Elopement and Wandering Off
Wandering off can be a life-threatening situation when it involves an elderly person with dementia or Alzheimer's. Elderly persons can wander into unsafe areas and be injured or killed. The most dangerous form of wandering is elopement in which confused persons leave the protected area of the nursing home or assisted living residence and do not return.
Causes of Elderly Wandering Off and Elopement
Many nursing homes residents are confused and disoriented and must be protected from wandering and elopement. It is estimated that half of all nursing home residents suffer from some form of dementia, most commonly Alzheimer's, and that 11 to 24 percent of institutionalized dementia patients wander. The Nursing Home Reform Act of 1987 requires nursing homes to provide residents with adequate supervision to prevent wandering or elopement. When a resident enters a nursing home, the resident's risk of elopement and/or wandering must be assessed and a care plan must be put into place to prevent harm to residents at increased risk for elopement or wandering.
Assessing Residents for the Risk of Wandering Off and Elopement
Individuals at risk for wandering include individuals with dementia, generally in the early to mid-stage. Nursing homes and assisted living residence should assess each resident when they are admitted for the following:
- Risks for wandering, such as dementia, Alzheimer's disease, and medications that cause confusion
- Prior history of wandering and forgetting whereabouts.
Wandering Off and Elopement - Care Planning
Nursing Homes and assisted living residence are required to develop a care plan for residents who are at increased risk for wandering or elopement. The nursing home or assisted living residence should take precautionary measures that include:
- Developing a proper plan of care
- Using preventive devices, such as alarms or electronic devices on the patient, alarms on the bed, or alarms on the exit doors;
- Monitoring the exit doors at all times, but particularly during shift changes and emergencies, as these are notorious times for residents to slip away unnoticed;
- Moving "at-risk" residents to rooms that allow for closer observation by the nursing staff; and
- Developing an individualized safe wandering program.
Injuries Caused by Wandering Off and Elopement
Wandering and elopement can pose significant dangers for the nursing home resident who wanders, and may result in injury or death. Here are examples of injuries a wandering resident may face:
- Entering areas that are physically unsafe, such as stairwells, poorly lit areas, construction areas, busy streets;
- Getting lost, not being able to find the way back, and suffering from heat or cold exposure, drowning, or being struck by a car or other vehicle.
- Being exposed to chemicals, fire hazards, tools and heavy equipment that pose safety threats;
- Encountering violent persons who may threaten the nursing home resident’s safety, including persons who may rob, assault or otherwise harm the resident;
- Suffering from dehydration or another medical crisis resulting from not having needs met.
It is estimated that dozens of cognitively impaired elderly people die annually as a result of wandering and elopement.
Liability for Elopement and Wandering
When nursing home residents who are not capable of protecting themselves or who are mentally impaired, elope or wander and get hurt or die, the nursing home may be negligent for:
- Lack of supervision
- Failing to hire enough staff to supervise the resident
- Failing to properly train staff on how to supervise residents
- Failing to use alarms or other devices to prevent elopement and/or wandering
- Employing staff who failed to properly respond to an alarm.
There are devices which cost only a few dollars that can prevent elopement or wandering. Exit doors should be alarmed to prevent wandering and notify staff when residents leave the facility unsupervised and the nursing home staff must know how to respond to alarms appropriately. Wrist bands and other devices on clothing that trigger alarms to warn staff that a resident is leaving a room or facility do not, in and of themselves, restrict freedom of movement and are not considered restraints under federal Medicare and Medicaid nursing home regulations.