Wandering Feature: Destination unknown

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Providers struggle with a growing population of wanderers and elopers – and ponder where the market may take them, as well. To say it was not a good month for Michigan nursing homes would be a vast understatement. And state officials know it. Two residents had frozen to death, one had drowned and another was hit by a car. One might have been harmed in yet another incident. That's why officials took the unusual step of issuing a blanket advisory to providers in February: Increase your watch over residents who might be likely to wander.

Officials did not immediately lay blame on any operators, but the implication was clear: Wanderer and eloper vigilance needs to improve.
The risks associated with caring for people with Alzheimer's disease or other dementia, especially those who are mentally impaired yet mobile, are expected to remain high. Currently, about 4.5 million people in the United States have Alzheimer's. That is expected to rise to as high as 16 million by 2050. Many will be wanderers.
That means providers will have to be even more creative about following regulations, building secure facilities, training staff members and buying appropriate technology.
"One of the highlights right now is there appears to be a real disconnect between states and the facilities they regulate," says David Meeks, an expert with the National Institute for Elopement Prevention and Resolution, Topeka, KS. "The state comes in from the perspective that all elopements are preventable. But a standard that says all elopements are preventable is unrealistic. Prisons can't do it. (Providers) are doing the best job they can with the equipment that is available."
Not all elopements involve wanderers, but many do. And when it happens, the results can be catastrophic -- for resident and facility alike. Reports of deaths or injuries like those in Michigan can be found in many places seemingly every day. Beyond that, facilities pay millions of dollars each year to settle legal claims and pay fines associated with resident wandering and elopements.
Meeks is a military veteran and tracking specialist who assists facilities' defense  teams in lawsuits. He says at least one estimate shows that 10% of all litigation against long-term care facilities involves elopements. Specific numbers are difficult to come by, experts say, because so many cases are settled privately.
"There has to be a shift in the paradigm that all elopements are preventable. Everybody says, 'C'mon, you can't prevent these elderly people from moving?'" Meeks said. "We want them to have freedoms and high quality of life. And to do that means there will be risks for elopement.
"Hospitals can't stop them, prisons with bars and locks can't stop them.  Another myth is that technology is the ultimate answer. Facilities put too much into prevention and they're not prepared for what happens. It appears to a jury that sometimes providers are just making things up as they go."
He and other experts say technology should be seen only as a complement to quality staff training: "Education isn't happening out there, and it's hurting them when they go to court."
There is no question lawsuits will continue to escalate, says Allan Thomas, the president of TAGWEB, a Richardson, TX-based consultancy that provides senior housing litigation management services.
Thomas calls the installation of alarm or tracking systems not an option but a necessity.
"I tell lenders that they can be worried about a loan, but if they don't give operators $30,000 for a system for those who are confused and wander, they're going to be worried about a lot more, and they could have their reputation in the industry ruined," he said.
Early identification of residents who are likely to wander, and then acting on that  information, is critical, Thomas says: "The issue all comes down to this: A vast majority of the industry does not consider a resident to be a risk for elopement until they've either attempted it or done it."
His company has developed screening and treatment policies for various providers and insurers, including the federal government. Its latest project is a video for educating prospective residents and family members that shows what they can expect from nursing home care.
"Wandering is not the issue. It's the consequence," stresses Dr. Nina Silverstein, associate professor of gerontology at the University of Massachusetts, Boston.
Silverstein should know. Co-authored by Gerald Flaherty and Terri Salmons Tobin, her 2002 book, "Dementia and Wandering Behavior: Concern for the Lost Elde