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Cultural Change: Getting Residents Out of Wheelchairs

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by maryharroun
Posted on Tue Feb 27, 2007 at 01:46:09 PM EST

Getting residents out of wheelchairs and up and walking and when rest is required to provide real chairs for them to sit in.  As many facilities have a great fear instilled in staff that residents must not fall, they have preferred to keep them in wheelchairs, with alarms and lap restraints to keep them seated.  This practice is not meeting the goals of real cultural change.  Read on.....

The elderly are people, just like you and me who happen to have gotten old and somehow ended up in a nursing home.   The old adage of the nursing home is that a resident gets a bed, pillow and also comes with a wheelchair and if the person did not get transferred into the facility in a wheelchair, the person will soon get one.  Once an elderly person is placed into a wheelchair, it takes only three short weeks and that person never walks again, no matter what was wrong with them in the first place. Staff will tell you that it is easier to move residents confined to a wheelchair, but is that practice in the best interest of the resident?
If a facility is really going to embrace cultural change, then people must be taken out of wheelchairs and taught to walk once again, safely.  Mucels and bones can be rebuilt to be used as they shoud be, for walking independently.  Falls may occur, but over time the falls will decrease and real cultural change will occur.  
Let's look at our own houses....do you walk into your house and see the people living with you sitting in wheelchairs?  Of course, not.  Then why should we see people living in long term care sitting around in wheelchairs when perfectly good furniture is sitting in the front parlors and living rooms of facilities basically untouched by residents.  
When a resident goes to the dining room and has the new dining room concept in place for cultural change, is the resident sitting in a real dining room chair or is the resident sitting in a wheelchair?  Do your guests,when they come to your home for dinner sit in wheelchairs or do you have regular dining rooms chairs around the table?  When you watch television, play a game, do a puzzle or engage in a craft, are you sitting in a wheelchair or a regular chair?
Let's start assessing our people for wheelchair use and if they do not really need a wheelchair due to a neulogical disorder that would affect walking such as M-S, ALS, Huntington's disease, or are paraplegics, or quadreplegics, why are normal elderly sitting for extended periods of time in wheelchairs?  Facilities are just beginning to look at this issue and if cultural change is really going to take affect in your facility, you take a look to at this wheelchair practice and change it. NOW!
< JCAHO Resident Identifier Regulations | Progress on Culture Change in So. Maryland >

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How many people did you get out of wheelchairs today?

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wheelchairs (4.00 / 1)

Clearly wheelchairs are a problem.  They are however in part a response to long halls and large central "day rooms".
To traverse these distances it clearly is easier to wheel than assist with walking.  
But we also need to realize that this is not an illogical response by both staff and elders to the environment they have to live and work in.  It will be hard to address the use of wheelchairs in any systematic way as long as the settings for care are built as institutions and not homes.

by pkmurray on Wed Mar 07, 2007 at 06:30:54 PM EST
Need for wheelchairs (4.00 / 1)

This is a new topic for me.  I've looked at wheelchairs for years now but never really thought about whether they are necessary or not.    I have to agree that our current nursing homes in particular do seem to be constructed to encourage the use of them.  For my own loved ones,  I can say that they can (or could) always get around in our home without a wheelchair.  But, in the nursing home setting, they often can't (or couldn't).  A part of the reason for this is definitely the relatively long distances one must walk in most nursing homes to even get to the dining area or nurses' station and the same relatively long distances one must walk once one gets there.  In those homes either of the nursing home or assisted living persuasion that serve smaller numbers of residents in separate wings or buildings this is not as much of an issue.  In these facilities, hallways are short and common areas are relatively small and easy to manouver through with a walker, cane, or no assistive devices whatsoever.

We do seem to have devised an architectural system for long-term care that seriously discourages the continuation of life as we know it for those who need this level of care.


by kate ricks on Sun Mar 11, 2007 at 09:57:48 AM EST
Misuse of wheelchairs, continued (none / 0)

In reading over the comments to my initial article; Cultural Change: Getting Residents Out of Wheelchairs, I would like to dialogue with the two comments that were made so far.
The first person talked about the long halls in nursing homes and how the wheelchair is necessary for residents to traverse the long hallways in wheelchairs. Once a resident does get to where they want to go they need to be transferred to a regular chair when seating is desired and then when they need to be transported to another area, then a wheelchair can be used once again.  Many elderly an be placed in rehabilitation to return then to functional ambulation with a walker, a cane, etc.    

by maryharroun on Mon Mar 26, 2007 at 10:54:44 AM EST
Functional ambulation (none / 0)

Even if a resident is given rehabilitation to ambulate better, it still does not impact the distance they would have to walk as described above. Many elderly prefer to be in a wheelchair for such distances and do very well ambulating in their room and about a particular room once they get there. I don't see rampant overuse or misuse of wheelchairs, or many elders sitting around in wheelchairs for extended periods of time unless they need to be in them and can self propel, but that is just my experience.  
One issue that I see more problematic is the fact that reimbursement for proper seating is not available to NH residents as it is to elders in the home. When you can't get the proper adaptive equipment for little Mary Jones who weighs 80 pounds who is in a small, but still ill-adapted wheelchair, it poses quite a problem not only for the resident, but for facilities who are really trying to do the best they can for those they care for.
Also, the chairs that are available to sit in in NHs are not necessarily the greatest alternatives to wheelchairs either. Many have too high a seat height, no arms, rigid backs, or they are too low, too soft and difficult to rise from. So I wouldn't necessarily consider many of them proper alternatives either.
I also see the lack of offering regular exercise and light strength training (if tolerated) as problematic. There are many factors that feed into functional physical mobility - four major areas we tend to focus on in NHs are bed mobility, transfers, wheelchair mobility and ambulation. Physical factors such as ROM, strength, balance, endurance, tone, proprioception, etc. all play into the complexity of movement for any one of these issues. It's not just as simple as giving someone a little rehabilitation, a cane, and taking away their wheelchair. It's much more complex.

by tess2564 on Mon Apr 02, 2007 at 06:01:00 AM EST
Keeping people out of wheelchairs (none / 0)

Concerned about whether residents get into wheelchairs too quickly, therefore causing more rapid functional decline, Iowa Veteran's Home in Marshalltown, Iowa has formed a Wheelchair Committee which looks at whether a resident needs a wheelchair before they get one issued or family purchase one. Their Functionality Committee discusses everyone admitted after they are assessed for function by nursing, physical and occupational therapies and the committee develops a plan to maintain function without a wheelchair when possible and for those in wheelchairs when necessary.

by cteed on Wed Sep 05, 2007 at 08:47:13 AM EST
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