Immediate De-escalation: The First Response
When a resident is attempting to leave, the staff's immediate response is crucial. The primary goal is to ensure the resident's safety while avoiding physical or verbal confrontation. This requires a calm, reassuring, and person-centered approach.
Use Calm and Reassuring Communication
Approach the resident slowly and from the front to avoid startling them. Speak in a low, gentle tone. Maintain eye contact to show you are present and listening. Avoid a firm or demanding tone, as this can heighten anxiety and trigger an aggressive response, especially in individuals with dementia.
Redirect and Distract Effectively
Rather than telling the resident they cannot leave, which can be seen as a challenge, use distraction. Try to engage them with a different, pleasant activity. Suggestions include:
- Offering a snack or drink.
- Suggesting a walk in a safe, controlled area.
- Bringing up a topic of interest, such as family members or hobbies.
- Playing familiar, calming music.
Address Underlying Needs
Often, a resident's desire to leave, especially when paired with confusion, stems from an unmet need or a misperceived threat. Asking simple questions can help identify the root cause:
- “Are you feeling tired?”
- “Are you looking for something or someone?”
- “Is there something wrong?”
Understanding their perspective, even if it is not based in reality, is key to providing compassionate care. For someone with dementia, the request to "go home" may signify a need for security or comfort, not a literal desire to return to a previous residence.
Following Facility Protocol: The Next Steps
Once the immediate situation is de-escalated, staff must adhere to the facility's established protocol for a resident elopement attempt. This ensures accountability, safety, and proper communication with all relevant parties.
Notify a Supervisor Immediately
As soon as the attempt occurs, the staff member must notify the on-duty supervisor or manager. This rapid communication is essential for several reasons:
- It escalates the situation to leadership who can manage the broader response.
- It brings additional staff to the area to help with supervision.
- It initiates the formal incident response, which may include reviewing surveillance footage.
Conduct and Document an Incident Report
Thorough documentation is a non-negotiable step after any elopement attempt. This report should detail every aspect of the incident.
- Timeline: Exact time the resident was found attempting to leave.
- Observations: Any verbal cues, non-verbal behaviors, or signs of agitation.
- Actions Taken: A step-by-step account of the staff's response, including de-escalation techniques.
- Notifications: A record of who was informed and when (supervisors, family members, etc.).
- Environmental Factors: Note any contributing factors, such as weather or nearby noise.
Comparison of De-escalation vs. Confrontation
This table illustrates the difference between proper and improper responses to a resident attempting to leave.
| Action | Non-Confrontational (Best Practice) | Confrontational (Poor Practice) |
|---|---|---|
| Communication Style | Calm, gentle, reassuring tone. | Demanding, authoritative, or condescending tone. |
| Verbally | "Let's go get a cup of tea first." | "You cannot leave! You are not allowed to go out." |
| Body Language | Maintaining relaxed posture, using open hand gestures. | Blocking the exit, crossing arms, or making sudden movements. |
| Addressing Needs | "I hear you want to go home. It sounds like you feel unsettled." | "You are home. You don't live anywhere else." |
| Overall Outcome | Reduces agitation, builds trust, and safely redirects the resident. | Increases resident's anxiety, aggression, and defiance. |
Proactive and Preventative Measures
Beyond reacting to an immediate attempt, facility staff should be trained in proactive measures to prevent future elopements. This involves a comprehensive understanding of resident needs and environmental safeguards.
Environmental Safeguards
- Ensure all external doors have functioning alarms and delayed egress systems.
- Use visual cues or camouflage on doors to make them less apparent as exits.
- Install cameras at key exits to monitor resident movement and identify patterns.
Individualized Care Plans
For residents identified as at-risk for elopement, a personalized care plan is essential. This plan should include specific interventions based on their known triggers and behaviors. It's a living document that should be updated as the resident's condition changes.
Consistent Staffing
Continuity of care is vital for residents with memory impairment. A consistent team of caregivers who know the resident well can more easily identify signs of agitation and intervene before an elopement attempt escalates.
Conclusion
Understanding what should staff do if a resident is attempting to leave the facility is a cornerstone of safe and ethical senior care. By prioritizing de-escalation, immediate notification, and thorough documentation, facilities can effectively manage these challenging situations. Crucially, a proactive approach focusing on environmental safety and individualized, compassionate care plans is the most effective long-term strategy for preventing elopement and ensuring the well-being of all residents. The Alzheimer's Association is an authoritative source for additional resources and best practices for managing wandering behaviors in seniors with dementia. The Alzheimer's Association offers resources for wandering and safety.
