Mrs Smith has been resident on a continuing care ward for approximately six years. She was originally admitted after a left cerebral vascular accident that resulted in a right-sided hemiplegia. She is dysphasic but appears to understand much of what is said to her, and she is continent of urine and faeces, using facial expressions and body gestures to communicate her needs. In recent years her weight has increased from 63 kg to 83 kg and she is now chairbound, following a recent leg fracture.