Larissa J. Lucas
Physician, Registered nurse
Elopement and wandering expert witness
An elopement case is a supervision case with a hardware component. Two independent questions decide it: did the facility know this resident was at risk of exit-seeking, and did the systems it relied on actually work on the day in question?
Risk is knowable. Residents who elope usually have a documented history of wandering, exit-seeking, or expressed intent to leave, plus a dementia diagnosis and a level of ambulation that makes leaving possible. That combination should appear in the assessment, drive the care plan, and often determine whether the resident belonged in a secured unit at all.
Systems are auditable. Wander guard bracelets have battery and function checks. Door alarms have maintenance logs and delay-egress settings. Staff assignments show who was watching the exits during a shift change or a fire drill, which is when many elopements occur. A facility that cannot produce those records is usually telling you something.
Records to request
- Elopement and wandering risk assessments, including on admission and after any attempt
- Behavior monitoring notes and exit-seeking documentation
- Care plan interventions for wandering and the dates of revision
- Wander guard or electronic monitoring orders, placement checks, and battery logs
- Door alarm testing, maintenance, and any work orders for failed hardware
- Video surveillance retention policy and any preserved footage
- Incident report and the facility's internal investigation and 2-hour or 24-hour report to the state
- Staffing assignment sheets, including who was assigned to the secured unit
- Missing resident policy and drill records
- Weather data for the time the resident was outside
Federal requirements experts apply
Tags from the CMS State Operations Manual Appendix PP, with the 42 CFR Part 483 citation. Whether a regulation establishes the standard of care is a question for your venue.
| Tag | Requirement | Citation |
|---|---|---|
| F689 | Free of accident hazards, supervision, devices | 42 CFR 483.25(d) |
| F744 | Treatment and services for residents with dementia | 42 CFR 483.40(b)(3) |
| F656 | Develop and implement comprehensive care plan | 42 CFR 483.21(b) |
| F600 | Free from abuse and neglect | 42 CFR 483.12 |
| F921 | Safe and functional environment | 42 CFR 483.90(i) |
Appendix PP is revised periodically. Confirm the version in effect on the date of the incident.
What counsel should investigate
- Was exit-seeking documented before the elopement, and what changed in the care plan when it was?
- Was the resident appropriate for the unit they were on, given cognition and ambulation?
- When did the alarm sound, when was the resident last seen, and when did the search start?
- Were device checks performed at the frequency the facility's own policy required?
- Was the state agency notified within the required timeframe, and does that report match the chart?
Which expert fits
- Licensed nursing home administratorSupervision systems, security hardware, policy, drills, and reporting obligations.
- Dementia care nurse or Director of NursingAssessment of exit-seeking, behavioral interventions, and appropriate placement.
- Physician experienced in memory careCognitive capacity, medication effects on ambulation and agitation, and causation.
Panel members who work these cases
Matched from the publicly profiled ECS panel. Availability and conflicts are confirmed on the call.
Robert D. Zitsman
Licensed administrator
April Johnston
Registered nurse, Licensed administrator
Priti S. Gujar
Physician
For the paralegal handling this
Ask for the door alarm maintenance log and the wander device check log by name, and send a litigation hold for video immediately. Retention windows are often 14 to 30 days, and that footage decides these cases more often than any expert report.
Related case types
Falls and fractures
Fall risk assessment, supervision, devices, and what happened after the fall.
See this case type ›Abuse and neglect
Staff and resident-on-resident abuse, screening, reporting, and investigation.
See this case type ›Assisted living negligence
State licensing rules, service plans, admission and retention, and memory care.
See this case type ›Twenty minutes on the care issues
Free screening with a nursing home expert.