Safe and sound: tackling the wandering problem with products and strategies. (Operations).

The risks of wandering--typical of residents with Dementia, Alzheimer's and Huntington's Disease--are so great that nursing homes once employed harsh measures to prevent such events. Wandering behavior that results in elopement--when a resident leaves a facility without being detected-often leads to trauma and even death by freezing, drowning, hypothermia or a car accident. In recent years, the use of physical restraints and drugs to control the behavior of potential wanderers has given way to other preventive methods.

There may be no single foolproof, fail-safe non-restraint method of preventing residents at risk from wandering. Instead, a tiered approach with several levels of gatekeeping in place may be the key.

One of the most important elements in deterring wandering is employing an attentive staff that is trained to recognize potential problems--ranging from the agitated, restless mood and excessive walking behavior that is considered predictive of wandering to the onset of a wandering event itself. A 1998 Health Care Financing Administration (now known as the Centers for Medicare and Medicaid Services) report to Congress points out that in order to be effective, restraint reduction activities must involve the whole facility, including "administrators, nursing directors, physical and recreational therapists, service delivery staff including nursing assistants, and housekeeping personnel."

Here are some helpful methods that don't involve any type of restraints:

* Assess a resident's behavior frequently to identify a potential wanderer early on.

* Provide activities to keep a resident busy, relaxed, oriented in the present time and place, and interested in their surroundings.

* Create safe, controlled areas where residents can wander freely indoors and out.

* Attend to any physical, social, and emotional needs of residents that may contribute to wandering behavior, such as:

* Hunger, thirst, toilet needs, climate and noise control, physical movement, and exercise

* Social contact with concerned and attentive staff members, friends, family, and other residents

* Train staff to intervene when residents exhibit behavior such as excessive walking, anxiety, agitation, or expressing a "need to get home."

Electronic products can also be useful when they are used correctly and when staff members don't rely on them as their sole source of protection. Since any equipment can fail, life saving electronic systems must be installed by a professional and tested thoroughly. Once installed, the system should be protected by backups, disaster plans and redundancy wherever possible. The testing procedure must be incorporated into a facility's security plan.

Staff members should understand how a system works and know of its possible points of failure--such as a battery that powers a transmitter. They should also know what to do when an alarm goes off to ensure that no one slips away while an alarm is being reset and what to do if the system fails.

Electronic product types include:

* Locking doors that can be opened only with a key, code or device such as a card key. Staff should be aware that residents might complain that locked doors make them feel as if they are trapped.

* Door alarms will inform staff of unauthorized use of a door. While this is valuable tool in wandering prevention, staff should remember that a resident can also exit through a window or unalarmed door, such as a loading dock. Staff members will also need to adjust to regularly using the security devices as they perform their normal routine.

* Transmitting devices that send--or sound--an alert to staff when a resident removes bed covers, leaves a chair, opens a door, or steps on a mat beside a bed or at the doorway of a room can be useful in preventing falls and wandering. Staff should be aware that these devices may not distinguish between the wanderer and visitors and staff, so false alerts must be monitored diligently.

* Transmitting device systems that lock a door or send an alert when a resident wearing a transmitter approaches an alarm point such as a building exit or unsafe area can be helpful in deterring wandering. Some drawbacks: Transmission can fail in a building with a lot of metal or interference--just as a cellular phone can fail in the same environment; this type of device may require some construction to install; and residents may not be cooperative about wearing transmitting bracelets and may try to remove them with scissors or a knife.

These electronic devices vary in cost depending on the technology involved. Prices can range from $800 to install a locking system and/or alarms for a door, to upwards of $10,000 for the most basic transmitting system that utilizes radio, infrared and low frequency signals. Bracelets can range from $33 to $215. Installation charges per resident, door or server may also apply.

Ellen Leolyn Dutton of EDI Electronic Data Industries Inc. consults on HIPAA Compliance, IT System Security Reviews, LTC software requirements and system design. She authored "The LAN Security Handbook" and is a Certified Information Systems Auditor. Dutton can be reached at [e-mail]