Wandering Can Be Prevented by Careful Risk Assessment and Supervision, Reports Nursing Journal

I recently ran across an article that may be of interest to and help for families of patients who may tend to wander in or elope from hospitals, nursing homes, and assisted living facilities.
The article, which can be found in the October 2008 issue of the American Journal of Nursing, is titled "Wandering in Hospitalized Older Adults:  Identifying Risk is the First Step in this Approach to Preventing Wandering in Patients with Dementia."  Although the title speaks only to hospitals, the article summarizes nicely the measures that all health care facilities, including nursing homes and assisted living facilities, should undertake to prevent demented mobile patients from wandering in and elopement from their facilities.  
 
Hospitals, nursing homes, and assisted living facilities, according to the article, should focus on three basic elements of prevention and action:  accurate assessment of at-risk individuals; intensive supervision; and implementation of a standardized search plan if a person with dementia is missing.  The journal's publisher offers a free video demonstrating the best practices for preventing wandering and elopement of demented patients
 
Technically, there is a difference between wandering and elopement.  Patients with dementia are at risk for wandering away (eloping) from health care facilities.  Wandering (elopement) incidents are critical because once a patient with dementia becomes lost, they may be injured or die before being found.  
 
Wandering refers to the random or repetitive movement of a patient within a nursing home or assisted living facility. The patient may wander in pursuit of a particular goal (e.g. searching for something such as an exit), or the wandering may be non-goal-directed or aimless. Non-goal-directed wandering requires the nursing home or assisted living facility to address safety issues and identify the cause of the wandering behavior. For example, aimless wandering may mean a patient is frustrated, anxious, bored, hungry, or depressed.
 
The patient may wander into acceptable or unacceptable areas. Wandering may occur when the patient enters an area that is physically hazardous or that contains potential safety hazards (e.g. chemicals, tools, equipment.). A wandering patient may also enter the room of another resident, which can result in a patient-to-patient altercation, a fall, or contact with a hazard. 
 
Elopement occurs when a patient who lacks safety awareness leaves a nursing home or assisted living facility or a safe area within or outside a facility without the knowledge of the facility’s staff and without proper supervision. A patient who elopes is at risk of heat or cold exposure, dehydration, drowning, getting struck by a motor vehicle, and falling. 

Nursing homes and assisted living facilities should clearly define the procedures for monitoring and managing patients at risk for wandering and elopement and otherwise minimize the risk that a patient will leave the facility or a safe area without authorization or appropriate supervision.  In addition, the patient’s care plan should to address the risk that patients could wander or elope.  A nursing home or assisted living facility’s disaster and emergency preparedness plan should also include a plan to locate a missing patient who has eloped.

The bottom line?  Wandering and elopement doesn't have to end in tragedy.  I've reported several times on this web site about the many types of preventative measures, including alarms, that can be used by nursing homes and assisted living facilities to protect their patients.  When they're not used, it's usually because facilities don't want to commit their resources (translation "time and money") to protecting their patients.

No patient should ever be permitted to leave a nursing home or assisted living facility without staff knowing about it and supervising the patient.  Patients of these facilities should never become the subject of a "missing persons" story!
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Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia

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