Seating & Mobility Senior Style

Don't Seniors Deserve Choices, Too?

My background is acute rehab for over 25 years, so when I started to work in geriatrics in a long-term care setting, I knew the pace would be slower and the patient population would be drastically different. I anticipated having to do my homework regarding geriatrics and evidenced-based practice, and to learn how to work within a different payor system.

What I was not prepared for was the isolation I quickly encountered regarding DME and, specifically, wheeled mobility.

A Different Paradigm

In acute rehab, sales reps were always stopping by to offer their services, and manufacturer reps were frequent visitors to introduce a new product or to leave a “long-term trial” product. I had the cell numbers of the local suppliers as well as local manufacturer reps, and they would always answer quickly when called. I wouldn’t hesitate to call late in the day to ask a question or to follow up on a status. I could quickly get a piece to trial equipment for an upcoming appointment. Naively, I thought this was the way the business worked everywhere.

Now here I am in a long-term care setting. I ask about the local suppliers who cover this facility, and I am given one name. Really, just one? For the next couple of months, I didn’t see any other sales reps or a single manufacturer rep in the therapy area. Not even the one supplier I was told covered the facility.

I asked my supervisor about this, and he didn’t even understand why I was asking to see a supplier. There was no need to see a supplier, since when seating equipment was needed, the therapist either looked in a closet for something or got something from a catalog without even trialing the product.

The residents want to self-propel to get to activities, visit other residents, go to the gift shop, go to meals and especially just be independent in their room. The Catch-22 here is that these residents are too medically or cognitively compromised to live at home, but the long-term setting is a significantly larger environment to negotiate than home. Our wheeled mobility solutions need to meet these additional considerations for long distances.

Starting a Paradigm Shift

Fortunately, I am in a facility that values therapy’s input. The facility is truly dedicated to providing the best care possible for our residents. When we discussed seating & positioning with administration, I had full support to get what the resident needed… with justification. While I appreciate now that this may not be the norm in long-term care, I would like to share what we do in my setting.

The first step is simply education. I don’t mean just “how to assess seating” education. Therapists can go to courses and learn how to identify the problems, but as important as problem-identification is to get educated on products available.

I contacted manufacturers for in-services and invited nurse managers, social services and wound care specialists. Now we invite maintenance as well, since they will need to service the products in house, and their buy-in to new equipment is essential. I started with wheelchairs and education on axle placement, seat height, and standard vs. recliners vs. tilt, as well as the proper measurements. Then we progressed with seating & positioning products for the wheelchairs.

Having some demo product to use, I now could trial equipment instead of ordering blindly from a catalog. The manufacturers started bringing new suppliers into the facility, and soon I was getting calls to schedule appointments with other vendors.

This provided the opportunity for competition and better pricing for the facility, as well as more resources for the therapists to get trial equipment or scheduling appointments for seating evaluations with suppliers for suggestions on products that may meet resident needs. Nursing was referring more residents to therapy, as they were seeing our success with proper positioning… and not just requesting residents be placed in geri recliners. Even better, we were getting requests to evaluate for alternate mobility for residents who had been in geri recliners with the goal of using wheelchairs or tilt chairs.

I contacted the manufacturer rep and asked him to help us with pressure mapping for proper product selection. We routinely utilize pressure mapping to assist with justification and product selection.

Providing education and resources to access products was the first step. Therapists needed to know what was out there and then be given “permission” to go after it! If we don’t have the contact information for a local manufacturer’s rep, I call the large freestanding acute rehab center in the city and ask the seating specialists for the information.

Reaching Out, Making Connections

The next step was how to provide optimal seating and mobility in a cost-effective manner in the long-term care setting.

We have worked with social services to reach out to the ALS Foundation, the MS Society, and the Muscular Dystrophy Association for equipment needs for the appropriate residents. We have contacted our manufacturer reps and suppliers to inquire about buying one of their demos at a discount, if it will meet the resident’s needs. We work closely with the maintenance department to adjust and maintain the chairs. We have purchased different sizes of wheels and casters to interchange on frames as needed, instead of buying new wheelchairs. We have a supply of pushrims to use, if we want to trial projections on a chair. We make sure that when a resident no longer needs the equipment, it is safely stored so we can access it again when needed.

When we do request a new seating system for a resident, we can justify the equipment and often have trialed equipment (or close to the equipment requested) and documented the success of the system. We may provide information from the pressure mapping sessions to help with justification.

Administration, realizing there is not just one product for everyone, is supportive of our efforts to control costs and to provide optimal seating for the resident to enhance comfort and function.

When Mobility Management asked how seating & positioning is different for the senior population, I understood the question was about the unique considerations of co-morbidities, caregiver ease of use, disease progression/change of status concerns, and payor limitations, as well as power vs. manual considerations.

However, in my setting of long-term care, I ask: Why can’t seniors be treated the same as community-based adults, with access to the resources available for evaluation, product trial and selection?

This article originally appeared in the July 2011 issue of Mobility Management.

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