The GROW Program, Getting Residents Out of Wheelchairs, was written by a geriatric psychologist, who received training in geriatric recreation therapy and is a former nursing home administrator, who has focused attention on restorative care and rehabilitation procedures in nursing homes for many years. As many as 77% of our institutionalized elderly are sitting for long periods of time in wheelchairs, it was felt that a training manual to retrain all staff in nursing facilities was needed, as most nurses have not had the training needed to get residents up and walking once again. At present, if the resident is a risk for fall, facility staff use the procedure of placing the resident into a wheelchair, which deteriorates muscles at a rate of 1.7% per day. Improvement in resident care and meeting the new concept of resident-centered care, the facility staff need to change the focus of all facility staff to completing comprehensive assessments for each resident to determine what could be done for that resident to get them up and walking again at a higher functioning level as they all once did walk. The GROW Program is based in the federal regulation, Quality of Care, and all certified nursing homes are supposed to follow. The intent of that regulation is that no resident shall deteriorate due to facility care.
The GROW Program requires a simple change in procedure that is presently not being followed in most nursing facilities. This change requires simply addressing the changes needed in the care plan meeting format. The GROW Program suggests that all facility departments complete comprehensive assessments on all residents prior to the care plan meeting, going beyond the existing requirements of the MDS. The assessment process will determine what each department needs to focus on when writing goals and objectives for each resident to enable each resident to reach their highest mental, physical and psychosocial level possible, the requirement of the Quality of Care federal regulation. The suggested assessments are included in The GROW Program. After the care plan meeting, goals and objectives have been then formulated for each resident for each department. The next step is to retrain all restorative certified nursing assistants in real restorative care. Presently most CNA’s are walking residents up and down the hallways, without real positive outcomes in increasing the resident’s walking status. This training is included in the second half of The GROW Program training manual, intended to retrain the CNA’s. The CNA retraining includes learning and leading daily prescribed exercises for up to four residents at a time and charting their progress which will then be reported at the next care plan meeting, showing progress in muscle strengthening and balance. Each exercise is clearly shown in the text with full explanations of using each exercise to either address muscle strengthening, balance or standing exercises. The exercise program is all reimbursable under the RUGS, RLA, low nursing rehabilitation.
When a facility wants to introduce The GROW Program to staff, residents and family members, a Power Point Presentation is available.