Where Should You Stand When Assisting a Resident with Walking?

According to the CDC, over 36 million falls are reported among older adults each year, resulting in more than 32,000 deaths. Knowing where you should stand when assisting a resident with walking is crucial for fall prevention and ensuring their safety and comfort. This guide outlines the best practices for caregiver positioning and technique during ambulation.

Quick Summary

Assisting a resident requires standing slightly behind and to their weaker side, especially when using a gait belt, to provide stability and react quickly to unsteadiness. Proper positioning helps maintain balance, encourages confidence, and minimizes fall risk during ambulation.

Key Points

• Stand on the Weaker Side: For residents with unilateral weakness (e.g., from a stroke), stand slightly behind and to their weaker or affected side to offer targeted support.

• Use a Gait Belt: A gait belt is essential for a firm grip, reducing caregiver back strain and providing a secure hold for resident stability.

• Position Yourself Behind and to the Side: Whether using a gait belt or providing hands-on support, position yourself slightly behind and to the side of the resident, allowing them to move naturally.

• Prepare for a Fall: If a resident falls, do not try to stop or catch them. Instead, move behind them, lower yourself and guide them safely to the floor.

• Walk at the Resident's Pace: Allow the resident to set the speed. Adjust your steps to match their pace and avoid rushing them, which could increase the risk of imbalance.

• Use Proper Body Mechanics: Bend with your knees and keep your back straight when assisting. This protects you from injury, especially when guiding a resident during a fall.

• Ensure Communication: Talk to the resident throughout the process. Announce your movements and provide encouragement to help them feel secure and confident.

Optimal Positioning for Safe Ambulation

Proper positioning during resident ambulation is vital for their safety and your own. The primary rule is to stand slightly behind and to the resident's weaker or affected side. This position allows you to provide maximum support where it is most needed, while staying out of their way so they can move naturally. Using a gait belt is a standard practice and offers a firm, secure point of contact for assisting and controlling balance.

Before You Begin: Preparation and Assessment

Prior to starting, a brief assessment and preparation can prevent many issues. Clear the path of any potential obstacles and ensure the resident is wearing non-skid footwear.

• Assess the resident's condition: Confirm their level of support needed. Ask them how they feel and if they are experiencing any pain or dizziness.
• Explain the process: Inform the resident what you are doing. This builds trust and ensures they can anticipate your movements.
• Apply the gait belt: Secure the belt snugly around their waist over clothing, with the buckle slightly off-center. Check that you can fit two fingers between the belt and their body.

The Role of the Gait Belt

The gait belt is an essential tool that facilitates a safe walking process. It provides a secure handle for you to grip, reducing the risk of strain on your back and ensuring you can provide support effectively. Your grip should be an underhanded, palm-up grasp on the belt at the resident's side.

Walking with a Resident

Once the resident is standing and you are properly positioned:

1. Maintain a steady pace: Let the resident set the pace and simply walk with them, matching their rhythm.
2. Provide encouragement: Use verbal cues to help them maintain good posture, encouraging them to look forward rather than at their feet.
3. Stay alert: Continuously observe their endurance and balance. Take breaks as needed to prevent fatigue, which increases fall risk.

Managing a Fall Safely

If a resident begins to fall, your reaction is critical for their safety and your own back health. Do not attempt to lift or catch the resident upright. Instead, use proper body mechanics to lower them gently to the floor.

1. Move behind the resident: Create a wide base of support by moving one leg back.
2. Lower the resident: Maintain a firm grip on the gait belt and slowly guide the resident down your bent leg to the floor.
3. Protect their head: As you lower them, use your free hand or forearm to protect their head from hitting the floor.

After a fall, do not move the resident. Call for a nurse immediately for assessment.

Common Assisting Scenarios

Scenario	Proper Standing Position	Key Technique	Fall Recovery
General Ambulation (no specific weakness)	Slightly behind and to one side.	Maintain a gentle pace; provide stability via gait belt.	Guide resident to floor gently using your leg as support.
Stroke Patient (unilateral weakness)	To the resident's affected/weaker side, slightly behind them.	Offer targeted support to the weaker side. Ensure the resident is aware of your position.	Be prepared to lower them, focusing on controlling the weaker side's descent.
Using a Walker or Cane	Beside the resident, on the opposite side of their cane.	Do not hold or pull their arm. Position your hand near their lower back via the gait belt for balance.	Let the resident steady themselves with the aid. Be ready to lower them if they lose their balance completely.
Two-Person Assist	One person on each side, slightly behind the resident.	Both caregivers support the resident at the waist using the gait belt. Coordinate movements and verbal cues.	Both caregivers work together to lower the resident slowly and safely.

Conclusion: Prioritizing Safety and Independence

Knowing where you should stand when assisting a resident with walking is a fundamental component of safe and effective caregiving. By positioning yourself slightly behind and to the resident's weaker side, using a gait belt correctly, and following proper fall protocols, you can significantly minimize the risk of injury for both yourself and the resident. The goal is to provide a supportive presence that promotes independence while ensuring maximum safety throughout the ambulation process. For more detailed best practices in resident care, the Wisconsin Technical College System's Nursing Assistant textbook provides an authoritative resource.

Frequently Asked Questions

What is the primary reason for standing on the weaker side of a resident?

You stand on the weaker side to provide the most effective support where it is needed most. This positioning allows you to immediately compensate for any imbalance or loss of strength on that side, greatly reducing the risk of a fall.

Should I hold the resident's arm while walking?

No, you should not hold the resident's arm, especially if they are using a walker or cane. Holding their arm can interfere with their natural movement and balance. Instead, use a gait belt for a secure and stable point of contact.

How should I hold the gait belt?

You should hold the gait belt with a firm, underhanded grip, with your palms facing up. This technique provides a secure and powerful grip that allows you to use your bicep strength to provide support if the resident stumbles.

What should I do if a resident starts to fall?

If a resident begins to fall, do not try to hold them up. Instead, maintain your grip on the gait belt, move one leg behind them for support, and slowly guide them down your leg to the floor while protecting their head.

Is it better to walk in front of or behind the resident?

It is best to walk slightly behind and to the side of the resident. Walking directly in front can cause you to obstruct their path and prevent you from effectively observing their balance. Walking slightly behind allows for natural movement while ensuring you are in a position to react.

What if the resident does not have a gait belt?

A gait belt is the safest tool for assisting with walking. In its absence, you can support the resident by placing your hands firmly around their waist. However, you should always try to use a gait belt for increased safety and to protect your back.

How should I position myself when two people are assisting?

If two caregivers are assisting, each person should stand on one side of the resident, slightly behind them. Both caregivers should use a gait belt and coordinate their movements to provide stable and balanced support.