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What factors contribute to a well executed restorative nursing program and how does the provision of such a program impact the economics of operating a SNF?
Hello! Thanks for your question about contributing factors to a well executed restorative nursing program (RNP), as well as its economic impact on a skilled nursing facility's operations.
The short version is that success factors for a restorative nursing program include proper administration, assessment process, documentation, staff education and competence, and quality assurance. Also, a restorative nursing program can also positively benefit a skilled nursing facility by decreasing staff burden as well as improve survey outcomes and rankings.
Below you will find a deep dive of my findings.
RNP BEST PRACTICES
The Ohio Health Care Association (OHCA) represents over 920 skilled nursing care facilities in the state. The OHCA published a best practices guide for the implementation of a high quality and well-executed restorative nursing program (RNP). The basic and important factors of an individualized restorative care program include:
• Administrative
- Involves management of policies and procedure
- Necessitates review and selection of program forms
• Assessment
- Identify the need for a restorative care program based on evaluation (ADL tracking/coding, range of motion screening, bowel and bladder assessment), input from residents, and activities of daily living (ADL) deficit.
- Determine the right restorative programs for residents
- Check that the restorative program is individualized for residents
• Documentation
- Includes ancillary assessments, plan revisions, staff documentation, and specific charts according to state requirements
- Staff needs to be trained to maintain ongoing monitoring and re-evaluation to make 'resident centered' adjustments for the highest quality
• Staff Education and Competence
- Nurses in charge should observe a minimum period of programs per week
- Staff should track employees' educational status as related to the restorative program
- Staff in charge of the restorative nursing program should keep an updated list of residents enrolled in programs
- Staff in charge should interview residents and their families' feedback about the restorative program
• Quality Assurance and Performance Improvement (QAPI)
- One quality measure is to check the percentage of residents with ADL enrolled in the program
You may also check the following materials:
A Nurse Leader’s Guide to a Successful Restorative Nursing Program 2017 by the American Association of Directors of Nursing Services
Quality Assurance and Performance Improvement (QAPI) by the American Association of Directors of Nursing Services (AADNS)
ECONOMIC IMPACT
In an McKnight article published in 2009, payment expert Patricia Boyer mentioned that a restorative nursing care program benefits a skilled nursing facility by positively affecting survey outcomes and rankings of the facility, therefore attracting more clients looking for trustworthy facilities for long term and quality care.
A 2010 study published in Educational Gerontology also suggested that restorative care programs can decrease the level of staff assistance to help residents complete ADLs as well as delay functional loss, thereby decreasing staff burden.
In 2004, Cove's Edge facility published its case study regarding its implementation of a restorative nursing care program. Three months after the launch of the RNP, Cove's Edge reported a 90% goal-obtainment average for participating residents. While the RNP was a success, the facility determined that it needed a program coordinator.
After 6 months, the facility's staff coordinator Ruth Veitze observed, "Restorative nursing changes the whole focus on the part of the staff," which resulted in clinically significant and personally meaningful outcomes.
From Cove's Edge story, we can conclude that a restorative nursing program can be successful and yet challenging to a facility's operations. However, with proper management and staff development an RNP can positively impact a skilled nursing facility's operations.
CONCLUSION
To wrap it up, success factors for a restorative nursing program include administration, assessment process, documentation, staff education and competence, and quality assurance. Also, an RNP can positively benefit a skilled nursing facility by decreasing staff burden as well as improving survey outcomes and rankings.
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