How To Stand Up From A Recliner: 8 Tips for Making Recliner Transfers Safer & Easier


Transferring from sit to stand on a rocking recliner can be challenging and difficult for an individual with weakness, compromised heart health, balance problems, and other impairments.  Sometimes family members will purchase a medical lift chair to decrease the effort and fall risk of a loved one that enjoys sitting in a recliner but cannot stand up from the soft, low, and rocking surface of a recliner.  However, if your loved one prefers his/her LAZY BOY recliner to a new medical lift chair, here are some tips for making recliner transfers & lifts easier:



picutre of a telephone book under the front of the recliner

Telephone book under the front of the recliner

  1. Place a telephone book under the front of the recliner- this prevents the chair from rocking forward and down

  2. If transferring to a wheelchair, place the wheelchair at a 45º angle from the recliner and lock the brakes

  3. Remove the wheelchair armrest toward your loved one’s stronger side – the direction you want to transfer your loved one because it is easier on you and him/her to go toward the stronger leg

  4. Remove both of the wheelchair’s footrests to decrease tripping/falling during the transfer

  5. Have your loved one scoot to the front of the recliner

  6. Use your knees to block your loved one’s weakest leg

  7. Ask your loved one to reach forward and “give you a hug”

  8. Spread your hands out wide over both hips to help you “scoop” up your loved one

These tips should make the transfer/lift of your loved one from a rocking recliner both easier and safer.




Please check my website frequently because I will be adding a video of this transfer soon.

As always,  if you have any questions or need further advice, please contact me.  I am honored to have you visit my site, and I will continue to provide tips/tricks in an effort to make daily care of a loved one easier and safer.  


Shawna PT, MPT

Categories: Weekly Tips & Tricks

Hello….Welcome to Tips From a PT

Picture of me, Shawna, holding a swissball and gait belt

Shawna, PT, MPT

Does this sound familiar? On top of a demanding job outside-of-the-home and taking care of kids/grandkids , you now have the responsibility of caring for an aging loved one with special needs (i.e. frequent Dr. appointments, hip precautions, assist with bathing/dressing/toileting/bed mobility/transfers/walking, complicated medical equipment, etc.). You desperately want/need to learn more about transfers, swelling control, and putting on those boa constrictor-like TED hose but there is not enough time in the day. So you hire help (in-home providers, CNA’s, Home Health nurses, Hospice services) and pray your loved one does not suffer any falls/injuries.  

Realistically, falls and injuries-like most everything in life-just happen.  However,  what if you had a Physical Therapist educate you in transfers/lift safety and/or give you tips for managing falls, controlling swelling and putting on those pesky TED hose without having to make an appointment or add to your already hectic schedule?

You’re not alone and now there’s another option via the convenience of technology and the internet!  Hello, I am a licensed Master’s degree Physical Therapist with 20+ years of patient care experience in a variety of settings. It will be my honor and privilege to provide easy-to-understand and useful tips I teach everyday to other caregivers struggling with the daily care of a loved one in the home.

I believe information, communication, and consistent handling techniques are the keys to making a difference in the lives of both patients and family members providing daily care. Therefore, if you ever need any feedback or support regarding transfers and care of a loved one, I would be more than happy to connect at I look forward to your comment(s) below, and make sure you visit my site frequently for my latest tips and information designed to help you navigate the responsibility for caring of a loved one or client.  Let’s work together and make daily care easier and safer!

Best Regards,

Shawna, MPT

Privacy Policy

No Comments

Privacy Policy for

If you require any more information or have any questions about our privacy policy, please feel free to contact us by email at:

At, the privacy of our visitors is of extreme importance to us. This privacy policy document outlines the types of personal information is received and collected by and how it is used.

Log Files

Like many other Web sites, makes use of log files. The information inside the log files includes internet protocol ( IP ) addresses, type of browser, Internet Service Provider ( ISP ), date/time stamp, referring/exit pages, and number of clicks to analyze trends, administer the site, track user’s movement around the site, and gather demographic information. IP addresses, and other such information are not linked to any information that is personally identifiable.

Cookies and Web Beacons does not use cookies.

DoubleClick DART Cookie

.:: Google, as a third party vendor, uses cookies to serve ads on
.:: Google’s use of the DART cookie enables it to serve ads to users based on their visit to tipsfromapt. com and other sites on the Internet.
.:: Users may opt out of the use of the DART cookie by visiting the Google ad and content network privacy policy at the following URL –

Some of our advertising partners may use cookies and web beacons on our site.

These third-party ad servers or ad networks use technology to the advertisements and links that appear on send directly to your browsers. They automatically receive your IP address when this occurs. Other technologies ( such as cookies, JavaScript, or Web Beacons ) may also be used by the third-party ad networks to measure the effectiveness of their advertisements and / or to personalize the advertising content that you see. has no access to or control over these cookies that are used by third-party advertisers.

Amazon is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking and the Tips From A PT app to the Amazon properties including, but not limited to,,,, or

You should consult the respective privacy policies of these third-party ad servers for more detailed information on their practices as well as for instructions about how to opt-out of certain practices.’s privacy policy does not apply to, and we cannot control the activities of, such other advertisers or web sites.

You can opt out of all communication with simply by leaving this page.

If you wish to disable cookies, you may do so through your individual browser options. More detailed information about cookie management with specific web browsers can be found at the browsers’ respective websites.

Ebay is a participant in the Ebay Partnership Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking and the TipsfromaPT app to the Ebay properties including, but not limited to,,,,, or

You should consult the respective privacy policies of these third-party ad servers for more detailed information on their practices as well as for instructions about how to opt-out of certain practices.’s privacy policy does not apply to, and we cannot control the activities of, such other advertisers or web sites.

You can opt out of all communication with simply by leaving this page.

If you wish to disable cookies, you may do so through your individual browser options. More detailed information about cookie management with specific web browsers can be found at the browsers’ respective websites.

Affiliate & Earnings Disclaimer

No Comments
Black & White Picture of Medical Equipment

Helpful Equipment & Tips

Affiliate Disclaimer

In an effort to be completely transparent, I want to let you know that I have an affiliate relationship with some of the companies whose products or services I recommend (Amazon, Ebay, Google Adsense, etc…).

This means that, at no additional cost to you, I will earn a commission or credit if you decide to buy any of their products or services.

This is one of the ways I pay for maintaining this site. Just to be safe, you can assume that any link that you click while on my site or using any of the products is an affiliate link and I will earn compensation as a result.

I urge you to not spend any money on any of these products or services unless you really need or can afford them.

Earnings Disclaimer

Every effort has been made to accurately represent the products, services, and/or techniques and their potential referenced on this website. I am not presenting you with a business opportunity. I am not presenting you with a distributorship.

I am not not making any claims as to income you may earn. I am not presenting you with an opportunity to get rich.

Before embarking on any endeavor, please use caution and seek the advice from your own personal professional advisor(s), such as your attorney, physician and/or your accountant.

Where income figures are mentioned (if any), those income figures are anecdotal information passed on to me concerning the results achieved by the individual sharing the information.

I have performed no independent verification of the statements made by those individuals. Please do not assume that you will make those same income figures.

Please do not construe any statement in this website as a claim or representation of average earnings. There are NO average earnings.

Testimonials and statements of individuals are not to be construed as claims or representations of average earnings. I cannot, do not, and will not make any claims as to earnings, average, or otherwise.

Materials in my product and my website may contain information that includes or is based upon forward-looking statements within the meaning of the securities litigation reform act of 1995. Forward-looking statements give my expectations or forecasts of future events.

You can identify these statements by the fact that they do not relate strictly to historical or current facts. They use words such as “anticipate,” “estimate,” “expect,” “project,” “intend,” “plan,” “believe,” and other words and terms of similar meaning in connection with a description of potential earnings, financial performance or possible outcomes (results).

Any and all forward looking statements in my materials are intended to express my opinion of potential earnings or possible outcomes. They are opinions only and should not be relied upon as fact.  Furthermore, the information provided within my website is not intended to replace the recommendations by a physician and should not be used if contraindicated by a physician or another therapist based on your unique situation, diagnosis, prognosis, and skill level.  ALWAYS consult a medical professional before attempting any of the tips/following any advice on this website.




All information contained on this website, including information related to medical matters, health issues, treatments, and products, serves only for informational purposes. It is not intended to replace the advice of your own doctor or specialist.

The information on this website is not intended to diagnose health problems or prescribe medications.

Before start taking the supplements which are recommended at, you should discuss this with your doctor or specialist. This applies specifically if you are already taking medication or are under medical treatment.

Despite the purity of a supplement, there can be occurring side effects. Every person is unique. Like many people, certain foods not well tolerated by intolerance or allergy so can also be a dietary supplement be tolerated poorly by therefore explicitly states that the use of nutritional supplements is at your own risk.

Before using products purchased via this site, you first need to read the information on the packaging.

Food supplements should not be used as a substitute for a varied diet.


Shawna PT, MPT

Mission, Value, Goal Statement

Everyone Matters

Everyone Matters

Success in any endeavor is based on many factors unique to you. I do not know your educational background, your skills, your prior experience, or the time you can and will devote to your endeavor(s).

Please perform your own due diligence before embarking on any course of action. Follow the advice of your personal qualified advisors.

There are risks in any endeavor that are not suitable for everyone. If you use capital, only “risk” capital should be used.

There is no guarantee that you will achieve your goals using any of the ideas presented in my materials. Examples in my materials are not to be interpreted as a promise or guarantee of success.

Many factors will be important in determining your actual results and no guarantees are made that you will achieve results similar to mine or anybody else’s. No guarantee is made that you will achieve any result at all from the ideas, tips, and information on my website.

You agree that I will not share in your success, nor will I be responsible for your failure or for your actions in any endeavor you may undertake.

Please understand that past performance cannot be an indication of possible future results.



Mission Statement

Provide physical therapy-based easy-to-follow tips and information designed to make daily care easier and safer for anyone responsible for the care of someone with special needs due to age, illness, disease, surgery, etc…


Honesty, integrity, safety and easy consistent handling techniques during transfers, bed mobility, daily care and the use of medical equipment.

My Goal

Caregivers, both with and without medical background, want and/or need to learn how to improve his/her ability to provide care.  However, the window of opportunity to observe or interact with Physical Therapists in all settings (Skilled Nursing Facility, Residential Homes, Assisted Living, Long-Term Care) is limited by careers out-of-the-home or hectic schedules. Tips From A will strive to bridge that gap.

Slips, Trips and Falls–Are You At Risk?

No Comments

Falls Prevention Risk Assessment & TipsFalls (1)



Slips, trips, and falls can be scary and even change someone’s quality of life and life expectancy–especially later in life.  With that in mind, I want to provide some fall risk assessment tools as well as some tips to decrease the risk of falls based on each of the assessment tools.  Should you have any questions, please feel free to leave a comment/question below and I will respond within 48 hours.

1.  How many times can you stand without using your hands from a folding chair?


When you stop using your hands to stand up, you force the muscles in your legs to do all the WORK to stand up.  If your legs are too weak to stand up without using your hands, you have an increased risk of falling.  According to STEADI (Stopping Elderly Accidents, Deaths & Injuries) established by the Centers for Disease Control and Prevention, there is an increased risk for falls based on an individual’s age, gender, AND how many times he/she can stand up from a folding chair in 30 seconds without using his/her hands.  In general, men and women 60 to 84 years old should be able to stand a minimum of 10 times in 30 seconds without using their hands, to be at a lower risk for falling!


Therefore, to decrease falls associated with weakness during hands-free Sit to Stands, I recommend completing sit to stand exercises from different surfaces such as a swiss ball, couch, toilet seat, bed and rocking recliner.


2. Do you have weak ankles causing weak balance strategies?


When your feet hit the ground, everything changes!  In other words, your feet and ankles are the 1st part of your body contacting and interacting with the ground.  If your ankles are weak (you cannot maintain standing before, during or following 20 standing heel raises and toe raises without holding onto a walker, counter, or someone else for support), then your fall risk is high.  Have you watched people working out at a gym?  Most of the time, you see people working out their stomach, legs, arms, and back.  Few people spend time strengthening their ankles–the first joint responsible for standing balance–and then they wonder, “Why am I falling?” Your feet/ankles are just like the tires on a car:  1) to run/walk properly you need good shoes (tire tread), 2) keep your ankle balance strategies in good condition (tire/wheel alignment), 3) and expect changes in the terrain such as gravel, loose floor rugs, water, etc (snow/rain/road construction) to require increased strength and balance to safely walk.  Just like poor tires or faulty alignment in a car can result in an accident, weak ankle strategies, and poor foot/ankle support can result in an increased fall risk.



What is a balance strategy?  When the feet contact the ground, the ankles absorb and adjust to the terrain by movements in 4 directions: up, down, and sideways to the inside or outside of the foot.  In other words, the ankle normally moves in a circular motion, unlike the knee that only bends and straightens.  Therefore, when the foot hits the ground, the circular movement of the ankles work to keep you up (balanced in standing/walking) against gravity.  If you are pushed or walk on rough surfaces (dirt, hills, thick-padded carpet, etc…), the ankles respond and attempt to keep you upright.  However, if you are pushed a little harder or walk on rougher terrain, the ankles transfer the extra balance demands from the ankles up to the hips because the hips are the only other joint in the legs capable of circular movements.


The movements of the ankles and hips to keep you upright during standing and walking are known as the ankle and hip balance strategies.  However, there is another balance strategy known as the “stepping balance strategy.”  When the ankles and the hips are weak or can’t move due to stiffness/injury/surgery, the last resort for maintaining balance and not falling comes from the “stepping strategy.”   In other words, you use the “stepping balance strategy” by taking quick steps to decrease the risk of falling and try to correct/maintain your balance when the ankles/hips cannot overcome the effects of gravity and loss of balance.  Consequently, keeping the ankles/hips strong and flexible as well as using appropriate footwear is very important for fall risk management.


Therefore, if you have an increased risk of falls associated with weak ankle and hip balance strategies, I recommend doing standing exercises with VERY limited use of the hands.


3.  How many times have you fallen in the past day, week, and month?

Anyone is capable of tripping, slipping and falling once in a while.  However, if you are falling multiple times over a short period of time (i.e. 2 or more times in a day), the risk for additional fall(s) is higher!  Changes in medications, diabetic complications (hypo/hyperglycemia), inner ear infections/vestibular disorders (BPPV), infections and other medical problems can increase the frequency and risk of falls in the elderly.


Having increased frequency of falls due to medical conditions should be addressed by your doctor.  Do not change your medications without consulting your doctor.  I also recommend an evaluation by an Ear, Nose, and Throat Specialist to rule out any inner ear based balance deficits (BPPV).  Being able to crawl or move around on the floor is a skill I teach in the home so my patients don’t get TRAPPED on the floor if he/she falls, HAS NOT sustained an injury, and needs to either access a phone or get off the floor.



3.  Anemia and Urinary Tract Infections

Anemia, low iron, can increase your fall risk.  Think of iron as a tug boat and oxygen as the large ship needing to get to port.  When large boats are too large to safely enter a harbor/port, they use a tug boat.  Oxygen is carried/delivered in the body by “clinging” to iron in your blood–just like a tug boat! So, if you are anemic (have low iron levels), then you do not have enough tug boats to carry/deliver the cargo ships full of oxygen to your body’s muscles and vital organs.  It does not how much oxygen is available–have large quantities of ships needing to get to port–if you do not have enough iron–tug boats in your blood–to deliver the ships (oxygen) throughout your body.  How do low iron and low oxygen levels increase the risk for falling?  Low oxygen from low iron causes symptoms such as muscle fatigue, muscle weakness, shortness of breath, and possible dizziness–especially during higher oxygen-demanding activities such as standing and walking.



Another common illness that can increase the risk of falls is urinary tract infection. The kidneys and urinary tract system filter (clean) the blood and then “flushes” the dirty contents out of the body through the urine.  If you have an infection of your filtration system (the filter is clogged and dirty), the blood is not effectively cleaned.  The dirty blood circulates all over the body to all the muscles, brain, and organs.  Poorly filtered blood associated with having a urinary tract infection can cause confusion in the brain, fatigue/weakness in the muscles, and increased opportunities for falls because of frequent/often fast trips to the bathroom.

A urinary tract infection is similar to an air conditioner with old and clogged up filters.  Air conditioners operating with dirty filters still work but it takes more energy and increased time to cool the air.  Similarly, the body will continue to move and operate with dirty blood associated with a urinary tract infection, but there are consequences (symptoms) of poorly filtrated blood.

 In the aging adult, unexplained and sudden confusion or decreased concentration can be the first sign of a UTI even before the other symptoms (burning, foul/strong urine odor, urinary urgency and increased frequency of urination) are present because the brain does not like to operate on dirty (poorly filtered) blood.  If my patient has a hard time following directions, requires increased time to read their home exercise program, or is easily distracted from one treatment to another, I suspect a urinary tract infection because the brain is running on dirty blood.  I also suspect a urinary tract infection if my patients complain about feeling really tired, are moving slower, and need frequent rests because the muscles including the muscles responsible for breathing are operating on dirty blood as well.


If my patients have an increased risk for falls associated with anemia or a urinary tract infection, I recommend appropriate medical intervention followed by a gradual resumption of physical activity that includes frequent rests.




Like Taking Candy From a Baby…Why Dizziness Occurs When Standing Up

Medical conditions, such as heart-related problems both with and without breathing disease/disorders (COPD, Emphysema, Asthma) can increase your risk for falls.  If you get dizzy when you stand up and walk, then the risk of falling is higher–especially if you start to walk before the dizziness goes away.  The easiest way to explain what is going on is this:  When you are lying in bed, your heart beats easily because it is not fighting/competing with the force of gravity.  When you sit up, the heart must react and overcome the effects of gravity by either beating with more force (pressure) or by increasing beats per minute (heart rate).  In the same manner, your lungs are under the same demand against gravity to supply the brain with oxygen.  The weaker your heart/lungs, the longer the dizziness lasts because it takes more time for your heart/lung to adjust and overcome/overpower the effects of gravity to get oxygen-rich blood to the brain.  Once the brain gets the oxygen it wants/needs, the dizziness goes away! Dizziness is usually worse when you stand up because the force of gravity on your body is larger when you stand up compared to when you rise from lying down.

Your brain is like a toddler and oxygen-rich blood is the brain’s candy!  When your brain has all the candy it wants, it allows all the other organs and muscles to have the extra oxygen-rich blood (candy) for digestion, walking, and other activities.  Let’s say the brain wants 80% of candy and allows 20% for the rest of the body.  When you stand up and get dizzy, the toddler is getting less than 80% so the brain throws a fit!  To appease the toddler, the heart and lungs increase the rate and/or effort to supply the toddler (brain) with more candy (oxygen).

If you start to walk while the toddler (the brain) is still not getting 80% of the candy (you are still dizzy), the toddler throws a worse fit and starts STEALING the candy (oxygen) from the rest of the body.  For example, imagine the toddler looking at the legs and saying, “Hey the leg muscles are really big and by walking those big leg muscles are taking lots of my candy from me–especially when the heart/lungs are trying to overcome the effects of against gravity.  So, I am going to take what is mine.”  As a result, the brain STEALS/DIVERTS oxygen to itself away from the leg muscles and the legs start to feel weak.

If you insist on walking and using more oxygen, the toddler will resort to making you pass out!  By making you pass out, the brain (toddler) quickly gets more oxygen because 1) the muscles in the legs are no longer moving and using as much oxygen, and 2) the heart/lungs no longer have to fight against the force of gravity to supply the brain with oxygen.  Ultimately, the toddler (brain) gets what it wants even with poor heart and lung health;  however, the brain has caused an increased fall risk either by making the legs weak (forcing you to sit down) or making you pass out! Obviously, there are other illnesses and medical conditions that increase the risk for falls, trips and slips such as Parkinson’s, Alzheimers, Stroke, etc…



5.  What might cause a fall in the home or residential care facility?



Poor lighting, loose rugs, wheelchair footrests, oxygen tubing, broken wheelchair brakes/medical equipment, poor quality footwear, and not setting up the environment (medical equipment)/yourself if you are transferring a loved one/or positioning your loved one safely before transferring, lifting and walking can increase the risk of falls.





FALL FACTS & STATISTICS: Healthcare Settings Outside of the Home


There are several reputable sites that provide statistics and data related to falls and the cost of falls in the healthcare industry.  According to OSHA (Occupational Safety and Health Administration), “Fall protection is the #1 OSHA violation resulting in 1.7 million WC (Workmen‘s Compensation) claims.” Similarly,’s website states, “failure to ensure fall risk management with adequate resident supervision and assistance to prevent accidents” is the most common deficiency observed in patient care facilities resulting in increased fall rates in both state and governmental care facilities  Moreover, the website for the Center for Disease Control and Prevention, highlights “1 out of 5 falls results in a hip or head injury” and “2.5 million elderly adults are hospitalized every year due to falling.” 


Below I have provided a Table with a summary of the information you can access when you visit the website.  I wanted to provide a resource for accessing fall risk measures and quality of care measurements in different patient care settings (i.e. Nursing Homes, Assistive Living Facilities, etc…) because there are falls risks associated with the quality of care and the staff to patient ratio when patients are not able to stay in his/her home.


Obviously, falls are expensive and multidimensional, so it’s important to know if you have an increased risk for falling!   Please click on any of the links below for additional information available on each of the above-mentioned sites.


Website Name Brief Overview/Description of Website Content Quick Link to Website
Medicare Browse/Compare Quality Measures (Fall Rates)and Staff details for different patient care settings (ALF, SNF, NH) Click Here
Healthcare Blue Book Research recommended costs for medical treatments and surgical procedures Click Here
CDC-Falls/Prevention Browse fall statistics and fall prevention programs for elderly adults NOT in a Nursing Home, ALF, hospital, or SNF Click Here

Falls, slips and trips can occur at any time; however, I hope I have explained some common risks and provided you with some helpful information regarding falls. Please leave a comment or ask a question below and I will be honored to respond as soon as possible. Also, be sure to check my website frequently because I will be adding more helpful tips, tricks and information on falls.  You can click HERE to see a video showing how to lift a loved one from the floor if he/she is not injured. I want to thank you again for visiting my site and I look forward to any questions, comments or ideas for future pages, posts, and blogs!



Until then, Stay Safe!!!


Shawna, PT, MPT

Categories: Weekly Tips & Tricks

What To Know When Choosing A Nursing Home



This page is dedicated to providing helpful tips to caregivers faced with deciding where his/her loved one would receive the BEST care when living at home is no longer an option.  Learn alternatives to nursing home placement, how to choose a nursing home if that is the BEST option, and the differences between Nursing Homes, Skilled Nursing Facilities, and Assistive Living Facilities.

The Primary Caregiver Shift


Illness, injury, disease, and or surgery can trigger the caregiver shift. For example, one moment your loved one was independent, capable of driving, preparing meals, completing household chores, bathing, dressing, and walking without any falls or concerns. Then you receive an unexpected call from the hospital or your loved one’s doctor because he/she suffered a STROKE, massive HEART ATTACK, substantial FALL with a BROKEN HIP/INJURY, and/or diagnosis of ALZHEIMER’S DEMENTIA, PARKINSON’S DISEASE, or CANCER. Life changes drastically in a moment’s notice and you realize you now have to make numerous decisions regarding the most appropriate setting for your loved one to either recover, rehabilitate and/or permanently reside based on:

  •  his/her potential to achieve their prior level of function
  •  future fall risk
  • and level of care needed to provide the optimal quality of life, functional independence, and safety.


Researching and deciding on an alternative residence for your loved one can be emotional, physical and mentally exhausting. Perhaps you experienced a similar decision-making process for your own children when you had to consider childcare in a home, church or daycare center; however, instead of dropping your child off and picking them up in 5-8 hours, you might be dropping your loved one off at a Nursing Home for the remainder of his/her life– hence the additional anxiety, fear and stress into your already busy LIFE!


Decisions…Decisions…Decisions….Picture of a Question Mark in Red


Where do you start and what should you know when faced with possible placement of a loved one? As a Physical Therapist, I am going in and out of different settings (Assistive Living, Nursing Home/Long-Term Care, Residential/Community Living Homes, Skilled Nursing and private homes) every day and at various times of the day. Coordination of care with nurses, bath aides, other therapists and doctor’s appointments results in unexpected arrival times and behind-the-scenes insight. Therefore, I recommend the following tips when looking and choosing a care home or facility for your loved one.


1.  Friendly Advice – You are neither the first nor the last person in this situation. Talk to friends, co-workers,and church members.  Listen to their experiences, concerns, and tips–especially if you have someone in your inner circle that works as a C.N.A, nurse, or therapist in one of the settings you are having to consider.


2.  Unexpected Visit – Be an undercover investigator! Walk in unexpectedly to any setting and get a first impression “feel” for yourself. Listen to your internal radar – does the environment feel warm, inviting, LOVING or do you feel like an intruder?

Get a “sense” of the environment. What does it smell like? Hopefully, it does not smell like bleach, ammonia, urine, or burned food. What does it look like? Take notice of the furniture, walls, other residents, and the employees. Pay particular attention to the last two: other residents and the employees. The residents should be groomed, using equipment that is not FILTHY or BROKEN, and fairly content/social if they are out of their rooms. Are the clients/patients and employee interactions appropriate? The employees should be actively engaged in providing care, managing fall risks, and pleasant/welcoming when interacting with fellow co-workers and residents. In other words, the employees should not be on private cell phones, ignoring call lights, avoiding care and fall risk management opportunities, demeaning or short-tempered, and appearing “put out,” apathetic, or inconvenienced with co-workers or residents. In the same manner, do you see someone roll their eyes when waiting for a resident that requires increased time to transfer, move in his/her wheelchair or walk? Do you see anyone walking around with dirty shirts/pants either from eating or having an accident? Do you see stains on the floor, holes in the walls, or “OUT OF ORDER” signs throughout the facility?


3.  Too Good To Be True – If you get the sense that you are observing “Top Notch” facility operations and patient care, be sure to intentionally look for a group of individuals with clipboards, dressed in business attire, and interviewing or closely observing the facility–this is a clear indication the facility is currently under STATE inspection. The Centers for Medicare & Medicaid (CMS) a division of the U.S. Department of Health and Human Services conducts an inspection of every patient care facility every 12-15 months. The inspection process can take several days and can be a “surprise” visit, but some of the process includes:


  • Touring/Observing the facility’s daily operation
  • Interviewing/Observing a sample (several residents) selection of clients and employees
  • Monitoring the Kitchen/Food preparation and quality
  • Observing Medication preparation and administration
  • Reviewing the Abuse Prevention protocol
  • Evaluating Quality of Life Measures and Assessment procedures
  • Determining/Document any below standard care or deficiencies

There will be a NOTICE on the door when INSPECTORS ARE present in the building; however, if you are walking into a facility that is BUSY and FRANTICALLY completing repairs, cleaning, and taking care of patients–the facility is most likely EXPECTING or ANTICIPATING an audit or inspection. Sometimes facilities are reviewed more often than 12-15 months as a result of numerous filed complaints or increased frequency of falls, slips, trips and injuries. For a more in-depth explanation of the Inspection Process, you can click on this link: [PDF] The Nursing Home Inspection Process – Office of the Legislative Auditor.  You can ask employees if you suspect you are observing “Too Good To Be True” patient care and facility operation, but you might not get a straight answer.  Therefore, I recommend waiting it out and returning several times over a period of a few weeks.


4.  Utilize the power/convenience of Web-based Research – If you want to look up specific data on specific care facilities, you can click on these links:


Medicare.govMedicare insignia



These websites provide information regarding patient care facilities and their State inspection data related to Quality Measures (statistics about falls, pressure sores, urinary tract infections, etc…) and how facilities compare to the STATE and NATIONAL average. In addition, you can compare specific facilities with the STATE and NATIONAL averages regarding how much time per day a patient spends with each discipline (Nurses, Certified Nurses Aides, and Physical Therapists).


INTERESTING TREND: I reviewed several facilities using these 2 websites.  Facilities with Higher Star Ratings (4 or More) in both Quality Measures (Falls) and Staffing (Time spent with each discipline), had less than the average number of falls when patients spent more time with Physical Therapists and Nurses! In other words, if a patient spent more than the state and national average time with C.N.A’s and less with Nurses/Therapy, the fall frequency INCREASED!


5.  Loved One Follow-up and Feedback – Listen and Observe your loved one for any signs/symptoms of neglect, abuse, failure to thrive, complaints/compliments to ultimately determine if your loved one’s needs and quality of life are being met.  Remember YOU can relocate your loved one at any time! Red flags and common warning signs/symptoms can be reviewed by clicking on this link:  HELPGUIDE.ORG


Proper placement of a loved one also depends on the level of care and rehabilitation potential of your family member.  For instance, if your loved one just had surgery and is slow but able to stand up, walk short distances, get in/out of bed, go to the bathroom, shower and dress, then placement in a Long Term Care Facility is NOT appropriate!  



The Difference Between Each Facility/Setting

Type of Facility

Long Term Care/Nursing Home

Skilled Nursing/Rehabilitative Facility

Assistive Living Home/Facility

Brief Description  On-site full staff including nursing (RNs, LVNs, CNA’s), full-service medication administration/management and business staff (Administrator, Director of Nurses, Maintenance, etc…) to provide skilled care 24 hours/7 days a week On-site full staff including nursing (RNs, LVNs, CNA’s), full-service medication administration/management and business staff (Administrator, Director of Nurses, Maintenance, etc…) to provide skilled care 24 hours/7 days a week Limited to no nursing (RN/LVN) staff on-site, full-service medication management to assist patients with medication administration/management.  On-site business staff (Administrator, Director of Nurses, Maintenance, etc…) available in the facility but less likely in a residential-based assistive living site.
Rehab Services Generally offers limited or NO rehabilitative services (Physical, Occupational/Speech Therapy) Readily available, daily rehabilitation services by Physical Therapy, Occupational Therapy and Speech Therapy depending on the patient’s needs.  For example, a patient admitted for total knee replacement rehab does not require Speech Therapy, but a patient with the diagnosis of a recent stroke would benefit from PT/OT and ST.  Physical therapy evaluates and treats any deficits involving the legs (walking, transferring, bed mobility, and standing balance).  Occupational therapy evaluation and treat any deficits involving the arms (dressing, bathing, toileting, eating, meal preparation).  Speech therapy evaluates and treats any speech, swallow, and cognitive deficits. Rehabilitation is offered by either on-site therapists or contract (off-site) therapists through Home Health Agencies.  Therapy requires a doctor’s order and rehab is NOT a daily service.  Generally, patients receive therapy either twice or three times per week.
General Patient Rehab Potential Poor.  Poor rehab potential means an individual either cannot or will not benefit from skilled therapy based on physical limitations (quadriplegia, advanced Parkinson’s Disease with contractures, unresponsive/coma), mental impairments (advanced Alzheimer’s/Dementia) and/or personality/emotional barriers (refuses to participate in therapy, becomes physically/verbally aggressive with therapy, is content with his/her level of independence/dependence). Fair to Good.  Initially patients require MAX (patient completes 25%, caregiver 75% or more) ASSISTANCE.  However, the patient is expected to progress with skilled therapy and eventually discharge home with home health services or home with doctor’s orders for outpatient rehabilitation. Fair+ to Good.  Initially, patients require MINIMUM (patient completes 75%, caregiver 25%) to CGA/Contact-Guard Assistance (caregiver touches the patient but the patient completes 100% of the transfer/bed mobility).  If patients receive therapy, the patient is expected to progress with skilled therapy and eventually discharge at indirect SPV/Supervision (patient completes 100% mobility and transfers and staff “watches” intermittently or as needed to decrease fall/injury risk) or MI/Modified Independence (patient completes 100% mobility and transfers but uses medical equipment such as a walker, wheelchair, or power chair)
General Patient Care Needs  High – Patients/Residents require TOTAL (patient completes 0%, caregiver provides 100%) to MAXIMUM (patient completes 25%, caregiver provides 75%) assistance from 1 or more caregivers for bathing, toileting, dressing, eating, transferring, walking or wheelchair-based mobility Initially High to Moderate but as the patient progresses with therapy, he/she generally discharges home at MODERATE (patient completes 75%, caregiver 25%) to MINIMUM (patient completes 50% and caregiver 50%) ASSISTANCE levels. Mild initially and eventually LOW.  Residents can transfer without assistance, get around using a wheelchair, scooter, walker, or cane without caregiver assistance, and are generally able to continue driving and/or enjoy planned community-based activities (shopping, BINGO, movies, etc…)


These are general descriptions, the level of care guidelines, and some facilities will provide higher levels of care regardless of  the patient’s rehab potential.  For example, I have provided treatment to a patient in an ALF (Assistive Living Facility) that required MAX A (the patient could not transfer, walk, or get in/out of bed without a great deal of efforts and consistent 75% or greater caregiver-assist level).  Generally, patients in an ALF should be able to transfer without the skilled assistance of a caregiver, nurse or therapist because most ALF’s DO NOT have or provide ON-SITE, SKILLED NURSING or REHABILITATION!  If your loved one requires assistance every time he/she transfers, walks, or gets in/out of bed, I recommend an SNF (Skilled Nursing/Rehab Facility) or Home Health with therapy until he/she is able to transfer, walk and get in/out of bed with less assistance.
Thank you for visiting my site and I sincerely hope you learned something to make the decision for placing your loved one in an alternative care setting easier.  However, if you have any questions or need further advice, please contact me.  If I do not know the answer, I will put forth my best effort to find the answer or tell you I do not know the answer.  I am honored to have you visit my site, and I honestly strive to make caregiving easier and safer.  


Til next time,



Shawna PT, MPT

Categories: Weekly Tips & Tricks

Drive-Poly Fly Transforming Wheelchair: The 2-in-1 Solution

No Comments

Drive-Poly Fly Transforming Wheelchair


Seat Width: 16″, 18″ and 20″
Weight 19 lbs (using 8″ transport chair caster wheels) 29 lbs (using larger 24″ standard wheelchair wheels),
Removable armrests
Swingaway footrest
No tools required to convert from Transport to Standard wheelchair
Anti-tipping kit


My Rating: 5 out of 5 stars


Product Overview

The easy converting 2-in-1 wheelchair makes accessing narrow doorways possible with decreased overall expense and fall risk!

Many established/existing homes are built with narrow bathroom doorways (28-32″) and standard wheelchairs with the large wheels require >34″ clearance.  Until now, this common environmental barrier was solved by either incurring an expensive remodeling bill ($1500+), using less optimal/safe equipment or opting for sponge/bed baths.

Hiring a carpenter or construction company to enlarge an existing doorway or remove the door frame and re-plaster the new opening is very expensive!  I have known families to spend $1500 on a doorway remodeling project—GOOD GRIEF!

As a Home Health Physical Therapist, I have resorted to training patient’s and caregivers to use a rolling, office chair to access a bathroom if the doorway is too narrow and he/she does not have a transport wheelchair. Since rolling office chairs are in most homes, the family is not out a large additional expense.  However, transferring from a wheelchair onto a rolling office chair takes A LOT of training, patience, and time–definitely NOT my first choice but sometimes it is the only viable/temporary solution.

Transport wheelchairs have in-line casters designed for narrow doorways and tight spaces.  However, if you read my page on “WHEELCHAIRS,” you know I DO NOT RECOMMEND a transport wheelchair in the home primarily because 90% of transport wheelchairs are designed with non-removable/fixed footrests and armrests.  Transfers are more difficult and dangerous because the patient has to be LIFTED over the height of the armrests while simultaneously avoiding tripping/falling over the footrests.  Then there is the final option–reverting to sponge/bed bathing.



Sponge/Bed Bath Disadvantages

Sponge/bed baths REALLY do not APPEAL to me for several reasons.  First is the limited overall CLEANLINESS.  Think about it.  Your loved one has been sweating, possibly eating, and maybe even had to use the bed for toileting.  He/she needs a bath.  A basin of warm soapy water and another basin of warm rinsing water is brought to the bed.  The cloth is used on the body to remove the germs (possibly from a wound), grime, and feces. Then dunked repetitively back into the soapy now contaminated and dirty water–YUCK!!!  In addition, those basins of water cool off really quickly–so what was originally warm is now cold within 5 minutes of starting the sponge/bath process–Brrrr!!!

When your joints ache from arthritis, being sick, or working out, does a nice hot shower/bath help?  ABSOLUTELY – heat relaxes muscles!  Now imagine how good it feels when you can specifically target hot water on those achy, sore, tight areas—AHHH.  Well, your loved one is no different.  Using a hand-held shower head while sitting on a shower chair or tub transfer bench, the patient can hold/target the constant stream of hot water over his/her shoulders, knees, hips, neck while the caregiver washes his/her hair, back, and feet.  Ultimately, bathing in a tub/shower:

  1. promotes improved cleanliness as the germs, grime/feces wash down the drain,
  2. provides a steady heat source,
  3. utilizes the benefits of heat on muscles and joints, and
  4. encourages out-of-bed activity thereby reducing secondary risks such as blood clots, pressure/bed sores, pneumonia, and urinary tract infections.



So now back to the original problem, you have a narrow doorway and the wheelchair does not fit through the door!  The solution–the DRIVE POLY-FLY TRANSFORMING TRANSPORT WHEELCHAIR!  This is literally 2 wheelchairs (a transport wheelchair and standard wheelchair) in 1.  You get the convenience of using the narrow design to access the bathroom plus the mobility associated with the large-wheeled standard wheelchair designed for easily navigating ramps, uneven terrain (grass, gravel parking lots, dirt) in one piece of equipment that is easily converted without requiring any fancy tools!

When you consider the price of a fall, the increased effort and fall risk associated with traditional transport chairs–or even unconventional rolling office chairs, an expensive remodeling project, and the disadvantages of sponge/bed baths, you should choose anything that is more versatile, functional and safer.


Home care of a loved one often requires various specialized equipment, but when you can use one piece of equipment for more than one task–you win! I have provided a link to where you can get a DRIVE POLY-FLY WHEELCHAIR HERE for just over $300, but make sure you are purchasing the COMBO and the appropriate seat width because the wheelchair comes in 16″, 18″ and 20″ seat widths.


I hope this review was helpful and informative.  Please contact me with any questions, concerns or ideas regarding this post or any other ways I can help you make caregiving easier!







Shawna PT, MPT

Diabetic Chocolate Chip Cookie Recipe


Diabetic Chocolate Chip CookiesDiabetic Chocolate Chip Cookie Recipes are becoming more and more popular.  Here is a Kid Approved, Healthy, and Easy Diabetic Chocolate Chip Cookie Recipe.



Delicious, Soft and Kid Approved these cookies have No Flour, Very Little Butter, and one of the Easiest Homemade Chocolate Chip Cookies I have ever made.
I have been asked more than once for my personal healthy alternative Sugar-Free Chocolate Chip Cookie recipe so here it is for one and all!  As a Physical Therapist, I endeavor to promote health and often times I have to “think outside the box” for alternative solutions to a problem.
I felt very hypocritical when I was 75 pounds overweight and my career was based on promoting healthy, safe, and independent lifestyles.  The ANSWER:  lose weight without giving up one of my sweet addictions.  Now I can eat these cookies, share these cookies with diabetic patients, and remain compliant with my goal to promote optimal health, safety and independence.
So enjoy and feel free to share or leave me a comment after you try a batch!
P.S. if the cookies turn out flat, you need to decrease the amount of butter!



No Flour Chocolate Chip Cookie Ingredients


3 1/4 – TBSP Stick Butter

1/3 – Cup Splenda Brown Sugar

1/3 – Cup Splenda Sugar

1 – Tsp Baking Soda

2  – Tsp – Vanilla Extract (I highly recommend Watkins Double Strength Clear Vanilla)

2 – Eggs

2 – Heaping cups of Almond Meal (I buy this in bulk at Sprouts)

1 – 8 oz bag Hershey’s Sugar-Free Chocolate Chips





Preheat oven to 350ºF.  Beat butter, brown sugar, sugar, and vanilla extract in a mixer until creamy. Add the eggs and baking soda and mix well.  Add almond meal at low speed.  Stir in chocolate chips (I have a Kitchen Aide mixer and I use “Speed 2” to mix the dough and “Stir” to add the chocolate chips).

Bake 8-9 minutes or until edges are slightly browned.  Allow the cookies to cool slightly and enjoy the best moist, soft and deliciously healthy treat!


Batch of Diabetic Chocolate Chip Cookies


I successfully completed the Trim HCG diet and lost 75 pounds.  I created this cookie recipe to be Carbohydrate Free and Sugar-Free as a personal sweet treat.  To this day, my entire family prefers these Healthy Alternative Chocolate Chip Cookies to homemade all purpose flour-based cookies.  Oh and these cookies do not get hard!

Gait Belt Product Review

No Comments

Gait Belts


Learn How to Use a Gait Belt Properly, Why You Use Gait Belts, and the Best Gait Belt For Optimal Safety,Effectiveness, and Adjustment.

Gait Belt with Metal Buckle

Gait Belt with Metal Buckle

I recently completed an online training course that included the use of a gait belt.  According to the course, the gait belt should be placed “right under the ribs of the patient.”–EEEK you have to be kidding me!

If you are wondering why this makes me shriek, then let me explain 🙂

The diaphragm, the primary muscle used for breathing, is located RIGHT UNDER THE RIBS.  Furthermore, to effectively use a gait belt, the belt must be securely tightened around the person.  Therefore, if I were to follow the instructions provided in the online training course, I would be decreasing my patient/loved one’s ability to breathe by TIGHTLY securing the gait belt over the muscle responsible for breathing!

Breathing is one of the primary requirements of life.  Personally, I prefer and demand my patients BREATH as easily and as deeply as possible–especially if he/she has a breathing disorder/disease such as Asthma, COPD (Chronic Obstructive Pulmonary Disease), or Emphysema–to decrease the risk of him/her losing consciousness while standing up or walking.  Therefore, I teach ALL my patients and their caregivers, the most effective placement of a gait belt is as close to and over the bones of the hips as possible.  In other words, try to secure the gait belt BELOW the belly button and on the boney area of the hips!

Whether you choose to use a gait belt or not to transfer/lift someone, you should know there are different types of belts available.  Below is a basic product review of gait belts.



Product:  Gait Belt

Price: $3.99 (Comfort up to $23.99 (

Description: Width: 2″, Lengths vary depending on the waist/girth requirement (I use a 60″), Cotton with Metal Buckle

My Rating: 4 out of 5 stars


Why Use Gait Belts


Gait belts are used by many Health Care Providers around the lower waist of a patient to 1) provide a leverage point of contact for a “controlled descent” if a patient loses his/her balance, 2) decrease having to use a patient’s clothing or body part while transferring or lifting of a patient, and 3) reduce a cooperative/oriented patient’s anxiety associated with attempting a new skill such as walking after a surgery or transferring from the bed<>chair/wheelchair.

The Best Gait Belt For Optimal Safety,Effectiveness, and Adjustment

If a caregiver prefers and/or feels more confident using a gait belt for daily transfers, walking and home care, I firmly believe in using a metal clasp/buckle and a fabric (cotton)-based belt.

Gait Belt with metal buckle

Metal Clasp Gait Belt

 Plastic-buckles (aka side-release clasps) have a tendency to break and the plastic-coated webbing (wipeable gait belt) causes increased sweating when applied to the skin and is more difficult to keep in place around the lower waist–especially after a shower/bath when the skin is wet.

Vinyl Gait Belt with Plastic Buckle

Vinyl Gait Belt with Plastic Buckle

Furthermore, tightening and securing the belt is more difficult because the vinyl either “slips” on itself or does not want to adjust readily to effectively accomodate various girth/waist sizes.

In comparison, the cotton belt is machine washable, wicks away sweat/moisture, and tends to stay in place against clothing/skin resulting in decreased “slipping of the belt up or down.” The metal buckle has “teeth” and are more durable/reliable as a securing mechanism when compared to the side-release plastic clasps, and those “teeth” allow for fast and easy adjustments around the hip area.


How To Put On A Gait Belt  

I always teach caregivers (both C.N.A’s and family members) to remember how you eat and that is how to put on a metal clasping gait belt.  You “chew” with the teeth and then “swallow”.  Therefore, take the end of the belt through the TEETH first (CHEW) and then loop it through the opening without teeth (SWALLOW).







Placing and Adjusting the Tightness

If you place the belt above the belly button, the belt is more likely to slip out of place.  The reason for slipping out of place is simple.  When you put on something tight, you generally take a deep breath in and hold it.  Consequently, you are CHANGING the girth or size around the waist.  The belt might be too tight or loose when you release your breath (exhale).  In the same manner, I notice when I approach a patient with a gait belt, he/she tends to take in a large breath too.  If I were to position the belt above the belly button, the belt would be tight/secure until the patient exhales.  Once he/she exhales, the belt will be loose and slip up towards the armpits.  If I secure the belt around the bones of the hips, the belt will remain tight regardless of my patient’s breathing pattern.


Ideally, the belt should be snug around the lower waist and NOT above the belly button. However, I never recommend the belt to be put over a colostomy bag, healing surgical incision or existing wound/injury site.

To tighten the Gait Belt simply pull the slack through the teeth area of the buckle first and take up the slack through the open end of the buckle.  You should have just enough room for your fingers to go between the belt and the patient/loved one’s body.  In other words, make sure the belt is tightly secured and there is minimal slippage!





Miscellaneous Uses


I have used a gait belt– secured in a figure 8 pattern– over the front of a rolling walker (RW) to help my patient maintain non-weight bearing restrictions.  This technique should be taught by a PT in person, but it is effective when a patient is weak and can’t hold up his/her foot during transfers/walking.

In addition, a gait belt can be used to secure the lower leg on the elevating footrests of a wheelchair.  Some patients with heavy casts or a great deal of swelling cannot keep his/her leg on the elevating pads and footrest of a wheelchair; therefore, I use a similar figure 8 pattern mentioned above and secure the leg on the footrest.


Finally, I have trained patients to loop his/her foot and ankle with a gait belt to help get a swollen/weak leg on and off the surface of the bed.



Gait belts are easy to use and can be used for a variety of patients, in different settings (home, hospital, nursing home), and for multiple purposes.  However, I recommend caregivers receive appropriate gait belt training before using a gait belt for transfers, walking, and positioning of a lower leg.

I hope this information was helpful, and please feel free to leave a comment or contact me regarding any questions, ideas, or additional tips related to gait belt use/safety.  As always, I am here to help you make daily home care easier and safer!


Best Regards,


Shawna PT, MPT