Posted May 8, 2013

What is restorative nursing?
Restorative nursing refers to nursing interventions that promote the resident’s ability to adapt and adjust to living as independently and safely as possible and attain maximum functional potential. The restorative nursing program actively focuses on achieving and maintaining optimal physical, mental and psychosocial function. 

Why is it important to implement a well-planned restorative nursing program?
The concept of restorative nursing actively focuses on optimal improvement of the resident’s physical, mental and psychosocial functioning.  Communication and documentation of resident progress is vital for the success of restorative programs.

Who is responsible for restorative care/programming?
These activities are carried out and supervised by members of the nursing staff.  Other departmental staff may be assigned to work with specific residents.

The Purpose of a Restorative Nursing Program is to increase the patients’ independence, promote safety, preserve function, increase self-esteem, promote improvement in function and minimize deterioration.  Specific patient goals, objectives and interventions need to be measurable.  A care plan outlining the program is required.

Restorative nursing programs are initiated when a resident is discharged from formalized physical, occupational, or speech rehabilitation therapy services.  A resident may also be started on a restorative program when a restorative need arises during the course of a custodial stay when the patient is not a candidate for a more formalized therapy program.

To remain in a restorative nursing program, the resident must maintain or retain their level of functioning.  In addition, nursing rehabilitation or restorative care must meet all of the following criteria:

• The individual problem must be clearly identified (ex. AROM, splint or brace assistance, transfer, walking, grooming, etc.).
• Measurable goals (objectives) and measurable interventions (actions) are clearly documented (care planned) for each individual program.
• Goals should be specific, reasonable, and attainable within a prescribed time.  These short-term goals should be seen in the context of long-term achievement.
• A periodic evaluation by a licensed nurse is present in the resident’s record for each individual restorative program.
• Nurse assistants/aides are trained in the techniques that promote resident involvement in the activity.
• A licensed nurse supervises the interventions; however, these interventions may be carried out by restorative nurses aides.
• The technique, procedure or activity practiced total at least 15 minutes during a 24-hour period to report one day of restorative.  To capture revenue for your Restorative Nursing Program, you must provide two separate 15 minute approaches per day provided over 6 days in the 7 day look-back period.

Posted December 21, 2011

With healthcare reform taking on an urgent tone as 2011 comes to an end, this article by colleagues Polsinelli Shughart does a great job of explaining what, exactly, is on the line.

House Passes 2-Year Doc Fix and “Medicare Extenders” Package

The House on December 12 passed legislation by a vote of 234-193 that includes a 2-year “fix” to the Medicare sustainable growth rate for physician reimbursement.  The bill would prevent the scheduled 27.4 cut in Medicare physician payments and instead increase the payment rates by 1 percent in 2012 and an additional 1 percent in 2013.  The legislation also would extend the therapy caps exceptions process through December 31, 2013 with some modifications to the current process.  The legislation would require that the physician reviewing the therapy plan of care be detailed on the claim.  Claims above the spending cap that do not include the proper billing modifier would be rejected.  A manual review would be required for all claims for high cost beneficiaries.  The spending cap for 2012 would be $1880 and this cap would be extended to the hospital outpatient department setting.  The Congressional Budget Office estimated the therapy caps provision of the legislation would reduce spending by $1.7 billion over 10 years. The legislation relaxes current restrictions on physician-owned hospitals by allowing those facilities that were under construction but did not have a Medicare provider number as of December 31, 2010 to open and operate under the whole hospital exception to the Stark antitrust laws.  The bill includes a reduction of $6.8 billion for hospital outpatient payments for evaluation and management and a reduction in Medicare “bad debt” payments that the CBO estimated would reduce spending by $10.6 billion over 10 years.  The legislation also would increase Medicare premiums by 15 percent for high-income beneficiaries.  Senate Majority Leader Harry Reid (D-NV) said the bill would not pass the Senate.  Reid said, “The bill passed by House Republicans tonight is a pointless, partisan exercise. The Senate will not pass it and the president has said he will veto it.” The American Hospital Association (AHA) and eight other hospital groups sent a letter to Congress stating their strong opposition to using reductions in Medicare payments to hospitals and Medicaid funding to offset the scheduled physician payment cut.  AHA is urging its members to oppose the cuts.  The letter to Congress is available here.