Preventing Nursing Home Wandering and Responsibility

In a nursing home environment where dementia and Alzheimer’s patients are prevalent, wandering is a true reality. However, this is also a major yearly issue and leading cause of injury in elderly patients. These patients are suffering from a loss of cognitive functions and may leave the safe areas under the radar of those working in the nursing home environment. With an estimated 31% of nursing home residents with dementia wandering at least once, these numbers can be troublesome when it comes to keeping our elderly safe.

What are the types of wandering you may see in a nursing home?

• Environmentally Cued Wandering: A patient responds to their environment, such as sitting when they see a chair. A hallway or a path may cue the patient to wander, so staff must watch these patients closely when there is an environment that may trigger the patient into wandering.
• Recreational Wandering: The need and desire for exercise may lead a patient to wander. Allowing the patient more time or means to exercise, explore, and interact and less time to limit them may offset reasons that a patient will engage in recreational wandering.
• Agitated Purposeful Wandering: The patient will have a purpose for wandering and may be agitated about whatever the said reason is. The reasoning behind it can be real or imagined, but that patient’s emotional state is no less disrupted when the threat is imagined. A patient may respond aggressively toward staff when confronted and unwilling to cooperate or return to safe areas of the nursing home.
• Fantasy or Reminiscent Wandering: The patient is unaware of real surroundings and proceeds to wander according to an environment that they imagine. The patient may imagine past surroundings and respond to them. It may be difficult to confront, as patients may be unable to grasp the situation and understand the real surroundings.
• Elopement: This is the most dangerous type of wandering, as patients attempt to completely leave the nursing home and wander outside. They are often hurt or killed during this type of wandering. Staff must learn to keep a close eye on patients that have attempted this type of wandering, as recurrences are very common.

Staff training is extremely vital in the prevention of nursing home wandering. As adults age and cognitive loss is more prevalent, staff must keep this in mind and be both knowledgeable and skilled in their specialized assessment, psychological interventions, and activity needs. Staff education should include understanding the effects of cognitive loss upon the person’s emotional state, function, and physical health. Upon this understanding, members of the staff team at a nursing home will be able to appropriately perceive wandering as a patient’s coping mechanism and see that it requires a safe way of expression.

Likewise, family members should always be informed of an incident including wandering. It may recur and become more dangerous, and input from loved ones may help in preventing these incidents. In some cases, it may be necessary to alter the patient’s environment or even sometimes further remove the patient from the nursing home to prevent injuries.

So, who is liable if a loved one wanders and becomes injured as a result?

Nursing homes are held to a sturdy agreement of “due care” which promises that they will take all reasonable precautions to keep the resident safe from predictable or foreseeable harm. If a nursing home fails to uphold this duty, then they may be held liable for negligence. If a nursing home staff fails to properly evaluate a resident at their intake or perform evaluations throughout their stay, the nursing home may be held liable for failing to stay informed of the possibility that the resident may indeed wander. They may also be held liable in a case where they have failed to properly train its staff on the possibility of wandering, monitoring residents who might wander, or train them to prevent wandering in general. Leaving a resident who might wander unattended for prolonged periods of time can lead to liability as well. No, not every case of wandering will be negligence or a liability, but in most cases it can be prevented and staff must take care of its patients to the utmost of their abilities as they promise.