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Stepping up Ambulation
Reinventing the Wheelchair
But older people's health, mobility and self-image can suffer from too much time in wheelchairs, say some who study geriatric issues. More than 24,000 North Carolina nursing home residents _ about two-thirds of the total population _ use wheelchairs as their main means of getting around, according to the most recent federal statistics. And that number has risen steadily in the 2000s, as sicker patients have entered nursing homes. If older people need wheelchairs to move around or be moved, that's fine, but it's past time to cut back on "parking" older people in wheelchairs, said Leslie Jarema, health service director of The Forest at Duke. "In an old-school nursing home, they are sitting around the nurses' station in wheelchairs and they are hollering, saying, `Help me!' because they are uncomfortable," Jarema said. Ways to limit unnecessary wheelchair use are part of a movement that gives priority to the well-being of residents and their caregivers, above the functions of the nursing home or convenience of the staff. "It's not good for anyone to sit anywhere, in anything, for long periods of time," said Nancy Fox, executive director of the Eden Alternative, a Texas-based nonprofit group that promotes the well-being of elders and their caregivers. Raleigh, N.C., resident Sylvia Weaver, a member of Wake County, N.C.'s nursing home advisory committee, puts her feelings about wheelchairs even more plainly: "You go sit in one!" Weaver said. "See if you can sit for 15 minutes." GETTING UP AND AROUND The group, which has asked Jarema to speak about her approach at The Forest at Duke, also tries to get residents to be as active as possible, encouraging walking to meals and other activities, going on foot to the bathroom or shower and taking outside walks with family and friends when possible. "I started off gently, informing the staff that our policy would be that no one could sit in a wheelchair," Jarema said. "They would be taken from point A to point B and put in a normal, comfortable-style chair. We are at about 90 percent compliance. I got a lot of resistance at first from the staff, from the families and the residents in the wheelchairs." Advocates acknowledge that wheelchairs have their uses for certain residents at certain times. "There are patients that feel very possessive of their wheelchairs," said Polly Welsh, director of regulatory systems for the N.C. Health Care Facilities Association, a nursing home trade group. "We like to encourage people to change their positions to stand up and bear weight as much as possible." For many, that's difficult. Joan Englund, 87, a resident at Forest at Duke, said she recently started using a wheelchair even to sit at a table because painful joint problems make it difficult to transfer to a chair. "I was a golfer and I must have played too much," she said. BREAKING THE CYCLE In addition, people in wheelchairs can be perceived as less able and are even spoken to differently in what becomes a self-perpetuating cycle of helplessness. Perhaps most importantly, loss of mobility can begin within a few days if someone starts using a wheelchair instead of walking. "It's just like with your education; if you don't use it, you lose it," said Michael A. Boles Jr., director of adult day services for Wake County's Resources for Seniors. "Our people are not parked in wheelchairs. Our participants who are in wheelchairs, it's necessary for their mobility." The more than 200 clients of the six adult day care centers that Boles supervises are diagnosed with dementia, stroke, hypertension and other illnesses. A goal of their treatment is to keep their immobility from getting worse. "They are not going to improve, but we can at least keep things from deteriorating as quickly." he said. BALANCING NEEDS "The need to transport people back and forth to their rooms, to access meals and other services, almost promotes a helplessness in them _ the staff has to get them there in a hurry," said Fox, with the Texas group Eden Alternative. "Someone who is walking slowly, who would be able to make it, would be put in a wheelchair just because of the time involved." Welsh, of the nursing home group, noted that newer nursing homes nationwide are moving away from an institutional norm to meet residents' needs and desires. "Dining rooms are being designed to allow people to get out of the chair and sit," she said. Ted Goins, president of Salisbury-based Lutheran Services for the Aging, agreed that new centers are emerging with features that should encourage residents' walking, instead of their being wheeled down long hallways. "A lot of nursing homes were built back in the `60s and `70s on that old institutional model," Goins said. "The facility we are getting ready to build in Wilmington will be part of a new breed of nursing home that is just starting to evolve.... It will have a pod-type design, where there will be 20-25 rooms on each unit, and each unit will have its own dining room." Easier access to meals and other services should mean that more North Carolina nursing-home residents will be able to stay healthy and mobile, like Edna Baker on her rolling walker. "It gives me a certain satisfaction that I'm doing it on my own," she said. ___ MOVING FOR CHANGE The Eden Alternative: ___ Reprinted by permission of THE NEWS & OBSERVER of Raleigh, North Carolina
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