Restorative Nursing

[LTCNurse13]

Hey,

I'm starting a new restorative nursing program at the SNF I work at in the next couple weeks. From what I understand residents need to have been seen 6 of the past 7 days for 30 minutes a day (working on at least 2 areas). We're going to have some restorative aides, but we have a great activities department who does group exercises every day. I know they can only have a 1:4 ratio but if people in activities are trained in exercises can this count for billable minutes (even though they aren't nursing assistants)? If it could we could get more residents in the program for the number of aides we have to hire...anybody have experience with this? If anybody has any tips for a new program please let me know thanks!

[Talino]

Most likely your program won't commence until after September. In that case, ask your MDS coordinator for the MDS 3.0 RAI Manual ( or you can download it from MDS 3.0 Training Materials Nursing Home Quality Initiatives. Read the guidelines for Restorative Nursing Program in pp O-28 to O-29.

All your questions are answered in those pages.

[SitcomNurse, BSN, MSN, EdD, RN]

For Therapeutic Exercize , you need to have the program overeen by the RN.

The TR can do the exercize provided she is not doing group of more than 4.(as you said)

This means if she has a room full of people, and your 4 are there, it dosent count.

NR is 15 minutes of two modalities. That means only 15 min of the ROM exercizes count. not 30 mins. Feel free to do 30 minutes though.

Section O of the MDS is a great starting point, because it is the reporting issues for Nursing Rehab, but it dosent explain the HOW of the NR. (Like Talino said)

Read that, really know it.

I have a book I use,

Nursing Rehab Made Easy katie Brewer of 'hcPRO' is the listed author. Its not the best book out there, but it can give you a basis of other books that may help.

It is covering the basics, careplanning and the education piece that must accompany all the resident specific issues you are covering. Every resident on program needs an individualized plan, with specific goals, and care plannning, plus review and evaluation of the program ongoing. The CNA's or RNA's will have to receive the education on the resident before the program can begin. We keep a book on each unit with the education for the residents in the book, so the CNA's can access them at any time.

Anyone who signs an inservice sheet that they were trained in what the specific ROM activities the resident who is in the program needs can do the ROM. This included family , friends, staff, volunteers TR. etc.

The only crossover it he the transition from PT/OT to NR. you cant do them both at the same time. If Nursing can do the task, then apparantly the skills of a licenced therapist arent needed. Their reimbursement will get booted.

ROM is also not about Full body ROM to all extremities for 15 minutes a day.

It is ROM to an affected area, (BLE) for a reason (PVD / circulation deficit) to improve or maintain something. (improve circulation, prevent skin breakdown, maintain ROM of joint) for 15 minutes a day.