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Elopement

Causes and prevention strategies

By Pam West

It's one of the last things an administrator wants to hear.

It's a Sunday morning and you are out for brunch with your family. Your cell phone starts vibrating and a text message pops up: "Emergency. Call the facility immediately." Dreading what you're about to hear, you head into the restaurant lobby and call the facility.

The supervisor answers the phone and tells you that the staff can't find Mr. Smith. He was last seen three hours ago at breakfast. They have already initiated a facility search and neighborhood search.

Resident elopement is one of the most frightening incidents that can happen at a long-term care facility.

According to Appendix PP of the State Operations Manual, "elopement occurs when a resident leaves the premises or a safe area without authorization (i.e., an order for discharge or leave of absence) and/or any necessary supervision to do so."1 Residents who elope are at risk of heat or cold exposure, dehydration and other medical complications, drowning or being struck by a motor vehicle.1

Additionally, elopement makes facilities vulnerable to civil actions, deficiency fines and potential licensure actions.2 Ten percent of all nursing home lawsuits involve elopement of residents who, for the most part, were known wanderers.2

Minimizing the risk of elopement

Facilities can help minimize the risk of resident elopement by ensuring that policies and procedures for addressing elopement are in place. The policies should clearly define the mechanisms of elopement and the procedures should address monitoring and managing residents who are at risk for elopement.2

Additionally, at-risk residents should have interventions in their comprehensive care plans that address the potential for elopement. Facilities should also ensure that their disaster and emergency preparedness plans include strategies for locating missing residents.1

Assessing elopement risk

Residents should be assessed for elopement risk on admission and then quarterly thereafter. Even if a resident isn't initially considered to be at risk for elopement, changes in the resident's condition or circumstances can lead to them being at risk. Staff should always be alert to the possibility of elopement and report any unusual resident behavior to the nurse in charge.2

The following characteristics can put a resident at risk for elopement:

  • Dementia, Alzheimer's disease and medications that cause confusion2
  • Inability to recognize and handle dangers in the environment2
  • Prior history of wandering and forgetting whereabouts2
  • Restraint use at prior nursing home2
  • Recent admission (45 percent of elopements occur in the first 48 hours of admission)3
  • Delusions or hallucinations2
  • Anxiety disorder, manic depression or schizophrenia2

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