Based on my experiences in healthcare, this presentation outlines how wandering detection is very much possible. This executive reflection is intended for directors and board members in healthcare who must provide freedom of movement for their clients in a controlled, lawful, and accepted manner.

Paul Jacobs: “It is not just about technology, but about the clinical problem and the individual client situation.“

Solution-oriented implementation of the Care and Coercion Act 

The use of technology in long-term care is developing at a rapid pace. Especially regarding conditions like dementia and Alzheimer’s, we face an urgent challenge: how do we safeguard the freedom and autonomy of residents while simultaneously organizing safety and supervision?

Wandering behavior is one of the most complex issues in this regard. New technologies, such as wandering detection via facial recognition, are increasingly mentioned as a solution.

But how does this application relate to the Care and Coercion Act, and what does it require from healthcare institutions? The law is clear: freedom is the starting point; involuntary care is the last resort. Technological interventions, in any form, must be proportional and effective, with the free choice of the client or their legal representative being a primary condition.

As an executive, you should therefore not focus primarily on the technology, but on the clinical problem and the individual client situation.

The Application

Wander detection with facial recognition, cameras at exits or high-risk points are linked to the 20faceXS solution, which recognizes residents. When a resident with an increased wander risk approaches a certain zone, a care professional is alerted. The facial vectors of only those residents with an increased wander risk are known in the locally hosted software; therefore, this does not apply to other residents, staff, family, visitors, or suppliers. The goal is to prevent the door/lock from opening and to inform staff in advance for an intervention. Existing overrule mechanisms for fire alarm systems or emergency buttons remain active and present; nothing changes in that regard.

Fit for Purpose

The use of wandering detection can fit within the Care and Coercion Act, provided all steps are carefully followed. The problem analysis must be clearly established, and alternatives must be investigated. If alternatives are insufficient to mitigate the wandering risk, it is important to record everything in the care plan and closely involve the family/legal representative.

Our experience is that the stigma or malfunctioning of wearables is often reason enough to propose facial recognition as an alternative; sometimes the responsibility currently lies with a receptionist. Being able to rescind the chosen option is also part of the explanation, as is clarifying which client data is recorded. 20face only records the facial vector and an identifier of the client, such as the room number or client ID from the EHR (Electronic Health Record). Furthermore, the use of facial recognition may never be a replacement for basic care or a solution for staffing shortages; the law does not allow for that.

Processing of Special Categories of Personal Data

Facial recognition processes biometric personal data. Under the GDPR, this is a special category with heightened protection requirements. Therefore:

• Performing a Data Protection Impact Assessment (DPIA) is mandatory.

• There must be a clear legal basis (often: vital interests or legal obligation within healthcare).

• Data minimization: no storage of visual footage unless strictly necessary.

• Transparency towards residents and representatives.

• Involvement of the Data Protection Officer (DPO).

• Clear agreements with suppliers (Data Processing Agreement).

From a governance perspective, this is a significant point. Reputational risk and supervision by the Data Protection Authority are real. 20face supports organizations in achieving the above, and through a preliminary study based on the SCOPAFIJTH analysis, all aspects are addressed and recorded so that everyone can verify that all steps have been taken to make wandering detection possible. Read more about the privacy rules here.

Ethical Dimension: Safety versus Dignity

The core question is not technical or legal, but normative: “Does this technology contribute to dignified care?” In people with dementia, we often see that wandering behavior is not “problem behavior,” but an expression of restlessness, a need for meaning, or disorientation.

A carefully designed application can actually:

• Enable greater freedom of movement.

• Reduce physical restraint.

• Safely guide nocturnal restlessness.

• Reassure family members.

However, without careful implementation, it can also lead to:

• A sense of surveillance.

• Reduced trust.

• A technocratic care culture.

This is where the executive responsibility lies for healthcare board members and directors. Implementing wandering detection is therefore certainly not a purely technical implementation. Most project activities leading up to a go-live involve process design, creating support, communication, and knowledge development among care staff.

Governance: What does this require from healthcare executives?

Before you proceed—and this applies to any innovation in healthcare—you should have the following in place:

• A clear vision on technology and innovation.

• Involved employee/client participation (medezeggenschap).

• Transparency towards regulators.

• Training for employees.

• A balanced assessment of risks and opportunities (business case thinking).

Regarding business case thinking, we want to emphasize that the implementation of wandering detection should not be seen as an efficiency operation, but as a way to increase the freedom of clients, reduce stress and unrest, mitigate environmental stigma, and thus provide a total package for a more pleasant living environment.

Wander detection via facial recognition can therefore be responsibly deployed within the frameworks of the Care and Coercion Act—provided:

• There is an individual risk assessment.

• The Wzd step-by-step plan is carefully followed.

• The GDPR is strictly adhered to.

• The application contributes to actual freedom of movement.

• Continuous evaluation takes place.

Our experiences with the numerous implementations we are now carrying out in healthcare have completed our picture of what truly matters in care, and our customers are happy to share more about this during our seminars or a reference visit.

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