Elopement: Designing for Dementia

Elopements are a big concern in dementia care communities. For so many residents, their entire life revolves around ‘going home’. They see family members leave through the exits, and the fact that they can’t follow them or get to the other side is disheartening and stressful. It reminds them they have lost their independence. So how do you use design to prevent elopements?

The most important thing to keep in mind is that exits cannot be eye-catching, attention grabbing, or a focal point. Don’t call attention to the fact that there is a door in front of the resident which they cannot leave through. Having to re-direct a resident constantly puts a huge strain on staff and other residents.

Here are some tactics we have used to avoid elopements:

Disguised or Unassuming Door Treatments

Rachael worked in a community that was not a “locked unit.” This sounded nice, but it really wasn’t: her residents with dementia were constantly going out the doors, sometimes outside, into the rest of the community, and the staff had to run and bring them back. There was one door, in particular, that residents gravitated towards. It was big, noticeable, and led right into the rest of the care community with the residents who did not have dementia. The door, although unlocked, was alarmed. Every time a resident opened it (maybe 20 times a day, on a bad day) the alarm would sound. It was loud, scary, and completely panicked all of the other residents. A staff member would charge down the hall, run after the resident who had gone out, and gently bring them back. It was exhausting for everyone, including the residents.

What Rachael ended up doing was something that she’d seen online, but never in person. She found a local vocational high school who made car wraps and asked them to make me a “bookshelf sticker.” She applied the sticker using squeegees and a hair dryer. It took a couple hours and a number of hands to apply (it was quite sticky) but the minute it was up, it worked. Her residents stopped going out of the door, almost entirely. The door decal looked so real that many residents actually believed it was a bookshelf. It became part of their everyday lives: just another bookshelf. Be sure that if you go this route, you use a quality image that truly looks like bookshelves and does not look cutesy or cartoonish.

Amanda often found communities who would put STOP signs on exits. The problem with this is that the bright red color brings attention to the door, it doesn’t actually make them stop. Her best route for making doors ‘go away’ was to paint the doors the same color as the walls. They can still be seen as exit doors, but they’re not blantantly calling attention to the fact they are there.

Furniture Placement by Exits

Avoid putting comfortable furniture near exits. Amanda once had a project where there was an alcove near a rear exit door, so she placed a couple of small lounge chairs and an end table in it. What she didn’t anticipate, was that residents would sit in those chairs and wait for staff to come through the doors and attempt to get out. So you might think, well what about residents waiting to get picked up by a family member? The family member has to get in through the coded entrance and check the resident out to leave the building, so the resident can comfortably sit in any common area and wait.

Block Direct Site Lines to Doors

We’ve seen so many communities where there is a sitting area immediately upon entering a community. While this is to make a community look more like a home, as stated above, it is encouraging residents to sit very close to an exit and wait for a chance to leave. Dependent on space available, a vestibule entrance could be moved to the side where it is not a direct site line. A decorative