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Technology in nursing homes: E-tagging of seniors boosts safety but is it dignified?

Some patients with dementia are prone to wandering and may get lost if not monitored

Janice Tai on 21 Apr 2019

The Straits Times


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Patients at some nursing homes here are being tagged and their movements tracked round the clock, in a controversial practice that has drawn mixed reactions.


At least three nursing homes and a senior care centre in Singapore have been tracking the movement of seniors within their facilities by tagging them with radio-frequency identification (RFID) tags, similar to the technology used to track animals.


A government-run nursing home - Pearl's Hill Care Home - also plans to start a pilot using Bluetooth low-energy technology to monitor the movement of residents.


Those that are currently using RFID are three nursing homes run by Econ Healthcare Group and Silver Circle senior care centre at Ci Yuan by NTUC Health, The Sunday Times has learnt.


Operators of these senior care facilities said the use of RFID systems is aimed at enhancing the safety and well-being of the seniors they care for.




However, the use of such tags on a long-term basis is rare and ethical concerns have been raised regarding the need to safeguard privacy and dignity of the elderly persons.


Econ said it has been testing the RFID system since late 2017.


Currently, residents in three out of the seven nursing homes it operates in Singapore wear RFID tags on their wrists.


Beacons that detect the tags are placed around its Upper East Coast, Braddell and Chai Chee nursing homes, so that Econ can track when and how long a resident spends time at a certain locality.


However, some residents do not want to wear the RFID tags and Econ is looking to get around this problem by embedding the tags in their clothes so they are "as unobtrusive as possible".


The RFID tags to be used on clothes will be miniaturised and made waterproof.


"The RFID system was introduced to foster improvements in residents' psychosocial well-being and their safety," said the Econ spokesman. "The data collected provides behavioural understanding for us to foster better care."


For instance, its staff can be notified and act accordingly should a resident enter a high fall-risk area, or leave the facility without informing anyone. Some patients with dementia can be prone to wandering behaviour and may get lost outside if left unattended.


"The RFID system is part of Econ's progress towards the vision of a non-gated community, where even people with dementia can go about their daily lives safely without being physically constrained to a vicinity," said its spokesman.


Tracking solutions provider JA Security and Innovations told The Sunday Times that it has installed RFID elderly monitoring systems for the Silver Circle senior care centre at Ci Yuan.


The RFID labels are attached to residents' identification cards that can be detected by overhead RFID gantries which are installed on ceilings to monitor patients.


This ensures operational efficiency and prevents unwanted exits by dementia patients by triggering an alarm, according to Mr Ganesan Alagappan, director of JA Security.


Such systems cost about $7,000, he added, though the cost depends on how complex the system is - such as the number of exits being monitored or whether alerts are needed to track falls or extended time spent in toilets.


The use of RFID technology in healthcare settings is not new, but its use is usually confined to hospitals, where patients are tagged from a few hours to a few days, to facilitate identification or location tracking.


Some hospitals in countries like Japan, China and the United States use RFID to tag their patients, along with Singapore's Sengkang General Hospital.


However, RFID tagging in nursing homes - which involves longer periods of stay stretching from months to years - is uncommon.


Dr Belinda Wee, director of the Assisted Living Facility Association, said tagging is "very intrusive" compared to other usual monitoring devices such as closed-circuit TV cameras.


"It feels like they are being tagged like prisoners or study subjects and it should not be used in place of good care practices," said Dr Wee.


"These seniors are sent to nursing homes where care staff are supposed to look after them. 'Alert fatigue' may set in whereby if the system keeps on beeping, care workers may get complacent and ironically fail to attend to them when there is a real need."


Dr Wee also runs an assisted-living facility in Adam Road where data is being collected for residents' care and safety. However this is done in a different way to respect their privacy.


For example, sensors are placed at the bedroom door to monitor if a senior is inactive for too long, and if so, a care assistant will check in on him or her.


Other eldercare experts here believe RFID is useful and important.


Associate Professor Philip Yap, director of the Geriatric Centre at Khoo Teck Puat Hospital, said: "RFID is particularly important if we want to afford more freedom for residents to move around on their own but desire to ensure their safety at the same time.


"RFID helps to ensure safety for residents who have a tendency to walk out of the nursing home or their bedrooms especially at night when nursing manpower is usually lower and hence close supervision is harder to secure."


However, Prof Yap added that it would be necessary to obtain consent from the residents to respect their personal rights.


Patients with mild to moderate dementia who retain mental capacity, he said, can still make informed decisions on such issues and would usually be agreeable if the rationale is explained to them.


When asked if consent for the RFID tags is sought from residents - whether with or without dementia - beforehand, the Econ spokesman said there is "implied consent if they use it".


Mr Bryan Tan, a lawyer from Pinsent Masons MPillay who specialises in technology law and data protection, said implied consent is currently permissible under Singapore data protection law.


"Implied consent is not the preferred way to go but getting explicit consent is. Tagging is problematic because any unchecked use of data collection always has the potential of over-collection and over-use," said Mr Tan.


Technology lawyer Koh Chia Ling of OC Queen Street said there are currently no legislation or guidelines, provided by both the Personal Data Protection Commission and the Ministry of Health (MOH), that specifically govern the adoption of RFID tagging and its implementation for medical purposes.


In Nevada, in the United States, legislation has been passed to ban the use of RFID chips on humans due to ethical concerns that it would be possible to hack the information contained within the chips or harass chipped individuals with the right type of reader, said Mr Koh.


The Ministry of Health (MOH), which operates Pearl's Hill Care Home, said patient or family consent will be sought prior to the start of its Bluetooth monitoring project.


A spokesman said: "The MOH supports innovative and patient-centric solutions which can enhance the quality of care for patients."


He added that RFID could alert staff who care for dementia patients who may display behaviour such as wandering or disorientation, which could affect their safety.


"RFID technology also enables residents to move around within the designated compound, giving them an unrestrictive and positive experience in the nursing home, while keeping them safe," he added.


RFID is the same technology being used to tag and track pets here - the Society for the Prevention of Cruelty to Animals encourages the microchipping of pets so that the animals can be traced back to the owner if it has lost its way.


Ms Janice Chia, managing director of Ageing Asia, a consultancy in ageing issues, said straddling the line between operational efficiency and dignity of the older person needs to be done carefully.


"Often we think about technology as an opportunity to help to keep our loved ones safe. However, it is just as important to put ourselves in their shoes and to consider how they feel when a certain technology means that they are being monitored 24 hours a day," said Ms Chia.


"It does not mean that someone with dementia cannot understand or feel what is happening to them."


Experts say one way to get around consent and ethical issues is to discuss the use of such monitoring technology in advance or get surrogate consent from patients' legally appointed representative for those who already lack mental capacity due to advanced dementia.


Said Prof Yap: "If the use of monitoring technology becomes more widespread, we can anticipate that this issue can be discussed in advanced care plans."


Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.


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