Ask the Care Expert about ... restorative programs
Sherrie Dornberger, RN, CDONA, FACDONA Executive Director, NADONA
Why do most restorative programs include only breakfast and lunch in a nursing home program? And should nurses/dining assistants keep a log for each resident?
Most of the time the dining program is done only at breakfast and noon due to restorative staffing and lighter nursing staff on evenings. A well-run program would be ideally completed at all three meals.
As for the documentation, there has to be a restorative care plan that addresses what they will be doing, to assist with the feeding, drinking and frequency, etc. There needs to be at least daily documentation by the aides — logs or electronic — if the treatment doesn't occur, and then a narrative note needs to explain it.
The restorative nurse should be writing a weekly narrative note discussing progress toward the goals, any barriers, and the need for treatment. Quarterly, the RN (and oftentimes the MDS nurse) will write a summary/assessment and make changes to the program, if needed, or discontinue the program if it's not working.
With such a restorative program, be sure that everyone still assists all the residents. Sometimes staff believe that if someone is on a restorative program, then they can't or shouldn't assist them. All staff should be familiar with the restorative program — a successful one happens when everyone working on that floor, from housekeeping to maintenance to activities, is well-versed in it.
If a restorative resident goes to an activity to bake cookies, and they are working on feeding themselves or on use of a spoon and they want to help stir the cookie dough, and then they do this well, that needs to be conveyed to the restorative nurse. Acknowledge every little milestone and celebrate them all.
Please send your resident care-related questions to Sherrie Dornberger at firstname.lastname@example.org.