April 11, 2011 | by Sandra Hoban

A cross-country ‘walk’

Emily “Lizzie” Tobin, one of the program’s farthest walkers, holds her certificate of recognition.

Mary Ann Morse Nursing and Rehabilitation Center in Natick, Massachusetts, listens to its residents. Through periodic resident surveys, it discovered that residents wanted more frequent physical activities, including walking.

To meet this request, Kaitlin Huntley, marketing director, and Chris Raffol, PT, put their heads together to develop a program emphasizing exercise for residents and, by virtue of their participation, staff. “We wanted to make walking fun and motivational for the residents as well as our staff. During the holiday seasons, we realized that residents and staff were more upbeat and motivated to walk and participate in decorating as well as in holiday-themed events and activities,” says Huntley. “We wanted to replicate this fun atmosphere and participation from month to month.”

The result was a yearlong journey “traveling” and learning about 12 states. Not only were the residents exuberant about covering the 3,095 “miles from Massachusetts to California,” staff also tied on their sneakers for this “Walk Across America”-the program’s name.

The program had goals that went beyond exercise and entertainment. “Not only were the residents and staff excited and engaged in Walk Across America, throughout the year both groups realized additional health benefits-increased heart health, improved sleep, more socialization, lower fall rates, and more,” Raffol explains.

CHARTING THE COURSE

Kaitlin Huntley (left) and Chris Raffol show the Walk Across America route.

To build excitement, Huntley posted large maps in every unit with the route highlighted as a road, running from Massachusetts continuing through New York, Pennsylvania, Ohio, Indiana, Illinois, Iowa, Nebraska, Wyoming, Utah, and Nevada, ending in California. Mary Ann Morse’s facility mascot is the cardinal. For Walk Across America, he “tied” on a pair of sneakers and moved along the maps on each unit, marking the progress. “To begin our Walk Across America, we replicated the start of the Boston Marathon for the kickoff. Kaitlin, with help from staff and families, gathered DVDs, posters, and pictures; researched fun facts and trivia from each state; and, every three months, arranged for food tastings from each state,” says Raffol. Boston baked beans, Coney Island hot dogs, and New York cheesecake are examples. Month after month, residents and staff enjoyed learning about the “flavors” of the states on their 3,095 mile “trip.”

AS THE PROVERB SAYS…

Walk Across America participants Alice Keeman and Restorative Aide Myleno Oliveira, add to their miles.
Anastasia Grupposo walks with Rafael Jalles, Functional Maintenance Aide.

The longest journey starts with a single step. Huntley and Raffol recognize certified nursing assistants (CNAs) as the principal drivers of Walk Across America, as they walk or wheel their way across the country. “CNAs already log their residents’ walking frequencies, so we added another column to track the distance walked,” explains Raffol. To do this, Raffol created the schematics of the hallways to reflect their different lengths and assist in the estimation of distance walked. “Then at the end of every month we have a spreadsheet that tallies these distances. Each participating resident is then presented with a monthly award certificate celebrating his or her walking achievement. For example: “Congratulations on the completion of your 12th mile in Utah!” Residents proudly display the certificate that serves as a reminder and motivator to continue walking.

In addition, the staff contributed mileage they ran or walked to add to the total distance walked. “We exceeded our goal by covering a total of 4,121 miles in 2010,” Raffol says proudly. Of that total, 1,201 miles were walked by residents and the longest distance covered by a resident was 48.1 miles. The most encouraging aspect with residents at different levels of active participation is that they are motivated by watching their progress.

BENEFITS

Not only have residents become stronger, more mobile, and more agile, but a significant decrease in the frequency of falls is credited to the consistent exercise the walking program provided.

“We wanted to see residents walk more and enjoy doing so. Chris and I were excited to see that residents wanted to walk more because of the program. We were also happy that our coworkers, specifically the CNAs, went above and beyond to help make this program a success,” Huntley says. Raffol adds that now, because of the additional charting, there is another tool to gauge a resident’s health status. “If I check the CNA log and see that a resident, who has been walking 500 ft. a day, suddenly doesn’t walk as far or as often, it sends up a red flag and we can intervene more quickly,” she explains.
In addition to decreasing the number of falls, Walk Across America has other benefits. “The increase in strength and endurance has therapy implications,” says Raffol. “For instance, if a resident stops walking, he or she becomes more susceptible to problems transferring without assist. A mechanical lift may need to be used in this case, making more work for staff and potentially leading to more health problems for the resident,” she adds.

The ultimate message is to keep people moving, make it enjoyable for them along the way, and to make sure health is a priority. LTL

For more information about developing a Walk Across America program, contact Kaitlin Huntley at khuntley@mamorsehc.com or Chris Raffol at craffol@comcast.net.

Long-Term Living 2011 April;60(4):39-41

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