Wandering & Resident Elopement in Nursing Homes
Major Cause of Injury for Nursing Home Patients
In nursing homes, wandering refers to a situation where a patient who is cognitively impaired leaves safe areas of the facility. Elopement is a specific form of wandering that involves leaving the facility entirely. Both wandering and elopement are especially dangerous for patients with Alzheimer’s or dementia, as the environment is always new and unfamiliar to them. This can cause them to feel overwhelmed by their surroundings and seek something that feels familiar and secure.
Other factors that can lead to wandering or elopement include:
- Changes in medication or new medications
- Unmet physical needs
- Not enough social interaction
- Missing family members or loved ones
Different Types of Wandering in Nursing Homes
Not all cases of wandering are the same. Some of the most common include:
- Environmentally Cued Wandering – This is triggered by stimuli in the patient’s immediate environment, such as a chair in the hall or a pathway.
- Recreational Wandering – This is triggered by a patient’s desire to get more exercise.
- Agitated Purposeful Wandering – This involves a patient who has a purpose for leaving—especially in cases of agitation.
- Fantasy or Reminiscent Wandering – This occurs when the patient is unaware of their real surroundings, causing them to walk through environments that are entirely imaginary.
Wandering & Elopement Causes
When a loved one moves into a nursing home, we expect that their care will be handled by qualified professionals who will monitor their residents for their safety. Unfortunately, an alarming percentage of nursing home residents wander away from their respective facilities without proper supervision.
Nursing home residents who leave their care facilities without staff knowledge or supervision engage in wandering and elopement behavior and run the risk of personal harm. Residents living with Alzheimer’s or dementia remain particularly vulnerable to this type of behavior that may lead to injuries. Knowing the causes of wandering and elopement may help caregivers and relatives prevent this dangerous behavior in nursing home residents.
The Need for Personal Evaluations
When moving into a nursing home facility, each resident should receive an individualized medical plan that includes information about their mental health. Some residents live with certain conditions that make them more prone to wandering. According to research from the Administration for Community Living, caregivers may resolve wandering through individualized care to respond to wandering and exit-seeking behaviors, which includes developing a relationship with the resident so that they may anticipate their particular needs and behaviors.
Every nursing home resident is entitled to good basic care, according to the Nursing Home Reform Act of 1987. Additionally, most states have legislation that reinforces the belief that good nursing home care includes individualized attention and supervision. Unfortunately, not all nursing home practices meet the standard of care. When they fail to do this and their failure results in injuries, they may bear liability.
People Who Live with a Higher Risk of Wandering
Those suffering from dementia may experience memory loss and impaired cognition that may cause them to wander. If your loved one remains mobile but has not received a formal diagnosis of any cognitive diseases like dementia, wandering may signal a need for a medical evaluation. Formally diagnosed or not, your loved one deserves a care plan that considers potential risks brought on by age-related diseases.
To mitigate the negative consequences of wandering, caregivers should practice re-evaluating each patient’s needs individually throughout their time in a nursing home.
Causes of Wandering and Elopement
Expressions of unmet needs may pertain to physical, social, or emotional issues that the resident has trouble communicating otherwise. Caregivers should consider an individual’s circumstances for good care in a nursing home.
- Unmet Physical Needs: A nursing home resident may wander if they get hungry or thirsty, need to use a restroom, or need to exercise. Wandering may result as the body’s physiological response to addressing these unmet needs without extra help from nursing home staff.
- Unmet Social Needs: If a nursing home resident is feeling isolated, wishes to see her family, or wishes to be alone, she may resort to wandering. Engaging the resident with activities that entertain and inspire them may prevent this.
- Unmet Emotional Needs: Emotional needs go hand-in-hand with physical and social needs. Emotional agitation can be real or imagined. If the nursing home resident feels as though she does not have a sense of independence or dignity, emotional neglect may be occurring. Nursing home law requires that caregivers maintain the highest sense of independence and dignity possible.
While you may suspect any or all of these reasons as the cause of your loved one’s wandering, you may not understand the best way to resolve the issue. Remember that wandering can happen as a sign of neglect or abuse in a nursing home. Even the slightest cases of nursing home abuse or neglect can lead to any of the above unmet needs. A good nursing home lawyer may help protect your loved one’s rights and may give you peace of mind while you help your loved one recover from any injuries.
Wandering & Elopement Risk Factors
For some nursing home residents, wandering from safe confines becomes a matter of life or death. Wandering proves dangerous because it puts vulnerable nursing home residents at the mercy of everyone else’s actions and behaviors and other unpredictable circumstances.
Knowing about the risk factors for wandering and elopement in a nursing home may help caretakers and family members prevent it from happening. In a nursing home, caretakers assume the responsibility for responding to wandering and exit-seeking behaviors exhibited by their residents, especially ones suffering from dementia or other cognitive impairments.
New Residents in a Nursing Home
Being in a new environment like a nursing home can challenge newcomers, especially if that person previously had a strong sense of home. Being unfamiliar with their new home can be completely overstimulating for nursing home residents. For residents who previously had a strong sense of home, wandering may result from memories of household duties and relationships they attended to at home.
Nursing home residents may wander as a side effect of medications, especially when caregivers overuse antipsychotic medications to restrain residents with dementia. When caregivers are burdened with a ‘difficult’ patient, they can use medications to control unwanted behavioral side effects of dementia. Unfortunately, the implication of this is that there is the potentially increased risk of wandering, worsened behavior, and a higher mortality rate.
Residents With Alzheimer’s or Dementia
Nursing home residents who have Alzheimer’s disease or dementia live with a high risk of wandering due to cognitive impairment. Caregivers have a responsibility to minimize the occurrences of harmful wandering, especially for these specific residents.
Some preventative measures against the risk factors for wandering and elopement include providing adequate and appropriate supervision and addressing residents’ needs as an individual with person-centered care. Caregivers also need to pay enough attention to their individual patients in order to address their specific needs and anticipate any potentially harmful behaviors, like wandering.
The Standard of Care
When an older person does not receive the attention they need, residents may wander as a means of addressing the situation independently. These needs can involve social, physical, or mental goals. Some examples of each type of need and how caregivers can address them include:
- Social needs: People living with dementia need social companionship more than ever. A resident suffering from a lack of social stimulation may engage in wandering and get hurt. Nursing home residents need to maintain a sense of dignity and independence, which can be helped by offering a breadth of social engagement to build a sense of community. It is crucial for the nursing home to provide social engagement opportunities that can engage people with dementia.
- Physical needs: Physical health problems can lead to wandering, such as when a resident needs to eat, use the restroom, or get a drink. In addition to assessing a patient’s needs for good physical health, good nursing home care engages residents with non-strenuous physical activities.
- Mental needs: Mental health can suffer from sudden changes in routines, medication side effects, or caregiver neglect. Caregivers must administer individualized care for nursing home residents to avoid mistakes and oversights. Since some instances of wandering result from an unmet need, nursing home caretakers may bear liability when a resident suffers injuries following a wandering accident.
To prevent wandering, good care for patients with Alzheimer’s or dementia should include tailored individual medical plans and individualized attention from caregivers.
Wandering & Elopement Agitated Purposeful
Nursing facilities try to prevent seniors from wandering away from the facility, but this becomes especially problematic when seniors experience agitated purposeful wandering. It is a form of wandering where seniors believe that they have a reason to go somewhere. Seniors with dementia are prone to wandering, but any senior can wander under the right conditions. All it takes is a little confusion.
Signs of Agitated Purposeful Wandering
Seniors that experience agitated purposeful wandering often exhibit signs of having a problem before, during, or after the incident. If left unaddressed, these issues may lead to further incidents and risk the health and safety of patients in nursing care. The signs to look for include:
The signs that indicate agitated purposeful wandering can vary based on each person. Some of the signs only appear during the incident, making it difficult to detect ahead of time. However, the careful observation of seniors and interference when necessary can prevent injuries and ensure that seniors get the help that they need.
Strategies for Managing Wandering Behavior
Every nursing home should have strategies for wandering behavior. Wandering is a somewhat common occurrence and is more common for seniors with memory care needs. The most common strategies focus on monitoring and prevention. There are emergency response pendants that can also be used to track seniors within a facility. If they try to exit from the facility, the staff will be notified by an automated system. Facilities also rely on door monitoring systems, like security cameras, locks, and door alarms to intercept seniors before they leave.
Prevention has also proven to be an effective way to reduce agitated purposeful wandering incidents. Care providers use a variety of activity-based techniques to reduce seniors’ need to wander by being proactive about daily activity. Seniors go on walks and participate in activities so that they don’t feel the need to get up and move around on their own when no one else is around. By proactively addressing the need to be active, seniors will be less likely to get up and leave when they are unsupervised.
Dangers of Agitated Purposeful Wandering
Agitated purposeful wandering can be dangerous for seniors, especially seniors with disabilities or cognitive impairments like Alzheimer’s. Without caregivers around, seniors risk injuries and other complications that they cannot receive expert help for right away. Some of the dangers of agitated purposeful wandering include:
- Getting lost
- Missing medications
- Fall injuries
- Becoming an easy target for criminals
These are just some of the dangers of agitated purposeful wandering. However, it is not a comprehensive list. There are dozens of ways that seniors can get hurt while wandering unsupervised
Reasons for Wandering
Wandering is generally due to seniors being confused. Agitated purposeful wandering involves seniors that are confused about their situation and are trying to go somewhere for some reason. It does not matter if the reason is real or not since the person that is wandering believes that the reason is real. This makes addressing agitated purposeful wandering difficult for care providers since it is difficult—if not impossible—to convince the patient otherwise. In many cases, the stress of the situation can also lead to irritable or even violent behavior from the patient.
Many seniors wander because they are confused about where they are. Often seniors that are new to a care facility can forget that they moved into the facility and try to leave. In other cases, seniors believe that they have an appointment or something important to do and wander while trying to get to their appointment.
Nursing Home Responsibilities
For anyone in the care of a nursing home, the facility is responsible for ensuring their safety. This includes preventing and responding to wandering in a reasonable manner. Many facilities use a collection of methods to try to minimize wandering, but accidents do happen. If you think that your loved one was in an agitated purposeful wandering incident, consult Pintas & Mullins Law Firm today to ensure that your loved one is well cared for.
Emotionally Cued Wandering & Elopement
In nursing homes, emotionally cued wandering refers to a reaction to events, situations, or the environment that causes elderly residents to wander in unsafe ways. This is a common behavior of nursing home residents with dementia and other cognitive impairments. When helping patients, caregivers should manage the residents in safe, healthy, and practical ways.
One side effect of dementia involves emotionally cued wandering. The term generally refers to the incidents in which vulnerable elderly adults wander unsupervised. The Centers for Disease Control and Prevention (CDC) published important facts about falls, including how elderly adults live at a higher risk of falling and suffering severe injuries from falls. Wandering increases those risks.
Cognitive Impairments and Emotionally Cued Wandering
Emotionally cued wandering can happen for a handful of reasons, as the reasons that trigger the wandering event differs from patient to patient. When dementia causes changes to the brain, it affects memory and thinking until individuals can no longer function independently on their own.
One report published by Harvard Health Letter says elderly adults suffering from Alzheimer’s may also show signs of:
- Short spans of attention
- Trouble speaking and expressing themselves with language
- An inability to rationalize or think clearly
Often, communication for people with dementia becomes limited difficult. When speaking with these individuals, you may find their behavior and actions strange. People with dementia may be trying to indicate unmet needs, frustrations, and more.
People at Risk for Emotionally Cued Wandering
Some nursing home residents remain at risk for emotionally cued wandering since they classify as people living with dementia. As a baseline, your loved one’s care plan should involve steps to prevent unsupervised wandering of any sort.
Ideally, you should attempt to address events or actions that may lead to avoid wandering before it even happens, when possible. For example, if you know that something is likely to trigger your loved one’s wandering, it can help to let nursing home staff know about it. Additionally, nursing home staff should have the training to recognize and report emotional symptoms in residents, like depression and agitation.
A few common causes for emotionally cued wandering in people with dementia may include:
- Visual or hearing impairments
- A lack of social interaction
- Care plans that do not meet the resident’s needs
A nursing home staff member must address any needs the resident has with good quality care in order to prevent wandering. Residents may become upset with an unmet need when they remain dependent on another person for care, which tempts them to address their needs themselves.
Addressing Emotionally Cued Wandering
Addressing emotionally cued wandering helps your loved one’s rights while also allowing them to maintain a sense of independence and pride. To do that efficiently, you may combine your care efforts with the resources of the nursing home and staff.
Some of the ways that caregivers may prevent emotional wandering include:
- Reduce waiting times: care routines should remain predictable, short, and simple. The shortened attention span of people with dementia can make waiting even a few minutes extremely agitating.
- Maintain supervision: proper supervision also helps nursing home residents who live at risk of wandering for any reason. Good supervision can reduce incidents of falling, unintentional wandering, and other harmful consequences.
- Individualize care: when caregivers see nursing home residents as individuals, their care will represent that. Understanding unique habits and making them a part of the nursing home care plan can help secure your loved one’s rights.
- Limit the use of restraints: restraints can upset your loved one, especially if they have an unmet need. Medication is one type of restraint, usually called a “chemical” restraint. A physical restraint can be something like wrist or waist restraints that prevent the patient from moving. Studies also show that antipsychotic medication has negative consequences for people with dementia.
- Limit stress and overstimulation: nursing home residents who wander may experience overstimulation or see something interesting outside of their usual confinements. Proactive nursing home care can include safety-locked doors and increased supervision of residents suffering from dementia.
The measures listed above do not include all practices for addressing residents with a tendency to wander. If you need more information on understanding nursing home laws and requirements, a lawyer may explain what options you have for protecting your loved one’s rights.
Recreational Wandering & Elopement
Individualized care in a nursing home means taking the individual lives of new residents into consideration when determining an appropriate care plan. Although your loved one may need time to adapt to life in a nursing home, caregivers should prioritize their safety and comfort.
In fact, the Nursing Home Reform Act mandates that caregivers provide care for residents’ physical, mental, and psychosocial well-being. When nursing home residents, especially those with cognitive diseases like dementia or Alzheimer’s disease, feel bored, they may wander.
Mitigate Harmful Wandering
Wandering may not always lead to an accident, but caregivers need to supervise elderly residents for their safety. Mental stimulation and social contact help maintain good mental and emotional health, while appropriate levels of mobility can regulate cell replacement and digestion, as well as enhance mood. Wandering can have some preventable negative consequences, too.
When Wandering Proves Harmful
When nursing home residents wander and leave the premises or enter an unsafe place without supervision, the situation can quickly spiral out of control. Wandering unsupervised, or in an unsafe place can result in injuries, dehydration, weight loss, excessive fatigue, or agitation. In extreme cases, it may result in the death of an elderly loved one.
Wandering May Communicate an Unmet Need
For people living with dementia, wandering can indicate an unmet need. In the case of recreational wandering, a resident may have tried to go to the bathroom, for example. For nursing home residents, fulfilling these needs keeps them secure and safe, but they rely on caregivers to assist them.
Meeting Recreational Needs
Nursing home residents may meet their recreational needs through any of the three following types of stimulation that help them engage with their surroundings:
- Exercise: Low-impact exercise for residents with mobility can have great health benefits. Physically engaging the body with an activity counteracts some of the physical impulses to wander. This may include getting fresh air, feeling sunlight, or simply moving.
- Exploration: When nursing home residents can safely explore their surroundings, they become mentally stimulated and more familiar with their home. Good familiarity and opportunities for exploration may prevent wandering.
- Interaction: A good sense of community can satisfy a nursing home resident’s psychological needs. Feeling engaged in simple social activities may help build rapport, improve mood, and fend off recreational wandering.
In some cases, recreational wandering happens when nursing homes fail to secure their premises. For example, if unlocked or unsecured doors remain available, a resident may wander to anything visually stimulating out of their confined space. While this may communicate a need for more engaging activities, it can also indicate overstimulation from external factors.
Preventing Harmful Wandering
When recreational wandering happens, one solution may not apply to all residents. An individualized approach to nursing home care can mitigate unique risks for wandering. The goal, of course, does not have to limit wandering completely but limit the potentially harmful effects of it. When nursing home staff practices risk management, they may prevent the harmful consequences of wandering.
You can help protect your loved one’s rights to independence and dignity by monitoring their care plan. You should see clear indications of measures that the nursing home takes to prevent your loved one from harm, in light of any cognitive disease or tendency to wander.
Call Our Illinois Nursing Home Abuse Attorneys Today
If your loved one has suffered injuries from wandering or elopement, do not hesitate to contact a skilled injury lawyer from our firm. By law, employees at nursing homes are required to supervise and monitor patients—especially those vulnerable to acts of wandering and elopement.
If neglect led to your loved one being injured, our Illinois nursing home abuse lawyers can help. Contact us at to schedule a free consultation.