Mobility Decline Prevention
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Modules - Mobility Decline Prevention
EXPERIMENT WITH THESE STRATEGIES
We pride ourselves on giving straightforward answers, but we have none for this question, nor could we find one in the literature. What works in one facility may fail in another for a myriad of complex factors: case mix, staff-to-resident ratios, organization of current services, even who is on which hallway.
What we can offer are strategies for tailoring your walking program so that it meets residents' needs without overwhelming your staff resources. Consider them all, then implement those that you believe will work best in your facility.
- Try it, then tinker
Pilot test the walking program with a handful of residents or on one or two hallways for up to two weeks. Then ask the staff involved to identify what worked well and what didn't. Make changes as needed to ensure that a facility-wide implementation rolls out smoothly.
- Ask CNAs for suggestions
CNAs can help you brainstorm realistic strategies for implementing the walking program. You might start by asking a question such as: "If you were assigned to walk with 1-3 residents for 10-30 minutes a day per resident, how would you manage this task?" (Keep in mind, and remind the CNAs, that most residents will probably not participate in the walking program.)
If CNAs feel they couldn't manage the task, ask them to consider variations on the program: "What if the walking program was implemented on fewer days?" "What if some residents walked in groups?" "What if walking was broken up over the course of the day and integrated with other daily care activities such as toileting?"
Listen to their answers. Try to implement their solutions.
- Establish a set time for walking
Find a time for daily walks that suits both the resident and the assigned CNA, then stick with the schedule. It may take several days to determine the best schedule for all involved.
In the initial screening (see Step 1), you should ask residents when they prefer to exercise. Try first to schedule walks at or as close as possible to those times. If you can't meet a resident's preference, go with the next best alternative. If the resident objects, you have several options: work with the resident to find a new time; explain your constraints to the resident and ask for cooperation; or ask the resident again in a day or two--it's possible the resident will have changed his or her mind.
Allow up to 30 minutes per resident per day for walking, though residents may walk fewer minutes at the start of the program. Expect increases in the amount of time that residents can walk. When we tested our walking program, participating residents increased the amount of time they walked from an average of 11 minutes at the start to 20 minutes after 12 weeks (1); at that point, walking times stabilized.
- Make walking a regular part of the day
An alternative to setting aside a specific time for walking is to integrate walking with residents' other daily care routines, such as using the toilet or going to the dining room. Residents do not have to walk all at one time to gain benefits from the program. Several short walks will probably work just as well as one long walk.
- Walk in groups
This may be an especially feasible (and enjoyable) option for residents who are rated "0," or independent, on the MDS walking items. One CNA could be assigned to assist two fairly independent walkers, or two CNAs could assist 3-4 walkers. This latter option allows the CNAs to cover for each other if a resident needs special assistance during a walk.
- Drop uncooperative residents from the program
Don't get us wrong; we're not trying to scratch participants from the program. Residents should be encouraged to walk, and if at first they refuse, as some likely will, they should be asked again within a day or two. And then again, if necessary. But it's reasonable to impose a stopping rule. So…any resident who refuses to walk on three occasions in a row should be dropped from the program. If, however, the resident still qualifies for the walking program at the next MDS reassessment, he or she should be considered a participant, and encouraged to walk, again, and again, if necessary.
- Graduate safe, active walkers from the program
Any participating resident who proves able to walk for more than 30 minutes a day probably does not need CNA assistance to walk. A registered nurse should evaluate these residents' ability to walk safely on their own. If they pass this assessment, the residents can "graduate" from the walking program. They may, however, still need verbal reminders and encouragement to walk daily.
- Cut back on the number of days the program is offered or the maximum number of minutes walked each day
We consider this a strategy of last resort because it will compromise the effectiveness of the program and dilute its beneficial outcomes. But if none of the above strategies work for your facility, then cutting back on days or minutes may be your best option. Better some walking than none. This option also is preferable by far to excluding willing participants from the program, a strategy that we believe is ethically and clinically unjustifiable.
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