Harmony Healthcare Blog

ICYMI: Restorative Nursing: Crucial for Patient Quality, Critical for PDPM

Posted by Pam Duchene on Thu, Aug 01, 2019


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


Continuous Improvement on the Mechanism of Metal Gears.

What patients can do today and what they will be able to do tomorrow may be the result of Restorative Nursing Programs.  That’s been the conclusion of multiple research studies, including a study from Johns Hopkins in which 31% of patients improved their ADL self-performance at 6 months with 15 minutes of Restorative Nursing daily. The new PDPM System recognizes the impact of Restorative Nursing Programs by emphasizing the Restorative Nursing Programs to the Behavior Symptoms/Cognition and Reduced Physical Function Nursing categories.  In fact, patients will not qualify for certain lower Nursing categories (BAB2 and PDE2, PBC2, PA2) unless they are participating in Restorative Nursing. 

Restorative Nursing Programs have long been a key to enhancing care and have made a positive impact on the outcome of care with the prevention of functional decline.  However, Restorative Programs have typically followed skilled rehabilitation services.  Often such programs have been designed by therapists working collaboratively with nursing. 

The change to PDPM requires that, in order to be captured on the MDS, the program must begin on Day 1 or 2 following admission.  That presents a challenge for programs and a change in culture.  

Typically, the focus has been around assuring that Therapy programs are initiated, with Restorative Programs delayed until the conclusion of skilled Therapy.  In order to capture Restorative Nursing Programs as a component of a Medicare Part A stay, the Restorative Nursing Program must be ready to roll on admission.  In other words, Restorative Nursing needs to become a routine part of every Medicare Part A program.  The landmark article by R.A.J. Asher on the Dangers of Going to Bed (1942) documented the impact of immobility on body systems.  Such immobility often occurs during hospitalization, and as such, it makes sense to standardize the Restorative Nursing Program.

Restorative Nursing

An example of the practical application at the patient and facility level includes:   

During a recent monthly on-site visit to The Lodge (Warner Robins, GA), Sandi Acock, Director of Nursing and Lakisha Howser, CNA met with the Harmony HealthCARE Specialist to design a Restorative Nursing Program that can be implemented on Day 1 of most patients in a Medicare Part A program.  

Following are the key components of the proposed program: 

  1. Transfers and Bed Mobility:
    • Goal #1: Resident will transfer to chair at bedside and back daily.
    • Goal #2: Resident will roll from side to side independently or with verbal cueing four times daily. 
  1. Communication: 
    • Goal #1:  Resident will engage in communication with staff members and other residents for five minutes or more each shift. 
  2. Grooming: 
    • Goal #1: Resident will work to independently or with verbal cueing complete morning and evening oral hygiene. 

These goals appear simplistic, however, they fit with most immediate patient care needs.  

As such, this program promotes 

  • mobility,
  • socialization, and
  • grooming needs 

that are often not addressed during acute care hospitalization and are key needs throughout the Medicare Part A stay.  

With the transition to PDPM, it makes sense to start implementing Restorative Nursing Programs for Medicare Part A residents today!  Please feel free to call Harmony Healthcare International (HHI) for any assistance with Program Development.

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

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