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A DOE Solid-State Lighting video about a GATEWAY evaluation of a trial LED lighting system at the ACC Care Center in Sacramento, CA, featuring commentary by Connie Samla of the Sacramento Municipal Utility District.
Video courtesy of the Department of Energy

The ACC Care Center is a local nursing home in Sacramento. And SMUD has a research and development department that we wanted to try new technology out in the real world. And they partnered with us to try out tunable white LED lighting in a circadian fashion.

We had two primary goals for this study. And the first one was to see if new technology and proper lighting could enhance the health and lives of individuals with dementia, specifically senior citizens, utilizing tunable white lighting and circadian cycle. And then the second goal was to see if we could help reduce or prevent falls by having the proper night lighting.

Well, what's important? The color temperature is important. The intensity of the light is important. What time do you do the color and intensity? And how long do you do that?

What do caretakers need? They need enough light to see their task, right? They need to be alert and awake, especially on the second and third shift. Also, they need to understand the concept of what is circadian lighting.

The answer is sleep-wake cycle, right? It's 24-hour lighting. So we had these subjects in this home for 24 hours. And we thought this would be a great place to test circadian lighting. And also we wanted to improve the lives of at least three individuals. These individuals have dementia, average age is 87, and they are wheelchair-bound.

So what do we typically have in here? Well, we have your fluorescent over-the-bed luminaire. The direct component is controlled by the resident, and the indirect component is controlled by the nurses or the doctors with the switch. This is not adequate lighting.

Nurses had to bring in flashlights. They had to bring in their iPads and turn them over for enough light just to see the legs and the feet of an individual. What if they had to install a catheter? Do they have enough light in these rooms to do that? Not really. And this is very typical lighting for these type of locations.

We had some tunable white cove lighting that we installed on the walls and put a plastic gutter in front of it. We increased the amount of light about three times in that room. That was great.

These are the schedules for that cove lighting. 7 a.m., lights on to 2 p.m., we had 6000K And then 2 p.m. to 6 p.m., we went to 4100 And then from 6 p.m. to 8 p.m., 2700 And then lights out at 8 p.m.

Hallways are very important. This is pretty typical. Fluorescent fixtures, 4100K. A lot of these facilities leave the doors open to the resident rooms. So all of that 4100 Kelvin lighting leads into the rooms. And that's kind of hard to be sleeping at night when all this lighting is going into the room.

All these residents are wheelchair-bound. And if I'm a nurse and I come up to you and I ask you a question, you would normally look up at me. But what else would you see in your field of view? That is pretty glaring. So that registered about over 5,000 candela per square meter. IES has a chart that says an 80-year-old can handle about 1,000 candela per square meter.

So in the hallway, we replaced the luminaires one for one, tunable whites. And we programmed these automatically. So from 7 a.m. to 2 p.m., we had 6500 Kelvin. And we dimmed them down because they were a little intense, 66% output. From 2 p.m. to 6 p.m. we have 4000 Kelvin. And then from 6 p.m. to 7 a.m., they were on at 2700K, dimmed down to 20%.

We worked with the nurses. And the nurses were OK with that amount of lighting in their space. It was only consuming 6 watts at this point. So of course, we saved a ton of energy.

So in the nurse's station, we replaced the three lamp troffers with the same tunable white with manual controls. We really had to educate the nurses on when to use them and why. What's really nice, though, is the nurses on the second and third shift would change these to about 6500 Kelvin to energize them. It's kind of like walking outside at 2 o'clock, and you get energized with the daylight. That's what they were doing at night.

The administrator also told us that coffee consumption has gone down on the second and third shift. Interesting. But also, they can utilize it when residents come out and talk to them. Maybe a resident's kind of agitated, and that resident would come out and talk to the nurses. And the nurses would dim it down to 2700K and help that resident relax a little bit more so that resident could go back to sleep a little quicker than they would have before.

Another thing that we did here is lights for safety because night lighting is very important for seniors because about 80% of the falls happen when they're getting up to go to the restroom and back. So we had an amber rope light on a motion sensor. Pretty simple. But we outlined the bed. So that really made a difference because now these seniors can see the outline of the bed.

Restrooms were glary. This is pretty typical though. And they were fluorescent. They were energy efficient, but they were glary. So we removed the fixtures altogether, and we replaced the mirror with LED-integrated lights in the mirror. And unfortunately, the lumen output was a little too bright, so we had to put them on dimmers.

We also replaced that globe on the ceiling with a nice wall sconce that happened to work on the ceiling. And then these places have to have handrails. Why not have amber LEDs in those handrails on a motion sensor? So any time the resident walked into that bathroom, those lights would come on.

But the cool thing is at night, it was enough light for them to see what they needed to do-- and the nurses also-- that they no longer had to turn that overhead light on. Because once you turn that overhead light on, you bleach out your rhodopsin, and you lose your night vision. For a senior, that can be 30 minutes. And when they go back to their bed, that's when the falls typically occur.

So these are the outcomes. I'm going to read this quote. "The quarter before the lights were installed, we had five falls on Cherry Lane." That was the hallway that was re-lit. The quarter after, it reduced to three falls. But there were no falls in the hallway in the last three months. Between all the hallways, Cherry Lane has fewer falls than all the rest. And a high-fall risk resident moved in in April. From April to October, he's had a 70% reduction in falls.

Residents are sleeping through the night. There was one particular resident that would not get out of his wheelchair. But after those night lights were installed, he would go to sleep in his bed. Can you imagine the quality of sleep he's now getting?

There's also been a reduction in psychotropic and sleep meds. That's huge for a center like this. One of the residents is totally off of her dementia meds. Maybe it's not only the lighting, but the lighting had a huge part in that. The nursing homes are trying to reduce the dependency on psychotropic meds. And lighting is now another tool that they can use to help reduce that.

There's been over a 40% reduction in common behaviors related to dementia, the yelling and agitation and things like that. Because if you think about it, if one resident yells at a nurse, that has ripple effect across the entire facility. And one particular dementia patient really had some severe behaviors. And he had a 70% reduction.

So residents on Cherry Lane that did not get their rooms re-lit are asking to be wheeled out or wheeling themselves out and just hanging out. The administrator is realizing the potential that this hallway has had. She is actually relighting the entire hallway with this tunable white fixture and going to program it the same before the remodel even occurs.

So I think one thing we all know is LEDs can save energy. Dimming LEDs can save even more energy. But what we need to realize is we want to use LEDs to their fullest potential, and we really haven't done that yet.

So when we add tunable white lighting and circadian lighting into the mix, we, as utility partners, can go to our customer and not just save them energy. But now we can be the trusted energy advisor for them and help them in other ways.