Managing elopement risk is crucial for ensuring the safety and well-being of residents in nursing homes, particularly those with cognitive impairments. Elopement, defined as when a resident leaves the premises or a safe area without the facility’s knowledge and supervision, poses significant dangers such as exposure to extreme temperatures, dehydration, medical complications, and accidents. In FY2023, 362 elopement-related F689 immediate jeopardy deficiencies were cited, underscoring the urgent need for effective prevention strategies. Key strategies for elopement risk management include:

Policies and Procedures: 

    • Clearly define mechanisms and procedures for assessing, identifying, monitoring and managing residents at risk for elopement.
    • Include elopement response protocols in disaster and emergency preparedness plans and conduct routine elopement drills to ensure staff understand and are competent in carrying out your procedures.

Assessment and Identification:

    • Conduct thorough resident assessments upon admission to identify residents at risk of elopement.
    • Consider factors such as elopement history, expression of the desire to leave or go home, adjustment difficulties, cognitive impairment, substance abuse, anxiety, vision impairment, psychiatric history and smoking history during assessments.

Care Planning:

    • Develop individualized care plans. with specific interventions tailored to the resident’s needs and risk factors, such as psychosocial interventions, close monitoring and regular rounds, environmental modifications, structured activities and the use of assistive devices (e.g., electronic monitoring/alarms, GPS tracking devices).
    • Involve resident representatives in the care planning process and educate them about the risks of elopement and strategies for prevention. Conduct root cause analysis when residents attempt to leave the facility and update the plan of care as necessary.

Environmental Modifications:

    • Create a secure environment within the facility that includes regular safety assessments of the environment, monitoring safety measures such as door alarms and keypad locks.
    • Ensure that all staff members are trained on how to use these security features effectively and conduct elopement drills as part of ongoing education..

Staff Training and Education:

    • Provide comprehensive training to staff members on elopement prevention strategies, recognizing signs of agitation or restlessness, and appropriate responses to wandering behavior.
    • Education should also include understanding the needs of residents with cognitive impairments and techniques for de-escalating challenging situations.

Supervision and Monitoring:

    • Increase supervision and monitoring of residents at risk of elopement, especially during high-risk times such as shift changes or meal times.
    • Implement regular checks and frequent visual contact with residents to ensure their safety and well-being.

Engagement and Activities:

    • Offer engaging and meaningful activities throughout the day to reduce boredom and restlessness, which can contribute to wandering behavior.
    • Tailor activities to individual interests and abilities to promote social interaction and cognitive stimulation.

Emergency Response Plan:

    •  Develop a comprehensive emergency response plan that outlines procedures for responding to elopement incidents, including staff responsibilities, communication protocols, and coordination with local authorities if necessary.
    •  Regularly review and update the plan to ensure its effectiveness.

Documentation and Reporting:

    • Document all elopement- related incidents and interventions in residents’ medical records.
    • Regularly review incident reports to identify trends or areas for improvement and adjust interventions accordingly.

Continuous Quality Improvement:

    • Implement ongoing evaluation processes, including audits and feedback mechanisms.
    • Ensure staff adherence to protocols, such as but not limited to responding to sounding door alarms promptly, and conducting a full facility head count if unable to determine the reason for the sounding alarm.

Preventing elopement requires a comprehensive approach that addresses both environmental and individual factors while promoting residents’ dignity, autonomy, and quality of life. By implementing these strategies, nursing homes can minimize the risks associated with elopement and provide safer environments for their residents.

For additional training on elopement prevention, join us April 16, 2024 for the webinar Documentation for Elopement Risk and Incidents, or access the on-demand webinar Immediate Jeopardy Risk: Elopement which explores strategies to prevent elopement and analyzes elopement incidents in the past year that resulted in Immediate Jeopardies.




Shelly Maffia, RN, MSN, MBA, LNHA, QCP, CHC, CLNC, CPC
Director of Regulatory Services

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