May 2025 | Written by Kim Doramus, Operations Specialist with RevealSol
In my years as a senior living professional, I’ve seen firsthand the challenges we face in ensuring the safety and well-being of our residents. One of the most critical, yet often undiscussed, issues is elopement. It’s a topic that can evoke anxiety, but with proper preparedness, planning, and prevention, we can significantly mitigate the risks. My recent presentation, “Prevention Vs. Panic: A Get Ahead Guide to Elopements,” was designed to provide actionable strategies, and I want to share some key takeaways with you.
Understanding the Urgency
Let’s start with some hard facts: Elopement, defined by the Texas Health and Human Services Commission (HHSC) as an individual leaving a safe area or premise and going to a known or unknown location that places them at risk of serious injury or death, is a serious concern. The Alzheimer’s Association reports that 60% of people living with dementia will wander at least once, and most wander repeatedly. Compounding this, if a person with dementia is not found within the first 24 hours, up to half will experience serious injury or death. These statistics underscore the urgency of having robust elopement prevention and response plans in place.
Key Risk Factors and Vulnerable Times
Elopements can occur for various reasons, and certain situations increase the risk. We need to be particularly vigilant during shift changes, when there may be confusion or lapses in attention. Facility failures, such as alarm doors malfunctioning, and residents pushing through emergency exits, are also significant risk factors. New staff who haven’t received adequate training, multiple residents leaving after an activity, the first 72 hours after a resident moves in, inclement weather, exit-seeking behavior, and blind spots that obscure exits all contribute to the potential for elopement. It’s crucial to address these vulnerabilities proactively.
Regulatory Compliance
In Texas, elopement in assisted living facilities is a reportable incident to HHSC. Facilities must report a missing resident if they can’t be located after a thorough search and if circumstances place the resident’s health, safety, or welfare at risk. This includes situations where residents require medications, are exposed to extreme weather, or are confused and unable to assess danger. It’s imperative to familiarize yourself with the Texas Health and Safety Code and Provider Letter PL 19-23 to ensure compliance. When in doubt, report!
Preparedness: Your First Line of Defense
Preparedness is paramount. I advocate for developing a resident profile system that includes photographs, medical information, and known triggers for wandering. Staff training is equally important; they must be able to recognize signs of agitation or restlessness. Establish clear search and rescue protocols, including communication strategies with local law enforcement. Emergency preparedness also means registering for STEAR (State of Texas Emergency Assistance Registry) and AlertMedia, and building relationships with your local police.
The Critical Assessment
The assessment process is a key time to begin elopement preparedness. A resident’s photo should be taken during the assessment or on move-in day, and updated regularly. These photos may be crucial for search efforts or even Silver Alerts, so ensure they are clear and current. Screen for elopement risk during the assessment and initiate open, trusting conversations with the family about this potential.
Training and Drills: Practice Makes Perfect
Regular training and drills are not just a requirement; they are a necessity. Facilities should train staff on elopement policies and procedures upon hire and quarterly. An elopement binder containing at-risk resident photos, contacts, DNR status, and health information should be prepared and updated monthly. Conduct realistic mock drills, including nighttime and multiple missing resident scenarios, at least quarterly, even though the requirement is annual. Document these drills thoroughly, including timestamps, and review and update your policies and procedures regularly.
When Elopement Occurs: A Systematic Response
Despite our best efforts, elopement can still happen. It is vital to have a clear, well-communicated plan. Upon discovering a resident is missing, the staff member must immediately notify the manager on duty. Check the resident sign-out book and page the resident. If the resident cannot be located, initiate a search, using a code like “Code Purple” to alert staff. Take a headcount of all residents and document this step. Notify the Administrator/Executive Director, the resident’s POA within 30 minutes, and the police department, providing a photo and description. Expand the search into the community, distribute flyers, and maintain hourly contact with the resident’s family. Once the resident is found, conduct a full physical and emotional evaluation, notify all parties, and create a detailed incident report. Hold a staff meeting to review the incident and update procedures to prevent future occurrences.
Tools for Identification and Prevention
Identification is key. Consider using identifiers like Road ID bracelets or keychains with community contact information. Prevention strategies include engaging residents in meaningful activities, providing personalized supervision, and promptly informing staff of new residents or changes in condition. Technology can also play a role; GPS trackers, door sensors, and smart locks can enhance monitoring. I also recommend considering a 72-hour care plan, where a companion assists new residents to acclimate to the community. Regularly review and update your community systems, including physical plant and hardware.
The Financial Impact of Elopement
Elopement isn’t just a safety issue; it’s also a financial one. A 2016 analysis of professional liability insurance claims revealed that elopement-related claims constituted 5.8% of all claims against assisted living communities. These claims had the second-highest average total payout, averaging $388,048 per claim. Assisted living communities accounted for 54.3% of elopement claims, and alarmingly, death was the most frequent injury associated with these claims. Investing in prevention is not only ethical but also financially prudent.
Understanding Dementia-Related Behaviors
Understanding dementia-related behaviors is crucial in search efforts. Residents who elope often walk in a straight line and don’t typically go backward. They may seek shelter in cars or barns or be drawn to familiar places like home. Check local landscapes, such as ponds and fence lines, and remember that most individuals are found within a 1.5-mile radius.
Post-Elopement Procedures
Once a resident is found, screenshot your phone to document the time. If transporting the resident in a personal vehicle, use the child lock. The resident must be checked out by the nursing team or paramedics, and the physician and HHSC must be notified. Finally, circle back with everyone involved to gather statements and document the incident thoroughly while it’s fresh in everyone’s mind.
In Conclusion: Prioritize Preparedness
Elopement is a serious issue, but with proactive strategies, thorough training, and a commitment to preparedness, we can create a safer environment for our residents. Let’s shift our focus from panic to prevention, ensuring the well-being and security of those in our care.
We’re here to help you navigate these challenges. At RevealSol, we offer consultation services to coach and guide senior living communities in developing and implementing effective elopement prevention and response strategies. Feel free to reach out – we’re in this together.