Questions on a rehabilitation center. How did this happen?

I would definitely talk to DON. Whoever is his M.P.O.A., ask for print out of all orders, diagnosises, medications. Make sure he is GETTING ALL MEDS AN CORRECTLY. You can ask to see his meds an even count them or see if they are saying their giving an not giving here an there. Copy of labs just to make sure no UTI. If they knew he might wander, to me thats negligence. You can also ask to talk to Facility Dr. My Mom is in a rehab rt now for broke ankle. Doirs lock at 7pm till 7am. But you can call on ur phone a # for a nurse to let you in after hrs. Also, in Tx that is. One person is allowed to spend night if so wishes esp MPOA. Also all meds fr pt's cart that were not used, even narcotics, go home with pt. They are the pt's property. Medicare pd for them. Ive already caught my Moms rehab 4 times with med errors. Saying they gave morn meds an didnt. Ive got pics of meds still in blister pack . Thats Medicare Fraud I think. Then slipping a Hydrocodone into her morn neds an she DID NOT ask for it! An Nurse should go over each pill in that cup of pills. Esp if Pt asks" what are all these?" Well My Mom asked her nurse that morn. She just said" ur morn meds!" Again Mom asked what are the names?" Since using generics they look diff an Mom wanted HER pills. Not Mrs Smiths down hall! Again Nurse says " its ur morn meds take them!" So not wanting to cause issues she takes them an as she swallowing the nurse says" oh an a pain pill." I came 15 min later an Mom told me...lets just say I was not happy. Straight to DON cause this was second incident. Filled out complaint #2. Oh an take pics of anything you can, i did. 2 more complaints Ive filled out an pics to prove. An argument with rude unempathtic P.A. who doesnt listen or stays in rm 3min an cant wait to leave an threatened by daughter with Med knowledge. Uggg... u can call Regulatory to. Or make a complaint to Health an Human Services. Call an Ombudsmen to help you an pt. They are advocates for pt an fam an all confidential whats said with Ombudsmen unless you say they can try to figure how this wont happen again with the rehab. Goodluck.

Sorry that this happened with your Father. It is scary, not only for you, but for the nursing staff as well.  No one "dropped the ball".  Your Father happened to walk "through" the "gaps" of people working at the Rehab facility. 

Sometimes the facility might not call the family until after the resident is found if the family do not live in the same town or if ALL of the staff are looking for the resident or if it is the middle of the night.  It depends on the facility's  "Policy and Procedures for "Resident Elopement" or "Resident Wandering".  Talk to the Director of Nursing and ask what their policy is in regards to contacting the family when a resident leaves the facility unescorted.

Also, investigate "WHY" your father left the facility.  Was he wanting to "go home"?  Was he looking for the restroom and got lost?  Does he remember the reason for leaving the facility? 

Since your Father has had a stroke and early onset dementia, it is possible that the dementia is getting worse and that your Father needs to be on a unit that has locked doors that prevent residents from leaving the unit or facility.  You need to talk with the Nurse Manager of the Rehab Unit and see if your Father is exhibiting any changes in behavior or increased confusion or decreased cognitive/mental ability.  If so, he needs to be checked for a UTI as that can increase confusion in the elderly.

I have worked 20+ years in long term care and I could spend ALL DAY telling you stories of residents leaving nursing homes, LTC/Rehab facilities, assisted living facilities and hospitals.  Some residents simply walk out the front door and others figure out how to "beat the system".  I have known residents who climbed fences because they wanted to "go for a walk", or "go check on their café/newspaper/store, etc."

Depending on where you live, many LTC facilities or assisted living facilities do not lock their outside doors except at night...and even then, the doors are locked to keep people from GETTING INTO THE BUILDING and not to prevent residents from leaving the building (due to FIRE CODES).  One of our local LTC/Rehab facilities encourages the Rehab residents to go outside and walk along the "Garden Paths" or sit on one of the many benches located around the property so the outside doors are unlocked during the day.

If someone develops a tendency to "wander" outside "too often" or at inappropriate times, then that resident is moved to the "Special Care/Memory Care Unit" and a Wanderguard-type device is placed on the resident or their walker or wheelchair. 

When Mom started to wheel herself outside looking for my brother or myself or for some grade school children who she thought were her grandchildren (who are in their late 20's and live in another state); she was moved from the Rehab unit to the "Memory Care Unit".  Whenever she wheeled her w/c too close to the unit door--which was always open--the "Wanderguard-type" device would activate the door to close immediately and could only be opened from by someone with a special key/code. Mom never did figure out why the door kept closing "in her face".

Some "Special Care/Memory care Units" are locked at all time and a code is needed to get into and out of the unit.

You need to focus on "WHY" did your Father leave the building and then attempt to "correct" the problem or "meet his need" so that he does not attempt to leave the building again.  It is also possible that your Father had no idea that he was leaving the Rehab facility without permission or even that he was leaving the building at all.  Dementia can cause people to do unusual behaviors that they did not do in the past.

Those are questions the rehabilitation center needs to ask and answer so that they can identify the problems. Then they can revise their Standard Operating Procedures, security and monitoring systems accordingly so that it doesn't happen again.

Have you asked for a full incident report and follow up? If not, do.

Every rehab in my area are lock down. You need to have a receptionist allow you in or out after u sign in and out.

This is a big oversight of the rehab and could be sued if something happened to him.

At least they called. The rehab my mom was at, didn't call when she was taken to the hospital. I only found out she was not there, after getting no answer from her on the room phone, calling front desk, where woman said she was taken to hospital.

Facility is now closed as of this year

This can happen VERY VERY EASILY. If your father was not known to wander, or was thought to be fairly oriented and not in this habit, then what in the world would prevent him from being dressed and exiting from the front door? It honestly isn't a prison. The doors are not typically locked. When my bro was in rehab he had to be caught over and over again trying to go out the front door for some sun. He simply forgot he couldn't leave with his partner when he visited, despite being told that "when you are well enough to walk out on your own they will consider you well enough for discharge; and you need more PT".
Funny story, though unlikely funny to you is that when I was an RN I occ. got
"floated" to psyc unit to work. There was a new fellow there being trained. The staff wore street clothes and the patients wore street clothes and the doc wore street clothes in psyc. So a patient comes up to new hire, Hanson, and says "I am ready to leave now" and Hanson unlocks the door and lets him go.
Thought he was a doctor.
So, yes, this happens. And yes, I am thankful that he was safe.But there are no guards at the doors and no locked doors, and people at desks are busy. In rehab, those who can walk out in the halls are encouraged to do so. It's good for them. And your Dad walked out the door. Yikes. So scary.
I am certain they will discuss some of this with you. So sorry it happened to you (which is likely what they will say, as well). I am not certain how they could prevent this sort of thing? Are you? Do you have suggestions to take to them on interview? Because docs, employees, visitors and patients who are dressed meld into a mix in these places that isn't always controlled. It's why memory care has locked units.

In my experience, neither the front desk or the nurses station have someone sitting tthere every second of the day. If it’s not a locked down unit then residents can “escape”, so to speak. It shouldn’t happen but it does.

Is he in a locked unit? If not, his wandering justifies an increased level of care.