Sandra Stimson CALA, ADC, CDP, CDCM
NCCDP
Executive Director
“A facility recently took their residents who lived on their dementia unit to New York City. The City is very crowded and the staff lost a resident when the resident wandered off.” Luckily, 24 hours later the resident was found by law enforcement wandering the streets and was unharmed.
“An assisted living facility took 8 dementia residents who were ambulatory, one activity assistant and one bus driver to a crowded mall. They lost the resident for over an hour. The elopement was never reported.”
“An activity assistant took 7 residents by herself to a large apple orchard. She had not taken a cell phone and no form of outside communication. All residents were ambulatory and diagnosed with dementia and Alzheimer’s. She drove to an isolated remote section of the huge apple orchard. She opened the van door and began letting the residents out of the van. They immediately scattered. She was unable to call for help. Luckily after an hour, she found all the residents. One resident had fallen in a hole but was unharmed.”
Residents diagnosed with dementia and or live on a dementia unit may go on supervised outings. But their needs to be thought and planning when taking residents on a trip.
Only take the number of residents that can be safely monitored. On all trips there should be an activity assistant, nursing assistant and a bus driver. Or two activity assistants and a nursing assistant. A nursing assistant should accompany all residents as they are trained in areas of ADL’s. Additionally, if you have only one activity assistant and a resident has to go to the rest room, who will be left to monitor the residents? Administrators and Director’s of Nursing must make it a policy to have appropriate supervision when resident’s have a diagnosis of dementia are on facility outings. The facility is leaving themselves open for possible accidents, elopements, fines and law suits should anything happen.
All residents should have proper identification. One creative way is to have the residents and staff wears T shirts that have the name of the facility printed on the front and back. This is really important in the case of elopement and the need to know what the resident was wearing. It is a quick visual way to monitor and supervise the residents.
If there is an elopement, administration is to be notified immediately before the search begins. Don’t wait! Time is not on your side. Residents can wander into traffic, fall and any of a number of serious injuries and accidents can occur. Remember there are only two kinds of people who may find your resident, a Good Samaritan and law enforcement. Let’s be honest. Yes, you may stop to help an elderly man wandering the streets in a small town, but would you stop the same elderly man in a large city? We hope the answer is yes but most often it is Law Enforcement who locates a dementia resident.
The Activity Director should complete and document an in-service that deals with Trips and emergencies. The in-service should specifically state what to do in situations of elopement, illness, falls and accidents and the reporting procedures. For example, is the Executive Director to be notified first? When are 911 to be called? Any elopement or missing resident is to be reported immediately before the search begins.
There should be a policy and procedure that specifically deals with trips and the proper protocols. This includes:
- Van Safety
- Seat Belts
- Loading and unloading
- Emergencies
- Falls
- Elopement
- Illness
- Food required to be on van for trips
- Gas & Inspection of Van
- Cell Phones
- Staffing for the Trips
- Proper reporting procedures
- 911
- Trip request form
- Training staff on use of Van
- Bus Driver
- Required CNA per trip
The Activity Director should have a Trip book that includes:
- The name of each location
- Address
- Phone number
- Rest room information
- Ramp information
- Directions
- Cost
The activity staff should be equipped with cell phones when on outings. The unit manager should be a part of the discussion of which residents are appropriate to attend facility outings. The receptionist, administrator, Director of Nursing, Unit Manager and the Activity Director should be provided with a trip form that states:
- Name of location
- Address and phone number
- Departure time and return time
- Resident names
- Staff names
- Cell phone number
Pick the location well. The Activity Director should visit the location prior to the trip to access the environment, crowds, bathroom facilities, parking lot and number of exits for the location. Smaller venues are recommended such as;
- Small diners
- Small pet shops
- Small stores
- Small stores such as five and dime vs. a large shopping mall.
- Drive to a resident old neighborhood
- Small zoo
Plan your time well. Probably the best time to go on an outing is 10:00 A.M. and return by lunch time. A long trip is probably not recommended as they tire easily. There are times through out the year that you may want to take residents on trips where they do not leave the van such as viewing holiday lights or observing fall foliage. Keep in mind the weather and dress the residents accordingly.
If the resident exhibits extreme anxiety over leaving or returning to the facility, perhaps it is best that the resident not attend future trips. This should be clearly documented in the resident’s chart. The staff should note the behavior and interventions used to calm the resident down.
Staff should be seated through out the van. As a resident may attempt to get out of their seat. It is important that one staff member is seated in the back of the bus to observe for safety concerns or illness issues.
On all trips, bring along snacks, crackers, orange juice and apple juice. There are times when the bus may be delayed due to accidents and traffic. You may also have a resident who is diabetic. Also bring along extra diapers, wipes, trash bags and paper towels in the event of accidents or spills.
Always communicate for success. Let the residents know where you are going. When you get off the bus, let the residents know what they will be doing. When they return, state to the residents, “that you are now returning and the name of your facility.” Keep your answers brief and to the point. There is a great communication book called Creating Moments of Joy and is available at www.activitytherapy.com web site. This could be used as part of your in-service and training. The book provides excellent responses for repeated questions, such as “I want to go home or where is my daughter, etc.”
Trips and outings are very beneficial to the dementia resident. Some of the benefits are;
- Relaxation
- Reminiscing about the location
- Fun
- Self Esteem Building
- Diversion
- Pleasurable
- Calming
There are also many products on the market for tracking elopements such as GPS systems. If you feel you may need additional support in the event of a possible elopement, you might investigate Project Lifesaver. Project Lifesaver has great success in locating missing residents in a matter of minutes.
You can avoid catastrophic reactions and situations if the Activity Director, Director of Nursing and Executive Director train the staff, plans the venues, provides enough staff on outings, communicates with the other staff in the facility, reporting procedures and have strong policies and procedures. |
The
Care Planning Cookbook for Activities
and Recreation
Grandfather's
Memories To His Grandchild
