Electronic eyes open improving and enhancing resident safety.

It's possible to monitor the movements of animal herds from thousands of miles away, down to the specific caribou if necessary. If a researcher can say where a yak stands on the Mongolian steppe, shouldn't it be simple to keep tabs on a resident who wanders off a long term care campus in illinois?

Of course, it's not so easy to do for people. Yet, wandering residents, particularly those who suffer from forms of dementia such as Alzheimer's disease, continue to be a concern not only for facilities but also the communities in which they reside.

And, if more states echo an Illinois decision earlier this year to increase monetary penalties when municipal services need to be called for lost residents of LTC facilities, the financial incentive to address the issue could become more evident.

Typically, facilities distinguish between wandering and elopement, where the latter occurs when a resident consciously attempts to leave a facility. Regardless of what it's called, when residents inappropriately flee their caregivers, they put themselves at risk. Consequently, the facilities are at risk for allowing it to occur.

The Alzheimer's Association created its "Safe Return" program to connect facilities with local emergency departments, through a toll free number [phone]. While those calls are free, becoming part of the program costs $40.

The association is currently evaluating its 10-year old wander-prevention program to see how various technological devices affect residents with dementia. A report is expected in the spring, according to Kathleen O'Brien, senior vice president for program and community services at the Chicago-based headquarters of the Alzheimer's Association.

There have been advances in door alarms, for example, so the alert goes to a staffer's monitor or cell phone, O'Brien said. Yet, even the simplest methods could complicate matters. "An alarm will create more stress and anxiety for the person with dementia and could be anti-productive," she explained.

Alzheimer's Association is also looking into different levels of sensors that detect movement and track people and alert the person responsible for the resident if the resident goes outside the environment. "There's also some proactive technology ... something the person would wear in their shoes," she said.

Several products already exist that enable facilities to keep residents from walking out of a facility unmonitored. The classic device requires residents to wear a water-resistant wristband (or anklet) that triggers a door alarm and lock system. Newer devices also embed triggers into watches or other wearable items.

At the recent American Health Care Association (AHCA) show in Miami, one device used technology originally designed for tracking wildlife, placing a chip in a belt, for example, thereby minimizing the potential for social embarrassment. The signal could be tracked for up to 50 miles via helicopter if necessary.

The potential problem with the bracelets or chips in the belt or shoes, however, is that they can be removed or damaged. Short of inserting a tracking device into the resident's body--which could present legal concerns under HIPPA regulations as well as raise personal dignity issues--only vigilant staff oversight can protect the persistent wanderer.

"None of them are perfect," O'Brien said of the latest technologies. "We're paying very special attention.... People involved in (dementia care facilities) are at very high risk for elopement and wandering."

Jennifer Bebinger, vice president of special programs with NuCare Services Corporation, based in Lincolnwood, Ill., said she thought the fines imposed by the state were steep.

She pointed out that when the state announced its fees earlier in the year, "one of the lower fees was $5,000. That's a lot of money." With elopement prevention systems ranging from $3000 to $15,000, "To put that alarm system, it doesn't seem like much (in comparison.)"

Bebinger said she's heard anecdotally of many Illinois facilities that looked into new alarm systems or to enhance their existing systems. In response, some operations have started to put safety officers in charge of training, she said, not simply nursing trainers.

One of the keys, however, is to make sure entire staffs are aware of potential problems. "Elopement is a team responsibility," Bebinger said. "It's a shared responsibility ... from the housekeeper through to the administrator."

She added, "There's a difference between wandering and elopement. ... Wandering is discovery." She explained that residents could be looking for something they've lost, whether it's a past role, a spouse, their children, or discovering the new faces around them. "Wandering within a special care unit is part of everyday life," she said.

"Wandering becomes elopement when the resident physically tries to leave.... A lot of facilities (consider them) the same."

"If you work in the dementia unit, it's almost a foregone conclusion (you'll have residents who wander)," said Annette LoCascio, director of special care services at The Claremont Rehab and Living Center in Buffalo Grove, Ill. She said the key is to make sure all the staff is aware of those residents who are at risk of wandering.

"Wandering doesn't upset me," LoCascio said, explaining that it helps to know how the residents lived before dementia affected their lives. "Maybe this person took a walk every day after work.... What if you had a mailman?"

Yet, she said the penalties in Illinois could cause facilities to look closer at their wander prevention programs. "With this economy the way it is and having every nursing home in the area trying to pull from the same resident pool," she said, "it's in everybody's best interests" to keep from getting fined for wandering residents.

LoCascio said the administrators have been aware of the state's efforts, but the facility has deemed its alarms and efforts are adequate. "When most of your elopement list are dementia patients," she said, "(we've found that) once they become acclimated to the environment and build rapport with and trust the staff" the problem lessens.

Mary Grace Smigiel, executive director of the Johnson Center at the Christian Living Campus in Centennial, Colo., said caregivers need to "provide (residents) with an alternative" to wandering, offering something to which they can relate. Her facility has used a portable computer with various programs to help stimulate activities among residents with dementia.

She acknowledged there are no simple solutions. "It's trial and error," she said. Smigiel added that she looks to staff members to be involved in coming up with solutions. "It really invigorates and challenges the staff to be the innovators."

STEP BY STEP

Think creatively to manage the wandering resident. Annette LoCascio, director of special care services at The Claremont Rehab and Living Center in Buffalo Grove, Ill., offered these suggestions to address those residents in your facility who are known wanderers,

* Have walking groups and use it as an exercise. Take four or five residents out at one time.

Have the ambulatory residents push those in wheelchairs,

Walk around the building a couple times.

Take the "pacer" with you if you're going to the copy machine or another area. Perhaps have this person walk with the CNA during the medication round and push the med-cart.

* Get to know more about your residents' lives before they moved to your facility.

* Communicate with the new shift so they know when residents went to bed, especially if anything was out of the ordinary.

* Keep residents' minds engaged and they're more likely to be content in the milieu.

* "Build a care plan based on what the family can tell you about that person," LoCascio said.--MS