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Talking Points • Overview• Statement of Beliefs• Proposed Wheelchair Assessment
Historically the use of wheeled chairs as both a stationary seating device and a mobility device has been virtually standard practice in long term care facilities. As the mission of care embraces person- centered approaches, normalization of stationary resident seating and mobility is a logical outcome. To that end GROW Coalition was formed to assist facilities to, as
the Quality First writings so aptly put it, “reach the next level of
quality.”
Additionally the goal includes maximizing resident mobility by walking in situations where walking would be the norm. Examples would include: walking to meals, walking to activities, walking outside, walking to deliver an item or a message, walking to therapy, walking to the hair dresser, walking to shower, walking to bathroom, walking to visit other residents and friends, walking with family, and walking to entertainment events. Further that an initial assessment needs to be completed to support the use of a wheelchair for stationary seating and for the primary mode of mobility. Finally appropriate restorative care be given to each resident to
assist them to attain and maintain their highest physical, psychosocial and mental well-being. *The name “Grow” comes from this goal and stands for Getting
Residents Out of Wheelchairs.” GROW* Coalition Statement of
Beliefs
The word “locomotion” is used. This accurately delineates the role of the wheelchair to provide a means of mobility for individuals with lower extremely weakness, paralysis or reduced stamina when ambulating. Although new wheelchairs are always being created, the vast majority of wheelchairs utilized in long term care facilities are constructed for use as an aide to seated mobility. They have sling bottoms and sling backs and are not individually fitted for the individual resident’s comfort. The lack of comfort is not a significant factor when the wheelchairs are used for transportation such as from bedroom to living room, living room to dining room or to and from the bathroom. Therefore, the non-individualized wheelchairs work for locomotion. However, it does become a serious consideration when the wheelchair is utilized as a seating device rather than a transportation device. With the percentage of residents in long term care facilities with short term memory loss reaching 75%, another dimension is added to the seating issue. Due to the resident’s cognitive loss they often cannot express their desire to seat in a regular chair or couch, or to ambulate rather than be transported. The decision as to where these residents sit and how they mobilize is often in the hands of the staff. Applying the positive aspects of regular chairs, and walking as a preferred mobility, as supported by extensive research-see Negative Effects of Wheelchairs section of the annotated bibliography, is vital as staff members assist residents in seating selection. The evolving focus is on making the care person-centered. This would indicate that choice of seating should be based on the resident’s previous seating preference. Additionally, there is often a perceived correlation between wheelchair use and the presence of disability. Utilization of regular chairs offers residents the opportunity to be socially engaged by others. There are many positive physical, mental or psychosocial outcomes realized by normalizing the seating for elderly persons in any institutional setting. The Talking Points presented below present enumerate the positive gains that are possible when residents sit in regular chairs and maintain their walking rather than using a piece of medical equipment as the primary intervention for either activity, i.e. the wheelchair. Positive benefits include provide residents person-centered restorative are/physical therapy which lead to attaining and maintaining their highest level of physical, psychosocial and mental well-being. GROW Coalition offers a sample of the type of assessment components that could be utilized in determining if a resident needs a wheelchair as a stationary chair and/or a primary means of mobility. GROW Coalition has also reviewed the federal regulations and
most current guideline updates. The use of regular chairs and
maintaining mobility by walking fits very well into the person-centered care and is supported by these documents. The
necessity of a wheelchair assessment would fit well in many of the
Ftag guidelines. Examples would include but not be limited to:
F241 Dignity; F246 Accommodation of Needs; F252 Homelike
Environment; F272 Assessments; F309 Right to Receive Care;
and 324 Accidents. GROW Flow Chart click here to download the flow chart pdf file GROW Wheelchair Assessment (proposed draft) click here to download the wheelchair assessment pdf file
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settings the simple things become more and more important.
As providers commit to performance excellence and to providing
the higher level of quality the issue “where residents sit” must be
addressed. 
one of the defining
characteristics of a long term care facility (nursing home) they
identify the number of residents in wheelchairs. The assumption
often is made that long term care residents “need” to be in a
wheelchair. A review of the Third Quarter 2005 MDS Active
Resident Report G5d-shows 64% of residents nationally use a
wheelchair primary mode of locomotion.