In the heat of the pandemic battle, staffing shortages and emergency prioritization of tasks left many facilities with no choice but to triage programming.  Functional decline is not unusual as residents already prone to decline faced pandemic driven activity limitations, quarantine, periods of necessary in-room isolation and possible residual “long haul” deficits following COVID-19 infection.  Care plans that address these potential changes and demonstration renewed attention to robust restorative programming are sure to be on state surveyors’ radar as health inspections resume.

Effects of COVID-19 Infection & Benefits of Restorative

COVID-19 causes neurological, cognitive and musculoskeletal deficits with clinical and/or functional decline, and the potential for reduced participation in activities of daily living with deterioration in quality of life. The recovery phase can be extensive depending on the severity of illness. The elderly and those with pre-existing comorbidities are at higher risk for more severe consequences. Restorative nursing programs are beneficial for these populations to maintain prior level of function to the highest practicable level and to enhance independence. Restorative is a vital strategy in the pandemic recovery process to ensure that elders restore functional abilities as much as possible, and to prevent or slow further deterioration which may lead to hospital admission or readmission.  Another benefit of Restorative is the social interaction provided through one-on-one programs, or provided in group sessions, as a measure to combat the social isolation many elders have experienced due to enhanced infection-control measures.

Restorative Programming

Reducing physical decline and generalized weakness and decreasing the possibility of contracture development and joint deformities are some of the more obvious physical health benefits of restorative programming.  In addition, physical activity and movement can improve resistance to infection by enhancing the immune response.  Restorative programs including ROM, ambulation, ADL, swallowing, cognition and communication interventions each may have a place in recovery focused care planning.

Resident activity levels and physical abilities pre-pandemic compared to the current status are important assessment factors.  In addition, the restorative care plan should address the level of assistance and patient monitoring required while performing programs as considerations for specific person-centered restorative goals and interventions.  By way of example, COVID-19 positive residents who required ICU admission and were immobile for an extended period of time will likely have decreased activity tolerance.  Interventions incorporated into the restorative program plan may include pacing strategies and breathing techniques.  Interventions may be tailored to resident needs including the type, intensity, frequency, and time/duration.

Rebuilding Restorative—Where Do You Start?

Join Proactive’s expert presenters for a weekly 6-part series that offers a fresh perspective on restorative with insights into considerations related to COVID-19 recovery.  This virtual series will cover:  restorative nursing staff orientation/competencies, program development essentials, care plans, promoting optimal care delivery and outcomes, compliant documentation, accurate reimbursement, and quality assurance best practices.

Register for Proactive’s Restorative Nursing webinar series!



      • American Occupational Therapy Association. The Role of Occupational Therapy: Providing Care in a Pandemic.
      • Sheehy, L. (2020, April-June). Considerations for Postacute Rehabilitation for Survivors of COVID-19. JMIR Public Health and Surveillance, 6(2). doi: 10.2196/19462

Blog by Kristen Walden, MSN, RN, RAC-CT, Proactive Medical Review

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