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#ActivitiesStrong 7

Fall Reduction: Uncovering the Winning Partnership of Resident Engagement and Technology

Shirley Nickels, Chief Operating Officer at SafelyYou and Sara Padilla, Vice President of Resident Care at Merrill Gardens share real-life examples to illustrate how technology revealed that even small changes in resident activities and daily routines created safer, more enjoyable environments and lives for residents. 

Technology is not the “end all, be all” problem-solver, but in this episode, learn how to find the right balance of digital and human interactions to elevate your programs while reducing risks and achieving immediate results. Hear real-life examples from leading providers such as Merrill Gardens to illustrate how technology revealed that even small changes in resident activities and daily routines created safer, more enjoyable environments and lives for residents.

Significant cost reduction, that can cover far more than your investment, is possible through the timely orchestration of digital and human interactions. Learn best practices to not only reduce falls and ER visits in your community but elevate your standard of care.

What you’ll takeaway from this episode:

  • Learn best practices for resident engagement to create safer environments and minimize risk
  • See how technology can uncover the root cause of falls to enable action plans to reduce falls and ER visits
  • Understand how technology can help elevate standard of care and provide significant financial benefits to both communities and families

Charles: Welcome everyone. Welcome to today’s activities, Strong Executive Edition Webinar, where I’m very excited to have vice president of resident care at Merrill Gardens and Shirley Nichols, COO at SafelyYou. Welcome, sir. Welcome Shirley. And I also wanted to welcome everybody on the line, actually let me just share with you that I hope that all of you had a wonderful, July 4th. I was talking to Shirleyand Sara just earlier here in Washington, DC. We had a lot of fireworks and tons of fun. I hope you were able to take a little bit of a break and have a relaxing weekend. Today’s webinar is one of our quote unquote Executive Edition that we have in partnership with Bridge the Gap where obviously as part of the Activity Strong initiative, it is all about acknowledging activity and investment professionals, empowering them and educating them, but also being proactive and inviting quote-unquote executives to the discussion.

So if you are a quote-unquote executive and you’ve joined us today, I wanted to welcome you, especially, but also thanking you for taking the time, because just your presence means that you value activity enough enrichment, and you’re part of our quote-unquote platform to help us elevate the discussion. Today’s topic is extremely important, and I will be sharing a quick introduction. But before that, I wanted to share with you a little bit about us for myself. Like Megan mentioned, I’m the CEO and co-founder of LinkedSr. LinkedSr is a resident engagement platform for senior living. We touch about 45,000 lives in the US and in Canada. And we work with leading operators such as my old garden heights, and we’re very excited to be partnering with these providers in elevating the experience for the elders, their residents. Our work is simple. It is all about resident engagement, and it’s also about helping quote unquote measure the impact.

So we’re the only platform in the market where the work has been published in a peer review journal in 2019. And we’re very passionate about measuring resume engagement and correlating that with outcomes. Some of these outcomes are actually very important, which comes to things that are measurable. And that includes obviously for reduction. And we know that the winning partnership that we all have their potential of enabling, and a lot of it has to do with this idea of collaborating, right? So I’m very excited. One of the many reasons I am very excited about today’s presentation is how we can quote unquote, collaborate with our elders so they can live each day with purpose. And how can we in doing that take into account their preferences to help build an experience where, you know, obviously we’re mitigating things that we want to avoid such as falls, but we’re helping them thrive every day. So again, with a lot of excitement, I’d love to introduce Shirley Nichols, as the COO SafetyYou.


Shirley: Hi, thanks so much, Charles, really excited to be here and to join Sara. Shirley Nichols, COO of SafelyYou, I am responsible for the customer journey from marketing and then through customer success, really excited to be able to share success stories with Merrill Gardens here today. I’d like to introduce you to Sara Padilla.


Sara: Good morning everybody, I’m Sara, I’ve been a nurse for over 20 years currently at Merrill Gardens for the last five years, heading up the resident care or the clinical facing front for the communities from the home office. We’re lucky to be able to partner with both LinkedSr and SafelyYou to really provide a wonderful program for our residents at Merrill gardens.


Shirley: Great. So now we’ll go ahead and transition to the age educational content here. So on the agenda today, we’re going to talk about why we focus on falls? And next we’re going to go through some statistics that SafelyYou has documented from over 15,000 on the floor events. And then we’re going to go through how we actually identify unmet needs. And how do we empower care staff with interventions through resident engagement, and that we’ll go through some best practices with leveraging technology. And Sara will kind of highlight how she’s leveraged technology with addressing unmet needs. And then we’re going to actually go through some case studies, why do we focus on falls? Well, to start off one in four Americans aged 65 and older will fall each year. I think we all know that falls are a leading cause of both fatal and non-fatal injuries and falling once doubles your chances of falling again. And we do focus a lot with safely you on those living with dementia. So a lot of our data will be around those with some sort of cognitive impairment. And what we want to highlight here right now is that those with some form, twice the likelihood of actually falling on than those without dementia. So they actually average four times per year, in addition, about 26% of Alzheimer’s disease related hospitalizations are actually caused by falls. So how do we minimize that type of outcome related to falls? In addition, over 80% of falls globally are unwitnessed, which occur in the bedroom.

And then specifically those living with dementia, unfortunately, aren’t able to articulate their falls accurately either. What was the cause of the fall before the event, or what were they attempting to do? Or even how long have they been on the floor? So how do we help address these and uncover what their needs are? So the reason why Safely You was really focused on falls is that we found that current fall measures didn’t really address how to uncover the root cause of falls. Instead, a lot of times they’re just really reactive responding to a fall. Sara, do you have any kind of context around Merrill Gardens and why you guys have become more focused around falls and why you’ve obviously partnered either with Safely or other technologies to really uncover unmet needs to reduce your resident risks?


Sara: Yeah. So as Shirley said, a huge volume of falls each year, for those of you that work in the industry, you know, we deal with falls on a daily basis. And so being able to have a better understanding of what’s happening with those residents when they’re in their room when they do fall. SafelyYou has enabled us to put forth better interventions to prevent future falls from happening. So it’s kind of being that fly on the wall to see what’s really going on in the unit. I know many times we have said, if we only knew what was happening and with this technology, it has enabled us to actually see what’s happening before that fall occurs.


Shirley: And I think you’d probably agree from the population in space, those residents with some sort of cognitive impairment do have a much higher risk of falling. So being able to have a way to uncover that is really crucial. So what has SafelyYou learned through our 15,000 on the floor events? So we kind of want to highlight here was of all of our communities, about 94% of the detections would actually be on witnessed meaning in the bedroom where the resident is alone happens. 94% of the time, in addition, this actually was kind of the most insightful statistic across all of our communities when they onboard is that 38% of what we used to call falls are actually intentional where the resident self lowers to the floor. They make a choice whether or not they’re cued by their shoes.

Maybe they just enjoy sitting on the floor, maybe they’re praying, maybe they like yoga. You know, we have several residents who enjoy that, but unfortunately they’re not able to get back up, right? So how do we create an environment and a space that can promote that independence, but again, reduce their likelihood of a severe fall and we’ll go through that more. And the next is that 22% of our detections are actually what we call silent. Silent means that the resident did unintentionally actually fall in their room alone and was able to get back up on their own. And in those events, a lot of times that actually might result in an injury of unknown origin. So meaning the next morning, or that two days later you notice a bruise forming or maybe a cut that we didn’t notice before. And it’s really difficult to obviously communicate to the family or come up with a root cause, which obviously creates not only extra work for caregivers, but also this feeling with family of this unsettling feeling of what happened. And so was SafelyYou where you are able to detect these events and again, address, well, what did occur? How do we actually help this resident from what they were attempting to do?

And then lastly here we’ve actually uncovered that most falls, only 4% of falls actually result in a more traumatic injury. So what this is telling us is that most of the time falls are solvable in a sense that they are not extreme, but we can help enable that environment to be safe for that resident so we can keep them safe in their community. So that we don’t have to send them out for unnecessary ER visits. Next we’re going to kind of get into our day falls. So we’ve been able to trend when goofballs actually occur. So as you know, sometimes if you’re not using technology, you’re doing your routine rounds, you know, wellness checks on residents. Unfortunately we don’t know how long they might’ve been on the floor. And so what we want to highlight here is pretty much two peaks that typically occur between three and seven and 6 to 10.

And that’s usually because the resident might be ready to get up in the morning a little bit earlier than they are used to, or they’re actually not ready to go to bed. We actually found that we might be putting our residents to bed at like 6:00 PM, a little too early. They actually still can be engaged and still can go do things or there might be some residents that just have a different pattern of sleep. And so again, how do we address this more from a person centered approach and really understanding what’s happening in the room. And we’ll kind of go through some of these examples, but again, I call out here, you notice the intentional versus a true fall event. You’ll see that they actually follow the same pattern in a sense that those that intentionally lower themselves to the floor and also fall are basically around the same times.

So again, how do we create that safe environment if a resident wants to exit their bed sooner in the morning? Well, how do we enable that? Or how do we create a safe space that they can lower and scoot themselves on the floor if they choose to, or create again, ways for them to transfer on their own. Now I’m going to kind of highlight some of the environmental design things that we’ve witnessed. And Sara, please feel free to kind of chime in on any stories that you’ve seen at your community. So here we’ve seen a cluttered room. So we know in a lot of our communities, families obviously like to send things. They also, when they move in, you might have a little bit more things than you probably would have wanted, but really understanding, keeping design spaces really not only making sure that the resident can focus on things that they’re interested in, but really if it’s cluttered, they’d actually don’t know what to go focus on. Right. And so keeping the environment clutter-free is really important. 

Sara: Shirley, real quick. As we’ve watched videos, families really want to recreate that same environment, maybe that mom lived at home. And so just making some minor adjustments, things should be eye level, or you might have a bookshelf where all of her favorite books are on the lower shelf and that’s the way her home was. But in looking at what she’s doing in the room and lowering herself down to dig through, or find those books, making simple adjustments as to moving those things up to a spot that she can reach them has made a difference, has made an impact in many of our cases.

Shirley: Yeah. We’ve also witnessed, think of surface area as well. So on top of that shelf or on that small little desk area, or by the TV console you want to have clean space, so it may not seem like it’s cluttered, but it does add, and it’s difficult for them to focus or even look for a TV remote. For example, when you have too many things, it can be distracting for them to know which thing is the TV remote. So making sure, again, you’re keeping the environment simple for them to engage in the things around them. Next year is about 18% of falls, we actually do see floor mats present. So, wondering if the floor mats are actually useful in the space or not, or is it actually hindering them to be mobile and to move about 46% of the time the rooms are actually dark?

So can the resident actually see in the room is also really important. The elimination of the room and preference, so some residents do want it pitch black, right. And so I understand that I like sleeping when it’s really dark, I like the black, you know, like the blackout shades and things like that. But some don’t, right. And so how do we change that preference and understand that we’ve actually seen a lot of times they’ll keep the bathroom room cracked open that actually could be a really big distraction. Can you imagine, like a little beam of light coming into your bedroom can also be very distracting? So how do we actually understand if, whether or not the resident prefers that today or not to help them make sure that they can still make the right choices, because it could be distracting that they want to get up and turn off the lights next as 81% of the falls mobility aids are present.

So what does that mean? It means that typically residents have to transfer or use some sort of a transfer aid to mobilize, but can they actually use it as is also the question here? So can they engage in their device? And what we’re actually finding is that half the time unfortunately we’re not actually setting them up for success. We actually have found that there might be a mobility aid in the room, but it’s not within their reach or they don’t even use it. And so again, how do we create that mobility aid of engagement of active use? Maybe you only use it when you’re with them and it’s something for them to do versus don’t having it in the room because it could actually be a fall risk for them.


Sara: I think the mobility aid is a huge opportunity to educate your team members or your staff. I know there’s been a lot of thought where out of sight, out of mind. And so we see care staff talking to mobility aid, whether it’s the walker or the wheelchair, they’ll put it in the far corner. And so when a resident goes to attempt to get up, they actually need that mobility aid, and so just making small adjustments like that, making sure the mobility aid is locked and in place next to them, so that if they do attempt to get up, they have it available. So just different insightful things as you watch fall videos that you learn along the way.


Shirley: Yeah, for sure. I kind of think of yourself sitting in a room and if you’re going to engage in anything in the room, it kind of prompts you to me, shoes is a prompt for me to want to go do something right. When I see my shoes and then obviously a mobility aid will prompt me to want to leave, right? So there’s things that make you want to take action. And so you want to make sure what action that could result in safe or unsafe behavior. And then that’s the thing that we want to make sure that we’re communicating here today, that we do think that engagement is great. It’s just, how do we make sure that environment is tailored to that resident based on their fall risk? And then lastly, here, we actually have noticed closet doors, a quarter of their time, which is interesting.

The closet doors are actually left open. I have a problem with this at home. I will get out of bed and close my closet door, cause I don’t know if it’s like the boogeyman or something. I don’t know what it is, but I always have to close the closet doors or even like the pantries. Right. And like my kids, I’m always having to close doors after them, that might be some other OCD things that I might have. But my point is, I know for myself, I definitely like things closed. So if you can imagine a resident would also feel the same way. Okay. So we’re going to go and transition now over to some of the things that we’ve witnessed and how do we address some of these unmet needs. Why do we want to do this specifically for those living with dementia, they cannot articulate their needs and desires. It is difficult to understand what they need. And so through the fall video, we’ve been able to better understand cues and things like that from an environmental space. Some of the reasons also around residents don’t have meaningful engagement. And so how do we design again, that space or design a new activity that is meaningful for them to reduce their likelihood of cognitive decline and then really about promoting routines and improving sleep and socialization. What we found a lot of times is if you notice those peaks and valleys, a lot of times those falls are occurring at night. It was because they weren’t restful. We see them walking actually around the room at nighttime because they weren’t engaged throughout the entire day. They were less active during the day. So if they’re in the room during the daytime, unfortunately we are going to see more falls at night, because they weren’t socializing or doing things.

And so really understanding that pattern is important and then of course, always about person centered planning will help mitigate that. And we called out earlier that those living with dementia will fall approximately four times per year. So how do we minimize that frequency with some of these opportunities? So, here first off, like how do we address this? You know, Sara, do you have any, you know, I know you guys are very proud of your program in memory care, but in regards to gathering detailed life stories and information, how does that help you guys from your process?


Sara: I think just knowing and having a better perspective of the resident. It does take families quite a bit of time to fill out the life story, but to be able to make that connection with them as to why we need that information, can really help make a difference in that residence life and knowing that they normally slept till 10:00 AM at home every day, or they went to bed late at midnight, kind of helps us tailor it specifically to that resident so that we can help meet those needs. Not everybody gets to bed at six o’clock, not everybody gets up at 7:30 to go down and have breakfast. So being able to make those accommodations per resident can be very impactful.


Shirley: I thought this was also pretty critical in regards to observing the resident within their own space. So I think a lot of times our care staff, they’re very task oriented, they have a lot to do. But if you don’t actually see residents engage within their own space, so are they actually using that chair? Are they actually using the TV? Do they actually still engage in the book? So making sure that the use of the environment remains engaged for them and even just the mobility aid a lot of times care staff won’t, we’ll just kind of help self help transfer the resident with the mobility as opposed to make it part of the engagement. Let’s actually get the resident to be part of the activity, even just transferring, but it also helps you observe them and their space to see if they can do things like that on their own. Does that make sense? You know, Sara, I think you guys do that pretty well.


Sara: Absolutely. I think we’ve encouraged or had our staff watch the SafelyYou videos. And so giving them that perspective of what’s happening with the resident while they’re in their unit has been eye opening for them and has allowed them to kind of change what they do when they go into an apartment to engage with that resident.


Shirley: Yeah. And I also think when there’s been a change in condition or a fall event, how do we create some sort of assessment of the room and how they’re using their space is really important. So how do we create again, that kind of cadence and the community to assess that?


Sara: I think the other piece, and we’re probably going to talk about it is we’ve also seen residents move a lot. So when you enter a room after a fall, a lot of times that’s not where the fall occurred or when they lowered themselves to the floor, they moved around quite a bit. And so being able to see that perspective and that they actually lowered themselves way over by the bed, but when you come into the room, we’ll go by the bathroom. And so seeing what they’re doing, definitely has made a difference in what we’re able to adjust or change within the room. I think three big things for us have been recliners or movable rocking chairs or rocking recliners have been a big impact for us and that discouraging families from bringing those types of things into the room has made a difference for us.


Sara: So other ways to address this is really about enabling your direct care staff as well. So, training them to see shifts and changes with a resident and what are clues to look for is really important as well. So we understand that they’re not going to be therapists and actually see some sort of gate change, but there might be just something subtle that is really helpful for us to try and prevent a fall or a fall risk or again, changing the room and the way that we use the room for that resident. It’s really important to collaborate with more than just care staff. I mean, you really want to involve the family in the process to get their buy-in, and having different perspectives is really key to really uncover a lot of this, especially with those living with dementia.

Another area we have seen is medication review actually does make an impact. Assessing if you’ve seen a change of condition, there might be something else that might be related. If they’re showing less interest or engagement, we have seen a lot of times that could result in falls because maybe they are spending more time in the room because they are less engaged, right? And now they’re spending time in a room alone, which then increases their likelihood of falling. And so how do we again keep all these different T coven team members involved in that process?


Sara: You know, I think a big takeaway is making sure that you’re utilizing your pharmacy partnerships. Most of you work with a long-term care pharmacy that can perform drug regimen reviews. And so if you have somebody who’s falling or falling frequently, make sure you’re asking your pharmacist to do a drug regimen review, because a lot of times they may uncover other things that may need to be changed and can discuss those medication changes with the physician.


Charles: Sorry, I have a quick question here. From a perspective of a typical activity, a lot from restaurant professionals, we hope as much as possible to get help from other departments, including nursing and care partners. Right. And we want to do that so that we have other team members that help us engage the older or our elders. And it seems to me that, I’ve counted, I think, five or six examples based on your data study. And we’re using Sara with your communities if we had a way to enlist activities and life enrichment around the preferences of our residents. So, you know, yoga the time of getting up or going to bed, the lighting, I mean, sorry, I’m the same, everything needs to be dark for me and closet clothes and all of that the amount of energy that partnership is often where we see things make it a break it, right, like that winning partnership. And I’d love to hear, certainly from your data or from your experience, the perspective of non-activity staff, like what have you seen to be helpful that you would hope the typical activity director knows about all the typical life mission professionals to always take into account? What is in these things that make or break it from your perspective?


Sara: Well, I’ll go first. So I think working on partnership between clinical and care staff and that we all have to take care of that resident. I think making sure that they’re communicating even the day-to-day changes, they may be seeing with the resident encouraging the engagement staff to participate, whether it’s in daily huddle or looking at our communication log on minor things that we may not think of big are a big deal, but the engagement staff would want to know too, like she’s really tired today or something else is going on with her. So I think making sure we have that open communication with engagement because they’re spending a good amount of time with the residents as well. And I think it goes both ways.


Shirley: Yeah. And I do think because our data is all in the bedroom. What we’ve seen is residents spending more time in the bedroom, which we want to promote their own independence to spend that time in the bedroom. I think that partnership though with activities or life enrichment in regards to what we do with that again, that bedroom space to make that environment more engaging. So it could be as simple as just color patterns, that will create some sort of feeling for that resident to want to possibly engage. I think that collaboration of just spending time in the room with possibly your activities partner of, Hey, let’s just sit in the room for a few minutes, I don’t think people do that enough of is this room engaging to you  and kind of making sure that you are partnering with that.

I know that and you know, when I’m very excited, I get to go tour some of our communities. Now I definitely need to sit in that chair with the resident and say, okay, if I’m sitting here, what is the room? Is this room engaging for me to feel like I could be engaged in anything? I do. I have my things accessible and can spend time in my room alone feeling like I can do something on my own and it’s okay if they want to be social and let’s go ahead and pull them out and let’s put them in group activities. But I do think we need to have more ideas. I think we need to pull more in for care staff to be creative in the room itself. So I think that the activities partners can co create some great ideas as a one-on-one activity or even alone in this space.

These are just the most common areas that we have seen in that space. So kind of on that thread there, Charles. So how do we, again, from partnering with what matters in this space, are there weight wakes, sleep patterns that can kind of help us out? Are there different comfort levels in the room? And then also even just, what do they like to engage in, in the room itself? Do they like to play with dolls or tinker with things, or do they like to read through the newspaper, things like that within their space. Then of course, on the ADL side, we do think that this is a great activity. We actually have an example on our case studies here, but how do we engage a resident with just basic ADL’s take your time. So how do we create a basic ADL to be active and engaging.

So even if it’s folding clothes, that is a very engaging activity that we all are used to doing. And how do we create that as a function, even in the room, even if it’s just socks, right? I mean, just give them a pile of socks and match socks. That could be a very engaging activity for somebody. So those are just different ways that we think are really important. So we’re going to actually transition now into fall huddles and practice around technology. So really around how we use this, here is a diagram on a fall workflow. And it can be this crazy. My point of kind of showing this all to you is really prompting you to say, Hey, do you actually know what you do after a fall?

When a fall event happens, what are the steps? And let’s actually make sure that you guys reflect on that and say, hey, who are our partners and team members that we involve in every step of the way. And it’s not just the response to the fall. What’s most important is actually, what do you do after the fall? How do we learn from that fall event? So we avoid it from ever happening again. And how do we communicate together to help solve this problem for the specific resident? Or how do we learn from it and actually pay it forward? Right. So what did we actually gain from this information and how do we actually share and collaborate as a team so we can actually support other residents? So some basics here is we believe the fall huddle structure is really important. So we believe in having a fall champion that really supports every detail of fall events and empower your staff.

We believe it’s really important to have accurate reporting and the ability to analyze interventions together as a group, as a multidisciplinary group here, which is where we have either your executive director, your general manager activities coordinator, as we just mentioned, your maintenance, direct care staff, have everybody in the room to talk about this, cause they all can impact this process and then really make sure it’s part of embedded in your fabric. Right? And so I think Merrill, you guys have done a great job partnering with our customer success managers and there’s process. So can you highlight at all in regards to how this has helped you guys identify resident needs here?


Sara: Yeah, the fall huddle has been key for us to review falls because I think two minds are better than one. And so when we get on our fall huddle calls, it’s a combination of myself, regional nurses, and representatives from the community. And so we’re looking through those videos and a lot of times it’s just different things that pop up or different perspectives. So that’s been very helpful in reviewing, especially for somebody where we feel like they may continue to fall and like, why can’t we figure out what’s going on? So those fall huddles have been eye opening. We’ve also included family members in watching the full videos. It’s been educational for the families as well to see what their loved one is doing and is able to use to make recommendations and changes to the family. Like changing out a chair. I can tell you, sometimes we get into deep discussions with families about how they’re really stuck on making sure mom has this one chair that’s been in the family forever, but they see what an impact it has on a fall and then that conversation completely changes. So fall huddles and reviewing them have been key to addressing our frequent followers and making sure that we’ve got appropriate interventions happening for those folks.

Shirley: Yeah, and really around that fall huddle, we talk about technology and best practices, whether or not SafelyYou or another technology partner, what we really want to make sure that when you do conduct your fall huddle, how are you bringing in all that information? How do you review that incident information together and does it really support all the details? Because a false scene, which we’re going to go through here soon, is captured, it’s kind of like a fall investigation. It’s kind of like a crime scene, right. And it’s how we actually understand what actually happened and making sure you’re collecting that information next is about obviously root cause analysis. So whatever technology you are leveraging during our fall huddles, how is it actually providing insight to the information? How is that providing the unique information about that resident and their care and how you’re gonna address that fall specific event.

And then of course, interventions and actions, how is your technology that you’re enabling? How is it actually helping you close that whole loop? A lot of times with fall prevention is actually the implementation of the intervention. So how do we close that last mile, in a sense.  A fall has happened, you find out that it’s the chair, right? So Sara keeps calling out the swivel chairs and lazy boys. So who’s going to actually close the loop there? How are we ensuring that we’re going to actually close that and get the chair removed? So a lot of times that’s always, actually the most difficult piece is who’s actually responsible for the execution. And how is your technology supporting that?


Charles: I have a question for you because we understand, we know that marijuana garden, highly values, activities, and life enrichment professionals, but we do have today in the origins members of organization where unfortunately it’s not quite the same respect, not quite the same value and sometimes activity professionals are not included in these huddles, whether the daily, what would be your word of advice that you could tell these activities directors that they intend to tell this superior about the importance of including them in that process?


Sara: No, I know that’s always tough, I saw some of the comments and chat about that, and I think it’s kind of, we have to be resident centered, right. And so it can’t just be all about one thing. It’s not just about dining or just about care. It’s kind of looking at the whole perspective of that resident and engagement plays a big part of that and maybe offering some insight. If we know Mary is falling all the time, maybe approach your clinical leader and say, I’ve noticed some changes with Mary and I’d love to be able to provide some input on what’s happening with her. If you guys are having a foal a little or talking about her falls, maybe offering the information that you have and making it accessible and knowing how you can build some value with them.


Charles: So what you’re saying is that instead of getting directly for the executive director, probably try to partner with other team members to make the case. That’s fantastic. Thank you. And then Shirley, we had a couple of this one actually kind of a question here asking from your perspective. Shirley, how well, because obviously I know the answer, but how well does this work for people with more advanced dementia? You know, could you speak to us about the different levels and how these processes actually would work hopefully with everyone?


Shirley: For sure. Yeah. I think kind of transitioning the perfect cue here on how the technology works and how we kind of advocate, or we actually believe that we support those that aren’t able to advocate for themselves. So I’ll kind of dive into how the technology works. I do know that we want to get into the cases. So real briefly, so we leverage artificial intelligence through using computer vision. This is actually an image from Tesla’s website and so we use the same type of technology that we take images from the camera, and we train our algorithms to detect certain events in the room. So here again, from a Tesla auto self-driving car, they have about eight cameras all the way around the car, and they’ve trained it to understand what the patterns are on the road and what safely you have done is taken that same type of technology, but applied it within assisted living and skilled nursing.

So here you see, this is actually me at Merrill gardens community, I’m sitting on a bed and the AI actually detects me as a human. But it has a confidence score of whether or not I’m on the floor or not. So this is an opt-in program also by the way. So this is a consented process. We only turn on the cameras for those that opt in and we also delete video upon recording if a fall is not detected. And so through this process, we can actually have a high accuracy of over 99% and we’re able to upload the pre-fall video. And so here, this is kind of the big takeaway here for advocating for those with some form of dementia is that we can actually not only notify the community immediately of the fault detection, but we can also provide the buffer video of what actually caused the fall.

So what happened minutes before the fall events? So we can advocate for that resident. So today, unfortunately somebody with severe dementia is not going to be able to communicate what they were doing, where they were, or if they’re hurt. So instead here’s actually a video clip that I’ll show you. This is a media release from a family member that approved us to share this with you. So this resident is living with dementia in memory care and assisted living. You’ll see here, she actually lowers herself to the floor with a pillow because she actually doesn’t want to hurt herself. And what she’s doing, she’s actually watching Big Bang Theory on her TV right now, and she’s looking for her TV remote. So the problem here is that she can’t find it mainly because as we could probably see here, there’s a lot of patterns right in this room right now.

So she’s shuffling around, this is actually a couch and this is her one bedroom. So this is her bedroom over here, but obviously you can see there’s a ton of pillows, different patterns and she is making a choice to lower herself safely to the floor. So this is at 38% that I mentioned to you earlier, that this was actually the intent of actually looking for something lowering herself to the floor. And how do we again, create a safe space for her or an engaging space that she can watch TV if she wants to, and she can change the channel because it’s clear, she still remembers how to use the TV remote. So here we are, now that we know what she needs, we can make sure we can declutter her room, right. Is one thing, and we can make sure the TV remote is accessible and we don’t see all the clutter in this room, right? So we’re talking about surface area and accessibility. So how do we again, make sure she can remain engaged if she wants to stay in her room to do an activity like watching TV. So hopefully that kind of answers some of that question regarding supporting those living with dementia, the purpose is to be able to observe an advocate for them, with actually seeing what happened in there.


Charles: Yeah, that’s a wonderful example. It showed in seeing this, obviously it makes me understand that actually the most value would actually be for the people that have probably a more advanced level of cognitive change.


Shirley: So now we’ll kind of go through the cases. So, our first case here. This resident, so Sarah, I know you know these stories pretty well, but for the attendees here. So this resident she’s had multiple falls before this where she’s seemed to be very busy in her room. She actually likes to exercise quite a bit and you see her actually holding some sheets. She likes her sheets. It’s an activity that she enjoys doing. But we saw that she would fall, as you can see. She also has a walker here in the bottom corner of the room where she also has her folded clothes. So she enjoys engaging in these types of activities in her room, but unfortunately she did fall repeatedly. So from here though, Sara, if you recall, kind of the interventions.


Sara: Yeah. You can see she’s very busy. So this will surely be when she’s older, everything’s neat and tidy. And that’s what she does, she’s very busy in her room. And so she loves to change her sheets. Her falls were centered, several of her falls were centered around while she was attempting to change her sheets. So as an intervention, we actually have engaged her so the care staff make it one of the things they do with her every two days. They help her now change her sheets, so they allow her to participate in that activity. And it kind of meets that need for her to do it, but we now can do it safely because we’ve added it to her care plan that the care staff is actually going to help with her change your sheets. So, I know a lot of times when they move into senior living, it’s kind of like, we want to take care of everything and really they still want to feel valued. Right. And so allowing them to participate in things they would have done every day or every few days can make a big impact. And really that’s what we’ve done for her in this situation.


Shirley: Yeah. And I know that activities one-on-one can be difficult to plan out I’m sure because your other care staff are obviously multitasking and having several other residents they have to support. So I do think, you know, I don’t know for those on the line in regards to how you support one-on-one activities in the room? It’d be great to maybe get some feedback there from those on the line. I think it would be a great collaboration cause that’s one of the shortcomings we’ve heard is that how do you try and find the same resources you already have, but create individualized one-on-one activities like this in the room to make sure we could do that for these residents. We had one resident that did the same similar type of thing where she enjoyed unpacking and repacking or  taking all of her stuff out of her closet and putting it in a laundry basket and then putting everything back onto the hangers and putting it back into the closet. That’s a great engaging activity that they enjoy doing, but it’s unsafe. It’s very unsafe for somebody that’s not very mobile. So how do we create that workflow environment where we can support that one-on-one activity time while still addressing group activities as well. So I think there’s that balance. Sara, if you have any comments on that, like at Merrill, how do you make sure you have one-on-one time?


Sara: So it’s just basically we try to incorporate, so the staff’s probably going to be in there doing it anyway. So some of it is just regular tasks that they have the responsibility of doing. And so engaging the resident to come along with you and to participate, doesn’t really create anything. You’re not having to go set something up. You’re just bringing them along with you to what you already have to do


Shirley: I think that’s great. We had somebody that at least brought them into the common space as an activity, they actually gave them a bunch of small towels to fold so let’s just have an engaging activity and have everybody just fold a bunch of face towels. So again, different things that you could do as well. Here’s our second case here, this case; unfortunately this resident did have multiple falls around her lazy boy, her recliner chair that I know Sara kind of mentioned is always at risk. But a lot of residents really enjoy those, they are very comfortable. But there’s obviously many problems with these types of chairs, especially when you’re talking about being able to self transfer. So you can see here, she can self transfer it to the wheelchair that’s right next to her.

We did witness a lot of times for being unsuccessful to do that because of course the wheelchair was unlocked many times or just you couldn’t transfer completely. And this is actually where one of the recommendations are around observing your resident in their own space, observing them transferring themselves, observing themselves engaging in their mobility aid to see if they’re successful in using it. So unfortunately here she did have repeated falls but by identifying her pattern in her room and what she was doing we also found that she was also using the call light. She actually knew how to use the nurse call button. She knew that by pressing this, somebody would come into the room, but she was always sitting in her chair when that would happen. Sara, if you want to give us some color to the interventions here.


Sara: Yeah. So this young lady did have several falls and through our fall little process recently, I was like, did she move out because she’s not been falling. And so when we started reviewing, it’s really kind of the interventions the community has put in place. So like Shirley said, she loved sitting in that recliner, that was her favorite chair to sit in. And so through some engagement and adding a recliner in our common space, she loved being around people and she would use her call bell and people would come in and she would want to engage with them. So by adding a special chair for her out in the common space, she now is engaged out where everybody can see her. She’s very comfortable and that has totally reduced her falls because now she’s out and she’s engaged. So it’s been a big impact for her. Somebody that could have broken a hip or ended out at the hospital and would have been a move out is now living successfully in our memory care unit. And so, just having this knowledge and being able to address her needs has made a difference in her life.


Shirley: For sure. Yeah. It’s just that somebody may want to be in the room. It may not be that they aren’t socially, you know, wanting to be a participant. So again, uncovering, what is that? How do we solve that for them?


Charles: Shirley and Sara I mean I’m sure you’re seeing the chat here, but I got excited a little bit like the audience from the perspective of the activity director, because obviously the technology is amazing, but it’s also a fantastic way to empower activity and life enrichment, right? Like you’ve given these five or six examples of interventions that without the technology we may have found out, but not. So right now that technology would actually enable and empower activity, not enrichment even more. So that’s really exciting and then kudos to you both.


Shirley: No, that’s great, it was great to hear. I think the point is that we believe there’s more collaboration that can be had, especially with our activities and life partners. So, thanks for calling that out.


Sara: And I think many times we tend to like, well let’s bring in therapy. We’re always thinking from a clinical perspective. And looking at this gives us again, I say, it’s like the fly on the wall perspective. It gives us the entire view of what’s happening. And sometimes our interventions don’t have to be clinical in nature. And I think that’s what we’re showing today. It doesn’t always have to be about clinical throw another med or order or another medication to make sure she doesn’t get up out of her chair.


Shirley: Yeah. That kind of wraps up, I think, on this last case here. So this is a false scene. You see there’s some books here on the floor and just a folding table, right. And then you also see this TV that’s on this really small little TV stand. So this resident actually enjoyed reading in his bed. What he would do is he’d lean down to the floor to go pick up his books and then he’d always miss his bed getting transferred back in. Cause obviously a dynamic reach down that low and then being able to come back up. Unfortunately they just witnessed that process wasn’t repeated and so what they were able to do was talk to the family about the furniture here in the room and replacing obviously this area right here, how do we make this more engaging for him and more space?  Sara, if you want to kind of talk through this.


Sara: Yeah. So after reviewing several of his falls, we definitely rearranged the room. You can tell several of these small tables are definitely not safe if he tried to get up and put any weight on him or maneuver anything or hold onto them. It definitely was not a safe space. The TV’s not secured, none of that. So by looking at what was happening in the room, we actually created some space where he could have his books. He could sit here. If he wanted to engage in watching his TV, he could do that. We have a chair with arms now, so it is easier for him to be able to help himself stand up and push himself up into a standing position. But I noticed some of the comments in that, that it is difficult to provide one-on-one, but in making some accommodations he actually can engage and do things that he enjoyed. And it doesn’t require a one-on-one staff there to be able to initiate that he now can read his papers or look at his books and his magazines in a very, in a much safer place.


Shirley: Yeah, I think coming up with ideas of independent engagement, you know, in this space and making sure that the space is optimal. So even though that chair, we had that chair, but it was tucked in this corner. So to him, who would want to sit in that corner, I mean, it’s just, it seems aha. Right. As we’re sitting here being very judgmental, I was sitting at a still frame. It’s very easy to be judgmental today. Right. And so we also, for your own purposes for everybody online, we actually recommend that if you don’t have SafelyYou, just take a picture of the room, take a picture of your rooms, and sit down as a team. I’m sure you guys can collaborate before falls occur. Right. So why don’t we just take the time and collaborate as a team on, hey, let’s just make sure our rooms are engaging and they want to use the furniture pieces that are even in the room to kind of inspire them to do something again, sitting in this corner without your books and being close by. That seems very obvious to us now, but it’s helpful by taking that pause like that freeze frame. And that is actually like taking the time and look and that’s kind of part of that whole prevention aspect of how we actually just learn from some of this that we’re sharing with you today. There’s a lot you can do indefinitely partnering with your life enrichment and activities, for sure. So that wraps up our last case. We just want to summarize on a high level kind of what we’ve talked about gathering life history. Obviously life stories are really critical, even though we know that that changes over time. But being understanding of that is really important and don’t keep that light story in a binder, right? I always see the binder when I come to visit the community that’s tucked underneath the desk, creating some sort of workflow that helps that process and making sure it’s top of mind. Observe the resident, can they access things, observe them in their space, sit down with them, take the two minutes, sit with them, actually in their chair or sit actually in their chair and actually scan the room. Making sure again, you’re frequently assessing, even though there might not have been an event or a change of condition, make sure there’s a repeated process. Again, take a still frame of the room, make sure that’s something you guys want to do as part of the process quarterly semi-annually and really try and train your direct care staff on engagement and includes to look for. It would be really helpful or even kind of Sara’s point, you’re already going to do certain ADL’s in the room. Let’s train the care staff, how engaging you can make that one activity, brushing your teeth. For example, it could be a lot more engaging than just doing every step of the toothbrush. You know, that could be a huge activity for them that they already need to take, take place. Again, also the interdisciplinary team definitely try to get more involved with multiple people in that room when you’re doing that fall huddle review. And then we did mention medication review can be really critical, especially when you end up seeing residents spending more time in the room and less engaged. There are typically sometimes related to med management and then of course, detailed documentation over the fall events are really important. So that kind of wraps up Charles. I can stop sharing here.


Charles: Thank you so much for sharing such an amazing presentation. I just want to congratulate you and the rest of your team for coming up and building such an amazing technology that is so obviously cool and interesting, but also kind of empowering of what we all want, which is a interdisciplinary approach really kind of seizing the opportunity for our staff, but towards this one common goal, which is to improve the life of our elders and Sara also thank you for joining us, but also kudos to you as an organization, as a professional, but also as an organization for embracing such technology it’s it’s. So so-called to see the quotes that I have in the back of my mind, which is that the future is already here, you just need to look around you. And I think that is such a perfect example because this is going to happen. This is actually happening now. And so I just want to thank you both for bringing this future closer to us and making it more digestible. Everyone on the line, thank you for joining us today. Here are the contacts of these amazing speakers. Please feel free to reach out if you have any questions, there’s a couple of questions about your processes at Merrill Gardens, including your life story. Shirely, I’m sure that people will be very interested in hearing about your four huddles and I invite anyone to just consider them. It’s a great way to get educated, maybe invite your nursing department, maybe invite also your executive director and hopefully work together collaboratively regarding Activity Strong. I do want to share a couple of announcements, which are some of our upcoming webinars, obviously.

We are continuing after our very successful summit that we had a couple of weeks ago. I invite all of you to come to our webinar on July 20th. We’ll understand how we can take the person centered approach by understanding the preferences of our residents. And then Tuesday, August 3rd, this is going to be an amazing discussion with Dr. Moore, the CEO of his Exxon living, who actually, when COVID hit, enabled her team to align. She has really interesting stories that obviously would benefit from all of us. And as an invitation, please consider our fall and winter gathering. And some of you have already registered for next year’s summit. It’s there. We have many of you who will join us and where I want to, again, thank everyone for joining. Wishing everybody to stay cool, it’s very warm out there regardless of where we are. And Shirley again, thank you so much for this presentation today.


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