Activities of daily living and restorative nursing present good chances to optimize reimbursement, a nursing expert said Tuesday at the National Association of Directors of Nursing Administration/Long-Term Care conference in Nashville.
“We want successful ADL tracking so we have successful coding,” explained Susan LaGrange, RN, BSN, NHA, the national education coordinator at Pathway Health Services, during her presentation.
Restorative nursing programs are identified in the RAI manual. They include urinary/toileting programs, eating/swallowing, bed mobility efforts and dressing/grooming. All restorative nursing programs, according to the MDS, must last at least 15 minutes each day.
“Does your documentation justify the program?” LaGrange asked. Benefits of a robust ADL and restorative nursing program include the increased likelihood of regulatory compliance, improved quality of care, a lighter workload for certified nursing assistants and a value in marketing the facility, she said.
Examples of tracking and coding errors around ADLs include defining what is a “limited” versus “extensive” assist, “copycat” tracking, the MDS coder not agreeing with the tracking, and tracking just once per shift. “If we only document once a shift, we have lost the opportunity to code,” LaGrange warned
One place to start for DONs looking to increase ADL function in residents — and maximize their coding returns — is bowel and bladder programs. These are “one of the most difficult but can be the most successful,” LaGrange explained. The programs must be resident-specific and are one of the top issues concerning resident dignity.
A restorative care program for residents concerning dressing/grooming could include having them choose clothes and putting them on themselves, rather than having a nursing aide dress them, she said. “We are required to train staff in how to encourage resident participation,” LaGrange reminded.
The annual NADONA meeting concludes Wednesday at the Gaylord Opryland Resort.
