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.

Courtesy of www.fischerprice.com.

The hustle and bustle from the holidays has finally died down, and you find yourself just now getting to organize all the toys your child received! On one hand, the generosity from family and friends is unbeatable. On the other, though, many of the toys don’t meet the needs of your child—with modified needs.

Afraid that returning the gifts and avoiding the follow-up, “How does he/she like the toy?” questions can be uncomfortable. But you’d also love to ensure them that their efforts are not for nothing. So The Comprehensive Group wanted to take a moment to go over a few resources for those spring birthday parties right around the corner.

For example, the classic Fischer-Price toy the See N’ Say is a great option. But the older versions came with a string the child had to pull to get the toy to activation which could be difficult. The newer version has a button in the middle or a lever to make things more accessible to more children. But even toys with buttons and levers can be a challenge to children with motor coordination issues.

One tip given by Toys R’ Us is to increase the surface area of levers or buttons. Attaching a bigger button, a foam shape, or Velcro to a button increases tactile feedback is an option. Adding an additional hand hold to levers can make an otherwise irrelevant toy relevant. It also notes that a switch and latch timer could be a great solution to battery-operated toys that require the child to hold down a switch to activate. In the “latch” mode, the toy will turn on with a simple switch of the latch; the same method is used to turn it off. In “timer” mode, the toy will stay activated for a set increment of time with a simple flick of the switch eliminating the need for constant contact from its user.

And remember, toys are great, but go beyond them. Music, computer games, cameras, even pots and pans (of course, used as drums… and did we mention some earplugs might be a nice investment as well?) can be equally as entertaining!

Resources for conscious toy-giving for special needs children:

Toys R’ Us Fall catalog for Differently Abled Kids:

www.Toysrus.com/DifferentlyAbled

Specially adapted toys: www.enablingdevices.com

Switch Latch and Timer: http://www.ablenetinc.com

Additional resource:

http://www.comprehensiveonline.com/staff/forms/ToysforChildrenwithSpecialNeeds.pdf

• PART B REIMBURSEMENT:  There is now a delay to the planned cut in Medicare reimbursement for all services paid by the Physician Fee Schedule which include outpatient therapy services.  The announced spending cut for payments was to be 26.5% for 2013. Under the legislation, the conversion factor is set at 0, which means payments will remain relatively unchanged for 2013.  Specifics related to the impact on therapy CPT codes to follow.

• MULTIPLE PROCEDURE PAYMENT REDUCTION (MPPR): For therapy services furnished on or after April 1, 2013 the 25% multiple procedure payment reduction is increased to 50% for all providers.

• THERAPY CAP
• Previous legislation set the therapy cap for 2013 at $1900 for PT/ST combined and $1900 for OT.
• The therapy cap extension process has been extended to 12/31/13.
• The therapy cap is extended to hospital outpatient settings through 12/31/13.
• The therapy cap is extended to therapy furnished as part of outpatient critical access hospital services.
• The Manual Medical Review process is extended through 12/31/13 for claims at or above $3700 for PT/ST combined and a separate $3700 for OT.

• SEQUESTRATION CUTS: Postponed until March 1, 2013. Under these cuts Medicare providers would see a 2% reduction in payment.

Additional information will be provided as clarification is received from our national associations.

If you have questions related to these changes, please contact your Regional Vice President for clarification.

edited by Becky Lerner

Deborah Connery, LCSW

It’s not news that placing a loved one in a residential care setting is one of the most difficult decisions families have to make.  Whether it is a Continuing Care Retirement Community, Assisted Living Facility, or nursing home, even the best-trained and most loving staff are not truly family.  No one knows the resident like the family. That’s why this month, TCG wants to acknowledge the family caregivers out there.

Families need not completely leave their caregiver role behind once mom or dad is settled into the new residential community.  While they may no longer be providing the direct, hands-on care, they can still be involved via collaboration with the community’s interdisciplinary team whose job it is to make sure the resident has the best possible quality of life.

In fact, collaboration between families and nursing care staff is critical. Families may be more familiar with how their loved one responds to medications, their customary routine—bed time, wake up time, meal times, and preferences for bathing—things that provide comfort and stability in the elder’s life. Sharing this background will give the nursing staff and the rest of the team a better chance of creating a schedule that is in sync with the resident’s life outside the facility and an easier transition for the resident.

Families should feel comfortable reaching out to the facility social worker for help in understanding their loved one’s adjustment to the new environment and for insight into the psychosocial challenges their senior may be experiencing. Conversely, the family can share invaluable social history information with the social worker that will help the social worker and the rest of the care team appreciate the resident as a unique individual and so tailor the care and services accordingly.

Families should also reach out to the facility staff responsible for resident activities.  How the resident spends leisure time has a direct impact on wellness. Families should freely share what they know about their loved one’s interests, hobbies, skills and abilities, so that the activity staff can design a program that is meaningful and satisfying to the resident. In turn, the activity staff can give families fresh ideas for activities that they can do with their loved ones when they visit.

Reaching out to therapists and restorative staff to understand movement and mobility and the expected results from a rehab or restorative program is another way that families and staff can work together for mutual edification. Sharing their perspectives on the resident’s strengths and weaknesses will help ensure that programs are reasonable, with goals that are realistic for the resident.

When the family has been the caregivers, they can develop a natural partnership with the care team at the facility.  Working together, the staff and family can minimize the sense of loss that comes with moving out of one’s home and maximize the quality of life for the resident.

Missed our Annual Awards Dinner? Don’t worry! We’ve got the skinny!

Sending a huge Congratulations! to all of our deserving winners. We are proud to be continuously wowed by the excellence of our staff!

To many, many exceptional years to come…

Congratulations to:

Jennifer S.- Gayle Allen Burket Memorial Award for Quality and Excellence recipient

Iwona S.- Cynthia Pler Round Memorial Award for Outstanding Customer Service recipient

Maryann S.- Sandra J. Lerner Award for Vision and Passion recipient

The British Home Team- P.R.I.D.E. Outstanding Team Award recipient

Melissa M.- Most Dedicated Office Employee recipient

Mae B., Susana F. and Wendy J.- Most Dedicated Clinical Employees

Brenda O.- Most Dedicated Clinical Support Employee recipient

And a huge congratulations going out to those employees celebrating a milestone anniversary with TCG!

Daryl Federman, PT

by Becky Lerner and Daryl Federman

We love our physical therapists. Aside from all the stretching and strengthening and grunting and groaning they force on us, we remain loyal. Why? Because a) they endure our whining and grunting and groaning, and b) they spend their days trying to make our lives better. It’s PT Month and we want to take a moment to recognize one of our very own physical therapists and celebrate with a reflection.

After observing a family member’s shoulder injury to recovery, and being exposed to the positive effects of therapy as she lived in a dorm in college with physically disabled students, Daryl Federman chose to become a physical therapist. Today she has been with The Comprehensive Group for eight years out of her 20+ year career and currently practices at the continuous care retirement community, Covenant Village of Northbrook.

“When I first came to The Comprehensive Group, I was working with seniors but in an out-patient facility. Because of the evolution of the job, I transitioned into the Medicare and short-term nursing facilities,” says Federman.

As a PT, Federman works in a unique environment. Continuous care retirement communities provide support for seniors while aiming to help maintain their quality of life. “A CCRC provides an independent living community with transitional services so that people can live there all the way through their end of life; including short-term rehabilitation, nursing home care, memory support units, etc.” So, Federman spends her time working with seniors with a range of needs which inevitably keeps things interesting.

“The challenge of it is looking at everybody and identifying what their individual needs are and treating them. They’re not a body part; they’re a whole,” says Federman. “You can have two people with total knee replacements–technically, the same procedure–but when you look at them as a total person, the rehab is different. That’s part of what keeps it fresh.”

What else keeps her motivated besides the challenge? Her patients. “I enjoy working with seniors,” she says. “Through my years of experience I began to see how therapy can improve the quality of life–especially with senior citizens. They’re struggling to maintain their independence, and as a therapist I see how I can maximize that.”

“If you’re interested in being able to help somebody improve their lives and their ability to live independently, this is a great field to go into,” Federman advises. “You have to be willing to give of yourself physically and emotionally because you have to be able to care about people not just for their physical needs, but holistically.”

Sending all our gratitude to all of our PTs and PTAs that spend their days improving the lives of others. Thanks from The Comprehensive Group!

Ugh, headaches. Tension headaches, sinus headaches, migraines–they’re all awful. Our friends at Rehabilitex, Inc. sent us some very valuable information about potential causes and prevention of headaches from a therapy perspective, and we felt compelled to share it with you. Thanks, Rehabilitex!

____________________________________________________________________________________

Everything You (Didn’t) Know About Headaches

The common response to a headache is “Let me pop a painkiller and hope the pain goes away”. While this isn’t necessarily a bad idea, it’s not a long-term solution for headaches, particularly the ones that that have a musculoskeletal origin.Most patients are unaware that physical therapy can play an important role in the treatment of headaches. Did you know that a physical therapist can evaluate symptoms and create a plan to reduce headache by restoring muscle balance? With certain types of headache, this has the potential to reduce or even eliminate the need for medication. For example, did you know that strengthening of the muscles surrounding the neck and jaw helps in the treatment of headache? It’s true; physical therapy can restore balance and relieve strain on muscles and joints in the head and neck region.After a complete evaluation, the physical therapist may decide to use manual therapy, which includes joint mobilizations and massage to provide welcome relief to overworked tissues. The result is relief from the pain of headache and a smile on your face.A migraine is a severe headache that may require medical attention. It is a disorder of the central nervous system involving blood vessels and nerves, resulting in intense pain. Once the cause of the migraine has been identified and treated by a physician, a physical therapist can facilitate a quick recovery to help the patient resume a normal, healthy life.

Pain Relief at the Source

One of the objectives of physical therapy intervention is adjustment of soft tissues and correction of mechanical dysfunction associated with the headache. There are several ways that a physical therapist can help achieve this. If sensitive tissues (blood vessels, nerves) in the neck are compressed, the physical therapist can use mechanical or manual traction procedures to facilitate decompression, improve circulation and relieve pressure around the affected tissues.The prescription of a home exercise program to improve posture and movement patterns can be another part of the treatment process. Unknown to most patients, poor posture contributes to head and neck pain.Depending on the severity of your headache, physical therapy can be a valuable adjunct to medications prescribed by a physician. While medications help control the pain of headache, a regimen of physical therapy improves the body’s inherent ability to fight factors that trigger headaches.

Physical Therapy and Referred Pain

One of the causes of headache is referred pain (from other parts of the body). When the muscles and joints in the upper back, neck and shoulder are under stress, they become inflamed and cause pain. Due to the complex and interconnected network of nerves and blood vessels in the upper body, this pain often spreads upwards, triggering a headache or a debilitating migraine.This is exactly where a physical therapist can help. With a precise combination of exercises, manual therapy and relaxation techniques, the therapist can facilitate pain relief. If you’ve been suffering from headaches, a viable, drug free option is available to you. You don’t have to live with pain any longer because physical therapy is a viable, scientific treatment option. Just call us and we’ll get you started. We’ll do everything we can to put that smile back on your face.

As I cruised the internet I stumbled upon an interesting fact:  There were 62.8 million adults volunteering almost 8.1 billion hours in local and national organizations in 2010, service valued at almost $173 billion.

Our very own Comprehensive Cares will be part of the 2012 stats by the end of the year, but we need your help.

Comprehensive Cares is a committee that was formed in September 2011 by recognizing a greater need for social responsibility and giving back to the communities we serve. But with so many options, we had to first find missing pieces, our fellow charities.

Our first goal was to identify charitable organizations that reflected our vision and our mission. Our vision is to strive to build organizational partnerships that focus on common goals of creating a better quality of life for its recipients. Our mission is our commitment to a corporate culture that supports and encourages community involvement, volunteerism and charitable contributions. After careful consideration and employee feedback the following organizations were selected for 2012:

Honor Flight of Chicago*: a non-profit organization that sponsors flights to Washington DC to honor veterans for their service which partnered with one of our clients, Pathway Senior Living. The Pathway organization identified all of their veterans and applied for the flight to Washington.

Thumbuddy Special**: a non-profit organization that benefits children and families in need of adaptive equipment, communication devices, and adapted wheelchairs and bikes. They also offer scholarships for kids to attend camp and special recreation programs throughout the year.

Community Health Clinic in Chicago*: the state’s largest free health clinic. It offers no-cost primary care, specialty care, medications, education, and mental health support services to men and women who are poor and medically uninsured.

*: needing  time  donations

**: needing  financial  donations

Volunteering has many unexpected payoffs. It’s enlightening; it gives you the opportunity to gain first-hand insight into a whole different world that you wouldn’t otherwise experience, but it’s inspiring to see what some can achieve despite what is lacking. And it’s re-energizing; I discover something about myself and others when I volunteer or work with those less fortunate, especially those associated with Honor Flight of Chicago, Thumbuddy Special and the Community Health Clinic. I truly believe that volunteering promotes the good in yourself and others in addition to improving the quality of life of its recipients.

As Ralph Waldo Emerson once stated,

“To know even one life has breathed easier because you have lived. This is to have succeeded.”

We appreciate those who have taken action with us, but need your help with increasing volunteers and donations. Invest in giving back with time, financial donations, or even just spreading the word about our efforts and helping us ask for involvement.

For more information contact Kelli Comise at kcomise@comprehesniveonline.com .

Edited by Becky Lerner

Dora Konstantos, Director of Recruitment

Aside from our efforts to maintain our exceptional customer care, keep our employees and patients happy and expand our presence nationally, we wouldn’t be anywhere without our diligent Recruiting Team. We’re always looking for great candidates, and we took a minute to talk to our team about who they are and who they seek to join the TCG family. Meet our Recruitment Team: Dora Konstantos and Robin Luman.

The Recruitment Team looks for “Comprehensive Material”—a therapist who is naturally driven, open to new ideas and does well with change, puts patients and patient families first, understands the importance of open communication, honesty and being a team player. Generally, someone who falls in line with our vision and values as a company. We like to hire therapists who are always learning and enhancing their skills no matter their years of experience.

Applicants can typically expect 2-3 rounds of interviews in order for them to better understand our values and culture and so we can assure we can ensure placement in the right setting with the right team where their skills can flourish. But you won’t meet Dora and Robin in the same sitting.

“Robin and I work closely together, but not necessarily during interviewing,” says Konstantos. “We tend to interview separately and discuss feedback after and if we feel we would want to bring that person on board. We have found that in order to understand or guide therapists in the right direction we must approach everyone with an open mind and with complete honesty. We strive to add value to both the therapists’ career and our growing company.”

The Comprehensive Group welcomes therapists in various different stages of their careers. We offer new grads because we have great programs in place for them to take advantage of: Tuition Reimbursement, Student Loan Repayment, Mentorship & Fellowship Programs. We are able to foster an environment where our current or veteran therapists take on the role as mentors and guide new grads through their first 1-2 years of being a therapist or therapist assistant. We work closely with various universities and colleges by sending monthly informational packets and by hosting recruiting events when available.

We also have six different service lines as well as management positions that allow both new grads and experienced therapists the versatility and variation they are looking for when trying to decide where they are happiest and where their skills are best utilized.

For more information on job openings at The Comprehensive Group, click here. We can’t wait to hear from you!

Suzann Mounts, PTA

By Becky Lerner

Summer has officially taken over! With temperatures breaking 100, the thought of doing squats and lunges and planks and stretching just seems all-the-more intense… on land. So The Comprehensive Group took a few moments to talk with one of our very own PTAs currently getting certified in aquatic therapy to learn the benefits and ideas that leave all of us buoying.

Suzann Mounts, PTA, has been with The Comprehensive Group’s facility, Plymouth Place,  for three of her 12 years as a physical therapy assistant.

“I’ve seen a lot of benefits with many different people—not just doing therapy, doing fitness as well. I grew up with a pool so I loved to do exercises in it,” says Mounts. “Many of my friends who have had injuries have gone into aquatic therapy and have healed much faster because of the buoyancy of the water.”

Working in the water (in a pool with a set temperature of 90 degrees) provides resistance for the patient in a low impact, soothing way; exercises can be gentle but still provide benefits.

An individual in water chest-deep feels the impact of only about 40% of one’s actual body weight which makes aquatic therapy ideal for orthopedic patients, seniors, those with proprioception or balance issues, and arthritis sufferers. But that lighter, more manageable feeling doesn’t mean that these exercises are going to be a breeze.

Goals for aquatic therapy are similar to most physical therapy: improving the active range of motion, decrease pain, increase mobility during exercise and during normal daily activities, decrease swelling, and improve quality of life.

Similar to most therapy forms, full body workouts—lengthening and strengthening muscles surrounding the ailing area—are absolutely necessary to reap lasting benefits; and this goes for aquatic therapy, too. According to Mounts, exercises and intensity vary depending on the patient and the goals, but core stability—strengthening the muscles in and around the trunk/torso area—is critical.

Aquatic therapy can benefit most, but is not ideal for those with communicable diseases, incontinence, or any open wounds.

If you’re interested in being “aquatically certified,” the National Aquatic Therapy Conference is coming to Chicago November 15-18, 2012.