Question: After Mom was diagnosed with Alzheimer’s three years ago, my father took care of her at home until he was unable to do so due to stress and safety concerns because Mom wanders. When she was home, it sometimes took us hours to find her, sometimes wandering near a busy highway. The police picked her up several times, and Dad was almost charged with neglect.

Finally, when Dad reluctantly agreed to admit her to a nursing home, we emphatically told the facility that if they did not watch her all the time, she would be out the door in a heartbeat, no matter what she was wearing – or not wearing. The nursing home assured us they had security systems that would prevent this.

However, Mom has been able to get out of the facility three times in the past month. The last time, she was gone for nearly six hours. The facility tells us they are reviewing their systems and have not had this problem before. Should we leave her there or move to another facility? We are paying a pretty penny for her care.

Answer: Because of cognitive deficiencies, wanderers misperceive their environment and tend to place themselves in dangerous situations. According to a study by the University of Florida, 60 percent of all Alzheimer's patients will stray at least once. And, of those who are gone for more than 24 hours, up to 46 percent may die. Many more may be injured from exposure to the elements or from being struck by a motor vehicle. With the number of dementia and Alzheimer’s patients increasing, wandering is fast becoming a law enforcement nightmare. And, as your father almost found out, criminal charges of neglect may be lodged, especially where the conduct is repetitive.

Nursing homes have an obligation to not only identify wanderers, but also to develop and implement prevention programs. According to federal law, Medicare- and Medicaid-certified facilities must develop and then review and revise each resident’s plan of care every 90 days unless there are significant changes in the resident’s needs -- in which case more frequent care plan review is mandated. Here, it appears that the facility’s systems are lacking and unacceptable, especially in light of your up-front warnings to the facility about this problem.

What to look for: Does the facility have a specialty unit for Alzheimer’s and dementia residents where the environment is specifically designed for the care of residents who wander or are aggressive? Has the facility made environmental modifications to discourage wandering such as: 1) putting full-length mirrors on doors and exits, 2) camouflaging doors with wall coverings or window treatments, 3) putting stop signs on doors, 4) installing an alarm system on all exits, 5) placing sensors on resident’s wrists or ankles that activate alarms when the resident approaches the exit, and/or 6) using chair and bed alarm systems which activate when moved?

What to do: In dealing with situations like this, we believe that the research should be done, if at all possible, before admission. Since families generally don’t know what to look for and are under tremendous stress, we can’t overestimate the value of hiring an experienced geriatric care manager to assist in choosing a facility that meets the needs of the family. To find a care manager in your area, go to http://www.caremanager.org.

Meanwhile, since your mother is at risk, we suggest that you obtain the facility’s records to determine whether there have been other complaints about patient wandering and, if security concerns are not resolved quickly, move your mother to another facility.