Wandering and Exit-Seeking: 9 Tips for Keeping Residents Safe

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?
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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?

• Residents with cognitive limitations or who recently moved to your home are at increased risk.
• Those who have a history of wandering or exit-seeking behavior are at great risk.
• Individuals who have some form of dementia are at greatest risk, especially individuals who are in the middle stage of Alzheimer’s disease.

Assessing for Elopement Risk
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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.
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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.
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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

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Author

Alyssa Elting McGuire, MA, MPA is founder and consulting & training director of Oregon Care Home Consulting & Training, and co-owner of Care Construction Northwest. 
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Email Alyssa