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Dementia Care Problem – The Resident That Got Away

By Lillian L. Hyatt, M.S.W. and a Resident of a CCRC

Excerpted from the Spring 2008 The CANHR Advocate newsletter

A major T.V. news program in California announced that a CCRC resident afflicted with Alzheimer’s had escaped from their skilled nursing home. Although a description was given for the public to contact the station, there was no mention of the resident’s name (a privacy issue) or the facility. Under the guise of resident privacy, the public was prevented from learning what CCRC was careless enough to allow a resident with Alzheimer’s to walk out of their facility unattended.

Some people might say, "Well, that is a rare occurrence." Routine practices at my CCRC point to a different conclusion. During dinner hour, no staff is at the nursing home desk to observe the exit door to the floor’s elevator lobby. One evening I tried to find staff to assist a resident in a wheelchair who had not received her dinner, and was looking for help. Several weeks later, I ran across a visitor who was trying to redirect a resident with dementia who was trying to leave the building. Again, staff was hard to find, and there is no wander guard system to alert staff to residents leaving the nursing facility. When I expressed my concerns about resident safety and directing visitors, I was told that all staff had cell phones, but how to contact staff was not posted. After being very persistent about my concerns, I was assured by the administrator that a part-time receptionist would be hired to be at the desk during dinner hours. However, I was told that there was no guarantee that the position would be approved for the following year – a sad commentary on commitment to resident safety.

A resident in the early stages of Alzheimer’s residing in assisted living did not sign out where she was going. No one was at the desk to ask her plans. She ate in the main dining room, and went to a friend’s apartment to talk after dinner. At ten o’clock, when the resident had not returned, the staff became alarmed. When the security guards failed to locate the resident, the police were called. After four hours of searching the stairwells, the roof and the entire building, the police left without finding the resident. The resident eventually returned on her own, explaining that she was visiting a friend, and could not leave sooner.

For many years, there has been a growing need for facilities to develop services to care for residents at different stages of dementia. Although this problem is "being studied," there are often too few alternatives being developed for people with early stages of dementia to remain in their independent units or for the development of specialty units for care of persons with more advanced stages of dementia. CCRC providers seem to view the problem from the standpoint of marketing image – keep persons with various stages of dementia out of sight – or how it affects the bottom line. In some instances, the "problem" is handled by sending residents to outside facilities specializing in dementia care, resulting in costs being borne by other residents without the benefit of developing on site dementia services.

Many CCRCs spend huge sums on marketing budgets and administrative staff, but economize where it may not be noticed, e.g., not staffing the front desks during dinner hours. The result can produce dangerous consequences for some residents in the nursing home and assisted living units. Persons who apply for admission to CCRCs are assured that they will receive a "continuum of care for the rest of their lives." However, it can be difficult to discover whether the CCRC is more interested in providing the promised care or in burnishing the image of the facility to a high polish to attract new applicants. Sometimes applicants are actively dissuaded or even stopped from visiting the nursing home or assisted living sections with the explanation that it will invade residents’ privacy. Prospective residents have a right to see all sections of the CCRC, as well as to review inspection and complaint reports. In addition, it is important to find out about present or planned specialty care services for persons with dementia.