Patients Routinely Eloping From Facility

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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Good morning,

I have been an LPN for 18 years and I recently transitioned from working rehab to assisted living. I have 64 residents on 4 different floors. The acuity is similar to that of skilled nursing. I was told before transferring that the residents' acuity would be minimal and residents with extensive nursing needs would be transferred to skilled. It's been 2 years and that clearly was untrue.

I can deal with the acuity but we have residents that have dementia and they refuse to wear wander guards which means they can walk out of the facility and nobody would know. We have a very specific resident that has dementia and has eloped several times.

He becomes combative and aggressive when staff attempts to redirect him. He recently left the facility and the security guard and I couldn't find him for quite some time. We located him in a nearby playground. About a month ago I spoke with the DON to inquire about the legalities of him possibly eloping without the staff knowing and getting lost.

The DON informed me that his elopements are well documented along with his refusing to wear a wander guard. I was also told that the family is aware of the risk involved. I am thinking about transferring back over to skilled due to this issue but wanted to make sure I am not overreacting. He is not the first resident to elope several times. Your advice and perspective would be greatly appreciated. I have also reached out the State of Missouri division of aging to clarify regulations with no response yet.

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Specializes in Tele, ICU, Staff Development.

Dear Overreacting,

Wandering in someone with cognitive loss is one of the most challenging aspects of care. Elopement is the most dangerous kind of wandering and can result in danger and even death.

Facilities have a responsibility to protect the people in their care. You describe the facility as aware that their residents are eloping but not overly concerned. It seems akin to a patient who falls in acute care. I've always said, "When a pt falls, they've in essence told you that they fall. So if they fall again, the facility is at higher risk." 

It sounds like this facility is not equipped to safely manage wandering residents. Are there criteria for transferring patients to a higher level of care, such as memory care?
I would ask to see the policies and procedures your facility has around wandering. Facilities are at the greatest risk when they don't follow their own policies. Look at the bottom of the policy for references. Are they up to date and relevant? What training is provided for staff? Are the residents regularly re-assessed for changes in mentation? Does your facility have a Risk Department? 

Assisted living facilities and residential facilities in Missouri fall under the Department of Health and Senior Services Regulations and must meet many requirements regarding staff education and staffing among others.

To answer your question, you are not over-reacting. It's an issue of your moral compass. In general, it's important to be able to align your ethics and values with those of your employer. It causes distress when you cannot.

Best wishes on your decision,

Nurse Beth

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