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).
Nursing Home Wandering Off (Elopement) Articles
Nursing Home Resident Dies Climbing Down Rope
William Strasner, whose death Monday morning appears to be accidental, had used a rope of bedsheets and clothing in an attempt to lower himself when he fell about 34 feet into a parking lot at Emerald South Nursing & Rehabilitation Center, Buffalo Police Capt. Jeffrey Rinaldo said. Strasner, a longtime Buffalo resident, apparently was trying to escape Emerald South at 1175 Delaware Ave. He was discovered lying in the facility's parking lot at 6 a.m. by an employee. Strasner died in an ambulance while en route to a hospital.The article describes a horrific situation where the safety locks on Mr. Strasner's window was not functioning properly. The article states that the Buffalo Police Captain reported that:
The sliding window in Strasner's room was only supposed to open 7 inches, Rinaldo said. A nut-and-bolt system was supposed to prevent the window from opening wide enough for a person to get out of it. Homicide detectives, the captain said, are investigating why the window did not function properly.According to the article, the Buffalo Homicide team will be working with the agency that oversees and regulates nursing homes. Sadly, the article also reports that the victim had little or no family in the area, so he had no one to check on him to make sure he was being properly treated at the nursing home or if his mental health was being properly addressed ...
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Nurses Charged After Resident Dies From Wandering in Freezing Weather
Campbell left the building through a set of doors whose alarm should have gone off, the report said. Employees tested the alarm system on the doors the day after Campbell’s death. They found that when the doors were propped open, the alarm did not consistently go off. Propping open those doors was common so staff could freely walk between units, according to the state report. A bracelet Campbell wore also failed to sound an alarm, according to the report. Two state-tested nurse aides said they did not check on Campbell at 2 a.m. and 4 a.m., though checks were documented as being completed, the report said.Nursing homes often utilize alarms and monitoring bracelets to keep track of residents who may wander off. Often times, residents who are at risk for wandering have a history of wandering. Other times, care providers can assess that someone with out a history can still be at risk because of other indications. 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 ...
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Nursing Home Resident Dies From Exposure
According to an article on the Canton Rep.com, a resident of a nursing home in Canton, Ohio was found dead after he wandered out of the Glenwood Care & Rehabilitation, located at 836 34th St. NW. The resident had a history of elopement, and was actually picked up by the police who were unaware that the resident had dementia. The article on the Canton Rep.com states that:A dementia patient with a history of escape attempts made his way out of a local nursing home, later telling police who found him he wanted to go home to Alliance. What police didn’t know was Mark Billiter had slipped out the care facility where he had lived for years. They drove him as far as they could — to the city limits. He was found dead there two days later.Nursing homes are supposed to create a safe environment for their residents, which includes keeping them from wandering off. This horrific and tragic incident could have been prevented. 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. 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. Residents with cognitive issues that affect their judgement are particularly at risk for elopement. This is important to be aware of as you search for potential care facilities for your loved one. Mr. Billliter had a ...
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Resident Left to Wander Found Dead
At some point during the evening of Dec. 1, 2015, Felts walked out of the nursing home. Golden Glades staff realized he was missing at about 9 p.m. A maintenance worker from the assisted living home next door found his body at about 3 p.m. the next day.Inspectors visited the Golden Glades Nursing and Rehabilitation Center after his death and cited the facility for multiple violations. The violations include not providing enough staff and failure to remove hazards. Mr. Feltz was a 75-year-old Veteran of the Vietnam War and according to the article he had a history of elopement. His family believed that he would be safer at a nursing home, but they were wrong. 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
Read More
Residents Found Outside of Nursing Home in Freezing Temperatures
One resident with Alzheimer’s disease went outside without a coat for 10 minutes on Jan. 3 when the temperature was 27 degrees. The next day, the resident again went outside without a coat or shoes when the temperature was 18 degrees. On Jan. 6, with a temperature of 4 degrees, the resident went outside a third time without coat or shoes. Family members had previously expressed concern about the resident’s tendency to wander.The facility failed to keep this resident safe, and out of extremely dangerous temperatures. Each of these situations could have very easily become deadly. Luckily, this was not the case. Inspectors came to the facility after the incident and the article reports that:
During the inspectors’ visit, there was no documentation of the resident as an “elopement risk” and no picture posted at the front desk as recommended. The resident’s doctor told the inspectors that the resident had worsening dementia and should not ...
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Nursing Home Lets Resident Die 30 Feet From Front Door in Freezing Cold
The woman, who earlier in the day told a nurse's aide she was going home, went through a door into a courtyard even though she was wearing a monitor that should have set off alarms, the report said. Two aides told investigators they did not do scheduled checks that night even though they were marked as completed, according to the Ohio Department of Health investigation. A coroner determined that Phyllis Campbell, 76, likely died an hour or two after she went outside the Hilty Memorial Home in Pandora, roughly 50 miles (80 kilometers) southwest of Toledo. She was found in the courtyard about 30 feet from its doors the morning of Jan. 7.That’s as preventable as it is unacceptable. When I investigate nursing home death cases, I look at whether the nursing home is to blame for an injury or illness. The fact is, every long-term resident ...
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