RE: Restorative Aides in LTC Settings

[Guest guest]

Responses below:

In a message dated 8/24/03 2:43:30 PM Mountain Daylight Time,

markdwyer87@... writes:

<< 1. What is the Restorative Aide's role in the facility? Is it for

maintenance only? If not, what else do they do?>>

Restorative Dining, ROM UE and LE, Ambulation Programs, Standing Frame

Programs, ADL Programs, etc. We also put a person in our Assisted Living to

perform

similar functions (Rehab aide though, reports to me and facility managers).

<<2. Do the therapists (PT, OT, SLP) write any goals or plans for the

restorative aides? If so, what is the follow-up that the therapists

perform, if any? >>

PT, OT, SLP are primary FMP writers. Some toileting programs and people

whose family doesn't want therapy may receive Nursing FMPs. Follow up here is

PRN

as needs (i.e. change of condition) warrants. Sometimes we screen for

appropriateness of present FMP, then either request orders or note that it still

seems appropriate.

Wade McDowell, OTR

Director of Rehabilitation Services

Activities Director

Family Health West

228 North Cherry

PO Box 130

Fruita, CO 81521

Ph:

Fax:

scout2ot@...

[Guest guest]

Mark,

We are going through some growing pains with a particular nursing home that

we do some coverage for as a part of another contract that we provide services

for in a rural health/critical care access hospital. Previously, the PT that

was there was doing ROM (goniometric measurements) on every resident every

year on every joint?????? Nursing tends to feel that we should continue this,

but can offer no justification for why or where it states that this is to be

done. We have pointed out to them that the PT is liable and if our hands go on

these residents and they report an injury or other problem, it is us who will

ultimately be responsible. Also if we measure, say AROM of the shoulder at 130

degrees this year and 128 degrees next year, that then shows a decline in

function. If they do not address this decline in function it could become a

deficiency when reviewed by the state. Further, they order an evaluation (not

screening) on every resident who is hospitalized and then returns to the care

home. (the Doctor has a standing order for PT evaluation on each resident

returning from the hospital).

We have contacted the KDHE MDS coordinator who states that these are not

mandated functions of a PT and further states that all screenings are a function

of nursing. Once a decline in function has been noted or recognized, then and

only then should PT become involved to do a screening of their own to

determine if skilled services are necessary.

Anyway, we have been involved in a battle so to speak with nursing as they

refuse to listen to us and refuse to do the research required to prove it to

themselves. Our hands are tied as we are providing a contract service for the

hospital and the hospital in turn provides us as a contract service for the

nursing home. I know--it gets a little confusing! My main reason for all of

this

rambling on is to ask you as you continue researching this if you find any

supporting documentation could you pass it our way? It would be much

appreciated. I am looking forward to the State Govt. Affairs meeting in KC.

Will you

be able to attend?

Thanks

Ric Baird, PT, ATC

Owner, Interactive Physical Therapy

[Guest guest]

I apologize to the list. I intended for that posting to go only to Mark.

Sorry everyone had to read my ramblings!

Ric Baird, PT, ATC

Interactive Physical Therapy

[Guest guest]

Dang Ric, it sounds like you're having fun. Do you want what we found

out about restorative aide programs, because what you are dealing with

sounds like a whole other ball of wax? If so, I'd be happy to send it

your way. Actually, the place where I found the most helpful info

regarding restorative programs is in the third chapter of the MDS 2.0

Manual. The link for that is

http://cms.hhs.gov/medicaid/mds20/man-form.asp. The parts about

supervision are on pages 189-195 in the third chapter.

As far as the ROM question, I would argue that a change in ROM is NOT a

change in function, it is simply a change in ROM that may or may not

alter the patient's functional abilities. After all, shoulder flexion

of 125° versus 130° will probably not affect the patient's ability to

dress him/herself. I would argue that as a way to at least get

yourselves out of that silly annual ROM assessment (what kind of PT

thought of that???). If they want to see whether there was a functional

decline then have the PT eval the patient.

As far as ordering a PT eval upon return from the hospital, I can see

the need for that for those patients who were seeing PT, OT, or SLP in

the hospital, but not otherwise. If a need is present it should be

documented by the nurse on his/her assessment upon the patient's return

to the hospital. But like you said, you need the documentation to

support your position and not just my position.

You may want to persue other chapters of the MDS 2.0 manual as that has

many guidelines about when you can do certain things. I found it very

eye opening about topics outside of just restorative aides.

As far as waiting for the nurses to do the research to back up your

position, I would not wait for that to occur. You are right in trying

to get this info yourself so that you can present it, especially if the

nursing home is using therapy inappropriately and could possibly be

construed as fraud.

Good luck. And feel free to contact me if you need more info. Here are

all of my numbers below.

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

20333 West 151 Street

Olathe KS 66061

(Phone)

(Fax)

mkdwyer@... (Work E-Mail)

markdwyer87@... (Personal E-Mail)

Re: Restorative Aides in LTC Settings

Mark,

We are going through some growing pains with a particular nursing home

that

we do some coverage for as a part of another contract that we provide

services

for in a rural health/critical care access hospital. Previously, the PT

that

was there was doing ROM (goniometric measurements) on every resident

every

year on every joint?????? Nursing tends to feel that we should continue

this,

but can offer no justification for why or where it states that this is

to be

done. We have pointed out to them that the PT is liable and if our

hands go on

these residents and they report an injury or other problem, it is us who

will

ultimately be responsible. Also if we measure, say AROM of the shoulder

at 130

degrees this year and 128 degrees next year, that then shows a decline

in

function. If they do not address this decline in function it could

become a

deficiency when reviewed by the state. Further, they order an

evaluation (not

screening) on every resident who is hospitalized and then returns to the

care

home. (the Doctor has a standing order for PT evaluation on each

resident

returning from the hospital).

We have contacted the KDHE MDS coordinator who states that these are not

mandated functions of a PT and further states that all screenings are a

function

of nursing. Once a decline in function has been noted or recognized,

then and

only then should PT become involved to do a screening of their own to

determine if skilled services are necessary.

Anyway, we have been involved in a battle so to speak with nursing as

they

refuse to listen to us and refuse to do the research required to prove

it to

themselves. Our hands are tied as we are providing a contract service

for the

hospital and the hospital in turn provides us as a contract service for

the

nursing home. I know--it gets a little confusing! My main reason for

all of this

rambling on is to ask you as you continue researching this if you find

any

supporting documentation could you pass it our way? It would be much

appreciated. I am looking forward to the State Govt. Affairs meeting in

KC. Will you

be able to attend?

Thanks

Ric Baird, PT, ATC

Owner, Interactive Physical Therapy