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How Communications Technology Reduces Risk

September 1, 2002
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Modern protections against the consequences of resident wandering By Ted Algaier
Residents' wandering opens up major legal exposures. The answer is communication-personal and technological In September 2001, a 75-year-old man suffering from Alzheimer's disease drowned in Lake Michigan a day after he had been reported missing. The fact is that dozens of our cognitively impaired elderly citizens lose their lives every year as a result of "wandering." This has not gone unnoticed in the world of legal liability.

Although every long-term care center wants to provide as permissive a living atmosphere as possible for its residents, it is also the facility's duty to keep residents as safe as possible. The likelihood of injury or death occurring once cognitively impaired individuals have eloped from the facility is high-they could fall victim to dehydration or exposure to heat or cold, or get struck by a vehicle or drown. The facility can be held liable if it can be proven that the incident was preventable. It is vital that long-term care centers understand the implications of this, particularly since the average cost of an elopement claim has doubled in the past five years to nearly $215,000 per claim.

Recently a jury in Florida awarded $6 million in a suit against a facility that allegedly was aware of an elderly woman's tendency to wander but failed to appropriately protect her. A Louisiana jury awarded a $200,000 judgment to a widow whose spouse was struck and killed by a vehicle after eloping from his care home.

In addition to the cost of damages to settle a claim, facilities also might be fined by a state regulatory agency. The Illinois Department of Health fined an institution $10,000 in August 2000 for failing to prevent an elopement.

There are several approaches to avoiding liability issues associated with wandering. A basic one is to have honest com-munication with families. Families that place their loved ones in a long-term care center expect that quality care in a safe environment will be provided. Many relatives anticipate the more intensive type of care that they have come to expect of hospitals, based on the mistaken assumption that skilled nursing facilities are simply an extension of those institutions.

When you admit someone into your facility, you also admit the family. Placement is one of the most difficult decisions family members will ever make. They are often overwhelmed with conflicting feelings of guilt, relief, gratitude and fear. You must help them understand that no nursing facility can cure the natural aging process. Relatives must accept a realistic prognosis and acknowledge the increased level of care their loved one will require over time. This is especially important for family members who live far away or are less involved in the decision making.

They need to be aware that events such as wandering and falls are common occurrences with aging people. You must explain that although your facility takes precautions (and more about that in a moment), sometimes unpreventable incidents occur. This does not necessarily mean that their loved one is receiving substandard care.

Even so, the facility does have the responsibility to provide the care necessary to protect the resident from foreseeable hazards. In doing so, it is more effective to change the environment than it is to try to change a resident's wandering behaviors. Facilities should implement preventive measures to help stop wandering and elopement whenever possible. Preventive measures include written protocols and procedures, as well as the use of technology designed to warn staff when a person at risk of wandering attempts to elope.

A number of electronic devices are available to help make the caregiver's job easier. Departure-alert systems are the industry standard for increasing the environmental safety of a facility and providing managed freedom for residents who wander. This technology will notify staff when a monitored resident is exiting, or it can be designed to automatically lock doors and prohibit the elopement entirely.

Simply installing a departure-alert system is not enough, however. Staff members require ongoing education on wandering management protocols and use of the equipment. It is also imperative to have the manufacturer perform regular system inspections and maintenance to certify that all of the components are operating effectively. In sum, taking advantage of manufacturer training and service programs can play an important role in reducing your exposure to fines and claims.

The challenge of managing older persons' wandering habits will not go away. In fact, the prevalence of wandering is predicted to rise continually in coming years simply because the population is aging. It is estimated that more than 22 million individuals worldwide will have Alzheimer's disease by 2025, and a large percentage of these might well have wandering tendencies.

Now is the time for providers to take action. Communicating with families and incorporating wandering-prevention tools into your facility's risk-management program are the best ways to help protect your residents, staff and reputation. NH

Ted Algaier is the vice-president of sales at Senior Technologies, Inc., a manufacturer of electronic risk-management products for the healthcare industry. For further information, phone (800) 824-2996. To comment on this article, please send e-mail to algaier0902@ nursinghomesmagazine.com.
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