Unit 1: Rehabilitation and Restorative Care Lesson 1: Introduction

Lesson 1 – Introduction Rehabilitation Helping patients attain the highest possible level of functional ability Focusing on physical ability Rehabilitation Rehabilitation is the process of helping patients attain the highest possible level of functional ability. For example, after a stroke, a patient may receive rehabilitation to help him speak clearly. Rehabilitation mainly focuses on physical ability. It is intense. And the therapies are planned for a limited amount of time. The rehabilitation team may include physicians, a physical therapy team, an occupational therapy team, a speech-language therapy team, a nursing team, and the patient's family and care givers. Rehabilitation services may be provided in hospitals, subacute facilities, nursing facilities, and home health care agencies.

Lesson 1 – Introduction Restorative care Helping attain and maintain the highest possible level of independence and well-being Focusing on mental, emotional and social well-being Restorative Care Restorative care is the process of helping patients attain and maintain the highest possible level of independence and well-being. For example, an elderly patient may receive restorative care to help her control incontinence. While rehabilitation mainly focuses on physical ability, restorative care also focuses on mental, emotional, and social well-being. Restorative care is often started after rehabilitation. It is less intense than rehabilitation. And the therapies are often on-going. The restorative care team may include physicians, a physical therapy team, an occupational therapy team, a speech-language therapy team, a nursing team, and the patient's family and care givers. The nursing team is primarily responsible for planning and providing restorative care to the patient. Restorative care is most often provided in nursing facilities and home health care agencies.

Lesson 1 – Introduction OBRA Recognizes importance of independence and well-being Requires rehabilitation and restorative care OBRA and Rehabilitation and Restorative Care The Omnibus Budget Reconciliation Act (OBRA) is a federal law that regulates health care facilities that receive funding from Medicare or Medicaid. OBRA recognizes the importance of patients' independence and well-being. As a result, OBRA requires that each patient receive the necessary care to attain and maintain the highest possible level of physical ability and mental, emotional, and social well-being according to the patient's care plan. This includes rehabilitation and restorative care.

Lesson 1 – Introduction Role of a health assistant in rehabilitation and restorative care Health Assistants and Rehabilitation and Restorative Care OBRA requires that each patient receive the necessary care to attain and maintain the highest possible level of independence and well-being. This care must be provided by qualified health care workers. Health assistants provide much of the care given to patients, including rehabilitation and restorative care. Therefore, health assistants must have the knowledge and skills to provide this care. Health assistants who specialize in rehabilitation and restorative care often have additional education and training. When providing rehabilitation and restorative care, health assistants must follow the patient's care plan. They must also observe the patient's physical, mental, emotional, and social conditions; document this information, and immediately report any problems to their supervisor.

Unit 1: Rehabilitation and Restorative Care Lesson 2: Patients

Lesson 2 – Patients Reasons for rehabilitation and restorative care Birth defects Diseases Injuries Surgery Aging Reasons for Rehabilitation and Restorative Care People need rehabilitation and restorative care for many different reasons. These include birth defects, diseases, injuries, and surgery. These are examples of situations that may require rehabilitation and restorative care:    Physical deformities    Diseases affecting the muscles, bones, and joints    Diseases affecting the brain and nerves    Heart disease    Lung disease    Stroke    Cancer    Brain injuries    Neck and back injuries    Fractures    Burns    Amputation In addition, people may need rehabilitation and restorative care as a result of aging.

Lesson 2 – Patients Goals of rehabilitation and restorative care “Highest possible level” Goals of Rehabilitation and Restorative Care Recall the goals of rehabilitation and restorative care:    The goal of rehabilitation is helping patients attain the highest possible level of functional ability.    The goal of restorative care is helping patients attain and maintain the highest possible level of independence and well-being. People need rehabilitation and restorative care for many different reasons. In addition, each person is unique. As a result, the goals of rehabilitation and restorative care are different for each patient. The "highest possible level" for one patient may mean to restore full ability. For another patient it may mean to improve ability. And for another patient it may mean to maintain current ability and prevent further loss of ability.

Lesson 2 – Patients Successful rehabilitation and restorative care must focus on mental, emotional, and social well-being as well as physical abilities Mental, Emotional, and Social Effects Problems that require rehabilitation and restorative care often have noticeable physical effects on patients. For example, patients may not be able to move about, do self-care activities, and perform job skills. Problems that require rehabilitation and restorative care, though, also have mental, emotional, and social effects on patients. For example, patients may sense a loss of dignity and control. As a result, they may have low self-esteem. They may feel sad, angry, embarrassed, worthless, anxious, and frustrated. And they may withdraw from social activities. As a result, successful rehabilitation and restorative care must focus on patients' mental, emotional, and social well-being as well as their physical abilities. Furthermore, OBRA requires that patients who experience mental, emotional, and social difficulties receive the necessary care to treat these problems.

Lesson 2 – Patients Principles of rehabilitation and restorative care Let patients make choices Protect patients’ privacy Avoid distractions Encourage independence Be sensitive, supportive and patient Use correct body mechanics Stop if patient is in pain Principles of Rehabilitation and Restorative Care When providing rehabilitation and restorative care, health care workers must adhere to the following principles:    Allow patients to make choices. This gives patients control even when they feel like they have none. For example, ask a patient what he would like to wear.    Protect patients' privacy. For example, close the bathroom door when a patient is toileting. In addition, patients should receive care in private so they won't feel embarrassed by others.    Avoid distractions. For example, turn off the television while a patient is eating.    Encourage patients to be as independent as possible, and provide the least amount of assistance necessary. This helps patients gain confidence and motivates them to attain the highest possible level of functional ability. For example, if a patient has been using a wheelchair but has the ability to walk, help her to walk using a walker.    Be sensitive, supportive, and patient. Patients may experience sadness and anger. They may be embarrassed and frustrated. Progress may be slow. Stress patients' abilities, not their disabilities. For example, if a patient becomes frustrated with washing her hair, point out that while it is difficult for her to wash her hair, she does a great job washing her body. In addition, allow patients to express their thoughts and fears. And never neglect, mistreat, or abuse patients. Use correct body mechanics. This prevents injury to health care workers and patients. For example, when helping a patient do exercises, practice good body mechanics, and teach the patient good body mechanics.    Stop if patients are in pain. Patients may complain of pain. For example, if a patient says his hip hurts when standing and bending over to put on his pants, have the patient sit down and then try to put on his pants. Health care workers should also observe patients for signs of pain, such as sweating, shortness of breath, and becoming pale.

Lesson 2 – Patients Recreational activities Promote physical abilities and mental, emotional, and social well-being Required by OBRA Recreational Activities Recreational activities promote patients' physical abilities and mental, emotional, and social well-being. For example, in terms of physical abilities, recreational activities may improve circulation, strengthen muscles, and increase flexibility. And in terms of mental, emotional, and social well-being, recreational activities may increase cognitive abilities, reduce stress, and foster relationships with others. As a result, recreational activities are an important part of rehabilitation and restorative care. Furthermore, OBRA requires that recreational activities be offered to patients.

Lesson 2 – Patients Encourage participation in events Events Subacute and nursing facilities plan events that include a variety of recreational activities. These activities may include the following:    Bingo and card games    Arts and crafts    Dances    Physical fitness activities    Coffee hour, birthday parties, and holiday celebrations    Concerts    Guest speakers    Religious services    Shopping trips, museum trips, and trips to community events Health care workers should encourage patients to take part in recreational activities. Patients, though, should be given the choice of which recreational activities to take part in.