Wandering and Exit-Seeking: Tips for Keeping Residents Safe

Article by Alyssa Elting McGuire, MA, MPA

Several years ago, I read an alert in the local paper I had seen many times over. Miriam*, who was 87, had wandered from her adult care home the previous day. She had fairly advanced Alzheimer’s disease. Though her memory and judgement were both strongly affected, she was physically able to maneuver with little issue, as is often the case with individuals who have Alzheimer’s disease. My stomach sank, though, as I continued reading. Miriam was still missing.

I kept an eye out for updates, but unfortunately there was no positive outcome in this case. The news updated the story soon after local law enforcement found Miriam deceased, not far from her care home.

This story highlights an extreme outcome of wandering and elopement, as 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.

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. Individuals who have some form of dementia are at greatest risk, especially individuals who are in the middle stage of Alzheimer’s disease. Additionally, residents with cognitive limitations 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.

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. 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 consider using an elopement risk assessment tool, either 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.

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.

• Care plan around wandering. Recognize and document when a resident is most likely to be at risk, and what possibly triggers wandering or elopement. Increase the level of observation.
• Meet the 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.
• Keep residents active during the day. Provide person-centered activities.
• Install door alarms all exterior doors of the home. Make sure to keep them turned on at all times.
• Consider using an ID bracelet, such as the Alzheimer’s Association Medic Alert + Safe Return® bracelet.
• 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.
• Make changes in the home environment. Paint exterior doors a similar color as the wall. Also consider putting a “stop,” or “do not enter” sign on doors.
• Provide a space for residents to wander safely inside. If a resident wants to walk outside, plan for a caregiver to go with him or her.
• Involve the resident’s family and/or legal representative and professionals to problem-solve around concerning, exit-seeking behavior.

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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.

Fortunately, what happened to Miriam is a rare outcome in situations when a resident elopes from the home. In most cases, with awareness, prevention, and intervention, you can keep residents who wander safe.

*name and details have been changed

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About the Author

Alyssa Elting McGuire is founder and consulting & training director with Oregon Care Home Consulting & Training. She has spent the majority of her career providing program service delivery, regulatory leadership, training development, and program coordination and management in government and not-for-profit organizations. She is passionate about helping current and  future adult care home providers in Oregon successfully navigate the licensing process and provide quality care to seniors. 

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