Preventing Seniors from Eloping or Wandering

Visit nearly any assisted-living facility that serves residents with dementia and almost all will have stories of residents who have escaped or attempted to escape. Owners, administrators, and staff employ many tactics to try to ensure the security of residents - including delayed egress locks, wristbands, closed circuit television systems, and other monitoring techniques to reduce the possibility of escape. The fact remains, however, dementia residents do escape - or elope, as it is called in the senior assisted-living industry. This article will review some of the unique ways residents have eloped from care facilities and offer suggestions for improving security to prevent elopements.

A family visiting a loved one in a locked dementia care unit was going to leave by entering the code onto a keypad that unlocked the delayed egress door. A resident, who the family mistook for another visitor, slipped out with them and eloped from the facility. Fortunately, the resident was spotted walking down the street by an employee coming in to work. The resident was then safely returned to the facility.

Residents have also been known to watch caregivers enter codes onto the keypad, memorizing the numbers and then letting themselves out at a later time.

Finally, an observant resident noticed that when fire drills were conducted, the fire alarm system released the locking mechanism on doors. He determined that by pulling the fire alarm he could elope from the facility. This resulted in a number of false alarms and elopement attempts.

Following are some tips for controlling these elopement attempts:

• Do not provide families with codes for accessing dementia wings. Only authorized employees should provide access to the dementia wing for visitors
• Routinely change the access code to the dementia wing and train employees to protect the keypad from view. This will help thwart residents who may memorize the code and also improve security
• Provide protective covers for fire alarm pull stations. Commercially available alarm covers will help deter false alarms

Many facilities have outdoor gardens or yards with paths allowing the resident a chance to exercise and perhaps safely spend time outdoors. However, residents can again elope without proper precautions.

In one case, a contractor hired to do some work in the secured yard left a gate propped open to make it easier to bring equipment in and out of the yard. A resident took advantage of this breach in security and eloped. Fortunately a search was quickly initiated and the resident was safely found and returned.

Some facilities report instances of residents taking lawn furniture and stacking it to climb over a fence; residents climbing trees near a fence to make their escape; or residents going so far as to break a hole in a wooden fence.

• Contractors working in any part of a facility should be given an orientation prior to starting work and made aware of safety and security precautions
• Make sure fencing is sturdy and high enough to prevent residents from breaking through or climbing over.
• Do not use furniture or materials that could be stacked to create a ladder over a fence. Similarly, trees with limbs over fences should be trimmed back
• Residents should be supervised by care-giving staff when using yard areas

Window Escapes

Windows are not normally viewed as a route of elopement but there have been several cases where residents have tried to escape in this manner - sometimes with tragic results. Again, the determination and creativity of eloping residents can be surprising.

In one case reminiscent of a child running away, a resident on the second floor tied bed sheets together, secured them to a bed, and was able to go out the window to the ground below. However, a resident at another facility was not so fortunate. Not recognizing the danger of climbing through a second-story window, this resident fell to the ground and was severely injured.

Other residents have simply climbed out windows and started their journey down the street. Without an alarm system to alert caregivers, the residents can be gone for hours before being discovered.

Some tips on reducing the danger of elopement through windows include:

• If possible, locate the dementia wing on the first floor. Second-floor or higher wings - with windows or balconies - invite the danger of a resident falling to the ground below if they attempt to elope.
• Have dementia wings face a secure courtyard area. If residents do go out through a window they will still be in a secured area.
• Use locks that will restrict opening the window to no more than four inches. Even if the window overlooks a secure courtyard, in areas with extreme heat or cold you may want to prevent a resident from going outdoors.
• Use alarms on windows that send a signal to the front desk. Caregivers must be properly trained to respond to these alarms and alarms should be checked regularly for proper operation.

In addition to the above, train staff in the procedures to follow in an elopement.

• Conduct a thorough search of the premises. Often when you think that someone has eloped, they are actually hiding within the facility
• Conduct a thorough search of the surrounding area
• Contact authorities to search the wider area
• Contact family immediately to let them know of the elopement. If there is family nearby, the resident may attempt to go to their home

Another way of helping to improve the safety and security of a resident is to participate in the Alzheimer's Association Safe Return Program. For a nominal cost, an ID bracelet is provided to the resident providing information to authorities when the resident is found. A new feature of the Safe Return Program is the addition of Medic Alert information on the bracelet. This will speed the identification of vital medical conditions and needed medications for a resident that has eloped.

Even with the best precautions, elopements can still occur. Focusing on proper controls, procedures and training will help to minimize the possibility of elopements.