Wandering Behavior in Nursing Homes

What is wandering?

Wandering is an aimless action that elderly people with dementia can sometimes engage in. Someone who is wandering is not specifically looking for an exit, but rather to move around. If they do exit a skilled nursing or assisted living facility, it is because they chanced upon an exit and walked out, or were aided by someone misinformed but with good intentions. 

Wandering is common in nursing homes: “Thirty six percent of community dwellers and sixty five percent of nursing home residents wander” (Smith, M., Schultz, S., Great Escapes: The wandering dilemma. The University of Iowa Geriatric Education, Iowa city, IA, www.mediciantuiowa.edu/igec/). Wandering may eventually lead to elopement, so the wanderer should be treated as a risk for elopement unless there is evidence that this is not a risk. 

Who is at risk for elopement?

          1. Residents who have a plan 

One factor that determines if a resident is at high risk for elopement is if the resident voices a specific plan of action to leave. He or she will precisely describe where they want to go. For example, an elderly resident who used to be a doctor might ask to ‘go see his patients’. He may then ask for a ride. This is a perspicuous sign for the staff that the resident may elope. 

         2. Residents who age in place

Residents who join the facility with Alzheimer’s disease or Senile Dementia Alzheimer’s Type may experience more memory loss over time that can lead to elopement behaviors that they did not have when they first entered the facility.

         3. Death of relative or friend

A resident who has lost someone important in their life may elope because they are looking for the person who is not visiting them anymore.

         4. New admission or readmission

Elderly people who are cognitively impaired may worsen when they enter a new nursing home because of the new and different surroundings. Here is the story of a nursing home resident who tried to leave the facility due to confusion and sadly ended up being injured in the process:

An elderly lady was admitted to a nursing home by her daughter who tricked her into going by telling her that they were only going there to visit. As soon as the lady was shown to a room, her daughter left. The elderly lady is highly functional and tries to leave a go back to her daughter multiple times. The staff, concerned by her repeated attempts to elope, put her in a new room alarmed and with a keypad. The resident was left in the room (which was on the second floor) unsupervised and was found on the ground after falling out of the window. She had lowered herself out of the window using the cord from the blinds, but the cord broke loose and she fell to the ground. She suffered multiple lower extremity and pelvis fractures.

         5. History of elopement behavior

It is a clear sign to the staff that the resident is at risk of elopement if the resident has attempted to elope multiple times in the past, unless there is evidence otherwise. Here is a short story exemplifying such a case:

A seventy-eight year old woman diagnosed with Alzheimer’s disease had a pattern of wandering away from her nursing home. She once managed to walk almost two miles away from the facility by the time she was found after tripping and falling. She later died from head injuries sustained due to the fall.

How to prevent wandering

         1. Alarm systems

There are two main ways that alarms in nursing homes work. One is that the room may be equipped with an alarm that will sound when the resident leaves. The other is an electronic bracelet, anklet, or necklace. Common problems that arise with alarms are that the batteries are not checked or replaced, equipment wires get disconnected, or electrical plugs are not secure. 

         2. Activities 

The resident may do many activities, which are designed to keep the resident from eloping. The staff must redirect the resident when he or she is displaying elopement behavior. 

         3. Video cameras 

Some nursing homes have cameras pointing at doors and hallways. However, very few of them actually manage to tape elopement behavior. These cameras give a false sense of security because they livestream, and there is rarely a nurse to watch over them as nurses are very often tending to other residents’ needs. Thus, these cameras do not serve a very useful purpose.

         4. Windows and screens

No matter what floor the room is on, the windows should not be able to open widely enough that a resident may get out through it. Screens that are torn or lost should be replaced.  

Next steps

Wandering and elopement is a major concern for elderly residents of skilled nursing and assisted living facilities who are experiencing cognitive decline. The family and the leadership team of the facility must work together to identify risks of elopement, develop a preventative plan tailored to each specific resident, and engage in consistent and determined actions to execute that plan.  

We hope you found this blog on wandering behavior helpful. If your loved one is at risk of elopement and you feel their needs are not being met in the nursing home or assisted living facility where they reside, please contact our team at Yeroushalmi Law

A special thank you to Margaret Chizek, RN, whose article “Wandering and Elopement” was informative in creating this blog. 

Super Lawyers
Justia Lawyer Rating
Contact Information