Rehab and Restorative Services

1. Rehab and Restorative Services In-service Training Guide

2. RESTORATIVE NURSING Restorative Nursing is defined as: • Nursing interventions that promote the resident’s ability to adapt and adjust to living as independently and safely as possible. (RAI, 2011) • The continuation of therapy by nursing following rehabilitation, with nursing responsible for both maintaining the status of the resident after discharge from rehabilitation, and documenting efforts to restore as much functional independence as possible. (OBRA , 1987)

3. Restorative Nursing The Benefits: • Prevents new / additional complications • Helps resident adjust to new problems and limitations • Prevents functional decline • Promotes Independence • Improves Quality of Care • Improves Quality of Life

4. Restorative vs. Rehabilitation Restorative Rehabilitation Retrain and education of new skills Fast pace, progress must be made Usually triggered by acute illness or injury • Restoring and maintaining • Long-term, ongoing process • Improves not restores or compensates for skills lost through chronic disease

5. Restorative Nursing Keys to Success: • RN or LPN must supervise • Nursing assistant must be an aide for at least 6 months and trained in the techniques that promote resident involvement • Nursing staff responsible for overall supervision and coordination

6. Restorative Nursing Keys to Success: • Nurses order restorative programs • Therapy department work as consultants

7. Restorative Nursing Keys to success: Restorative should begin • When a resident is discharged from therapy • Upon admission if the resident is not a candidate for therapy but has a restorative need • At any time a restorative need arises during the residents stay

8. Restorative Nursing Keys to Success: • The resident should have an identified deficit and be at risk for a functional decline. • Resident does not have to show a potential for improvement. • Exercises and treatment are planned, scheduled, and documented.

9. Restorative Nursing Keys to Success: • All staff must be onboard with restorative nursing approach / Holistic care • Care Plans • Good communication / education for your frontline staff: CNAs & Charge nurses !!! • Look at the individual resident • Consistent staffing assignments • Team work

10. Restorative Nursing MDS rules are specific for restorative care. • Restorative care must be given 6 days a week. At least 15 minutes of care to qualify for one day of reimbursable care. • Some categories require two restorative nursing programs with a total of 30 minutes a day of restorative care to place residents in the higher RUG groups. • The 15 minute increments must be given to each modality and not figured by adding time from different programs. • Restorative nursing can be offered in groups with similar needs. However, it cannot be larger than four residents per caregiver.

11. Restorative Programs: • Range of Motion: PROM/ AROM/ AAROM • Splint or Brace Assistance • Transfer • Ambulation • Bed Mobility • Dressing and Grooming • Amputation/Prosthesis Care • Eating and Swallowing • Scheduled toileting / Bladder retraining • Communication

12. Restorative Nursing Documentation: • Care plan must include objective, measurable goals • Documentation of assessed need for services • Nurse must periodically evaluate the resident’s progress and change care plan if needed.

13. Restorative Nursing Documentation Includes: • Showing that the restorative nursing care provided was accurate and met nursing standards • Narrative note reflecting progress/lack of progress, refusal, or medical withholding of care • Clearly identify deficit and/or need for maintenance

14. Restorative Nursing TRAINING RESOURCES • AHCA Restorative Certification Class (Highly Recommended) • Long-Term Care Nurse Assistant’s Guide to Advanced Restorative Skills by Barbara Acello • Restorative Nurse: A Training Manual for Nursing Assistants by Linda Pierce • Long-Term Care Restorative Nursing Desk Reference by Barbara Acello • RAI Manual Section O0500 • Therapy Department

15. Restorative Nursing REFERENCES Centers for Medicare and Medicaid services (CMS)2009. “Long-Term Care Facility Resident Assessment Instrument (RAI) User’s Manual”. The Centers for Medicare and Medicaid Service http://www.care2learn.com/userfiles/files/restorativenursingprograms:nowmorethanever (Accessed January 19, 2013)

16. Thank You! For your efforts to restore movement among our residents.