 Thieves,
babies and the elderly might not, at first glance, seem
to have much in common. However, each group has been subjected
to monitoring through electronic tags that set off alarms
if a subject leaves a certain perimeter. These devices
are used to prevent infants from being kidnapped from
maternity wards, prisoners from evading house arrest,
and elderly patients with dementia from wandering away
from longterm care facilities.
The technology has been especially
controversial when it comes to dementia patients. Although
touted as a means of improving patient safety, some
think electronic tags infringe too much upon a patient's
dignity and freedom. While the ethical particulars are
being dissected in the medical journals, electronic
tagging has quietly taken hold in nursing homes across
Canada.
MONITOR
VS MANACLE
Ridgeview Long Term Care Centre, a 120-bed for-profit
Hamilton facility, has used the devices since it opened
two and a half years ago. They decided on a system designed
by Austco called Dementia Care into which each patient's
16 'normal' behaviours are pre-programmed. A motion
sensor monitors the patient's movements, and determines
which are 'normal' or not, alerting hospital staff when
he or she deviates from normality. According to Susan
Mountpleasant, Ridgeview's Assistant Director of Care,
electronic monitoring has been enormously helpful to
the staff, hasn't bothered the patients, and has drawn
little criticism from patients or their families.
But other care homes are moving in the opposite direction.
Carewest, a group of longterm care facilities and a
wholly owned subsidiary of the Calgary Health Region,
has been phasing out the use of Wander Guard -- a lightweight
signalling device worn around the patient's wrist --
over the past five years.
"That kind of tagging is being used less and less,"
says Marlene Collins, programme leader for Supportive
Pathways, the dementia-care branch of Carewest. "It's
not considered the best practice." She should know.
Alberta Health and Wellness has designated Supportive
Pathways as the provincial standard for dementia care.
Currently, some of the Carewest facilities, such as
the new Colonel Belcher Hospital, use a more sophisticated
and less obtrusive monitoring system called Sentinel
Care. This system places sensors under patients' beds,
and on the doors of their rooms, in order to track their
movements. It also requires pass codes for all outside
doors. By using a more discreet system, Ms Collins says
that residents don't feel as scrutinized as some did
with the bracelets. No monitoring system is needed to
make sure dissatisfied residents don't cut off their
tags, and there is no longer the constant sounding of
alarms. "Current thinking around appropriate dementia
care is to minimize extraneous noise, as it overstimulates
and agitates the residents," she adds.
OUT
FOR A STROLL
For Dr Irene Turpie, director of the Division of Geriatric
Medicine at McMaster University, the decision to use
tagging is not one that can be made by individual facilities.
Instead, she says, it's a question of economics and
ethics: where should we spend our healthcare dollars
and to what degree of risk should a patient be exposed?
"I don't blame longterm care facilities,"
she says. "I know what the funding is. I expect
it's a lot cheaper to put a tag on patients." However,
she says that sufficient staffing would be a better
way to control straying patients, and argues that wandering
does have its benefits. Allowing some movement keeps
residents active, strengthens their muscles, and imparts
a sense of independence.
There are limits, though. "Do I think it's a good
idea if someone walks out from a nursing home to go
across the road to Tim Hortons to get a coffee and walks
in front of a car? No." says Dr Turpie. "But,"
she adds, "there are risks associated with everything
that we do."
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