Restorative Care, Mobility and Body Mechanics
Restorative Care
Philosophy
Restorative care keeps residents functioning at their highest possible level rather than doing everything for them. The core idea: if a resident can do part of a task, let them, and assist only with what they cannot do. This applies to bathing, dressing, grooming, eating, walking, and toileting. Doing for someone what they can do for themselves causes decline.
Key programs
Range of motion: passive ROM is performed by the caregiver, active ROM by the resident, and active-assistive means the resident does part. Perform ROM only to the point of resistance or pain, never force a joint, and stop if the resident reports pain. Positioning with proper alignment, turning on schedule, and using splints as ordered prevent contractures. Ambulation programs, bowel and bladder retraining, and ADL retraining are all restorative. Consistent repetition across shifts matters more than intensity.
Devices and communication
Encourage the use of prescribed devices - walkers, canes, splints, hearing aids, glasses, and adaptive utensils - because the goal is function. Report progress and declines to the nurse so the plan can be updated, and follow the therapy plan exactly as written. Never change a device setting on your own.
Dignity
Restorative care takes longer. Build the time into the routine, praise effort without being patronizing, and let residents make choices about how tasks are done. A resident who feels rushed tends to give up and let the aide take over.
Traps
Test writers love the choice between "finish the bath quickly" and "let the resident wash their own face." Another trap is forcing a joint past resistance or skipping splints because they are inconvenient.
Rule of thumb
Hands off what the resident can do; hands on only where help is needed.
Mobility and Body Mechanics
Protecting yourself
Use the mechanics that keep your back intact: feet shoulder-width apart, bend at the knees instead of the waist, hold the resident or object close to your body, and pivot with your feet rather than twisting. Never lift more than you can safely manage - get help or use a mechanical lift. Lifts are required for residents who cannot bear weight, and never catch a falling resident with your back; lower them gently to the floor while protecting their head.
Moving and positioning
Keep the body in alignment with pillows and reposition at least every two hours for residents on bed rest. Use a log roll to keep the spine straight for residents who require it. Raise the bed to working height for care, then lower it. Dangle a resident at the side of the bed before standing if they are at risk for dizziness from orthostatic hypotension.
Transfers and devices
Lock wheelchair wheels and move footrests out of the way before a transfer. Apply a gait belt around the waist over clothing and grasp it, not the resident's arm. Stand on the resident's weaker side and slightly behind when walking. A walker is picked up and placed ahead, then the resident steps in; a cane goes in the hand opposite the weak leg. Follow the ordered weight-bearing status exactly.
Traps
Questions love the aide who grabs a resident by the arm or under the shoulders, leaves wheels unlocked, or uses a gait belt as a restraint. Another favorite: an aide who twists while transferring.
Rule of thumb
Bend your knees, keep the load close, pivot your feet, and get help early.