Frontline Initiative: Health and Wellness

Day 117 of Winter in Michigan


Shanna Mabrito is a home supervisor at MOKA in Muskegon, Michigan. Shanna can be reached at

A man standing in snow-covered woods. He is dressed in a blue and gray winter coat, gray gloves, and a green knit hat. He is holding a pole used for snowshoeing.

James Hill Jr. makes the best of winter by snowshoeing through the woods.

Today is Day 117 of winter in Michigan. We are all struggling with not seeing the sun shine for days and it is too cold and icy for outdoor walks. Daily exercise is challenging for most of us, but it is even harder when you work as a direct support professional (DSP) and are trying to promote health and exercise among the people you support, many of whom have challenges already. Then add in people using walkers and wheelchairs, and it can get tricky. Getting outdoors during the winter months can be next to impossible!

As DSPs, we become the biggest cheerleaders and inventors of fun as we put on YouTube videos and find amazing bike trails on screen while the people we support ride recumbent bikes. We offer lots of praise and blast workout music! We have them walk on a treadmill while encouraging them and listen to their favorite music while looking outdoors into the woods in our backyard. We even tried out snowshoes for the first time this year. What an amazing workout for all! It can be very challenging to rally interest in exercise, and as DSPs, we are always trying new things. Staff have incorporated yoga, stretches, and light weights into the morning routine to build muscle and lose weight. The people we support love to have staff participate right alongside them, so they don’t feel alone.

In addition to exercise, we promote healthy living through our menus. Each menu is tailored to each person's preferences, needs, and goals. They are balanced, low-sugar, high-fiber meals that promote good bowel health and weight loss where needed. Two people in the home where I work have dysphasia; their drinks are thickened, and their food is softened mechanically to improve digestion and reduce the risk of choking. Despite these measures, we notice that sometimes one of them has aspirated by repeated coughing after a meal. Staff are trained for this and are quick to take their temperatures as this is the first real sign that it has occurred. Every day at mealtime, staff sit beside them, prompting them to take small bites and sips of their drinks. Staff are trained and ready to provide the Heimlich maneuver if needed.

Making sure the people supported have regular bowel movements is also a huge concern for DSPs. We talk a lot about it. We chart about it. We seek proof as detectives, to see that it occurred, and we take steps with protocol to ensure it happens in a timely manner. Bowel obstructions have occurred in previous years, and it was found that there was an impacted old stool that had to be removed by hospitalization. Staff follow the outlined orders from their doctors and administer the medicines as prescribed to maintain healthy bowel movements. DSPs spend so much time with the people we support that we are the often first to recognize when someone does not seem to be feeling their best. DSPs know the individuals better than anyone else and because of their quick recognition of ailments, care is almost immediately provided, and the person is back on their feet in record time!

Staff are required to take yearly updates in several areas of training. Many are outside the home in classrooms provided by HealthWest and MOKA Corporate Offices. Some trainings occur online with Lakeshore Training or Network 180. DSPs wear many different “hats” in their daily jobs. We are cheerleaders, health coaches, counselors, chefs, detectives, transporters, advocates, teachers, maids, nurses, and most importantly, family to the people we support. Knowing they are loved and well-cared for supports good mental health. Staff show up every day and reassure them; this helps them feel healthy on the inside.

Knowing how good it feels to be clean and how important it is to monitor their skin and bodies for new findings, individuals are offered regular showers or baths daily. Some prefer night showers over morning ones; it really is up to the individual. If someone is incontinent in the mornings, a shower is always given first thing to protect the skin, but staff does wake those individuals throughout the night shift in case this doesn’t occur. We use lots of creativity and vocal encouragement to get the sleepy individual to cooperate.

There are also appointments. DSPs take the people supported to the family doctor for annual physicals, and to see their dentists, psychiatrists, psychologists, podiatrists, ENTs, ophthalmologists, dermatologists, orthopedics, and other specialists as needed. We attend monthly clinical meetings with HealthWest officials to discuss their health and medication effectiveness. Medications are constantly being changed and staff are trained in passing medications thoroughly. Every day, they are expected to count and monitor controlled substances, and set up medication boxes and signed sheets for the guardians when people supported go away for any amount of time. DSPs are responsible for passing medications and applying ordered treatments at various times every day, all throughout the day. It is a huge responsibility. Staff deal with feeding tubes, catheters, colostomy bags, insulin injections, blood sugar test strips, and more.

Everyone is looking forward to spring and getting back outside where we can walk trails, ride bikes, swim, and get regular exercise out in the fresh air! Look for us as we are out and about and be sure to say hi!

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