How to do it... Wander care

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With the number of residents with Alzheimer's disease and other forms of dementia expected to skyrocket in the coming years, providers will continue to face challenges from wanderers. Conducting a safe, efficient wander control program should be at or near the top of each operator's priority list. That means a lot of planning and strategy. The size, layout and condition of a facility may be just as important to consider as prices and ranges of tools. Here is some advice from key players:

1 It may sound obvious, but develop policies and procedures for dealing with wanderers and potential elopers — before an incident occurs, says Sylvia Williams, RN, MA, vice president, patient care services, Parker Jewish Institute for Health Care and Rehabilitation.
"The nuance is when you get into writing policies and processes, you begin to realize what all the elements are," Williams said. "If somebody elopes, what about those people who didn't wander? You need a process to do a headcount. And just how should you search the building?"

2 Before you buy or install anything, remember that having good preventive measures in place is vital. Reduce "environmental triggers," says Danielle Riebe, associate product manager, Crest Healthcare Supply, Dassel, MN.
"Use the typical causes of wandering, such as boredom, confusion and excess energy, to create programs that combat them," she advises. "Ensure that your residents have lots of activities to engage in that help stimulate them in healthy ways and keep them active. Be sure to include plenty of outdoor opportunities that allow residents to spend structured time outdoors in a safe environment."

3 Once residents are assessed as to wandering potential, it's time to consider your building and other physical surroundings. Evaluate all doors and other access opportunities.
"Doors with different uses can be secured in different manners," noted Lorna Schaefer, national sales manager, Senior Care, RF Technologies Inc., Brookfield, WI. "For example, a visitor door may be best secured by a resident-specific system that allows visitors and staff to exit freely, whereas an alarm would be activated when a resident who is wearing a transmitter bracelet attempts to exit."
"Use more of the selective monitoring equipment," agrees Secure Care's Michael McKerley. "That way, there's more control over who's coming and going. That way a resident cannot 'tailgate' out behind someone else."

4 McKerley and others also recommend using a system that will identify which resident is setting off an alarm. Many times an alarm has gone off and providers have dutifully hauled back someone found in a taboo area, only to find out later it was another still-absent resident who set off the alarm.
"Our industry is moving away from just door security systems and moving toward resident monitoring systems," acknowledged Joe Whitt, vice president of sales and marketing for Home Free Inc., Milwaukee. "Look for a system that is proactive and monitors the resident at all times."

5 You also should have a system that can gather and analyze all of that monitoring, Whitt and others believe.
"Using a system that gives you data and information on a resident's wandering patterns helps you manage change and high-risk residents," Whitt said.
"Surveyors and the courts are getting very strict about accountability," added McKerley. "They want to know how many alarms went on, who responded and how long it took to respond."

6 Along those lines, always carefully investigate technical support capabilities when comparing wander-control systems, experts advise. Is there daily 24-hour support available? Are there local contacts for installation and service calls? Remote technical monitoring also is available in some cases and can be worth it, Schaefer notes.

7 Reliability of another kind also is important to consider. "Use a product that has a guaranteed battery life between two to three years. Facilities using radio frequency identification technology must ensure that their device has detachment alerts and water resistance — this is the only way that medical administration can be aware of their patients at all times," says Steve Pacicco CEO of eHealth Solutions, New York. "Also, be ready to tailor your 24-hour locator to each patient."

Tips for providers
- No matter what tools you use, don't forget they're only as good as the people who use them.

- Don't be a slave to the system. Use common sense.

- Demand customized answers and plans from vendors. In this realm, every job is customized.

- Make sure all staff members are involved in wander control plans, not just in nursing or security.