Main image courtesy of McKnight’s Long-Term Care.
Nursing facilities have a duty to their residents to provide a safe and secure environment. They also need to ensure that residents' physical and social needs are met, by providing assistance from staff and meaningful activities to do throughout the day. While there are many challenges that staff face on a day to day basis while caring for residents with different cognitive abilities, one of the most crucial to manage is preventing elopement in seniors.
How are staff to know who is at risk for elopement, and what are some of the strategies that facilities can use to reduce the chances of wandering and elopement? Mariposa Training has courses specifically related to preventing and managing elopement that are a great place to start. In this article, we’re going to cover that and more, including:
- The difference between wandering and elopement
- The patients who are most at risk for elopement
- How facilities can prevent and manage elopement in seniors
What is the difference between wandering and elopement?
Is there a difference between the two behaviors or are they the same?
Seniors with cognitive disabilities may engage in wandering or elopement behaviors. Image courtesy of The Guardian.
In the senior care community there are many challenging behaviors exhibited by patients with dementia. These challenging behaviors are the resident’s way of communicating that they have an unmet need, are in pain, fatigued, or feeling a loss of control. It is the job of the staff in these facilities to dig deeper and go beyond the challenging behavior to find the root problem. One of the common challenging behaviors you find in dementia patients are wandering and elopement.
- Wandering. This is a separate behavior, and is not the same as elopement. When a senior resident is engaging in wandering, they are showing to the staff that they are still capable of moving around physically and engaging with the outside world. These are residents who are focusing on what they can still do, which is walk and move about.
- Typically, residents engage in two types of wandering, goal-oriented wandering and non-goal directed wandering. Residents have a “goal” such as wanting to go home, or feeling like they need to go to work. They could also be searching for someone or something. When there is no goal, you tend to find residents walking aimlessly without specifically seeking out a person, place, or thing.
- Elopement. Elopement occurs when a resident leaves the secure nursing facility without staff or family supervision. This is very concerning behavior with dementia residents who may not be able to protect themselves from potentially harmful situations.
- Nursing homes are very concerned with elopement because it can result in altercations, falls, getting lost, or residents injuring themselves.
- Elopements can also lead to penalties for the nursing facilities.
What patients are at most at risk to experience elopement?
Is there a way to tell which patients are more at risk to elope?
There are some factors that increase the risk that a senior will elope. Image courtesy of The Caregiver Space.
A resident may be considered more at risk for elopement if they are dealing with a dementia-related condition such as Alzheimer’s. Most elopement cases occur when the resident is mentally impaired in some way. However, there is no one set of traits that will determine whether or not someone is more likely to elope. It is also more common for those residents who are more mobile, and not in a wheelchair for example, to elope. However, there may be additional factors that could increase the risk that a resident is likely to elope.
- Psychiatric condition. Cognitively impaired residents are not the only ones who are at a greater risk of elopement. Those patients that have a psychiatric condition such as an anxiety disorder or schizophrenia may be more likely to try and leave the facility. When the patient is both cognitively impaired and has another mental condition, their risk increases.
- Recent admission. Many elopements take place after a recent admission to a nursing facility. In fact, almost half of all elopements occur within the first few days after admission. This is because the resident is trying to make sense of their new surroundings and does not understand why all these large changes are taking place.
- History of wandering/elopement. If a resident has engaged in wandering or elopement behavior in the past, they may continue to do it in the future.
- Restlessness. If a patient is found constantly moving around the inside of the facility, either aimlessly or searching for a person or item, they could be trying to signal that they have an unmet need.
- Poor adjustment to admission. If a resident is having a difficult time adjusting, and even making statements such as “I want to go home,” they are expressing their desire to leave the facility. This can be a trigger for them to start trying to find an exit and leave the building.
- High staff turnover. When there are new people constantly coming in to care for residents, this can interrupt their routine. New staff need to learn their preferences and interests, which can be confusing for residents. Even regular staff rotations are a change to the routine, and can cause residents to react in a challenging way.
- Inadequate care plans. Residents who are at facilities that have inadequate care plans to account for wandering and elopement are at a greater risk for elopement because there is a higher chance that their movements will go unsupervised.
- Lack of training. Staff should be trained to handle elopement, and there should be a care plan in place that they can rely on. How to implement the care plan for dealing with elopement should be properly communicated through training.
Nursing facilities can be found negligent if the staff are not properly trained, there is no plan to assess patients’ risk, and there is not a proper care plan to protect residents.
While these are some of the factors that can contribute to a greater risk of elopement, it’s also crucial to understand that some residents may be wandering or wanting to elope because they have an undiagnosed condition, they are in some form of physical discomfort, or they have an unmet need.
How can nursing facilities prevent and manage elopement in seniors?
Create a care plan to reduce the risk of elopement
Preventing elopement requires a plan and the proper training for staff. Image courtesy of Penn Today.
It’s important for nursing facilities to follow a care plan in order to reduce the risk of elopement among its residents. In order to ensure that the residents are living in a safe and secure place, proper training for staff and continued vigilance are key. There is a way to ensure each resident is evaluated to determine their elopement risk, and that starts with creating a plan.
Patients should be assessed regularly for their risk
First, each patient when they are admitted into the nursing facility should be assessed to determine their specific risk for elopement. Because those at risk don’t always show the symptoms, the only way to determine risk factors is to assess all patients. The initial assessment is key, however, it shouldn’t be the only one. Ongoing assessments will ensure your staff can reevaluate whether a patient’s condition has changed, increasing the likelihood of elopement.
Staff should use the assessment to determine the cognitive ability of patients, and determine if there are signs of dementia or any medication that might contribute to wandering or restlessness.
If there is a past history of wandering and elopement it should be noted, and what techniques were used to help avoid this behavior. Additionally, if there is a history of elopement, it would be helpful to note what time of day this happened and if it was goal-seeking or non-goal seeking.
Customized care plans are essential
Once you have a good assessment of the patient, you can move onto creating a customized plan. This care plan should be continually re-evaluated, as it is designed to adjust to the changing needs of the patient. There should be a care plan for each resident, since all residents have unique needs. Care plans can include a variety of different techniques to help reduce the chances of wandering, but will still allow the resident the dignity and freedom to move around that they deserve.
Environmental modifications
Making changes to the everyday environment is one of the best ways to help reduce the likelihood that a resident will elope. Nursing facilities should be designed to look as much like a home as possible, with welcoming additions to all the rooms that are regularly used by residents. Some great ways to help create a non-threatening and relaxing feeling among residents are to include:
- Plants
- Wall décor
- Pillows
- Curtains
These items can instill a home-like feeling among residents whether they’re in the bathroom areas, dining room, or their own room.
Environmental modifications can also include camouflaging exits and windows that might be triggers for a resident who may elope. Painting murals on exit doors is a great example of changing the environment so a resident no longer considers that as a way out of the facility.
Keeping pathways clearly marked may also be helpful to those residents who want to still go walking, but may not be able to find their way back. Outside you can use pathways to show where residents are able to go (such as a walk in the garden). When indoors, clearly marked paths can also show residents how to get to the dining space, activity room, or the bathroom.
Use of technology
In addition to changes to the physical environment of the facility, staff can also employ technology to help track patients who may be at risk for elopement. GPS or RDF trackers can be very helpful notifying staff when a resident may be trying to leave or going into an area unsupervised. They can be in the form of a watch, bracelet, or even sewn into their clothing.
In order to let staff know when an exit door has been used, it might also be helpful to have an alert or an alarm placed on them. Alternatively, in order to prevent resident access to restricted doors, the facility could have a keypad that requires a code for entry and exiting.
If there are patients who tend to leave their bed during the night, you could consider including a notification system that alerts staff when the patient has gotten out of bed and is starting to walk around.
While technology is incredibly useful for elopement prevention, it is not 100% guaranteed. Devices can fail, which is why it’s also important to employ some additional prevention strategies.
Psychosocial interventions
With proper training, staff will be able to intervene and employ psychosocial interventions such as validation. When staff know how to enter into the reality of the patient, it can help get to the root cause for the challenging behavior. By asking what the patient is feeling and why they feel this way, it may help determine if they are in pain or trying to communicate an unmet need.
Many residents could be wandering or seeking to elope because they are bored and searching for meaningful activities. Activities throughout the day should be based on the interests and preferences of the patient, which can be determined during their assessments.
Proper care plans and procedures should be in place
Every nursing facility should have an elopement prevention plan in place as well as an elopement response plan in case a resident does elope. These procedures are crucial to preventing elopement and can include the techniques we’ve discussed throughout this article.
An elopement response plan is also necessary should a patient elope. The staff will be trained to follow the plan that lay out specific steps to be taken should an elopement situation occur. Staff should be prepared to address this issue by participating in mock exercises so everyone is familiar with the proper procedure.
Elopement risk can be minimized with the right kind of planning. When you assess all your residents for their elopement risk, utilize a variety of prevention techniques, and have trained staff ready to deal with both prevention and response, you can provide residents with the security and care they need.
