Sound risk management can benefit a senior living community
More than 10 years ago the director of nursing at my mother’s assisted living community called me. She told me she had good news and bad news. “Tell me the bad news first,” I said.
She did. I dropped the phone and ran to find my car keys and head to the community. I was in shock and frantic to get there so I could see for myself that my mother was not injured.
When I arrived, the director of nursing further explained that my mother, who was diagnosed with early onset dementia, had eloped and was found crossing railroad tracks behind the community where a friend was waiting in a car to pick her up.
As the story unfolded, I learned that my mother had recently, prior to her admission to the assisted living community, met a man at a local senior citizen activity center. They had skillfully planned her exit from the community.
A thorough investigation identified this man as a predator with a long history of connecting with and befriending women at the senior center. He specifically targeted widows. He had promised my mother that he would take care of her once she escaped from the assisted living community.
At the beginning of the investigation, I asked myself, “How could this happen?” I had believed the community was a safe place for my mother, and I began to reflect on what I and the community could have done to prevent such an incident and how to avoid a reoccurrence.
After discussion with the assisted living executive director and community care team, I discovered several gaps in the community’s policies and procedures for managing residents at risk for elopement. The incident underscored the necessity for a review and update of the community’s elopement policies and risk management systems.
Elopement is the act of an elderly person leaving a senior living community without proper authorization or supervision, and it can be very dangerous for the resident.
60% of people living with dementia will wander at least once.
According to the Alzheimer’s Association, six in 10 people living with dementia will wander at least once; many do so repeatedly.
Elopement presents many safety concerns:
Recent media articles have drawn attention to real estate investor shortfalls for managing care at senior living communities. These articles featured lawsuits and state inspection reports that pertain to resident elopements, poor quality of care and understaffing.
While a community cannot predict resident elopements, it can determine residents at risk for elopement. Risk factors include a resident’s:
Internal systems to address hazardous wandering and elopement should be multidimensional, tailored to the community population and flexible to allow for customization. The community should engage residents with dementia diagnosis, their family members and all staff.
Policies and procedures should include:
The senior living community leadership should consider moving beyond simple reporting of elopement events by creating a severity-based classification system. For example, a witnessed elopement is when a resident is safely and immediately redirected back to a safe area. The resident has a lower severity score or potential for harm than a resident who wanders into a hazardous area in the community or outside of the community building. Classification can capture all events for investigations as well as calculate different statistics about the severity of events; for example:
The above classification system denotes levels of risk associated with hazardous wandering and elopement events. Educating staff in the differences helps to ensure they are reporting events correctly and improves the overall understanding of elopement risk and incident management. The incidents and data gathered can be used to improve the quality of resident activities and determine the root cause of the event.
The community should have a missing resident protocol or a checklist to assist in the event a resident is found to be missing. The process should assign staff responsibility for search locations, communications and internal alert reporting, notifications to physician, family and law enforcement. The process should activate the community’s incident command process to keep the search organized and communications managed.
Elopement doesn’t happen often in senior living; however, elopement incidents can be dangerous to the resident and damaging to the community’s reputation. Communities may face regulatory consequences resulting in financial penalties and incur additional expenses due to the need for increased staff time and legal expenses.
Overall elopement events greatly impact resident safety, affect staff morale, and can be emotionally draining as staff may feel responsible and distressed by any harm to a resident.
Many elopements do not end in tragedy; however, when they do, senior living operators are often found negligent in their duty of care. This can lead to negative publicity resulting in decreased community occupancy levels, adversely affecting the community’s financial stability.
The good news about my mother’s story is that she was found and was not harmed during her elopement.
However, I never recovered from that day’s trauma, but I have applied that experience to my role as a risk manager. I learned the importance of interviewing family members to get a full history of the resident’s background, including monitoring of visitors, keeping an open dialogue with the resident and staff members, educating staff members in elopement policies, ensuring internal controls for residents that wander, conducting mock missing resident drills and monitoring all residents who have a dementia diagnosis for their risks for wandering and/or elopement.
Senior living communities can minimize the risk of elopement by enhancing security, staff training and individualized care plans. Recognizing the factors unique to each resident’s assessment can effectively aid in elopement risk mitigation.
Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).
| Title | File Type | File Size |
|---|---|---|
| Senior living elopement toolkit | .8 MB | |
| Missing resident search | .2 MB |
