Wandering/Elopement Risk Evaluation and Care Planning Policy

Wandering/Elopement Risk Evaluation and Care Planning Policy

Effective Date: [Original NPP Date]
Revised Date: [Current Date]

Goal

To identify residents at risk for wandering/elopement and to implement interventions designed to promote resident safety and well-being.

Policy

Residents who can mobilize or ambulate independently and who lack the cognitive ability to make relevant decisions will be evaluated for risk of wandering/elopement on admission and when clinically indicated.

• Residents identified to be at risk for wandering/elopement will have a photograph at the reception desk.
• Facility staff will be notified that a resident is at risk for wandering/elopement.
• An individualized care plan will be developed based on the resident’s identified risk factors and needs. The plan of care will be evaluated for its appropriateness and effectiveness on at least a quarterly basis or with a significant change in condition.

Procedure

Evaluation

I. On Admission/Readmission and with Significant Change in Condition:

• Assess each resident’s risk for wandering/elopement using a standardized risk assessment tool.
• Document findings in the resident’s medical record.

II. Ongoing Monitoring:

• Continuously monitor residents for signs of wandering or elopement risk.
• Reevaluate residents as needed based on observed behaviors or changes in condition.

Notification and Documentation

III. Photograph and Identification:

• Ensure that a current photograph of the resident at risk is available at the reception desk.
• Clearly mark the resident’s medical record and care plan to indicate the risk of wandering/elopement.

IV. Staff Notification:

• Inform all facility staff of the resident’s risk status during shift changes, staff meetings, and via electronic health record alerts.

Care Plan Development and Interventions

V. Individualized Care Plan:

• Develop an individualized care plan tailored to the resident’s specific risk factors and needs.
• Include the following potential interventions:

1. Room Assignment:

   • Assign the resident to a room located away from exits to reduce the risk of elopement.

2. Environmental Modifications:

   • Decorate rooms with favorite pictures, art, etc., to provide a sense of comfort and familiarity.
   • Provide large-print signs and/or pictures to assist the resident in finding his/her room.

3. Structured Activities:

   • Offer activities that address memory loss, anxiety, restlessness, and limited attention span.
   • Implement exercise and walking programs to provide physical outlets, relieve tension, and offer stimulation.
   • Engage residents in activities that increase self-esteem, such as watering plants, folding linen, gardening, and setting tables.

4. Communication Adaptations:

   • Adapt communication to the resident’s memory challenges, history, preferences, routines, and values to promote a sense of security.

5. Consistent Routines and Caregivers:

   • Maintain consistent daily routines and caregivers to provide stability and predictability.

6. Behavior Monitoring:

   • Monitor behaviors to establish patterns and anticipate potential wandering episodes.

7. Pain Management:

   • Implement pain management strategies to address discomfort that may contribute to restlessness.

8. Medication Evaluation:

   • Regularly evaluate medications to ensure they are not contributing to wandering behaviors.

VI. Quarterly Review and Updates:

• Evaluate the care plan’s effectiveness quarterly or with any significant change in the resident’s condition.
• Update interventions as necessary based on the resident’s current needs and risk factors.

References:

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM]
• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]