Skilled Nursing Facilities
Skilled Nursing Facilities
Some skilled nursing facilities do not want their residents to have power wheelchairs or scooters. I feel that this is because it is such a new market and little history of nursing home residents using a power chair. As the baby boomers begin to age and as technology has advanced to make it easier to travel within a home environment and or community environment, some residents are coming to facilities with power chairs.
There are a few SNFs (skilled nursing facilities) that are willing to work with the therapists to determine the best method for assessing a resident's ability to safely operate a power wheelchair.
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Power chairs and scooters can be safe within a skilled nursing environment if the residents have been properly assessed and regular monitoring occurs. It is imperative that all staff stay alert to the residents performance and alert the therapist for a re-evaluation if there are concerns, a decrease in physical abilities or mental alertness.
The first step to determining if a resident can safely operate a power mobility device is to complete a mini mental exam, which determines if the individual is oriented to the present tense, can follow simple directions and assesses memory.
If the skilled nursing facility resident safely completes the mini mental exam, a trail test for visual motor skills can be performed. Safety and operation guidelines can then be reviewed, and finally working on safe transfers and operation of the chair.
Does the resident have good posture and trunk control? If they have stooped posture, fall asleep often and have limited neck ROM (range of motion) they many times are not physically able to safely operate a power chair.
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Practice And Education
Be sure to have several practice sessions in the environment. Also, patient and staff education is vital and an agreement can be written and signed that should the resident become unsafe in the operation of their power wheelchair that a reassessment and/or removal from the power chair is possible. Good thorough documentation and periodic review is necessary.
There are different guidelines available, however, it is imperative that the facility staff have the understanding that they must maintain the well being and safety of the other residents, staff and visitors as well as the individual in the power chair.
You will rely on the skilled nursing facilities staff for further feedback and monitoring of the resident.
Occupational Therapy True Story
Too much you say! Nothing ventured nothing gained. Would you like to spend your day just trying to push yourself to the dining room with your manual chair, and then be too tired to eat? Where is the quality of life issue in this?
As an Occupational Therapist you have the opportunity to promote independence while helping determine the best method for each individual client.
I have had the opportunity to do this in a skilled nursing facility and the cooperation with the administrator, nursing staff and other therapists have proven it to be successful. It takes additional monitoring by all staff, but is well worth the end results.
Negative And Dependent
My personal experience of working with an aka (above the knee amputee) with limited mobility, and receiving dialysis is that now he has a new attitude and outlook on life. This person had spent most of his day propelling himself in a manual wheelchair, and had been a hoyer lift for transfers.
Skin breakdown was occurring and pressure sores were needing attention from the wound nurse on staff.
He had a negative outlook and attitude with all staff and had given up when he was not able to use his prosthesis due to skin issues.
I can tell you that this individual went through Occupational Therapy, completed the mini mental exam, the trail test, has limited neck ROM, and is able to recall safety and power wheelchair operations. One stipulation I had was this individual would need to be able to safely transfer on and off the power chair with supervision only.
Given my recommendations he was ready to work and work he did! He could not wait to use that power chair and looked forward to his therapy sessions. He was motivated to work hard and in time was able to successfully complete this task. It took time, persistence and patience on his part.
Positive And Independent
His quality of life changed for the better. He is more engaged in his environment, is happier and initiates greetings with others he meets in the hall.
He has never failed to say “Hi, Marcie” when we meet in the hallway. My last noted observation is that he continues to follow the rules, participates in activities and interacts with staff.
From the staff's perspective he is pleasant, more cooperative and independent which means he is less reliant on staff for some of his personal needs.
Make A Difference
So, if you are up for a challenge and want to make a difference as an Occupational Therapist then power wheelchairs can become a part of your program in your skilled nursing facilities.
Put your creative minds to work and you can make a difference!