Assessing resident mobility and transfer status
Eve Wilson
Are we to assess the resident and report on what we observe? How should we allow for (or indicate on forms) the need for occasional additional assistance?
Eve Wilson
A great question Tim and an issue that we all encounter at times!
Aged care is a unique environment in that the performance of an elderly resident can fluctuate substantially from one end of the day to the other as you know. With this in mind, our assessments need to reflect the worst case scenario for each resident. I understand that this goes against all that we have learnt and been trained to do and it took me a while to get my head around it – our goal has always been to maximise independence afterall.
I guess what we need to remember that in aged care, what we see a resident do at the start of the day, may be quite different to how they perform at the end of the day when they are tired, more confused (sundowning), in more pain or when the effects of their medications are wearing off and they ready for a top up. In this respect aged care is unique, and to ensure adequate levels of care are being provided to the resident, and for the safety of resident and staff at all times, we need to make sure our recommendations have considered these factors and have a worst case scenario option built in.
The other thing to consider is that we are experts in using lots of strategies to promote independence with the residents (sit to stand is a good example – bottom to edge, feet back, lean forward, push through arms of chair etc, etc). These prompts come naturally to us. Care staff do not typically use these strategies unless they work at a site where MH training is done regularly, either formally or informally. So, whilst we may be able to get a resident up out of the chair with standby S/V and verbal prompting, care staff may need to use A x 1 with the same resident. Does that make sense?
The way I get around this at my facilities is that I write up their mobility recommendations as I have assessed them but I will often include a prn recommendation of a higher level of assistance. For example, a resident who is A x 2 for transfers out of the chair may need a prn standing machine option for times when the resident is tired, unable to co-operate or is generally not performing at his/her maximum. This is not done routinely with everyone but I usually do this if I sense performance may fluctuate and following thorough dialogue with CCC or RN re performance of this resident at other times of day.
We can easily add this recommendation to our assessment form in the mobility and transfers section and must include it in progress notes and our verbal handovers. I usually preface these prn recommendations with a comment that care staff should always attempt the preferred option for transfers first, and if this is not working then they default to the prn recommendation.
Hope that helps Tim!
