Elopement from a Nursing Home: A Serious and Potentially Deadly Situation
Today, when a person picks up a newspaper and reads a headline like this, “Woman Who Eloped from XYZ Nursing Home Still Missing,” they are not reading happy news like you would find on the social pages detailing weddings and engagements. Elopement from a long-term care facility perspective is certainly not something to smile about since it signals that a resident could be in danger because the nursing home may have failed to ensure their safety.
Nursing home statistics reported in the Journal of Advanced Nursing indicate that 31 percent of residents with dementia wander at least once. This wandering term is used in reference to “a disoriented or mentally-impaired elderly patient’s ability to aimlessly move unsupervised throughout a nursing home or other long-term care facility,putting the resident at risk of entering a potentially dangerous situation.”
If unchecked, wandering frequently leads to elopement—a potentially much more dangerous behavior. Elopement happens when a cognitively impaired resident leaves the premises without being noticed or supervised. When a resident elopes, they can easily become disoriented or lost and suffer from exposure to the elements.They can also be injured or die from a fall, walking onto a busy street or falling into a body of water. There is a 25 percent fatality rate when a resident elopes and is not found within the first 24-hours. This death rate rises to 54 percent after the resident is missing for 96 or more hours.
Here are two examples that demonstrate the potentially deadly results of elopement:
Case Number One
An 84-year-old resident with dementia was found dead outside of the facility last December due to hypothermia. The resident’s family reported that it was the facility’s marketing and promotion regarding the center’s ability to provide special care for persons with dementia that caused them to relocate their family member from the “traditional nursing home” where she lived to the assisted living center.
An investigation by the Wisconsin Department of Health Services reported that the resident had been identified as being at risk for elopement because the center’s records indicated that she tended to wander throughout the center. Yet, on the night the resident eloped,the doors were propped open and no alarms were activated.
Case Number Two
A 77-year-old woman with Alzheimer’ Disease, who had been missing for almost a month, was found dead about two miles away from the nursing home where she lived. When the woman’s body was discovered on September 17, the police and family members had been searching for her since August 23.
A spokesperson described the center as a “secured memory care residence providing an atmosphere that is relaxing, comfortable and safe.”
The resident’s family reported that it was their trust in the facility’s assurances to them about their ability to provide secure care for residents with dementia that caused them to choose this center for the resident.
Both of these long-term care providers had problematic histories and had received numerous citations regarding their failure to provide a safe and secure environment for their residents.
Just like the families of these two residents, most families try very hard to find along-term care provider that they can trust to provide a safe and caring environment for their loved ones. This is an especially big concern when the elderly loved one has dementia or Alzheimer’s.
Section §483.25(d) (1 & 2)of the Code of Federal Regulations (CFR) governing long-term care providers reads like this:
The facility must ensure that –
§483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and
§483.25(d)(2) Each resident receives adequate supervision and assistance devices to prevent accidents.
“Accident” refers to any unexpected or unintentional incident, which results or may result in injury or illness to a resident. This does not include other types of harm, such as adverse outcomes that are a direct consequence of treatment or care that is provided in accordance with current professional standards of practice (e.g., drug side effects or reaction).
“Avoidable Accident” means that an accident occurred because the facility failed to:
• Identify environmental hazards and/or assess individual resident risk of an accident,including the need for supervision and/or assistive devices; and/or
• Evaluate/analyze the hazards and risks and eliminate them, if possible, or, if not possible,identify and implement measures to reduce the hazards/risks as much as possible; and/or
• Implement interventions, including adequate supervision and assistive devices, consistent with a resident’s needs, goals, care plan and current professional standards of practice in order to eliminate the risk, if possible, and, if not, reduce the risk of an accident; and/or
• Monitor the effectiveness of the interventions and modify the care plan as necessary, in accordance with current professional standards of practice.
Here are some specific ways for a facility to interpret the above regulation to provide the expected standard for quality of care and to prevent residents from eloping:
- Each resident should receive an elopement assessment when they are admitted, when they experience significant changes and on a regular basis throughout the year.
- Take pictures of residents who are known to be wanderers/elopers and place them in a notebook on each unit/department. The receptionist should also have a notebook with the pictures of wanders/elopers at his or her station.
- Residents having a high risk for elopement should not be placed on the first floor of a facility or in locations close to an exit.
- Disguise doors so that it is not obvious it is a door. For example, a facility in Canada uses optical illusions on doors to keep dementia patients from wandering. Hidden doors help to distract residents who tend to get upset if they realize they can’t leave.
- Paint a black circle that looks like a hole on the floor in front of emergency doors to deter residents from crossing and trying to exit. Another way to discourage residents is to use tape and create a grid-like pattern on the floor that gives an unstable appearance to the floor.
- During times like shift changes or at the close of visiting hours when people are going in and out of the doors, provide planned activities for the residents that take place in their rooms and in areas away from the doors.
- Maintain adequate staffing to ensure each resident’s safety.
- Provide safe places for a resident to wander.
- Keep walking paths uncluttered and well-lighted.
- Provide an individually-focused variety of sensory stimulating activities for residents at risk of wandering/eloping.
- Create an atmosphere of comfort and familiarity in the resident’s room with favorite pictures, art and other personal touches.
There is a myriad of innovative and creative things that a nursing home can do to reduce the likelihood of elopement and to curb a resident’s desire to wander. The key is to be practicable, but at the same time to think “outside the box.”
Along with all these ideas and suggestions, one thing should not be overlooked—training! It is of vital importance that all staff receive ongoing training regarding the protocol to follow for immediate response to a sounding alarm or the realization that a resident is not where he or she should be or cannot be located and may be missing from the facility.
