Pathways to the Past
by Sandra Stimson ADC, CALA, CDP
Executive Director,
Alternative Solutions in Long Term Care
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SANDRA STIMSON
Executive Director
Alternative Solutions in LTC
and
National Council of Certified
Dementia Practitioners
http://www.nccdp.org  
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ABOUT SANDRA

Sandra Stimson has
experience as a corporate
consultant, Corporate Trainer
and National Speaker. Her
experience is in long term
care, as Activity Director,
Director of Alzheimer's Units
and Assistant Administrator of a
550 bed long term care county
home.  She is Co-founder of
Pet Express Pet Therapy Club,
is a Life Replay Specialist.  
Sandra implements dementia
units nationwide.  Sandra has
written several books,
Volunteer Management
Essentials for Long Term Care
and Pet Express Pet Therapy
Program. Sandra has been a
facilitator for Alzheimer's
support groups and is the
Awards Chair for the NJ
Association of Activity
Professionals.  Sandra is the
Executive Director of
National
Council of Certified Dementia
Practitioners
http://www.nccdp.org  

Alternative Solutions in Long
Term Care offers resources for
health care professionals in
many areas of dementia care,
care plans, Snoezelen
products, dementia activity
calendars, adult day care
calendars, sensory calendars,
reminisce videos for dementia,
activity books, and dates to
remember, party supplies,
resources and links.
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Trip Planning for Dementia

A facility recently took their residents from a dementia unit to
New York City. The City is very crowded and they ended up
with a resident wandering off.” Luckily, 24 hours later law
enforcement found the resident wandering the streets and
unharmed.

“An assisted living facility took several dementia residents with one activity assistant
and one bus driver to a crowded mall. They lost the resident for over an hour. The
elopement was never reported.”

“An activity assistant took 7 residents by herself to a large apple orchard. She had no
form of communication. All residents were ambulatory and diagnosed with dementia
and Alzheimer’s. She opened the door and began letting the residents out of the van.
They immediately scattered. She was unable to call for help. Luckily after an hour, she
found all the residents. One resident had fallen in a hole but was unharmed..”

Residents diagnosed with dementia and/or live on a dementia unit may go on
supervised outings; however, there needs to be some thought and planning given
when taking residents on a trip.

Only take the number of residents that can be safely monitored. On all trips there
should be an activity assistant, nursing assistant and a bus driver, or two activity
assistants and a nursing assistant.  A nursing assistant should accompany all
residents as they are trained in areas of ADL’s. Additionally, if you have only one activity
assistant, and a resident has to go to the rest room, who will be left to monitor the
residents? Administrators and Director’s of Nursing must make it a policy to have
appropriate supervision when residents diagnosed with dementia are on facility
outings.  The facility is leaving itself  open for possible accidents, elopements, fines
and law suits should anything happen. The best solution for these trips is one
assistant (could be a volunteer or family member) to one resident.

All residents should have proper identification.  One creative way is to have both the
residents and the staff wear T shirts that have the name of the facility printed on the front
and back. This is really important in the case of elopement and the need to know what
the resident was wearing. It is a quick visual way to monitor and supervise the
residents.

If there is an elopement, administration is to be notified immediately before the search
begins.  Don’t wait! Time is not on your side.  Residents can wander into traffic, fall and
any of a number of serious injuries and accidents can occur.

The Activity Director should complete and document the in-service that deals with Trips
and emergencies.  The inservice should specifically state what to do in situations of
elopement, illness, falls and accidents and the reporting procedures. For example, is
the Executive Director to be notified first? When should you call 911?

The activity staff should be equipped with cell phones when on outings. The unit
manager should be a part of the discussion of which residents are appropriate to
attend facility outings. The receptionist, administrator, Director of Nursing, Unit Manager
and the Activity Director should be provided with a trip form that states:
  • Name of location
  • Address and phone number
  • Departure time and return time
  • Resident names
  • Staff names
  • Cell phone number

Pick the location well.  The Activity Director should visit the location prior to the trip to
access the environment, crowds, bathroom facilities, parking lot and number of exits for
the location. Also, call the destination to make sure they are prepared to receive you.  
Smaller venues are recommended such as;
  • Small diners
  • Small pet shops
  • Small stores
  • Small stores such as five and dime vs. a large shopping mall.
  • Drive to a resident old neighborhood
  • Small zoo

Plan your time well. Probably the best time to go on an outing is 10:00 A.M. and return
by lunch time.  A long trip is probably not recommended as they tire easily.  There are
times through out the year that you may want to take residents on trips where they do
not leave the van such as viewing Christmas lights or observing fall foliage.

If the resident exhibits extreme anxiety over leaving or returning, perhaps it is best that
the resident not attend future trips. This should be clearly documented in the resident’s
chart. The staff should note the behavior and interventions used to calm the resident
down.

Staff should be seated through out the van because a resident may attempt to get out of
their seat. It is important that one staff member is seated in the back of the bus to
observe for safety or illness issues.

On all trips, bring along snacks, orange juice and apple juice. There are times when the
bus may be delayed due to accidents and traffic.  You may also have a resident who is
diabetic.

Always communicate for success. Let the residents know where you are going.  When
you get off the bus, let the residents know what they will be doing. When you with them
return, tell the residents that you are now returning and the name of your facility.  Keep
your answers brief and to the point.  There is a great book on communication called
Creating  Moments Of Joy on the
www.activitytherapy.com web site. This could be used
as part of your in-service and training.

Trips and outings are very beneficial to the dementia resident. Some of the benefits are;
Relaxation
  • Reminiscing about the location
  • Fun
  • Self Esteem Building
  • Diversion

There are also many products on the market for tracking such as GPS systems. If you
feel you may need additional support in the event of a possible elopement, you might
investigate Project Lifesaver. Project Lifesaver has great success in locating missing
residents in a matter of minutes.

You can avoid catastrophic reactions and situations if the Activity Director trains the staff,
plans the venues, provides enough staff on outings and communicates with the other
staff in the facility.
-END