Virginia Nursing Elopement and Fall Injury

Last week, a nursing home resident in Charlottesville, Virginia fell into a creek and died. The Daily Progress reported that the man fell out of his wheelchair and into a creek. Found 20 minutes later after someone called the fire department.

The man who died was a resident of Cedars Healthcare Center, which is owned and operated by CommuniCare Family of Companies. The company defended the incident by saying the man had signed himself out of the facility on multiple occasions without injury. The facility is going to conduct an internal analysis to determine whether the incident could have been prevented.

Unfortunately, this is a common occurrence in nursing homes. While there is little information about what happened in Cedars Healthcare Center at the moment, it sounds like this was an “elopement incident.” Elopement is unsupervised wandering and typically occurs in those who have dementia or Alzheimer’s. People with cognitive deficiencies like these require more supervision than others, or they may become confused and feel that they need to leave for some reason.

Frequently, nursing home residents will be perfectly fine from a physical standpoint but have difficulty appreciating their surroundings from a mental perspective. Further, people who elope can put themselves at risk of severe injury or death. This cognitive split is a dangerous combination and can lead older adults to cross highways, walk into extreme cold or extreme heat by themselves. The risk of elopement has increased over the years. Between 2006 and 2009, the number of reported cases of elopement increased by 38%.

Fortunately, there are many things a nursing home can do to prevent injury from elopement. The first step is identifying those who may be at risk to elope. The National Institute for Elopement prevention defines elopement 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 caregiving facility or environment unsupervised, unnoticed, and/or prior to their scheduled discharge.”

A reported history of wandering may indicate an increased risk of elopement. The facility must ask questions such as:

• How many times as the person eloped?
• Is there a particular time of day when the person elopes?
• Where does the person go when they wander off?
• Does the wandering appear to be purposeful?

Once the risk of elopement identified, the nursing home must employ preventative measures. Such measures can include an alarm attached to the nursing home resident when they get up from their wheelchair or leave a specific area. This alert would make staff aware that the resident is about to leave and could be putting themselves endanger. More low tech solutions include merely ensuring that someone is available at the nurses’ station at all times to monitor any residents who may wander. Also, a video camera system could locate a resident who has strayed. Wandering is a simple problem to address – the nursing home just has to have sufficient resources.

Wandering or elopement injuries happen quite frequently in poorly staffed nursing homes because such facilities do not have the proper human resources to watch all residents adequately. Medicare sets the required staffing levels for each facility based on reports of each resident’s condition provided by the nursing homes. If the nursing home fails to provide sufficient staff, an injury is bound to occur.

If a resident does go missing, the nursing home must have an absent resident protocol in place so that staff can quickly retrieve the missing person. The nursing home should follow the following steps:

• Install an alert system to signal staff if a resident is missing
• Initiate an action plan to search for the resident
• Search the grounds, including potential hazards like ponds, roads, etc.
• Notify the police for assistance
• Notify the family
• Document all actions taken during the search

If your loved has had a fall or wandered outside of a nursing home and was injured, please contact us for a free consultation.