Patent Publication Number: US-2013238350-A1

Title: Caregiving management systems, methods and article

Description:
BACKGROUND 
     1. Field 
     This disclosure generally relates to management of the provision of care in caregiving facilities, and more particularly to the use of handheld devices in accomplishing such. 
     2. Description of the Related Art 
     The caregiving industry (e.g., assisted living, skilled nursing, hospital care, in-home nursing, adult family homes) continues to grow as the “baby boom” generation retires. This has created unprecedented demand for services, placing pressure on the limited infrastructure. Hence, efficient distribution of resources is critical to meeting the demand. 
     Oftentimes care is reimbursed by a private or government insurer. Such payers often set strict guidelines for how much care will be compensated, and often do so on a task-by-task basis. Whether the payer is an insurer or a private individual, tracking of actual time versus expected time or reimbursable time or actual fees received is important to proper distribution of the limited resources. 
     The conventional approach appears to employ paper time sheets which are completed by caregivers, typically at the end of their shift. Caregivers often do not fully complete these time sheets, and the information is often inaccurate. Some of this information may, from time to time, be entered into a computing system. There does not appear to be any real systematic attempt to consistently record and analyze data. 
     Consequently, conventional approaches may be inadequate. 
     BRIEF SUMMARY 
     The systems and methods described herein are purposely designed for the caregiving industry. Time spent on each resident by all staff members may be analyzed for the purpose of comparison of labor time to fees billed, to identify undercharged residents. 
     The techniques described herein may primarily focus on identifying undercharged residents. The techniques may also focus on detailed task histories, which helps increase care fees, validate care provided, etc. Such may enable an accurate and documented discussion with payers. 
     Analysis may be apartment or room specific. Focusing on defined spaces rather than residents or spaces may address concerns regarding data management and transmission under the Health Insurance Portability and Accountability Act (HIPPA) requirements. 
     Caregiving sessions may automatically start with or without automatically reading a space identifier (e.g., apartment identifier), for example by reading a machine-readable symbol or a wireless transponder (e.g., RFID transponder) at least proximally associated with the space. 
     The systems and methods allow recording of completed tasks. Caregiving tasks may be logically tied to service plans. Required, upcoming and even overdue tasks may be visually highlighted and/or appropriate notifications electronically sent or alerts produced. This may take advantage of a two-way interface with a second party electronic service plan system. 
     The systems and methods may accumulate time from all caregivers over a period. This allows analyses which are not skewed by too few interactions, generating more accurate data. Notably, caregiving is often provided by multiple staff over 24-hour days, 7 days a week. Thus, accumulation of time over a representative period is highly useful to producing accurate assessment. 
     Information may be output in a variety of formats, for example to Microsoft Excel® or CSV format, allowing easy manipulation. Information may be output in graphical and/or text forms, allowing for easy communication. This approach may produce immense data sets by apartment, to be compared to service plans to identify where such a service plan inadequately accounts for needed care. 
     This use of handheld devices makes training simple; and makes the reporting of services less onerous and even enjoyable, both of which increase usage and reliability. Smartphones, tablet computers, PDAs, netbooks and the like may be configured with appropriate software or firmware applications to implement the desired functionality. 
     A mobile device to track care may be summarized as including a housing sized to be carried by an end user caregiver; at least one reader operable to read identifying information proximally associated with respective ones of a plurality of defined spaces which are in turn logically associated with respective ones of a plurality of care recipients; at least one transceiver operable to provide wireless communications; a touch-sensitive display operable to display information including a number of user-selectable icons as at least part of a user interface on one or more successive screens presented by the touch-sensitive display; at least one nontransitory processor-readable medium that stores data and executable instructions which at least in part define at least part of the user interface; at least one processor communicatively coupled to the at least one reader, the at least one transceiver, the touch-sensitive display, and the at least one nontransitory processor-readable medium to implement as least part of the user interface, the at least one processor configured to: in response to a first user input, cause the at least one reader to acquire a defined space identifier that uniquely identifies a specific defined space to be logically associated with the delivery of care; and in response to a second user input, display a space identification user selectable icon which allows the end user caregiver to uniquely specify a specific defined space to be logically associated with the delivery of care by the end user caregiver. 
     The at least one processor may be further configured to cause a display of a start scan user selectable icon, and in response to a user selection of the start scan user selectable icon cause the at least one reader to acquire information which uniquely identifies a specific defined space to be logically associated with the delivery of care and start a timer for a current care session. The at least one processor may further be configured to cause display of a plurality of service type user selectable icons, each of the service type user selectable icons which specify a respective type of service provided as part of caregiving, where the second user input is a user selection of one of the service type user selectable icons. The at least one processor may be configured to cause the display of the start scan user selectable icon selection concurrently on a single screen with the display of the plurality of service type user selectable icons. The at least one processor may further be configured to, following the start of the timer for the current care session, cause a display of a task screen including a plurality of task selection user selectable icons which specify a respective one of a plurality of tasks provided as part of caregiving for the current care session. The at least one processor may further be configured to, in response to a user selection of the one of the service type user selectable icons, stop the timer for the current care session and logically associate the respective task with information indicative of at least an elapsed time for the current care session and indicative of the defined space for the current care session. In response to the end user caregiver uniquely specifying the specific defined space to be logically associated with the delivery of care for the current care session, the at least one processor may further be configured to start the timer for a current care session. The at least one processor may further be configured to, following the start of the timer, cause a display of a task screen including a plurality of task selection user selectable icons which specify a respective one of a plurality of tasks provided as part of caregiving for the current care session. The at least one processor may further be configured to, in response to a user selection of the one of the task selection user selectable icons, stop the timer for the current care session and logically associate the respective task with information indicative of at least an elapsed time and indicative of the defined space for the current care session. The at least one processor may be configured to display the space identification user selectable icon as a scrollable set of room numbers. The at least one reader may be a machine-readable symbol reader operable to read machine-readable symbols located proximate an access way to the defined space. The at least one reader may be a machine-readable symbol reader operable to read machine-readable symbols located proximate a doorway of the defined space. The mobile device may be execute a specific application program with a machine-readable symbol reader scanner removably coupled to the housing thereof. 
     A method of operating a mobile device to track care may be summarized as including at least one reader, at least one transceiver, a touch-sensitive display, at least one nontransitory processor-readable medium that stores data and executable instructions which at least in part define at least part of the user interface, and at least one processor communicatively coupled to the at least one transceiver and the at least one nontransitory processor-readable medium, the method comprising: causing by the at least one processor a displaying of a start scan user selectable icon by the touch-sensitive display; and causing by the at least one processor a displaying of a plurality of service type user selectable icons by the touch sensitive display, each of the service type user selectable icons which specify a respective type of service provided as part of caregiving; in response to a user input by an end user caregiver indicative of a selection of one of the service type user selectable icons, causing by the at least one processor a displaying of a space identification user selectable icon on the touch-sensitive display, selection of the space identification user selectable icon which allows the end user caregiver to uniquely specify a specific defined space to be logically associated with the delivery of care for a current care session. 
     The method may further include: in response to a user input by the end user caregiver indicative of a selection of the start scan user selectable icon, causing the at least one reader to acquire information which uniquely identifies a specific defined space to be logically associated with the delivery of care and starting a timer for the current care session. Causing the at least one reader to acquire information which uniquely identifies a specific defined space may include causing at least one of a scanning or an imaging at least one machine-readable symbol at least proximate an access way to the defined space by the reader. Causing a displaying of a start scan user selectable icon by the touch-sensitive display and causing a displaying of a plurality of service type user selectable icons by the touch sensitive display may include causing the displaying of the start scan user selectable icon selection concurrently on a single screen presented by the touch-sensitive display with the displaying of the plurality of service type user selectable icons. The method may further include: following the starting of the timer for the current care session, causing a displaying of a task screen by the touch-sensitive display, the task screen including a plurality of task selection user selectable icons which specify a respective one of a plurality of tasks provided as part of caregiving for the current care session. The method may further include: receiving a user input indicative of a selection of the one of the task selection user selectable icons; and in response to the received user input indicative of the selection of one of the task selection user selectable icons, stopping the timer for the current care session and logically associating the respective selected task for the current care session with information indicative of at least an elapsed time for the current care session and indicative of the defined space for the current care session. The method may further include: receiving a user input uniquely specifying the specific defined space to be logically associated with the delivery of care by the end user caregiver for the current care session; and in response to the received user input uniquely specifying the specific defined space to be logically associated with the delivery of care, starting a timer for the current care session. The method may further include: following the starting of the timer for the current care session, causing a display of a task screen including a plurality of task selection user selectable icons which specify a respective one of a plurality of tasks provided as part of caregiving. The method may further include receiving a user input indicative of a selection of the one of the task selection user selectable icons for the current care session; in response to the received user input indicative of the selection of one of the task selection user selectable icons, stopping the timer for the current care session and logically associating the respective selected task for the current care session with information indicative of at least an elapsed time for the current care session and indicative of the defined space for the current care session. The method may further include: receiving a user input indicative of an identity of the end user caregiver providing care for the current care session; receiving a user input indicative of a selection of the one of the task selection user selectable icons for the current care session; in response to the received user input indicative of the selection of one of the task selection user selectable icons, stopping the timer for the current care session and logically associating the respective selected task for the current care session with information indicative of at least an elapsed time for the current care session, indicative of the defined space for the current care session, and indicative of the identity of the caregiver providing care for the current care session. Causing a displaying of a space identification user selectable icon on the touch-sensitive display may include causing the displaying of the space identification user selectable icon as a scrollable set of room numbers. 
     A method of operating a caregiving tracking system may be summarized as including receiving information by the caregiving tracking system for each of a plurality of tasks performed by each of a number of caregivers, the information specifying for each of the tasks a defined space identifier associated with where the respective task was performed, and at least one value indicative of a date on which the respective task was performed and indicative at least of an elapsed time during which the respective task was performed; from time to time, analyzing the information; and identifying any of the performed tasks having defined criteria which are outside of a defined threshold of a defined value. 
     The method may further include automatically electronically transmitting a notification for any defined task having defined criteria which are outside of a defined threshold of a defined value. Identifying any of the performed tasks having defined criteria which are outside of a defined threshold of a defined value may include identifying any defined tasks for which an elapsed time exceeds a defined expected time by more than a defined amount. Identifying any of the performed tasks having defined criteria which are outside of a defined threshold of a defined value may include identifying any defined tasks for which an elapsed time exceeds at least one of an average or a median elapsed time for the respective task over a population of care recipients. Identifying any of the performed tasks having defined criteria which are outside of a defined threshold of a defined value may include identifying any defined tasks that are inconsistent with a list of expected tasks for a selected service. Identifying any of the performed tasks having defined criteria which are outside of a defined threshold of a defined value may include identifying any defined tasks that are inconsistent with a list of expected tasks for a respective defined space. Identifying any of the performed tasks having defined criteria which are outside of a defined threshold of a defined value may include identifying any defined tasks that are inconsistent with a list of expected tasks for a care recipient logically associated with a respective defined space. The method may further include generating a graphical representation of a respective elapsed time for each occurrence of selected task. The method may further include visually emphasizing in the graphical representation any tasks having defined criteria which are outside of a defined threshold of a defined value. The method may further include generating a graphical representation of a respective elapsed time for each occurrence of a selected task as performed by a selected end user caregiver. The method may further include generating a graphical representation of a respective elapsed time for each occurrence of a selected task as performed by a population of end user caregivers. The information may further specify for each of the tasks an identifier indicative of an end user caregiver that performed the respective task. 
    
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
       In the drawings, identical reference numbers identify similar elements or acts. The sizes and relative positions of elements in the drawings are not necessarily drawn to scale. For example, the shapes of various elements and angles are not drawn to scale, and some of these elements are arbitrarily enlarged and positioned to improve drawing legibility. Further, the particular shapes of the elements as drawn, are not intended to convey any information regarding the actual shape of the particular elements, and have been solely selected for ease of recognition in the drawings. 
         FIG. 1  is a partial environmental view of a care facility with a caregiver operating a handheld device, according to one illustrated embodiment. 
         FIG. 2  is a schematic view of the handheld device with a detachable reader module coupled thereto, according to one illustrated embodiment. 
         FIG. 3  is a screen print of a login screen displayed on a touch-sensitive display of the handheld device, according to one illustrated embodiment. 
         FIG. 4  is a screen print of a main navigation screen displayed on a touch-sensitive display of the handheld device, according to one illustrated embodiment. 
         FIG. 5  is a screen print of a space identifier entry screen displayed on a touch-sensitive display of the handheld device, according to one illustrated embodiment. 
         FIG. 6  is a screen print of a task selection screen displayed on a touch-sensitive display of the handheld device, according to one illustrated embodiment. 
         FIG. 7  is a plot or graph of costs or fees versus elapsed time per space or care recipient, according to one illustrated embodiment. 
         FIG. 8  is a plot or graph of costs or fees versus elapsed time per task, according to one illustrated embodiment. 
         FIG. 9  is a flow diagram of a high level method of operating a processing system, according to one illustrated embodiment. 
         FIG. 10  is a flow diagram of a method of operating a backend or back office computing system to analyze information, according to one illustrated embodiment. 
         FIG. 11  is a flow diagram of a method of operating a backend or back office computing system to analyze information, according to one illustrated embodiment. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     In the following description, certain specific details are set forth in order to provide a thorough understanding of various embodiments of the invention. However, one skilled in the art will understand that the invention may be practiced without these details. 
     Unless the context requires otherwise, throughout the specification and claims which follow, the word “comprise” and variations thereof, such as “comprises” and “comprising”, are to be construed in an open, inclusive sense, that is as “including, but not limited to.” 
     The headings provided herein are for convenience only and do not interpret the scope of meaning of the claimed invention. 
     The term “processor-based system” is used herein to denominate systems that include a processor such as a microprocessor, microcontroller, digital signal processors (DSPs), application specific integrated circuit (ASIC), programmed logic controller (PCL), programmable gate array (PGA) for instance a field programmable gate array (FPGA) or other controllers. 
     Overview of Processing System 
       FIG. 1  shows a portion of a caregiving facility  100 , according to one illustrated embodiment. 
     The caregiving facility  100  includes a number of defined spaces  102  (only one shown), which may be denominated as apartments or rooms, as appropriate to the particular caregiving facility  100 . Each space  102  has an associated access way  104   a - 104   c  (three shown, collectively  104 ), for example a door, which provides access into and from the defined space  102 . The access ways  104  may for example lead to a corridor  106  or some other space. While not illustrated, the caregiving facility  100  may have a variety of other spaces, for example break rooms, day rooms, game rooms, cafeterias, dining rooms, exercise rooms, therapy rooms, etc. 
     As illustrated in  FIG. 1 , a caregiver  108  may arrive at an access way  104  of one of the defined spaces (e.g., apartment or room)  102  in order to provide care to a care recipient  110 , for instance a resident or patient who resides in or is otherwise assigned to the particular defined space  102 . 
     The caregiver  108  may carry a handheld caregiving management device  112 . One or more handheld caregiving management devices  112  (only one illustrated) are communicatively coupled via one or more communications channels  114  with one or more caregiving management backend or back office computer systems  116  to form an integrated caregiving management system, as described herein. The communications channels  114  may include one or more transceivers  114   a  and associated antenna  114   b  to provide wireless communications with the handheld caregiving management devices  112 . The transceivers  114   a  and associated antenna  114   b  may, for example take the form of a wireless “hotspot” using conventional wireless communications protocols, for example IEEE 802.11 protocol. The communications channels  114  may include one or more wired or wireless channels, for example a network  114   c , for instance a local area network (LAN) and/or wide area network (WAN), which couples the transceivers to the caregiving management backend or back office computer system  116 . 
     The caregiver  108  uses the handheld caregiving management device  112  to collect and record information about care provided by the caregiver  108  to the care recipient  110 . Such may be collected and recorded in terms of discrete caregiving sessions, which may include performance of one or more caregiving tasks. 
     In some situations, the caregiver  108  may use the handheld caregiving management device  112  to automatically read a data carrier at least proximally associated with the particular space and/or care recipient. For example, the caregiver  108  may use the handheld caregiving management device  112  to read information encoded in a machine-readable symbol  118   a ,  118   b  (two shown, collectively) posted proximate respective access ways  104   a ,  104   b . Also for example, the caregiver  108  may use the handheld caregiving management device  112  to read information encoded in a wireless transponder, for instance a radio frequency identification (RFID) transponder  118   c  (only one shown) posted proximate a respective access way  104   c.    
     For example, the access way  104  may have inscribed on, include, carry or bear a machine-readable symbol  118   a ,  118   b  at least proximate to an access way  104 . The machine-readable symbol  104   a ,  104   b  may take any of a variety of forms, for instance a one-dimensional machine-readable symbol (i.e., barcode symbol) or two-dimensional machine-readable symbol (e.g., area or matrix code symbol) which encodes a unique identifier (e.g., apartment or room identifier) and is readable by a machine-readable symbol reader or subsystem of the handheld caregiving management device  112 . The machine-readable symbol  118   a ,  118   b  may, for example, be printed on a label and adhered to or proximate the access way  104 , for instance on an appropriate surface thereof. 
     Also for example, the access way  104  may carry or bear a wireless transponder  118   c  such as a passive radio frequency identification (RFID) transponder or tag which encodes a unique identifier and/or other information that is readable and/or writeable by a reader (e.g., interrogator) of the handheld caregiving management device  112 . The wireless transponder  118   c  may, for example, be formed as a printed circuit trace antenna and integrated circuit component on a tag and adhered to an appropriate surface at least proximate the access way  104 . 
     As another example, a combination machine-readable symbol and RFID transponder or tag (not shown) may be employed, which encodes a unique identifier and/or other information that is readable by a reader or interrogator and/or writeable thereby. In each of the above examples, use of a wireless transponder may provide advantages over machine-readable symbols, for example allowing storage of information, data or conditions after the transponder or tag is applied to the component. Such may also provide for non-line-of-sight reading. Various examples of operation advantageously employing wireless transponders and/or machine-readable symbols are described herein. 
     The caregiving management backend or back office computer system  116  may take the form of a conventional mainframe computer, mini-computer, workstation computer, personal computer (desktop or laptop), or handheld computer. The caregiving management backend or back office computer system  116  may include a processing unit  120 , a system memory  122  and a system bus (not shown) that couples various system components including the system memory  122  to the processing unit  120 . The caregiving management backend or back office computer system  116  will at times be referred to in the singular herein, but this is not intended to limit the embodiments to a single caregiving management backend or back office computer system  116 , since in typical embodiments there may be more than one caregiving management backend or back office computer system  116  or other device involved. Non-limiting examples of commercially available computer systems include, but are not limited to, an 80×86, Pentium, or i7 series microprocessor from Intel Corporation, U.S.A., a PowerPC microprocessor from IBM, a Sparc microprocessor from Sun Microsystems, Inc., a PA-RISC series microprocessor from Hewlett-Packard Company, or a 68xxx series microprocessor from Motorola Corporation. 
     The processing unit  120  may be any logic processing unit, such as one or more central processing units (CPUs), digital signal processing units (DSPs), application-specific integrated circuits (ASICs), programmable gate arrays (PGAs) programmed control units (PLUs), etc. Unless described otherwise, the construction and operation of the various blocks shown in  FIG. 1  are of conventional design. As a result, such blocks need not be described in further detail herein, as they will be understood by those skilled in the relevant art. 
     The system bus can employ any known bus structures or architectures, including a memory bus with memory controller, a peripheral bus, and a local bus. The system memory  122  includes read-only memory (“ROM”)  124  and random access memory (“RAM”)  128 . A basic input/output system (“BIOS”)  471 , which can form part of the ROM  124 , contains basic routines that help transfer information between elements within the caregiving management backend or back office computer system  116 , such as during start-up. 
     The caregiving management backend or back office computer system  116  may also include one or more media drives  130  (e.g., a hard disk drive, magnetic disk drive, and/or optical disk drive) for reading from and writing to computer-readable storage media  132  (e.g., hard disk, optical disks, and/or magnetic disks). The computer-readable storage media  132  may, for example, take the form of removable media. For example, hard disks may take the form of Winchester drives, optical disks can take the form of CD-ROMs, while magnetic disks can take the form of magnetic floppy disks or diskettes. The media drive(s)  130  communicate with the processing unit  120  via one or more system buses. The media drives  130  may include interfaces or controllers (not shown) coupled between such drives and the system bus, as is known by those skilled in the relevant art. The media drives  130 , and their associated computer-readable storage media  132 , provide nonvolatile storage of computer readable instructions, data structures, program engines and other data. Although described as employing computer-readable storage media  132  such as hard disks, optical disks and magnetic disks, those skilled in the relevant art will appreciate that caregiving management backend or back office computer system  116  may employ other types of computer-readable storage media that can store data accessible by a computer, such as magnetic cassettes, flash memory cards, digital video disks (“DVD”), Bernoulli cartridges, RAMs, ROMs, smart cards, etc. Data or information, for example, data collected from operation of handheld caregiving management device(s)  112  related to provision of care, can be stored in the computer-readable storage media  132 . The data related to provided care may include data that is indicative of space or care recipient identity, caregiving task performed, date, start time, end time, and or elapsed time of caregiving session, and/or identity of caregiver. 
     Program engines, such as an operating system, one or more application programs, other programs or engines and program data, can be stored in the system memory  122 . Program engines may include instructions to store and/or retrieve information regarding the providing of care, and particularly information related to each caregiving session, the caregiving tasks performed and the time required to adequately perform those caregiving tasks. For example, a program engine may store and/or retrieve collected data representing the operation of the handheld caregiving management device(s)  112 , the characteristics of a caregiving session to the nontransitory storage media  142 . Such may, for example, be stored in and/or retrieved from one or more data structures  144 , for example data structures of a relational database  146 . Such may, for example, be broken out by defined space and/or care recipient, by caregiving task, caregiver, and/or by facility. 
     Program engines may include instructions for analyzing the caregiving related data. For example, the instructions may cause comparison of billed costs or fees versus actual costs or fees or time actually spent on providing care. Such may be analyzed on a space-by-space or care recipient basis. Such may be done on a caregiver-by-caregiver basis. Such may be done on a facility-by-facility basis. The instructions may cause the production of one or more graphs illustrating the analysis. The instructions may cause the identification of discrepancies from expected values, and particularly identification of discrepancies that are outside of a threshold or range of an expected value. The instructions may cause electronic transmission of a notification when a discrepancy occurs and/or produce a notification or alert, for instance a visual emphasis in a graph. Additional details regarding the various operations are discussed herein with respect to the various methods of operation. 
     Program engines may include instructions for handling security such as password or other access protection and communications encryption. The system memory  122  may also include communications programs, for example, a Web client or browser that permits the caregiving management backend or back office computer system  116  to access and exchange data with sources such as Web sites of the Internet, corporate intranets, extranets, or other networks as described below, as well as other server applications on server computing systems such as those discussed further below. The browser may, for example, be markup language based, such as Hypertext Markup Language (HTML), Extensible Markup Language (XML) or Wireless Markup Language (WML), and may operate with markup languages that use syntactically delimited characters added to the data of a document to represent the structure of the document. 
     While described as being stored in the system memory  122 , the operating system, application programs, other programs/engines, program data and/or browser can be stored on the computer-readable storage media  132  of the media drive(s)  130 . 
     An operator can enter commands and information via a user interface  134  through input devices such as a touch screen or keyboard  136  and/or a pointing device  138  such as a mouse. Other input devices can include a microphone, joystick, game pad, tablet, scanner, etc. These and other input devices are connected to the processing unit  120  through an interface such as a serial port interface that couples to the system bus, although other interfaces such as a parallel port, a game port or a wireless interface or a universal serial bus (“USB”) can be used. A display or monitor  140  may be coupled to the system bus via a video interface, such as a video adapter. The caregiving management backend or back office computer system  116  can include other output devices, such as speakers, printers, etc. 
     The caregiving management backend or back office computer system  116  may be communicatively coupled to one or more handheld caregiving management device  112 , for example via a dedicated communications channel such as a set of wires or wire bundle, employing serial or parallel communications, or via a shared, network communications channel. The caregiving management backend or back office computer system  116  can operate in a networked environment using logical connections to one or more remote computers and/or devices. For example, the caregiving management backend or back office computer system  116  can operate in a networked environment using logical connections to one or more handheld caregiving management device  112 . Communications may be via a wired and/or wireless network architecture, for instance, wired and wireless enterprise-wide computer networks, intranets, extranets, and the Internet. Other embodiments may include other types of communication networks including telecommunications networks, cellular networks, paging networks, and other mobile networks. 
       FIG. 2  shows a handheld caregiving management device  112 , according to one illustrated embodiment. 
     The handheld caregiving management device  112  may, for example, take the form of a dedicated device, or may take the form of a Smartphone, personal digital assistant (PDA), tablet computer system, netbook computer system, laptop computer system, handheld communications device or the like running one or more caregiving management applications. 
     The handheld caregiving management device  112  has a housing  200 , which is preferably configured to be portable, and handheld when in use. The handheld caregiving management device  112  may include a number of subsystems housed by the housing. For example, the handheld caregiving management device  112  may include a control subsystem  202 , an input/output (I/O) subsystem  204 , a wireless communications subsystem  206 , and may include one or more communications ports  208  (only one shown) to provide wired communications therefrom. The various subsystems  202 ,  204 ,  206  and communications ports  208 , and/or components thereof are powered and/or communicatively coupled via one or more buses  210  (only one shown) or other structures. The buses may, for example, include one or more power, communications, data, instructions, and/or address buses. 
     The control subsystem  202  may take any of a large variety of forms. Without limiting the alternatives, the control subsystem  202  may include one or more controllers  212 , for example one or more microprocessors (e.g., ARM based CPU), digital signal processors (DSPs), application specific integrated circuits (ASICs), programmable gate arrays (PGAs), programmed logic controllers (PLCs), etc. programmed or otherwise configured to control operation of the handheld caregiving management device  112 . The controller  212  may be communicatively coupled to one or more nontransitory processor readable media. For example, the controller  212  may be coupled to nonvolatile memory which stores instructions and/or data, for instance read only memory (ROM)  214  or Flash memory  216 . The ROM may store processor executable instructions, for instance an operating system  218 . The Flash memory  216  may store processor executable instructions, for example one or more caregiving management applications  220 . Additionally, or alternatively, the controller  212  may be coupled to volatile memory which stores instructions and/or data, for instance random access memory (RAM)  222 . 
     The control subsystem  202  may include a power supply subsystem  224 . The power supply subsystem may include circuitry (not shown) and other components for conditioning power, for instance step up converters, step down converters, rectifiers, filters, etc. The power supply subsystem may include an on-board power source  226  (e.g., secondary chemical battery, fuel cell, ultra-capacitor array). 
     The I/O subsystem  204  may, for example, include one or more displays, such as a touch-sensitive display (e.g., LCD touch panel)  230 . The touch sensitive display  230  may display user selectable icons, for example including virtual keys of a virtual keyboard or keypad (not shown). The I/O subsystem  204  may optionally include a physical keyboard or keypad  232  having physical keys. The I/O subsystem  204  may include one or more speakers  234  to provide sounds such as alerts and or spoken prompts. The I/O subsystem  204  may include one or more microphones  236 , for example to allow entry of spoken voice commands. The I/O subsystem  204  may include one or more vibrators  238  (e.g., piezoelectric vibration elements) to provide tactile alerts or feedback to the end user. The I/O  204  may include an accelerometer, for example a three-axis accelerometer  240  allowing detection of acceleration, movement, or gravitational force. 
     The wireless communications subsystem  206  may include one or more transmitters, receivers or transceivers, collectively referred to herein as radios, and associated antennas. The radios and antennas may be operable to communicate over a large variety of frequencies (e.g., radio or microwave frequencies), using a large variety of communications protocols (e.g., CDMA, TDMA, GSM). 
     For example, the wireless communications subsystem  206  may include one or more cellular radios  250  and associated antennas  252  configured to communicate via a cellular communications of a cellular service provider. Such communications may include data, voice, SMS, etc., employing any protocol supported by the particular cellular service provider network. Also for example, the wireless communications subsystem  206  may include one or more radios  254  and associated antennas  256  configured to communicate via Wi-Fi® or similar IEEE 802.11 compliant wireless network infrastructure. Also for example, the wireless communications subsystem  206  may include one or more radios  258  and associated antennas  260  configured to communicate via Bluetooth® compliant wireless infrastructure. 
     The wireless communications subsystem  206  may include one or more Global Positioning System (GPS) receivers  262  or similar such receivers and associated antenna(s)  264 . The GPS receiver  262  receives signals from GPS satellites (not shown), allowing determination of a position of the handheld caregiving management device  112  in a global coordinate frame (e.g., longitude, latitude). Various spatial location determination units (e.g., GPS) are commercially available in a variety of form factors, including those suitable for inclusion in handheld devices. 
     The communications port(s)  208  may provide communications with external devices and systems. The communications ports  208  may include wired as well as wireless ports. For example, the communications ports  208  may include Ethernet ports, Universal Serial Bus (USB) ports, Firewire ports, Thunderbolt ports, etc., and/or ports compliant with various IEEE 802.11 protocols. 
     The handheld caregiving management device  112  includes a reader  270 , which may be integral thereto, or removably coupled to the housing  200  of the handheld caregiving management device  112 . The reader  270  is operable to read information encoded in one or more data carriers (e.g., machine-readable symbols  118   a ,  118   b , RFID transponders  118   c ). 
     The reader  270  may take the form of a machine-readable symbol reader which itself may take any of a large variety of forms, for example laser based or scanning machine-readable symbol readers or flood illumination or imaging based machine-readable symbol readers. Machine-readable symbol reader scanning units are commercially available in a variety of form factors, including those suitable for inclusion in handheld devices. Without limiting the alternatives, the reader  270  is discussed below with respect to a machine-readable symbol reader embodiment. The reader  270  may include one or more illumination sources  272 , or may rely on ambient lighting. Suitable illumination sources  272  may include a laser and optionally a scanning mirror (e.g., oscillating mirror or rotating polygonal mirror, neither shown). Suitable illumination sources  272  may include one or more LEDs. The reader  270  may include one or more sensors or detectors  274 . Suitable sensors or detectors  274  may, for example, include linear or two-dimensional arrays of charge coupled devices (CODs), photodiodes, Vidicons, and/or CMOS image capture devices. The reader  270  may include one or more controllers  276 , for example one or more microprocessors, DSPs, ASICs, PGAs, PLCs, etc., to be programmed or otherwise configured to decode information read from the machine-readable symbols. The controller  276  may be communicatively coupled to one or more nontransitory processor readable media. For example, the controller  276  may be coupled to nonvolatile memory which stores instructions and/or data, for instance ROM or Flash memory  278 . Additionally, or alternatively, the controller  276  may be coupled to volatile memory which stores instructions and/or data, for instance RAM  280 . Alternatively, the reader  270  may rely on the control subsystem  202  to control operation of the various components of the reader  270 , including decoding. 
     Where implemented as a detachable component, the reader  270  may include one or more ports  282  to provide selectively detachable communicative and/or power coupling to the handheld caregiving management device  112 . This allows existing Smartphones, PDAs, computing tablets or netbooks to be easily retrofitted to perform caregiving monitoring. 
       FIG. 3  shows a login screen  300  which can be displayed on the display  230  ( FIG. 2 ) of a handheld caregiving management device  112 , according to one illustrated embodiment. 
     The login screen  300  includes a number of user selectable icons and/or user fillable fields. For example, the login screen  300  may include a list of user selectable care provider identifiers  302 , for example names or partial names of the various caregivers who may use the handheld caregiving management device  112 . An end user may select the end user&#39;s own name from the list  302 . The list  302  may be scrollable. 
     The login screen  300  may include a password field  304  into which the end user enters a password. The end user may use a physical keyboard or keypad to enter a password, which may or may not include alphabetic characters, digits, and other symbols. Alternatively, selection of the password field  304  may automatically bring up a virtual keyboard or keypad for the end user to enter the password. 
     The login screen  300  may include a user selectable login icon  306 , selection of which submits the selected user identifier and password for verification. Verification may be performed by the handheld caregiving management device  112 . Alternatively, selection may cause a message including user identity and password information to be sent to the caregiving management backend or back office computer system  116 , which performs the verification and transmits an appropriate message back to the handheld caregiving management device  112 . 
       FIG. 4  shows a main navigation screen  400  which can be displayed on the display  230  ( FIG. 2 ) of a handheld caregiving management device  112 , according to one illustrated embodiment. 
     The main navigation screen  400  includes a number of user selectable icons and/or user fillable fields. For example, the main navigation screen  400  may include a start scan user selectable icon  402 . User selection of the start scan user selectable icon  402  causes a reader to try to automatically read space or care recipient identification information. For example, selection of the start scan user selectable icon  402  may cause a processor to cause the reader to optically scan or image a machine-readable symbol and attempt to decode information encoded in such, and/or wirelessly interrogate a wireless transponder and attempt to decode information encoded in such. 
     Also for example, the main navigation screen  400  may include a plurality of service type user selectable icons  404   a ,  404   b ,  404   c ,  404   n  (eight shown, only four called out, collectively  404 ). Each of the service type user selectable icons  404  specifies a respective type of service which may be provided as part of caregiving. Types of service may, for example, include: escort, resident call, eat, laundry, toilet, room tray, medications, and other care. This list should not be considered exhaustive. The set of service type user selectable icons  404  may be scrollable where there are too many to fit on a single screen. In response to user selection of one of the service type user selectable icons  404 , the processor displays a space identifier screen  500  discussed below with reference to  FIG. 5 . 
     The service type user selectable icons  404  may be displayed currently on same screen with start scan user selectable icon  402 . Such advantageously automatically implements a bifurcated algorithmic approach to account for two distinctly different situations in the caregiving environment, explained in more detail below. 
     The main navigation screen  400  may also include a synchronize and logout user selectable icon  406 . In response to user selection of the synchronize and logout user selectable icon  406 , the processor may synchronize information for a current caregiving session and may log the end user caregiver out. Synchronization may, for example, include packaging relevant information in a packet and transmitting such to the caregiving management backend or back office computer system  116 . Such may alternatively include saving the relevant information in some data structure in a nontransitory storage medium of the handheld caregiving management device  112 . For example, information may be stored until either a wired or wireless connection becomes available. 
       FIG. 5  shows a space identifier entry screen  500  which can be displayed on the display  230  ( FIG. 2 ) of a handheld caregiving management device  112 , according to one illustrated embodiment. 
     The space identifier entry screen  500  includes a number of user selectable icons and/or user fillable fields. For example, the space identifier entry screen  500  may include a scrollable list of space identifiers  502  (e.g., apartment or room numbers). Such allows the caregiver to select a space or care recipient that is to be logically associated with a current caregiving session. Such may, for instance, be implemented to appear as a wheel or reel which appears to rotate when swiped or otherwise activated by the end user caregiver. Such may allow scrolling in two opposed directions. 
     Also for example, the space identifier entry screen  500  may include a select apartment user selectable icon  504 . Selection of select apartment user selectable icon  504  accepts or submits the currently selected space identifier. 
     Also for example, the space identifier entry screen  500  may include a cancel user selectable icon  506 . User selection of the cancel user selectable icon  506  causes display of the main navigation screen  400  ( FIG. 4 ). 
       FIG. 6  shows a task entry screen  600  which can be displayed on the display  230  ( FIG. 2 ) of a handheld caregiving management device  112 , according to one illustrated embodiment. 
     The task entry screen  600  includes a number of user selectable icons and/or user fillable fields. For example, the task entry screen  600  includes a plurality of specific task selection user selectable icons  602   a ,  602   b ,  602   c ,  602   n  (seventeen shown, four called out, collectively  602 ). Each of the task selection user selectable icons  602  specifies a respective caregiving task which may be provided as part of caregiving. Types of caregiving tasks may, for example, include: wake-up, bath, dress, tidy, bedtime, health related, safety related, phone or television assistance, escort, pet care, residential call, eat, laundry, toilet, room tray, medications, and other care. This list should not be considered exhaustive. The set of task selection user selectable icons  602  may be scrollable where there are too many tasks to fit on a single screen. Selection of one of the task selection user selectable icons  602  causes the associated task to be logically associated with the current caregiving session. 
     Also for example, the task entry screen  600  includes an end session user selectable icon  604 . Selection of the end session user selectable icon  604  may signify an end of a caregiving session, causing tracked or recorded information to be saved or transmitted. 
       FIG. 7  shows a graphical relationship  700  of care fees versus elapsed time for a plurality of spaces or care recipients, according to one illustrated embodiment. In particular, care fees are represented along the vertical or Y-axis  702  while elapsed time is represented along the horizontal or X-axis  704 . This relationship  700  is not intended to necessarily reflect any actual processing or actual collected information, but rather is provided to illustrate the various concepts employed herein. 
     The relationship  700  may be presented on a display and/or provided on paper as a hard copy. A plurality of data points  706   a ,  706   n  (many shown, only two called out, collectively  706 ) corresponding to respective spaces or care recipients are each illustrated as square blocks. Many of the data points  706  have identifiers  708  (only one called out) proximate thereto, identifying the specific space (e.g., apartment) to which the data point  706  corresponds. 
     An average or median of actually elapsed time is represented by a straight line  710 . Data points which are inconsistent or outside a threshold or range of the median may be visually emphasized  712 , for example using a different color, highlighting, flashing or some other visual effect. 
       FIG. 8  show a graphical relationship  800  of care fees versus elapsed time for a plurality of caregiving tasks, according to one illustrated embodiment. In particular, care fees are represented along the vertical or Y-axis  802  while elapsed time is represented along the horizontal or X-axis  804 . This relationship  800  is not intended to necessarily reflect any actual processing or actual collected information, but rather is provided to illustrate the various concepts employed herein. 
     The relationship  800  may be presented on a display and/or provided on paper as a hard copy. A plurality of data points  806   a ,  806   n  (many shown, only two called out, collectively  806 ) corresponding to respective spaces or care recipients are each illustrated as square blocks. The data points  806  are grouped by task, and have associated task identifiers  808   a ,  808   b ,  808   c  (three called out, collectively  808 ) proximate thereto, identifying the specific task (e.g., apartment) to which the data point  806  corresponds. 
     Data points which are inconsistent or outside a threshold or range of the median may be visually emphasized  812 , for example using a different color, highlighting, flashing or some other visual effect. 
       FIG. 9  shows a method  900  of operation of a caregiving management system, according to one illustrated embodiment. 
     At  902 , a processor of an end user caregiver operated handheld caregiving management device causes a display of a login screen on a display thereof, for example on a touch-sensitive display. 
     At  904 , the processor receives user input indicative of an identity of an end user caregiver who will be delivering care to a care recipient during a current caregiving session. For example, the end user caregiver may select the end user&#39;s own name from a list of caregiver names. Alternatively, the end user caregiver may select some other identifier from a list of other caregiver identifiers. As a further alternative, the end user caregiver may enter the end user&#39;s name or some other identifier, for example via a keyboard or keypad. The keyboard or keypad may, for instance, take the form of either a physical keyboard or keypad or a virtual keyboard or keypad displayed on the touch-sensitive display. Additionally, the processor may require the end user caregiver to enter a password to authenticate or otherwise verify an identity of the end user caregiver. 
     At  906 , the processor causes a display of a start scan user selectable icon. The start scan user selectable icon allows the end user caregiver to trigger a reader of the handheld caregiving management device to read (e.g., scan or image and decode) a machine-readable symbol at least proximately spatially associated with a defined space, for instance a room or apartment. 
     At  908 , the processor causes a display of a plurality of service type user selectable icons. Each of the service type user selectable icons specifies a respective type of service which may be provided as part of the caregiving. The service type user selectable icons may be displayed currently on the same screen with the start scan user selectable icon. Such advantageously automatically implements a bifurcated algorithmic approach to account for two distinctly different situations in the caregiving environment, explained in more detail below. 
     In one situation, the end user caregiver is proximate a defined space (e.g., room, apartment) logically associated with a particular care recipient. In such a situation, a machine-readable symbol is typically present, which encodes information that uniquely identifies at least one of the defined space and/or the care recipient. For example, the machine-readable symbol may encode a room or apartment number or identifier. The room or apartment number or other identifier may be logically associated, for instance via a data structure, with a particular care recipient (e.g., resident, patient). Such greatly expedites the management process by allowing automatic entry of information which reduces caregiver work load as well as reducing the occurrence of errors. 
     In the other situation, the end user caregiver may not be proximate the defined space or the machine-readable symbol may otherwise not be available or readable. For instance, a caregiving session may start in a common space, for example a common room, dayroom, break room, cafeteria or dining room, exercise room, entertainment room or visiting room. While not as automated as the first situation, the approach described herein automates the collection of information to the extent possible, again reducing caregiver workload and reducing the occurrence of errors. 
     At  910 , the processor determines whether the end user caregiver has selected the start scan user selectable icon, indicating that a machine-readable symbol is likely present and that the reader should be triggered to read the machine-readable symbol. 
     In response to selection of the start scan user selectable icon, at  912  the processor causes the reader to acquire information from the machine-readable symbol, if present. The information should uniquely identify a specific defined space. The reader may acquire the information by, for example, scanning the machine-readable symbol, and capturing a scan profile of the machine-readable symbol. For instance, the reader may cause a laser beam produced by one or more laser diodes to scan across the machine-readable symbol and capture the scan profile with one or more photodiodes. Scanning may be accomplished by, for instance, an oscillating reflector or mirror or by a rotating polygonal reflector or mirror. Alternatively, the reader may acquire the information by, for example, flood illuminating the machine-readable symbol, and capturing an image of the illuminated machine-readable symbol. For instance, the reader may cause a number of light sources (e.g., LEDs) to emit light, and capture light returned from the machine-readable symbol with a one- or two-dimensional charge coupled device (CCD) array or a complementary metal oxide semiconductor (CMOS) imager. The reader may decode information encoded in the machine-readable symbol, for example using a digital signal processor to decode information based on any one or more machine-readable symbologies (e.g., UPC/EAN, UNICODE). As used herein and in the claims, the term scanning is used consistently with its vernacular use, that is to apply to both scanning with a point of light or imaging using flood illumination. Whether using the scanning approach or imaging approach, the processor may verify that the decoded information corresponds to a valid space identifier, for example checking a lookup table or some other data structure, or sending a query to an external system. 
     At  914 , in response to the reading of a valid identifier, the processor starts a timer for the current care session. The timer may be implemented using one or more clocks of the processor, or using a discrete clock. 
     At  916 , the processor determines whether the end user caregiver has selected one of the service type user selectable icons. As previously explained, the service type user selectable icons specify various different types of services which may be provided as part of providing care. Selection of a service type of user selectable icon indicates that reading of a machine-readable symbol will be skipped. As explained above, this will typically occur when away from a defined space associated with the care recipient (e.g., resident, patient) or when a machine-readable symbol is otherwise not available or readable (e.g., damaged or obscured). The provision of two alternatives (i.e., scan selection or service type selection) automatically implements the bifurcated approach discussed above. 
     At  918 , the processor causes a displaying of a space identification user selectable icon. The space identification user selectable icon allows the end user to enter an identifier associated with at least one of a defined space or a care recipient logically associated with the defined space. Such is particularly useful where a machine-readable symbol encoding similar information is not available or readable. In particular, this allows automatic tracking of a caregiving session even when started away from the defined space logically associated with the care recipient. The space identification user selectable icon may, for example, take the form of a scrollable set of room numbers. Such may, for instance, be implemented to appear as a wheel or reel which appears to rotate when swiped or otherwise activated by the end user caregiver. Such may allow scrolling in two opposed directions. 
     At  920 , the processor determines whether a space identifier has been received or selected. If not, a wait loop may be executed by returning to  920 . Alternatively, in response to receipt or selection of the space identifier, at  922  the processor may start a timer for current care session. Again, the timer may be implemented via one or more clocks integral to the processor or via some discrete clock. 
     Whether the space identifier was determined by the reader or was otherwise selected or entered by the end user caregiver, at  924  the processor causes a displaying of a task screen with a plurality of task selection user selectable icons. The task selection user selectable icons specify specific tasks associated with caregiving. Different sets of tasks may be logically associated with respective ones of the types of service (i.e., service types). One or more tasks from one set associated with one type of service may appear in one or more sets associated with other types of service. 
     At  926 , the processor determines whether the end user caregiver has selected a task selection user selectable icon or whether a user selection has been received. In response to selection of a task selection user selectable icon, at  928  the processor stops the timer for the current care session. Stopping the timer allows elapsed time for the current care session to be determined. For example, the processor may determine the start time and the stop time, storing such information. Alternatively or additionally, the processor may determine and store the elapsed time. 
     In response to selection of a task selection user selectable icon, at  930  the processor also logically associates the selected task with information indicative of elapsed time (e.g., start and stop time and/or determined elapsed time), the defined space (e.g., defined space identifier) and/or end user care provider identity (e.g., end user caregiver name or identifier) for the current care session. The processor may store this information in a data structure, for example a record or entries in one or more tables on appropriate nontransitory processor-readable storage media. Additionally or alternatively, the processor may electronically transmit this information. Such may be performed substantially continuously, during performance of  902 - 926 . Alternatively, such may be performed at or during defined portions of the method  1000 . 
       FIG. 10  shows a method  1000  of operation of a caregiving management system, according to one illustrated embodiment. 
     At  1002 , a processor of a caregiving management backend or back office computer system receives information collected by one or more end user caregiver operated handheld caregiving management devices. The received information specifies each of a plurality of tasks performed by a plurality of caregivers. For each task the information specifies a defined space identifier, an end user caregiver identifier, and values indicative of date and/or elapsed time of task performance. The defined space identifier may be logically associable by the processor with a care recipient. For instance, an apartment or room number may be logically associated with a resident or patient who resides in or has been assigned to the particular apartment or room. The end user caregiver identifier may take the form of the caregiver&#39;s name or some other identifier such as a number or employee identifier. The date may be provided in any desired format, for example month, day, year, or day, month, year. The information indicative of elapsed time may be the actual amount of elapsed time and/or may be a start time and stop time from which elapsed time may be determined. Where start and stop times are provided, dates associated with the start and stop times should also be provided. This permits correct determination of elapsed time in instances where a caregiving tasks starts one day (e.g., 11:30 PM) and ends the next day (e.g., 12:36 AM). 
     At  1004 , the processor analyzes or otherwise processes the received information. For example, the processor may determine elapsed time based on start and stop times for each task. Other specific examples of analysis are discussed below with reference to  FIG. 10 . 
     At  1006 , the processor identifies any of the performed tasks which have one or more criteria that fall outside of respective defined thresholds or ranges of a respective defined value. 
     At  1008 , the processor causes the automatic electronic transmission of a notification for tasks with one or more criteria outside of the respective defined threshold. For example, the processor may cause one or more of an electronic mail message (i.e., email), short message service (i.e., SMS) message, facsimile, voicemail, or other electronic message to be sent to a remote device. The processor may also cause an alert or other notification to be produced at the caregiving management backend or back office computer system. 
     At  1010 , the processor generates a graphical representation of fees versus elapsed time for each defined space or care recipient. For example, the processor may cause a graph representing such information to be displayed on a display or monitor, or to print a paper hardcopy of such a graph. Such allows easy assessment of when fees charged are either insufficient to cover the actually provided services or where fees charged exceed the amount of provided services 
     At  1012 , the processor generates a graphical representation of elapsed time for each occurrence of a selected task. Again, the processor may cause a graph representing such information to be displayed on a display or monitor, or to print a paper hardcopy of such a graph. Such allows a comparison of cost recovery on a per task basis. In particularly, this facilitates easy comparisons between tasks. 
     At  1014 , the processor visually emphasizes in the graphical representation any tasks having one or more defined criteria that fall outside of respective defined thresholds of expected values for the criteria. Such may include changing a visual appearance of a marker or indicia associated with one of the criteria. For example, a marker or indicia representing an out-of-range value may be represented in a different color, with highlighting, flashing or marqueeing effects. Such is indicated for a selected space (e.g., apartments in  FIG. 7 ). 
     At  1016 , the processor generates a graphical representation of elapsed time for selected tasks as performed by one or more selected caregivers. 
     At  1018 , the processor generates a graphical representation of elapsed time for selected tasks as performed by caregivers. 
     Optionally, the at least one processor stores or causes the storage of the response relationship, and data defining the response relationship or information discerned therefrom. For example, the at least one processor may store information in one or more nontransitory storage media collocated with the processor, or may cause the storage of such in one or more nontransitory storage media coupled to store information from a plurality of handheld caregiving management device(s)  112 . Such may be performed substantially continuously, during performance of  1002 - 1018 . Alternatively, such may be performed at or during defined portions of the method  1000 . 
       FIG. 11  shows a method  1100  of operation of a caregiving management system, according to one illustrated embodiment. 
     At  1102 , a processor of a caregiving management backend or back office computer system identifies any tasks for which elapsed time exceeds defined expected time by more than a defined amount. For example, specific amounts of expected or acceptable elapsed time may be established for various caregiving tasks. These may be based in part on actual experience, for example across a large population of care recipients, care facilities, and/or population or caregivers. Such may, or may not, be based in part on an ability to recoup costs associated with a given task, for instance an ability to receive reimbursement from a payer, whether private individual, private insurer, or public insurer (e.g., Medicare, Medicaid). The processor may compare actual elapsed times for performance of caregiving tasks to that specified or listed as expected or acceptable for a given caregiving task, identifying or noting any discrepancies. Such may employ a threshold or range around the specified or listed expected or acceptable elapsed times. 
     At  1104 , the processor identifies any tasks for which elapsed time exceeds an average/median elapsed time for a general or specific population of care recipients. For example, the processor may determine either an average or median or both of actual times for performance of one or more caregiving tasks. Such may be specific to a particular caregiving facility or portion thereof (e.g., independent living, assisted living, or skilled nursing units, hospitals, in home care, adult family homes). This approach may readily account for discrepancies which are related to a particular facility or portion thereof. Thus, the system may automatically account for differences in the resident or patient population, or differences in physical infrastructure, or even differences in training and/or compensation of the caregiving personnel. The processor may compare actual elapsed times for performance of caregiving tasks to that specified or listed for a given caregiving task, identifying or noting any discrepancies from an average or median. Such may employ a threshold or range around the average or median. 
     At  1106 , the processor identifies any caregiving tasks that are inconsistent with a list of expected tasks for a selected service. For example, a defined caregiving service may be logically associated with a set (i.e., one or more) or a particular prescribed list of defined caregiving tasks to be performed as part of performing the particular caregiving service. The list of defined caregiving tasks may simply define one or more caregiving tasks to be performed for the particular caregiving service. Such may additionally specify a frequency of performance for one or more of the caregiving tasks. Such may additionally or alternatively set out a specific order in which the caregiving tasks are to be performed as part of the defined service. Such may additionally or alternatively set out specific times at which one or more of the caregiving tasks are to be performed. Such may additionally or alternatively set out specific elapsed times for performing one or more of the specific caregiving tasks on the list. The processor may compare actually performed caregiving tasks, frequency, order, elapsed times, and/or actual times of performance to that specified or listed, identifying or noting any discrepancies including omissions. 
     At  1108 , the processor identifies any caregiving tasks that are inconsistent with a list of expected tasks for a defined space. For example, a defined space may be logically associated with a particular prescribed list of defined caregiving tasks to be performed. The list of defined caregiving tasks may simply define one or more caregiving tasks to be performed for the particular resident or patient. Such may additionally specify a frequency of performance for one or more of the caregiving tasks. Such may additionally or alternatively set out a specific order in which the caregiving tasks are to be performed. Such may additionally or alternatively set out specific times at which one or more of the caregiving task are to be performed. Such may additionally or alternatively set out specific elapsed times for performing one or more of the specific caregiving tasks on the list. The processor may compare actually performed caregiving tasks, frequency, order, elapsed times, and/or actual times of performance to that specified or listed, identifying or noting any discrepancies including omissions. 
     At  1110 , the processor identifies any caregiving tasks that are inconsistent with a list of expected caregiving tasks for a care recipient logically associated with a defined space. For example, a defined space may be logically associated with a particular resident or patient for which a prescribed list of caregiving tasks may be defined. The list of defined caregiving tasks may simply define one or more caregiving tasks to be performed for the particular resident or patient. Such may additionally specify a frequency of performance for one or more of the caregiving tasks. Such may additionally or alternatively set out a specific order in which the caregiving tasks are to be performed. Such may additionally or alternatively set out specific times at which one or more of the caregiving tasks are to be performed. Such may additionally or alternatively set out specific elapsed times for performing one or more of the specific caregiving tasks. The processor may compare actually performed caregiving tasks, frequency, order, elapsed times, and/or actual times of performance to that specified or listed, identifying or noting any discrepancies including omissions. 
     CONCLUSIONS 
     The foregoing detailed description has set forth various embodiments of the devices and/or processes via the use of block diagrams, schematics, and examples. Insofar as such block diagrams, schematics, and examples contain one or more functions and/or operations, it will be understood by those skilled in the art that each function and/or operation within such block diagrams, flowcharts, or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. In one embodiment, the present subject matter may be implemented via microprocessors, Application Specific Integrated Circuits (ASICs), programmable logic controllers (PLCs), or programmable gate arrays (PGAs). However, those skilled in the art will recognize that the embodiments disclosed herein, in whole or in part, can be equivalently implemented in standard integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more controllers (e.g., microcontrollers), as one or more programs running on one or more processors (e.g., microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and or firmware would be well within the skill of one of ordinary skill in the art in light of this disclosure. 
     Various methods and/or algorithms have been described. Some or all of those methods and/or algorithms may omit some of the described acts or steps, include additional acts or steps, combine acts or steps, and/or may perform some acts or steps in a different order than described. Some of the methods or algorithms may be implemented in software routines. Some of the software routines may be called from other software routines. Software routines may execute sequentially or concurrently, and may employ a multi-threaded approach. 
     Causing electronic transmission of an alert to a device located remotely from the handheld caregiving management device(s)  112  may, for example, include sending an electronic message (e.g., email message, text message, voicemail message) to a host computer system, an end user computer system, a telephone or Smartphone. The message may optionally identify the specific space or care recipient, caregiver, facility, date and/or time, or even the condition that gave rise to the alert. 
     In addition, those skilled in the art will appreciate that the mechanisms taught herein are capable of being distributed as a program product in a variety of forms, and that an illustrative embodiment applies equally regardless of the particular type of nontransitory signal bearing media used to actually carry out the distribution. Examples of nontransitory signal bearing media include, but are not limited to, the following: recordable type media such as portable disks and memory, hard disk drives, CD/DVD ROMs, digital tape, computer memory, and other non-transitory computer-readable storage media. 
     The various embodiments described above can be combined to provide further embodiments. 
     The information collected, tracked or discerned may allow management of a caregiving facility, for instance a managed care facility or even a hospital. Such may allow identification or separation of variations related to human (e.g., user or operator) performance from variations related to care recipients or facility infrastructure. Such may be particularly useful in targeting remedial actions. Remedial actions may include training of individuals or groups, redesign or reengineering of processes, changing procedures, directives or specifications, or even suppliers or vendors. Remedial action may also include increasing or decreasing fees for services, for example increasing or decreasing a periodic payment for services on a space-by-space or care recipient-by care recipient basis. 
     The various methods and techniques described above provide a number of ways to carry out the various embodiments. Of course, it is to be understood that not necessarily all objectives or advantages described may be achieved in accordance with any particular embodiment described herein. Thus, for example, those skilled in the art will recognize that the methods may be performed in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other objectives or advantages as may be taught or suggested herein. 
     Furthermore, the skilled artisan will recognize the interchangeability of various features from different embodiments disclosed herein. Similarly, the various features and acts discussed above, as well as other known equivalents for each such feature or act, can be mixed and matched by one of ordinary skill in this art to perform methods in accordance with principles described herein. Additionally, the methods which are described and illustrated herein are not limited to the exact sequence of acts described, nor are they necessarily limited to the practice of all of the acts set forth. Other sequences of events or acts, or less than all of the events, or simultaneous occurrence of the events, may be utilized in practicing the embodiments of the invention. 
     Although the invention has been disclosed in the context of certain embodiments and examples, it will be understood by those skilled in the art that the invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses and obvious modifications and equivalents thereof. Accordingly, it is not intended that the invention be limited, except as by the appended claims. 
     The various embodiments described above can be combined to provide further embodiments. All of the U.S. patents, U.S. patent application publications, U.S. patent applications, foreign patents, foreign patent applications and non-patent publications referred to in this specification and/or listed in the Application Data Sheet, including but not limited to U.S. Provisional Application No. 61/608,525 filed Mar. 8, 2012 (130246.401P1), and U.S. Provisional Application No. 61/727,547 filed Nov. 16, 2012 (130246.401P2), are incorporated herein by reference, in their entirety. Aspects of the embodiments can be modified, if necessary to employ concepts of the various patents, applications and publications to provide yet further embodiments.