Long Term Care
Anthony Fagg, administrator of Oakwood Terrace
July 13, 2009
Wheelchair, Seating, and Power Mobility Assessments and Intervention
Seating and mobility can be one of the most important aspects in a person’s life. A proper fitting wheelchair with seating features enables one to perform meaningful activities, e.g., accessing the bathroom sink without the risk of falling or wheeling to the dining room or recreation activities independently. An ill fitting wheelchair can impede swallowing, breathing, and social interaction. It can also result in skin breakdown and other medical concerns.
Together with the resident and staff, Jacqui reviews functional ability, posture, skin integrity, lifestyle, medical history, and environment. The process also includes a MAT assessment or a modified version of the MAT to identify areas requiring special positioning, e.g., a pelvic obliquity or posterior tilt. After an interview and functional assessment, a trial of equipment takes place using products from medical suppliers. A comprehensive report is completed for the Department of Health. Equipment is provided through the Red Cross using the details of the occupational therapy report.
Follow-up and training for the client and / or caregivers takes place when the equipment is delivered. These events ensure that the equipment fits properly and that the resident and staff become familiar with the parts of the wheelchair.
Skin Integrity
An occupational therapist can assist in the provision of necessary equipment for prevention and treatment of skin breakdown. In collaboration with nursing staff, information is collected, e.g., Braden Scale scores, treatment of skin breakdown, nutrition, mobility, equipment use, and the client’s expressed views. The approach or equipment used depends on various factors. Comprehensive reports are completed for the Department of Health. Equipment is provided through the Red Cross Loans Program using the details of the occupational therapy report.
Feeding and Swallowing Assessments
Swallowing problems (dysphagia) can appear for various reasons in the elderly population. Dysphagia may be the result of a neurological condition such as Parkinson’s or the person’s position at meal time. Dysphagia can be a worrisome problem due to choking risks and also aspiration which can lead to pneumonia. The occupational therapist and dietitian assess a resident during meal times. The types of observations made during assessment include muscle control and coordination, timing of swallows, frequency of swallows, tongue control, and clearing of foods. Recommendations may include a change in texture, positioning at meal time, review of medications, or the resident’s location in the dining room.
Lifts and Transfers / Staff Education
Assessment for lifts and transfers as well as staff education can be provided in long term care. Review of pivot transfers and placement of a wheelchair beside the bed, reminds staff to use efficient and safe techniques. As related to lifts, the type of sling and method used can improve the resident’s comfort and the efficiency for staff. For example a toileting sling may be considered for a resident. To know if it is feasible, the occupational therapist assesses the person’s functional abilities and interviews nursing staff regarding routines. Instruction is provided for staff on the safe use of the toileting sling.
