The Courtyard Walk: Rights, Risk, and a Daughter's Instruction
Mr. Halvorsen is 84, has mild dementia, and walks with a cane. Every morning after breakfast he announces he is going to the courtyard 'for my walk.' The courtyard path is uneven brick, and facility policy says residents who need supervision must be accompanied there. His daughter told staff she does not want him going outside at all. This morning he is at the door saying, 'I am not a prisoner here,' and he has left his cane in his room. You have four other residents to get up and it is 8:15.
1. What do you say and do at the door right now? Explain the reasoning behind your choice.
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What this tests: balancing a resident's right to move about freely against a real safety risk - without grabbing, locking, or simply quoting policy.
Do not: block the door, take his walker or cane 'so he can't leave,' tell him he is not allowed, or argue that the courtyard is off-limits. Physically preventing a resident from leaving is a restraint and is reportable. Confiscating his cane is both a restraint and a fall risk.
Do:
- Acknowledge the feeling first. 'You have walked outside every morning for years. Being cooped up is miserable.'
- Give the real reason, briefly. 'The brick out there is uneven. I have to be with you - not because of rules, because I do not want you to fall.'
- Offer a genuine choice. 'I can walk out with you at 8:45 when I finish Mr. Bell's breakfast, or we can do the hallway loop right now with your cane.' Choice preserves independence; the supervision requirement is still met.
- Report to the nurse. A CNA does not change the care plan alone. The nurse and social worker can build a scheduled supervised walk into the plan and address the daughter's blanket 'no' at a care conference.
Key point: the least restrictive option that manages the risk is supervision, not confinement. 'No' is not the least restrictive option.
2. Ten minutes later, while you are in another resident's room, you see Mr. Halvorsen go out the courtyard door alone and without his cane. What is your response, and what do you not do?
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What this tests: elopement response and triage when you cannot be in two places at once.
Do not chase him down and physically pull him back, and do not silently continue your task and hope he returns.
Do:
- Secure immediate physical danger first. If the resident you are with is in a filled tub, in a mechanical lift, or on a toilet unable to bear weight, you cannot walk away for even 60 seconds. Call out for help (call light, radio, phone, or the hallway) so someone else responds to Mr. Halvorsen while you finish making your resident safe - usually a matter of seconds.
- Notify the nurse immediately - not at the end of the shift. Elopement is an emergency, and the nurse decides whether to call a code, search the grounds, or contact family.
- Follow at a safe distance with his cane if you are free to do so, continuing to redirect calmly rather than scold.
- Document the time, what he was wearing, direction taken, who was notified, and what was done. An incident report goes to risk management - it is a quality tool, not a punishment, and you do not argue about it with the resident or family.
Afterwards: the nurse reviews the care plan. Ask why he left - was the walk never offered? Was the door alarm off? Was his cane out of reach? Those answers prevent the next elopement.
3. A coworker says, 'Just tell him his daughter said he can't go out - that shuts him up.' Explain what is wrong with that approach and what the aide should understand about the daughter's request.
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What this tests: who actually holds decision-making authority, and how communication affects trust.
Problems with the approach:
- It misplaces authority. A daughter's verbal request is not a physician's order, a guardianship, or a court-appointed conservatorship. Unless she is the legal decision-maker and the restriction is in the care plan, she cannot override a resident's right to move about and to accept ordinary risk.
- It damages trust and the family relationship. Framing the daughter as the jailer sets the resident against her and makes the next aide's job harder.
- It shuts down rather than solves. 'Shuts him up' means the unmet need - fresh air, routine, autonomy - returns tomorrow, louder.
- It hides the risk. The actual issue (uneven brick, supervision) never gets addressed in the care plan.
What the aide should do instead: route the family's concern to the nurse and social worker, keep explaining the real safety reason to the resident, and offer supervised alternatives. Then chart what the resident said and what was offered.
Rule of thumb: when a family request conflicts with a resident's rights, the CNA does not referee. The CNA reports and follows the current care plan.