Wandering is a common phenomenon among nursing home residents with dementia and represents one of the greatest safety threats. Although the etiology of wandering is not clearly understood, many factors and behaviors have been linked to an increased risk of wandering among individuals with cognitive impairment. The authors report a case of a nursing home resident with dementia who managed to leave the facility despite his dependence on a motorized wheelchair and discuss the need for nursing homes to implement measures that protect residents from the dangers associated with wandering and elopement.
Wandering and Elopement: Litigation Issues
Marie Boltz, MSN, APRN-BC, NHADirector of Practice Initiatives
The John A Hartford Foundation Institute for Geriatric Nursing
NYU College of Nursing
Laws For WANDERING
One of the most challenging, life-threatening issues related to care of the person with cognitive loss is the occurrence of wandering, wherein the person strays into unsafe territories and may be harmed. The most dangerous form of wandering is elopement in which the confused person leaves an area and does not return. The risk of wandering has become a growing concern of families, long-term care facilities, regulators, and insurers.1 In addition to civil liability, care providers can be fined by the state regulatory agency for failure to prevent elopement.2 The effects upon the population served and the staff are no less dramatic. The sense of security of those served and their families is severely shaken, and staff morale as well as the organization’s reputation is dealt a devastating blow. 3 The aim of this chapter is to define wandering, elopement, and related issues, and to summarize the scope of the problems in terms of prevalence and effect. The types and causes of wandering and generally accepted approaches to care will be discussed. The regulatory and risk management considerations will also be presented. A hypothetical case will be presented. Finally, the role of an expert witness will be discussed.
The North American Nursing Diagnosis Association (NANDA) defines wandering as “ meandering, aimless, or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles.” 4 A common behavioral problem, wandering involves cognitive impairment that includes difficulty with abstract thinking, language, judgment, and spatial skills. 5 Wandering is also associated with disorientation and difficulty relating to the environment, and low social interaction, excessive pacing or increased motor activity. The person who wanders may also unknowingly trespass in another person’s nursing home room and an altercation may result. There are two types of wandering: goal-directed and non-goal directed. In goal-directed wandering, the person appears to be searching for someone or something. The person may also be looking for something to do and may make gestures as if performing a task. In contrast, in non-goal directed wandering, the person may wander aimlessly, and has a very short attention span. 6 Continue reading “Wandering and Elopement: Litigation Issues”