Wandering and Exit-Seeking: How California Memory Care Homes Keep Residents Safe

The Alzheimer's Association says everyone living with Alzheimer's or another dementia is at risk for wandering, and that six in 10 will wander at least once, many of them repeatedly. Signs it lists include forgetting how to get to familiar places, talking about old obligations such as going to work, wanting to "go home" even when at home, pacing, and trouble finding the bathroom or bedroom.

California's regulations use two terms. Unsafe wandering is when a resident at risk enters an area that is physically hazardous or holds hazardous items, for example a room where cleaning is under way. Elopement is when a resident who is at risk of harm because of a cognitive condition leaves the facility unsupervised. Walking the halls or the garden safely is neither.

If wandering is the reason you are looking at care, when is it time for memory care covers the wider set of signs.

Assisted living communities and board and care homes, licensed as residential care facilities for the elderly (RCFEs), work under Title 22, section 87705. A home with residents at risk of elopement must have an auditory device or other staff alert on the exterior doors and perimeter gates those residents can reach. The other tools are optional for the home, and each has conditions:

A delayed-egress door looks like an ordinary exit with a push bar. When someone pushes, an alarm sounds at the door and the door opens after a set delay, which gives staff time to come.

Health and Safety Code section 1569.699 describes the device. The building must have automatic sprinklers and smoke detection throughout. The door must release when the sprinkler or smoke system activates or the power fails. It must open within 15 seconds of being pushed, or up to 30 seconds if the fire authority approves that in a home serving people with Alzheimer's disease. A sign on the door must say to keep pushing, how many seconds until it opens, and that an alarm will sound.

That statute says it gives way to building standards once the state adopts them, and the local fire authority decides what it approves for each building. Ask the home what delay its doors use and to see the fire clearance that covers them.

Health and Safety Code section 1569.698 says all admissions to an RCFE remain voluntary on the part of the resident, or with the lawful consent of the resident's legal conservator. A person who is not conserved and is entering a locked or secured-perimeter home signs a statement of voluntary entry, and the home sends a copy to the Department of Social Services.

Title 22 spells out what the home keeps on file. For a resident under conservatorship, it is the court order showing the conservator's legal authority to place the person in a home with locked exterior doors or perimeter gates. For every other resident, it is a written statement signed by the resident saying they understand the home has locked doors or gates and consent voluntarily.

Notice what is not on that list: a signature from a relative who holds a power of attorney. Whether an agent may consent for a person who can no longer understand the statement is a legal question. Ask the home what it requires, and put the question to an elder law attorney or the local Long-Term Care Ombudsman.

A secured home must also have indoor and outdoor space where residents with dementia can walk freely and safely. A dementia diagnosis alone does not require a locked setting, as California's dementia care rules explain.

Residents of every RCFE keep the personal right to leave the facility at any time and not to be locked into any room, building or premises. The dementia rules work inside that right.

Staff are to try to redirect a resident at risk who is trying to leave. Under the delayed-egress rules, a resident who still wants to go after redirection must be allowed to leave with staff supervision. The California Department of Social Services gives the same answer for a resident who wants to go out at night or in bad weather, and for one whose records say they need supervision outside.

That takes people. The regulation says delayed-egress devices and locked doors may not substitute for trained staff in sufficient numbers, including staff to escort residents. Staffing is covered in memory care staffing and training.

Staff must look after the resident's continued safety. Then come the reports and the plan:

1. 1

   The family is told immediately

   The home reports each elopement to the resident's representative as soon as it becomes aware of it, and follows with a written report.

2. 2

   The licensing agency is told by the next working day

   The report goes to the regional office's Officer of the Day by telephone, email, fax or hand delivery. A telephone report is followed by a written one.

3. 3

   The absentee notification plan is followed

   Health and Safety Code section 1569.317 requires every home to have a plan for a missing resident. It covers informing the resident's authorized representative and the circumstances in which the home notifies local law enforcement.

4. 4

   The care plan is looked at again

   In the department's examples, a new elopement that puts a resident at risk is a significant change in condition, which calls for a reappraisal of the resident's needs.

If your relative is missing or in immediate danger, call 911. Concerns about how a licensed home supervises its exits can be reported to California's Community Care Licensing Division.

Ask which of the tools above the home uses, what you would sign, how many times a resident left unsupervised in the past year, and where residents can walk. Building size matters here, and board and care versus large memory care compares the two.

Hamssa Benrekia is a senior living placement specialist in Torrance. She helps families in the South Bay and Harbor area of Los Angeles County find licensed homes for a person who wanders, and goes on tours with them. To talk about memory care placement, contact Hamssa. The California Assisted Living Placement Guide covers the other steps.