Power struggles: Many problems and some solutions related to power wheelchairs in LTC

by Rebecca Ferrini, MD

Power wheelchairs are increasingly being requested and used by long term care facility residents. Residents often enter the facility with a power chair or scooter and hope to continue to use this vehicle while in the facility These chairs offer increased mobility and autonomy, but bring potential problems of fires, accidents, storage, repairs, and elopements, posing risk to the user, the other residents and the facility as a whole. Some facilities choose to prohibit power chairs, but for residents with extremely limited mobility and intact cognition (such as a young quadriplegic) this practice severely impairs quality of life and functional status. Others have implemented mandatory safety checks, individualized driving assessments, patient agreements and other policies to promote safety, One way to manage the chairs is to assure that residents and staff understand that the storage and use of the chair in the facility is a privilege, not a right, and that this privilege will be revoked if there are significant safety risks. Requiring a physician order (obtained only after the mechanical safety check and the driving assessment) is one way to assure safe operation. Driving assessments can be done with observation (skilled therapy or registered nurses can conduct this) and/or with a computerized wheelchair simulation program (e.g. wheels…) and should be repeated periodically and with any adverse wheelchair event. Problems can arise with power wheelchairs—such as use of the chair to leave the facility and purchase contraband for oneself or others, getting “stuck” in the community and needing help getting back, broken chairs, operating chairs too fast for conditions and how to “take away “ a chair from a resident with advancing dementia. Educating staff about their responsibilities to promote safety is important—for instance, staff should not place residents with delirium, sedation or intoxication in the chairs and should assure that those who operate t a motor vehicle while taking sedating medications are monitored and counseled on the risks. The facility can exert “control” over the situation through establishment of rules for operation and storage and enforcing them. We have developed a toolkit to help facilities think about the use of power chairs and better manage the risk associated with these chairs. This tool kit includes:

  • A resident agreement about the use of the power chairs
  • A sample policy on power wheelchairs
  • A safety check for power wheelchairs
  • A quick list of problems and solutions related to power wheelchair operation.
  • OPTIONAL—borrowed power wheelchair agreement and policy if the facility chooses to “loan out” chairs that have been donated

This information was presented at the California Association of Long Term Care Medicine annual meeting as a poster called “Power struggles, many problems and some solutions related to the use of power wheelchairs in LTC”

Further questions can be directed to [email protected]

Additional resources:

Good things about Power Chairs

  • They let people go faster and get to places than they otherwise could not.
  • Can really enhance the quality of life of those with disabilities.
  • Promote autonomy by correct positioning allowing self feeding, for example.
  • Can save staff time in transport, feeding, mobility

Bad things about power wheelchairs

  • They let people go faster and get to places than they otherwise could not.
  • Consume staff resources in checking, charging, fixing, loading and unloading, cleaning
  • People pile stuff in the back of them or store things near them that can be hazardous
  • Big liability possibility--staff damages it, people use it unsafely, batteries catch fire, elopement,
  • Many staff have no idea how to do something mechanical.
  • They break down and need fixing
  • post-manufacturing modifications carry risk of liability
  • they are the lifeline of a resident, but easily broken
  • The batteries have to be charged--that risks fires
  • They are bulky and need storage
  • Everyone wants one
  • Once people have them, they feel entitled to them
  • It is hard to tell exactly when they can no longer operate them safely--there is a gray area of danger to the person and those around them.

Facility role and responsibilities

  1. Require MD order and take it seriously
  2. Establish mechanism for initial and ONGOING safety check to reduce risk of fires.
  3. Require functional assessment with computer program and observation (initial and ongoing)
  4. Require wheelchair agreement
  5. Limit use in your facility
  6. Promote staff accountability: don’t put someone in the chair who is sick, confused….

How much control the facility can exert have depends on who owns the chair and how much help the resident needs to get into and use it.

Facility owns chair, resident needs help –HIGH DEGREE OF FACILITY CONTROL
Resident owns chair, requires at least some staff assistance –MODERATE DEGREE OF FACILITY CONTROL

Facility owns chair, resident does not need any staff help to transfer–MODERATE DEGREE OF FACILITY CONTROL
Resident owns chair, can transfer himself into it, needs no help at all—LITTLE, BUT SOME FACILITY CONTROL (storage, in-facility operation)