The Resident Who Wants to Leave
A resident at your facility, assessed as having capacity to make their own decisions, tells you at 21:30 that they intend to walk to the bus station and travel to their sister's house 40 km away. It is dark, the temperature is 2°C, and the resident is wearing indoor clothing and slippers. Their care plan records a falls risk (two falls in the past month) and no cognitive impairment. They have not been assessed as lacking capacity, and there is no legal hold or guardianship order in place. They are becoming agitated as you explain your concerns and say: 'You can't keep me here. I'm going.' A colleague suggests locking the front door and calling the resident's sister to come and collect them.
1. Can you prevent the resident from leaving? Justify your answer against the facts given.
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No - not by locking the door or physically blocking them. The resident has been assessed as having capacity, there is no legal hold or guardianship order, and no cognitive impairment is recorded. Detaining a capacitous adult is a deprivation of liberty and is not justified by our concern for their welfare.
The colleague's suggestion to lock the front door is unlawful detention, however well-intentioned. Calling the sister is fine as support, but not as a mechanism to override the resident's decision or to have them 'collected' against their will.
What we can do is everything short of detention: express concern, offer alternatives, and make the journey safer. The falls risk and the cold are real and should be raised plainly with the resident - but they inform the advice, not the resident's right to leave.
2. Set out the actions you would take in the next 30 minutes, distinguishing what you may do from what you may not.
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May do:
- Explain the specific risks concretely: 2°C in indoor clothing and slippers, dark, 40 km, two recent falls.
- Offer realistic alternatives: wait until morning, a warm coat and shoes from lost property or stores, a lift, calling the sister to confirm she is home and expecting them, or a taxi arranged with the resident's agreement.
- Offer to call the sister with the resident's consent to let her know they are coming.
- Give the resident a charged phone or the facility number, and record the time they leave and their stated destination.
- If the resident accepts help, provide it fully.
May not do:
- Lock doors, block exits, take the resident's shoes or coat, or physically restrain.
- Call the sister to have them collected against their wishes.
- Misrepresent the situation to keep them in.
Record: time of departure, stated destination, advice given, and what was offered and declined. If the resident leaves, follow the facility's missing/absent-person procedure for a capacitous adult who has left of their own accord - which is a welfare follow-up, not a pursuit.
3. The resident leaves anyway and it is now 22:15. What is your priority, and what would you record?
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Priority: the resident's immediate safety, given the cold, the clothing, the dark, and the falls risk. That means notifying the manager on call and, if the facility's procedure allows and the resident's consent position permits, contacting the sister to say the resident is en route and may arrive cold and on foot. If there is a genuine belief of immediate danger to life, the emergency services are the appropriate route - the justification is risk to life, not the fact of leaving.
Record, factually and contemporaneously:
- The time the resident stated their intention and the time they left.
- That capacity had been assessed and no legal authority to detain existed.
- The specific risks raised and the alternatives offered, and that they were declined.
- Who was notified and when (manager, sister, emergency services if applicable).
- The resident's stated destination and route.
Keep the record descriptive, not defensive. Its purpose is to show that the decision was reasoned and the response proportionate.