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Field Trips, Resident Safety and Liability: Considerations for Long Term Care Facilities

Long Term Care Newsletter
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In virtually any skilled nursing or assisted living facility, activities for senior residents are an integral part of the facility's operations. Many facilities tout or advertise the activities that their facility offers to residents, for good reason. Facilities usually employ an activity director or activity coordinator, whose job duties include planning activities for residents, with the goal of enhancing residents' psychological and emotional well-being. Recreational activities can and should be an important part of residents' lives.

Activities can include arts and crafts, group games such as bingo and music or dancing. Another common group activity which facilities offer residents is off-site field trips to places such as a zoo, museum or even to a shopping mall. Unfortunately, any off-site activity raises safety and liability issues not present for activities performed at the facility. Relatively minimal pre-trip assessment and planning, however, can ensure resident safety, therefore minimizing liability, and should be done before every field trip.

Off-Site Safety Concerns on Field Trips

Any problem that can occur at the facility can occur during a field trip. Unlike problems that occur at the facility, however, issues that arise off-site present an additional layer of difficulty. Off-site locations are often not equipped to meet the needs of a resident, especially if problems occur. For field trips, the two most common sources of injuries to residents are falls and wandering/elopement.

Outside the controlled environment of the facility it becomes impossible to ensure that residents' paths are clear and level. Handrails may not be present and assistive devices such as walkers or wheelchairs may become difficult, if not impossible, to use. Similarly, interventions such as a Wander Guard become useless outside the facility. As with all care and services provided to residents, the facility must ensure resident safety while providing the highest possible level of emotional and psychological well-being for its residents. A facility can do both, while minimizing potential liability, by taking a few simple precautions before a field trip.

Ensuring Safety and Minimizing Liability

Ensuring safety and minimizing liability for a field trip comes down to two questions: 1) is the resident's condition suitable for this field trip; and 2) can the facility provide adequate staff to ensure the safety of every resident on the field trip? An off-site environment is not a controlled environment, and what may be adequate staffing at the facility will not be adequate staffing on a field trip.

1. Assessing Resident Condition
The first step to ensure safety and minimize liability on a field trip is to ensure that a resident is a good candidate for the field trip in the first place. Halfway through a walking field trip to the zoo is too late to realize that a particular resident was not strong enough to make the trip. Pre-trip assessment of the resident's condition is critical and resident safety should always trump a resident's desire to participate in a field trip.

Any resident at high risk for a condition requiring acute medical treatment is probably not good candidate for a field trip. A resident with symptomatic congestive heart failure is likely not appropriate for a field trip to walk around the mall. Although exercise may be appropriate for that resident, the exercise should occur in a controlled environment such as the facility.

Similarly, even relatively healthy residents must be assessed for their suitability for a particular activity. Is the resident a high-fall risk with unsteady gait? If so, then the resident should likely not participate in a field trip to an area with uneven terrain. Is a resident wheelchair bound? If so, then the resident is not a good candidate for a field-trip to a location that is not wheelchair friendly. Furthermore, although many places such as museums or zoos may provide wheelchairs or assistive devices, many do not. The logistics of transporting wheelchairs, walkers, etc., must also be considered, even if the field trip location is wheelchair friendly.

The facility must also consider the resident's wander/elopement risk. This assessment will often require some tough decision-making, as residents with the highest wander/elopement risk are often the very residents who are most able and desirous to participate in field trips and off-site activities. Residents who are high risk for wander/elopement can be great candidates for a field trip, but only if the facility can provide adequate safety for the resident while on the field trip.

2. Staffing for Field Trips
Even residents who are fall risks, are wheelchair bound or are elopement risks may be able to participate in a field trip, if there are adequate staff available to meet the off-site needs of the resident. For example, if the facility can provide stand-by assistance for a resident who is a fall risk, that resident may be able to participate in the field trip. If the facility can provide the appropriate wheelchair and staff to assist the resident, then a wheelchair-bound resident can be an appropriate candidate for a field trip. Even residents who are high-risk for elopement can be appropriate for field trips, if the facility can provide adequate staffing to keep eyes on these residents at all times.

Of course, providing sufficient staffing is never easy, even at the facility. Furthermore, providing sufficient staffing for a field trip may mean pulling staff away from the facility while leaving the highest need residents at the facility. However, the facility may find that its employees are much more willing to spend a few overtime hours on a trip to the zoo than at the facility.

It is also important to consider the role that residents' families can play in providing assistance on field trips. Although the facility may determine that there is insufficient staffing to take a particular high-risk resident on the field trip, that resident's family may wish to accompany the resident or provide a sitter to accompany the resident on the trip. Additionally, the families of low-risk residents may also wish to accompany their loved one on a field trip. These additional family members can allow staff to focus on high-risk residents and improve overall safety on the trip.

Conclusion

An off-site field trip will always pose challenges and potential risks greater than those posed by an activity at the facility. Field trips can, however, be tremendously beneficial to residents and field trips can and should be part of the activities that a facility offers to its residents, if possible. A facility can offer field trips, ensure resident safety and minimize potential liability by ensuring that a resident is a good candidate for a particular trip and providing sufficient staff to account for the challenges of an off-site environment.

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