Skilled nursing operators across multiple regions are grappling with how to better handle resident elopement in the face of a narrowly applied definition of elopement by surveyors, a trend that doesn’t help residents at risk and causes facilities to dock up high financial penalties.
Elopement refers to situations where a resident leaves the premises without proper supervision or authorization. The exact definition and penalties may vary depending on regulatory standards and specific state guidelines, but nursing home operators say the criteria for determination of incidents of elopement have recently become more severe and punitive in nature. This, in the midst of a staffing shortage means more headaches for operators.
Most operators have protocols in place to prevent elopement, promptly respond to elopement incidents and ensure resident well-being. Penalties for elopement can range from citations, fines, or even potential legal action, depending on the severity and consequences of the incident.
Yet operators have received penalties for incidents they say are out of their control, leading to financial penalties that set them back.
“I had a woman open the window,” Fran Kirley, CEO of Nexion Health, told Skilled Nursing News. “She was ambulatory, cognitive. She opened the window, got out of the building, and went down the street. We found her 20 minutes later. [Surveyors] gave me the immediate jeopardy for that. And I said, what could I have done differently?”
Nexion Health operates skilled nursing facilities across Texas, Mississippi, and Louisiana and recently acquired seven new facilities in Southeast Texas.
Kirley said that Nexion, as a company, emphasizes a culture of preparedness, with five deficiency free buildings in the past year. But staying prepared is getting harder, Kirley said, because of a ‘“punitive” and “arbitrary” survey process that does little to substantially improve quality.
“What could I have done to change that [elopement]?” he said. “Lock the windows? I can’t do that. So, there was no benefit to that kind of a penalty, but because they’re mandated, in my opinion, to give more punitive immediate jeopardies, that’s what we got.”
How elopement is defined in MDS and state manuals
Amy Stewart, Vice President of Education and Certification Strategy, said that both the Minimum Data Set and the State Operations Manual Appendix PP provides guidance to surveyors on what constitutes elopement.
“Does the person wander?” she said. “And are they at significant risk of getting into potentially dangerous situations, like stairs or areas outside of the facility? That’s the quote unquote elopement question.”
Stewart said the second part of the question is in regards to if the wandering significantly intrudes on the privacy or activities of others. State surveyors will investigate if operators made sure the resident and other residents were safe, and that there was a plan in place to ensure that similar incidents did not occur again.
“If they leave the building unattended and are not seen by staff, there are instances where a facility may not think that it constitutes elopement, but yet, it is,” she said.
Rick Forscutt, CEO of Priority Management, said that his company has also been grappling with how to respond to elopement.
“When it comes to elopement, the interpretation and enforcement of the regulations can sometimes feel challenging,” Forscutt said. “For example, we’ve had situations where a resident opens the door for another resident who then briefly steps out of the premises. The resident who walked out had a wander guard bracelet on, and the wander guard system alerted us. However, another staff member happened to be in the parking lot, saw the resident, and immediately brought them back inside the facility.”
Interim solutions
Forscutt said in some scenarios, even if a resident is only outside for a brief moment, a facility can be penalized with an Immediate Jeopardy.
“This interpretation of elopement is concerning to us because we used to consider it in terms of residents being found within the vicinity, not exposed to extreme conditions for a prolonged period, and not missing medications,” he said. “But now, it seems the criteria have become more severe, potentially punitive.”
Forscutt said it is difficult to interpret what should be considered elopement and what shouldn’t be – and that facilities are penalized based on what could happen in a severe case, when the day-to-day reality at facilities can consist of manageable incidents.
“This is causing a lot of discussion within our company,” he said. “As an administrator for 16 years, I’ve encountered many instances where residents allowed someone to briefly leave, which wasn’t classified as elopement in the past. Now, it is considered elopement, and it concerns us that facilities can be penalized for such cases.”
An interim solution, he said, was to ensure that front desk staff are trained to respond rapidly to incidents and to remain diligent.
Executives at Health Dimensions Group, a management and consulting organization that serves senior living, post-acute, and long-term care providers, said that staff retention efforts are key in preventing elopement and other incidents.
“[Operators] don’t have enough people out there to bring in and sometimes they’re only keeping them for days, not months or years,” she said. “And it’s very hard to get them as well trained to care as deeply as we need them to and so on. Retention is your key here to preventing accidents.”
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