Maximizing Independence through Restorative Programming

1. Maximizing Independence through Restorative Programming IHCA Quality Summit Fall 2011

2. Restorative Programming To aid residents in improving or maintaining the highest practicable physical, mental, and psychosocial well being A means to stimulate, motivate, support, encourage and assist residents to grow and develop physically, mentally and emotionally beyond their current capabilities, or to aid residents in adapting to their current health status.

3. Importance of Restorative Programming Minimize functional loss due to aging and/or disease process Increase self-esteem and motivation to preserve one’s quality of life Increase and maximize opportunities for independence Has an impact on reimbursement

4. Importance of Restorative Programming • Prevents problems associated with functional decline: • Depression • Withdrawal • Social isolation • Complications of immobility (incontinence, pressure ulcers)

5. Restorative Programs are… A planned, systematic program that builds on positive goals Consistently focused on what the resident can do for themselves rather than what staff needs to do for the resident Based on small steps and progress (ie – being able to brush the right side of hair for five strokes; being able to ambulate independently)

6. Requirements for Success • Referral from physician, therapy, or RN • RN oversight • Individual care plan consisting of 2 programs • 15 minutes each (does not have to be at once) • 6 days per week • Maximum ratio of 4:1 • Documentation of daily attendance • Weekly and/or month summaries by RN **Review facility policies and procedures**

7. Restorative Attitudes • Development of a mental attitude of: • “I can” • “I will try” • “I believe I can” …..versus….. • “I can’t”

8. Restorative Programs Self-care (dressing, grooming, etc) Toileting Bathing Swallowing and feeding Mobility and/or ambulation Range of motion Splinting, braces, and prosthetics/orthotics Communication

9. Self-care • Any daily activity that involves dressing, grooming, hygiene, bathing, etc. • Brushing Hair • Applying Make-up • Shaving

10. Self-care • Care Plan • Res will be able to apply make-up independently • Res will be able to brush the right side of her hair with set up 2 x day

11. Self-care • Activities • Beauty Day • Manicures • Pedicures • Hair • Aromatherapy • Applying lotion

12. Swallowing and Feeding • Allowing resident to eat as independently as possible • Cueing to • Pace self • Swallow • Take drinks between bites • Hand-over-hand assistance • Using contrasting plates

13. Swallowing and Feeding • Care Plans: • Resident will improve/maintain ability to ingest food and fluids • Resident will maintain nutrition and hydration • Resident will consume meal with hand over hand guidance • Resident will feed self independently after set-up

14. Swallowing and Feeding • Activities: • Cooking • Snacks • Going out to eat • Meals

15. Mobility and Ambulation • Improving and maintaining ability to be independently mobile for as long as possible • Walking with gait belt • Verbally cueing for posture, pace • Using armrests to push self from seated position

17. Mobility and/or Ambulation • Care Plans: • Resident will improve or maintain the ability to ambulate (independently, 30 feet with assistance of walker, etc) • Resident will maintain an upright posture while ambulating • Resident will improve or maintain the ability to use wheelchair to get to/from areas of interest independently

18. Mobility and/or Ambulation • Activities: • Exercise • Outings • Gardening • Walking to/ from activities

19. Range of Motion ROM exercises are indicated for the resident with temporary or permanent loss of mobility, sensation, or consciousness and as a restorative measure to prevent loss of function of those residents with existing mobility.

20. Range of Motion • Active ROM • Performs exercise independently • Active Assistive ROM • Assisted with performing the movement, but resident actively participate to their highest ability • Passive ROM • Staff provide the movement, resident is not able to participate

22. Range of Motion • Care Plan: • Resident will maintain optimal functional ROM by involving _____ (joints/extremities) 2 x day • Resident will restore functional ROM

23. Range of Motion • Activities • Structured Exercise Group • Passive ROM – massage, 1:1’s, music • Checkers, puzzles, board games • Kicking the ball – soccer, balloon, beach ball • Wii

24. Communication… …is the ability to comprehend and use verbal and non-verbal language for the purpose of expressing wants, needs, and desires

25. Communication

26. Communication

27. Communication Resident will improve/maintain the ability to ________________ (answer yes/no questions, make needs known, use body language, etc) Resident will compensate verbal communication with _______ (eye contact, nodding, hand gestures) to make needs known. Resident will engage in conversation for 5+ minutes appropriately.

28. Communication • Activities • Trivia • Word Scramble • Hangman • Reminiscing • Music

29. Fall Prevention Exercise Program • Resident will improve gait pattern and balance to prevent falls • Targets • Communication • Range of Motion • Ambulation/Mobility

31. Restorative and Survey • F309 • Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest, practicable physical, mental, and psychosocial well being in accordance with the comprehensive assessment and plan of care.

32. Restorative and Survey • F310 • A resident’s abilities in… • activities of daily living • bathing, dressing and grooming • toileting • abilities to use speech, language, or other functional communication …do not diminish unless circumstances of the individual’s clinical condition demonstrate that the diminution was unavoidable

33. Restorative and Survey • F311 • A resident is given the appropriate treatment and services to maintain or improve his or her abilities

34. Restorative and Survey • F313 • Vision and hearing

35. Restorative and Survey • F314 • A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates they were unavoidable; and • A resident having pressure sores receives a necessary treatment and services to promote healing, prevent infection and prevent new sores from developing

36. Restorative and Survey • F316 • A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible

37. Restorative and Survey • F317 • A resident who enters the facility without a limited range of motion does not experience reduction in range of motion unless the resident’s clinical condition demonstrates that a reduction in range of motion is unavoidable

38. Restorative and Survey • F318 • A resident with a limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion

39. Restorative and Survey • F221-F222 • The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms

40. Interdisciplinary Approach • RNA Staff • CNA’s/Nurses • Ambulation/Walk-to-dine • Set-up for • Meals • ADL’s/Self-care • Grooming • Toileting • Transfers • Range of Motion

41. Interdisciplinary Approach • Dietary • Flexible meal times • Finger foods • Utensils • Grasped with one hand/one finger • Lightweight • Colorful (contrasting with plates/napkins/ tablecloths/etc.)

42. Interdisciplinary Approach • Social Services • Assistance with • Meals • Residents on ambulation programs that require stand-by assist • Daily communication program • Counseling for residents experienced a significant life change – i.e. – stroke, CVA, etc. “To aid residents in adapting to their current health status. “

44. Re-cap • Referral from physician, therapy, or RN • RN oversight • Individual care plan consisting of 2 programs • 15 minutes each (does not have to be at once) • 6 days per week • Maximum ratio of 4:1

45. Re-cap Documentation of daily attendance Weekly and/or monthly summaries by RN Goal of maintaining or improving functional abilities