CMS Issues Guidance on Wandering Behavior in HCBS Settings

On December 15, the Centers for Medicare and Medicaid Services (CMS) released a set of FAQs that discuss strategies to ensure the health and welfare of Home and Community Based Services (HCBS) participants who are at risk of wandering. The FAQs focus primarily on how person-centered planning should be used to identify appropriate restrictions while facilitating individualized activities, supports, and access to the community. Other areas of emphasis include adequate staffing to allow for various activities in and outside HCBS settings, proper staff training to identify issues and promote person-centered responses, and the establishment of programs and environments that engage participants, reduce overstimulation, and promote overall beneficiary wellness. 

According to the FAQs, “person-centered planning, staff training and care delivery are core components of provider operations to meet HCBS requirements while responding to unsafe wandering and exit-seeking behavior in an individualized manner.” CMS indicates that “provider staff serving beneficiaries who wander or exit-seek should receive education and training about how to communicate with individuals living with conditions that may lead to unsafe wandering or exit-seeking, and recommends “integration of the following promising practices around person-centered planning specifically for people who wander or exit-seek unsafely:”

• Assessing the patterns, frequency, and triggers for unsafe wandering or exit-seeking through direct observation and by talking with the person exhibiting such behaviors, and, when appropriate, their families. 
• Using this baseline information to develop a person-centered plan to address unsafe wandering or exit-seeking, implementing the plan, and measuring its impact. 
• Using periodic assessments to update information about an individual’s unsafe wandering or exit-seeking, and adjust the person-centered plan as necessary.