Restorative Nursing Defined for Case Mix
By: Ruby B. Pecot, RN
Case Mix Documentation R.N. Manager
Generally, restorative nursing programs are initiated when a resident is discharged from
formalized physical, occupational, or speech rehabilitation therapy. A resident may also be
started on a restorative program when a restorative need arises during the course of a custodial
stay and they are not a candidate for a more formalized therapy program. Restorative nursing is a
nursing function and does not require a physician‟s order or oversight by a licensed therapist.
Assessment skills are crucial. To remain in a restorative nursing program, the resident must
maintain or retain level of functioning. In addition, rehabilitation or restorative care must meet
all of the following criteria:
The individual problem must be clearly identified (ex. AROM, splint or brace
assistance, transfer, walking, grooming, etc.)
Measurable goals (objectives) and measurable interventions (actions) are clearly
documented (care planned) for each individual program. (For something to be
measurable it must have a particular unit of measurement attached to it, e.g. a time-
scale, a weight or a distance and it must be measured against a particular goal or
Goals should be „specific, reasonable, moderately challenging and attainable
within a short space of time‟. These short-term goals should be seen in the
context of long-term achievement. Cannot include “canned” or “one-size-fits-
all” “pre-printed” care plan for each program. These do not address the
individual or their needs.
A periodic evaluation by a licensed nurse is present in the resident‟s record for each
individual restorative program
Nurse assistants/aides are trained in the techniques that promote resident involvement
in the activity
The activities are supervised by a licensed nurse, although these interventions may be
carried out by nurse assistants/aides, other staff or volunteers,
Exercise groups with more than four residents per supervising helper or caregiver are
The technique, procedure or activity practiced total at least 15 minutes during a 24-
hour period to report one day of restorative.
Documentation Requirements for Case Mix:
The Restorative Nurse must care plan each problem, establish measurable goals and measurable
interventions specific to each individual resident.
The MDS requires each technique, procedure or activity practiced totals a minimum of 15
minutes during a 24-hour period for at least six of the seven days during the observation period
for each problem addressed. The case mix reviewers are required to review actual minutes
provided each day and signed by the staff providing the service.
Interventions may be carried out by nurse assistants/aides, or other staff or volunteers. However,
a periodic evaluation of each problem the resident is receiving restorative services for must be
documented by a licensed nurse.