restorative nursing

rnkarengail · Aug 26, 2011

I too am new to restorative nursing and have SO enjoyed this thread. Thanks to all you wonderful nurses for sharing. I still have more questions than answers and don't know where to start, but if ANYONE knows of somewhere I can get some training please let me know. I've tried to find something online and it just explodes in non-related dead ends. A course in Ohio or Las Vegas would be great. THANKS

rndebracoll · Mar 1, 2012

Hi,

The CMS RAI Users Manual for MDS 3.0 has a lot of resources. You can download the book free on their web site:

http://www.cms.gov/NursingHomeQualityInits/20_MDS30RAIManual.asp

RestoreNurse · Mar 19, 2012

Unlike quite a few nurses here, I've actually been in charge of our Restorative nursing program for 6 years, but the ground has shifted a bit underneath our feet due to changes in our administration and the director of nursing and suddenly I feel as if I'm a newbie.

When we started the program I was told not to worry about the reimbursement side of restorative nursing since the reimbursement for straight restorative nursing was fairly nominal, so other than the occasional Rehab Low, we focused instead on just establishing a broad range of restorative programs to meet our resident's functional needs and we actually had a lot of success with this. Unfortunately, due to financial constraints, our program has had our staffing cut a number of times over the last two years and I was just informed by our DON that they are now thinking of disbanding us altogether and just have the CNAs do any restorative programs. She was effusive in praising us for our "value-added" services, but stated that because we didn't bring in any money to the facility, we couldn't afford to continue with the program.

I feel more than a little frustrated, but I suppose I should have seen this coming. Either way, I now find myself having to explore the options for reimbursement for restorative programs and was wondering what suggestions any of you might have. Is the only practical option the Rehab Low category? We have done a number of these, but our therapy department hasn't been generating many of these in the last year or so.

I feel that if I can make the case that our program can at least bring in some money to the facility, then I might be able to convince our DON to give us another chance. I would hate to see this program go down, and I think we all know how effectively the restorative programs will be when they are just another task added to the workload of the already overloaded CNAs.

Any suggestions would be highly valued!

SitcomNurse, BSN, MSN, EdD, RN · Mar 22, 2012

If I only counted on the RL category to get anywhere, I'd have 5 people under my belt in 2 years. That wont do! Do you have a RUGs IV breakdown for your facility? How to acheive a RUGS of course is in the MDS, but each state has different reimbursement categories. I concentrate on getting the '2'. PD2, PC2, there is a financial difference in PD2 and PD1, the difference is Nursing Rehab. Certainly formal therapy carries more weight for reimbursement, but the standard is, to have any resident on program get 15 minutes of combined ambulation(or any other single therapy) in 24*. So, between days eves and nights, I get my 15 minutes. Then the second therapy.. dressing and grooming.. days & eves gotta pull together. When we are headed for look back in an MDS. I send a reminder to notify me if there are any problems, and to re-inforce with the CNA's to spend the extra time encouraging the ADL task, to be sure we are getting the capture. MOST of the time it works, sometimes, it dosent. I have people on program because it is better for them to be there, and I KNOW I will get no capture. But they do not out number the persons who I capture in the '2'.

Simply, I have a list, and monitor RUGS scores monthly (for those on program who have an MDS due) and write down how much more we obtained because of NR. and how much we failed to capture too, that is equally important for Admin to see, if we lose the program, we have no hope of X dollars, and will lose XX dollars. If you need any other help, look me up, send an inbox if you like, I would be glad to help in any way I can.

RestoreNurse · Mar 29, 2012

Thanks for the reply. I tried to find a way to contact you directly, but private communication was disabled.

We do have the RUGS IV breakdown, but everything in our facility is broken down into specialties and I actually don't work with the MDS directly, but depend on others to inform we when a need has been identified. Obviously, that is not an optimal arrangement. I do know our Medicare Utilization nurse quite well, however and I think we can work to change this.

I realize that some of this varies from state to state, but do you have any rough estimates how much difference, money-wise, there is between getting a PD2 vs a PD1? This had been reviewed a long time ago by another "specialist" within our facility and was deemed to be not worth the effort. That always stuck in my craw a bit, but my view is that it is worth the effort even if there is NO monetary gain since it addressses the resident's needs.

Also, do you have the CNAs actually document time, or do you build that into the wording of the care plan/program? I've read arguments both for and against this and I'm not sure what is required legally.

Thanks again.