When an older person’s physical abilities remain, but their cognitive abilities fade such that they can no longer consistently recognize dangers and keep themselves safe, they are at risk of wandering off injuries or death. Nursing homes must protect residents at risk of wandering off.
What is elopement?
Wandering off—sometimes called “elopement”—refers to a nursing home or hospital resident leaving their room, the facility, or another safe, monitored space and being exposed to the risks and dangers of the outside world, without assistance or monitoring.
The North American Nursing Diagnosis Association (NANDA) defines wandering as “ meandering, aimless, or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles.”[1]
While “wandering” sounds innocent enough, the results can be deadly: exposure, freezing to death, dehydration, drowning, wandering into a busy road and being hit by a car or truck, falling and hitting your head or breaking a bone, falling out of windows or down stairs . . . the list goes on.
When a nursing home fails to adequately evaluate the risk of elopement, or address the known risk to prevent it, the nursing home may be liable for the harm that results. Ohio law, as well as Ohio and federal regulations, require adequate, regular assessments of mental ability, elopement risk, and safety.
If you would like to discuss your loved one’s situation, injuries, or death at a nursing home caused by wandering off, call us at 216-777-8856.
Is Wandering Always Dangerous?
“Wandering” in the sense of strolling or moving about a facility can be a healthy, safe behavior for some residents. Residents may be encouraged to engage in, and benefit from, strolling through the hallways for exercise activity or to reduce stress.
When a resident leaves the nursing home, however, or gets into an area that is not safe for them (such as a stairway or high edge like a balcony), wandering can be deadly. Elopement occurs when a resident successfully leaves the nursing facility or safe unit undetected and unsupervised.
The risk of wandering is not limited to people who can walk or use a walker. If someone is able to propel themselves in a wheelchair or other ways, they can be at risk for elopement.
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Risk Factors for Dangerous Nursing Home Resident Elopement
Residents can be at significant risk for elopement when they experience:
- Agitation, anxiety, boredom, or stress
- Disorientation to surroundings
- Cognitive issues affecting judgment, such as Dementia or Alzheimer’s Disease
The resident’s own past behavior can be a red flag or warning sign for elopement, too, such as prior wandering off that did not lead to injury. If someone has eloped but been recovered safely, that means they are at risk of elopement and that risk must be addressed by the nursing home.
Disorientation can result from cognitive changes, issue, or (frequently) when they have just recently moved into the nursing home. The first few weeks after moving in are a frequent time for elopement, whether due to disorientation, change in setting, or the desire to return to their prior home. Nursing home staff must evaluate and monitor residents during this time to prevent residents from wandering out of the unit or facility and being injured.
Wandering can also be triggered when a resident is thirsty or hungry, or needs to use the bathroom. They start off to meet that need, become confused or disoriented, and wander. Residents may be trying to find their home or other familiar surroundings. These incidents can be traumatic for the resident. Residents can become defensive, feel trapped, or otherwise react negatively to being guided back to the facility or their rooms. Staff training to help them is critical.
What Can Nursing Homes do to Prevent Wandering Off Injuries?
The first thing every nursing home must do is an adequate assessment of the resident’s needs—at admission, and periodically thereafter—as required by federal regulation § 483.20 (“resident assessment”). This includes identifying cognitive, mood, and behavior patterns, and “develop[ing] a comprehensive care plan . . . to meet a resident’s medical, nursing, and mental and psychosocial needs.”
Nursing homes cannot use restraints on residents simply to make managing the residents easier; restraints must be medically necessary under § 483.13 (“Resident behavior and facility practices”). Under that rule, the “resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.” So nursing homes must provide safe spaces for residents at risk of elopement so they can interact socially and enjoy their life.
Nursing homes can reduce the risk of wandering and elopement injury by implementing appropriate policy and procedure, staff training, and quality assurance/improvement activity. Every nursing home must have an elopement plan for high risk residents. This can include a bracelet on the wrist or ankle identifying the resident as a fall risk and placing photos of the high risk residents at all exits and doorways. Residents can be provided personal alarms to notify the staff if they attempt to leave the facility. Staff should be trained and required to regularly monitor at-risk residents to prevent them from wandering from the facility.
Doors at the facility should have alarms to notify the staff if a patient is leaving out of a side door or emergency exit. Many times these alarms are disabled of simply do not work. Other times, the doors are not securely closed and locked.
The tools available include diverting agitated or wandering residents, such as:
- Familiar objects
- Hobbies
- Pet therapy
- Reading/music/movies
- Family, volunteer, group
- Change of staff
- Rocking
- Social interaction
- Walks/regular exercise
- Orientation/reorientation to unit
- Purposeful focused activities
Interventions can also include monitoring, such as one-on-one monitoring, medication review (to reduce medication-caused confusion or anxiety), escorts and sitters, and regular location checks.
Even the design of nursing home facilities—or dementia units—can be done to reduce the risk of elopement, such as:
- Unit-specific color schemes that make the unit familiar, versus other units
- Easily understood location maps so residents can orient themselves when confused
- Circular unit design, so wandering residents remain in the unit when walking forward
- Clearly marked signs that can be easily read
- Clearly marked resident’s room
- Orientation boards
- Offer a quiet room
- Camouflaged doors
There are tools that can be used to properly assess the risk of a resident from wandering off. For example, nurses and care providers can utilize assessment exercises like the one below. This tool allows the resident’s mental state, history, and behaviors to be analyzed.
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When there is a known risk, nursing homes should implement security protocols such as:
- Door alarms to alert staff if a resident is leaving a safe zone or the facility. This can include wrist bracelets so the alarm only sounds for certain, at-risk residents.
- Locked units to prevent at-risk residents from wandering off.
- Window locks or guards.
- Tracking systems for residents, which can include GPS systems to quickly locate residents.
- Seclusion rooms.
- Search plans, rapid response, team coordination to recover residents quickly and safely
If you would like to discuss your loved one’s situation, injuries, or death at a nursing home, call us at 216-777-8856. If you would like more information about helping a loved one at risk of wandering off stay safe, see the VA National Center for Patient Safety Toolkit for Patients at Risk of Wandering.
How do You prove a Wandering Injury or Death Claim?
The nursing home’s records will reveal the assessments they did, care plans put in place, risk of elopement, and (if the records are accurate and honest), any prior incidences of wandering or elopement. It will also show interventions, if any, put in place.
Unfortunately, medical records are all too often self-serving and omit facts that are negative for the nursing home.
State inspection records will show whether the nursing home has been cited in the past for failures that could involve elopement or elopement risks.
We also investigate staffing levels versus resident care needs, which can show whether there is a systemic failure to provide enough caregivers to meet needs, like monitoring locations of people a risk for elopement.
We utilize experts, including doctors and nurses, to evaluate potential claims before filing lawsuits to determine whether the assessments and interventions were adequate. It is possible for a resident to elope without the nursing home being to blame. We find out and tell you, candidly, whether we believe you have a case.
We also make the nursing home answer questions—called “discovery”—and make caregivers answer questions under oath—called depositions—to fill in the gaps, and show inaccuracies, if any, in the medical records.
If you would like to discuss your loved one’s situation, injuries, or death at a nursing home, call us at 216-777-8856. You can also read our Nursing Home Lawsuit page for more information on the process, or sign up to start an investigation.
[1] NANDA, Nursing Diagnosis: Definitions and Classifications, 2001-2002, nanda, Philadelphia, PA, 206-207 (2001).
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