Source:  iadvanceseniorcare.com
by Paige Cerulli

Assisted living and dementia care facilities were recently thrust into the spotlight when The Washington Post published an article highlighting thousands of resident wandering events. The resident elopements, which occurred since 2018, resulted in nearly 100 deaths due to extreme heat or cold, and the article garnered significant public attention.

Elopements are a serious risk in senior care settings, and it’s essential that senior care communities take precautions to prevent elopements and respond to them appropriately if and when they occur. We spoke with two experts about what senior care communities can do to address elopement risks.

Common Risks Associated with Resident Elopement

Mark Prifogle, vice president of operations, Indiana, at BHI Senior Living, explains that several risks can contribute to resident elopement:

• Cognitive Impairments: Conditions like dementia or Alzheimer’s can impair a resident’s understanding of their need for assistance or cause disorientation.
• Environmental Factors: Confusing layouts can lead to disorientation, while inadequate signage and labeling can fail to guide residents effectively.
• Sundowning: Increased confusion during late afternoon and evening, particularly following new admissions, can heighten the risk of elopement.
• Psychological Factors: Feelings of loneliness or a desire for independence can motivate attempts to leave.
• Inadequate Supervision: Staff shortages or lack of specialized training can lead to lapses in supervision.

Determining Resident Elopement Risk

Since elopement risk factors may vary depending on the resident, it’s essential to determine each resident’s risk on an individual basis. Admission screening and regular assessments, including quarterly assessments, help to monitor risk factors. Those standard assessments are paired with continuous monitoring by staff from various departments, including reception, housekeeping, and maintenance.

Prifogle explains that BHI Senior Living also uses behavioral analysis, including “evaluating past wandering behaviors and considering significant life events, such as when a resident stopped driving.”

Certain situations, like new admissions, can increase the risk of resident elopement, so senior care communities need to be prepared to respond appropriately. “New admissions and evening hours pose greater risks,” says Prifogle. “Recognizing and addressing confusion in new residents or during evening hours is key.”

If residents in assisted living are deemed to be at higher risk for elopement, then family or sitter/companion involvement is sought until the resident can be moved to a more secure setting. “A deep Root Cause Analysis is recommended to determine the cause of the exit-seeking to create effective interventions to return the resident to contented engagement,” Prifogle explains.

Designing Elopement Prevention Strategies 

To prevent elopements, senior care communities may need to implement different strategies, protocols, and staff training for a comprehensive approach. While alarm systems may seem like the first line of defense, Prifogle explains that they aren’t a solution for all situations.

“Depending on state regulations, assisted living [communities] may not be able to employ specific alarm technologies for elopement prevention,” says Prifogle. “Strategies like night checks, medication administration, and post-dinner assistance are critical. Also, the use of alarms, even when permitted, can be very disorienting and disruptive to people living with dementia.”

He notes that BHI Senior Living memory care units are typically locked, and controlled access prevents unsupervised exits. “Family and guests are escorted to ensure residents’ safety,” he notes. The skilled nursing units utilize alarm systems, and those systems are regularly monitored and maintained for functionality.

Additionally, all staff are trained in BHI Senior Living elopement prevention and response protocols. Those protocols involve practice drills and keeping information for handling potential elopements accessible at nursing stations.

The Use of Technology in Elopement Prevention

Tony Conaway, vice president of information technology services at BHI Senior Living, explains that the communities utilize several different types of technology that help to prevent elopement and promote resident safety. The communities have nurse call systems, and updated technology is being installed in the communities as budgets allow. “Wander management systems have been in both assisted living and memory care for well over ten years,” explains Conaway. “Residents in licensed areas who are identified as being at risk of wandering wear a small, hard to remove device. The system locks doors when residents wearing a device are near the door.”

The communities’ systems are all monitored by a remote company, which means the communities don’t have to depend on a staff person who might be caring for another resident instead of being readily available to respond to a system alarm. “The alert goes to the nurse call system via phone or pager,” says Conaway. “Additionally, there is an escalation system that goes all the way to the Executive Director. If someone can’t answer the phone and acknowledge the alert it will automatically escalate to the next person.  This will not stop until someone answers and acknowledges the alert.”

All of the systems are tested monthly, and that testing process involves several different departments. The systems are also on a back-up power source to ensure they remain operational in the event of a power outage.

Additionally, all new staff members receive training in the safety and monitoring systems. “It is part of the standard processes for our communities,” Conaway notes. “The training data is collected so we can ensure that it’s taken place, and the team members have a good understanding of the systems.”

How Senior Care Communities Can Strengthen Elopement Prevention and Response

Conaway encourages communities to test their security systems regularly. “It’s also helpful to explore new technologies,” he says. “For example, we are looking at piloting a program for a radar system for monitoring wandering and fall prevention without using cameras. Of course, we can’t rely solely on technology, but it plays a critical role in our approach to preventing resident elopement.”

Prifogle highlights the importance of staff knowing each individual resident. He encourages senior care communities to focus on engaging with residents at different times to evaluate any growing confusion. Additionally, gather a detailed personal history, preferably provided by the resident or their close family members. “A detailed history, especially of prior routines, can help with Root Cause Analysis,” says Prifogle.

“For example,” he adds, “the resident left the house every day at 5 am to go to work for 40+ years. She woke up, took a shower, went back into the bedroom to dress, then would go to the garage, start the car and drive to work. If you know this about the resident, and you see them mimicking these familiar patterns, you can gently intervene intelligently to redirect the resident away from exit-seeking.”

He recommends looking for signs of potential elopement, such as if a resident starts to pack up items in their apartment. Strategic resident placement, especially of residents with dementia, can also help minimize confusion and wandering.

Managing resident elopement requires a multifaceted approach. This approach needs to include an understanding of individual resident needs and behaviors. The community must adopt appropriate environmental cues and safety measures, and also ensure that all staff members are trained and prepared to respond to potential elopements. Prifogle adds, “regular assessments, family involvement, and continuous improvement of protocols are essential in creating a safe and nurturing environment for seniors.”