Patent Publication Number: US-2003229512-A1

Title: System and method for operating a long term care facility

Description:
CROSS-REFERENCE TO RELATED APPLICATION  
     [0001] This application claims the priority benefit of U.S. Provisional Application No. 60/295,853, filed on Jun. 6, 2001, which is incorporated herein by reference. 
    
    
     
       FIELD OF THE INVENTION  
       [0002] The present invention generally relates to systems and methods for operating a long term care facility.  
       BACKGROUND OF THE INVENTION  
       [0003] The Long Term Care (LTC) industry is experiencing widespread and catastrophic problems including bankruptcy, high staff turnover, resident dissatisfaction and departure, abuse and neglect allegations, insurance rate increases, litigation, and governmental regulations. Despite these problems, the market for the LTC industry continues to grow. The number of persons in America age 65 and older will double from 35 million to 79 million between the years 2000 and 2030. Presently, 6.5 million older Americans need help with daily living. This number is projected to double by 2010. Further, 600,000 additional LTC facility caregivers will be needed by 2011. The state of the LTC industry, coupled with the inevitable increase in elder population, threaten to not only exacerbate these problems, but also further erode the national confidence in LTC facilities and their financial viability.  
       [0004] Instead of focusing on the needs of the residents, today&#39;s LTC industry focuses on products and services. Further, LTC facility caregivers lack the skills, the tools, and the motivation to effectively assess the needs of the residents. Still further, there are no adequate staff training curricula focused on reducing staff turnover rates and increasing job performance.  
       [0005] Accordingly, there is a need in the LTC industry for a business model that focuses on the needs of the residents. Further there is a need in the LTC industry for training programs for LTC facility caregivers.  
       SUMMARY OF THE INVENTION  
       [0006] In accordance with the invention, there is provided a method for operating a long term care facility comprising observing a resident&#39;s behavior, entering at least one observation in an input device and receiving information from the input device based on the at least one observation. There is also provided a method for operating a long term care facility comprising providing training to a caregiver on age related issues, providing training to a caregiver on how to recognize a problem in a resident, providing training to a caregiver on how to respond to a problem in a resident, and providing an input device for entering an observation and receiving information based on the observation.  
       [0007] There is further provided a system for operating a long term care facility comprising means for entering an observation and means for receiving information based on the observation.  
       [0008] Still further, there is provided a computer readable medium containing instructions for controlling a computer system to perform a method comprising receiving electronically at least one observation, providing information electronically based on the at least one observation, and storing the at least one observation in a database. There is also provided a computer readable medium containing instructions for controlling a computer system to perform a method comprising providing training to a caregiver on age related issues, providing training to a caregiver on how to recognize a problem in a resident, providing training to a caregiver on how to respond to a problem in a resident, and receiving an observation and providing information based on the observation.  
       [0009] Advantages of the invention will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The advantages of the invention will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims.  
       [0010] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed. 
     
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
     [0011] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several embodiments of the invention and together with the description, serve to explain the principles of the invention.  
     [0012]FIG. 1A illustrates an environment in which traditional LTC facilities operate.  
     [0013]FIG. 1B illustrates an environment in which to practice the systems and methods consistent with the present invention.  
     [0014]FIG. 2 illustrates a method for operating a LTC facility consistent with the present invention.  
     [0015]FIG. 3 illustrates a method for providing training to a caregiver.  
     [0016]FIG. 4 illustrates a method for operating a LTC facility consistent with the present invention from a caregiver&#39;s point of view.  
     [0017]FIG. 5 illustrates a method for operating a LTC facility consistent with the present invention from an observation processing system&#39;s point of view. 
    
    
     DESCRIPTION OF THE EMBODIMENTS  
     [0018] Reference will now be made in detail to the exemplary embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.  
     [0019]FIG. 1A illustrates an environment  100 A in which traditional LTC facilities  110 A operate. Environment  100 A comprises one or more LTC facilities  110 A, each having one or more administrators  120 A, one or more caregivers  130 A, and one or more residents  140 A.  
     [0020] Traditional LTC facilities  110 A are designed based on a medical model. Under the medical model, caregiver  130 A is trained to function similar to an assistant in a hospital. For example, caregiver  130 A is trained to take resident&#39;s  140 A temperature and give resident  140 A medicine. There is no training on how to evaluate the physical and/or emotional needs of residents  140 B. Accordingly, today&#39;s caregivers  130 A lack the skills, the tools, and the motivation to make assessments of the needs of residents  140 A. Further, under the medical model, traditional LTC facilities  110 A focus on delivering products and services instead of focusing on the needs of residents  140 A. While operating a LTC facility  110 A based on a medical model may be effective for healing, the medical model does not bring satisfaction to residents  140 A, resulting in high dissatisfaction departures by residents  140 A or depression in those residents  140 A that remain at the LTC facility  110 A.  
     [0021] According to social science and medical research, general health is positively correlated with a sense of well-being, fulfillment, and happiness. Therefore, it is absolutely essential that a LTC facility develop a culture that facilitates positive emotions in residents  140 A. Unfortunately, the current LTC facilities  110 A have failed to provide a culture that facilitates positive emotions in residents  140 A. Instead, the LTC industry has built LTC facilities  110 A expecting residents  140 A to adjust to the facilities  110 A instead of adjusting the facilities  110 A to meet the emotional needs of residents  140 A. Further, traditional LTC facilities  110 A are not designed to handle the changing needs of residents  140 A as they age. Still further, caregivers  130 A are generally fatigued, disinterested, poorly managed, and under-trained, resulting in abuse and neglect of residents  140 A.  
     [0022] Being acutely sensitive and vigilant to the needs of residents  140 A is one of the keys to reducing risk, providing quality service, and increasing resident  140 A satisfaction. Accordingly, LTC facilities  110 A need to become skilled at observing, recognizing, capturing, and acting upon the needs of residents  140 A. Administrators  120 A must understand the needs of residents  140 A including the psychological needs of residents  140 A and the emotional issues affecting residents  140 A. Further, administrators  120 A must ensure that caregivers  130 A have sufficient knowledge of the needs of residents  140 A, sufficient intervention skills, and are trained to adjust to the changing level of services required by residents  140 A as they age. Still further, administrators  120 A must understand and manage culture to provide meaningful satisfaction to residents  140 A and caregivers  130 A.  
     [0023] Accordingly, systems and methods for operating a LTC facility consistent with the present invention focus on the needs of the residents. Further, systems and methods for operating a LTC facility consistent with the present invention provide a culture that facilitates positive emotions in the residents. Still further, systems and methods for operating a LTC facility consistent with the present invention staff the LTC facility with trained caregivers focused on the needs of the residents.  
     [0024] Focusing on the needs of resident  140 A may be achieved by increasing caregiver&#39;s  130 A knowledge of aging, increasing caregiver&#39;s  130 A skill sets (i.e., action specific responses to the resident&#39;s needs), and improving caregiver&#39;s  130 A attitude. A caregiver&#39;s  130 A knowledge, skill sets, and attitude is known collectively as Behavior Capital™. Caregiver&#39;s  130 A Behavior Capital™ may be improved through curriculum training. However, improving Behavior Capital™ may not change a caregiver&#39;s  130 A actions. Behavior Capital™ may only be useful in a framework of rules, guidelines, and incentives that govern the complex nature of staff actions and interactions (i.e., culture).  
     [0025] Accordingly, systems and methods for operating a LTC facility consistent with the present invention facilitate improving a caregiver&#39;s Behavior Capital™ and providing a framework of rules, guidelines, and incentives for changing a caregiver&#39;s actions.  
     [0026] Uniform, consistent, and predictable actions by caregivers  130 A are also required to reduce risk, provide quality service, and increase resident  140 A satisfaction. Successful behavioral change is a function of the frequency and quality of personnel monitoring, management, and maintenance activities. In a workplace, it is very difficult to provide a continuous flow of personnel monitoring, management, and maintenance activities. Even in the best workplace environments, only intermittent management and direction is possible. In the LTC industry, caregivers  130 A are given limited guidance by administrators  120 A who are generally distant to the activities and the realities of caregivers  130 A. As a result, caregivers&#39;  130 A behavior may be inconsistent and unpredictable.  
     [0027] To achieve uniform, consistent, and predictable actions by caregivers  130 A that reduce risk, provide quality service, and increase resident satisfaction, universal controls over caregivers&#39;  130 A actions that concentrate caregivers&#39;  130 A attention on the needs on residents  140 A are required. Systems and methods for operating a LTC facility consistent with the present invention provide universal controls over caregivers&#39;  130 A actions to ensure uniform, consistent, and predictable actions by utilizing a handheld observation manager (HOM™).  
     [0028] Further, training caregivers  130 A in the habit and process of observing residents  140 A may concentrate caregivers&#39;  130 A attention on residents  140 A thereby reducing risk, providing quality service, and increasing resident satisfaction. Training caregivers  130 A in the habit and process of observing residents  140 A also enables anticipating and solving problems before they occur. For example, if a caregiver  130 A is trained to observe the type of shoes resident  140 A is wearing, caregiver  130 A may prevent a fall by observing that resident  140 A is wearing inappropriate shoes and assisting resident  140 A in replacing the shoes for more appropriate shoes.  
     [0029] Accordingly, systems and methods for operating a LTC facility consistent with the present invention provide training to caregiver  130 A in the habit and process of observing residents  140 A. HOM™ in combination with caregiver training provide universal controls over caregivers&#39;  130 A actions that concentrate caregivers&#39;  130 A attention on the needs on resident  140 A.  
     [0030]FIG. 1B illustrates an environment  100 B in which to practice the systems and methods consistent with the present invention. Environment  100 B comprises one or more LTC facilities  110 B, a resource partner  170 , an observation processing system  180 , and a database  190 . Each LTC facility  110 B comprises one or more administrators  120 B, one or more caregivers  130 B, one or more residents  140 B, and one or more handheld observation managers (HOMs™)  150 . Observation processing system  180  includes a processor (not shown) comprising computer instructions for implementing methods consistent with the present invention.  
     [0031] LTC facility  110 B may include any senior housing facility such as a nursing home, assisted living facility, independent living facility, board and care home (a/k/a adult family home, adult foster care, or group home), continuing care retirement community, adult day care facility (a/k/a senior day care facility), home health care facility, hospice facility, or hospital. The LTC facility  110 B may be public, private, for profit, non-profit, licensed, unlicensed, or any combination of the foregoing.  
     [0032] For each LTC facility  110 B, administrator  120 B manages LTC facility  110 B including caregivers  130 B. Resource partner  170  may be a person or entity that provides assistance to administrator  120 B in operating LTC facility  110 B consistent with the teaching of the present invention.  
     [0033] Caregivers  130 B observe and interact with residents  140 B. HOM™  150  maybe a handheld device (e.g., a palm pilot) that is used by caregiver  130 B to enter observations. These observations are transmitted to the database  190  via connection  155 . The data stored in database  190  may be retrieved by or transmitted to administrator  120 B and resource partner  170  via connections  125  and  175 , respectively. In addition, the data stored in database  190  may be retrieved by or transmitted to a family member, a solution provider (e.g., a physician), or any other authorized person or entity. For example, the data may also be transmitted to a regulatory entity such as Medicare.  
     [0034] Connections  125 ,  155 ,  175  may be any system, network, or device that facilitates communication (e.g., data communication or telecommunication) using any appropriate communication protocol (e.g., TCP/IP, HTTP, HTTPS or any other security protocol, FTP, SMTP, or any other proprietary protocol). Connections  125 ,  155 ,  175  may comprise a local area network (LAN) connection, a wide area network connection, an Internet connection, or a combination of the foregoing. Connections  125 ,  155 ,  175  may also comprise a telephone line, optical fiber, coaxial cable, twisted wire pair, or a combination of the foregoing. In addition, connections  125 ,  155 ,  175  may be a wireless connection using any appropriate technique to provide wireless transmission including infrared line of sight, cellular, microwave, satellite, packet radio, spread spectrum, or a combination of the foregoing.  
     [0035] Generally, caregiver  130 B uses HOM™  150  to report observations of resident  140 B and to receive instructions on how to interact with resident  140 B based on the observation. Caregiver  130 B may observe and report general conditions (e.g., weather, conditions in a room, etc.) and incidents (e.g., accidents, emotional outburst, etc.). Generally, for each observation, caregiver  130 B reports resident&#39;s  140 B activity (i.e., what resident  140 B is doing), resident&#39;s  140 B location, and the time of day. For example, caregiver  130 B may observe and report that resident  140 B is sifting in the recreation room, eating in the dining room, standing and talking in the courtyard, or sleeping in the bedroom. The amount and frequency of the observations may be any amount and frequency that reliably reflects the conditions of the environment and the profile of resident  140 B.  
     [0036] Caregiver  130 B may also observe and report resident&#39;s  140 B response to caregiver&#39;s  130 B interactions with resident  140 B. For example, suppose caregiver  130 B observes that resident  140 B is unhappy and enters this observation in HOM™  150 . Caregiver  130 B may receive via HOM™  150  one or more solutions for making resident  140 B happy. For example, HOM™  150  may suggest that caregiver  130 B turn on the television, greet resident  140 B, or pat resident  140 B on the back. Caregiver  130 B may implement one or more of the solutions and observe and record resident&#39;s  140 B response to each solution. For example, if caregiver  130 B turns the television on but resident  140 B is unresponsive, then caregiver  130 B may observe and report resident&#39;s  140 B unresponsiveness to turning on the television. If caregiver  130 B greets resident  140 B and resident  140 B smiles, then caregiver  130 B may observe and report that resident  140 B smiled in response to a greeting. This information may be used in the future to determine the appropriate solution for making resident  140 B happy. For example, it may be determined based on past reported observations that resident  140 B does not like watching television. Therefore, HOM™  150  may not return a solution to turn on the television when caregiver  130 B enters an observation that resident  140 B is unhappy. Instead, based on past reported observations, HOM™  150  may return a solution to caregiver  130 B to greet resident  140 B.  
     [0037] HOM™  150  may comprise observation menus providing a plurality of predetermined observations, which caregiver  130 B may pick and select to enter observations. Providing predetermined observation allows caregiver  130 B to efficiently report observations. For example, if caregiver  130 B observes a particular behavior, then caregiver  130 B may pick the appropriate menu and select the appropriate behavior.  
     [0038] HOM™  150  may include a menu having a list of mutually exclusive behaviors. These mutually exclusive behaviors (i.e., behaviors that resident  140 B may not perform concurrently) may include sitting, standing, lying, walking, running, etc. HOM™  150  may also include a menu having a list of concomitant behaviors (i.e., behaviors that resident  140 B may perform concurrently) such as smoking, talking, play cards, watching television, etc. HOM™  150  may include a menu having a list of locations in LTC facility  110 B (e.g., dining room, bedroom, recreation room, courtyard, etc.). Still further, HOM™  150  may include a menu having a list of foods and drinks. HOM™  150  may also include a menu having a list of medications (e.g., prescription or over-the-counter drugs).  
     [0039] HOM™  150  may also include a menu having a list of regulatory items that caregiver  130 B must record. For example, Medicare has regulations that LTC facility  110 B must comply with to receive reimbursements for products and services. The regulations may require caregiver  130 B to check a resident  140 B for bedsores, to turn resident  140 B over a predetermined number of times, or to get resident  140 B out of bed for exercise.  
     [0040] The menu items available to caregiver  130 B may be customized for a particular LTC facility  110 B and/or customized to a resident  140 B. For example, suppose a LTC facility  110 B has a recreation room, but not a courtyard. To customize HOM™  150  to LTC facility  110 B, the location menu having a list of locations in LTC facility  110 B may include a recreation room, but not a courtyard. As another example, suppose a resident&#39;s  140 B weight needs to be monitored based on a physician&#39;s instructions. HOM™  150  may be customized so that caregiver  130 B may report resident&#39;s  140 B weight.  
     [0041] In addition to providing a mechanism for entering observations, HOM™  150  may guide, direct, and monitor the nature and quality of caregiver&#39;s  130 B actions. HOM™  150  may be characterized as a constant management companion. HOM™  150  brings a meaningful, measurable, and verifiable resident focus to all caregiver  130 B behavior. HOM™  150  overcomes the management control difficulties discussed above by facilitating a continuous flow of personnel monitoring, management, and maintenance activities. HOM™  150  may be used to monitor caregiver&#39;s  130 B actions to ensure that caregiver  130 B is focusing on resident  140 B by determining whether caregiver  130 B is entering a predetermined volume of observations at a predetermined frequency. For example, administrator  120 B may instruct caregiver  130 B to enter twenty-four observations of a resident  140 B over an eight hour period at a rate of three observations every hour. When caregiver  130 B enters an observation into HOM™  150 , the observation may be time-stamped to determine when the observation was entered. Administrator  120 B may monitor caregiver&#39;s  130 B actions by retrieving the observations entered by caregiver  130 B from the database  190 . If caregiver  130 B meets the requirements, then caregiver  130 B may be rewarded. Once caregiver  130 B learns that a record is being produced of his/her behavior and learns what behavior produces a reward, then caregiver  130 B may change his behavior to receive a reward. HOM™  150  serves to provide purpose and direction to caregiver  130 B in a way that results in behaviors that are goal seeking, uniform, and unifying in culture. Thus, HOM™  150  also facilitates behavior management.  
     [0042] Further, a management control system that enhances self-esteem and confidence is essential. Having confidence in knowing what to do and how to do it is a powerful contributor to the satisfaction of caregiver  130 B, which may reduce caregiver  130 B turnover rates. By continuously guiding caregiver&#39;s  130 B actions, HOM™  150  improves caregiver&#39;s  130 B self-esteem and confidence.  
     [0043] Observation processing system  180  predicts risks by creating norms based on the observations received from HOM™  150  and stored in the database  190 . Based on observations on a resident  140 B, the processing system  180  may determine a profile of resident  140 B. The processing system  180  may detect a deviation in the profile of resident  140 B, which may signal the processing system  180  to problems or increased risks.  
     [0044] The processing system  180  may flag anomalous behavior in a resident  140 B based on the observations stored in the database  190 . For example, suppose the observations stored in the database  190  indicate that a resident  140 B usually plays cards four out of five days a week between 11:00 a.m. and 12:00 noon. If observations indicate that resident  140 B is no longer playing cards, then the processing system  180  may determine that resident&#39;s  140 B lack of playing cards is an anomalous behavior and may send a message to caregiver  130 B via HOM™  150  to check on resident  140 B or interact with resident  140 B to determine if there is a problem. The processing system  180  may also send a message to administrator  120 B or some other person or entity (e.g., family member or doctor) when an anomalous behavior is discovered.  
     [0045] The processing system  180  may also create an anticipated agenda of resident&#39;s  140 B activities based on the observations stored in the database  190 . For example, data stored in the database  190  may suggest that resident  140 B typically awakens at 8:00 a.m., eats breakfast at 8:30 a.m., takes a walk at 9:00 a.m., plays cards at 10:00 a.m., eats lunch at 12:00 noon, and watches television from 1:00 p.m. to 3:00 p.m. Based on this data, the processing system  180  may create an anticipated agenda of resident&#39;s  140 B activities and transmit the anticipated agenda to caregiver  130 B via HOM™  150  or to some other person or entity.  
     [0046] The anticipated agenda builds predictability around the activities and behavior of resident  140 B that may be useful in assisting resident  140 B to fulfill the agenda, which may provide a more fulfilling lifestyle for resident  140 B. For example, if the processing system  180  determines based on data stored in the database  190  that resident  140 B likes to watch a particular television show at 1:00 p.m., but needs assistance changing the channel, the anticipated agenda created by the processing system  180  may include an entry that resident  140 B is expected to watch the particular television show at 1:00 p.m. and needs assistance changing the channel. Once caregiver  130 B receives the agenda via HOM™  150 , caregiver  130 B could ensure that resident  140 B is able to watch the television show at 1:00 p.m. by providing assistance to change the channel. Thus, by knowing resident&#39;s  140 B agenda, caregiver  130 B knows what to do to support the fulfillment of that agenda for resident  140 B.  
     [0047] As another example, the processing system  180  may determine that resident  140 B generally experiences a leg ache each day at the same time. The data stored in database  190  may include information on what has been done in the past to alleviate resident&#39;s  140 B leg ache. The information may include successful and unsuccessful solutions to alleviate resident&#39;s  140 B leg ache. Based on this information, the processing system  180  may transmit instructions to caregiver  130 B via HOM™  150  to check on resident&#39;s  140 B at a specified time and may also suggest a solution to alleviate resident&#39;s  140 B leg ache based on the successful solutions stored in the database  190 .  
     [0048] Further, the processing system  180  may determine based on the data stored in the database  190  whether resident&#39;s  140 B support needs have increased. If the processing system  180  determines that resident&#39;s  140 B support needs have increased, then a message may be sent to caregiver  130 B to provide additional support to resident  140 B. This facilitates aging in place.  
     [0049] The processing system  180  may also produce reports based on the data stored in the database  190 . For example, the processing system  180  may produce a report that caregiver  130 B would typically have to prepare providing caregiver  130 B with more time to spend with resident  140 B.  
     [0050] Still further, the processing system  180  may assign one or more scores to a resident  140 B. For example, the processing system  180  may assign a score for the general health of resident  140 B and/or for the activity level of resident  140 B. The processing system  180  may also assign a score relating to regulatory compliance. Scores for a group a residents  140 B may also be assigned. The processing system  180  may compare one resident&#39;s score to another resident&#39;s score or to a group score. Further, the processing system  180  may detect a change in resident&#39;s score or the group&#39;s score. When the processing system  180  detects a change in resident&#39;s score or the group&#39;s score, the processing system  180  may notify caregiver  130 B via HOM™  150 . The processing system  180  may also notify the administrator  120 B or some other person or entity. A change in a resident&#39;s score or a group&#39;s score may indicate a problem with one or more caregivers  130 B. For example, if resident&#39;s score or a group&#39;s score changes only when one or more caregivers  130 B are working, then it may be determined that the one or more caregivers  130 B are not properly performing their job.  
     [0051] The processing system  180  may also detect changes in resident&#39;s  140 B social behavior and recreational activity based on the data stored in the database  190 . Based on a change in resident&#39;s social behavior and/or activity score, the processing system  180  may predict the emotional state of resident  140 B. For example, the processing system  180  may predict whether resident  140 B is depressed, confused, afraid to take actions, or experiencing a loss of motivation or energy. A drop in the activity score may indicate that resident  140 B is depressed or has lost motivation, for example. The processing system  180  may also infer whether resident  140 B is experiencing a loss in personal management skills (e.g., unable to handle a bar of soap properly) or chronic indecision.  
     [0052] The processors  180  may determine based on the data stored in the database  190  the physical state of resident  140 B. For example, the processing system  180  may detect whether resident  140 B is experiencing memory loss or loss of mobility. The processing system  180  may also quantify the frailty of resident  140 B. The processor  189  may detect whether resident  140 B has Alzheimer&#39;s.  
     [0053] As mentioned above, caregiver&#39;s  130 B Behavior Capital™ (i.e., caregiver&#39;s knowledge, skill sets, and attitude) may be improved through curriculum training. In one embodiment, curriculum training may be provided via distant learning (e.g., via Internet, videotape, CD-ROM, DVD, or other recording medium). Curriculum training may comprise three phases: instruction, modeling, and guided participation. During the instruction phase, caregiver  130 B learns through instructions. That is, caregiver  130 B learns through written and/or oral lessons. During the modeling phase, the written and/or oral lessons are reinforced through demonstrations of the lessons. The guided participation phase further reinforces the written and/or oral lessons by allowing caregiver  130 B to practice what was learned during the previous phases. For example, suppose it is desired to teach caregiver  130 B how to properly check a resident  140 B for bedsores. Caregiver  130 B receives written or oral lessons during the instruction phase on how to properly check for bedsores. If the curriculum training is being conducted via distant learning, caregiver  130 B may receive written or oral lessons via the Internet or via a videotape, CD-ROM, DVD, or other recording medium. Alternatively, caregiver  130 B may receive written or oral lessons in a classroom setting. During the modeling phase, caregiver  130 B may see a demonstration on how to properly check for bedsores. During the guided participation phase, caregiver  130 B practices (e.g. on a person or model) how to properly check for bedsores.  
     [0054] During curriculum training, caregiver  130 B may gain knowledge on the aging process and aging issues, which include anything that may impact on the life of a resident  140 B as they age. For example, caregiver  130 B may gain knowledge on issues related to Alzheimer, memory loss, hearing loss, eyesight loss, strokes, cancer, or heart disease. Caregiver  130 B may also gain knowledge on issues related to motion and mobility such as osteoporosis and arthritis. Still further, caregiver  130 B may gain knowledge on issues related to injuries such as fractures, burns, bruises, contusions, and chronic pain.  
     [0055] Further, during the curriculum training, caregiver  130 B learns how to observe and recognize problems in resident including social or behavior changes. For example, caregiver  130 B may learn how to observe and recognize when a resident is having a stroke or suffering memory loss. Indicators or predictors of problems may include weight loss, hearing loss, falls, high blood pressure, and high cholesterol, which caregiver  130 B may learn to recognize during the curriculum training. Caregiver  130 B may also learn how to recognize suspicious, sluggish, incoherent, and/or radical behavior in resident  140 B. Caregiver  130 B may also learn how to recognize failing physical resources in resident  140 B, such as hearing, eyesight, and muscular control.  
     [0056] Still further, during the curriculum training, caregiver  130 B may learn skills that impact on the quality of life for resident  140 B including skills that facilitate aging in place. For example, caregiver  130 B may learn skills for helping a resident  140 B that has suffered a stroke through a rehabilitative process. Caregiver  130 B may also learn lifestyle enhancement behavior and strategies. This includes training caregiver  130 B to interact with resident  140 B in a way that brings comfort to resident  140 B. This also includes training caregiver  130 B to understand resident&#39;s  140 B interest and to help resident  140 B get involved in activities that support resident&#39;s  140 B interest. Caregiver  130 B may also learn risk avoidance strategies such as fall prevention. For example, caregiver  130 B may learn how to determine if resident  140 B is wearing appropriate shoes to prevent accidental falls.  
     [0057]FIG. 2 illustrates a method for operating a LTC facility  110 B consistent with the present invention. At stage  210 , LTC facility  110 B provides training to caregiver  130 B on age related issues. Age related issues include anything that may impact on the life of a resident  110 B as resident  110 B ages. For example, age related issues may include issues related to at least one of the following: the aging process; age related medical problems such as strokes, cancer, heart disease; age related cognitive/memory problems such as Alzheimer, dementia, or memory loss; failing physical resources such as hearing loss, eyesight loss, or muscular control; motion and mobility problems such as osteoporosis and arthritis; injuries such as fractures, burns, bruises, contusions, and chronic pain; and psychological problems such as depression, confusion, or chronic indecision.  
     [0058] At stage  220 , LTC facility  110 B provides training to caregiver  130 B on how to observe and recognize a problem in resident  140 B. A problem may include any action, condition, or any other thing that has or may have an adverse affect (including physical, mental, or psychological affect) on resident  140 B. For example, a problem may include a physical, mental, or psychological condition of resident  140 B. Further examples of a problem include weight loss, high blood pressure, high cholesterol, social or behavior changes, suspicious behavior, sluggish behavior, incoherent behavior, radical behavior, a stroke, failing physical resources such as hearing, eyesight, and muscular control, or wearing inappropriate shoes.  
     [0059] At stage  230 , LTC facility  110 B provides training to caregiver  130 B on how to respond to a problem. This may include training caregiver  130 B in risk avoidance strategies. This may also include training caregiver  130 B in lifestyle enhancement behavior and strategies. Still further, this may include training caregiver  130 B on using HOM™  150  to enter problems and receive solutions.  
     [0060] At stage  240 , LTC facility  110 B provides an input device to caregiver  130 B for entering an observation and receiving an instruction based on the observation. The input device may be HOM™  150  or any other handheld computer such as a palm pilot.  
     [0061]FIG. 3 illustrates a method for providing the training recited at stages  220  and  230 . At stage  310 , LTC facility  110 B provides written or oral lessons. At stage  320 , LTC facility  110 B provides modeling on the lessons. At stage  330 , LTC facility  110 B provides guided participation on the lessons.  
     [0062]FIG. 4 illustrates a method for operating LTC facility  110 B consistent with the present invention from caregiver&#39;s  130 B point of view. At stages  410 ,  420 , caregiver  130 B observes resident  140 B and enters an observation in an input device. An observation may include any action, condition, or anything else observed. As discussed above, generally, for each observation, caregiver  130 B reports resident&#39;s  140 B activity, resident&#39;s  140 B location, and the time of day. Caregiver  130 B may also observe and report resident&#39;s  140 B response to caregiver&#39;s  130 B interactions with resident  140 B. The input device may be a HOM™  150  or any other handheld computer such as a palm pilot.  
     [0063] At stage  430 , caregiver  130 B receives information from the input device based on the observation. Information may include a command, a suggestion, a warning, or any other information. As discussed above, the input device may return a warning of anomalous behavior, one or more suggestions for assisting resident  140 B, or an anticipated agenda of resident  140 B.  
     [0064]FIG. 5 illustrates a method for operating LTC facility  110 B consistent with the present invention from the observation processing system&#39;s  180  point of view. At stage  510 , system  180  receives electronically at least one observation. At stage  520 , system  180  provides information electronically based on the at least one observation. Information may include a command, a suggestion, a report, a warning, or any other information. For example, system  180  may send a message to administrator  120 B, caregiver  130 B, or some other person or entity when an anomalous behavior is discovered or may send an anticipated agenda of resident&#39;s  140 B to caregiver  130 B or some other person or entity. As another example, system  180  may produce reports based on the observation. At stage  530 , system  180  stores the at least one observation in database  190 .  
     [0065] At stage  540 , system  180  transmits the observation to an authorized person such as a family member, a solution provider (e.g., a physician), or any other person or entity that has permission to receive the observation.  
     [0066] Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. For example, HOM™  150  and observation processing system  180  may be used in any industries where controlling complex behavior is desirable. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.