Preventing Elopement in Nursing Homes

June 14, 2016

Nearly a third of nursing home residents and up to 70 percent of community-dwelling older adults suffering from cognitive decline wander from their supervised homes at least once during their stay. Wandering describes older adults with dementia who appear to be moving aimlessly, but are often doing so purposefully. Not all wandering is dangerous. Physical activity encourages cognitive and social stimulation and helps maintain mobility in older adults.
However, when wandering is unsupervised, it puts residents at risk for elopement, or leaving a facility, which can result in injury and even death. Elopement is frightening for residents and their families and has resulted in large liability claims and business closures.

Preventing Elopement in Nursing Homes & Long-term Care Facilities

Even with the best intentions, it is difficult to guarantee residents will never attempt to leave their facilities. Therefore, it’s extremely important to have liability insurance. However, the best solution is elopement prevention. Facilities can significantly decrease the risk of elopement and injury by taking these steps:

Know the Red Flags

Some residents are very vocal about their desire to leave a facility. These residents should be checked regularly. Short-term rehabilitation residents who express frustration over the length of their stay but don’t vocalize their complaints are actually at greater risk. Any resident who expresses unhappiness about the duration of their stay or timing of their discharge is at a very high risk for elopement. Additionally, older adults who see themselves as a caretaker (of a pet, garden or even wildlife in their backyard) are at a higher risk as well, as they will attempt to return to the responsibilities they had at home.

Ask the Right Questions

It’s imperative that health care professionals ask the right questions regarding a resident’s behavioral history to get a good sense of their patterns. Did the resident smoke cigars or cigarettes? Did they drink alcohol regularly? Those who did either or both are at a much higher risk of elopement because they won’t have access to alcohol or tobacco in a supervised health care setting, but may attempt to seek either or both out. These activities also are likely to go unreported by the resident or family. Has the resident ever been in a room, unsure how s/he got there? Has s/he ever wandered away at the grocery store for no apparent reason? Or roamed the house without completing a task? The answers can be indicative of emerging cognitive decline, and should be taken seriously. Don’t be fooled by a resident’s record of “no prior incidents.” As memory declines, the risk for wandering increases.

Disguise Exits

One simple way to deter elopement in long-term care facilities is to make exits less obvious to residents. Some facilities have had success painting murals on exit doors or creating never- ending walking paths within the building. If residents wander unsupervised, it will be more difficult for them to actually exit the building.

Use Technology

There is a great deal of emerging technology specific to older Americans with cognitive decline. Bracelets that lock exits when a resident walks by are fairly common. Shoes with GPS chips in them were recently developed. The shoes send alerts if the wearer walks beyond the regulated coordinates. Whereas bracelets can be easily removed, residents are less likely to take off their shoes when attempting to walk outside.

Encourage Interaction Between Nurses and Residents

When nurses have a relationship with their residents, they’re more likely to learn their habits and mitigate the risk of them wandering unsupervised. It is highly encouraged that nurses monitor behaviors and become familiar with individual habits. Having a nurses’ station between residents’ rooms and exits decreases the chance a resident will wander outside unnoticed.

Allow for Supervised Wandering and Mental Stimulation

Residents usually wander for a reason, whether it’s unhappiness at being in the facility or believing they must care for a pet. Permitting and encouraging supervised walks around the facility and in safe areas outside are ultimately beneficial to a resident’s physical health and mental well-being. It also might decrease their risk for wandering alone. A resident may be prone to wandering because nothing in their room is holding their interest. Rooms with aquariums or interesting decorations and artwork tend to hold attention and decrease the risk a resident will walk off.

Carl Bloomfield, AAI
Managing Director, Vice President
The Graham Building
Philadelphia, PA, 19102




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