When someone with dementia keeps leaving the house

You will see the word wandering used for all of this, because it is what families type into a search box. The Alzheimer's Society avoids it, because it suggests walking with no purpose when there is usually a reason or a belief behind it. The distinction is practical as well as kind: a reason can be met, and aimlessness cannot.

Keep a short note for a fortnight of when it happens and what came just before. A pattern usually shows up: the same hour, or a visitor leaving. Take the notes to the GP, particularly if the change came on over days rather than weeks, because sudden confusion is more often an infection, dehydration, constipation, pain or a new medicine than the dementia moving on. Signs that dementia is getting worse covers what to rule out, and what sundowning is covers restlessness that builds in the late afternoon.

The reason for the order is in the law. Under section 6 of the Mental Capacity Act 2005, anything you do that restricts your relative's liberty of movement is lawful only if you reasonably believe it is necessary to prevent harm to them, and only if it is proportionate both to how likely that harm is and to how serious it would be. A locked door to stop somebody stepping onto a dual carriageway is a different proposition from a locked door because it is easier than sitting with them. Nothing on the first three rungs restricts anybody, so they are worth exhausting first.

Your relative's own view comes before all of it: if they can still make this decision, it is theirs to make, even where you would decide differently. When someone with dementia refuses care covers that conversation.

Once your relative can no longer make the decision themselves, locking a door restricts their freedom of movement, and the Alzheimer's Society advice is that social services should be consulted first, so somebody can assess whether it is in your relative's best interests. That is not a formality. The Mental Capacity Act does not by itself allow anyone to deprive another person of their liberty, and the Deprivation of Liberty Safeguards that cover care homes and hospitals do not reach into somebody's own home. Arrangements at home that go that far have to be authorised by the Court of Protection, and it is the council that applies. A social worker will usually help you find something short of it.

Fit a key safe either way, so a carer, a neighbour or an ambulance crew can get in without the door being opened from the inside. Elderly security at home covers the fittings.

The consent point is the one families get wrong. The Alzheimer's Society says a person needs to consent to tracking before it is switched on. Where they cannot understand what the device does, the decision can still be made for them, but in their best interests rather than for the family's peace of mind, and with them part of the discussion as far as they are able.

Sensors and alarms come under telecare, and the route to them is a care needs assessment from the council. Anyone can ask for one, it is free whatever your relative's income or savings, and the NHS says equipment and small adaptations are provided free where the assessment finds they are needed. Ask for a carer's assessment for yourself in the same call. Home technology that helps at night goes through the devices, and dementia assistance cards covers the card.

A carer does what no sensor does. They can walk out with your relative and walk back with them, which makes it an outing rather than an escape. They notice the infection behind the restlessness, and settle somebody at 4am without an argument. Where the trigger is the same hour each day, a carer booked for that hour costs far less than cover through the night: visits on PrimeCarers are £18 to £25 an hour with our fee included, against £28 to £35 from an agency. You can search for carers near you and compare their rates before committing to anything.

Carers on PrimeCarers are self-employed, and you choose and book them yourself. Before a carer appears we check their identity and right to work, check an enhanced DBS kept on the Update Service, and interview them online. We do not check qualifications, training or references, so ask the carer about their dementia experience yourself. Carers are insured while they work.

If the nights are the whole problem, night care for dementia sets out what a night carer does, and waking night or sleeping night explains which of the two a family needs. If days and nights both need somebody, read how live-in care works. If you are doing this alone, arrange respite care for dementia before you reach the point of needing it.

1. 1

   Fill in a Herbert Protocol form today

   Before anything happens

   A national police scheme. You complete a form in advance with a recent photograph, a description, medication, daily routine and the places that mean something to your relative, including where they used to live and work. Hand it to the police when you report them missing, so the search starts on facts rather than questions.
2. 2

   Check the house and the obvious places

   First few minutes

   Gardens, sheds, the car, a neighbour's. Then think where they set out for: a former home, an old workplace, a park.
3. 3

   Ring the police

   Do not wait

   Call 999 if you believe your relative is in immediate danger, and 101 if not. Say they have dementia, and say you have a Herbert Protocol form. There is no period you have to wait through before reporting them missing.
4. 4

   Leave somebody at the house

   While others search

   People often come home on their own, and an empty house makes the next hour worse. Keep one phone free for the police to ring back on.
5. 5

   When they come home, keep it calm

   Afterwards

   They may be frightened and will not remember going. Questions and anger make it more likely again. Once they are settled, ask gently where they were going, because the answer tells you what to change.

Neighbours and shopkeepers who already know about the diagnosis are the fastest help there is, which is a reason to tell them in advance, with your relative's agreement. Afterwards, look at what set it off rather than only at the front door: a first time is often the day something else changed, whether a new medicine, an infection coming on, or a room rearranged. The Alzheimer's Society runs a support line for weeks like this, and its guidance on supporting a person who walks about goes further.