9.5 Rehabilitation Versus Restorative Care

As previously explained in “The Rehabilitation Process” section, speech therapists, occupational therapists, and physical therapists create the client’s rehabilitation plan with the goal of returning them to their level of function prior to the injury or illness. When an individual has progressed to their highest level of functioning, a restorative care plan is established to ensure this level of function is maintained. Although therapists provide rehabilitation therapy, nursing assistants are responsible for providing restorative care planned by the therapy team.

Common restorative plans include assisting with ambulation (Chapter 8.5); performing passive or active range-of-motion (ROM) exercises (Chapter 9.6); assisting with activities of daily living (ADLs) (Chapter 5.2); and applying prosthetics, splints, and orthotics (Chapter 8.6). Providing restorative care should be documented because it is an integral part of keeping residents as independent as possible and maintaining their overall health and quality of life. If the client resides in a facility that receives Medicare reimbursement, restorative care is reported as part of the person’s quarterly minimum data set (MDS) assessment. (To review aspects of MDS, see Chapter 1.5, “Documenting and Reporting.”) If it is found that a resident experienced a decline in mobility because their restorative care plan was not being followed appropriately, the facility must provide therapy at no charge to restore their prior level of function.

Restorative care can occur individually or within a group. An individual activity means the nursing assistant is working with one resident at a time on that resident’s specific restorative needs. Restorative care can also occur in a group setting, such as an exercise group where residents follow the lead of an aide and participate as they are able. As discussed in the Chapter 8.6, “Applying Prosthetics and Orthotics” section, it is the nursing assistant’s responsibility to know how to properly perform restorative care, as well as keep residents safe from injury during restorative activities. If you are unsure about any aspect of restorative care, seek instruction from your supervising nurse.

Although clients benefit from restorative care and are encouraged to participate, they do have the right to refuse to participate in restorative care, just as they do in any other aspect of their health care. Certain situations, such as those described below, can make it difficult to motivate residents to participate in restorative care^[1]:

• The resident has cognitive deficits that make the benefits of restorative care difficult to understand or impair their ability to participate.
• The resident has been dependent on others for their daily care for a long time.
• The resident experiences pain associated with the activity.
• The resident (or their caregiver) is fearful of falling or becoming injured when performing the activity.
• There is unfamiliarity or the lack of a trusting relationship between the caregiver and resident.

If these circumstances occur, the nursing assistant should continue to encourage the resident to participate in the restorative care in a respectful manner. It may be helpful to delay the care and reapproach the resident at a different time of day. If the resident displays any subjective or objective signs of pain, it should be reported to the nurse for assessment and treatment. Involving loved ones in explaining the importance of restorative care can also enhance a resident’s participation, along with reassurance from a nurse or therapist who oversees the restorative plan. If the resident continues to decline participation despite these attempted approaches, the nursing assistant should report the situation to the nurse, as well as document it was the resident’s choice to not participate in restorative care activities despite the approaches attempted.