereby we use a fully-supervised “self-healing mesh” to contend with all the Wi-Fi pollution (our mesh approach is described here: https://blog.tel-tron.com/2010/05/15/network-heal-thy-self/.  The critical difference is that our pendants and wireless pull cords upload emergency call alerts to the network backbone using 312 MHz, not 2 GHz; residents are using the best-of-breed technology to make sure their emergency call penetrates though floors and walls and is not trounced by a Wi-Fi surfer or a rogue microwave oven.

Finally, I would be remiss if I didn’t mention that many of our competitors use 900 MHz for their wireless emergency nurse call systems.  That certainly is not as bad as 2.4 GHz.  Still, there are tons of 900 MHz cordless phones, wireless speakers, wireless headsets, etc. out there that clutter that frequency band too.  To attempt to compensate for losses and interference from other devices, they typically opt to transmit at higher power levels. Again, why not use “quiet” 312 MHz which is essentially interference-free and has the best wall/floor penetration, and gives you the greatest peace of mind?

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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