Why are many of your residents still sitting in wheelchairs? For fall prevention? Are you aware that they are losing up to 2% muscle mass per day sitting for extended periods of time in wheelchairs?
The present nursing procedure: complete a fall risk assessment, followed by wheelchair placement to prevent falls. This is not the answer.
Your facility staff, starting with nursing, must start to realize that extended wheelchair use augment resident deterioration and start working on new procedures focusing in the opposite direction: Rebuilding all Resident Muscles. That new procedure must include all facility staff and including all restorative nursing staff. All facility staff must start using the opposite procedure to prevent resident falls, making the residents stronger, rebuilding atrophied muscles by using the intent of the Quality of Care federal regulation: comprehensive assessments, enhancing the MDS 3.0, thorough care planning to assess real causal factors and then placing the resident into a daily exercise program utilizing the training that the restorative CNA received.
Please read the following Quality of Care regulation, carefully and note the intent of this regulation.
§483.25 Quality of Care (F-tag 309)
States that “Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”
The stated Intent of section: §483.25 is that the “facility must ensure that the resident obtains optimal improvement or does not deteriorate within the limits of a resident’s right to refuse treatment, and within the limits of recognized pathology and the normal aging process.”
Once new procedures, assessment and daily exercise are started in your facility, the results will become very obvious to everyone in your facility very quickly. Costs of care, psychotropic medications, agitation, depression, restraints (chair alarms), injurious falls, pressure ulcers, contractures, muscle atrophy, re- hospitalizations, staff turnover will become much lower, along with Medicare and facility expenses.
This is all because walking residents are much easier to care for and quality improvement will be noted immediately, along with resident and family satisfaction of care being received. Instead of searching for ways to cut Medicare benefits and costs of care, we must look for a means to reduce the expenses that Medicare and other insurance is presently covering. Returning resident to AMBULATION INDEPENDENCE is one major way to stop pressure ulcer formation, injurious falls and pneumonia. Advancing Excellence is advocating this factor as one of their goals: “Increasing resident mobility” and it is a WIN, WIN for everyone. All of your residents walked once and every effort should be made to assist them in walking once again.
Start today by having all of your staff read the Quality of Care regulation and hold meetings throughout your facility, and make new plans to initiate this regulation throughout your facility at all staff meetings, family council, resident council meetings. Remember all of your residents walked once and your responsibility is to get them walking once again.
Mary M. Harroun, MS, LNHA is the inventor of the Merry Walker Corporation product line and president of the GROW Corporation.
