Tinetti balance score

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Our professional therapy services performs a Tinetti on all our residents and if the test results indicate a high fall risk our RT aide initiates a walk and dine program on residents who are independent with cares and ambulation. The question I have is if a resident is a fall risk and environmental interventions and monitoring are implemented to prevent falls do we take away their independence to move freely or do we restrict their mobility and make them wait to use the bathroom or go to meals or elsewhere?? Especially if they are cognitive? I think this gets started quickly just to capture in RT to make money. What do you guys do??

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If they are independent with ambulation they do not qualify for walk to dine. If they are high risk for fall, then they should have assist with all ambulation and not be considered as independent. If they wish to have more freedoms, see if therapy can improve their ability with independence as a goal, or else allow for w/c use for independence as desired and continue walk to dine or as able with staff to not lose that ability.

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Specializes in Gerontology, Med surg, Home Health.

..."especially if they are cognitive..." What does that mean? Impaired? We strive to maintain our residents' independence as much as possible. Everything is a risk vs benefit. If they can ambulate...let them.

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..."especially if they are cognitive..." What does that mean? Impaired? We strive to maintain our residents' independence as much as possible. Everything is a risk vs benefit. If they can ambulate...let them.

I agree...it's just confusing for me because some residents are fully capable of being independent and are but then therapy does this test and they want to have staff assist for all cares! There's always a risk for falls...I get that!! I also do MDS and I get frustrated because ADLs are coded as independent but then I'm having to code for walk and dine and half the time they ambulation alone anyways!! I probably make no sense...lol

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By cognitive I mean alert and oriented but I guess even residents who have Alzheimers or dementia that are ambulatory who want to wander or explore. If a resident is ambulatory, is steady, uses no mobility aide but just needs cueing and direction due to disease process would that qualify as walk and dine??

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Walk to dine can only be counted if the resident is otherwise in a wheelchair. If they walk at all times, either independently or with assist, then it is not counted, it is simply their standard care. Restorative programs are to be above and beyond standard care. If they only need directions to locate the dining room then it absolutely does not count.

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Thank you for your responses!! Now if I can only get my DON and RT aide to understand this in regards to the MDS...Unfortunately I'm only a substitute to do MDS and they don't seem to wanna hear me out! I'm just concerned on how our state surveyors will view this.

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Walk to dine can only be counted if the resident is otherwise in a wheelchair. If they walk at all times, either independently or with assist, then it is not counted, it is simply their standard care. Restorative programs are to be above and beyond standard care. If they only need directions to locate the dining room then it absolutely does not count.

I agree!! Off the ambulation subject...would you consider toileting every resident upon rising, before/after meals, HS, and PRN standard care or a "bladder and bowel program" in regards to RT program?

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Toileting ur, ac & pc, hs, & prn is also standard practice, not a program. Toileting programs are resident specific, evaluated and reassessed to reduce incontinence based on each residents personal pattern.

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Specializes in Assisted Living nursing, LTC/SNF nursing.

I always loved the thought of keeping people to their highest level of functioning but where I work, they are so embedded with 'resident rights' that if they ask, we HAVE to do for them even though they could easily do for themselves. No questions asked, you do it since it's their right. I try to educate and feel it's a lost cause since no one else does. Nothing about that keeps them at their highest level of functioning because it's 'the residents rights'. The more you do, the more money the PTB make and the more burnt out everyone gets. Resident rights and highest level of functioning is almost an oxymoron :banghead:.

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Agreed!! Thanks for the information...it's nice to be able reaffirm that maybe I'm not wrong about my facilities "programs". I have no choice but to go with the flow because now that I have brought up these questions and concerns I have quite a few people upset with me!! I guess we'll see what happens!!

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And what's even more concerning and frustrating is that when I was researching our toileting program and directed questions to the DON...her comment.." gee, I'm not really aware of how our program is set up...I wasn't a part of it!!" I think that's cause for concern

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