The empty bed and the unanswered calls

The sign-out sheet says he left at ten. It does not say where he went, when he is coming back, or whether he has decided to turn a quick outing into a small vacation. Now the phone goes to voicemail, the family has no idea where he is, and everyone is looking at the administrator.

This is where nursing home administration gets interesting, usually without asking our permission.

An alert, independent resident has the right to go out. Living in a nursing home does not mean surrendering adulthood at the reception desk. But when someone does not return and nobody can establish that he is safe, “he does this all the time” is not much of a plan.

We have work to do. Check the sign-out record, talk to staff, call the resident, contact appropriate family members, and review medications or treatments he may have missed. Follow the facility’s procedures and involve law enforcement when reasonable efforts cannot establish his safety. Notify the practitioner, assess reporting requirements, and make sure the next shift gets more than “Oh, by the way, he’s still out.”

Then document accurately. Going to voicemail does not mean he refused your call. Leaving on pass does not automatically make it an elopement. And police saying they found him safe does not tell us whether he plans to return, whether he needs help getting back, or whether his medications are sitting untouched in our cart.

Once the immediate concern is resolved, there is still the census, billing, follow-up, and care plan to sort out. Administration has a remarkable ability to produce paperwork even when the person at the center of it is nowhere near the building.

The useful conversation afterward is with the resident: How can we make future outings work for you while giving us a reasonable way to check that you are okay? A workable agreement might accomplish more than another stern reminder taped beside the sign-out sheet.

We cannot manage adults as though they are children. We can, however, make sure our staff have a plan that does more than stare at an empty bed.