Last year, Florida Health Care Association established a Risk Management/Compliance Council (Council) to study elopement and create tools that members could use for helping to prevent elopement of vulnerable residents.
As part of my responsibilities to the Council, I researched the law relative to assisted living facilities (ALFs). While we work toward finalizing the tools and developing education, I wanted to share some of what I learned in the short term.
Elopement in the ALF can be much different than in a nursing center, or it can be much the same. This depends on the makeup of the facility’s residents, the building and the staff. The new regulations applicable to nursing centers require the provider to complete a facility assessment. Even though there is no similar requirement for ALFs, they can use this concept to assist in developing policies and procedures to avoid elopement and address it when it occurs.
I recommend every ALF provider look at the facility assessment provisions found in the Centers for Medicare and Medicaid Services (CMS) State Operations Manual (available in the Survey Readiness section of FHCA’s website). Take from it the elements which would pertain to your ALF. Although not required to prepare
a facility assessment, doing so helps an ALF focus on the aspects of the facility that are critical to preventing elopement.
Start with the basics
58A-5.0131 (14), F.A.C. defines elopement as …”an occurrence in which a resident leaves a facility without following facility policies and procedures.” First, the ALF must have policies and procedures. Because of the diverse characteristics of member facilities, these policies and procedures cover a broad spectrum. Below are some characteristics of a facility’s operation and examples to consider when writing policies and procedures for
• Location — is the facility on a busy street, is there water behind the building, such as a lake, swamp or retaining pond? Characteristics like this must be evaluated when designing policies and procedures.
• Building — is it two-stories with an elevator that opens into a busy lobby? The building structure will play a part as well.
• Do you have an alarm system?
• Facility population — are the residents young with the need for minimal supervision? Do some suffer from memory loss? Do some routinely leave the premises for socialization with friends or family?
• How do you maintain knowledge of where residents are when they are not on the premises? 58A-5.0182 requires a “general awareness of [your] resident[s] whereabouts” and recognize the resident’s right “to travel independently in the community.” Of course, a facility would not allow a resident with cognitive impairments to leave the building unsupervised; that is not what the requirement states. Rather, the facility should have a system for knowing where even the most independent resident has gone. The facility should have procedures in place for contacting that resident while he or she is not on site.
• An assessment of the resident for elopement is required by 58A-5.0182. With many residents, the assessment should include a thorough assessment of his/her ability to travel independently. This is an important part of the facility’s process and should be included in the policies and procedures and enhanced by your practices (see below for specific case studies).
• Supervision and support should be identified as needed, and follow-through is important.
• Facilities are required to have two resident elopement drills per year. See F.S. 429.41(1)(a)3 for detail.
• Residents at risk or with a history of elopement must be identified so staff can be aware of their needs for supervision.
• Facility policy must include photo identification for those residents assessed.
• Residents should carry identification. See 58A-5.0182(1) and (8) for more details on these requirements.
These are just some of the factors to consider when drafting policies and procedures. The Council is working on several tools to assist facilities in responding to an elopement when it occurs, determining its root cause and implementing preventive measures for the future. FHCA will make those tools available once our group has completed its activity.
The need for assessment – case studies
Most of the regulatory cases argued in the Division of Administrative Hearings relate to the failure of facilities to conduct meaningful drills. There are two cases which provide good discussion of when an elopement is a violation of the regulation and when it is not.
Case no. 16-7558/17-2087 involves a resident who routinely left the facility to go to various local places to drink alcohol. The facility policy and procedure required him to sign out, which he often did not. On more than one occasion, he could not find his way back and knocked on neighbors’ doors who gave him directions or escorted him back. On the occasion for which the facility was cited, he left at 11:00a.m. (per one witness) or later in the afternoon (as per another). On this occasion, he knocked on a neighbor’s door, who called the police. Officers returned him to the facility and found no supervision there. At the hearing, the administrator argued that it was this resident’s routine to leave without signing out and to seek help when he couldn’t find his way back. The resident having a dangerous routine did not negate the facility’s requirements to follow its policies and procedures; thus, the resulting deficiency.
In contrast, in case 15-4847, the facility required that when residents were leaving they notify staff as to where they were going.The resident in question routinely left for a few days at a time to visit friends and family. He always returned when he said he would.He had two assessments to determine whether he was safe to leave
the facility; both were positive. He left the facility and told staff he was going to visit family for a week, which was documented in his record. A day after he left, the resident was hit by a car and died inthe hospital. The facility was unaware of this until, after almost a week,his mother came to the facility to tell them about the accident. The administrative hearing officer found that the facility had assessed this resident for safety; the resident followed facility procedure in saying where he was going and when he would be back; and the facility
played no role in the accident. Therefore, the administrative hearing officer found the deficiency was not supported by the evidence.