CMS SOM App. J, Tag W246

portion of each waking day out of bed and outside the bedroom area, moving about by

various methods and devices whenever possible.

Guidance §483.440(c)(6)(v)

Clients with sensory or physical difficulties should be given the same opportunities to move

around in their environments as clients who do not have those difficulties. Even clients who use

specialized wheelchairs should be given the opportunity to utilize other devices such as walkers,

wagons and scooters to move about and/or change their positions.

With the exception of those clients who are acutely ill (such as those who are hospitalized or

incapacitated by a “short term” illness), all clients should be out of bed and outside their

bedroom area as long as possible each day, and in proper body alignment at all times. This is a

necessity in order to prevent regression, contractures, and deformities and to provide sensory

stimulation.

Bed rest is a temporary situation associated most usually with a medical condition and must be

ordered by the medical staff of the facility. The term implies that the client will remain in

his/her bed for most of any 24-hour period. Although active treatment programs may be

carried out to some extent while the client is on bed rest, the client’s program cannot be

completed in its entirety. While there may be situations where continuous bed rest may be

necessary, these situations are rare.

For those rare instances where out-of-bed activity is a threat to a client’s health and safety (e.g.,

blood clot in the leg), active treatment adapted to the medical capacity of the client must be

continued.