Sue Coffman, a certified nurse’s aide at Heritage Manor Nursing Home, and restorative nurse Jim Cohenour, left, lead Edith Danner, right, and other residents of the Chillicothe nursing home in exercises they hope will lead to less reliance on wheel-chairs. Cohenour and Coffman conduct the class three days a week.

reprinted from the Peoria Journal Star written by Pam Adams 11/12/2010

Pushing aside wheelchairs:
Area nursing home aims to keep residents as mobile as possible

When Sue Coffman started working as a certified nurse’s aide in 1992, she routinely saw nursing home residents “basically” tied to their wheelchairs.

“Unless you moved them, they didn’t move all day,” she says, “and I thought, something’s wrong with this picture.”

Today, in fact, three days a week, she leads a group of residents at Heritage Manor Nursing Home in Chillicothe through a series of exercises designed specifically to get them up and moving, whether they use wheelchairs or walkers.

The goal of the Stepping On program is to improve balance and muscle strength to the point that fewer residents need wheelchairs.

Coffman’s work at the nursing home is a part of a fledgling national movement pushed by GROW, or Getting Residents out of Wheelchairs, an advocacy group based in Mundelein.

Nursing home staff, health care professionals, even family members and residents have to get out of the mindset that wheelchairs are the norm in long-term care facilities, says Mary Harroun, a co-founder of GROW.

“It’s a little tiny area that’s been totally ignored, but we really need to focus on it,” says Harroun, a geriatric psychologist.

Dependency fallout
In 2005, when Harroun and Diana Waugh, a nurse, founded GROW, federal statistics reported 64 percent of nursing home residents nationwide used wheelchairs as a primary source of locomotion.

The problem, according to Harroun, is wheelchair dependency affects every part of the body except the hair and toenails and too much of the wheelchair use in nursing homes is unnecessary.

Conventional wisdom says putting residents in wheelchairs is a safety issue. Reliance on wheelchairs prevents falls, injuries, and, potentially, lawsuits. It’s also staff-centric, Harroun says, in that pushing residents down the hall in wheelchairs is less time consuming than waiting while they walk.

“But while they’re sitting there, everything is wasting away.”

Over-reliance on wheelchairs can have negative effects on breathing, nutrition, digestion, bone density, bowels and muscle strength. Harroun became interested in the topic five years ago while reading a new set of nursing home regulations that included 63 pages on guidelines for treating pressure ulcers, more commonly known as bed sores.

“There shouldn’t be anything in the nursing homes regulations on pressure ulcers because there shouldn’t be any pressure ulcers. That’s from bad care. That’s from not getting them up and walking.”

While some residents must rely on wheelchairs, Harroun thinks too many of them may not be properly assessed for movement functions and rehabilitation potential before they’re automatically confined to a wheelchair. Factors as simple as hearing aid problems or a Vitamin D deficiency can affect balance or gait. Instead of treating the problem, however, wheelchair use becomes the standard.

Many doctors, as well as caregivers “don’t understand the importance of keeping the elderly walking,” Harroun says. “I want to see them up and moving instead of sitting around the nurse’s station rotting in wheelchairs.”

Research rolling
Though there is not yet a body of research backing up her theories, a Veterans’ Administration program in Florida recently started a research project on the issue.

Coffman and other staff members at Heritage Manor heard Harroun’s presentation at a Culture Change Coalition symposium recently at Illinois Central College. As the name implies, the Culture Change Coalition’s goal is to change the culture of care at long term care facilities.

Heritage Manor Stepping On
Heritage Manor instituted GROW’s Stepping On, designed and used with her permission by Lindy Clemson, OT/R, PhD.,Sydney, Australia, exercise program soon after the symposium. “We’ve always wanted to get something like this going, we just didn’t know how,” says Jim Cohenour, a restorative nurse at Heritage Manor.

In less than a month, Cohenour says he’s seen some of the class participants become more functional.

Contrary to conventional wisdom, he says, a wheelchair dependent population doe s not necessarily make residents safer from falls or make work easier for staff.

“They fall out of wheelchairs, too,” Cohenour points out.

Improving a resident’s mobility with movement and exercise decreases the potential for falls. Improvements also take strain, physical and otherwise, off CNAs such as Coffman.

“The more they can do for themselves, the easier it is for the CNA,” she says.

GROW, Getting Residents out of Wheelchairs, www.growcoalition.org

Culture Change Coalition of Peoria, go to www.cccofpeoria.com