It may be time to assess your facility Restorative Nursing Program as part of your PDPM transition preparedness plan.

Restorative Basics

The fundamental requirements for Restorative nursing will remain the same under PDPM. Per the RAI manual, Restorative Nursing Programs actively focus on achieving and maintaining a resident’s optimal physical, psychosocial and mental well-being while promoting their ability to adjust and adapt to living as independently and safely as possible. The standard for a minimum of two programs provided for 15 mins or more each day for at least 6 days during the look back period to be reimbursed for restorative services is also unchanged. Restorative programs include passive range of motion, active range of motion, splint or brace assistance, bed mobility, transfers, walking/ambulation, dressing and/or grooming, eating and/or swallowing, amputation/prosthesis care, communication, urinary toileting program and bowel program.

PDPM Considerations:

  • Under PDPM, Nursing Case Mix Groups (currently, RUGs) will be reimbursed in their own component separate from therapy. For residents who are categorized into the Behavioral Symptoms and Cognitive Performance or Reduced Physical Function Nursing Case Mix Group, Restorative Nursing Programs can offer flexibility in providing services so long as they do not overlap with those functional needs that require a therapist.
  • Given that, in most cases, the PPS 5-day scheduled assessment sets reimbursement for the entire stay, the Clinical Admission Team should develop a system to promptly determine if a newly admitted skilled patient would benefit from restorative services and establish the restorative plan of care.
  • Under PDPM, the average financial impact of providing clinically appropriate RNPs can be between $8.27 – $10.75 per day depending on various other patient characteristics.
  • In order to report the RNPs for the 5-day assessment under PDPM, programs will need to be initiated on Day 1, 2 or 3 of the stay to allow enough time for the required 6 days of RNPs to be provided by day 8 of the covered stay (the last allowable day for scheduling the 5-day assessment). This could challenge providers to determine, develop, and implement programs that could effectively be performed by Restorative in a timely and efficient manner, especially for those residents who admit on weekend days.

With these considerations in mind, providers will need to implement systems for performing admission assessments that review restorative needs, and coordinating interdisciplinary team discussion on the restorative care plan and goals for newly admitted patients.

Partner with Proactive today to jump start your restorative programming and prepare for PDPM!

Proactive offers a partnership plan to guide a successful transition. Our training, tools, and clinical reimbursement experts ensure you’re ready with monthly work days and step by step guidance from a Proactive consultant. Contact us for more information on our budget friendly flat- rate partnerships billed in easy installment payments.

Featured Toolkit: Restorative Nursing Competency

This Tool-kit download includes a Lesson Plan/Instructor Guide for team training. Competency can be evaluated through the use of the included tests and Competency Evaluation forms covering 17 individual skills. Toolkit details here.

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Blog by Eleisha Wilkes, RN, RAC-CT, Clinical Consultant, Proactive Medical Review

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