People have many reasons for choosing a career in long-term care. Some come into the profession because of family members. Some find that it's their passion. As the author of this article, I came into the profession as a college student, attempting to finance my way through undergraduate school. I worked in a nursing home to assist with financing through college in the late 70's and witnessed, first-hand, why we have "resident's rights" to this day. I left the nursing home in dismay due to what I saw -- residents restrained and medicated for no apparent reason and with no regard to their human rights. I vowed I would never go back to the nursing home setting, but here I am. I believe that every human being deserves to live his or her life to the fullest and to be provided care that is "restoring" in nature in order to improve quality of life to the very end. This is quality of care.
In 1987 OBRA-Omnibus Reconciliation Act mandated that nursing homes:
- Provide the necessary care and services to maintain and attain residents at their highest practicable physical, mental, and psychosocial well-being
- Must ensure that a resident obtains optimal improvement or does not deteriorate within the limits of their rights to refuse treatment and within the limits of recognized pathology and the normal aging process
- Provide residents with appropriate treatment and services to maintain or improve abilities
- Provide residents who are unable to carry out ADL's with the appropriate services to maintain good nutrition, grooming and personal and oral hygiene.
These acts then became their own Federal regulations which all pertain to "restoring a resident's function and preventing deterioration:
F 309 Quality of Care
F310 ADL's
F311 Appropriate Treatment and Services (among other regulations).
The Minimum Data Set (MDS) was added to the OBRA budget bill of 1987 to "universalize assessment " so that all residents could receive a basis for an individualized plan of care that would provide service to maintain them at their highest level of function. The MDS became ground zero.
Many organizations attempt "restorative nursing" programs, but few actually achieve what they set out to do. Restorative nursing programs assist residents in maintaining their highest potential, assist in preventing complications of chronic conditions, help prevent overall de-conditioning and reduce the level of care required to perform daily tasks. Restorative programs need to be overseen by a licensed nurse and implementation of these programs needs to be done using a "team" focus. Entire care centers need to commit to providing quality care to all residents.
Restorative nursing can only be implemented after proper training of staff on the principles, purpose and techniques to promote independence. Observation and documentation is necessary to ensure the program is administered as planned. In addition, a successful restorative nursing program will improve care center quality indicators and measures, raise the RUG category of the resident to increase the overall reimbursement rate of the care center and improve the marketing strategies within the community while increasing the likelihood of CMS regulatory compliance.
In summary, CMS believes that a resident's potential for maximum functionality is often greatly underestimated by family, staff and the resident themselves. Thus all residents are candidates for nursing-based rehabilitative care that focuses on maintaining and expanding abilities in ADL's MDS 3.0 pg. 3-73. This is what the United States (CMS) wants all care centers to do for all their residents and the MDS is the basis for determining these needs.
Pathway's vision is for a focus on Restorative Nursing nationally and internationally for all the elderly. If you want to hear more about restorative nursing programs, please join me in the upcoming audio conference.