Nursing Home Quality Improvement Initiative

Quality Measure Fact Sheet:
Percent of Chronic/Long Term Care Residents who Spend
Most of their Time in Bed or Chair

Why residents may not be out of bed or chair despite good care:
Many residents of long term care facilities have suffered a decline in physical activity due to muscle loss, depression, fear of falling, arthritis, or decline in overall condition due to their medical conditions. They may progressively lose the ability to perform activities of daily living (ADLs) such as eating, getting to the bathroom, or dressing, then ability to ambulate and transfer. They may be unable to participate in physical and social activities due to dementia, or be more comfortable in bed due to severe pain. This cycle of decline may be especially seen near end of life.

Even when nursing home staff makes a good effort to keep able residents more active, encouraging them to take part in physical and activities and/or go on regular walks with assistance, some residents will choose to remain in bed or in a chair. Side effects of some medicines include drowsiness and confusion which make it more likely that a resident will want to stay bedridden or in a chair. Certain medical conditions, such as a stroke or congestive heart failure, may cause resident to experience severe loss of function. Even with the best efforts of nursing homes, some residents will spend most of their time in bed or in a chair. It is also important to note that some residents may be counted in this measure due to a temporary illness that confines them to bed or chair.

What conditions exclude a resident from this measure: (Risk adjustment)
Residents who are comatose are excluded from this measure.

Questions you can ask the facility if they are rated high in this measure: How many of the residents are bedridden or spend most of their time in a chair? What does the facility do to encourage residents to participate in physical activity? What does the facility do to encourage residents to participate in social activity? What rehabilitative care does the facility provide to residents to expand their activity? How does the facility try to improve the quality of life for those residents that remain bedridden?