Unit 8
Elopement is defined as “when a patient or resident who is cognitively, physically, mentally, emotionally, and/or chemically impaired wanders away, walks away, runs away, escapes, or otherwise leaves a care-giving facility or environment unsupervised, unnoticed, and/or prior to their scheduled discharge,” (The National Institute for Elopement Prevention and Resolution).
Every year a resident dies from elopement. These cases are so sad and almost always due to the person being unaware of safety concerns. A person living with dementia wanders off in his PJs in a snow storm as he is convinced his cattle need to be put in the barn, or an elderly woman living with dementia sure she is late to pick up her small children from the bus stop wanders out into traffic. These folks time travel in their memories which are very real to them. When they are worried and stressed that they must leave to perform a duty they can be very panicked and creative in their quest to leave.
Here are some safety tips:
1.) If you notice a resident living with dementia walking out the door, do not run yelling "no, stop, you cannot go, stop!" This will only make them feel that they need to rush even faster and can cause injury.
2.) Do not run up behind them and grab their arm in attempts to stop the exit. This frequently results in the confused and panicked resident turning to hit the person trying to stop the exit. In their mind, a stranger is coming from behind grabbing them, and impulsively turning and hitting is a basic human response.
3.) Do alert other staff, then quietly follow the person out the door unnoticed if possible, then come around to their front and state their name with a big smile, "Agnes, there you are, I thought I would walk with you to get the kids from the bus stop". Now you are not a threat to her, now she sees that you are 'on her side' aware of her duties to her children. Now she will not fight, but she is wanting to go get the kids... It should be noted that this is not considered to be an elopement at this point because Agnes left with a staff member, which is very important as every elopement must be reported to state and is a violation of regulation.
4.) The next steps take practice to really master, but will lend you much success. Do not try to redirect just yet. Never try to redirect before you connect. Now is the time to connect and the best phrase to use is 'tell me about it'. In the case of Agnes and her picking up the kids, I would say Agnes tell me about your kids, boy/girl... etc.. then let her tell you all about it... even if you already know and have heard her story hundreds of times.
5.) Now that you have been walking and talking... connecting... it is time to redirect start talking about an attribute of her child that she mentions then connect this with something else then perhaps to the flowers and as you continue to walk and talk she will forget why she came outside.
6.) Return to the building but try not to go into the same door as it might trigger the memory again. Go in another door. "Oh Agnes, let's check out this little place, I hear they have great coffee", then enter a side door, back door, etc. to go get coffee.
This takes time but no one is hurt, there is no elopement, Agnes is calm. Will she go back to thinking she needs to pick up her children at the bus stop? Yes, but for now count your victory and enjoy some coffee.