How Should Nursing Homes Prevent Elopement & Wandering?
Effective prevention of elopement and wandering in long-term care settings requires a proactive approach, including risk assessments, environmental safeguards, and ongoing supervision. Nursing homes must develop and implement comprehensive plans tailored to residents at risk, particularly those with cognitive impairments like dementia or Alzheimer’s disease.
A facility’s first obligation is to conduct thorough initial and ongoing assessments to identify residents most at risk for wandering. Failing to do so is a common factor in elopement incidents. (See last week’s blog for more detail on how residents are identified as high-risk).
Once a resident is identified as high-risk, the facility should create and implement an individualized care plan to address and mitigate those risks.
Supervision and Safety Measures
Residents identified as high-risk should receive increased supervision and appropriate security measures, tailored to their individual needs. Such measures may include:
- Increased staff oversight
- Door alarms and motion sensors
- GPS-enabled bracelets or anklets
- Secured or locked units
- Placement in specialized dementia care settings
Assisted living facilities housing residents with dementia must also include safety protocols in their operational plans to address wandering behaviors.
Skilled nursing facilities are federally required to maintain environments “as free of accident hazards as is possible” and to provide proper supervision and assistive devices.
Tools & Technology
There are a number of technological solutions and devices designed specifically to meet the requirements outlined above. Common examples include:
- WanderGuard Systems: Wearable sensors that trigger alarms or lock doors when a resident nears an exit.
- Delayed Egress Devices: Doors with a timed delay and alarm to alert staff, giving them time to intercept a resident before they leave a secured area.
- Video Surveillance: Cameras in common areas and exit points help staff detect wandering in real-time.
- Door Alarms & Motion Sensors: Alert staff when residents approach or attempt to open secured doors.
- Secured Units: Locked areas designed to protect residents with high elopement risk by restricting unauthorized exit.
- Personal GPS Devices: Worn by residents, these allow staff and families to track real-time location outside the facility.
Personnel
Increased oversight and monitoring by staff is a critical tool in the prevention of elopement and wandering. Common staff-based interventions include:
- Behavioral Assessments & Reassessments: Regular evaluations help detect changes in cognition or behavior that increase elopement risk.
- Resident Check-Ins: Scheduled monitoring, especially at night or during transitions, ensures high-risk residents are accounted for.
- Adequate Staffing: Sufficient staff presence — particularly during evenings or nights — is vital to monitor residents effectively.
- One-on-One Supervision: For extreme cases, continuous personal monitoring may be necessary to ensure safety.
- Transfer to a Higher Level of Care: If a resident’s needs exceed a facility’s capabilities, they must be transferred to a higher-level facility, such as a SNF or behavioral health unit. Failure to do so can result in serious harm.
Responding to Elopement: Every Second Counts
If a resident elopes, immediate action is imperative due to the dangers they face outside the facility — exposure to traffic, weather, unfamiliar terrain, or confusion that could lead to injury or death. The longer a resident remains missing, the greater the danger. Timely, decisive intervention can be life-saving. Immediate response measures include:
- Alarm Activation: Systems like door alarms and WanderGuard must be triggered instantly to alert staff and begin the search.
- Law Enforcement Notification: If the resident isn’t found quickly, authorities should be contacted immediately and provided with relevant details.
- Facility-Wide Search Protocol: Staff must follow a predefined search procedure, covering both indoor and outdoor areas, focusing on exits, parking lots, and nearby hazards.
- Family Notification: Families should be informed without delay and may offer helpful insight into possible locations based on the resident’s history or preferences.
Post-Elopement Procedures
After the resident is found and returned safely:
- Conduct a full review of the incident
- Update the resident’s care plan and reassess their placement
- Identify system failures or missed warning signs
- Ensure staff understand protocols and that response equipment (e.g., flashlights, radios) is available and functional
Preparedness is essential. Staff should receive ongoing training and participate in regular drills. A facility’s ability to respond swiftly can mean the difference between safety and tragedy.
If your loved one has wandered or eloped from a nursing home or other long term care facility, a dedicated elder abuse attorney can help you understand if you have a case. For a free consultation with an elder abuse attorney in Los Angeles, San Francisco/Bay Area, or Sacramento, contact Dudensing Law here.
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