Eldercare change: Get folks out of wheelchairs

RALEIGH, N.C. — It's a common sight in many long-term care centers: residents in wheelchairs lining hallways, just sitting or rolling slowly down the hall.

But older people's health, mobility and self-image can suffer from too much time in wheelchairs, say some who study geriatric issues.

More than 24,000 North Carolina nursing-home residents — about two-thirds of the total population — use wheelchairs as their main means of getting around, according to the most recent federal statistics. And that number has risen steadily in the 2000s, as sicker patients have entered nursing homes.

If older people need wheelchairs to move around or be moved, that's fine, but it's past time to cut back on "parking" older people in wheelchairs, said Leslie Jarema, health service director of The Forest at Duke.

Ways to limit unnecessary wheelchair use are part of a movement that gives priority to the well-being of residents and their caregivers, above the functions of the nursing home or convenience of the staff.

"It's not good for anyone to sit anywhere, in anything, for long periods of time," said Nancy Fox, executive director of the Eden Alternative, a Texas-based nonprofit group that promotes the well-being of elders and their caregivers.

Raleigh, N.C., resident Sylvia Weaver, a member of Wake County, N.C.'s nursing-home advisory committee, puts her feelings about wheelchairs even more plainly:

"You go sit in one!" Weaver said. "See if you can sit for 15 minutes."

Getting up and around

The Midwest-based group called GROW — Get Residents Out of Wheelchairs — has taken up the cause on a national level. The nonprofit urges nursing homes to help residents use regular chairs, couches, recliners and the like at times when sitting "is considered the norm and socially accepted." That includes for meals, TV watching, socializing with family and friends, and resting when tired.

The group also tries to get residents to be as active as possible, encouraging walking to meals and other activities, going on foot to the bathroom or shower and taking outside walks with family and friends when possible.

"I started off gently, informing the staff that our policy would be that no one could sit in a wheelchair," Jarema said. "They would be taken from point A to point B and put in a normal, comfortable-style chair. We are at about 90 percent compliance. I got a lot of resistance at first from the staff, from the families and the residents in the wheelchairs."

Advocates acknowledge that wheelchairs have their uses for certain residents at certain times.

"There are patients that feel very possessive of their wheelchairs," said Polly Welsh, director of regulatory systems for the N.C. Health Care Facilities Association, a nursing home trade group. "We like to encourage people to change their positions to stand up and bear weight as much as possible."

Breaking the cycle

Advocates and academics say the downsides to spending too much time in a wheelchair are varied, but specific. They include a greater chance of pressure sores, significant discomfort and physical strain from operating chairs.

In addition, people in wheelchairs can be perceived as less able and are even spoken to differently in what becomes a self-perpetuating cycle of helplessness. Perhaps most important, loss of mobility can begin within a few days if someone starts using a wheelchair instead of walking.

"It's just like with your education; if you don't use it, you lose it," said Michael A. Boles Jr., director of adult day services for Wake County's Resources for Seniors. "Our people are not parked in wheelchairs. Our participants who are in wheelchairs, it's necessary for their mobility."

The more than 200 clients of the six adult day-care centers that Boles supervises are diagnosed with dementia, stroke, hypertension and other illnesses. A goal of their treatment is to keep their immobility from getting worse.

"They are not going to improve, but we can at least keep things from deteriorating as quickly," he said.

Solutions are readily available in concept, but harder in reality. The GROW Coalition wants a requirement that nursing homes carry out a resident assessment before placing anyone in a wheelchair. In addition, lowered staffing ratios would let a center's caregiver take more time with slow-moving residents.

"The need to transport people back and forth to their rooms, to access meals and other services, almost promotes a helplessness in them — the staff has to get them there in a hurry," said Fox, with the Texas group Eden Alternative. "Someone who is walking slowly, who would be able to make it, would be put in a wheelchair just because of the time involved."