The Heart of Health Care: Restorative Nursing Programs
Ensuring that residents are at their highest level of functioning is a key factor in quality care today.
The Restorative Nursing Program is specifically outlined in the CMS Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual. It is essential that each program is organized and planned based on the comprehensive, individualized assessment and documented, monitored and evaluated. Goals can include the following:
- Restore or maintain an individual to their highest practicable physical, mental and psychological functional level and well-being.
- Utilize the skills and expertise of each discipline to plan, implement and facilitate all pathways for the best individual outcome.
- Maintain as much independence as possible and for some residents, successful discharge to home.
As leaders, consider the following as you develop and implement a solid Restorative Nursing Program:
- Documentation requirements cannot be taken lightly for evidence of program implementation, number of minutes provided, assessed need for the program, MDS coding to substantiate quality of care and quite certainly for reimbursement.
- A good understanding of the assessment process, restorative nursing programs and principles and accurate documentation for oversight is crucial.
- The nurse in charge of the Nursing Rehabilitation/Restorative Programs will need to be well-educated in the Restorative Process in order to educate and mentor staff working with the residents. (For example, Restorative Program implementation records, minutes monitoring/documentation, encouraging resident participation in the programs, compliance with documentation, are just a few areas that the Restorative Nurse will need to educate staff and oversee on an ongoing basis.)
- Accurate ADL tracking will lead to evidence for accurate MDS coding to determine resident function and need for a program.
- Restorative Program implementation records, minutes monitoring/documentation, encouraging resident participation in the programs, compliance with documentation of the toileting program process, are just a few areas that the Restorative Nurse will need to educate staff and oversee on an ongoing basis.
The Quality Measures will identify multiple areas for Restorative Nursing intervention and can also indicate a potential problem regarding function. When resident function declines or does not improve as planned, the facility will be faced with identifying if the decline is avoidable or unavoidable. Are you prepared to be able to validate reasons for functional decline?
A solid Restorative Nursing Program is key in ensuring residents receive appropriate individualized programs based on the comprehensive assessment and resident choice.
If you have policies and procedures in place for a successful Restorative Nursing system and if you individually assess residents, determine the deficit, put them in a planned, organized and individualized program, ensure consistent implementation, oversee the documentation components for evidence of compliance and revise the program as resident needs indicate, you will find success in quality, regulatory compliance and reimbursement.
Director of Education, Pathway Health