Prevent elopement in healthcare facilities
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January 12, 2017
Who are those most likely to try to escape, and what are some of the ways you can prevent it?
In long-term care facilities, one of the greatest risks to elderly residents is their ability to leave the facility unseen and put themselves in harm’s way. Called elopement, this is often associated with wandering, an act whereby the person is disoriented or disengaged in his or her environment and goes about seeking someone or something or just wanders randomly.
The critical first 48 hours
Elizabeth Gould, MSW, is the director of state programs at the Alzheimer’s Association in Chicago. Gould reports that people who wander persistently are the source of 80% of elopement cases. Additionally, she notes that 45% of these incidents occur within the first 48 hours of admission to the residence.
For those in the role of protecting residents—including administrators, staff, and security at long-term care facilities—Gould stresses it is important to understand why a person wanders, so the necessary safeguards can be anticipated.
For the elderly, especially those with cognitive issues, wandering may serve as a form of communication for both physical and psychological needs. Wandering may indicate something as elemental as needing to use the bathroom or wanting a glass of water, or it may be a reaction to something in the environment that is irritating to the resident. Other factors behind wandering include medical or emotional conditions or the desire for physical stimulation, such as wanting to feel the warmth of the sun.
By understanding someone’s needs, says Gould, security and others may be able to anticipate what is necessary before the wandering or elopement takes place. Staff should be especially aware of these issues when a resident first enters a facility, because a new environment often triggers a desire to return home.
Have a “lost person” plan
Gould says all staff involved with residents should be trained on the risks of wandering and the approaches for prevention. In its Dementia Care Practice Recommendations, the Alzheimer’s Association outlines several effective staff approaches, such as developing a care plan based on a resident assessment that allows mobility but takes into consideration wandering patterns; working with residents to develop a feeling of safety and familiarity with staff; alerting staff about those who have a tendency to wander and under what conditions it may occur; and providing additional staff assistance as new residents adjust to the environment.
Facilities also should have a “lost person” plan in place that can be activated in the event of an elopement, says Gould. The plan begins with regular accounting for residents, such as at mealtimes and shift changes. Another component is developing a sign-in/sign-out policy for family and visitors who take residents out of the facility.
If an elopement does occur, having recent photos of residents and their former address is important so police can look for and follow up on exiting seniors. Management, family, law enforcement, and state agencies as required should be notified when someone elopes from the residence and police should be provided with a description of what the person was wearing. Within and around the facility, staff should carry out an organized search, keeping in mind that the person, especially if he or she has dementia, may not respond to his or her name.
For some facilities, using electronic devices to track patients with memory or wandering issues provides an extra layer of prevention and protection. Al Arzola, the facilities director at the 250-resident TLC Care Center in Henderson, Nevada, says he uses a cut band system from Accutech for the 20 residents of the facility’s Alzheimer’s unit.
Residents in that part of the building wear wristbands with transmitters. The bands can set off different sounding alarms depending on the situation, he says. If someone is playing with the band, one alarm will sound, while a much louder, persistent one sounds if the band is cut. A softer alarm is triggered if a resident loiters in one spot for an extended period, and there is yet another alarm if someone exits through the unit’s doorway.
Arzola says that for staff one of the biggest learning curves is recognizing the different alarms and responding accordingly. For those wearing the bands, the transition has been quite easy.
Other precautions for reducing elopement
In addition to the alarm system, Arzola says TLC has taken other precautions to reduce elopement, such as having windows that only partially open and closing facility doors at 8 p.m. each evening so anyone leaving the building has to go through the front doors. All staff, from nurses and aides to housekeeping personnel, are also trained on the signs of wandering and elopement, he says. Arzola notes that making sure the right residents are assigned to the proper units also helps with security procedures.
If a facility is going to use an electronic monitoring system, Arzola says there needs to be a review of the facility to see how easily it can be fitted for the system and if it continues to meet local and state regulations for fire and patient safety.
Even if a facility has an electronic monitoring system or uses wrist, bed, or chair alarms for individual patients, Gould says it may be beneficial to enroll the patients in the Alzheimer’s Association’s Safe Return program—a nationwide program that helps identify, locate, and return dementia patients to their homes.
Editor’s note: Portions of this story originally appeared in Facility Care, a publication of Thompson Information Services.