Restorative Nursing Programs are essential for provision of care for residents in long term care. Imagine yourself as a resident in a nursing home (for some that though alone causes anxiety) – would you want to maintain your physical ability to continue to be as independent as possible? Would you want to have trained staff to provide individualized services for your needs (resoundingly the answer is yes!) Beyond this fact, there are 4 distinctive reasons to build a robust Restorative system.
OBRA 1987 – mandates we take care of our residents’ needs. The OBRA mandate specifically states that long term care facilities seeking Medicare or Medicaid funding are to provide services so that each resident can attain and maintain highest practicable physical, mental, and psycho-social well-being. Further, each resident’s ability to walk, bathe, and perform other activities of daily living will be maintained or improved absent medical reasons. This is clearly instructing all of us in long term care that we have a responsibility to each of our residents to provide care equitable to the mandate. Per the RAI Manual, “Restorative nursing program refers to nursing interventions that promote the resident’s ability to adapt and adjust to living as independently and safely as possible. This concept actively focuses on achieving and maintaining optimal physical, mental, and psycho-social functioning. These 2 descriptions are exceptionally similar, indicating that Restorative Care Nursing programs are instrumental in meeting the OBRA 1987 requirements.
5-star rating system, with emphasis on Quality Measure portion - There are multiple quality measures that can be positively affected with Restorative Nursing Programs. Long-Stay resident measures include:
Percentage of residents whose need for help with activities of daily living has increased
Percentage of residents whose ability to move independently worsened
Percentage of high-risk residents with pressure ulcers (sores)
Percentage of residents who self-report moderate to severe pain
Percentage of residents experiencing one or more falls with major injury.
With appropriate Restorative Nursing Programs in place, residents can be assisted with maintaining physical functionality and mobility which will also decrease risk of pressure ulcers and pain from inactivity.
Jimmo V Sebilius which resulted in Medicare adding specific wording for skilled therapy services for “prevention of deterioration.” Some of residents appropriate for this level of therapy can certainly benefit with the addition of Restorative Nursing Programs in conjunction with the skilled rehab services. Maintenance therapy appropriate goals include:
Preventing unnecessary, avoidable complications from a chronic condition, such as deconditioning, muscle weakness from lack of mobility, and muscle contractures
Maintenance therapy goals also include reducing fatigue, promoting safety, and maintaining strength and flexibility.
For a patient with a progressive neurologic condition, appropriate maintenance therapy goals include:
Maintaining joint flexibility
Reducing the risk for skin breakdown
Ensuring appropriate positioning.
Conjunctive skilled rehab services with Restorative Nursing Programs are key to adding into routine care services to assist with maintenance.
Appropriate use of resources as related to reimbursement. Regardless of RUG version and grouper utilized in each state, the addition of Restorative Nursing Services does not only provide required and appropriate care for residents but also includes a potential increase in reimbursement. Restorative Nursing Programs can have a positive effect in numerous RUG categories including: Rehab, Behavioral Symptoms and Cognitive Performance and Reduced Physical Functioning.
Restorative often takes a back-seat to more pressing issues, like staff shortages, but as you can see, it’s deeply important to our communities and deserves our best effort.