Risk Factors for Wandering and Elopement in Nursing Homes

The main risk factors for wandering and elopement are cognitive impairment, dementia-related confusion, prior wandering attempts, poor supervision, understaffing, unmet physical or emotional needs, medication-related changes, and facility security failures that make it easier for a resident to leave unnoticed.

42 C.F.R. § 483.25(d) requires nursing homes to keep the resident environment as free of accident hazards as possible and to provide each resident with adequate supervision and assistive devices to prevent accidents.

If your loved one was hurt after wandering or eloping from a nursing home, we can review what the facility knew, what steps it failed to take, and whether the facility’s failure can support an abuse or neglect claim. Contact us for a free consultation today.

What Is Wandering and Elopement in Nursing Homes?

Wandering and elopement are similar concerns, but there are important distinctions. Wandering refers to behavior that occurs on nursing home property. A wandering resident moves about the facility without regard for their safety. 

This person is unsupervised and could be exposed to physical dangers while they wander. A wandering resident could suffer injuries if they fall or enter the wrong place. They could also get into trouble entering other residents’ rooms or walking off the property. 

Elopement occurs when an elderly person leaves the facility altogether. Again, this only happens if the person is unsupervised. The consequences of elopement can be severe, including significant injuries, malnutrition, getting lost, or even death. 

What Are the Individual Risk Factors for Nursing Home Elopement?

There are many risk factors for wandering and elopement. These characteristics could indicate that a patient is more likely to wander or elope if left unsupervised for too long. 

Cognitive Impairment

Cognitive decline, developmental disabilities, and other cognitive impairments can cause disorientation or memory loss, placing nursing home residents at greater risk of wandering or eloping. Conditions like dementia or Alzheimer’s disease can cause confusion in the patient, causing them to wander about looking for familiar surroundings. Often, they do not realize the danger they are in, especially if they leave the facility altogether. The Alzheimer’s Association says 6 in 10 people living with dementia-related behaviors will wander at least once, and a study of 325 missing-person incidents involving people with dementia found that 32% were found dead.

Mental Health Conditions and Emotional Distress

Mental health conditions can also make nursing home residents prone to wandering off. They might be doing so on purpose if they are experiencing anxiety or depression. A patient with bipolar disorder or other psychiatric disorders could become agitated by their environment, which would trigger wandering behavior, leading to potential dangers and serious injuries.

Physical Limitations

It might seem counterintuitive, but nursing facility residents with physical limitations are sometimes more likely to wander or elope. Staff may assume these patients are unlikely to go anywhere unsupervised, so they won’t take steps to prevent wandering or elopement. 

Mobility issues, visual impairments, and hearing loss are not rigid barriers to elopement or wandering, so staff members must still supervise residents with these physical limitations. 

Previous History of Wandering or Elopement

A resident who has wandered off in the past is more likely to do so again. Nursing staff and administrators must communicate with each other about residents who have displayed these behaviors in the past and take additional steps to prevent elopement or wandering a second time. 

Medication Side Effects

Medications often have various side effects on patients. When a resident is given medication, it could result in symptoms like confusion, disorientation, anxiety, or depression. A person suffering from these side effects may wander the facility and leave the property. 

Other unintended consequences of medication could include agitation or restlessness, both of which may lead to wandering. 

What Environmental Factors Are Considered Elopement Risks?

The facility environment is not always the safest, especially for those prone to wandering or elopement behavior. Often, wandering occurs due to nursing home neglect or staff failing to provide a certain standard of health care.

Inadequate Security Measures

Lack of security can lead to serious injury for a wandering resident. The facility must provide a secure property to keep all residents and visiting family members safe. 

Unfortunately, accidents can happen because of failing to secure doors, inadequate alarm systems, and lack of surveillance. These conditions can create a high risk if a resident is unsupervised while wandering the facility. 

Staffing Shortages or Inadequate Training

Nursing facilities must have enough trained staff to provide a safe space for each resident and offer the proper standard of care. This personnel includes administrators, security members, and nursing specialists. If a facility has a staffing shortage or employs unqualified people, it is at an increased risk of losing track of residents. 

Hiring the right people and having adequate staffing levels are proactive steps nursing facilities can take to ensure constant supervision of all residents. 

Poorly Designed Facilities

The design of nursing facilities can also be a factor in preventing elopement or wandering. A confusing layout could cause residents to get lost in the hallways and enter rooms they shouldn’t be in. Inadequate signage will also make it easier for people to get lost. 

Also, the lack of clear exits from rooms and the building itself may cause more incidents. When a patient goes missing, it could result from a poorly designed facility. 

How Nursing Homes Can Prevent Dangerous Wandering 

Nursing home staff are responsible for preventing these incidents. Since wandering can be extremely dangerous for residents, all practices must be designed to prevent it from happening. Here are some strategies facilities can employ to protect patients from the dangers of wandering and elopement. 

Comprehensive Risk Assessments

Risk assessments are essential when evaluating a patient. A comprehensive assessment can identify individual vulnerabilities, whether physical, mental, or emotional. 

From this assessment, a care plan can be created. This plan should include practices for supervising the patient and preventing them from wandering around the facility. If a nursing home fails to conduct these assessments, it could be guilty of neglect. 

Individualized Care Plans

An individualized care plan is specific to each patient. It outlines the resident’s risk factors, including their likelihood of wandering. 

Do they have Alzheimer’s disease, making them at risk for confusion? Do they get agitated easily, making them seek out familiar places not in the nursing home? What medications do they take that could have worrying side effects? Every resident must have a tailored care plan to prevent wandering or elopement. 

Environmental Modifications

If modifications are needed to make the nursing home safer for residents, they should be implemented as quickly as possible. Adding more signs, creating a simpler layout, and having sufficient exits are good starts. 

Better security and designated safe areas should also be in place to protect residents from neglect and abuse. With better security, patients are less likely to get hurt when walking around the facility unsupervised.

Staff Training and Education

The best way to prevent neglect and abuse in all forms is to hire well-trained staff. All nurses and administrators must have access to comprehensive training to recognize and respond to wandering patients. Additionally, these employees must know how to assess a patient’s risk factors and enact measures to protect them from injury. 

Technology and Monitoring Systems

Technology can significantly improve the care provided in nursing homes. GPS trackers, door alarms, and surveillance cameras can help ensure residents are monitored appropriately and find them quickly when wandering unsupervised. These tools are beneficial for patients with dementia or other mental disorders who are more likely to wander the facility. 

An early warning system will allow the staff to find the wanderer or eloper and return them to safety before they suffer a major injury. 

When Wandering and Elopement Constitute Nursing Home Neglect

Nursing homes are supposed to provide sufficient care for elderly individuals. This care includes protecting them from harm caused by wandering the facility or leaving the property. If the staff fails to uphold its duty of care, the facility could be guilty of nursing home neglect. Here are some legal implications that may result from a wandering or elopement incident. 

Nursing Home Liability

An injury or other type of harm suffered during a wandering incident could implicate the nursing home in a potential lawsuit for neglect. If a nursing home elopement lawyer is able to prove negligence, a lawsuit could cost the nursing home thousands of dollars. Examples of nursing home negligence leading to wandering and elopement include:

• No admission elopement-risk assessment;
• No reassessment after behavioral or medication changes;
• No individualized care plan for a known wandering risk;
• Door alarms or other security measures not working;
• Inadequate staffing, especially on evenings or weekends;
• No documented response to prior exit-seeking behavior;
• Delayed search efforts after a resident went missing;
• Delayed 911 notification after elopement was discovered.

Negligence and Duty of Care

One of the primary elements in a nursing home abuse or neglect lawsuit is the duty of care. Plaintiffs must prove that the facility owed a duty of care to the harmed resident. This duty represents the facility’s legal obligation to provide adequate care and protection for the resident. 

To win a lawsuit against a nursing home, the plaintiff must provide evidence that proves the defendant owes a duty of care, that the duty was breached, and that there is a causal relationship between that breach and the harm suffered by the victim. 

Seeking Compensation for Damages

Claims against nursing homes are usually filed to recover compensation, although they can also be used to prevent future negligence. Victims of abuse or neglect can pursue compensation for multiple types of legal damages, including medical expenses, emotional distress, physical pain and suffering, and loss of quality of life. 

If an elderly loved one dies due to wandering or elopement and the nursing home is liable, surviving family members could file a wrongful death lawsuit, pursuing other forms of damages like funeral costs, loss of financial support, or loss of companionship. 

Book a Free Consultation With an Experienced Nursing Home Abuse Lawyer and Seek Justice for Your Loved One 

Winning lawsuits against nursing homes is a significant challenge. The burden of proof is on the plaintiff to demonstrate that the nursing home is more likely than not responsible for the harm suffered. Most families do not have the resources or legal expertise to win this battle and seek compensation for damages. 

The Nursing Home Law Center is a specialized team of experts that supports victims of abuse and neglect in nursing homes. Our nursing home abuse and neglect legal team can provide legal guidance throughout the claims process to increase your chances of winning. We will investigate your case, collect evidence, negotiate for a fair settlement, and protect your rights throughout the legal process. 

Call our team today at 800-926-7565 or complete the online form to explore your legal options. 

FAQs

What is the difference between wandering and elopement?

Wandering usually means a resident moves about without clear direction or awareness of danger, often in an unsafe area inside or around the facility. Elopement is more serious. It happens when a resident leaves a safe, supervised area without staff knowledge or permission, creating an immediate risk of harm.

What are the warning signs a resident might wander or elope?

Common warning signs an elderly resident might wander or elope from a nursing home include:

• agitation or pacing;
• trying doors;
• asking to go home;
• searching for a spouse, child, or former workplace;
• exit-seeking after shift changes or family visits;
• a resident who is physically mobile enough to leave unnoticed;
• prior episodes of wandering or attempted elopement.

What are common injuries sustained in wandering and elopement cases?

Common injuries in nursing home wandering and elopement cases include:

• falls and fractures;
• head injuries, such as subdural hematoma;
• cuts, bruises, and abrasions;
• dehydration;
• heat exposure or hypothermia;
• medication interruption;
• traffic-related injuries;
• drowning or other fatal injuries after prolonged disappearance.

Does dementia always lead to wandering?

No. Dementia does not always lead to wandering. Even so, dementia and Alzheimer’s disease are one of the clearest risk factors. Residents with dementia may become disoriented, confused, or focused on reaching a familiar place, which can increase the risk of wandering or elopement.

What should a nursing home do if a resident is missing?

A nursing home should respond immediately to a missing resident. That usually means:

• starting a facility-wide search at once;
• checking exits, cameras, alarms, and sign-out records;
• notifying supervisors and the resident’s physician;
• calling 911 without delay if the resident is not found quickly;
• alerting the family or responsible party;
• documenting the incident and reviewing how the resident was able to leave.