In this article, the health care experts discuss nursing home neglect. The purpose of this article is to define neglect and its key components, explain the responsibility for a facility to investigate…
In supervised care environments, the term “elopement” describes when a resident leaves the premises without authorization and/or necessary supervision. If elopement occurs, the individual who left the premises unsupervised is at a substantial risk of injury and/or death.
This article examines contributing factors to the occurrence of elopement in residential facilities, the potential consequences of elopement, and some of the factors that should be considered when evaluating why an elopement incident occurred and if the facility met the standard of care.
Frequency and Consequences of Elopement in Residential Facilities
Many individuals admitted to a residential facility or agency require assistance with their medical, emotional, behavioral, or physical needs. As a result, supervision and care are needed to ensure their safety.
According to the Journal of Advanced Nursing, approximately one in three nursing home residents who have dementia and/or cognitive impairments will elope from the facility at least once during their residency. If the resident is not located within the first 24 hours, there is approximately a 25% chance that they will not survive.
Children, adolescents, and adults within residential facilities are also prone to elopement. It is common for this population to have developmental disabilities including autism spectrum disorder and intellectual disabilities or mental health conditions which present as behaviors that compromise their safety and well-being. As with adults, the consequences of elopement in children can often result in severe injury or death. Deaths or severe injuries associated with elopement are serious, reportable events to state governing agencies.
In addition to individual harm and the emotional burden on affected families, elopement incidents can carry a significant financial burden for the facility. Reported incidents may require increased monitoring and supervision within the residence, and potentially a re-evaluation of existing policies and procedures. Facilities may also face negative citations from governing agencies with required corrective action plans, and quality ratings may decline.
Elopement Prevention
Facilities need to have processes in place to assess each resident’s risk of elopement, and strategies to prevent elopement. Assessments should be performed at the time of admission, and if there is a change in condition or behavior. These assessments typically include:
Determining the Standard of Care and Causation in Elopement Cases
The Agency for Healthcare Research and Quality notes that breakdowns in individual assessment and team communication are top contributing factors in elopement. Staffing shortages, along with a failure to secure the physical environment and follow the individual’s care plan also contribute to the likelihood of elopement in these settings.
The standard of care in each case will be determined based on a number of resident-specific risk factors. Examples of precautions that may be relevant include the placement of at-risk individuals where they can be closely monitored and away from exits; access controls at exits, alarm systems, and electronic monitoring devices may also be relevant.
Even facilities with advanced security systems can experience elopements resulting from procedural failures. Procedural causes of elopement may include:
When investigating these matters, careful consideration needs to be placed on these standard of care issues. Facilities have a responsibility to ensure they are properly staffed to meet the needs of at-risk individuals, staff is trained accordingly, and policies and procedures are developed, communicated, and implemented.
Among the supervision experts at Robson Forensic are nurses and nurse practitioners, social workers and psychologists, special education and child / adult care program coordinators. They have hands on experience working in organized care settings, implementing and evaluating the processes and procedures used to ensure resident safety. This includes, among others, effectively screening staff during the hiring process, training and retaining staff, and reporting/investigating incidents.
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