Reducing “Road Rage” in Nursing Home Residents

So, maybe in seeing this title, what came to mind for you was the idea of nursing home residents crowding hallways and griping at each other about who gets to pass first (I work in a nursing home for veterans – a nearly all-male facility, so this actually happens fairly frequently). So, no, wheelchair “traffic jams” isn’t what I had in mind…. Although that might be a good topic for another post. I’ll make the connection in a few paragraphs here, below.

What I had in mind was the subject of the “call button,” something all residents of nursing homes (and pretty much anyone who’s ever spent any time as a patient in a hospital) knows about:

Hospital call bell

For residents in nursing homes, overwhelmingly older adults, many of whom who are completely dependent on nursing staff for their mobility, food, water, and other ADLs, the call button represents pretty much a lifeline. If you have a need to use the bathroom (and you’re able to use the toilet), but you need help from a staff member to get up from your bed safely, you hit the call button.

And you wait. And sometimes, you wait some more.

Although I haven’t run the numbers myself at the Community Living Center I work at (e.g., the nursing home care unit of the Palo Alto VA system), I would guess a significant proportion of both falls and behavioral issues such as yelling, verbal abusiveness, and agitation, are related to the interval between the time a call bell is answered (e.g., via intercom – a nurse usually answers and a disembodied voice speaks in the patients room, “how can I help you”), and the time it takes for a nurse to arrive in a residents’ room. There seems to be some consensus that extended wait times for call bells to be answered can be a contributor to fall risk (see here).

This makes intuitive sense, of course – the longer you wait (and the more urgent your need is), the more agitated and anxious you will be if you’re a resident / nursing home patient in need, correct? This seems to suggest a straightforward, technological or human-resources approach to fix to the problem – just increase staffing, or more intelligently balance staffing in order to minimize as much as possible the amount of time it takes for nursing staff to reach a patient who has depressed their call button.

Of course, there’s another take on this. While the above approach of increasing staffing obviously helps with the task of offering quality nursing care – it ignores the psychological dimension, and a possible psychological solution to the problem of the call button wait time intervals (as an aside, for a wonderful discussion of the value of paying homage to the psychological dimension in addressing human problems, I highly recommend viewing this “TED Talk” with UK advertising executive Rory Sutherland…. Goes to show you that sometimes the best psychologists are often people in the marketing field).

So what’s this possible solution? This brings us back to “road rage.” Imagine yourself at a red light (not hard to imagine for many of you – you may have had to wade through a dozen of them prior to getting to the office this morning). How many of you feel agitated, impatient, somewhat anxious when you’re at a red light and you’re on your way to an appointment, or to work? Most of us. Of course, studies have reportedly shown that longer, unjustified wait times for red lights increases driver frustration and can lead to increases in accidents – so again, the simple, technological approach, is to use advanced signaling technology, more intelligent use of sensors, etc., to minimize unjustified wait times at intersections, and to therefore decrease driver frustration and accidents. Of course, there’s a problem – drivers will still have to wait.

Enter the Eko Stoplight (mentioned in the TED Talk, referenced above):

Eko Stop Light

This stoplight, a really brilliant invention in my view, has as a feature a visual progress bar which gives immediate feedback to drivers at intersections how long they have to wait prior to the signal changing to green. Apparently there is data from Korea and also other data from the manufacturer that strongly suggests that this innovation significantly decreases red light running and accidents at intersections. Put simply – without even changing the wait time interval at traffic intersections, people are more able to be patient and wait, because they know how long they have to wait. And as you know, a minute at an intersection when you’re late for an appointment can sometimes feel like a hour!

So what if such an innovation could be applied to wait times for residents in nursing homes? As far as I can tell – although there is active work on improving call-bell technology in inpatient units (e.g., experimenting with wireless technology and IP-based call systems), as yet I have not seen this idea applied to the nursing home environment. But maybe it should! It would take some work – as my wife pointed out the other night, the Eko Stoplight idea doesn’t precisely map onto the nursing home situation – while the interval between when a stoplight goes from red to green is known precisely (thereby allowing the Eko to precisely calibrate the progress bar), the amount of time it takes for a nurse to reach your room after a call bell is activated tends to vary based on staffing, workload, and other factors. Still, one way of getting around that is allowing individual nurses to calibrate their assigned residents’ progress bars (their ‘Eko timers’) on-the-fly. As long as a nurse arrived before the progress bar elapsed in the patients’ room, I think this psychological, calming effect would still potentially hold. There could be other ways of implementing this idea.

What do you think?

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