Respecting and Protecting Elders

By Elliott A. Boxerbaum, CPP, and Patrick F. Donaldson

Long-term-care facilities vary greatly in size, but whatever the size of the facility, it will face some of the same issues, many of which are unique to that environment. For example, during hospital stays, patients are encouraged to leave valuable items and keepsakes at home. But for many individuals, the long-term-care facility is their primary domicile, and residents bring these items with them. Thus, security of those items must be addressed.

Unfortunately, as residents continue to age, their memories and cognitive abilities may deteriorate to the level of unreliability. Because of this, reported incidents of property loss are sometimes written off as imagined events and not fully investigated. That type of response clearly does not serve the residents or the facility well.

Currently, the long-term-care (LTC) community includes more than 20,500 nursing homes. Most are for-profit institutions, placing them squarely in the purview of private security. However, a recent search of the ASIS International membership revealed fewer than a dozen members who list nursing homes, long-term-care facilities, convalescent facilities, or similar organizations as their primary employer.

Based on the authors’ experiences, this is because security services to the eldercare facilities are generally provided by contractors who report to facility administrators. In some instances, security is the responsibility of the maintenance or nursing supervisor. At hospital-based facilities, by contrast, there is usually an in-house security director or manager. Perhaps as the LTC industry matures, its approach to security will also evolve.

Types of facilities. Many LTC residents live independently. They come and go as they wish, do their own shopping and cooking, control access to their buildings and apartments, and rely on their facility for only minimal services.

As their ability to care for themselves wanes and residents require a greater level of care, they move from independent living or congregant care to assisted living, then to sub-acute nursing, acute care, and finally to hospice care.

More and more often, these care options are provided by a single organization. Sometimes, the entire spectrum of long-term care is provided on a single campus.

 Assessment. Whether the LTC facility offers some or all of these care options, the first step in developing appropriate security is a thorough risk assessment. The key, of course, is for management to act proactively. They should not wait for an incident to occur before conducting an assessment. Recently, the majority of the authors’ work in this arena has been based on this proactive model, showing that administrators of these facilities are beginning to place the proper priority on security.

To determine a facility’s unique security program needs, LTC administrators, working with security professionals, should assess each of these four points:

  • Perimeters and access controls to protect residents from the outside world.
  •  Internal security to protect residents from threats within the facility.
  •  Measures to protect residents who cannot protect themselves or are a danger to themselves.
  •  Measures to protect caregivers and loved ones.

Perimeters, access controls. As with any facility, if an LTC facility is to protect residents from the dangers of the world outside, it must have adequate controls securing the perimeter and managing access to buildings and grounds.

When assessing the perimeter, key areas for review include geographical risks and area-crime trends and incidents. For example, if the facility is surrounded by a suburban neighborhood with regular Neighborhood Watch patrols, the outsider threat to the facility will be less than if the facility borders a major thoroughfare or areas known for dangerous activities such as drug dealing. The previous several years’ worth of local crime statistics should be perused, and in addition, the assessors should contact local peers and law enforcement officers for their input.

When assessing the grounds, existing lighting, fencing, landscaping, natural surveillance, and signage should be reviewed. Residents’ physical limitations including impaired vision, reduced mobility, reliance on walkers or canes, hearing impairment, and other factors should also be taken into account.  Many residents cannot perceive hazards in their environment as well as younger individuals.

For example, an assessment of one facility by the authors found that care had been taken to clearly define the property with aesthetically pleasing security fencing, low and neatly trimmed shrubs, lighting, and plentiful signage.

Although family and visitors are welcome at these facilities, trespassers, unescorted juveniles, and panhandlers are not. Using techniques associated with crime prevention through environmental design (CPTED), facilities can clearly convey the demarcation between the public right of way and private property, creating well-defined space and empowering staff to assume a personal responsibility for activity on the grounds. These concepts are not unique to LTC facilities, but they are often underused in these types of eldercare environments.  

In addition, the assessment should look at overall site usage. Are there existing patrols and electronic surveillance? Are there any problems with any of these systems? 

Moving concentrically inward, the assessors should next focus on individual building access control. The assessment should include a review of existing access control, alarm, and communications systems.  Interior patrols, front desk management, and dock and remote-entrance management should also be studied, as well as   visitor sign-in, badging, and on-site management procedures. The assessors should also investigate current CCTV and recording technologies and real-time CCTV management capabilities.

One facility we assessed had an effective policy in which all staff assisted in making sure that visitors did not roam into the facility without first being logged in. Whoever saw the visitor first approaching would escort them to a designated visitor entrance, where they were registered.

Although not necessarily a “high-security” registration process, the act of requiring visitor sign-in, in plain view of a CCTV camera, and using visitor identification badges can reduce the anonymity of anyone bent on criminal behavior, thereby acting as a deterrent as well. Most visitors in LTC facilities are known to the security staff.  However, they should still be required to sign-in and wear appropriate identification at all times.



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