Mobility is a crucial aspect of a long-term care facility resident's health and quality of life. As people reach a certain age, they tend to move less and much of their ability to perform activities of daily living (ADL) decreases. Add the social isolation from the COVID-19 pandemic and chances are, a resident will experience an increased loss of mobility. This can result in a loss of muscle tone and flexibility, leading to increased pain, falls and depression. Loss of mobility may also contribute to incontinence and pressure sores, as well as lack of appetite and dehydration, which are contributors to UTIs and malnutrition. It is extremely important to help residents remain as mobile as possible.
The Comagine Health Mobility Learning Guide includes approaches for helping residents increase strength and flexibility, which can prevent complications that decrease their quality of life. Topics include body mechanics, simple and easy range-of-motion exercises, explanations of the role of movement in managing pain and mood issues, and prompts to help increase a resident’s ability to perform ADLs.
Consider the scenario below using the Situation, Background, Assessment and Recommendation (SBAR) method of communicating ideas.
Residents are spending their days in their rooms instead of moving about in the facility and interacting with their neighbors and friends. Staff has noticed an increase in requests for pain medication, as well as an increase in assistance with performing ADLs, such as bathing and eating.
Because of active COVID-19 cases in the facility, residents have experienced a significant decline in ambulation and activities outside their rooms. This social isolation and lack of ambulation can lead to a rapid decline in a person’s muscle strength and loss of balance, which can lead to increased falls. It can also contribute to depression, exacerbating their lack of mobility and negatively impacting their appetite, leading to complications that include urinary tract infections and malnutrition.
This time of social isolation requires thinking outside the box for interventions that allow for maximum self-care and preventing loss of balance and muscle strength.
Implement an interdisciplinary care conference to review the Mobility Learning Guide. Provide information to staff about simple exercises they can easily incorporate into a resident’s daily activities. These can include things like moving arms and head while bathing or exercising the arms and fingers when using the remote control (pages 16 - 17). The guide also shares ideas for prompts staff can use while encouraging residents to provide self-care and encouraging independence as much as possible.
Staff will also need to be proactive in identifying residents at high risk for decline in functional mobility levels due to inactivity. This Bed Check Activity is extremely easy to do and is often an eye-opener for nursing staff and leaders. Do this:
- Stroll down your facility’s hallways at 10 a.m. and again at 4 p.m. on the same day. Write down the names or room numbers of residents you observe in bed.
- Compare the two lists to identify those residents observed in bed at both times.
Research at Vanderbilt Center for Quality Aging indicates that residents who are on both lists are most likely spending an estimated 16 or more hours a day in bed, and often are not “bed-bound” for medical reasons. These residents definitely are not “using it,” and there’s a good chance they’re “losing it.”
You may also be interested in a recent Comagine Health webinar Innovative Activities: Preserving Functional Ability During the COVID-19 Crisis. The presenters are activity professionals sharing their experiences for improving quality and stimulating activities for residents, particularly while living in isolation during a pandemic.
Keep good notes on the residents and help track responses to the increased focus of providing exercises and activities to improve resident mobility and moods. Inform and update the QAPI Committee about the project. Give your facility credit for the quality improvement work done to improve the quality of life for your residents!
- Mobility Learning Guide This guide includes approaches for helping residents increase strength and flexibility and prevent complications that can decrease their quality of life. Topics include body mechanics, range of motion exercises, prompts to encourage independence, and the role of movement in managing pain and mood issues.
- Bed Check Activity. Guidance on the assessment of those most at risk for a decline in functional mobility levels due to inactivity.
- Innovative Activities: Preserving Functional Ability During the COVID-19 Crisis (5/22/2020). Webinar session featuring activity professionals who shared their experiences from the front line and explored the current state of social engagement within the care communities.
- IHI Age-Friendly Health Systems Initiative. Recommendations for reliably providing a set of four evidence-based elements of high-quality care, known as the “4Ms,” to all older adults in your system: What matters, medication, mentation and mobility.
- How to Improve. An Institute for Healthcare Improvement (IHI) website resource – A simple, yet powerful tool promoted by IHI for accelerating improvement.
- QAPI for CNAs Toolkit: In-Service Facilitator Guide. A facilitator's guide with learning activities, a roleplay exercise, discussion questions and a quiz.
- Root Cause Analysis (RCA) Resources. Links to an RCA worksheet, an outline of the necessary steps for RCA and a process for reducing future events.
- IHI – 5 Whys: Find the Root Cause. When a problem presents itself, ask why again and again until you reach the root cause.
- IHI – Failure Modes and Effects Analysis (FMEA) Tool. A proactive method for identifying what parts of a process are most in need of change.
For more information and resources on this or other quality improvement topics, please contact one of our nursing home improvement advisors: