Demystifying Elopement Risk Assessments
Elopement is the act of a resident leaving a care facility without authorization and supervision, which can pose significant risks to their safety. To mitigate this, senior care facilities use structured risk assessments to evaluate a resident's likelihood of wandering or attempting to leave. The term “evaluation” refers to a variety of clinical tools, meaning there is no universal scoring system or highest score. The score that indicates a high risk depends entirely on the specific tool and its methodology.
Why Different Tools Have Different Scores
The variance in scoring systems exists because different tools focus on different aspects of risk. Some are comprehensive and include multiple factors, while others are quick screening instruments. This means a "high-risk" score on one assessment could be an entirely different number on another.
The Waypoint Elopement Risk Scales (WERS)
One example of a structured tool is the Waypoint Elopement Risk Scales (WERS), which is comprised of three scales to be used in conjunction:
- WERS-Historical (WERS-H): Scores past behavior, with a maximum of 16 points. A score over 10 indicates a high-risk category.
- WERS-Stable (WERS-S): Looks at current, but potentially changeable, factors. Scores 11 or higher are considered high risk.
- WERS-Acute (WERS-A): Assesses immediate, imminent risk. Scores over 6 indicate high risk for the short-term.
The WERS scales can be combined to give an overall risk assessment, where a score of 21 or higher is categorized as high risk.
Facility-Specific and Other Assessment Tools
Many facilities develop or adapt their own elopement risk evaluation tools tailored to their specific resident population and environment. This can lead to a wide range of maximum scores and risk thresholds. For example:
- One facility's assessment might indicate high risk if a patient scores >=60.
- Another, simpler tool might deem a resident at risk if they score 9 or higher on a smaller scale.
- An older document from the California Department of Public Health mentions a tool where a score of eight or above indicates a risk for elopement.
- The Cohen-Mansfield Agitation Inventory (CMAI), while assessing agitation, can also help determine elopement risk. It has a different scoring mechanism entirely, based on frequency of behavior rather than a total accumulation of risk points.
Factors That Influence a Resident's Risk Score
Beyond the specific scoring method, several factors contribute to a resident’s elopement risk. These are the very components that the different assessment tools evaluate and quantify:
- Cognitive Impairment: Conditions like dementia or delirium significantly increase risk by affecting memory, judgment, and disorientation.
- History of Wandering/Elopement: Past incidents are often the strongest predictors of future events.
- Statements of Intent: Verbally expressing a desire to leave, such as “I want to go home,” is a key indicator.
- Physical Mobility: A resident who retains physical strength and mobility, despite cognitive decline, is at a higher risk.
- Behavioral Conditions: Agitation, restlessness, or paranoia can trigger an attempt to leave.
- Environmental Triggers: An unfamiliar environment or changes in routine can increase confusion.
Comparing Different Elopement Assessment Scales
| Feature | Waypoint Elopement Risk Scales (WERS) | Custom Facility Tool | Generic Screening Tool | Cognitive Screening (e.g., MMSE) |
|---|---|---|---|---|
| Purpose | Comprehensive assessment across historical, stable, and acute factors for psychiatric patients. | Designed for specific facility needs and populations; varies widely. | Quick check for admission or transfer, usually less detailed. | Primarily assesses cognitive function, not just elopement risk. |
| Highest Score | Can be calculated by combining scales; combined high risk starts at 21+. | Varies; could be based on a point system (e.g., >=60). | Varies, often with a simple pass/fail or low-risk threshold (e.g., >=9). | Typically maxes out at 30 points, not directly an elopement score. |
| Interpretation | Risk level determined by a combination of scales and scores. | High-risk defined by facility-specific policies based on a set score. | High-risk determined by meeting a specific threshold on a brief checklist. | A low score might indicate cognitive impairment, increasing elopement risk, but is not an elopement score itself. |
| Risk Factors | History of elopement, wandering, self-harm, substance abuse, agitation. | History of wandering, cognitive status, mobility, behavioral cues. | Basic history, mobility, and desire to leave. | Memory, attention, language, and other cognitive functions. |
Beyond the Score: A Holistic Approach to Risk Management
An elopement risk score is a critical data point, but it should never be the only factor used in managing a resident's safety. A holistic approach is essential, involving several key strategies:
- Individualized Care Plans: Based on the assessment, create a plan that addresses specific triggers, wandering patterns, and personal needs.
- Environmental Safeguards: Implement technology like door alarms, and ensure secure, yet non-confining, environments for residents.
- Staff Training: Regularly train staff on how to identify risk factors, respond to elopement attempts, and manage incidents effectively.
- Meaningful Engagement: Keep residents engaged with purposeful and stimulating activities, which can reduce restlessness and the impulse to wander.
- Effective Communication: Maintain open communication with family members and the care team to stay aware of changes in a resident's behavior or needs.
Conclusion
So, what is the highest score for the elopement safety risk evaluation? There is no single answer. Rather than focusing on a single number, caregivers must recognize that different tools have varying scales. A comprehensive risk management strategy, which includes regular assessments, staff training, and a focus on individualized care, is far more important than any single score in ensuring a resident's safety. For further information on the risks and prevention of wandering, an authoritative resource is the Alzheimer's Association.
