Self-Care and Independence

Why it matters on this exam

Four items, but it carries a principle that decides answers across the whole exam: do for the resident only what the resident cannot do for themselves. Promoting residents' independence is one of the five areas required before any direct resident contact, at 483.152(b)(1)(iv).

It also maps onto two NNAAP skills — modified passive range of motion for one knee and ankle, and for one shoulder — so it is tested practically as well.

Key concepts

Section 483.152(b)(6), basic restorative services, names the content:

• Training the resident in self care according to the resident's abilities. The goal is the resident doing more, not the aide doing it faster.
• Use of assistive devices in transferring, ambulation, eating and dressing.
• Maintenance of range of motion. Passive range of motion is performed to the point of resistance, never to the point of pain, and never forced past it. The resident tells you when to stop, which is why the skill checklist has the aide instruct the resident to report pain before starting.
• Proper turning and positioning in bed and chair.
• Bowel and bladder training.
• Care and use of prosthetic and orthotic devices.
• Transfer belts. Two NNAAP skills use one — ambulating and transferring bed to wheelchair — and the belt is applied over clothing, never against skin.

Common mistakes

• Completing a task for the resident because it is quicker. That is the answer the exam is built to catch; independence is the goal of the role, not an obstacle to it.
• Pushing range of motion past resistance. Resistance is the stopping point, and pain means stop immediately and report.

Worked example

A resident can wash their own face but not their back. The correct approach is to set up the basin, hand them the washcloth, let them wash what they can, and assist only with what they cannot reach. Doing the whole bath would be faster and would be marked wrong: 483.152(b)(6)(i) is explicit that restorative care means training the resident in self care according to the resident's abilities, and independence maintained is the clinical goal.