Monitoring Nursing Home Residents

People end up in nursing homes because they can no longer care for themselves and require monitoring; however, how much monitoring and what type of monitoring residents should receive are up for debate. The use of surveillance video cameras in nursing homes is one monitoring issue that continues to generate a lot of controversy. Proponents of the cameras say that they can prevent elder abuse and ensure that residents receive optimal care, whereas individuals opposed to the cameras note concerns over invading residents’ privacy and limiting nursing homes’ ability to attract quality staff. Although video surveillance is not yet widespread in the nursing home setting, several states have recently signed bills to enable residents to keep hidden video cameras in their rooms as a means of ensuring their safety. Such hidden cameras recently led to a home in Ohio closing after they revealed substandard care was being delivered to at least one resident. What do you think about this complex topic? Should hidden cameras be allowed in the nursing home? Be sure to vote in this month’s online poll or write us a letter to the editor.

Of course, the monitoring issues in nursing homes extend well beyond video surveillance. We explore a few of these issues in this month’s Annals of Long-Term Care: Clinical Care and Aging^® (ALTC).

In our first article, “Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities”, the authors discuss how to develop an effective protocol for managing suicide risk in long-term care (LTC) facilities. One traditional approach for managing suicide risk is placing any residents who are perceived to be at risk for suicide on 15-minute checks or close observation. The authors discuss why this monitoring strategy is problematic, indicating that it places additional strain on staff, is costly to implement and maintain, and often makes at-risk residents feel ostracized, all while providing negligible benefits per currently available data. Therefore, before routinely implementing close monitoring or other more extreme measures, such as sending potentially suicidal residents to an inpatient psychiatric unit, the authors recommend determining these residents’ level of suicide risk by using the P4 screener and then following an appropriate protocol for managing their risk. The authors provide an example of a decision tree that tailors suicide management to residents’ risk levels. Having such a protocol in place is an important step to empower staff to appropriately handle the challenging situation of suicidal ideation and behaviors and to improve nursing home care quality.

In our second article, “Robot-Guided Exercise Program for the Rehabilitation of Older Nursing Home Residents”, the authors outline their research, which sought to determine whether a robot could be used as an exercise trainer in the nursing home setting. They had previously used the robot for another research study that examined the same robot’s ability to serve as a remote monitoring system. With regard to the exercise study, the robot led participants through a series of leg and arm movements, but it did not monitor their actions. For the remote monitoring study, the robot did not interact with the residents, but responded to their call alarms and opened communication with the staff to enable them to monitor the situation and react if necessary. Although robotics still has a long way to go, this report inspires reflection on just how robots might transform the eldercare landscape once they become capable of independently performing multiple functions while also monitoring and gauging their surrounding environment and reacting to it. In the meantime, robots like the one the authors assessed may still find a place in the nursing home setting by facilitating functions that might be burdensome or for which resources are limited.  

In our third article, “Uncovering a ‘New’ Clinical Niche for the Geriatrician”, the authors discuss how geriatricians may become the perfect facilitators of care coordination, serving as important monitors when it comes to overseeing patient care between care settings. As the authors note, geriatricians are perfectly suited for this purpose because they have a solid understanding of inpatient, outpatient, and long-term care settings, and of geriatric syndromes and end-of-life care issues. However, they note that substantial reimbursement changes would have to occur to make this role a feasible one.

We welcome your thoughts on the articles in this issue of ALTC. Responses can be sent to our associate editor, Allison Musante, at amusante@hmpcommunications.com and may be published in an upcoming issue of the journal.

Thank you for reading!