Computers opening worlds for older care residents

Flower-arranging class at Barclay Friends, a West Chester nursing home with expansive gardens, was winding down when horticulturist Cheryl Bjornson pulled out her newest tool: a computer system called Linked Senior.

It's loaded with activities meant to appeal to audiences like Bjornson's - 13 quiet, aged ladies with small vases of zinnias before them and one sleeping man.

To liven things up, Bjornson displayed a garden trivia game on a giant screen.

A woman who used to work at Waterloo Gardens correctly chose the number of flower species (between 250,000 and 500,000). Her classmates clapped. Ninety-five-year-old Anna DiGati was a standout player, guessing the (Persian) origin of the word tulip and an unusual use for sunflower petals.

Just for fun, Bjornson switched to a slide show of the animals that were apparently created for the computer. Yes, cats.

Instantly, the ahhhs started. "Oh, that's so cute," one resident said.

Computers permeate life for most of us, but their vast potential to entertain and stimulate as well as trigger memories and connect scattered families has only recently begun being tapped in a rapidly growing, but still small, number of nursing homes and assisted-living facilities. Companies like Linked Senior and It's Never 2 Late (IN2L) offer simplified gadgets and programming meant to appeal to people with limited exposure to computers and, often, brains in various stages of dementia.

Some places are also using iPads and Wii games. A few are experimenting with a cuddly, interactive Japanese-made baby seal named Paro. One gushed about the impact of individualized music play lists. Laura Hotinger, resident life coordinator for Kendal at Lexington (Virginia), called iPods "one of the biggest revolutions for activity programming."

One of her residents - blind, hard of hearing, and very anxious - cried when she heard her music through the headphones.

"It's a real change in how activities are done," said Peggy Sinnott, Kendal Corp.'s director for health services. The Kennett Square-based organization is using Linked Senior in four of its facilities and IN2L in three. Barclay, an affiliate, has both.

As baby boomers age, "we're going to have computers in every room," Sinnott predicted.

The computers help long-term care communities offer more varied programming and more activities tailored to individuals. That dovetails nicely with the trend toward "person-centered" care and the growing realization that nursing homes should be caring not just for bodies but for souls. "Engagement" is all the rage these days, a recognition that residents who join in activities that make them feel good are likely to have better health and behavior.

When placed on an adjustable cart, the computers can be used for physical therapy. Residents forget they're exercising if they're enjoying playing games on the touch screen. The IN2L system also offers a flight simulator - a hit with aging pilots - and virtual biking.

There are games to keep brains sharp and videos to help people calm down or reminisce. You can convert a family picture into a puzzle, "paint" a picture, or virtually visit your hometown. Linked Senior created localized slide shows of the Mummers and Amish country for Barclay. Skype is a big hit because it allows families to stay in touch.

"The residents just thought it was the coolest thing ever," said Theresa Belczyk, an activities assistant at Holy Family Home in Southwest Philadelphia. She is 25 and estimates the average age of the residents is near 90. " . . . It was hilarious."

One nursing home helped a resident watch her family open the presents she had bought them for Christmas. One woman in her 90s, who lived in a Brookdale Senior Living facility in Cleveland before her death, talked to her sister in another state every day by Skype.

"They were never going to be in the same room again," said Juliet Holt Klinger, senior director of dementia care for the organization, which runs 1,150 communities, "but they could see each other and have conversations daily."

Sunrise Senior Living, another large provider, began experimenting with computers two years ago. It is using structured programs like Linked Senior in 20 of its 270 homes and will soon start more pilots.

Revera Health Systems, which operates nine facilities in New Jersey, is piloting Linked Senior.

A Silicon Valley veteran, Jack York, founded IN2L about 15 years ago after he saw what happened when he donated computers to an assisted-living facility. Clearly there was a need. He couldn't believe how disconnected the older people were. But the computers were too hard to use. It took nine years for the company to become profitable. The systems are now in 1,700 nursing homes, twice the total just 21/2 years ago.

"It really has been a sea change over the last two years," York said.

Charles de Vilmorin started Linked Senior after observing his grandmother's life in a facility in his native France. His company, based in Washington, D.C., is now in 200 locations, double the number 18 months ago.

With 52,000 potential locations, there's plenty of room for growth, he said.

The obvious question is, Why did this take so long?

Money might be part of it. Linked Senior costs $1,000 to $4,000 up front and, on average, $400 a month. IN2L has initial costs of $2,000 to $10,000 and an average subscription cost of $200 a month.

De Vilmorin said many facilities don't see engagement as a measure of care. What he hears is that "the organizations are in the care business and they're not in the entertainment business."

Randy Griffin, a nurse who helps long-term care organizations improve dementia care, is blunter. People with dementia, she said, aren't in a position to demand better care.

"It's so easy just to do the same thing," she said. "I can't tell you the thousands of places that are doing the same old same old they were doing 30 years ago. Are they bathed? Are they clothed? Are they dressed? That's it.

"Who is this person?"

Used well, the computer can help you find out.

An Italian artist, who lived in a Vetter Health Services community, lost the ability to speak English as his dementia progressed. This summer, the staff showed him an IN2L art site that allowed him to "paint" on the touch screen with a blunt paintbrush. While he worked, they played Italian music. He painted for two hours.

"He was singing and painting and smiling," said Cameo Rogers, life enrichment coordinator for the Nebraska-based company. "It was incredible."

To calm one Catholic woman, a family videotaped the priest she grew up with saying the rosary, York said.

Holy Family's Belczyk said she uses the computers every day. It's easier to start a conversation after the residents have watched a video of laughing babies or sung along with a favorite song. They like the trivia questions: How much did milk cost in 1912? Two of her residents play solitaire. It keeps one from sundowning in the afternoon. The other has trouble holding real cards.

"The place is more alive," she said. "I wouldn't say it's 100 percent because of the computer. I think it's because we can do so many activities."

IN2L's York, who is, of course, biased, thinks baby boomers, who are making decisions for parents and will soon be residents themselves, will crave better use of technology. "Two or three years from now," he said, "it's going to be demanded."