How Often Should Elopement Drills Be Conducted? A Director of Nursing’s Guide to Prevention, Preparedness & Survey Readiness

Before you sip that morning coffee, let me ask you something…If a resident walked out of your building right now, would your staff know what to do?

Because in long-term care, elopement is not a “what if. "It’s a when — especially when routines change, staffing is tight, or the weather drops.

And as someone who has lived this firsthand, let me take you back…

I remember vividly stepping into my role as the Administrator of a Personal Care Home with over 100 residents. The building had just transitioned from assisted living, and with that transition came new regulations, new challenges, and new fears.

Two fears topped my list:

Fire. And elopement.

My very first WEEK on the job proved why.

One night, the fire alarm went off for hours. The fire department came, cleared the building, and it ended up being a faulty sensor — but it was still a nerve-wrecking introduction.

Then the following week, someone walked into the building and said, “There’s a man walking in the street.”

My heart dropped.

Sure enough, he was one of ours. Thank God, we brought him back safely, but that was the moment everything shifted for me.

Coming from a skilled nursing environment into Personal Care was an adjustment. In skilled nursing, residents are under much tighter supervision. In PCH, many can come and go as long as they sign out — which is why this resident, though considered “independent,” was clearly not appropriate for that setting.

That experience opened my eyes.

Elopement is real.

Elopement is fast.

Elopement is unforgiving.

So let’s talk about what every Director of Nursing, Administrator, RN Supervisor, and Leader must know — especially as we head into colder weather.

⭐ How Often Do Elopement Drills Need to Be Conducted?

Here’s what you need to know as a nurse leader:

🔹 Best Practice:

Conduct elopement drills monthly on each shift.

This ensures all staff — day, evening, and night — remain confident, competent, and prepared.

When I served as a Risk Manager, I conducted elopement drills monthly on every shift. It kept my team sharp, uncovered gaps early, and gave us real confidence that we could respond effectively in an actual event.

That has been my standard practice ever since — and it’s the same guidance I teach Directors of Nursing today.

🔹 Minimum Expectation:

Conduct drills quarterly at the very least.

Quarterly drills help reinforce staff response, identify weak points, and ensure your team stays survey-ready and resident-focused.

This standard keeps you aligned with strong leadership practices and demonstrates your facility’s commitment to resident safety.

⭐ Before We Go Further… Let’s Talk About Weekends (Because That’s When Your Facility Is Most Vulnerable)

And since we’re heading into the weekend, let me ask you this:

Does your team know how to manage elopement risks when leadership isn’t in the building?

Here’s something every Director of Nursing learns—sometimes the hard way:

Most elopement risks don’t occur simply because it’s the weekend. They occur because of the conditions… and weekends create ALL the conditions.

While published research does not conclusively show that elopements happen more on weekends, we do know this from real-world practice:

• Staffing is lighter

• Leadership is off-site

• Admissions still arrive

• New residents may not be fully assessed

• Agency staff may be covering

• Behavior changes may be missed

• Oversight decreases

• Communication delays happen

  
  

So even without a study saying, "Weekends = highest elopement rate, "every experienced DON and Administrator will tell you:

Weekends and off-hours are when facilities are most vulnerable.

Now picture this:

You receive an admission on a Saturday. The resident triggers for elopement. MDS is off. Social worker is off. Leadership isn’t in the building.

Does your weekend team know what orders to put in place? Do they know:

✔ How to complete the elopement risk assessment?

✔ Which safety interventions to initiate immediately?

✔ Where to document Wander Guard placement?

✔ How to update the care plan?

✔ Who must be notified?

✔ How to monitor the resident each shift?

These decisions determine whether you prevent a tragedy or invite one.

And boo, let me be clear:

Your weekend process must be just as strong as your Monday-through-Friday leadership.

This is why monthly (minimum quarterly) drills matter. This is why education matters. This is why systems matter.

⭐ What Is the First Step in Preventing Elopement?

The FIRST and most important step is:

✔ A thorough admission and elopement risk assessment.

This includes:

• Cognitive assessment

• Behavioral triggers

• Exit-seeking history

• WanderGuard (if indicated)

• Documentation every shift

• Updated care plan interventions

• A current photo

This step sets the foundation for everything that follows.

⭐ Your Comprehensive Elopement Prevention System

1. Complete a Strong Admission & Risk Assessment

Identify high-risk residents early and implement prevention interventions immediately. Update the care plan and include a current photo.

2. Conduct Monthly Elopement Drills (Minimum Quarterly)

Your drills should:

• Mirror a real event

• Use walkie-talkies or assigned phones

• Include searching exit doors and surrounding areas

• Identify vulnerable exit points

• Assign roles during the drill

Practice prevents panic — and panic is what leads to mistakes.

3. Document Staff Response Immediately

Your documentation should include:

✔ Time the drill began

✔ Who participated

✔ Search zones

✔ Gaps in response

✔ Corrective action

✔ Education provided

Surveyors WILL ask," How do you train your staff on elopement response?”

4. Review Elopement Risk Quarterly — and With Every Change in Condition

Review elopement risk at least quarterly, but never wait for the 90-day mark if you identify a change.

If your team notices:

• Increased confusion

• New behaviors

• Exit-seeking

• Agitation

• Restlessness

• Mood changes

• Wandering attempts

• Post-hospital decline

  
  

You MUST reassess the resident’s elopement risk immediately and update:

✔ The assessment

✔ The care plan

✔ Interventions

✔ Staff communication

✔ Monitoring frequency

This keeps your documentation tight, your team informed, and your residents protected.

At the quarterly meeting, continue to:

• Reassess risk

• Update interventions

• Review behavioral patterns

• Reevaluate WanderGuard orders

• Update the photo

• Involve the family

Quarterly review + real-time response = elite leadership.

5. Keep Resident Photos Updated

If the photo is outdated, the search is delayed. Keep photos updated — especially after significant appearance changes. Trust, I have seen where the picture did not look like the person we were looking for.

6. Consider Weather & Environmental Risks

Weather plays a MAJOR role in elopement outcomes.

Winter

Risk of frostbite, hypothermia, and decreased visibility.

Summer

Heatstroke and dehydration.

Surrounding Hazards

Parking lots, unlocked cars, nearby bus stops, and high-traffic zones increase danger.

⭐ A Personal Note About Environment: My Uncle’s Experience

Let me add this from my own family experience:

My uncle was at a nursing facility in New York, and if you know NYC… you know. The subway was right there. The bus route ran nonstop. Taxis were everywhere. Stores on every corner. Crowds in every direction.

If an elopement were to occur in an environment like that, finding him would have been an enormous challenge — not because the facility didn’t care, but because the environment itself created a maze of risk.

This is exactly why environmental awareness is just as important as assessments and interventions. Your surroundings matter.

7. Secure Your Facility Perimeter

During drills, walk the perimeter:

• Are all exits alarmed?

• Any blind spots?

• Any gates unlocked?

• Any doors propped open?

• Staff cars locked?

Small details save lives.

8. Equip Your Team With Communication Tools

Each responder should have:

✔ Walkie-talkie or phone

✔ Clear search zones

✔ A description of the resident

✔ A response map

Communication is everything in an elopement.

9. Keep Families Involved

Inform families of:

• Behavior changes

• Risk status

• Care plan revisions

• Any attempts at exit-seeking

Families often notice patterns we don’t see.

10. Involve Your Social Worker

Your SW should:

• Monitor BIMS and mood changes

• Track cognitive decline

• Collaborate on interventions

• Update the care plan regularly

Your SW is your partner in prevention.

⭐ Final Thought

Elopement is one of the most terrifying events in long-term care — but with preparation, prevention, and consistent team training, it becomes manageable and preventable.

And boo, always remember:

Preparation prevents panic. Training saves lives. Your leadership protects your residents.

💜Lead with Love

YourFavNurseLeader

Bilquis Ali