Elopement. For some, the word might conjure up images of a romantic wedding in the Caribbean or Niagara Falls.

But for those of us in care professions, the word has a different meaning.

It often brings up emotions of fear and anxiety, as we understand that when it comes to dementia, elopement can be downright scary for anyone concerned. 

And as we know, it can be dangerous. According to Confronting the Risk of Elopement, “Elopement is widely defined as a dependent resident leaving a facility without observation or knowledge of departure and under circumstances that place the resident’s health, safety, or welfare at risk.”

The article’s author, Jan Bennet, RN, HNA notes that “The definition of ‘at risk’ varies greatly, and frequently depends on facility location. For example, in an urban area, at risk may simply mean walking out the front door onto a busy intersection,” potentially resulting in grave danger. “Whereas in a rural area,” Bennet writes, “the facility may be surrounded by grounds that might provide some safety to a resident outside the building,” where a staff member can escort the resident back to safety before danger arises.

In any setting, elopement is an unsafe occurrence that we can and must prevent. This can be done with measures such as securing exit doors with a lock mechanism, allowing residents to exit only when they’re accompanied by a trusted companion such as a family member or an appropriate staff member.

Some doors in a secure memory care household are of great interest to residents who are looking for an exit to “home.” There are strategies to decrease the risk of someone heading out the door as others enter.
  • One strategy is to limit traffic to essential staff only.
  • Another is calling out to the memory care neighborhood when a family is arriving to allow the staff to assist a person at risk to a location that would prevent the resident from seeing the door being opened while the family members enter.
  • If a person at risk of elopement is near the door when it’s opened, it can be helpful to have staff work as a team: One person opens the door and attends to whoever is coming or going. Another staff member uses supportive touch with the resident who wants to leave, gently leads her away from the door, and kindly says, “Justine, will you show me a picture of your beautiful granddaughter?” 
Of course, there are nearly as many strategies and ways to adapt them as there are individuals. Because each community is unique, as part of the Warchol Best Abilities Care Model℠, our consultants work with communities to develop specific strategies that suit their environment to decrease the risk of someone heading out the door.

“Wandering” can present challenges too.

While “wandering” has its challenges, it’s important to note that it is not the same as elopement.

And wandering is often misunderstood.

The term “wandering” suggests aimlessness. However, a person who “wanders” is in fact showing us that he has the ability to walk or move around. He’s showing us that he has the ability to engage with his environment. He’s showing us that he has interests and the ability to communicate. He’s showing us what he can still do.

Instead of wandering, the Alzheimer’s Society of the UK uses the term walking about. “Walking is not a problem in itself,” the society’s factsheet explains. In fact, walking “can help to relieve stress and boredom and is a good form of exercise. As with all behaviour, walking about can indicate a specific underlying need that the person with dementia has. Understanding what this is and finding a solution could help to maintain the person's wellbeing.”

One way to understand what needs a person may be trying to fulfill by walking about is to understand their life story.

Also consider what it might mean when a person is walking and repeating “Have you seen my mom? I want to go home!”

It might not be so much that the person is searching for their mom or their childhood home. Rather, they might be actively seeking the emotion of mom and home, and what mom and home represent: love, acceptance, comfort, safety, familiarity, purpose.

Safe exploration and person-centered support

Whether a person is “wandering,” or trying to elope, what they’re looking for is care and support. And this is our role as caregivers in a Dementia Capable Society. We have an opportunity to be proactive and to examine our environments to determine potential risk. If risk is identified, we can put supports and/or systems in place to minimize or eliminate the risk.
Whether a person with #dementia is wandering or trying to elope, what they’re looking for is care and support.

It’s also just as important to create environments that support safe exploration and walking about. When we do this, we promote purposeful opportunities that meet the needs and interests of those who continue to have the desire to use their abilities. Tapping in to the knowledge learned in our Dementia Capable Care Foundation Course helps participants understand how to set up environments that enable best-ability approaches at every stage of dementia, which can foster successful and safe exploration. If further clinical expertise is required, our consultants are here to help.

Every person with dementia does have abilities, and their needs and desires are unique. Therefore, when aiming to decrease risk and promote remaining abilities, the solution is best understood when you take time to get to know the person inside. By doing that, you’ll create a place where no resident wants to escape, but every person feels respected, at home, and safe.