Search and Rescue Workshop

1. Search and Rescue Workshop Search is an Emergency Task Force, Waterloo Region TIME: 8:30 a.m. The first part of this presentation is designed to function as an educational tool for staff, whereas the whole presentation can function as an educational tool for facility representatives who are considering implementing the Search is an Emergency preplan.TIME: 8:30 a.m. The first part of this presentation is designed to function as an educational tool for staff, whereas the whole presentation can function as an educational tool for facility representatives who are considering implementing the Search is an Emergency preplan.

2. Dorothy Dorothy was accidentally let out of the care facility�s secure unit, and is hurrying down the street a few blocks away from the facility. She is talking to herself, or to a companion whom she is hallucinating, as she walks. �I must hurry. Whatever will mother say to me for being so long coming home from school? I am never this late. She will be mad that I wasn�t there to peel the potatoes. And the cows will be coming home to be milked soon. I�d better hurry so I am not out in the barn after dark.�Dorothy was accidentally let out of the care facility�s secure unit, and is hurrying down the street a few blocks away from the facility. She is talking to herself, or to a companion whom she is hallucinating, as she walks. �I must hurry. Whatever will mother say to me for being so long coming home from school? I am never this late. She will be mad that I wasn�t there to peel the potatoes. And the cows will be coming home to be milked soon. I�d better hurry so I am not out in the barn after dark.�

3. The Nurse The nurse looks frantic - repeatedly brushing back her hair or holding her hand over the base of her throat. �I just can�t believe this. Dorothy isn�t here. Just an ordinary day one minute, and an hour later, I feel like I am in the middle of a night mare. The police are here. They are looking at me as if I must be to blame for this. Dorothy�s daughter yelled at me. She told me I shouldn�t even be a nurse! I know she is just worried about her Mom, but still, it hurt me. I gave Dorothy her pills at noon, just as she was eating lunch. I stayed with her while she took them. When the other nurse on the team came back from lunch, I gave her a brief report about what was happening, and then left to take my own lunch break. The other nurse doesn�t usually work on this unit, but we had two people call in sick today. The receptionist is from the agency. She was at the desk when Dorothy went out. The receptionist said she thought Dorothy was a visitor; so nicely dressed. I helped Dorothy put on her favorite pink dress this morning, because her daughter was coming after lunch. But when her daughter came, just as I came back from my lunch, she couldn�t find her. That�s when all hell broke loose. We searched every room. I gave her daughter the picture of Dorothy that we keep in her chart, and she went around to all the visitors to see if they�d seen her mother. That�s when we found out what happened. Another patient, Mary, is having a visit from her daughter from California. Mary�s daughter has never visited this facility before. She said that Dorothy came up to her and told her that she couldn�t remember the combination to the door, and her eyesight wasn�t good. Dorothy asked Mary�s daughter to help her out because she was in a hurry to get home, So Mary�s daughter from California helped her out the door and asked her if she wanted her to call a cab. She said yes, so she left her waiting outside on the bench and went back in to call a cab. We called the cab company. One driver said he had come here, but there was no-one waiting for him, so he left. Now we have implemented our search protocol. I never thought we would ever need this. What if we don�t find her. What will happen to her?�The nurse looks frantic - repeatedly brushing back her hair or holding her hand over the base of her throat. �I just can�t believe this. Dorothy isn�t here. Just an ordinary day one minute, and an hour later, I feel like I am in the middle of a night mare. The police are here. They are looking at me as if I must be to blame for this. Dorothy�s daughter yelled at me. She told me I shouldn�t even be a nurse! I know she is just worried about her Mom, but still, it hurt me. I gave Dorothy her pills at noon, just as she was eating lunch. I stayed with her while she took them. When the other nurse on the team came back from lunch, I gave her a brief report about what was happening, and then left to take my own lunch break. The other nurse doesn�t usually work on this unit, but we had two people call in sick today. The receptionist is from the agency. She was at the desk when Dorothy went out. The receptionist said she thought Dorothy was a visitor; so nicely dressed. I helped Dorothy put on her favorite pink dress this morning, because her daughter was coming after lunch. But when her daughter came, just as I came back from my lunch, she couldn�t find her. That�s when all hell broke loose. We searched every room. I gave her daughter the picture of Dorothy that we keep in her chart, and she went around to all the visitors to see if they�d seen her mother. That�s when we found out what happened. Another patient, Mary, is having a visit from her daughter from California. Mary�s daughter has never visited this facility before. She said that Dorothy came up to her and told her that she couldn�t remember the combination to the door, and her eyesight wasn�t good. Dorothy asked Mary�s daughter to help her out because she was in a hurry to get home, So Mary�s daughter from California helped her out the door and asked her if she wanted her to call a cab. She said yes, so she left her waiting outside on the bench and went back in to call a cab. We called the cab company. One driver said he had come here, but there was no-one waiting for him, so he left. Now we have implemented our search protocol. I never thought we would ever need this. What if we don�t find her. What will happen to her?�

4. Dorothy�s Daughter Dorothy�s daughter is angry at the beginning, stamping her foot: �I can�t believe this is happening. We moved Mom in here because she would take the bus around town and get lost and call us. Then she started having difficulty using the phone. So we worried that she would get lost and not be able to call us. Sometimes she couldn�t remember our first names. The last time she got lost when she lived at home, she went out after I�d checked on her at 9 p.m. The staff at Tim Horton�s called the police at 1 a.m. because she�d been sitting there for three hours. And she couldn�t give them anyone's phone number to call. I checked on her again in the morning and she wasn�t there. Her bed hadn�t been slept in. I called the police and they said her description matched that of a lady who had been with them for quite a few hours.� Now Dorothy�s daughter is anguished, pushing her hair back from her face, and shaking her head: �I hope she finds a Tim Horton's this time. I hope the staff call the police. I was so upset when it happened before, but now it would be the best thing in the world. What if they don�t find her before dark? What if she is out all night or more than one night? What if they NEVER find her? Oh! Mom! I am so sorry! If I had stopped working so I could keep you at my place with me, this never would have happened!�Dorothy�s daughter is angry at the beginning, stamping her foot: �I can�t believe this is happening. We moved Mom in here because she would take the bus around town and get lost and call us. Then she started having difficulty using the phone. So we worried that she would get lost and not be able to call us. Sometimes she couldn�t remember our first names. The last time she got lost when she lived at home, she went out after I�d checked on her at 9 p.m. The staff at Tim Horton�s called the police at 1 a.m. because she�d been sitting there for three hours. And she couldn�t give them anyone's phone number to call. I checked on her again in the morning and she wasn�t there. Her bed hadn�t been slept in. I called the police and they said her description matched that of a lady who had been with them for quite a few hours.� Now Dorothy�s daughter is anguished, pushing her hair back from her face, and shaking her head: �I hope she finds a Tim Horton's this time. I hope the staff call the police. I was so upset when it happened before, but now it would be the best thing in the world. What if they don�t find her before dark? What if she is out all night or more than one night? What if they NEVER find her? Oh! Mom! I am so sorry! If I had stopped working so I could keep you at my place with me, this never would have happened!�

5. Discussion Have you experienced a person missing from your facility? What went well? What did you think about while working through this experience? What did you feel? What was the outcome? What would you do differently? Have you experienced having a person go missing from your facility? What went well? What did you think about while working through this experience? What did you feel? What was the outcome? What would you do differently? Have you experienced having a person go missing from your facility? What went well? What did you think about while working through this experience? What did you feel? What was the outcome? What would you do differently?

6. Wandering Emergencies Gail Morphat 1998 North York, ON Consider the following cases: 1998: North York- Gail Morphat died from exposure after wandering from a high-security LTC facility in North York. Her body was found at 11:30 am the next day (Feb. 11th, 1998) in a snow-covered gravel pit across the road, 260 meters from the facility. She had been wearing slacks and a sweater. Gail was 62 years old, and had Alzheimer disease for 10 years. She was a former head nurse in the emergency room at Hamilton General Hospital. A security camera showed her following a construction worker out the door at 2:30 pm. She was not missed until 5:30 pm dinner time. The police were called a half hour later. Her son felt that it shouldn�t have taken 3 hours for someone to notice that she was missing, nor should it have taken 30 minutes to call the police. The police did a search, but called it off because of the fog and the darkness. They did not search the gravel pit because they did not think that she would go there. A formal search task force was not set up until the next morning. Many established procedures were not followed by the police in this search. Since then, the police have reworked their search and rescue protocols. People with dementia are now given the highest emergency rating and police services are receiving appropriate training in the characteristics and traits of dementia patients which make them become easily lost and difficult to find. The coroner�s jury recommended that there be strict observance of head-count regulations in nursing centres, that electronic bracelets be in use, that there should be intensive monitoring of those at high risk for wandering. Consider the following cases: 1998: North York- Gail Morphat died from exposure after wandering from a high-security LTC facility in North York. Her body was found at 11:30 am the next day (Feb. 11th, 1998) in a snow-covered gravel pit across the road, 260 meters from the facility. She had been wearing slacks and a sweater. Gail was 62 years old, and had Alzheimer disease for 10 years. She was a former head nurse in the emergency room at Hamilton General Hospital. A security camera showed her following a construction worker out the door at 2:30 pm. She was not missed until 5:30 pm dinner time. The police were called a half hour later. Her son felt that it shouldn�t have taken 3 hours for someone to notice that she was missing, nor should it have taken 30 minutes to call the police. The police did a search, but called it off because of the fog and the darkness. They did not search the gravel pit because they did not think that she would go there. A formal search task force was not set up until the next morning. Many established procedures were not followed by the police in this search. Since then, the police have reworked their search and rescue protocols. People with dementia are now given the highest emergency rating and police services are receiving appropriate training in the characteristics and traits of dementia patients which make them become easily lost and difficult to find. The coroner�s jury recommended that there be strict observance of head-count regulations in nursing centres, that electronic bracelets be in use, that there should be intensive monitoring of those at high risk for wandering.

7. Wandering Emergencies Allan Goulding 2002 Vancouver, BC 2002: Vancouver BC - Allan Goulding, aged 80, was missing a month before his body was discovered in a crawl space of a mechanical area off limits to patients, at a Vancouver hospital. He had been transferred from a secure unit in a LTCF by ambulance for treatment of pneumonia. The information sent to the hospital included the fact that he had dementia and a history of wandering. What went wrong: The Hospital was not well-equipped to track people who wander. Even though this man had a history of wandering, supervision was not provided. The hospital staff put him on a stretcher in the hallway, and did not check on him for another 2 hours, at which point he was found to be missing. No ID bracelet was put on this man. Mr. Goulding went missing at 10:30 a.m.; the family were not notified until 9:30 p.m. The hospital had 8 people searching for Mr. Goulding for 14 hours. Security video showed that Mr. Goulding was taken away by an X-ray technician and then returned to his stretcher. Shortly thereafter, he got off his stretcher, and wandered down the hallway. The camera did not show which way he went. He had no money, and no identification. When the hospital search failed to find him, the police were called in The hospital officials said they made no mistakes and if forced to relive the same episode, would do exactly the same things. The family organized a community search for the next 30 days and received almost no help from the hospital. The family finally insisted that a second search of the hospital be conducted a month later, and during this search, Mr. Goulding�s body was found. His body was one floor above the emergency unit, in an area that was always left locked. 2002: Vancouver BC - Allan Goulding, aged 80, was missing a month before his body was discovered in a crawl space of a mechanical area off limits to patients, at a Vancouver hospital. He had been transferred from a secure unit in a LTCF by ambulance for treatment of pneumonia. The information sent to the hospital included the fact that he had dementia and a history of wandering. What went wrong: The Hospital was not well-equipped to track people who wander. Even though this man had a history of wandering, supervision was not provided. The hospital staff put him on a stretcher in the hallway, and did not check on him for another 2 hours, at which point he was found to be missing. No ID bracelet was put on this man. Mr. Goulding went missing at 10:30 a.m.; the family were not notified until 9:30 p.m. The hospital had 8 people searching for Mr. Goulding for 14 hours. Security video showed that Mr. Goulding was taken away by an X-ray technician and then returned to his stretcher. Shortly thereafter, he got off his stretcher, and wandered down the hallway. The camera did not show which way he went. He had no money, and no identification. When the hospital search failed to find him, the police were called in The hospital officials said they made no mistakes and if forced to relive the same episode, would do exactly the same things. The family organized a community search for the next 30 days and received almost no help from the hospital. The family finally insisted that a second search of the hospital be conducted a month later, and during this search, Mr. Goulding�s body was found. His body was one floor above the emergency unit, in an area that was always left locked.

8. Alzheimer Canada Preplan Manual In the Pre-Plan Manual as published by Alzheimer Canada, pages 2 � 8 are a general review of Alzheimer Disease and other dementias and of Planning for Individualized Care Overview of AD � could be done in another inservice Understanding Wandering � will be covered in greater detail in this presentation Person-Centred Care � Philosophy Statement � could be covered in another inservice Guidelines for Care � for facilities � the Enhancing Care program availiable from the Alzheimer Societies in Ontario is based on these guidelines In the Pre-Plan Manual as published by Alzheimer Canada, pages 2 � 8 are a general review of Alzheimer Disease and other dementias and of Planning for Individualized Care Overview of AD � could be done in another inservice Understanding Wandering � will be covered in greater detail in this presentation Person-Centred Care � Philosophy Statement � could be covered in another inservice Guidelines for Care � for facilities � the Enhancing Care program availiable from the Alzheimer Societies in Ontario is based on these guidelines

9. Why Preplan for Wandering? Wandering is a predictable pattern in dementia due to geographic disorientation and seeking a familiar and comfortable milieu No matter how thorough the security, something can go wrong � count on the fact that people with dementia will wander out, and you will be ready when they do Why Plan? (pg. 9-10) Alz Can model A person with dementia can slip out when a door is closing and a staff member is rushing to help someone else The magnetic locks on the doors of a secure unit may fail during a power outage Someone who does not know the rules and restrictions may let them out Accepting the fact that this is a possibility allows your facility to manage the risk by: trying to imagine all the ways this could happen and plan to avoid them have a good plan for noticing when someone has gone and for finding them quickly when they have wandered outWhy Plan? (pg. 9-10) Alz Can model A person with dementia can slip out when a door is closing and a staff member is rushing to help someone else The magnetic locks on the doors of a secure unit may fail during a power outage Someone who does not know the rules and restrictions may let them out Accepting the fact that this is a possibility allows your facility to manage the risk by: trying to imagine all the ways this could happen and plan to avoid them have a good plan for noticing when someone has gone and for finding them quickly when they have wandered out

10. Wandering Characteristics Have a 12-hour survival window Travel in a straight line Attempt to return to former residence Usually has a history of wandering Hide from searchers Don�t leave many clues Research also shows that people with dementia exhibit unique wandering characteristics: People with dementia: one research study found that people with dementia are likely to die of exposure, dehydration or drowning if they are not found within a 12 hour time period � this 12-hour survival window may be closer to 24 hours in warmer weather / climates - and may be shorter in cold weather people with dementia tend to Travel in a straight line - the evidence for this has accumulated because that�s where people have been found - whether they are dead or alive; the reason for this is uncertain, but likely possibilities are the tunnel vision that many people with Alzheimer�s have, and the lack of ability to problem-solve their way around obstacles, or to find the path of least resistance, such as a roadway People with Dementia may Attempt to return to former residence/work place - since their context for orienting themselves to the time of their life has been distorted by the retrograde amnesia in their long-term memory � they may seek a familiar place, and if they can travel on a well-known route, may actually get there Usually have a history of wandering - this behaviour is a very common occurrence for people with dementia, for many reasons they need to be accommodated by being facilitated to have a safe place in which to wander - for a detailed analysis of wandering behaviour please consult http://www.dbs-sar.com/SAR_Research/wandering.htm �Normal adults (who often become lost also) rely upon three intact systems to know where they are in space.� Short and long term memory to identify landmarks, a sense of time and speed to judge distance, and an intact visual-spatial sense to know direction angles and expected arrival times between landmarks. All three of these systems are impaired in the Alzheimer's subject.� everyone with a dementia who can walk is a potential wander and at risk hide from searchers - are unable to judge their context and may be afraid don�t leave many clues - their intentions cannot be evaluated as with a well-person, because they either have no intentions, or no way of communicating them � don�t communicate a plan, pack a bag, use a map, or know how to seek directions Research also shows that people with dementia exhibit unique wandering characteristics: People with dementia: one research study found that people with dementia are likely to die of exposure, dehydration or drowning if they are not found within a 12 hour time period � this 12-hour survival window may be closer to 24 hours in warmer weather / climates - and may be shorter in cold weather people with dementia tend to Travel in a straight line - the evidence for this has accumulated because that�s where people have been found - whether they are dead or alive; the reason for this is uncertain, but likely possibilities are the tunnel vision that many people with Alzheimer�s have, and the lack of ability to problem-solve their way around obstacles, or to find the path of least resistance, such as a roadway People with Dementia may Attempt to return to former residence/work place - since their context for orienting themselves to the time of their life has been distorted by the retrograde amnesia in their long-term memory � they may seek a familiar place, and if they can travel on a well-known route, may actually get there Usually have a history of wandering - this behaviour is a very common occurrence for people with dementia, for many reasons they need to be accommodated by being facilitated to have a safe place in which to wander - for a detailed analysis of wandering behaviour please consult http://www.dbs-sar.com/SAR_Research/wandering.htm �Normal adults (who often become lost also) rely upon three intact systems to know where they are in space.� Short and long term memory to identify landmarks, a sense of time and speed to judge distance, and an intact visual-spatial sense to know direction angles and expected arrival times between landmarks. All three of these systems are impaired in the Alzheimer's subject.� everyone with a dementia who can walk is a potential wander and at risk hide from searchers - are unable to judge their context and may be afraid don�t leave many clues - their intentions cannot be evaluated as with a well-person, because they either have no intentions, or no way of communicating them � don�t communicate a plan, pack a bag, use a map, or know how to seek directions

11. Wandering Characteristics Never call for help and don�t respond when their name is called Often found within short distance of roadway Often get stuck (ditches, fences, brush) Often found by people not involved in official search Found within 2.4 km radius of home People with dementia: Never call for help and don�t respond when their name is called - calling for help and answering when their own name is called requires reasoning ability, name recognition, problem-solving and language skills - often when people with dementia respond to their own name when they are with caregivers, it is because of a recognition of the welcoming body-language, not the verbal message Are Often found within short distance of roadway - because they do not get far without becoming unable to problem-solve their way out of difficulties - they will not sit by the road to await rescue, but track off into the bush and sit when they become tired they Often get stuck (ditches, fences, brush) - they will go until they become stuck, and they are unable to turn around and try another way, as this, too, requires rational problem-solving (Gail Morphat could go no further when she entered a culvert; Alan Goulding was found at the far end of the maintenance area, not at the door where he could have banged for help) they are Often found by people not involved in official search - may be doing something unusual that draws attention - for example, walking down a grassy hill with a walker, with the sidewalk a few feet away are usually Found within 2.4 km radius of home - this information is from statistical post-search analyses - people can walk about one kilometer per hour People with dementia: Never call for help and don�t respond when their name is called - calling for help and answering when their own name is called requires reasoning ability, name recognition, problem-solving and language skills - often when people with dementia respond to their own name when they are with caregivers, it is because of a recognition of the welcoming body-language, not the verbal message Are Often found within short distance of roadway - because they do not get far without becoming unable to problem-solve their way out of difficulties - they will not sit by the road to await rescue, but track off into the bush and sit when they become tired they Often get stuck (ditches, fences, brush) - they will go until they become stuck, and they are unable to turn around and try another way, as this, too, requires rational problem-solving (Gail Morphat could go no further when she entered a culvert; Alan Goulding was found at the far end of the maintenance area, not at the door where he could have banged for help) they are Often found by people not involved in official search - may be doing something unusual that draws attention - for example, walking down a grassy hill with a walker, with the sidewalk a few feet away are usually Found within 2.4 km radius of home - this information is from statistical post-search analyses - people can walk about one kilometer per hour

12. Wandering Characteristics All behaviour has meaning Purposeful / aimless Not harmful if in a safe environment We all know that people with dementia wander. We know that all behaviour has meaning. - sometimes discovering the meaning can help prevent the wandering or can help locate the missing person discovering the meaning may allow you to eliminate the problem - for example, one fellow who was labelled an �exit-seeker� was misinterpreting his own reflection in the glass window of the door - each time he stood in front of the door he thought he saw his (deceased) brother on the other side and attempted to get to him - the �exit-seeking� disappeared when the glass was covered - the meaning was �exit-seeking� to the staff, but not to him - another fellow was a former marathon runner � he began running for miles, without knowing the way home, and sometimes running on busy roads, as he no longer understood traffic rules - the family built a large fence between his garden and the roadway which blocked his vision of the place he used to run and he was no longer stimulated to �answer the call of the road� Wandering can be purposeful or aimless - sometimes people are trying to find things in their own past which they are perceiving as their present - their parents, their childhood home, their school, their workplace, their favourite coffee shop � somewhere that they feel safe and comfortable - other people are restless, or have an organic cause to their constant motion, and just have to keep going � may have extreme motor restlessness � have to keep moving We also know that wandering is not harmful if it is done is a safe environment - not facilitating safe wandering may cause considerable stress to the person with dementia We all know that people with dementia wander. We know that all behaviour has meaning. - sometimes discovering the meaning can help prevent the wandering or can help locate the missing person discovering the meaning may allow you to eliminate the problem - for example, one fellow who was labelled an �exit-seeker� was misinterpreting his own reflection in the glass window of the door - each time he stood in front of the door he thought he saw his (deceased) brother on the other side and attempted to get to him - the �exit-seeking� disappeared when the glass was covered - the meaning was �exit-seeking� to the staff, but not to him - another fellow was a former marathon runner � he began running for miles, without knowing the way home, and sometimes running on busy roads, as he no longer understood traffic rules - the family built a large fence between his garden and the roadway which blocked his vision of the place he used to run and he was no longer stimulated to �answer the call of the road� Wandering can be purposeful or aimless - sometimes people are trying to find things in their own past which they are perceiving as their present - their parents, their childhood home, their school, their workplace, their favourite coffee shop � somewhere that they feel safe and comfortable - other people are restless, or have an organic cause to their constant motion, and just have to keep going � may have extreme motor restlessness � have to keep moving We also know that wandering is not harmful if it is done is a safe environment - not facilitating safe wandering may cause considerable stress to the person with dementia

13. Searching From Page 12 in the Alzheimer Canada version of the Search is an Emergency manual The Search plan should carefully delineate the staff into teams and assign each team an area of the facility to search, so that all sectors of the building(s) are covered thoroughly in the search.From Page 12 in the Alzheimer Canada version of the Search is an Emergency manual The Search plan should carefully delineate the staff into teams and assign each team an area of the facility to search, so that all sectors of the building(s) are covered thoroughly in the search.

14. Searching a Room One person checks behind objects while the other keeps an eye on the door in case the missing person slips out while a searcher�s back is turned Remember that if the context of the person�s thought is in the past, they may be actively avoiding capture. Many people who have Alzheimer disease now have been in conditions of extreme hardship such as war and natural disasters, or have suffered abuse in the past, and they may mistakenly view the searchers as people who want to harm them, because of this context. Fire evacuation mechanism is a small piece of Plexiglas attached to the door, which can be swung around to lean on the door frame. If the door is opened again, it will fall down, allowing searchers to know at a glance that the door has been reopened.One person checks behind objects while the other keeps an eye on the door in case the missing person slips out while a searcher�s back is turned Remember that if the context of the person�s thought is in the past, they may be actively avoiding capture. Many people who have Alzheimer disease now have been in conditions of extreme hardship such as war and natural disasters, or have suffered abuse in the past, and they may mistakenly view the searchers as people who want to harm them, because of this context. Fire evacuation mechanism is a small piece of Plexiglas attached to the door, which can be swung around to lean on the door frame. If the door is opened again, it will fall down, allowing searchers to know at a glance that the door has been reopened.

15. Care Strategies Lost communication skills may no longer have expressive communication � unable to say what they want � feel insecure where they are � may look for a place where they feel secure Their understanding is lost in 1) the words eg. cup 2) attaching meaning to the words � one uses a cup 3) knowing what function the object named has � use a cup to drink fluid because you feel thirsty (may no longer recognize the sensation of thirst either) STRATEGIES � know what abilities and inabilities the person has � compensate for the inabilities and facilitate the person to do the things they can do B. Inability to interpret the environment Lost in place, time and person You are part of the environment � use unconditional positive regard and conscious positive body language � to help them feel they are with family Facilitate safe wandering � move obstructions, place handrails in helpful places, facilitate turning corners Familiar objects, name cards, to give a sense of belonging Good illumination Remove cues for leaving � hang outdoor clothing in a closed cupboard � consider wallpaper over doors to prevent constant attendance at doors Provide activities during the times of day when there is most disorientation or agitation (eg. Sundowning) C. Inability to perform a task � unable to coordinate or perform the sequence of physical movements required D. Physical Discomfort � Unmanaged pain may increase restlessness and agitation and encourage a person to go into a �seeking� mode Lost communication skills may no longer have expressive communication � unable to say what they want � feel insecure where they are � may look for a place where they feel secure Their understanding is lost in 1) the words eg. cup 2) attaching meaning to the words � one uses a cup 3) knowing what function the object named has � use a cup to drink fluid because you feel thirsty (may no longer recognize the sensation of thirst either) STRATEGIES � know what abilities and inabilities the person has � compensate for the inabilities and facilitate the person to do the things they can do B. Inability to interpret the environment Lost in place, time and person You are part of the environment � use unconditional positive regard and conscious positive body language � to help them feel they are with family Facilitate safe wandering � move obstructions, place handrails in helpful places, facilitate turning corners Familiar objects, name cards, to give a sense of belonging Good illumination Remove cues for leaving � hang outdoor clothing in a closed cupboard � consider wallpaper over doors to prevent constant attendance at doors Provide activities during the times of day when there is most disorientation or agitation (eg. Sundowning) C. Inability to perform a task � unable to coordinate or perform the sequence of physical movements required D. Physical Discomfort � Unmanaged pain may increase restlessness and agitation and encourage a person to go into a �seeking� mode

16. Care Strategies cont�d D. Inability to handle environmental press � may need to reduce sensory stimulation � eg. Turn off TVs (one lady wondered why a show was so cluttered with noises � music, laughter, sounds that had no relationship to the movie, and why things skipped in a movie � we automatically integrate and blend video clips that are edited together and the sound tracks that are added for effect � she couldn�t stand to have the TV on because she couldn�t follow the plot as the scenes jumped around and the sound tracks were unnecessary distractions, rather than augmenting the effect. Others have complained that the people on the TV are laughing at them facing a person toward a wall in a dining room may allow them to decrease visual stimulation keeping the person dressed as they�re used to (some dress more warmly than others � need to ask family), decreasing unnecessary noise, keeping the facility well-lit lack of tolerance for environmental press is very individual � eg. Pet therapy had to be stopped in caring for concentration camp survivors, because they thought they were attack dogs. E. Personal habits / expectations � very individual � one fellow would not settle all night until the staff learned to tell him that they would peel the potatoes for the next day � he had been a cook on a merchant marine vessel, and that was always his last task before going to bed F. Emotional or psychological state � agitation and anxiety are part of dementia � learn what will calm a person down when there has been no trigger � eg. Video � one woman calmed down every time she was shown pictures of cats � - restraints will cause agitation � go to any lengths to remove restraints, including putting a bed on the floor D. Inability to handle environmental press � may need to reduce sensory stimulation � eg. Turn off TVs (one lady wondered why a show was so cluttered with noises � music, laughter, sounds that had no relationship to the movie, and why things skipped in a movie � we automatically integrate and blend video clips that are edited together and the sound tracks that are added for effect � she couldn�t stand to have the TV on because she couldn�t follow the plot as the scenes jumped around and the sound tracks were unnecessary distractions, rather than augmenting the effect. Others have complained that the people on the TV are laughing at them facing a person toward a wall in a dining room may allow them to decrease visual stimulation keeping the person dressed as they�re used to (some dress more warmly than others � need to ask family), decreasing unnecessary noise, keeping the facility well-lit lack of tolerance for environmental press is very individual � eg. Pet therapy had to be stopped in caring for concentration camp survivors, because they thought they were attack dogs. E. Personal habits / expectations � very individual � one fellow would not settle all night until the staff learned to tell him that they would peel the potatoes for the next day � he had been a cook on a merchant marine vessel, and that was always his last task before going to bed F. Emotional or psychological state � agitation and anxiety are part of dementia � learn what will calm a person down when there has been no trigger � eg. Video � one woman calmed down every time she was shown pictures of cats � - restraints will cause agitation � go to any lengths to remove restraints, including putting a bed on the floor

17. Search and Rescue Workshop Purpose of Workshop Search is an Emergency Task Force Long-Term Care Retirement Homes Alzheimer Societies Waterloo Region�s Psychogeriatric Consultant Waterloo Regional Police Purpose of this workshop: To learn what to do if a resident is missing. To learn how to plan be prepared for a wandering emergency. Search is an Emergency Task Force This workshop was developed through the Search is an Emergency Waterloo Region Taskforce The task force involved staff from area Long-Term Care facilities and retirement homes in Waterloo Region, staff from the Alzheimer Societies of K-W and Cambridge, Waterloo Region�s Psychogeriatric Consultant and Waterloo Regional Police the materials developed in Waterloo Region were further developed by the Alzheimer Society in Cornwall and eventually adapted for use across the country by the Alzheimer Society of Canada the manual and binder material that was originally developed in Waterloo has been altered for this educational presentation to fit the content and the order of the Search is An Emergency preplan located on the Alzheimer Canada website -HAND OUT SEARCH AND RESCUE MANUAL at this point of the presentation Reference: Phillips, Constable Ted (2000). �When Residents with Dementia go Missing�, Long Term Care, May/June 2000, p.20-24. Purpose of this workshop: To learn what to do if a resident is missing. To learn how to plan be prepared for a wandering emergency. Search is an Emergency Task Force This workshop was developed through the Search is an Emergency Waterloo Region Taskforce The task force involved staff from area Long-Term Care facilities and retirement homes in Waterloo Region, staff from the Alzheimer Societies of K-W and Cambridge, Waterloo Region�s Psychogeriatric Consultant and Waterloo Regional Police the materials developed in Waterloo Region were further developed by the Alzheimer Society in Cornwall and eventually adapted for use across the country by the Alzheimer Society of Canada the manual and binder material that was originally developed in Waterloo has been altered for this educational presentation to fit the content and the order of the Search is An Emergency preplan located on the Alzheimer Canada website -HAND OUT SEARCH AND RESCUE MANUAL at this point of the presentation Reference: Phillips, Constable Ted (2000). �When Residents with Dementia go Missing�, Long Term Care, May/June 2000, p.20-24.

18. It is important to plan ahead. When people react in an organized and efficient manner, it increases the likelihood of finding the lost resident quickly. There are four things to think about when planning for search and rescue operations: Information to collect about the resident Information and resource material to keep at your facility (Search Kit) A wandering incident policy and procedure (what to do if someone is missing) Educating staff and family/volunteers about the procedure We are going to talk about all four things today. It is important to plan ahead. When people react in an organized and efficient manner, it increases the likelihood of finding the lost resident quickly. There are four things to think about when planning for search and rescue operations: Information to collect about the resident Information and resource material to keep at your facility (Search Kit) A wandering incident policy and procedure (what to do if someone is missing) Educating staff and family/volunteers about the procedure We are going to talk about all four things today.

19. Information about the Resident The first area that we are going to look at is the importance of getting information about clients who are at risk of wandering. -review all current residents, you will need to plan carefully how to do this, as it could be a big task -adapt the admission procedure to include a wandering risk assessment - Adapt the annual review procedure � may need to include a procedure whereby a review is triggered by a change in status / disease progression Identifying those at risk: We need to assess upon admission and at every care conference - who is mobile and has a prior history of wandering or exit seeking behaviour. Need to have a mechanism in place whereby a change in condition will trigger a review of the resident�s risk for wandering Because AD is progressive, reassessment is important (ie. at every care conference) Don�t be fooled by people�s mobility! Example: woman leaves walker behind and goes down the stairs Pg 10 � AC Manual � �All people with Alzheimer Disease and related dementias should be considered at risk of wandering and getting lost� The first area that we are going to look at is the importance of getting information about clients who are at risk of wandering. -review all current residents, you will need to plan carefully how to do this, as it could be a big task -adapt the admission procedure to include a wandering risk assessment - Adapt the annual review procedure � may need to include a procedure whereby a review is triggered by a change in status / disease progression Identifying those at risk: We need to assess upon admission and at every care conference - who is mobile and has a prior history of wandering or exit seeking behaviour. Need to have a mechanism in place whereby a change in condition will trigger a review of the resident�s risk for wandering Because AD is progressive, reassessment is important (ie. at every care conference) Don�t be fooled by people�s mobility! Example: woman leaves walker behind and goes down the stairs Pg 10 � AC Manual � �All people with Alzheimer Disease and related dementias should be considered at risk of wandering and getting lost�

20. Information about the Resident Responding to the Risk Care Plan Other Information Wandering Person Profile Wandering Registry Resident photos � initial and updated version Where will you keep the information? How will communicate to staff which residents are at risk? Responding: Care Plan-Ideally, we will prevent these wandering incidents by developing interventions in the resident�s care plan. There were some suggestions on managing wandering given previously in this presentation. These interventions need to be individualized for each person. Other information: It is important to get info ahead of time to help searchers respond during an emergency by completing a �Wandering person profile� for them - page 24 in Alz Can preplan and registering at-risk residents on the Alzheimer Wandering Registry it is important to dispel myth amongst staff that a profile and WR application are not needed if the person is in a locked facility or a facility with its own security system Also, we know that lost residents can be found by people not officially involved in the search. Alzheimer Wandering Registry bracelet prompts people to call police Resident photos � taken on admission (or at the start of the Search planning), and updated � put in procedure for reviews to evaluate need for new photo � use full face photo as well as head to toe to show build, posture Decide where to keep everything Decide how to notify others who is at risk for wandering All staff need to know who is at risk of wandering: Inform staff (especially new staff) who has been at risk of wandering. Could identify on resident�s chart (highlight in yellow) those who are at risk. Responding: Care Plan-Ideally, we will prevent these wandering incidents by developing interventions in the resident�s care plan. There were some suggestions on managing wandering given previously in this presentation. These interventions need to be individualized for each person. Other information: It is important to get info ahead of time to help searchers respond during an emergency by completing a �Wandering person profile� for them - page 24 in Alz Can preplan and registering at-risk residents on the Alzheimer Wandering Registry it is important to dispel myth amongst staff that a profile and WR application are not needed if the person is in a locked facility or a facility with its own security system Also, we know that lost residents can be found by people not officially involved in the search. Alzheimer Wandering Registry bracelet prompts people to call police Resident photos � taken on admission (or at the start of the Search planning), and updated � put in procedure for reviews to evaluate need for new photo � use full face photo as well as head to toe to show build, posture Decide where to keep everything Decide how to notify others who is at risk for wandering All staff need to know who is at risk of wandering: Inform staff (especially new staff) who has been at risk of wandering. Could identify on resident�s chart (highlight in yellow) those who are at risk.

21. Facility Information Information about your facility needs to be clear and descriptive and readily available to allow searchers to cover every area in the facility and on the grounds, and to be able to clearly check off and initial each area that they have searched. This information will also need to be handed to the police if they are needed to continue the search. Having this information available will save precious time when a resident is missing.Information about your facility needs to be clear and descriptive and readily available to allow searchers to cover every area in the facility and on the grounds, and to be able to clearly check off and initial each area that they have searched. This information will also need to be handed to the police if they are needed to continue the search. Having this information available will save precious time when a resident is missing.

22. Alzheimer Canada Manual Page 18 � 19 gather the things you will need for the search kit � keep them on each unit � eg. In a decorated box � perhaps close to other emergency equipment on the unit Office supplies such as a note pad, pens and highlighters Flashlights and batteries floor plans � may want to laminate them, or have multiple copies so they can be written on during a search so staff can check off areas as they proceed includes basements and rooftops and garages includes all maintenance rooms, kitchens, resident rooms, offices, exits, stairs etc., all rooms that are typically kept locked Grounds Plan and Photos � This will help identify hazards or likely places of concealment in the surrounding landscape daytime photos will help night or winter searches to easily identify landscape features Topographical / aerial photographs of the area have a large (24-36� ) aerial photograph with your facility in the centre and a 2.4 km radius in all directions a binder-sized version for the BINDER - agree where these will be kept -figure out how this will be communicated to staff that need to know (all those who will be in the facility and �take charge� should an incident occur) Alzheimer Canada Manual Page 18 � 19 gather the things you will need for the search kit � keep them on each unit � eg. In a decorated box � perhaps close to other emergency equipment on the unit Office supplies such as a note pad, pens and highlighters Flashlights and batteries floor plans � may want to laminate them, or have multiple copies so they can be written on during a search so staff can check off areas as they proceed includes basements and rooftops and garages includes all maintenance rooms, kitchens, resident rooms, offices, exits, stairs etc., all rooms that are typically kept locked Grounds Plan and Photos � This will help identify hazards or likely places of concealment in the surrounding landscape daytime photos will help night or winter searches to easily identify landscape features Topographical / aerial photographs of the area have a large (24-36� ) aerial photograph with your facility in the centre and a 2.4 km radius in all directions a binder-sized version for the BINDER - agree where these will be kept -figure out how this will be communicated to staff that need to know (all those who will be in the facility and �take charge� should an incident occur)

23. Aerial Map -each facility can purchase an aerial map � from the municipality or regional office (large (24�) aerial maps were bought by facilities in Waterloo Region from the regional government, with their facility at the centre of the map, a 1 mile diameter view, and these were laminated � facilities also purchased binder-sized maps for their letter-sized binders) -agree where this will be kept and that it must be available for POLICE should they get involved with a search -you may want to take a tour of your facility outside, and/or go through the neighborhood, looking for hazards that may be nearby. Knowing the neighborhood is a good idea and gives a new perspective of your �HOME� Allows you to: -understand the outside facility hazards -may want to wander through the yard, neighborhood -may want to know nearby businesses -daytime photos are helpful Ordering information is available in your binder -each facility can purchase an aerial map � from the municipality or regional office (large (24�) aerial maps were bought by facilities in Waterloo Region from the regional government, with their facility at the centre of the map, a 1 mile diameter view, and these were laminated � facilities also purchased binder-sized maps for their letter-sized binders) -agree where this will be kept and that it must be available for POLICE should they get involved with a search -you may want to take a tour of your facility outside, and/or go through the neighborhood, looking for hazards that may be nearby. Knowing the neighborhood is a good idea and gives a new perspective of your �HOME� Allows you to: -understand the outside facility hazards -may want to wander through the yard, neighborhood -may want to know nearby businesses -daytime photos are helpful Ordering information is available in your binder

24. Search and Rescue Binder Missing Person Incident Form Emergency Contact Information Floor and Grounds Plan Daytimes photos of facility Facility Key List Small version of aerial map Blank forms The search and rescue binder contains information about your facility and residents that will help rescuers in their search effort. (SHOW EXAMPLE OF A BINDER) The binder contains information on: Incident Procedure: what to do during a wandering emergency Emergency Contact Information: key staff, police, local businesses, taxi company etc. Floor and Grounds Plans: easily accessible for rescuers Daytime Photos of grounds: helpful during night time searches Facility Key List: who has what keys in the facility and where they are kept Information about residents: can keep it here or in the resident�s file - don�t assume the resident won�t be behind a locked door! Small version of aerial map: for portability Everyone who has come to the workshop today will all get template for a binder for their facility that they can adapt. We we will be going over this in more detail later in the workshop. The search and rescue binder contains information about your facility and residents that will help rescuers in their search effort. (SHOW EXAMPLE OF A BINDER) The binder contains information on: Incident Procedure: what to do during a wandering emergency Emergency Contact Information: key staff, police, local businesses, taxi company etc. Floor and Grounds Plans: easily accessible for rescuers Daytime Photos of grounds: helpful during night time searches Facility Key List: who has what keys in the facility and where they are kept Information about residents: can keep it here or in the resident�s file - don�t assume the resident won�t be behind a locked door! Small version of aerial map: for portability Everyone who has come to the workshop today will all get template for a binder for their facility that they can adapt. We we will be going over this in more detail later in the workshop.

25. The third aspect of preparing for a wandering emergency is to create the formal policy and procedure for your facility. Firstly, create or update a policy which states your ultimate goal � as soon as a staff member realizes that a resident is not where they are expected to be, that resident will be located. If a resident is not able to be located within for example � 2 minutes � the formal search procedure will be started. Think about the hourly rounds that are done at night. Is there a way that you keep track of everyone�s presence during the day? Eg. Med rounds � - suggestion - map out the day to see when the surveillance is lacking and put in a round? The third aspect of preparing for a wandering emergency is to create the formal policy and procedure for your facility. Firstly, create or update a policy which states your ultimate goal � as soon as a staff member realizes that a resident is not where they are expected to be, that resident will be located. If a resident is not able to be located within for example � 2 minutes � the formal search procedure will be started. Think about the hourly rounds that are done at night. Is there a way that you keep track of everyone�s presence during the day? Eg. Med rounds � - suggestion - map out the day to see when the surveillance is lacking and put in a round?

26. Policy and Procedure Missing Person Incident Form CONTAINING: Search Plan Secondly, write or rewrite the facility�s �code yellow� wandering incident procedure. The Alzheimer Canada Manual has the Missing Person Incident form on pages 14 � 17, and suggests that the Search Plan (page 13 Alzheimer Canada Manual) should be inserted into each form - THE SEARCH PLAN needs to be developed by each facility to suit their own facility. Secondly, write or rewrite the facility�s �code yellow� wandering incident procedure. The Alzheimer Canada Manual has the Missing Person Incident form on pages 14 � 17, and suggests that the Search Plan (page 13 Alzheimer Canada Manual) should be inserted into each form - THE SEARCH PLAN needs to be developed by each facility to suit their own facility.

27. POLICY AND PROCEDURE STEP ONE: Get the Search Binder which contains the Missing Person Incident Forms STEP TWO: Follow the procedure outlined in the Missing Person Incident Form Make the process as simple as possible for staff to follow in a crisis. Points about the Missing Person Incident form: Why it is useful: Gives specific instructions on what to do if a resident is missing and provides space to document the actions taken Make the process as simple as possible for staff to follow in a crisis. Points about the Missing Person Incident form: Why it is useful: Gives specific instructions on what to do if a resident is missing and provides space to document the actions taken

28. First page of the Missing Person Incident Form in the Search Binder should identify who is in which role: Need to assign these roles ahead of time so there is no hesitation in a crisis Alzheimer Canada Manual page 13 First page of the Missing Person Incident Form in the Search Binder should identify who is in which role: Need to assign these roles ahead of time so there is no hesitation in a crisis Alzheimer Canada Manual page 13

29. �Walk Through� scenario for MISSING PERSON INCIDENT Sadie Miller is a 62 year old retired teacher who was diagnosed with Alzheimer disease four years ago. Every morning she gets dressed and talks about going to school. Today is Tuesday, September 15th. This morning the PSW, Angela Snow, helped her with her bath and laid out her clothes. Sadie dressed in her navy slacks, a white and navy striped blouse and matching shoes, then Angela helped her find her way to the dining-room, where Sadie enjoyed a good breakfast. At ten o�clock, Angela Snow looks for Sadie to remind her to go to the singsong. She does not see Sadie in her room or on the unit. Angela does another quick walk through the unit, asking other nurses if they have seen her and she is unable to locate Sadie. Angela notifies the charge nurse that Sadie is missing. �Walk Through� scenario for MISSING PERSON INCIDENT Sadie Miller is a 62 year old retired teacher who was diagnosed with Alzheimer disease four years ago. Every morning she gets dressed and talks about going to school. Today is Tuesday, September 15th. This morning the PSW, Angela Snow, helped her with her bath and laid out her clothes. Sadie dressed in her navy slacks, a white and navy striped blouse and matching shoes, then Angela helped her find her way to the dining-room, where Sadie enjoyed a good breakfast. At ten o�clock, Angela Snow looks for Sadie to remind her to go to the singsong. She does not see Sadie in her room or on the unit. Angela does another quick walk through the unit, asking other nurses if they have seen her and she is unable to locate Sadie. Angela notifies the charge nurse that Sadie is missing.

30. Missing Person Incident Form Charge Nurse (CN) � important not to lose time by sending the person to do another search � the next pass through the unit needs to be formal Charge Nurse (CN) � important not to lose time by sending the person to do another search � the next pass through the unit needs to be formal

31. Missing Person Incident Form Charge Nurse (CN) � checks sign-out sheet - resident has not been signed out Charge nurse � gets Search Binder, removes a blank incident form and starts The documentation record CN � notifies the other two staff on the unit. One is in the middle of bathing a resident and cannot leave, the other is asked to stop feeding a client in order to supervise the other residents and the unit doors as the search of the unit is completed CN and missing resident�s nurse together systematically search the entire unit. they follow the search plan for their unit, starting farthest from the door and working their way forward, searching each room at a low, medium and high level, and looking inside all closets and behind doors they close each door as they finish and put the fire security marker in place they do not find Sadie MillerCharge Nurse (CN) � checks sign-out sheet - resident has not been signed out Charge nurse � gets Search Binder, removes a blank incident form and starts The documentation record CN � notifies the other two staff on the unit. One is in the middle of bathing a resident and cannot leave, the other is asked to stop feeding a client in order to supervise the other residents and the unit doors as the search of the unit is completed CN and missing resident�s nurse together systematically search the entire unit. they follow the search plan for their unit, starting farthest from the door and working their way forward, searching each room at a low, medium and high level, and looking inside all closets and behind doors they close each door as they finish and put the fire security marker in place they do not find Sadie Miller

32. Missing Person Incident Form Charge nurse calls a Code Yellow and two people from each unit come immediately to the nursing station identified in the Code Yellow (the staff availability and the area set up as command post will vary considerably from facility to facility and during various shifts) Searchers are shown picture and given description (in a small facility, bringing the searchers to the unit may not be necessary, because all the staff know all the residents � and the clothing can be broadcast with the initial code yellow. Charge nurse calls a Code Yellow and two people from each unit come immediately to the nursing station identified in the Code Yellow (the staff availability and the area set up as command post will vary considerably from facility to facility and during various shifts) Searchers are shown picture and given description (in a small facility, bringing the searchers to the unit may not be necessary, because all the staff know all the residents � and the clothing can be broadcast with the initial code yellow.

33. Missing Person Incident Form Need to monitor the door to make sure the missing resident doesn�t leave during the search � the door will be open a lot with people coming and going from the unitNeed to monitor the door to make sure the missing resident doesn�t leave during the search � the door will be open a lot with people coming and going from the unit

34. Missing Person Incident Form Judy accepts the reports from the other units. Maintenance staff report no sighting of Sadie on the grounds. The CN, following the procedure, realizes That it�s time to call the police. Decide who to call first � likely the police � it may take time to locate the administrator � family will be reassured if you can tell them that the police have already been called Discussion about when to call police: -goal - to have them understand why it is important to have the police notified early and that this is easier to call off a search that has started than to start one too late. -know that the sooner the police come, they will then take over and you can get on with your days activities - quote from Constable Ted Phillips, former lead instructor for Search and Rescue for the Ontario Provincial Police academy: �Over-reaction is justified. Under-reaction is inexcusable.�Judy accepts the reports from the other units. Maintenance staff report no sighting of Sadie on the grounds. The CN, following the procedure, realizes That it�s time to call the police. Decide who to call first � likely the police � it may take time to locate the administrator � family will be reassured if you can tell them that the police have already been called Discussion about when to call police: -goal - to have them understand why it is important to have the police notified early and that this is easier to call off a search that has started than to start one too late. -know that the sooner the police come, they will then take over and you can get on with your days activities - quote from Constable Ted Phillips, former lead instructor for Search and Rescue for the Ontario Provincial Police academy: �Over-reaction is justified. Under-reaction is inexcusable.�

35. Missing Person Incident Form Using an exact script will allow even a new or temporary employee who has received no inservice on searching, to know the information they will need to impart and to deliver it with accuracy.Using an exact script will allow even a new or temporary employee who has received no inservice on searching, to know the information they will need to impart and to deliver it with accuracy.

36. Missing Person Incident Form When Sadie is not found in the first search, the Search Coordinator tells the searchers to start all over again and complete a second search. The police will do this again when they arrive. Search Coordinator uses the time during the first search to prepare for the call to the police and to prepare for their arrival.When Sadie is not found in the first search, the Search Coordinator tells the searchers to start all over again and complete a second search. The police will do this again when they arrive. Search Coordinator uses the time during the first search to prepare for the call to the police and to prepare for their arrival.

37. Missing Person Incident Form Police - Look at the aerial map see that she was a teacher call dispatch have received a report from a school that an apparently confused lady has wandered into a classroom there. Police - Look at the aerial map see that she was a teacher call dispatch have received a report from a school that an apparently confused lady has wandered into a classroom there.

38. Missing Person Incident Form Later � When all the staff were questioned, a new lab technician from a local lab recognized her picture as the woman who had left when she entered the unit. The lab technician had thought that such a well-dressed and well-groomed lady was either a visitor, volunteer or senior staff. Later � When all the staff were questioned, a new lab technician from a local lab recognized her picture as the woman who had left when she entered the unit. The lab technician had thought that such a well-dressed and well-groomed lady was either a visitor, volunteer or senior staff.

39. The fourth aspect about preparing for a wandering emergency is to educate staff about what to do during a wandering emergency. Develop an Education Plan Making a plan to educate others: If your facility is in ONTARIO, and has participated in Ministry of Health training with the �PIECES� Training, review the section of that program that relates to education tips and techniques for adult learners Plan with your administration - Who, What and When the training of others should take place. Doing so within a few months of this training will be helpful Use the material at the beginning of this presentation, and review the Alzheimer Manual - Page 20, for guidelines on educating staff. INSERVICES REHEARSALS � MOCK SEARCHES � can check timing, use to work �bugs� out of the procedure � will heighten awareness Discussion: What specific education pieces can you see being necessary for staff/volunteers/families/community at your facility? Discussion about incident procedure: How would this disrupt the day�s activity for people? Ask them to dispel myths they may have i.e., not really an emergency, not wanting to decide to call police, knowing when to notify administrator. Know that someone needs to be designated to support the family. The fourth aspect about preparing for a wandering emergency is to educate staff about what to do during a wandering emergency. Develop an Education Plan Making a plan to educate others: If your facility is in ONTARIO, and has participated in Ministry of Health training with the �PIECES� Training, review the section of that program that relates to education tips and techniques for adult learners Plan with your administration - Who, What and When the training of others should take place. Doing so within a few months of this training will be helpful Use the material at the beginning of this presentation, and review the Alzheimer Manual - Page 20, for guidelines on educating staff. INSERVICES REHEARSALS � MOCK SEARCHES � can check timing, use to work �bugs� out of the procedure � will heighten awareness Discussion: What specific education pieces can you see being necessary for staff/volunteers/families/community at your facility? Discussion about incident procedure: How would this disrupt the day�s activity for people? Ask them to dispel myths they may have i.e., not really an emergency, not wanting to decide to call police, knowing when to notify administrator. Know that someone needs to be designated to support the family.

40. Alzheimer Canada Manual page 21Alzheimer Canada Manual page 21

41. Checklist on page 22 of Alzheimer Canada Manual -identify the changes that will need to be made to incorporate the info learned from the workshop into your facility procedures - identify who needs to be involved to make the changes -know what it is that needs to change, and plan how you will implement this before you begin making the changes, so that the plan is completed �all at once� -know this is a step by step project that will be successful and add to your organization giving care to residents. -outline the next steps: Rewrite current policy and procedures Make a search kit to include with the search binder Assess all residents for wandering RISK Educating others, staff, volunteers and family members -outline the next steps and work that will need to be done prior to an education session -go through the search and rescue binder, and demonstrate how this will need to be adapted to each individual facility Checklist on page 22 of Alzheimer Canada Manual -identify the changes that will need to be made to incorporate the info learned from the workshop into your facility procedures - identify who needs to be involved to make the changes -know what it is that needs to change, and plan how you will implement this before you begin making the changes, so that the plan is completed �all at once� -know this is a step by step project that will be successful and add to your organization giving care to residents. -outline the next steps: Rewrite current policy and procedures Make a search kit to include with the search binder Assess all residents for wandering RISK Educating others, staff, volunteers and family members -outline the next steps and work that will need to be done prior to an education session -go through the search and rescue binder, and demonstrate how this will need to be adapted to each individual facility

42. Where is everything? Be certain that you will be able to locate everything a year or more from the first implementation A couple of years after this project was completed, a few facilities quietly said that they weren�t quite sure where their aerial map had been put. The location of the elements of this plan must be easily found, if they are to be useful in a crisis situation.Be certain that you will be able to locate everything a year or more from the first implementation A couple of years after this project was completed, a few facilities quietly said that they weren�t quite sure where their aerial map had been put. The location of the elements of this plan must be easily found, if they are to be useful in a crisis situation.

43. Next steps Working with your administrator Working with your quality assurance staff Working with the plan to implement -working alone is too difficult and risks missing some key components -you will need administrative staff to support this endeavour -work with administrator and another staff person, preferably someone that all others respect, perhaps someone who also has some responsibility for QUALITY ASSURANCE - is there a quality assurance team in your facility -have the goal of your work, to educate all staff, volunteers and family members, perhaps include some �neighbours� Anticipate problems � Formalize a weekly or monthly check of the search kit � staff will be tempted to raid it for pens, flashlight batteries, etc. Assign a person to recheck the kit after it has been used and restock it with new floor plans etc.-working alone is too difficult and risks missing some key components -you will need administrative staff to support this endeavour -work with administrator and another staff person, preferably someone that all others respect, perhaps someone who also has some responsibility for QUALITY ASSURANCE - is there a quality assurance team in your facility -have the goal of your work, to educate all staff, volunteers and family members, perhaps include some �neighbours� Anticipate problems � Formalize a weekly or monthly check of the search kit � staff will be tempted to raid it for pens, flashlight batteries, etc. Assign a person to recheck the kit after it has been used and restock it with new floor plans etc.

44. Plan to Implement Write a plan to implement Call resource person to review Plan delivery of training Make it a joint project CELEBRATE YOUR SUCCESS Write the plan and review with your administration Consult with a resource person, as a review and to plan the actual �teaching session� Having an operational pre-plan for an emergency search is a sign of strength for an organization. It is a win-win-win proposition: The person wins as they are more likely to be found if they become lost The families win as there is a good structure in place to locate the person should they become lost And the organization wins because it is better able to manage the risk of caring for people who get lost and better able to respond in the event of a missing personWrite the plan and review with your administration Consult with a resource person, as a review and to plan the actual �teaching session� Having an operational pre-plan for an emergency search is a sign of strength for an organization. It is a win-win-win proposition: The person wins as they are more likely to be found if they become lost The families win as there is a good structure in place to locate the person should they become lost And the organization wins because it is better able to manage the risk of caring for people who get lost and better able to respond in the event of a missing person

45. YOUR RESOUCE TEAM ALZHEIMER SOCIETY OF KITCHENER-WATERLOO Tiffany Wurdell / Charlotte Sider, Education Coordinator ALZHEIMER SOCIETY OF GUELPH �WELLINGTON Robin Smart, Education Coordinator ALZHEIMER SOCIETY OF CAMBRIDGE Jennifer Ghent-Fuller, Education Coordinator PSYCHOGERIATRIC RESOURCE CONSULTANTS Sharon Gingerich, Sharon Stap, Cathy Sturdy-Smith We will be willing to assist you with your staff education, please make contact with your local Alzheimer Society to arrange this Key points: Seriousness that �search is an emergency�. Importance of planning ahead That we will help them with educating their staff on request Questions: Concluding Activity: Bring out point that you are not alone in developing this. For further information, contact resource team� Collect Evaluations We will be willing to assist you with your staff education, please make contact with your local Alzheimer Society to arrange this Key points: Seriousness that �search is an emergency�. Importance of planning ahead That we will help them with educating their staff on request Questions: Concluding Activity: Bring out point that you are not alone in developing this. For further information, contact resource team� Collect Evaluations