Restorative Nursing programs are vital to long term care. These traditional nursing home programs, if not well managed and organized may leave long term care residents with an overall poorer quality of life lower and declines in function that impact quality assurance measures and generate facility deficiencies. The Omnibus Reconciliation Act (OBRA) 87’ requires the facility provide to “each resident the necessary care and services to attain or maintain the highest practical physical, mental, and psychosocial well- being, in accordance with the comprehensive assessment and plan of care.” (483.25) Throughout the OBRA guidelines both restorative and maintenance programs are identified. Specifically, 483.45 (b) states: “specialized rehabilitative services are provided for individuals under a physician’s order by a qualified professional. Once the assessment for specialized rehabilitative services is completed, a care plan must be developed, followed, and monitored by a licensed professional. Once a resident has met his or her care plan goals, a licensed professional can either discontinue treatment or initiate a maintenance program which either nursing or restorative aides will follow to maintain functional and physical status.” The purpose of the restorative nursing program is then described as providing restorative care necessary to meet the needs of residents in order to achieve the standard as described by the Omnibus Reconciliation Act of 1987.

How this mechanism works in your facility is driven by the needs of your resident’s and the capabilities of your staff to consistently implement the program. Developing a clear process for the delivery of the restorative services and assigning role responsibilities is crucial. Although the therapist may refer a resident to the restorative program, nursing must supervise and drive this program. Further clarification on restorative care and requirements for inclusion in the MDS are in Section O: Special Treatments, Procedures, and Programs, in the CMSD RAI Version 3.0 Manual. Restorative programs that can be counted towards the MDS include:
• Range of Motion
• Bed Mobility
• Transfers
• Walking
• Dressing and/or grooming
• Eating and/or swallowing
• Amputation/Prostheses care
• Communication
Additional restorative intervention may include:
• Body alignment/Positioning
• Bowel and Bladder Retraining

The Medicare requirement for inclusion in the MDS to generate the rehab low RUG category is 2 restorative programs for a minimum of 15 minutes daily during the 7 day look back period of the current assessment. The benefit of developing a restorative program is sweeping—

 It ensures a proactive approach to prevent future functional decline
of the resident
 It creates continuity of care across the continuum and generates
communication with the interdisciplinary team
 Maintains the residents function for a longer period of time,
indicated in quality measurement tools and generates good surveys

The increased scrutiny and focus on quality initiatives by Medicare and other Insurer’s within our industry necessitates the further development of key services being provided in long term care and CCRC communities. With innovative thinking and well developed partnership strategies we can continue to promote and provide effective services for our residents that will positively affect quality of life, improve our admissions, and decrease re-hospitalization.