Restorative Nursing Programs

Posted by LTCS on February 14, 2013

Restorative Nursing ProgramFrom the Revised Long Term Care Resident Assessment Instrument (RAI) User’s Manual, CMS: 

Generally, Restorative Nursing programs are initiated when a resident is discharged from formalized physical, occupational, or speech rehabilitation therapy.

A resident may also be started on a Restorative program when he/she is admitted to the facility with restorative needs, but is not a candidate for formalized rehabilitation therapy, or when a restorative need arises during the course of a custodial stay. 

Restorative Nursing programs:

Do not require a physician’s order. 

Do not include procedures or techniques carried out by or under the direction of qualified therapists. 

Do not include groups with more than four residents per supervising helper or caregiver. 

Restorative Nursing programs must meet all of the following criteria: 

Measurable objectives and interventions must be documented in the care plan and in the clinical record. 

Evidence of periodic evaluation by a licensed nurse must be present in the clinical record. 

Nurse assistants/aides must be trained in the techniques that promote resident involvement in the activity. 

These activities are carried out or supervised by members of the nursing staff. Sometimes, under licensed nurse supervision, other staff and volunteers will be assigned to work with specific residents.

Restorative Nursing Care Plans

 Ambulation Evaluation

 Restorative Dining Evaluation 

Skilled Charting Guidelines Increase Reimbursement

Posted by LTCS on December 7, 2012

Money Stethoscope Long Term Care Costs Director of Nursing BookCheck out this free sample Skilled Charting Guideline for Tube Feeding.

Federal regulations for long term care facility Medicare reimbursement are very specific about exactly what must be charted in nurses notes and in nursing care plans to justify payment for skilled nursing services.

With high turnover in nursing staff, having clear and handy instructions can vastly improve quality of care, documentation, and Medicare reimbursement.

Therapeutic Dining and Culture Change

Posted by LTCS on July 2, 2012

Dining Room Director of Nursing BookSurvey protocols examine elements that enhance the quality of dining experience such as attractiveness of food, sound levels, and seating comfort.

There are many influences on appetite and comfort, and the Director of Nursing and the entire nursing home staff can contribute to developing a therapeutic dining environment. These efforts are best focused on decreasing the institutional influences on nutrition and increasing more homelike attributes and increasing quality of care.

On the matter of diets, The American Dietetic Association now recommends against restrictive diets for the elderly in long term care facilities.

They state that therapeutic diets or overly restrictive diets do not make sense for residents with poor intake. They recommend having a Dietician assess the risks versus benefits of therapeutic diets, and evaluate the need for therapeutic diets according to each resident’s individual medical condition, and needs and rights.

Offering as many choices as possible will increase the intake of residents.

Studies have shown residents especially prefer buffet style dining because of the presentation, freedom of choice, and the variety of choices. The studies found that looking at the food stimulated appetites, and residents ate more and gained more weight. Comprehensive admission assessments with interviews of the residents and family members will give information on food preferences and histories. Resident council meetings are an opportunity to hear requests, ideas, and complaints concerning meals.

A lot can be done to improve the nursing home dining room environment.

The temperature of the dining room should be adjusted to the comfort level of the residents. Noise should be at a minimum, and soft, pleasant music can be played in the background. Ideally the smells of the food being cooked will reach the dining room. Tables with nice tablecloths and pretty centerpieces will make the meal more pleasant.

The attitude of the staff at mealtimes has a big impact on the residents’ appetites.

Bad feelings and negativity are contagious. Negative comments from the staff about the food, such as “same old thing again” or “mystery meat” will certainly reduce a resident’s intake, whereas remarks like “that looks so good” or “this is making me really hungry” can only have a positive impact. Having enough staff to assist with meals is vital.

Feeding assistants can help to provide more staff at mealtimes. The meal should never seem rushed.

Promoting a therapeutic dining experience will increase the resident’s intake and happiness with meals. The impact of the environment on nutrition can not be overestimated.

Read more about topics of interest to the DON in long term care in the book Director of Nursing Book and in the book Nursing Policy for Long Term Care.

Coding Section G of the MDS 3.0, Activities of Daily Living

Posted by LTCS on May 30, 2012

The intent of section G of the MDS 3.0 is to assess the need for assistance with Activities of Daily Living (ADLs), altered gait and balance, and decreased range of motion. In addition, on admission, resident and staff opinions regarding functional rehabilitation potential are noted.

Restorative nursing care plans that may be generated from section G include:

Fall Risk

Physical Mobility, Ambulation

Physical Mobility, Bed Mobility

Physical Mobility, Locomotion

Physical Mobility, Range of Motion

Physical Mobility, Transfers

Self Care Deficit, Bathing

Self Care Deficit, Dressing and Grooming

Self Care Deficit, Eating

Self Care Deficit, Hygiene

Read more about section G coding and how it relates to significant changes, care area assessments, quality indicators and measures, and RUG IV categories.

Coding Section G Functional Status of the MDS 3.0

A complete program for increasing independence in activities of daily living and mobility can be found in the book Restorative Nursing Care Plans.