One of the biggest fears that an administrator of a senior care facility has is elopement of residents, especially those with memory impairment or dementia. Elopement can lead to tragic consequences for the resident, family, facility and community.

Depending on design concept and facility/operational program, incorporation of elopement prevention methods may be minimal to allow residents to access the entire property with only a passive perimeter fence or be as intrusive as active electronic systems to monitor memory care patients from the moment they step out of bed.

For memory care and long term resident/patients, prevention of elopement should be redundant with a combination of passive and active means incorporated. Active preventions include staff direct observation and protocols, electronic access control, patient monitoring, video surveillance and alarm systems.

For larger facilities, one of the most effective passive means to prevent elopement are courtyards designed to be internal to the building which are ideal in creating outdoor space that is safe, allows social interaction, exercise/walking, interaction with natural plantings, water features and other features. Adequate, if not abundant windows, can allow direct observation of residents by caregivers and bring daylight into interior living areas. Porches incorporated in courtyards are very effective, especially in the south which allow courtyards to be utilized year round.

For existing buildings and those not designed to incorporated internal courtyards, external courtyards can be created with masonry garden walls and privacy fencing in combination with building elements. Privacy fencing either of the wood or plastic may used to surround courtyards but quality of the outdoor space may suffer if landscaping is not adequate. If the facility is located in a planned or traditional neighborhood, restrictions will require compatible materials for all construction.

For smaller and decentralized or individual residences, yards should include residential types of enclosures or perimeter passive barrier in keeping with surrounding neighborhood character,

In rural settings, fences can enclose property and wooded areas and be hidden by design.

In interiors, decrease the visibility of doors that residents should not access such as staff rooms, storage, and housekeeping. Exit doors should be situated parallel to the hallways so they are less visible to residents than at end of corridors.

No matter the solution to preventing elopement, the designer must incorporate all code requirements.to allow residents and staff safe egress during emergency situations from buildings, courtyards and yards

Technology is ever-changing and incorporating systems that integrate nurse call, access control, patient monitoring and other systems.

The total design concept of the facility whether new or renovated, should include not only the building elements, but access control, nurse call, surveillance and alarm systems that allows the facility to maintain residential character and as much dignity as possible for the residents.