A restorative communication program can and should include all components of communication, including compensatory strategies and training/instruction for hearing loss and cognitive deficits. The Speech-Language Pathologist and nursing staff should collaborate as part of the care plan team to determine the best interventions to address the resident’s deficits in order to promote quality of life and maximize appropriate and meaningful communication. Many restorative nursing program manuals generalize interventions and it is up to care givers to make them more meaningful to the individual resident based on their history and clinical needs.

Your physical rehab service program would indeed be considered a restorative program and would fall under the state guidelines of “restorative” intervention for purposes of documentation and care planning. I would reconsider the program name as it may be perceived as “skilled” intervention since the name suggests that skilled physical therapy is being provided. A policy and process for this program would be beneficial as well. I think the program is a good idea and proactively addresses maintaining function!

Most facility restorative program manuals have an outline of what is required for documentation of a walk and dine program. It is also very easy to research on line. You may want to review the RAI manual, section 0 for specific guidelines on restorative components for Medicare part A. A walk to dine program can be set up similar to an restorative ambulation program and would follow the same documentation guidelines. Usually this entails setting the individual resident goal, including care plan, daily documentation of participation by the CNA and a monthly note indicating supervision of the program by a licensed nurse.

I have always considered Walk to Dine a restorative nursing program. The parameters for using it as such is up to the individual facility, however, I would not use it for independent ambulators. A walk to dine program should be used for those residents that require assistance to ambulate and would not be able to get to the dining room independently. Conversely, if the resident needs maximum assistance and can only walk a few feet (or less), then a more specific and guided restorative program for walking may be needed and Walk to Dine would not be optimal for that resident (they would require more time and one on one cueing). It may be helpful to get the care plan team together and discuss the parameters of “when” a resident would qualify for Walk to Dine program so there are specific guidelines that everyone can agree on. Ultimately, our goal is to promote quality of life and prevent functional decline. So, how we get there is open for discussion with the team. Please let me know if you would like more specific information and I will be happy to share.

Cherie

There is no requirement of a set time, however, it should start as soon as possible for the resident to facilitate continuity of care and prevent decline.

Walk to dine is NSG/CNA staff encouraging, supervision and providing SBA for residents that Primarily ambulate with walkers that are at risk for falling and require staff to be watching / SBA in order to go the distance 3 x a day to meals, to provide exercise, stretching / mobility, improve appetites and fluid intakes. WE have VERY FEW residents that are Independent for ambulation in the facility, that have not had falls or other risk events.

Walk to dine is a nursing intervention program to address / improve outcomes in the areas of concern: weight loss, UTI’s and falls.
I mean I agree with the nursing intervention program part…however that nursing intervention would fall under restorative nursing. Or at least thats what I think/feel.
Can you shed an inch of light on this situation for me?

Allison
Please also remember that a resident can qualify for Medicare Part A Rehab Low Intensity if the following criteria are met:
Total Therapy Minutes of 45 minutes or more and At least 3 days of any combination of the three disciplines (O0400A4 plus O0400B4 plus O0400C4) and Two or more restorative nursing services received for 6 or more days for at least 15 minutes a day
Be sure you follow the recommendations provided by Cherie in her response as well
Sincerely
Sheila Capitosti

Hi Allison,

Restorative can provide a program for the resident while they remain on therapy caseload as long as is not a duplication of the primary therapeutic intervention. Therapy services are “skilled” and therefore denote a level of complexity that is not provided in a restorative program. For instance, if Physical Therapy is treating for gait deficits, restorative can provide a walk to dine program to provide follow through of gait strategies and cueing for safety,as instructed by the PT, this is what often occurs when we apply the rehab low expectations with a Medicare A reimbursement scenario. If therapy is providing specific interventions that address exercise and ROM or any other type of skilled intervention, then restorative should wait until therapy discharges them and provides a plan for the restorative team.

Sincerely,

Cherie