Poor sitting posture is a common problem in long-term care and has an effect on function and performance of ADL skills. Skilled Nursing Facilities strive for a restraint free environment, no recorded falls and eliminating the occurrence of skin breakdown at the facility level. Committee meetings, QA teams and active walking rounds are a part of the daily operations in the SNF aimed at minimizing and eliminating the above listed clinical barriers to function.
The resident's ability to function in their environment is improved through good body alignment. The primary goals of a positioning program include improving body alignment, preventing or mitigating of the effects of pressure on existing pressure ulcers and improve in ADL participation. Example: A patient was admitted with multiple pressure ulcers (6) stage II and (2) stage IV. A brief period of skilled therapy intervention was appropriate to determine the best seating system including cushions, lateral supports etc., and tolerance of the system. Goals included identifying the most appropriate system, successful follow through by staff and maximum time recommended that the patient should be in a specific position to reduce risk factors.
It is as important for caregivers to understand the unique situation of the identified patient at risk. 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 improve strength in upper and lower extremities?
- 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. This intervention meets the skilled criteria by definition and qualifies for coverage under Medicare Part A and B. Specialized positioning evaluations should be available to the therapy team to assist with individualized programing and goal setting for successful seating systems.