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I have been approached by an RN in an SNF to provide sort of a general overall strengthening and ROM exercises that the restorative therapists do in that facility even though I do not supervise what they do or even work with them. I have some serious reservations about doing this as I'm concerned about liability if something should go wrong when they are doing a tx that I have shown them. Typically, the PT on contract will get a referral and have the restorative therapists perform the service. That may be an upper or lower extremity exercise program, then he comes back periodically to review how the patient is doing. This is primarily a psyc facility and they have no full time OT or PT. I mainly work in a state psychiatric facility and the SNF is located on the grounds and I go see patients periodically for positioning or when there's a decrease in ADL's. If tx is involved, I always do the tx. I don't rely on the restorative therapists. I was told they need to receive "some training" from the PT and the OT to continue doing their jobs. I'm not sure I feel comfortable providing that training. Does anyone have opinions about what I should do? Thanks, Suzy
-------Original Message-------
Date: Saturday, July 12, 2003 12:04:05 PM
Subject: Re: [OTlist] Three Questions
----- Original Message -----
Sent: Saturday, July 12, 2003 7:16 AM
Subject: [OTlist] Three Questions
1st Can COTA/L do recerts?
No, recertification (i.e, 701s usually used) is a process involving 'assessment' of status/ goals and establishing/ re-establishing them along with an updated plan of treatment. The OTR is responsible for all these functions, as the physician recertifies the need for continued skilled services. A COTA/L may assist with the process such as, writing down demographics and gathering data, however, the regs requires the OTR to infer, modify and re-establish need for services.
2nd What requirements are necessary for a restorative Aide? Either by the State or by Medicare? A restorative aide is different from a Tech. How?
as far as the requirements?
A restorative aide usually functions based upon a restorative 'nursing' plan of care that may have been established with the assistance of a therapist; but again an RN should be signing-off on the POC nad reviewing it 'periodically'. In states that count the restorative programs for their case-mix index (CMI), e.g., OH & WV, you must be aware that you must have at least 2 programs run 6 days a week, at least 15 mins each program, each day. I have not come across a written statement from Medicare or the State (my state OH), where, they mandate any particular qualification for restorative aides. But prudently as supervised under a nursing POC technically, they should be CNAs/ STNAs. Most facilities prefer an CNA with 1 year experience.
Again to the best of my knowledge, there are no mandated qualifications by the states or medicare for techs. either. Hence, it's upto the discretion of the SNFs. They are different in the sense that a restorative aide has the prime responsibility to carry out the restorative programs, and at least technically for the states that have restorative programs count towards CMI are supervised per a nursing POC. Techs basically assist therapists to file, clean-up, set-up, provide non-judgmental/ simple direct care under 'line-of-sight' supervision of a licensed therapist in states that allow it, and ofcourse also perform......other duties as assigned!
A restorative aide may function as a rehab technician as well. Most facilities require both the restorative and rehab aides to be CNAs. And, in states that do not count restorative programs towards CMI, I do not see why a non CNAs/STNAs ( a rehab tech not also certified as a CNA) can not perform a maintainence program as a rehab aide that is periodically reviewed by a therapist or nurse.
Joe
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