Patient Elopement: When Supervision and Safety Expectations Fall Short

The risk of patient elopement endangerment is on the rise, for no good reason at all. Between 2006 and 2009, the number of cases of elopement increased by 38 percent.

As the baby boomer generation ages, the number of people with dementia is rising steadily. Approximately 50% of all people over the age of eighty-five have Alzheimer’s dementia, and about half of assisted living facility and nursing home residents suffer from some form of Alzheimer’s dementia.

Wandering is most often associated with Alzheimer’s dementia, usually occurring two to four years after the onset of the disease.

When we feel that we are not properly equipped to handle or care for a loved one with special cognitive needs, we turn to specialized facilities who are better equipped to care for them.

We place our trust in these facilities and their staff, believing and assuming that they have the expertise and the resources needed to give our loved ones  proper attention and care they need and deserve.

Statistics indicate that in the United States, more than 34,000 Alzheimer patients wander out of their homes or care facilities each year. Studies vary on the prevalence of wandering in institutionalized dementia patients, but it is estimated that 11 to 24 percent will wander.

Sometimes, we place our trust in facilities who do not deliver on their obligation to keep our loved one safe, and they carelessly endanger their lives. Patients in facilities like these who suffer from mental disabilities have a tendency to wander away. If not properly supervised, this can result in a serious injury and even death.

The National Institute for Elopement Prevention and Resolution’s (NIEPR) definition of patient elopement is:

When a patient or resident who is cognitively, physically, mentally, emotionally, and/or chemically impaired; wanders away, walks away, runs away, escapes, or otherwise leaves a caregiving facility or environment unsupervised, unnoticed, and/or prior to their scheduled discharge.

When patients wander away from health care facilities, nursing homes, mental health hospitals or other assisted living facilities, the result can be tragic. The reason events like these are so tragic is because they are entirely preventable.

They should never happen. 

Patient elopement, however, is an event that is not limited to senior citizens in nursing home facilities only. It also occurs every day in hospitals and mental health facilities all over the United States.

Patient Elopement Scenarios

Studies show that there is a 25% fatality rate when a patient wanders and is not found within 24 hours.  

This is why it is so important for the staff at mental health facilities to make sure patients do not wander away. Consider these three scenarios of patients who have wandered away from safety and right into danger:

1. A mentally disabled patient living in a mental health care facility needs some dental work done. A sitter from the facility is asked to transport the patient to the dentist, wait for her until she is finished, and bring her right back to the facility. However, while the dental work is being performed, the sitter leaves the office briefly to get a cup of coffee and take a restroom break. While she’s gone, the dentist’s office releases the patient without regard to waiting for the sitter, and the patient wanders outside of the office where she is mugged and seriously injured.
2. A mentally disabled patient living semi-independently in a healthcare facility becomes very ill and has to be taken to the ER by a staff member of the facility. The ER nurses are instructed to call the facility where the patient is living when finished with treatment so they can come pick him up. The nurses fail to call, however, the patient leaves on his own and is struck by a car and killed after wandering into traffic.
3. A senior citizen is supposed to be closely supervised because he has severe Alzheimer’s. He is supposed to be wearing a tag on his wrist to alert nursing home workers if she gets near the front door. However, the alarm system is not working properly, and the patient wanders out of the facility into winter weather. She is later found dead from exposure to cold winter temperatures.

Each of these scenarios could’ve been avoided if the proper communication had occurred and if proper safety measures had been in place. This is negligence on the part of the facility, and the facility should be held accountable.

Why do Patients Wander?

Patients with certain mental illnesses often have some type of memory loss that causes them to forget where they are. They then can become quite anxious and begin wandering around, looking for a familiar place.

Elderly people, especially, who suffer from mental disabilities like Dementia or Alzheimer’s are often frail, vulnerable and in a precarious state. They can easily become confused, have memory loss, and wander off aimlessly. Patients who wander off can disappear from a facility almost without a trace if not properly supervised.

Unfortunately, sometimes the staff of nursing homes or hospitals is careless or negligent with patient care, failing to care for them the way they should. Patients’ aches and pains are continually ignored or overlooked and their issues never get resolved, giving patients the desire to wander off.

Often, the patient may keep wandering further and further trying desperately to remember where they are, and they never do. These types of instances often times lead to serious injury or death.

Why Wandering Off is Worrisome

There are numerous hazards that can seriously harm an elderly or mentally disabled patient who is not properly supervised:

• They can wander into stair wells and fall.
• They can wander into construction zones.
• They can wander into busy streets, intersections and traffic.
• They can easily get lost, losing all recollection of where they are and how to return to safety.
• They can run into other patients that may be mentally ill and could harm them.
• They can wander near facility visitors who may have bad intentions and harm them.
• They can be exposed to hazards, such as extreme hot or cold weather conditions.

Lack of Resources, Training and Expertise

More and more, nursing homes and assisted living facilities lack the proper resources to properly care for wanderers. This happens often times because they are understaffed or the staff simply lacks the knowledge and expertise to prevent patients from eloping. Mental health facilities and nursing homes may lack training or the proper equipment as well.

Unfortunately, the staff at facilities who care for mentally ill patients can just be flat out uncaring. Workers have been known to act unprofessionally or to be overworked, though this is no excuse for the neglect of mentally ill patients and it is absolutely unacceptable. Every issue must be taken into account and taken seriously.

Solutions to Prevent Patient Elopement are Available

The best solution for preventing patient elopement and wandering is, without a doubt, the careful monitoring of patients or residents. Mental health facilities are responsible for making sure patients don’t wander into danger or harm themselves or other patients. Patient elopement is a fairly common event…

6 out of 10 with dementia will wander, according to the Alzheimer’s Association.

Careful Patient Assessment

Facilities with patients who could potentially wander off must assess each patient’s tendency to wander or leave the facility at the beginning of their stay. All patients should be assessed, even those who may appear unlikely to leave or wander.

Caregivers must also understand the early warning signs of dementia, the risk factors involved with an increased chance of a patient wandering, and the factors like brain injury or mental impediments that can adversely impact a patient’s judgement. Staff must be aware of each patient’s likelihood and potential to wander off to be able to assess them correctly.

Technology and Safety

New technology provides better anti-wandering solutions for caregivers.

Alarm systems are a very effective and readily available option for preventing residents from wandering. One such tracking system is available in the form of a bracelet or small lightweight device that is placed on a buckle, watch, or into a piece of clothing worn by the patient.

This solution is referred to as electronic tagging and it is a very reliable solution for tracking residents. When a resident exits a door or enters a certain area, an alarm sounds notifying the staff that a patient has wandered into an area that could be dangerous.

Video surveillance is another option that works well. In addition, door alarms can be utilized and are most commonly used today, but they can be unreliable if the staff does no respond or the alarm is turned off.

Bed alarms are frequently used for the resident who leaves the bed at night to wander and/or is at risk for falls/injuries. These alarm  systems are designed to alert the staff when a resident is out of bed and requires supervision and assistance.

These types of alarms are most effective when they are paired with an individualized plan to prevent nighttime injuries. This can include the following:

• Attention to comfort 
• Attention to toileting needs 
• Safe bed height 
• Use of nightlights 
• Following of a routine 
• Supervision  

Supervision

Without careful supervision, which is mandatory, none of these solutions are fool proof. Nursing home and mental health facility personnel are responsible for creating a safe environment by having a safety plan in place that addresses the needs of potentially wandering patients. Procedures of this type must be put in place, staff must be trained properly, and the procedures must be followed properly.

Comfortable Environment

Following this, specific and personal measures to prevent patients from eloping should be developed. Also, the environment should be comfortable and basic needs should be met, lessening the desire of a patient to elope.

Emergency Plan

Nursing homes and mental health hospitals should have a plan in place to deal with such an emergency situation if a patient goes missing. It should include a formal search procedure, law enforcement notification, and the maintenance of a current photograph of each patient.

Alarms

Exits that are not intended to be operated by residents should be either locked securely or equipped with alarms. In addition to keeping a close eye on residents, it is important for nursing home staff to make sure that the alarms on exits work correctly. It is also the responsibility of nursing home staff to respond promptly in the event that a door alarm goes off.

Conclusion

With all of these technological advances that can effectively prevent patients from wandering, why is the problem still growing?

We conclude that it is because of healthcare provider negligence.

The only way to impress upon them the importance of keeping our loved ones safe is to hold them legally responsible when their carelessness causes harm.

How Van Wey & Metzler Can Help

If you wish to pursue a lawsuit, you will need the assistance of an experienced patient elopement attorney who understands the complexity of cases like these.

Van Wey & Metzler, PLLC can help those who wish to fight back against unprofessional, negligent nursing homes, hospitals and mental health care facilities and staff.

There is no place for the lack of care or proper management and safety measures in these facilities today. Patient lives are at stake, and carelessness, when it comes to patient safety, can lead to serious injury and even death. Contact Van Wey & Metzler, PLLC today for compassionate, tenacious assistance with your particular situation.

By: Kay Van Wey | January 31st, 2016