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ADL Coding-Positioning and Seating

  
  
  

Positioning and Seating
 
Poor sitting posture is a common problem in long-term care and has an effect on function and performance of ADL skills.  The resident's ability to function in their environment is improved through good body alignment.  The primary goals of a positioning program includes improving body alignment, preventing or mitigating of the effects of pressure on existing pressure ulcers and improvement in ADL participation.  It is as important for caregivers to understand the unique situation of the identified patient at risk and document using and ADL flow sheet.  For example, one patient may tolerate sitting for 2 hours without skin compromise while another should be limited to 45 minutes out of bed. 
 
There are many factors to take into consideration when addressing positioning needs:
Is there abnormal tone contributing to poor posture and can it be normalized through treatment?
Is there muscle weakness contributing to poor posture and body alignment and can it be improved through treatment?
Can the patient get stronger?
Are there contractures contributing to positioning problems?
Can the contractures be reduced?
Is there any skin breakdown?
Is there adequate support of the extremities in the current seating system?
Does the patient have pain?
Does the patient have circulatory compromise?
Does the patient's position in the seating system vary throughout the course of the day or during specific tasks?
Evaluation and treatment of the above concerns are areas of specialty for a therapist versus the nurse or CNA.  This intervention meets the skilled criteria by definition and qualifies for coverage regardless of the patient's ability to demonstrate functional improvement.

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