Lower the risk and deter elopement
The single most cited F-tag in a Centers for Medicare & Medicaid Services survey is F-323 in regards to resident safety and supervision. This alone should lead organizations to stand up and pay attention to the risks inherent with a lack of adequate resident supervision.
Elopement occurs when a resident leaves a healthcare facility without staff knowledge of their departure. These events can be an area of both claim frequency and severity in the senior living residential care setting. Adults with a history of Alzheimer's disease and/or dementia are at risk for wandering and elopement. Since this could result in an injury or a fatality, it is advisable to consider evaluating existing organizational protocols and strategies for elopement prevention.
Here are some situations that have occurred over the past few years:
Scenario 1: A dementia resident exited unsecured assisted living unit and fell while walking outside after dark; fractured right shoulder and suffered a closed head injury.
Scenario 2: An assisted living resident smashed a window, crawled out of his room and wandered across a parking lot into a field. He subsequently collapsed and died in the freezing temperatures.
Scenario 3: A resident was found by construction workers in a garbage bin behind a nursing home.
Based on the three scenarios above, it is clear that a senior living organization may have a liability exposure for wandering and elopement incidents at all levels of care from assisted living to skilled nursing to memory care/dementia units.
The assessment of elopement risk needs to start at the time of admission, and even prior to admission if possible. Approximately half of all elopements occur within the first days of admission as residents are adapting to their new environment (Barnett, 2010). A documented, individualized assessment of elopement risk can provide valuable information to all disciplines that provide care to the resident.
It is optimal to place new residents in rooms away from exits and closer to community areas, providing them with less opportunity to elope. It is important that staff be extremely vigilant in the initial days following admission, until they become familiar with the resident's behavior patterns and until the resident becomes familiar with their new surroundings.
Some additional items to consider (Norman, 2016):
- Focus on resident safety and management of the wandering behavior.
- Institute “whereabouts” checks so that staff can account for all residents on each shift at regular intervals.
- Instruct staff to maintain visibility of exit doors, particularly during shift changes and emergencies as these are times when residents may be able to exit the facility unnoticed while staff attention may be diverted.
- Install electronic equipment such as bed and door alarms, video cameras and resident tracking devices to help alert staff when a resident is attempting to leave the unit.
Missing resident protocols
It is also important to have a missing resident protocol in place so that staff is aware of the procedures to follow, should an elopement occur. Some items to consider when developing such a protocol include:
- An internal alert system to signal staff if a resident is missing and to implement response procedures. Consider assigning staff to specific areas and using a checklist of searched areas or shading in searched areas on a floor plan.
- A systematic search of resident care units and other immediate areas - this means rooms, closets and stairwells, even those areas that are normally locked, along with the roof if there is roof access.
- A thorough search of the grounds – alert staff of potential hazard areas such as parking areas, major adjacent roadways or ornamental ponds.
- Notification of management, family members and physician(s).
- When to notify local police to request their assistance in conducting the search.
- Documentation of all actions taken either at the time of the incident or immediately afterward.
What to do when the resident is located:Complete an assessment and medical evaluation to identify potential injuries and provide necessary treatment.
Notify any previously contacted individuals of the resident's return.
Conduct an investigation to determine how the elopement occurred in order to correct any underlying contributing factors.
In summary, resident elopement is a significant safety risk and a potential liability exposure for senior living organizations. When you hear about incidents at other facilities that result in injury or even a fatality, don't automatically think, “That could never happen here.” Take the opportunity to re-evaluate your practices to see if you are doing all you can to identify at-risk residents, manage wandering behavior and limit elopement risk within your facility. Click here for more information, including a checklist to help you evaluate your practices.
Betty Norman is the Director of Risk Control Services GHP at Glatfelter Insurance Group.