Article originally published March 2019. Updated December 2021.
When I was an elder abuse investigator several years ago, I investigated a challenging case. Miriam*, who was 87, had eloped from her adult care home the previous day. She had managed to leave out the one door that was not alarmed. She had fairly advanced Alzheimer’s disease, and though her memory and judgement were both strongly affected, she was physically able to maneuver with little issue. This is often the case with individuals who have Alzheimer’s disease. My stomach sank, though, as I continued reading the report. Miriam was still missing.
I investigated and hoped for a good outcome, but unfortunately there was no positive outcome for Miriam in this case. I found out a few days later that local law enforcement found Miriam deceased, not far from her care home.
This story highlights an extreme outcome of wandering and elopement. Fortunately, most cases end with the resident safely back at home. Still, this story reinforces the importance of not becoming complacent. This situation could have happened to any care home provider. It’s an unfortunate story that illustrates the importance of managing wandering and preventing elopement in adult care homes.
Wandering vs. Elopement
The terms wandering and elopement are often used interchangeably; however, they are not exactly the same. Wandering is pacing or aimless walking. This generally takes place inside the home or facility, though it can also take place outside. These are the individuals you see who pace up and down the hallway, seemingly without direction.
Elopement, on the other hand, is the unplanned exiting of the home or facility. It commonly includes “exit-seeking behavior.” This exit-seeking behavior and elopement from the home puts residents at great risk of harm, as Miriam's story tragically illustrated.
According to the Alzheimer’s Association, 60% of people living with dementia will wander at least once.
Who is at Risk?
According to the Alzheimer’s Association, 60% of people living with dementia will wander at least once. Additionally, according to adult foster home surveys conducted by the Portland State University Institute on Aging, 45% of residents in adult foster homes in Oregon have some type of dementia.
Who is most at risk?
Assessing for Elopement Risk
What can you do to recognize and reduce the risk of elopement? Your screening process is the first step. It is important to conduct a thorough screening to find out if your potential resident is at risk for elopement and if you have elopement prevention options in place. During your screening interviews, ask if the individual has ever displayed exit-seeking behavior or wandered outside the home or facility. Additionally, if the individual is currently in a facility, review their narratives, care plan, and any incident reports to find out if there is a concern about wandering and/or elopement.
Also, be sure to assess for elopement risk both during screening or after the resident has moved to the care home when their condition has changed.
It is important to understand, even if you’ve conducted a thorough screening, or the resident has no prior history of wandering or elopement, they could still elope from your home after admission. In these instances, it's vital to put interventions in place and care plan to reduce further risk of elopement.
9 Tips for Keeping Residents Safe
How do you keep residents with wandering or exit-seeking behaviors safe? Below are several tips and evidence-informed interventions for keeping residents safe. This is not an exhaustive list, as each resident’s needs and situation are unique, but it is a place to start.
Tip 1: Care plan around wandering
Recognize and document when a resident is most likely to be at risk, and what possibly triggers their wandering or elopement. Increase the level of observation.
Tip 2: Meet the holistic needs of the resident
If a resident is confused about where he or she is and insists he or she needs to “go home,” or “go to work,” use non-pharmacological interventions to address his or her underlying feelings and needs. Could she be bored? Might he be lonely?
Tip 3: Keep residents active during the day
Provide person-centered, meaningful activities and tailor the activities to the cognitive abilities of the resident.
Tip 4: Install door alarms on exterior doors of the home
Make sure to install alarms on all exterior doors and keep them turned on at all times.
Tip 5: Consider using an ID bracelet
An example of an ID bracelet is the Alzheimer’s Association Medic Alert + Safe Return® bracelet.
Tip 6: Enroll the individual in a local safe return program
Ask the resident's legal representative to contact your local sheriff's office or police precinct to find out if they have a registry for individuals at risk, like the Washington County Sheriff’s Office Help Me Home Program.
Tip 7: Make changes in the home environment
Paint exterior doors a similar color as the wall or consider a mural. Make the home environment comfortable, as well.
Tip 8: Provide a space for residents to wander safely inside or outside
Residents can wander safely with advanced planning. If a resident wants to walk outside, plan for a caregiver to go with him or her.
Tip 9: Include the resident's care team
Involve the resident's family and/or legal representative and others to help problem-solve around concerning, exit-seeking behavior. You don't have to do this alone.
Awareness, Prevention & Intervention
Sometimes you can do everything within your power to keep residents safe, and things will still happen. It is important, then, to recognize the point at which an adult care home may no longer be the safest placement for a resident with exit-seeking behavior who is an elopement risk.
Fortunately, what happened to Miriam is a rare outcome in situations when a resident elopes from the home. With awareness, prevention, and intervention, you can keep residents who wander safe.
*name and details have been changed
Running an adult foster care home can be stressful enough, but when you expand or remodel, how do you know that the home you and your residents live in is up to, or even built to, current standards and codes for safety? Permits seem like an added hassle and expense, so what are they for? Are they necessary for all work being completed on the home?
Why Do I need a Permit?
Permits protect you and your home by having experts in the code and construction field verify your home is built to minimum safety standards by licensed, insured contractors. Part of a licensed contractor's responsibility is to know the codes and procedures for obtaining a permit when required.
Permits are required by law and may be required for insurance purposes. Additionally, Oregon Administrative Rule requires any remodeling that must have a permit to be permitted. Licensing will request proof of permitted work.
Also, if work was done without a permit in your home, you may be required to upgrade the home to current code standards or have the work done without a permit demolished. Building codes have evolved over time and are subject to constant change, so it is important to have a contractor who knows code, as well as the construction knowledge for the work to be performed.
Who Oversees Permits?
Inspections are performed by individuals who work for the local government. They are referred to as the Authority Having Jurisdiction (AHJ) and are required to have state and national certifications for their respective inspection trades. The inspector will verify the work is completed per approved plans that have been reviewed for compliance with local and state codes that state minimum requirements for structural, mechanical, plumbing, electrical and life safety. There are few exceptions for what does not need a permit, but all work done must still meet the code.
Working with a Licensed Contractor
Is your contractor licensed? Be sure to check the Oregon Construction Contractors Board to verify a contractor's license status. Ask your licensed contractor about the requirements for construction activities on your AFH, as they should be able to tell you if you need a permit. If you are not sure, or are not satisfied with their answer, call the local building department in your jurisdiction and they can answer your questions.
Remember that it is your home and your responsibility to meet all requirements for alterations and modifications to the AFH, so when in doubt, contact your local building department. This will ensure your home meets minimum building code and safety standards, which will help keep all occupants of the adult foster home safe.