Here is a white paper on the importance of appropriate restorative nursing programs for residents’ quality of life. Author Barbara Acello is an independent nurse consultant and educator in Denton, Texas.
The paper discusses the background and importance of restorative nursing programs.
"Restorative nursing is more important now than it has ever been. The Omnibus Budget Reconciliation Act of 1987 (OBRA) required skilled nursing facilities to identify and act on risk factors to prevent functional decline in residents. OBRA included the legislative mandate for facilities to allow only medically unavoidable declines. Facilities are expected to plan care that will delay any decline in function in the residents. When the Resource Utilization Groups (RUGs) were
initiated, restorative nursing programs became part of Medicare reimbursement. The Resident Assessment Instrument (RAI) Manual for 2010 defines restorative nursing as “nursing interventions that promote the resident’s ability to adapt and adjust to living as independently and safely as is possible” (CMS, 2010).
The RAI Manual instructs facilities to begin restorative nursing programs when a resident is discharged from therapy, at admission if the resident has restorative needs and is not a therapy candidate, and at any time during the resident’s stay that restorative needs arise. In March of 2011, the National Quality Forum released 21 measures for public reporting and quality improvement that will be used at the Nursing Home Compare website. Both short-stay and long-term residents are included in this data.
Restorative nursing programs affect resident quality of life by allowing the resident to be as independent as possible. Restorative nursing programs also affect reimbursement, survey, and resident/family facility choice. Restorative nursing is basically person-centered, whole-person
nursing care; the kind of nursing that we practice every time we care for a resident. The difference in a formalized restorative nursing program is that activities of daily living are considered therapeutic modalities. Nursing assistants are trained to instruct, encourage, guide, and assist residents to perform self-care skills with as much independence as possible. Quality of life is a natural outcome of restorative care.
Functional decline, on the other hand, can lead to depression, withdrawal, social isolation, and complications of immobility, such as incontinence and pressure ulcers. Functional decline has
been described as the “main determinant of quality of life, cost of care, and vital prognosis” (Baztan, 2009). The OBRA legislation and Medicare recognized the importance of preventing decline and created both a legislative and financial incentive to provide restorative nursing programs in skilled nursing facilities.
Regulations drive reimbursement, a fact of life in long-term care. Reimbursement dictates the amount of resources available for resident care and services. A well-managed restorative nursing program can bring profit to the facility’s bottom line. This is one of the ways that good care creates
resources for more good care – a positive cycle.
For the program to be profitable, attention to, and support for, the restorative nursing must come from the top. The facility administrator, director of nurses, and therapy director must be on board. A facility-wide culture of restorative nursing must be present. If not, the “helpful” housekeeper who does a task for the resident instead of with the resident will undermine the program.
Nurses, not physicians or therapists, order restorative nursing programs. Therapists work with nurses as consultants. However, restorative nursing is not rehabilitation therapy. Rehab and restorative nursing are complements to one another, but not the same. Restorative nursing, on the other hand, focuses on maintaining function in a long-term, ongoing process. Improvement is hoped for but not required. Restorative nursing bases treatment on restoring or compensating for skills lost through chronic disease, disuse, or other physiological factors.
CMS believes strongly that restorative nursing programs are appropriate for almost every resident. Quoting from the RAI Manual:
Most residents are candidates for nursing-based rehabilitative care that focuses on maintaining and expanding selfinvolvement in ADLs.