Beyond traditional techniques: Functional movement training for safe resident handling

RHONDA DEMENO: Well, welcome to today's Senior Advisor podcast. My name is Rhonda DeMeno. I will be your host for today's podcast. Today's podcast is titled Beyond traditional techniques: Functional movement training for safe resident handling. I have the pleasure of introducing Kristi Moore, who is a Senior Ergonomics and Wellbeing Consultant for WTW's Workforce Vitality Group. Welcome, Kristi.

KRISTI MOORE: Thank you for having me, Rhonda.

RHONDA DEMENO: We are so excited to have you share on your knowledge and your experience with our audience today. With that said, today, we will explore the transformative world of healthcare with Kristi, who is an occupational therapist and certified industrial ergonomist. She has over 15 years of experience in diverse healthcare settings and nine years in industrial environments. Today's discussion will focus on functional movement and how it differs from traditional techniques, its benefits for health professionals and its role in resident and patient-centered care.

We will also discuss insights on functional movement training for safe resident and patient handling excellence, and redefining standards in patient care. Kristi will walk us through functional movement, how it differs from those traditional techniques and its great benefits to protect health care workers from injury, and again, the important role that it plays for safe resident moving and positioning. We're going to also cover the challenges of implementing functional movement training, overcoming some of the resistance to change, your staff may have some resistance, and trying to really work through this new concept, and the future of patient handling in senior living and healthcare environments. So let's get started. So, Kristi, my first question, what inspired you to explore the topic of functional movement and patient handling?

KRISTI MOORE: I guess it started when I was an occupational therapist. Working with patients and having to train nurses and CNAs bedside and how to move in use their body when they're moving patients. And I always saw that was like an area that needed more training on or whatever. But then when I transitioned to working at WTW and becoming a consultant and really going to different healthcare clients and seeing what they do is when I really started to notice that the piece of the puzzle that was missing was the understanding how to use your body so that you're in the strongest position possible.

So, obviously, with safe patient handling, there was a huge emphasis on using equipment, which is phenomenal. The equipment has really, really helped decrease the amount of injuries and the demand on the body when moving patients. But the thing that I noticed with was that the training doesn't involve how to use your body. And if it doesn't involve using your body, it doesn't get to the root cause of it. How do you actually position your body properly when you're using those body mechanics.

So think of functional movement as the baseline of all movement. There's eight functional movements in life. And every other movement stems from that. So I looked at it as we're trying to teach people how to move patients. And we focus heavily on equipment and how to use the equipment. But the focus isn't always on how do you use your body as the caretaker or the nurse, or the CNA, or the therapist? It doesn't focus on that. And doing CrossFit and learning more functional movements, it's almost like all came together for me when I was seeing different parts of it. And then looking back on my own experience being bedside and seeing what I was doing.

RHONDA DEMENO: Really good. I know we look at as risk consultants, workman's comp claims, and oftentimes, we are seeing back strain and the overall physical requirements of CNAs in senior living environments, and in nurses, and all other types of health care workers, even dietary staff just not using their bodies correctly when they're delivering meals or whenever they are transferring a resident from a lower position, from bed to wheelchair, or from wheelchair to the toilet. So, I mean, this is very interesting to me. Because in senior living, we always discuss safe resident moving and positioning. But let's talk about functional movement and how it differs really from that traditional resident moving and positioning program.

KRISTI MOORE: Absolutely. So traditional handling techniques, you hear people like you got to bend at your knees, you got to get the patient close to you, which is traditionally what you would tell people. But the problem with that is, is you're not teaching people how to actually engage their muscles. You're not teaching them how to properly squat down. Bending at your knees. Drives me crazy when I hear that. We'll just bend with your knees. Well, if you're bending with your knees, you're putting all your weight into your toes and you're not hinging at the hips.

So you're not really getting into a proper squat position. So teaching people just body mechanics without going to the baseline, the fundamental of movement, you're doing them a disservice. Because in order to transfer a patient, you got into a good squat position. Well, bending your knees is not actually how you do a squat position. You want to hinge at your hips, keep your weight towards your heels. And keep that ear, shoulder and hip in alignment. Instead of when you say get someone close to you, you're basically trying to keep the spine in neutral.

So the functional movements teach you that. You got to learn how to crawl before you can walk and run. So functional movements is just like the baseline of it. So, like I said, there's eight functional movements in life. Every other movement stems from this. So it's a squat, a lunge, a push, a pull, a hinge, twist, gait, and then a grip. So the difference is, is when we focus on that first. So when we teach people, this is how you're going to properly do a squat.

Now, this sounds like you're learning, how to do exercise movements. But these all transition to functional movements in life like squatting. We all squat every single day. Every time we get on a chair, off a chair, on a toilet, off a toilet, we're squatting. But if you're not squatting properly, and you're not using the muscles the way they're designed to be used, you're actually probably doing more harm than good. So when we can teach people how to actually use and engage their muscles the way that their body is designed to do the movement patterns, we can actually make people stronger, which is the goal.

But for me, it was just the traditional training is teaching people some body mechanics and how to use lifts. And the piece of the puzzle that I kept seeing that was missing was that basic movement patterns that people weren't doing. Even simple things like getting closer to the patient. Well, how do you get close to the patient? Do you want to get into a lunge? Do you want to get into a squat? You want to get close to them? There's just these little things, like you want to keep that ear, shoulder and hip in alignment, so you're in that neutral spine position to protect your spine.

When you're doing that stuff, you want to be engaging your core to protect your back. So it's those little things that you can teach that are a little bit more getting back to the basics of it. And then how to apply it to what you're currently doing. Even with all the equipment, the Hoyer lift, the sit-to-stand lifts, all these things. People are still getting injured because they're not being taught how to use their body when they're working with patients, regardless of the environment they're in.

RHONDA DEMENO: I'd say that's always misunderstanding when staff members think, well, using the lift will prevent me from hurting my back. But what ends up happening is if they're not using a lift correctly to your point, they end up getting injured. And then we do see a lot of resident injuries because of the lift has a malfunction or the lift is not being used appropriately, or the straps on the lift are, you know, really rubbing the resident's skin.

So there's a multitude of problems that can occur from misuse of lift. So that's not a safe net for sure. So I hear that your passion for functional movement. But why do you think it's really crucial for achieving excellence and patient handling? Can you elaborate on that.

KRISTI MOORE: So I think it's crucial for achieving excellence with patient handling is because when you're in the strongest position and you're using your body and your muscles the way they're designed to be used, your patient is going to be safer. Because you're thinking, if I get into this strongest position, I can help them more. And then also along the way, you can also coach them. You can actually coach your patients on even how they should be doing stuff.

Just simple like simple cues like, scoot your hips to the edge of the bed, bring your heels back. And I want you to push, you know, through your legs and push off the bed. Engage that core. Squeeze that core. You can even coach your patients on how to move stuff. But the thing that I find that I think the most critical and beneficial to it is because while you're working, you're using your muscles, you're getting stronger. And when you get stronger, you're building up your confidence of moving with patients. You're building up your confidence to helping coaching them.

And the great thing about it is, is when you learn how to use and move your body, you can apply it to any environment you're in. People always ask me, well, how do you do like a sit-stand transfer? I'm like, well, it's the same way no matter what your environment is. If you're in the shower, if you're doing, if you're in a home, if you're in there, an apartment in assisted living, the principles are always the same. Because if you control how you're using your body, and you're the safest you can, as strong as you can be, you're also making sure your patient is also the safest and the strongest they can be. So it's a combination of the two.

RHONDA DEMENO: So there's definitely benefits that you're describing, I think, employee confidence and security really knowing that they have this expertise and this training, they're really able to protect the resident from having a poor experience. And at the same time, they're protecting themselves from injury. Are there any other benefits, key benefits that you'd like to talk about today?

KRISTI MOORE: So some other benefits, too, is you always hear facilities have a lifting limit, which always makes me laugh a little bit. Because if you have a patient who had a stroke or whatever, or they're a larger patient, and you have to help them move their leg, that leg could weigh over 50 pounds. So even though you're a no lift facility, moving patients or moving people and interacting with people is not easy. Even a petite woman who is like 80 pounds trying to get her to move if she has cognitive impairment can be difficult.

RHONDA DEMENO: So I get that question all the time, what's the maximum amount of weight that we should have in our policies? Because it is a case-by-case scenario. Can you explain that a little bit more on the weight limit?

KRISTI MOORE: And that petite woman who's has cognitive impairment, she could also resist you. So there's that part, too.

RHONDA DEMENO: Absolutely.

KRISTI MOORE: They resist your movement if they're not fully understanding what you're asking them to do. So a lot of facilities, they have weight limits, which, you know, I think are important to have. Most times, it's 50 pounds. But when I do training and I talk to employees, I always tell them this thing. This is how you know if something is too heavy for you, and you need help. If you can do it and talk while you're doing it, it's probably not too heavy for you.

But if at any point you can't talk, and you have to grunt, it's probably time to get help. Even if it's 50 pounds or 40 pounds, if you find that that's still heavy for you and you're not able to lift it or move someone's arm and talk while you're doing it, that's probably heavy for you.

RHONDA DEMENO: That's really good advice. Really, really good advice. So let's talk a little bit about patient-centered care, or resident-centered care, and how functional movement contributes to more patient-centric care.

KRISTI MOORE: So I think it contributes to patient-centered care indirectly. Because if the caretakers are really focusing on making sure that they're the strongest and using their body the way it's designed to use, and following these functional movements and applying them to body mechanics, your patient is going to be safer that way because you're thinking about how am I the strongest that I can help them if they need it?

So when you focus on yourself first and making sure that you're doing everything correctly, your patient is going to be safer because you're not putting yourself into an awkward position that could lead to your injury, and then you can actually be there for your patient.

RHONDA DEMENO: Every senior living organization, I hope they listen in and realize that this would be a great concept, even to bring forward during an orientation to educate their staff on functional movements. I just want to clarify, too, in our discussion today, we may be talking about patients and residents. They're interchangeable. This is a Senior Advisor podcast where we talk really about senior. But it can translate to other health care settings for certain. But when we're talking about senior living specifically, what would be some of the challenges an organization would face when they are implementing a functional moving program?

KRISTI MOORE: So I think just like everything, people don't really like change. But the hard thing is, is it's changing people's behaviors, which can be challenging. It's always challenging to change someone's behaviors. But if everyone's on board and everyone's doing it, it's a lot easier to do, especially if they coach each other. So if you see someone doing something and their back is rounded. You can say, hey, don't forget to do it this way. It becomes a team approach.

We coach each other when we see something or we help somebody or someone's like, hey, I'm having a really hard time with this, can you help me? But if everybody's on board and everyone's doing it, it's a lot easier. Because we as humans, we want to fit in. If everyone else is doing it, we want to be part of it. So when you make it more of a team approach to it, I think that makes it better. I think they did in psychology. If they walk into a room and everyone stands up when the red light comes on, eventually everyone follows, and they have no idea why.

So what happens is, especially with function movement, why we've gotten away from it is because of the fact that we've seen people move differently. And then we mimic that. So if everybody can get on board and understand the importance of it. And a lot of times the way that I get people to really get on board with it is I turn it to them. I'm like, if you're squatting. And when you're having to transfer someone and you're really getting to that squat position, you're engaging your glutes, and your posterior chain. Your glutes going to get firmer. Your legs are going to be toned. And they're like, OK. So I try to turn the training. So it makes it to them. This is going to benefit you. You're moving people all day. Your legs and everything is going to get nice and toned. And they're like, they're on board. But I think everyone has to be involved. Because that's the only way you're going to get real change is if it starts from the top down.

RHONDA DEMENO: So it's really an investment in a wellness program really, when you think about it. For the employees, I think we all want to be in better shape and keep our muscles and our bodies in good working order and tone, for sure.

So what do you advise for health care organizations or a senior living organization to really overcome the resistance to change? Is there certain things that you work through with them? I know you said this approach of encouraging employees that they're going to actually get toned and remain in better shape, what have you. But is there any other ideas that you have to help these organizations?

KRISTI MOORE: To try to find people within your organization that are really good at it. And that can help be almost like a lead for the facility. I typically will find people that work out or lift weights because they already understand these concepts. Because they do things like deadlift and back squats, so they have to understand the technique. So I usually to try to find someone in the organization or within each facility that can be the go-to person when you have questions.

But I find it's best as if you do in-person training or training everyone like the hands-on training. And then having someone on site that can eventually do the train, the trainer. And they can take over, whether it be a therapist or somebody within the facility that lifts weights. It doesn't have to be someone in management. It could just be someone who's already passionate about it and already gets it. That can help train it.

Whenever I have resistance to things, I always go back to when I was in OT school. And one of my professors always told us, there's no such thing as a difficult patient. You just haven't figured out the way to get through to them. So that's the thing that goes through my mind. When I have people resist me, I try to think of, how else can I explain it or build a rationale why it's important to them to get them to buy into it. And the beautiful thing once again, about the functional movements is it doesn't just apply to your work. It applies for all areas of your life because it's how you use your body.

RHONDA DEMENO: Correct. I really like that, you had good advice in OT school. And that really flows into the next question I have. How does do the functional movement principles that you're discussing enhance the therapeutic relationship between the resident and the staff member? I think you've hit on some of those areas.

KRISTI MOORE: I think what it is, once again, it's focusing on your safety first. And if you're safe and strong, your resident will be safe and strong. And then once you build up the confidence and you understand how to move it, you can also coach them. And when you're working with these residents every day, it's also good for them to be using their muscles the way that they should be using them. Because you want them to stay as independent as possible. You want them to be using their bodies and doing stuff as much for themselves as they can.

If all they can do is wash their face, have them wash their face. Let them maintain some independence, whatever they can do. Because when they're using their muscles, and you're getting comfortable using yours, and how you use it, you can coach them. And especially if you're a CNA, you're interacting with them so much throughout the day. If you have to help them get dressed or assist them with dress, encourage them to be really using their muscles when they're standing because you're going to help them maintain their level of independence. And shockingly, they might even get stronger along the way.

RHONDA DEMENO: That's so true. We did talk about some of the barriers and some of the resistance. And I'm very fortunate at all my position. I'm able to go to communities all across the U.S. And actually, I'm going to one next week to do a tour and to observe some safety issues at the community. My question is, our communities are so busy. There's not enough hours in a day to really achieve all the tasks that are necessary.

And with residents coming into communities now, they're more acutely ill, more dependent, have more needs. So what would be the key points to discuss even with the leadership about not another task? We're not sure if we can take this new program on. We don't have enough hours in the day. So what is all involved in the program implementation?

KRISTI MOORE: So what it requires is a bunch of training sessions. Because it really does need to be like in-person, hands-on for a little bit. And then it only needs to take an hour, an hour and a half at the most. And we could do small, small groups. And just either have people come, an hour earlier or stay an hour or later just to get that training or come in just the way that they like. Especially for onboarding, make it part of the onboarding process. And then try to train your current staff that you have.

Because the hardest thing to do is because most people have been in this profession for years. So it's really trying to change some of their habits. But it is possible. I believe change is inevitable. People's behaviors can change when they can apply to why they need to do it, or why it's good for them to do it. But it is a little bit challenging because it does take some investment to have each all the staff trained, at least do the one, just the hands-on training one time.

And then it could be followed up with some just video content of reminders of how to do it, posters around the facility about how to actually do the movements. Try to find somebody who can be your lead functional movement, liaison, or whatever you want to call it.

RHONDA DEMENO: That makes a lot of sense. Is there any type of readiness assessment when you know a community is truly ready to take on the program?

KRISTI MOORE: I don't have anything like readiness assessment. I'd say it's when they're ready. When they know that they can put the time into it and really implement it.

RHONDA DEMENO: I think that if we're looking at loss runs, and we see a lot of losses related and staff turnover. And a lot of workman's comp days, I think to me, those would be selling points where leadership really needs, to your point earlier, make the commitment, the time commitment for those educational hours. And just have that buy in, appoint a leadership-type person to really spearhead the program. I mean, you brought up all those points, which I think would really help set the stage for a successful program.

KRISTI MOORE: And if they're having a lot of work comp claims around musculoskeletal disorders, which is usually the top claim for everybody, then they can start there. And they can even do, you know, a pilot program in one facility just to see how effective it is. And then build from there and do almost like a process of doing like each facility, or start with kitchen staff, or anything like that just to get the ball rolling. But they have to be ready to make that change. So everyone's on the same page.

RHONDA DEMENO: That makes perfect sense. Can you walk us through what a functional assessment, movement assessment, what that looks like?

KRISTI MOORE: So it would be like the training would be, once again, you'd have maybe 15 people at the most per class. And it would run through each one. So it'd be like a quick little overview about ergonomics real quick. And then it would go over it. So then we would go squat. We will demonstrate how to do it, walk it through it, and then everybody would do it. And then I would typically me or what a colleague would walk around. And then we would coach them on how to improve what they're currently doing.

We do that for each movement. Obviously, not some of them. So lunge, push pull, hinge, twist. Gait is just walking. But we go over what you should be doing walking to avoid slip, trip and falls doing that. And then the last one is grip. I usually bring my dynamometer to test people's grip strength. But what it is it's literally hands-on. It's demonstrating how to do the functional movement, how it applies to their job. And then them doing it with us, and then going around and coaching them, and how to do it better, and how just to critique what they're currently doing.

RHONDA DEMENO: That's great. So are there any costs associated with program implementation other than staff time? The training, there would be staff hours build into that and the expense there. Any other expenses?

KRISTI MOORE: Just the expense for us doing the training. And then if they wanted videos that follow-up to go along with it, custom videos, or they just wanted the training, and then do a train the trainer, if they want to have somebody on site continue with it. Because once again, it doesn't have to be us. We can do a train the trainer. And then they can implement it and then use us as needed. But yeah, the cost would be us coming on-site and performing the training.

RHONDA DEMENO: Very good. One final question. Well, I guess I have two final questions. But how does functional movement programs differ from safe resident moving and positioning programs?

KRISTI MOORE: So I wouldn't say it differs. I'd say it adds to it. To me, when I look at safe patient handling, there's pieces of the puzzle. So you have the equipment which is one piece. And then you have typically the somewhat the body mechanics that they do a little bit. But typically, what I see in safe patient handling is just the technique of how to do a sit-to-stand transfer or using the Hoyer lift. And the piece of the puzzle for me that's missing is this piece of teaching people how to actually use and move their muscles, and then apply it to the body mechanics of how to do a sit-to-stand transfer, or how to position the bed so that they're in a better position to boost a patient up in bed, or to reposition someone in bed, or a resident in bed.

So, to me, I think it's just the piece of the puzzle. It's just a piece of the puzzle that needs to be at the beginning, the foundation, the fundamental part, and then you can add on to it. So I look at it as just adding on to what they currently do to fix that one piece of the puzzle that's missing.

RHONDA DEMENO: That's great information. Is there any data that we can demonstrate or that you can demonstrate where these programs actually show a decrease in resident and employee injuries? Are there any data points out there?

KRISTI MOORE: So, unfortunately, not really, because no one's really doing this. My Capstone project on this, I'm getting my doctorate in occupational therapy. And I'm doing my Capstone project on this. And there's not a lot of research out there. But there's a lot of research that shows the importance of functional movement and how it decreases your risk of injury and increases your strength around exercise and fitness. The clients that we have done some functional movement training on, we haven't done it so that we have a lot of data yet for it. But I can say that most of the employees that we've done any type of functional movement training on, they've all loved it.

RHONDA DEMENO: Because to me, I mean, it just goes hand in hand with just being in good physical condition. And of course, along with that comes healthier employees and reduced resident injuries. So, to me, they complement one another. And like you said, it's a nice way to augment a safe resident moving and positioning program. And it's no surprise. There's a lot of senior living organizations don't have safe resident moving and positioning programs. And they're really necessary to really help to drive better care outcomes.

That's why we're talking to you today, because I think it's very necessary. And organizations really should think about it. So one final question. How can our clients or those that are listening today get in touch with you, Kristi?

KRISTI MOORE: Well, they can get in touch with me via through you, Rhonda. Or they can email me. It's just Kristi Moore. K-R-I-S-T-I dot M-O-O-R-E @ wtwco.com.

RHONDA DEMENO: Well, I really appreciate that. And we appreciate you taking the time out of your busy schedule today.

KRISTI MOORE: Thank you for having me.

RHONDA DEMENO: Thank you very much for listening to this episode of Senior Advisor. And please be on the lookout for a future Senior Advisor podcasts. Thank you and have a great day.

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