Movement Issues in Nursing Homes

There is a lot of movement in nursing homes, with healthcare providers, facility staff, residents, and visitors moving about the facility. The high prevalence of frailty and cognitive impairment among nursing home residents requires that movement of individuals throughout the facility is well controlled. It also necessitates that proper measures are in place when residents are moved out of the facility to another care setting or when returning to the facility from another care setting. As demonstrated in two articles in this month’s issue of Annals of Long-Term Care: Clinical Care and Aging^® (ALTC), when movement of residents in and out of the facility are not managed properly, there may be negative consequences, including hospital admissions or readmissions and even death.

In “Post-Hospital Transitions for Individuals With Moderate to Severe Cognitive Impairment”, Epstein-Lubow and Fulton discuss several resources and initiatives that clinicians and residents’ family members can use to secure better quality transitions for residents with cognitive impairment who were previously hospitalized. Some of the initiatives outlined include Project BOOST (Better Outcomes for Older Adults Through Safe Transitioning), Project RED (Re-Engineered Discharge), the Care Transitions Intervention, and the Transitions of Care Consensus Conference report. The objective of these initiatives is to prevent individuals with advanced dementia from being moved unnecessarily between care settings, which incurs great financial expense and can lead to poor patient outcomes.  

In “Wandering and Elopement in Nursing Homes”, Lester and colleagues review the phenomenon of wandering among cognitively impaired nursing home residents, outlining strategies that nursing homes can take to ensure that this behavior does not lead to harm. As the authors note, when a cognitively impaired individual manages to elope from a nursing home, the fatality rate is high if the individual is not found quickly, with reports indicating a mortality rate of 25% for residents not found within the first 24 hours of elopement. Many strategies can be employed to protect residents who are prone to wandering, from individualized approaches (eg, encouraging social contact among residents) to facility-wide interventions (eg, use of alarms). They also emphasize the importance of evaluating wandering risk in all residents, as even those who appear to be nonambulatory may be able to elope from the facility, as demonstrated by the authors’ case report of a cognitively impaired man who was found alone outside of the facility despite depending on a wheelchair for mobility. 

We hope that you find these articles interesting and useful. Of course, you are always welcomed to send us feedback on the journal and any articles that we publish by sending an e-mail to Allison Musante, assistant editor, at amusante@hmpcommunications.com. ALTC will also be at the American Geriatrics Society 2012 Annual Meeting this May. We hope you will stop by our booth to pick up some copies of ALTC and to let us know if there is anything we can do to make the journal more useful to you.

Thank you for reading!