Getting More Residents Up and Walking Once Again

[MARY HARROUN]

I am a geriatric psychologist who did invent the real Merry Walker ® over 24 years ago. Since that time, I have worked on research as to why residents are not walking. From what I have read in your responses, nurses are destined to keep residents safe from all falls, assessing for fall risks and then placing up to 77% of residents, on the national level, into wheelchairs. Wheelchairs were invented to provide transport, not to be used for extended seating.

As all of your residents walked once, you need to ask yourself why are they not walking now? Did you know that up to 1.7% of muscle mass is lost by sitting in a wheelchair per day? You have restorative CNA's in your facility, and they are walking residents, right? Did you know that walking residents does not return lost muscle mass? All residents need to be assessed thoroughly and comprehensively and placed into a daily exercise program to return them to a higher ambulation status.

Using prescribed daily exercises will certainly be in the best interests of the resident as reducing the presence of decubs and increased muscle atrophy will be reversed once the resident is at a higher ambulation level.

[amoLucia]

WOW!!! I loved those Merry Walkers!!!!

First time I ever saw one being used, that pt could have been a 'poster boy' for its use! Pt walked around very well using that device - until he started running over/into other residents. He WAS NOT doing it maliciously. He just no longer had the cognitive safety awareness how to navigate around. Eventually we had to take it away. I resigned shortly thereafter so I never knew how he fared.

What I see as the big cause to walking decline is it takes forever for pts to walk to the BR, to the Dining Room, etc. To do it safely and for pts to walk without getting further fatigued or overworked.

OP - I'm sure I'm not telling you anything you don't know. As an RN with 35+ years experience, I grab for the whch. For pt safety & comfort and expediency.

Your recommendation for a real therapeutic exercise program is NICE but.... Who, in today's LTC $$$ environment, can do all the steps you identify? Biggest question - how will it get reimbursed? I don't think there's the right mix in LTC to do such a truly comprehensive and effective program. At least NOT the way it is now.

We in nsg can't do it. Sheesh! Our services get lumped into one big MDS process. And we're being funneled into doing more with less.

What's your suggestion on how to implement your idea?

[ktwlpn, LPN]

We utilize Merry Walkers when appropriate. However we have had more then a few residents suffer some pretty serious falls OUT of them. They still must be monitored pretty closely.

I have a clear answer to the question of why some residents are no longer walking. They have a progressive and terminal or life limiting disease of dementia.You can try to stretch out those last stages as long as possible but they WILL stop ambulating.

[CapeCodMermaid, RN]

I dislike Merry Walkers...never saw a good response from one.

Most residents have Med B....get a rehab eval, set up a plan, and have the restorative aides carry it out. We had one guy who was always being told "Sit down Norman" If he moved half an inch in his chair, the staff would yell "Sit down Norman". The poor guy probably thought that was his name. I was new to the facility and didn't like this at all. I spoke to the rehab staff....try a merry walker they said. He fell. He'll fall they said. Yes he might I replied but we are going to do what we can. I literally had to stamp my foot to get them to pay attention. It's two years later. Has he fallen? Yes...and it was the staff's fault for not following his plan of care.

Is his life far better? Yes. He walks from his room to the dining room and back....happy as a clam. And now he knows his name is just Norman.