Gait Belts

Gait Belts 

Purpose: 

To prevent injury and/or discomfort to the resident during transfer. To prevent injury to the staff member during resident transfer. To provide a means of support while ambulating the resident. 

Policy: 

In the interest of the safety and welfare of residents and staff, the facility requires that all employees use transfer/gait belts when transferring or ambulating residents unless contraindicated, or unless “supervision only” or “independent for transfers” is indicated per the care plan. 

Employees will receive training on the use of transfer/gait belts. Initial training will occur during orientation. Ongoing inservices will be held as necessary. 

Notes: 

Contraindications for use of a gait belt might include: 

• Recent fractured ribs (especially lower ribs) 

• Recent surgery in the area of the belt 

• Gastrostomy Tube 

• Hiatal Hernia 

• Colostomy 

• Severe heart or respiratory disease 

• Severe degenerative disease of the spine 

*Use information learned from the assessment to determine whether the belt is to be used or not with an individual resident. Communicate information through the Resident Care Plan, CNA Assignment Card, and/or MD Order. 

Procedure: 

A. To Transfer Resident With Gait Belt 

• 1.  Assess the resident (follow care plan and CNA Card), considering physical, mental, mobility, strength, balance, motivation, equipment, and limitations. 

• Properly place the wheelchair, chair, etc., at an angle close to the bed on the resident’s unaffected side. Lock or brace the chair, wheelchair, shower chair, or bed to prevent slippage during transfer. 

• Apply the transfer/gait belt to the resident’s waist and tighten it to fit snugly (placement is close to the resident’s center of gravity). 

• Always consider the use of the transfer/gait belt when the resident requires “hands-on” assistance to transfer/ambulate. 

• Always place the belt around the waist in soft tissue and never over ribs, hip bones, or breasts. 

• Always apply the belt snugly so there is no possibility of it sliding up on ribs – never loosely. 

• Always place the belt over clothing or some type of skin covering – never on bare skin. 

B. Bed Chair Transfers Using a Gait Belt 

• 1. Follow the procedure to transfer the resident with a gait belt. 

• 2. Ensure the resident is close to you. 

• 3. Always move toward the unaffected side. 

• For fractured hip residents, always have a pillow between the knees and assist as necessary to the edge of the bed. 

• For stroke/paralyzed residents, use the “strong” side to assist the “weak” side and assist as necessary. 

• Assist the resident to a sitting position. 

• Always come to a sitting position on the unaffected side. 

• Instruct the resident to use elbows, then hands and arms, to raise the trunk to a sitting position. 

• Swing legs over the side of the bed. 

• Aide “supports” involved leg of fractured hip as necessary. 

• If the resident is unable to assist by self, the aide rolls the resident onto the affected side, bending the resident's knees to place feet at the edge of the bed. Support the resident’s upper body to elevate to an upright position. 

• Let the resident sit on the edge of the bed for a few moments to get balance. 

• Apply the belt if it has not been done earlier. 

• Assist the resident to a standing position. 

• Grasp the transfer/gait belt with both hands; one at each side of the resident’s waist. 

• Brace the resident’s knees with your knees as necessary; brace feet at the same time. 

• For hip fractures, brace the involved leg as necessary. Have the resident extend the fractured hip leg if partial weight-bearing or non-weight-bearing. 

• Have your own knees bent; use large leg muscles. 

• Instruct and assist the resident to: 

• Grasp the wheelchair arm. 

• Lean forward slightly. 

• “Stand Up” (resident pushes self up) 

• Firmly guide the resident as necessary. 

• Let the resident stand for a few moments to get standing balance. 

• Assist the resident to the chair. 

• Have the resident “pivot” or “turn” on the toe of the unaffected leg – toward the unaffected side – toward the chair. 

• Control the resident with the belt, assist as necessary, move your body as a whole with the resident. 

• Assist the resident to lower self onto the chair, guiding with the belt and body mechanics. 

• Carefully remove the transfer/gait belt. 

• Make the resident safe, comfortable, and in correct anatomical alignment. 

• To return the resident to bed, reverse the steps of the procedure. 

• C. Ambulation of Resident with Gait Belt: 

• Grasp the belt firmly in the middle of the resident’s back. 

• Use necessary equipment, walk alongside and slightly behind the resident. 

• To break and stop a fall: 

• Push against the resident’s knees with your knees. 

• Control with the belt. 

• To control a fall: 

• Pull the resident toward you with the belt. 

• Ease the resident to the floor by allowing them to slide down your leg. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the use of gait belts, including the resident’s response and any observations, in their medical record. 

• Note any difficulties encountered during transfers or ambulation. 

• Regularly review and update gait belt techniques according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper gait belt procedures to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.