A falls-risk resident, a walking frame and a stretched aged-care team
At a 60-bed aged residential care facility in Tauranga, the manager asks you to 'sign off' a walking frame for Mrs Ngata, 84, who has had three falls in four weeks. She has mild cognitive impairment, osteoarthritis, and postural hypotension. Her medication list includes three antihypertensives and a sedative. The GP visits weekly but is not due until Friday. The registered nurse is covering two units. Mrs Ngata's daughter wants her to 'keep walking every day' and has asked why physiotherapy has not yet seen her. The facility has no hoist in the shared bathroom and one care worker on night shift for 30 residents. The physiotherapy contract provides 30 minutes per resident per week. You are on site for a 30-minute contracted visit and have two other residents to see.
1. How do you respond to the manager's request, and what assessment and interprofessional actions are needed?
Read the worked answer
I would not 'sign off' a walking frame without assessment. The request is administrative, but the clinical decisions are about falls risk, cognition, medication, postural hypotension and safe mobility. I would explain that a frame alone does not prevent falls and could increase risk if not matched to her ability. I would start a focused assessment: lying and standing blood pressure, medication review, cognition, vision, footwear, pain, strength, balance, gait, and the bathroom environment. I would ask the GP to review medications urgently, not wait until Friday, because postural hypotension and sedation are modifiable. I would involve the registered nurse, care workers and daughter in a coordinated plan. Interprofessionally, I would request an occupational therapy home assessment and a pharmacist medication review. I would document that the facility has one night carer for 30 residents and no shared-bathroom hoist; those are organisational risks that need escalation to the manager, not just a frame. I would recommend a supervised mobility plan and a falls review.
2. What are the key risk, capacity and consent issues?
Read the worked answer
Mrs Ngata has mild cognitive impairment, so I need to assess her capacity to consent to assessment and mobility recommendations. Capacity is decision-specific; she may be able to choose whether to walk with supervision. I would explain in plain language and involve her daughter with her consent. Risk issues include falls, fracture, head injury, postural hypotension, sedation, and unsafe manual handling for staff. There is also a dignity issue: restricting her walking entirely may be harmful. I would use a least-restrictive approach: supervised walking, correct equipment, environmental changes and medication review. I would not use a frame as a substitute for supervision. I would document capacity, risks, benefits and the decision. If there is serious risk and she lacks capacity, I would follow the facility's policy and the Code, involving the GP and family in her best interests.
3. How do you document and communicate your recommendations to the GP and family?
Read the worked answer
I would write a concise physiotherapy note: assessment findings, falls risk, medication concerns, equipment recommendation or why not, supervision level, and who I have spoken to. I would use SBAR to communicate with the GP: situation (three falls, postural hypotension, sedative), background (medications, cognition), assessment (mobility, capacity), recommendation (urgent medication review, supervised mobility, equipment review). I would send a copy to the registered nurse and manager and document the daughter's views. I would avoid blaming staff; I would flag the staffing and hoist issue as a facility risk. I would arrange a review date and tell the daughter what to expect. Good documentation protects the resident and supports the team.