 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Alzheimer's / September 2004Wandering/elopement/exit-seeking bahvior
Pop has AD, but is still mobile and semi-coherent, though easily confused. It's early days, yet. We've spent the last couple of months shepherding him from the hospital to a nursing home to (after touring several different facilities) this very nice group home where we finally managed to get him a private room. It seems he's getting very agitated and restless at night 7:00 to 9:00 PM especially.(Sundowning?) He's made several attempts to try and leave the premises, much to the frustration of the single caregiver who is there in the evenings. (Not an issue during the daytime, as there are 2 people on duty for the 8 residents in the place, so 1-to-1 attention is possible.) He keeps trying to find his nonexistent car in order to go "home"-- which no longer exists since we had to clear his apartment out and dispose of his belongings, except for what would fit into his single room at the group home. This process involved deciding what to keep, store, salvage, donate or dispose of-- the criterion being "Will he ever *really* need this item again?" and then saying "no" to things like books, a wallet, neckties, credit cards, pots and pans, etc... It was scary and depressing as hell; like I need to tell you folks about this...! Anyway, they're talking about having to discharge him, as they refuse to keep people who are at risk for "elopement" as they call it-- escape, in other words. They told us up front that the only reasons they'd refuse to continue to keep a resident there was if the person became abusive or combative, or if they demonstrated "chronic exit-seeking behaviors". The options are for them to hire another staff person (not realistic) or to simply medicate the hell out of him, keep him so doped up or downed out that it'd be rather impossible for him to go anywhere... and I'm loathe to authorize that. We are facing having to find some brand new, locked ward facility of some sort, that isn't an absolute goddam snakepit-- something we encountered many, many, MANY of while looking for the current facility where he is now. We're completely over a barrel. Anyone familiar with whatever medication(s) might be used to subdue wanderers, and what side-effects-- or just plain effects-- there are? Have you found anything else that works to dissuade/discourage/prevent "elopement"? This facility is a private home, and Fire laws preclude adding locks to the rooms. Sigh.... Thanks for any feedback-- Jef. > The options are for them to hire another staff person (not realistic) or > to simply medicate the hell out of him, keep him so doped up or downed out > that it'd be rather impossible for him to go anywhere... and I'm loathe to > authorize that. not all anti-agitation meds will dope him up or down him out. talk to a geriatric psychiatrist about which drugs might be able to help. a good psych doc should be able to recommend one of several drugs that would work well for him. I hate to tell you this, but the only way to prevent wandering when you've got a mobile patient is with alarms and locks. You can reduce agitation with some meds, but if he's a wanderer...! Its an extremely common problem. You can't tie the guy in bed or in a chair. You can't drug him into oblivion. If he's on his feet, the potential for him to try and go out in his confused state is really high. A fairly simple and effective solution is a wander guard - i.e. the person wears a bracelet (they can't take it off) that sets off an alarm if they pass through an entrance. Here is a sample of one of these units - they make small ones for homes and fancier ones for larger facilities. EVERY entry point must be alarmed. http://www.seniortech.com/wanderguard/wanderguard.htm However, for this to work, you need on the ball staff - it might be okay in a group home, but not in a larger institution i.e. someone has to respond to the alarm STAT before the person gets away onto the street etc. One of the best solutions is permanently locked doors with a keypad entry so the person with dementia can't get out, but anyone with it enough to remember a three or four digit entry code can get in and out. Most locked AD wards have a similar system on all doors, stairwell entries, elevators etc. and combine this with the wanderguards. You need the wanderguards as back up since people coming in and out will often unknowingly let someone out (i.e. the wanderer seizes the opportunity to escape when a visitor opens the door, not realizing that the person is demented and must not be let out unescorted). This happened at a large institution in Toronto a couple of years ago, and the gentleman died of exposure. He had just moved to a locked ward, and hadn't yet been fitted with a wanderguard - they did have him in a special bright coloured t-shirt to identify him as an inmate of the locked ward, but an unknowing visitor came in and let him out quite innnocently. He got into a ravine and - ! You might also want to iron name tags into his clothing with contact numbers, have him registered as a wanderer with the local police, and get him to wear a medic alert bracelet with similar information. Mary G. > A fairly simple and effective solution is a wander guard - i.e. the > person wears a bracelet (they can't take it off) that sets off an > alarm if they pass through an entrance. There are also systems that use similar bracelets or sensors embedded in clothing that lock the door when a person with the sensor on is nearby. Most use keypads to override the door lock. The nursing home my husband was in used sensors on the wheelchairs that locked the door when the chair came close. Gwen > > A fairly simple and effective solution is a wander guard - i.e. the > > person wears a bracelet (they can't take it off) that sets off an [quoted text clipped - 3 lines] > embedded in clothing that lock the door when a person with the > sensor on is nearby. Most use keypads to override the door lock. When I looked for a group home for Evan I came across an arrangement I would very much like to see more of. Evan was not a wanderer, but we did come across a facility set on about half an acre that was entirely gated. The setting was very park-like, and since no one was able to come and go without passing through the main entrance the clients were in no danger of "eloping". I would hope there are facilities near to you or anyone else who has an LO with the same desire to wander. A gated home is the simplest, most elegant solution. I am highly opposed to medicating LO's simply for the convenience of staff overseeing clients, when there are so many other reasonable options. Dennis > Pop has AD, but is still mobile and semi-coherent, though easily confused. > It's early days, yet. [quoted text clipped - 48 lines] > Thanks for any feedback-- > Jef. I've often thought that a good design would be something built like a donut around a central courtyard that residents could go into. The other good thing about a ring design is that pacers can go around and around, and there are no dead ends for them to get "stuck" in. My MILs locked AD ward (full of quite advanced but still ambulatory patients) had a ring on one side and a T shaped hall on the other, although the center of the ring in her facility was occupied by utility rooms (the bathrooms, nursing station, supply rooms etc. rather than a nice courtyard or garden. Some of the residents would get into the T section and really have trouble getting out, and the ones with Parkinson's often got stuck there (it was something about a dead end), but in the ring portion, they would just shuffle happily around. The staff also used the ring shape to get the residents a little exercise - a few times a day they just got everyone up and herded them around the ring a few times. They did have a fenced secure garden on the main floor off the dining room, but the AD patients would not have been able to get into it alone (i.e. they would have had to be escorted off the floor and let into it). Mary G. My MIL is at a dementia-specific ALF of a corporation that designs specifically for this kind of issue. There is a circular hall with 4 "neighborhoods" (L-shaped) of 15 beds each off of it. Mary, you're right, the pacers go round and round and round. There are patios at 9 & 3 o'clock but they're not really used, just let in natural light and allow you to see the outside weather. Janitorial, staff lounge, nursing office, salon, restrooms are within that circle. Each neighborhood has a kitchen, dining area, laundry, living room, plus 2 complete bathrooms. Each resident has a room with a half-bath and there is a suite for 2 at the end of each neighborhood (they regularly have couples). Outside is a gated, paved U-shaped path around the building(200')-with covered patios outside of each neighborhood and a large one out behind the community center where they have the BBQs. There is 1 exit you punch a keyboard to get out to the main office area and parking lot. Positives, all ground level and once you're in, you're in. Residents have to really hunt to be able to see the parking lot (it's visible from some of the room windows), so they do not see traffic; just trees and a wetleand with 1 neighbor who rides a mower, keeps up birdfeeders, and so on. You can walk the circle, step into each neighborhood and see the kitchen and whether the nurse is handing out meds there. For the ones going home, they walk and walk- and they're still looking to "catch the bus" but they tire doing it. It can be confusing to find your own neighborhood, but there's often someone in the circle who can direct. We enjoy just sitting and watching the comings and goings inside, or the trees and birds outside. Plus the staff are pretty good and attentive. It's worth the cost. E-mail me and I can give more specifics. Beth in Maryland > My MIL is at a dementia-specific ALF of a corporation that designs > specifically for this kind of issue. snip... Both you and Mary bring up good and bad points to how a facility is thought out. I think that if families and clients start demanding better facilities eventually ALF,s AFH's, etc.. will have to respond to our needs. As I said before, I am vehemently opposed top medicating our loved ones simply to make it easier for staff...and that goes for making up for poor design /use of a facility. Especially given the costs we and the State must pay for them. The people who run these places would never move into a home that was so lacking in design and/or amenities that it would necessitate *them* taking drugs! Why put our LO's through that!!! By the way, just so no one gets me wrong on this point: I have no objection to medicating those who truly need the calming or stabilizing effects of drugs. Dennis White Beth, This is exactly the layout of the facility that my mother lives in. The only difference is there are 13 beds on each neighborhood. She is in Houston. The arrangement works extremely well. She calls the community center the town hall. Camille > My MIL is at a dementia-specific ALF of a corporation that designs > specifically for this kind of issue. There is a circular hall with 4 [quoted text clipped - 27 lines] > > Beth in Maryland > I am highly opposed to medicating LO's simply for > the convenience of staff overseeing clients, when there are so many other > reasonable options. There is a difference between convenience and reducing agitation. If the patient is agitated, there are drugs that will reduce the agitation without putting them to sleep. > > I am highly opposed to medicating LO's simply for > > the convenience of staff overseeing clients, when there are so many other [quoted text clipped - 3 lines] > If the patient is agitated, there are drugs that will reduce the > agitation without putting them to sleep. Perhaps your mail reader did not include the second paragraph of the post you refer to above. It reads: "By the way, just so no one gets me wrong on this point: I have no objection to medicating those who truly need the calming or stabilizing effects of drugs". Dennis White |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2009 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.