Independent Living Monitoring: Walking the Line Between Safety and Intrusion

Making sure senior living community residents are safe is a top priority for operators, and while new technology is being developed to facilitate this goal, there’s also a question of the appropriateness of monitoring independent living residents.

Much of the new technology centers around helping residents remain safely independent, but while it can be a lifesaver for some, others question whether it goes too far. For Rick Cumberland, a senior vice president at Greystone Communities, there is a fine line.

“It’s a delicate balance,” he says, adding that achieving this balance differs from provider to provider. For Greystone communities, his company believes in its responsibility to provide a safe environment but has chosen not to directly monitor its residents’ whereabouts.

It can come down to the issue of intrusion versus liability. Residents want to live independently, but especially for those who are older, there are troubling possibilities of slipping and falling, or suffering a stroke or heart attack, without anyone to assist or check up on them.

It all comes down to residents’ choice

Greystone residents can choose to wear a personal emergency alert device, in a wristwatch or neck pendant form, that allows them to press a button in case of an emergency.

At a few of Greystone’s independent living communities, residents can also opt in to pressing a button or making a phone call each morning to let staff know they’re OK, in addition to wearing the personal emergency device.

That’s similar to what Tulsa, Okla.-based senior housing and care provider Gold Medallion offers at Broadmoor Retirement Community, the independent living portion of its continuing care campus.

Each apartment comes equipped with a system that allows residents to punch a button when they get up in the morning and before they go to bed, to let the provider know they’re alert and well.

“If they haven’t punched a button by a certain time, we go find out why they haven’t, or call on our intercom system,” says Diane Hambric, president of Gold Medallion. “That gives us the security of knowing they’re not laying on the floor and have had a stroke or a heart attack. With the increased acuity, you have to be sensitive to it—but it is a fine line.”

Gold Medallion spent about $400,000 installing the communications system into its three senior living and care communities, and Hambric acknowledges that not all providers are willing to invest that kind of money into a system, especially in independent living communities where residents are supposed to be on their own.

So far, residents are happy to participate in the limited monitoring, and Hambric says her company hasn’t encountered anyone who disagrees with letting someone know they’re up and about for the day, or are turning in for the night. “We’ve saved some people’s lives with that system when they didn’t answer,” she says.

What happens if the system fails?

There is always a risk that the system will fail, and that no one will notice that a resident hasn’t pressed a button until it’s too late.

This can be a complicated issue, says Paul Gordon, a partner at San Francisco, Calif.-based law firm HansonBridgett, and it can come down to a provider’s responsibilities and obligations.

Take for example a resident in a community with a communications system that also gives people the option of wearing personal emergency alert devices. If that resident chooses one day to not wear that device, and experiences some sort of medical trauma that goes undetected by the community for any period of time, the provider can’t necessarily be held liable.

“An operator is not responsible for an independent resident’s failure to use a safety device,” he says, although he adds that in assisted living, there’s “generally an obligation to monitor the resident’s use of such a device to the extent reasonably feasible.”

And if the personal emergency response system device itself fails, the manufacturer is held legally accountable for equipment malfunction, says Gordon.

When do communities go too far?

At Greystone communities and at Gold Medallion’s campus, the technology employed is non-invasive in nature. But it can be difficult to draw the line as far as what kind of monitoring works best.

“It’s a complicated problem,” Gordon says. “You need to have consent—in writing—of the person who is being monitored, particularly if the monitoring involves video cameras.”

In places where residents have an expectation of privacy, such as in their rooms or private living quarters, it’s extremely important to disclose monitoring. “People generally don’t like to be monitored, period, in their own homes,” Gordon says.

But in hallways, campus grounds, or parking lots, there isn’t much of an expectation for privacy, and in these places video monitoring could be acceptable.

Be upfront about the services offered

In any event, it’s best to communicate clearly to incoming residents what monitoring is available, whether or not someone chooses to utilize it. “Clarity and disclosure is very important,” says Gordon.

In Greystone communities, residents are not required to wear any sort of emergency alert device, and some choose not to.

“We ask them to sign a waiver [indicating] we’re not responsible for an accident that might happen where they can’t notify us,” says Cumberland of the residents who don’t want to wear a personal safety device, or who opt out of notifying the provider when they’re up for the day. He adds that residents consent or sign a waiver to the kind of security system a particular community offers upon entering.

Different providers generally have different philosophies when it comes to keeping track of independent living residents.

Some make it clear they have no responsibility at all to monitor their residents and are strictly providing a place to live, along with whatever other non-healthcare services they may offer, says Gordon, adding that in many cases independent living residents are free to purchase their own alert systems or hire a private duty aide to stay with them.

Options seniors can consider on their own

“There’s technology out there that families can buy,” confirms Andrew Carle, a former senior living administrator and founder of George Mason University’s senior housing administration program. “The provider shouldn’t be a broker of these technologies, but they should be aware of them. They can allow home health agencies to come into the community, but they shouldn’t broker those agencies.”

For residents wishing to remain in independent living for as long as possible, technology is “clearly” the answer, he says. “There’s no reason people can’t remain for longer, and sometimes significantly so, by using technology such as medication systems, PERS [personal emergency response system], even GPS shoes.”

Some manufacturers have released their own medication dispensers, where an individual’s specific medications are placed in pill cups on a carousel that can be pre-programmed with reminders for taking those medications at a certain time each day.

Other companies, like Intel-GE Care Innovations, are introducing programs with a preventive mindset to focus on keeping seniors healthy and well rather than treating them once they become sick or develop chronic illnesses.

The Care Innovations systems can often be used by residents in independent living settings who want to participate in remote monitoring, manage chronic illnesses, or connect socially with others.

For communities that don’t offer any sort of safety systems or options, residents can take advantage of products like Life Alert, a medical alert system designed to help keep seniors independent, or, as Gordon and Carle mentioned, hire a third-party home health agency.

Know your risks

When it comes to what a provider could be held responsible for, the best advice is to talk to a lawyer, says Carle.

“Make sure you don’t place yourself in a risky position by assuming, either intentionally, or in a de facto manner, responsibility for something in which you should not be involved,” he says.

Years ago, Carle says he came across an independent living community that had pull cords in apartment bathroom units for residents in case of an emergency. But the people who answered those pull cords were maintenance staff—not licensed caregivers.

Independent living communities generally aren’t licensed to be providing healthcare, so it’s important to determine who, exactly, would be responding to a resident’s emergency call.

At Greystone, the personal emergency alerts predominantly go directly to 911, or a professional paramedic or EMT.

“It doesn’t conflict [with not being a licensed healthcare provider] because we’re contracting with licensed providers,” Cumberland says. “We’re not administering care; we’re merely serving as vehicle to get appropriate emergency care.”

Written by Alyssa Gerace

This article is sponsored by the Assisted Living Federation of America (ALFA) as part of its efforts to advance excellence and explore topics impacting the future of senior living. For more information about ALFA, visit www.alfa.org.