Monitoring Technology is on the Rise — SNFs Decide if it Helps or Hinders

As nursing home operators introduce more sophisticated monitoring technology to their facilities, the benefits of such tools sit on a knife’s edge.

Monitoring platforms may help caregivers do more with less during a pandemic-exacerbated staffing crisis. It’s also possible that operators can open themselves up to potential litigation, depending on if they have the staff and education to utilize such tech properly.

“In my experience, it can cut both ways,” said Bill Wilson, founding partner and litigation attorney at Wilson Getty in San Diego, Calif. “I’ve had cases where … there was an inadequate response to an event, and when we were able to pull cameras in the common area hallways, it clearly shows staff responding within 10 seconds of an event.”


Wilson represents long-term care facilities, as well as other types of health care providers.

Litigation Mitigation

About 75% to 85% of Wilson Getty’s SNF cases arise from skin breakdown, falls from injuries, and allegations of inadequate response. Implementation of monitoring technology will help address that third category of defense cases, Wilson added.


“It also can have devastating consequences for the provider. These types of tools can be equally powerful for a plaintiff’s attorney,” noted Wilson. “From my perspective, if I’m representing a provider who is paying attention and really working to diligently put the right number of staff that are properly qualified, and they do the right thing, I believe that monitoring technology can assist the provider in providing better care.”

Becky Anderson, chief clinical officer for Focused Post Acute Care Partners, feels there could be more litigation if changes in vitals aren’t acted upon timely, but such tech also “removes barriers” for caregivers to monitor more residents as changes happen.

The Texas-based operator uses Real Time Medical Systems, a software platform that analyzes electronic health record data and alerts staff of small changes to a resident’s condition in — you guessed it — real time. FPACP uses Team TSI too, which reviews minimal data sets (MDS) before they’re submitted to the Centers for Medicare & Medicaid Services (CMS) for reimbursement.

“If not acted upon appropriately, the staff are going to be more culpable,” added Anderson. “This industry has come a long way from when I started more than 20 years ago. Paper charts are a thing of the past and as we now are all electronic with the medical records, I only see more and more companies trying to build upon what Real Time and Team TSI does to assist this industry.”

Anderson said staff at FPACP will take the time to get better at existing monitoring tech before adopting anything else. The operator in fall 2019 started Real Time as a pilot program in 11 of its facilities, and decided to roll it out across all 31 facilities right before the pandemic, in February 2020.

“There was definitely trial and error,” explained Anderson. “You’ve got some of the nurses that have been in the field a long time that were still getting used to, you know, paper charting and still getting the hang of documenting electronically via computer … younger generations that we have in the field, they probably took better to the technology.”

Ultimately, SNFs are headed toward more monitoring tech in resident rooms, Anderson told SNN. She believes it will be more of the “norm” and acceptable as we head into the next few years.

The health care industry has historically lagged behind other industries in terms of adopting the latest technology, and within health care, skilled nursing facilities are even more hesitant, according to Dr. Justin Di Rezze, CEO of provider Theoria Medical in Novi, Mich.

“Health care in general has always lagged simply because of the regulatory components,” Di Rezze explained. “Then when you get to post-acute care, because there’s not a lot of resources available, it’s even lagging farther behind than the overall health care system.”

Anderson considers FPACP to be a bit of an outlier in the industry, with its tech-forward attitude.

“I worked for other organizations that were not as tech savvy or use as much technology. We definitely try to be forward thinkers in the industry,” added Anderson.

The Future of Monitoring Tech

Monitoring technology is going beyond simple video and audio now, with companies like Circadia Health offering radar-based platforms to monitor biosignals.

A small disk mounted to the wall uses radar signals to read certain biosignals — the U.S. Food and Drug Administration (FDA) last June approved the technology to read respiratory signs, and the company is working on getting its heart rate readings approved next.

Fall prevention and patient roaming notifications are in the pipeline too.

“Fundamentally, the technology uses something similar to WiFi,” Fares Siddiqui, CEO and co-founder of Circadia, told SNN. “It’s a contactless monitoring sensor that’s powered by our proprietary algorithms which are all AI and machine learning, effectively. It beams 100-million pulses at your body, it maps your body and it looks for tiny changes in your physiology; it’s very good at picking up motion.”

Circadia doesn’t charge facilities to use its monitoring tech, Siddiqui said, adding that it’s incorporated into a value-based model. If facilities see a change in their metrics, like the 30-day readmission number, then the company can bill CMS and insurance companies directly for the services they provide.

The U.K. and California-based medtech company currently has just 10 U.S. nursing homes using its monitoring technology. Plans to expand are already in development, Fares said, with about 66 more facilities signed on to receive Circadia equipment.

Wilson has not seen any cases arise from radar monitoring technology, but that’s because it’s so new to the skilled nursing industry.

“From a litigation standpoint, the technology is not marketed as a life saving vital signs monitor. That’s made very clear in our FDA submission,” added Siddiqui. “This technology is primarily used to capture continuous data. It’s not the same as your ICU hospital grade monitoring system, which is a class two or class three medical device, it’s a low risk device, and it should only be used under the supervision of a physician, meaning a physician has to review the data.”

Good Faith in the Industry

Simply purchasing monitoring technology, a sometimes expensive investment, can refute wider claims of liability in the industry, Wilson said: “A good defense lawyer and the right set of facts can use this.”

“They don’t have to utilize this, this is cutting edge technology that they’re trying to implement in their facility,” added Wilson. “This technology is evidence that we’re not about profits over patients. We’re about trying to find a way to empower our people that are in the facility or the community to be able to do a good job.”

Insurance underwriters might find monitoring tech attractive too, Wilson said, when a provider is looking to secure liability insurance.

“Anything that a broker can do to help make the provider an attractive insured is good in today’s hard insurance market,” he added.

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