Nursing homes work to protect wandering dementia patients

Six out of 10 people with dementia will wander, sometimes putting themselves in danger, the Alzheimer's Association reports.

Two Eastern Iowa nursing homes faced combined fines of $17,000 last year for allowing residents to slip away from their facilities. In one case, a resident left in the middle of the night, fell and got a bloody nose.

In another case, the resident hitched a ride in a stranger's pickup to a business a mile away.

Both facilities' violations were scored as J level violations on the federal scale of A to K, with K being the most severe, indicating an isolated risk of immediate harm for the resident.

'Facilities are supposed to know where their residents are and protect them from hazards in the environment,' said Dave Werning, spokesman for the Iowa Department of Inspections and Appeals. 'The size of the state fine is an indication of the severity of the identified deficiency.'

And yet, wandering is a challenging behavior — at home or in a nursing home — because caregivers want to keep residents safe without unduly restricting their movements.

Who's at risk?

Anyone who has memory problems and is able to walk is at risk for wandering, the Alzheimer's Association reports. People may try to fulfill former obligations, such as going to work, or may try to go 'home' even if they're already where they live. Wandering can happen when a resident has difficulty locating a place, such as the bathroom.

'We don't know what's going on in their brains or what they're processing,' said Ann Drobot, director of programs and advocacy for the Alzheimer's Association of East Central Iowa.

There are an average 125,000 search-and-rescue missions involving volunteers each year for people with Alzheimer's disease, according to Kimberly Kelly, founder and director of Project Far From Home, a Ramona, Calif.-based program designed to teach first responders about people with Alzheimer's who go missing.

A Maryland woman was struck and killed by a car after wandering away from her assisted-living center in October 2014, WBAL-TV reported. A Colorado man died from complications of hypothermia after he left his assisted-living facility March 3, 2015, according to the Longmont Times-Call.

The risk of dementia doubles every five years between ages 65 and 95, the Alzheimer's Association reports. With baby boomers turning 65, the number of potential wanderers could explode in coming years.

Violations in Iowa

Two Eastern Iowa nursing homes were cited in 2015 for serious deficiencies, both related to residents wandering, or eloping, from the facilities.

At Rose Haven Nursing Home, a 58-bed facility in Marengo, a resident diagnosed with non-Alzheimer's dementia left the nursing home early Oct. 14 with her walker. When staff entered the resident's room at 11:45 p.m., she was in bed, but when they returned at 1:05 a.m., she was gone.

'The building was thoroughly searched, phone calls made to the prior shift staff to determine whether Resident No. 3 was checked out of the building, extra staff called in to assist and the administrator was notified,' the state citation noted.

Nearly an hour later, staff found the resident about a block and a half away, lying face down in the grass with the walker under her lower legs. The resident had a bloody nose, cuts on the nose and a sore arm — but didn't remember why she left the nursing home.

The state initially fined Rose Haven $10,000 -- the highest fine allowed -- but a revisit showed the nursing home had fixed the problems. The facility paid $6,500 because owners did not appeal.

At Marion's Willow Gardens Care Center, with a capacity of 91, a resident with dementia and severe cognitive impairment told staff on Nov. 28 his or her daughter was coming to pick up the resident for lunch. The resident, sitting on a chair by the front door, left when the employee went to the restroom. The staff member looked around, but assumed the resident's daughter had picked up the resident.

Willow Gardens got a call about 10 minutes later from the resident's son's place of employment, the state reported. The resident had flagged down a driver, who gave her or him a ride more than a mile to the son's workplace.

A state investigation showed the staff member should have verified whether the resident was with his or her daughter and if it was an authorized leave. Willow Gardens, which is certified both by the state and federal Centers for Medicare & Medicaid Services, was initially fined $7,550, but paid $4,900.

Administrator Matt Carpenter declined to comment.

Security for wanderers

Willow Gardens and Rose Haven had anti-wandering systems when residents eloped last fall. The WanderGuard systems used by the facilities sound an alarm if a resident wearing a device approaches. However, neither resident had been judged a wandering risk and they were not wearing devices, citations stated.

Part of the reason Rose Haven was cited was because the resident who eloped had a change of condition that should have resulted in increased supervision, Werning said.

Rose Haven upgraded its security in November to the Door Guardian system, a $20,000 system that requires people entering the building from the outside to push a button for admittance and people on the inside punch in a code to get out.

'We changed it because of that incident,' Rose Haven Administrator Randi Roggentien said. 'It's expensive, but you want your residents to be safe.'

Rose Haven, which changed ownership in January, does elopement risk assessments for all residents, Roggentien said. For residents who have dementia and are at risk for wandering, the center might put them in rooms farther from entrances.

For a previous resident with dementia who had been a construction worker, they posted a 'work area — keep out' sign on exits to remind him not to leave at night.

'We have activities every day to keep them engaged and keep their minds off leaving,' Roggentien said. 'We do golf cart rides outside and have a screened-in porch to get fresh air.'

There are a host of GPS-based and cell tower tracking systems that allow emergency responders and family members to keep tabs on wanderers. More nursing homes are adding locked units for patients with Alzheimer's.

Investing in the nursing home workforce may be another way to reduce wandering, said Fran Mancl, who has been a certified nursing assistant at Stonehill Care Center in Dubuque for 20 years.

Caregiver jobs generally are low paying with low prestige, which makes it tough to keep quality employees. Iowa's nursing homes lose about 40 percent of staff each year, according to the Iowa Department of Human Services.

'It is important with someone with dementia that you know their routine and behavior,' Mancl said.

Caregivers who know what residents like to do may be able to engage them in activities that will keep them from trying to leave the facility, he said.

Mancl would like to see some of the fines collected from nursing home citations go to improved training, cited as a way to reduce staff turnover. Now, the fines go into the state's general fund.