Father with dementia in Assisted Living keeps escaping and the facility wants to kick him out. How can we get him protected?

I am in a similar situation with my father, except he is petite and can sometimes be re-directed by staff to return to residence. These are the measures I've taken:

- GPS to locate him if he goes out and missing
- hired private caregiver to keep him busy (wandering often due to boredom)
-facility now has screeners at the front door with yellow caution tape and pylons, and my father is told that he is not allowed out anymore (normally, they cannot legally stop him from going out but now due to pandemic they have new policies)

Is there a waiver you can sign that would legally allow them to keep him indoors? My father's facility tried kicking him out ("he's exceeded our level of care") but I continue fighting to keep him there. I sympathize with your situation. Good luck.

Sounds like he needs to be assessed again for memory care. A lot can change in a year and it apparently has.

Sounds like he needs to be moved to Memory Care.
Ask the facility to transfer him to Memory Care and see how he does there.
Also ask the doctor about prescribing medication for agitation and anxiety. It might calm him enough that he would stop wandering and he can relax a bit easier.
(and I am not one to suggest medicating someone to the point of being in a stupor but enough to calm anxiety.)

Get someone to him (as soon as lockdowns and quarantines permit), who is a TRAINED geriatric specialist, a psychiatrist, psychologist, or Degreed social worker, and have a formal assessment done including cognitive functioning and behavior.

Request that the examiner make recommendations for behavioral management techniques and medications. Request also that the specific behaviors being observed at his residence are addressed in the recommendations, including whether a locked unit is necessary for his safety.

I’ll echo what others have said, he needs locked ward memory care. But I’m gonna ask.... what’s the issue with your hubs???

if where FIL is has MC (sounds like it does, like it’s a big tiered facility), why isn’t FIL transitioning there this week? Your hubs is his guardian, correct? If so that’s a full on legal designation, so hubs legally can have him go into MC, whether or not his dad likes it. Hubs - if he’s the legally court appointed guardian- has the power to do this....& the authority to get his dad evaluated, get a fresh assessment done. So what’s the issue? What’s the hesitantcy in your hubs in doing this?

if hubs won’t pivot on this, & make a decision to move him to MC, you can’t expect the facility to do this. I’d be super concerned that they can & will do a “30 day notice”. FIL is technically in AL, & as he’s in AL, he’s in theory all pretty ok on his ADLs with perhaps a bit of assistance or needs some medication management. He can be evicted with no real repercussions as he’s just “in AL”. The required medical safeguards that are there for skilled nursing care & MC are not there for AL. Really work with FiL current facility. Otherwise he’s gonna be in your home with you, unless there’s a huge pool of $ to have him do a big big buy-in (400k+, likely lots more) for an individualized care type of CCRC.

And yeah his current facility will need to re-evaluate his meds to get him at least for the initial first few days to get him quelled and compliant. FIL sounds like a health and safety risk, both for himself & staff and other residents.... this is a big deal; if it means he gets settled down by meds, it is what it is.
I’d suggest you all do whatever to get hubs to understand the need to keep his dad where he is but moved into higher level of care. Now is not the time to cast about to find & move him to a new place. FIL existing health chart will be a hurdle to overcome.... he’s just too much risk for a new facility to take on in general. Plus Covid-19 is a fast moving situation..... today a facility might just be ok for a new resident but maybe manana may not be. Best of luck on this and please let us know what happens.

Anoush YOU can bring in a specialist. We happened to like a professional who worked in my LO’s AL as a psychiatric PA, but I also had the option of bringing someone in from outside.

Once you have the report IN YOUR HAND you have a tool to negotiate getting him more appropriate care.

If the staff at your dad’s facility is overwhelmed because of the pandemic, explain that you’re in the process of developing a plan to help your father become more manageable. If he truly is presently dangerous, it’s going to be tough to get him services during the national emergency.

That facility needs to provide assistance to coordinate care to a transfer to a more secure Memory Care Facility. Until this can happen, it is their legal responsibility for protect him! This staff needs to respond quickly to alarms when he is out of bed, his chair, or his room.

Staff is stretched thin now, but until they can help arrange transfer to appropriate care, especially with a Federal Lockdown, no one should be wondering out (or in)!!!

Call Ombudsman & push back. Call State Representative and have them call, or send a letter asking for their plan for Transfer of Care. State licensed the facility to operate! So State Rep will get their attention.

Is it possible for the facility to reevaluate him for admission to the locked memory care unit? Has he been evaluated by a geriatric psychiatrist? The psychiatrist could then prescribe medications to address the behaviors. I am surprised that the facility is not being more proactive regarding this situation since safety is paramount for the residents. I would contact his primary care physician as well as the ombudsmen in order to get their involvement. The primary care physician can order the psychiatric evaluation and the ombudsmen can address the issues with the facility in rega4ds to his care and safety.

Something is off ... Some of your terms utilized aren't U.S. terminology, yet your husband seems to be operating as if he is in the U.S. Are you directly speaking to the facility people, or is everything being relayed through your husband? Without knowing what's truly happening it sounds like your husband might be manipulating some things.

In the U.S. a 30-day notice, must be provided in writing, During this pandemic, many states have issued stops on evictions. A 30-day-notice is an eviction. On March 18, 2020 VIRGINIA placed a temporary suspension on all evictions. As mentioned technically that 30-day eviction notice must be dated and in a physical letter in writing; by the way, your local ombuds gets a list of those being evicted.

Your post and responses describe too many basic procedure violations which collectively make me think that your husband is NOT relaying accurate information, perhaps deliberately placing YOU into crisis mode.

When you talk with your husband tell him to show you that 30-day notice, and then send it to the facility to double-check that it's legitimate. every facility in the U.S. is VERY aware that the facility must pre-approve of your FIL's next housing location Meaning your FIL is not going to be tossed out with zero pre-approved place to go. (Usually the social worker or someone from the facility will visit the place where the resident will end-up, to approve or disapprove the discharge.) Assisted Living/nursing homes

Anoush, ok so y’all now know as of yesterday FIL under 30 day notice.

Unless you, hubs & kids are totally ok on FIL moving in to your home, your choices imho are stark:
- is the current tiered facility willing to have him transition into locked ward memory care and do trials of psych meds?
So do they want him or not? your hubs is his legal guardian, he can sign off on all this. The situation is imo way past the niceties of lets see what happens in a few days. FIL has express suicidal thoughts and placed himself and other residents and staff at risk. This is pretty serious stuff in normal times, now so even more.

If facility is not interested to have him be a resident in MC, he’s probably toast on getting into another MC or NH. His health chart will detail all issues. He poses just too much risk for most places. If there has been non-response by hubs for care plan meetings or doing followup to past concerns by the facility, those too will be in FILs chart.

if there is a LTC psych facility or state psych hospital, he might could be admitted there. Ask about this ASAP. If FIL has $$$, there will be a private pay psych place somewhere that will take him.

If I had to guess, you have probably 10 days to figure out the next step. Not 30 but 10, cause he’s gonna do something that forces the AL to do a 5150 call on him. How 5150 runs very interdependent on your states laws. One of my best friends has a sister who has had extreme mental health issues with more than 1 5150s done. Where I am, Louisiana, for her the 5150 request was done by her Sis who is legal guardian. She called first the medical examiner to issue an order of protective custody; then order becomes a 5150 carried out by EMS or police. Usually it’s cops, and they place them into an involuntary 72 hr hold either on locked psych ward if there’s a bed or single cell jail. If it’s drugs or alcohol that caused this, their ok before 72 hrs & released at hour 73 with a court date. The others stay in the psych ward beyond 72 hrs as still at risk of endangerment to self; there’s Mental health court hearing set (& they stay in psych ward, maybe move to another unit in the state). The mental hearings pretty perfunctory, like they are back on their meds so behaving & ok OR going into multi week care & assessment at LTC psych place. Each time, she as guardian got Sis placed in private psych facility. The sister has actually been ok past few years as finally right blend of meds and living situation, but it was a pretty scary yo-yo for abt 5 years. They are fortunate as parents left a trust for her care. If your hubs is legal guardian, he’s either going to have to be very proactive about finding his dad a place or the judge just might revoke his guardianship and then have dad become a ward of the state with an independent guardian named. Sometimes this actually is best as so often family just cannot come to grips to do just what must be done. Plus that outside guardian knows what’s what statewide for resources. Guardianships aren’t necessarily till forever.

Most other states do not have the medical examiner issue a protective order part for a 5150s; it’s done via a Baker Act. Where FIL lives at likely has done 5150s. Ask this week if they are likely to do this and how they run based on past ones done. If FIL been “at risk” for quite a while now, facility doesn’t have many options. Covid-19 just heightens risk. Good luck in getting him into the care fIL needs.

Thank you all so much for all the information - it really has helped. This has been an exhausting few days, plus I still have to work my “essential” job, as does my husband, so I’m not replying frequently as I’d like.
First, some of my terminology may be off because I’m new to this. Same for my husband - he’s not hiding anything or being vague on purpose; just doesn’t understand a lot of this because, up until the court order making him the guardian, his mother (who has local government experience & knows things) wanted to be doing everything & was doing fine. Family just wanted to take some of the load off her 75-yr-old shoulders! Sorry for any confusion.
We got the local Social Services and Adult Protective Services involved, as well as the regional Ombudsman, and the tables have turned. Now the facility understands that we aren’t just going to roll over, they are walking back their threats. And yes, it was a threat, not a legal eviction notice because, as it was pointed out, those have to be given in writing. FiL did get a psychiatric evaluation late this afternoon & husband should get the report in the morning. Also learned that the no-evicting mandate in VA, where we live, was designed for landlords whose tenant might not be paying rent; APS indicated that we might be able to apply it here, though because of the mandate’s intent - to protect the Shelter-in-place order.
I can’t thank you all enough for the information and the support - I feel like we have the information to help us resolve this for the whole family’s good.

Glad things seem to be working out but I need to put my 2 cents in.😊

Just realize that ALs are not lockdown facilities. At Moms the front door was key pad to gain entry but the firedoors were just alarms. It would unlock after 15 seconds of pressure on the handle. People who escape all the time are a liability to an AL. They are short staffed. So can't be chasing residents down all the time. And if he continues to be aggressive, the AL will not be able to care for him. I was told if Mom continued to escape, she would need more care than they were able to give. The next step was LTC since Moms AL did not provide MC.

ALs are just that for people who need some type of assistance. Sounds to me Dad does or will need more than an AL. They don't monitor and adjust meds accordingly. They only work from a Doctor's order.

My mom is in an AL facility. This past Tuesday the police found her a block away on a busy street. This is the first time she has walked away. However, in the past month her dementia has gotten worse. She wonders around the facility looking for her children, and refuses to go to her room. Once she escaped they put her on the memory care unit the next day. They said they had to, I think it may be a state (Virginia) law. You should check with your department of aging; they maybe able to help.

Why is he not in a LOCKED FACILITY? My aunt was in a locked facility, they should all be locked with DEMENTIA PATIENTS....

Ankle bracelet. There have been several residents at my mother’s Assisted Living who had a tendency to wander. The facility uses ankle bracelets so that an alarm sounds when they approach the door. This has worked very well.

Nursing home placement, or you take him home to live with you all.

When my mother in law was first put in assisted living she was allowed to go outside when ever she wanted. (years ago). She took a walk and got lost. She flagged down a police car and they gave her a ride home. Of course at the time no virus lock down going on. I'm surprised she didn't give them our address.

I read your updated post about them backing down....? How does that help protect your FIL from wandering. When my LO wandered, the regular AL, said they would cover around the clock supervision for a few days, then, she'd have to pay for someone to supervise her for her own protection. That was not feasible, so, her doctor prescribed Secure Memory Care, where she went and did very well there. Having a person who is incompetent, which your post says, in a facility that is not secure, seems very risky. I hope you can find him help.

Just have to say, I think we all realize we are in lockdown for now. I don't think it has to be mentioned everytime we post something. I think OPs are very much aware that at this point they will not be able to place LOs in ALs or LTC or transfer.

Find another doctor to evaluate him and give the doctor the heads up beforehand that he has been able to outsmart the previous evaluation/doctor.  Explain that this is now a safety issue.

There is a company called  "GPS SmartSole" , they sale insoles for a person's shoes that have a GPS tracking device in them. So as long as the individual is wearing their shoes when they leave, you can track them. You will always know where they are!

Here is the website.
https://gpssmartsole.com/gpssmartsole/

Good Luck!
Cheryl J. Wilson, M.S.

My father did the same thing. He'd go out, rain or shine, day or night, and wander the streets causing the police to keep bringing him back to the facility. Finally, the nurses hid his shoes. He'd wander around the facility looking for his shoes instead of going outside. If he really needed to go out, suddenly they would "find" them for him. This worked until he regressed to where the outside had no attraction for him.

I am an elder law attorney. I agree with everyone who said that your husband (his guardian) needs to have a chat with the doctor and his attorney. In my state, before you can move a person from an unlocked facility to a locked facility, you have to get a court order allowing it. Evidence to support that need for that can be medical report, but it can also be testimony from people with first hand information to show that it is needed for his safety, even if there is not a medical report stating he needs it. Also, it is not a one way street. If he is moved to a locked facility now, and you find another unlocked facility that is capable of managing his wandering, or that provides wandering companions, after the lockdowns are over, then you can always move him somewhere else.

I had to put my husband in memory care this past November. All of them in memory care are automatically in lock down, and trust me, they can't get out. No court order needed. We're in Florida.

my sister had similar issues became very frustrated and angry with staff always telling her what to do. Then she watched the front doors of the place-unlocked and tried to leave. Several trips to ER when she had meltdowns-drug her up enough to send back to facility. Few days or weeks later repeat. This was not going to get better without an intervention. Sister was admitted to psych hospital to evaluate meds, testing, etc. It was awful-she was in restraints for 3 weeks, kept trying to get out of bed, she was looking for exit, wanted to go home. Only one place would take persons with agitation-this was the last place we were in for 6 mo. She became frustrated with staff there too-they were not nice, there were no activities she was interested in, food was awful, she had unexplained injuries and was unclean many times. trying to get her to new place ever since. She would not be safe at our house, steps, shower, bed, etc. She cussed at staff-all put in nursing notes which made my life a night mare trying to find another place that would take sis. Finally in new place she is crying a lot due to the big change and I can not go see her in person. She cries on the phone-more depressed now than angry-they are trying new meds... not helping so far.

If he is leaving he is endangering himself. That alone should qualify to get memory care. Sorry, and hope you have success with this. MANY are in memory care for simply leaving. People have been lost, been killed.

It sounds like he has progressed beyond the criteria for "assisted living." He probably needs to be in a nursing home - which would have locking doors. Many nursing homes have "wander guard" bracelets on each resident. If they get too close to an exterior door, the door automatically locks.

My mother-in-law was in AL , when she got worst , with dementia , she was moved to another section . The doors had a locked door that was coded for family to enter .She was much safer .

It sounds like he is well beyond the "Assisted Living" level of care. Sure, he may have tricked the system once, but more than likely as his disease progresses, he wouldn't be able to again. He needs a higher level of care.

Speak to the Social Worker there or even Involve Adult Elderly Protective Services. it seems they cannot just KICK HIM TO THE CURB. THAT IS ENDAGERMENT TO HIM.