Restorative right or wrong??

[120961mykel]

The LTC facility that I work at has a very poor restorative program. We have no restorative aides, the cnas are suppose to do the restorative as well as all other ADLs. We were told from our corporate office that ROM can be counted when the resident is dressing, bathing , or any other ADL even tho they are not doing any reps. This doesn't sound right to me I thought a ROM and dressing program were two different things? Also if a resident is alert et oriented, and when asked if they would like to do their exercises if they stated that they had already done them independently then we can count that as well? If a resident can perform ROM exercise independently then why are they on a ROM program?

[rpsychnurse]

It sounds like your restorative program really needs a leader! Is there someone who is in charge of it that you can pose these questions to? (We have an OT and a Home Care RN who are our 'leads')

I would say if the resident is A+O you can absolutely take their word about exercises - just ensure that you chart properly to reflect that!

The reasons residents who can independently perform ROM are on a program could b a variety of things and that would be for the rehab team/OT/PT to assess. Perhaps they are weak and they are doing the exercises for strength. Maybe they are getting close to D/C and will have to do them on their own at home. Have you ever been to PT? They often send independent exercises home with patients.

It sounds to me like yur program needs better direction and more specific care plans though. Bring it up the chain if you can!

[Medicarenurse1]

In a perfect world, the floor CNAs would be able to do restorative programs, most especially ambulation, brace/prosthesis assist, feeding and actually all of them. The CAVEAT is the charting for both the CNAs and the nurses. The RN needs to over see the plan and tweak it, and write a progress note (narrative-not checkbox) weekly or at least monthly. In order to count for reimbursement, that is. Also, just to clarify, it is OK, I repeat-Acceptable and OK to employ restorative techniques that are provided to MAINTAIN THE CURRENT LEVEL OF FUNCTION. This was in the last revision of the Medicare laws. If a person is likely to decline without being cued and prompted to put joints through a full functional range of motion, then ROM is perfectly acceptable, but it should be observed and not just reported by the resident to the CNA. Not opinion, part of the rules. Just ask them to show you or the CNA what they did this morning.

[shlay51]

I'm new to MDS, only been doing it since November. The administrator wants to completely revamp our restorative program. I'm not sure if I would even call what we have a program. I would be playing a big part in this revamp and I'm looking for any advice or some direction. It's a small facility, only 30 beds total. We also don't have any restorative aids and the caregivers are expected to do the restoratives. I question frequently how well, if at all they are being done. This is why we are looking to revamp the entire program.