Any good nursing home should understand that elopement is a major safety problem that must be prevented. There are numerous steps nursing homes can take to prevent residents from wandering away.
Elopement, in a legal context, refers to the act of "wandering away" from a safe environment. In nursing homes, this occurs when a resident leaves the premises or a designated safe area without proper authorization or the necessary supervision.
Elopement poses severe risks to nursing home residents, often resulting in injuries or death. Common causes of death following elopement include being hit by a vehicle or train, falling, suffering head or bone injuries, drowning in pools or ponds, exposure to extreme temperatures, or wandering into another resident's room where a confrontation might occur. The longer a resident remains missing, the higher the likelihood of serious injury or death.
Nursing homes must never allow a resident to leave unsupervised if it is unsafe. According to the law, neglect is defined as the failure of the facility, its employees, or service providers to provide goods and services necessary to avoid physical harm or emotional distress. If a resident leaves without supervision, the facility is liable for any injuries the resident suffers.
By law, nursing homes must be adequately staffed to ensure that all residents are supervised and safe. Most wandering incidents stem from poor staffing or untrained staff, particularly during periods of low staffing, such as late afternoons, mealtimes, or in underperforming facilities. Residents who are more likely to wander typically have complex medical needs that require increased supervision.
Some residents are more likely to wander than others, especially those with conditions such as dementia, Alzheimer’s, or brain injuries caused by trauma or stroke. About one-third of residents with dementia are prone to wandering, often due to environmental stressors or unmet needs, such as toileting or seeking safety.
People with dementia are highly sensitive to their surroundings and often have a lower threshold for stress. As their disease progresses, they become more susceptible to wandering, particularly when internal discomfort or environmental factors exceed their coping ability.
Risk factors for dementia patients include:
Wandering is not exclusive to Alzheimer’s and dementia patients. Other conditions, including Parkinson’s disease, autism spectrum disorder, Down syndrome, and certain infections, can also lead to wandering. Psychosis caused by long-term medication use or mental status changes due to infections can contribute to wandering behavior.
Residents recovering from stroke or traumatic brain injuries may display wandering behavior due to impaired memory, judgment, or decision-making abilities. Nursing homes must implement safety measures to prevent wandering, regardless of the underlying cause.
Psychological conditions like confusion, forgetfulness, or agitation can increase the likelihood of wandering. Elderly individuals with these conditions may also have other underlying medical issues, and medications they take can exacerbate confusion or agitation. A nursing home must develop a comprehensive care plan that considers all of these factors.
Nursing homes are legally required to assess each resident’s risk of wandering and implement appropriate interventions to prevent it. These interventions should be tailored to the resident's needs and documented in their care plan. Risk assessments are conducted upon admission, quarterly, and whenever there is a significant change in behavior or cognition.
Understanding the reasons behind a resident’s wandering behavior is essential. Factors like boredom, confusion, frustration, or following past routines can trigger wandering. Nursing homes must address these underlying causes to prevent elopement.
Nursing homes must implement specific interventions for residents at risk of wandering, such as:
Nursing homes use various security systems to prevent wandering, including:
Some nursing homes design their memory care units to allow safe wandering. This may include rounded hallways, minimal dead ends, and painting doors to resemble walls to discourage residents from leaving.
Regular monitoring of interventions is crucial. If the current measures are not working, the facility must adjust them to prevent wandering.
If a resident elopes, nursing homes must act immediately. The longer a resident is missing, the higher the risk of death. Research shows that:
Most deaths are caused by hypothermia, dehydration, or drowning. Nursing homes must have a clear plan for locating missing residents and ensure staff know their roles in the search effort.
When residents elope, they generally don’t travel far. Nearly 89% of missing residents are found within a mile of the nursing home. They typically take the path of least resistance, walking on paved or flat areas until they become exhausted or succumb to the environment.
Elopement places an enormous emotional burden on the families of nursing home residents. It is a serious safety concern, and nursing homes must take all necessary steps to prevent it. Proper staff training, care plans, and security measures are essential in protecting residents from wandering away.
A good nursing home recognizes the importance of elopement prevention and takes proactive measures to ensure residents are safe at all times.
