Rehabilitation Versus Restorative Care
Key Points
- Rehabilitation aims to regain prior function; restorative care maintains highest achieved function.
- Therapists design plans, while CNAs commonly implement daily restorative activities.
- Restorative care adherence and documentation affect resident outcomes and reimbursement reporting.
Pathophysiology
After acute recovery, residents may either continue to improve or plateau. Rehabilitation targets active functional restoration, while restorative care prevents decline once progress stabilizes.
Without consistent restorative follow-through, deconditioning and mobility loss can recur rapidly. This can reverse gains and reduce quality of life.
Motivation barriers, cognitive deficits, pain, and fear of injury can interfere with participation, requiring tailored encouragement and escalation.
Classification
- Rehabilitation phase: Therapist-led interventions to restore prior functional level.
- Restorative phase: CNA-supported daily function-maintenance activities.
- Delivery format: Individual restorative sessions or group restorative activities.
- Participation barriers: Cognitive deficits, pain, dependence habits, fear, and trust gaps.
Nursing Assessment
NCLEX Focus
Priority questions ask how to respond to refusal while preserving autonomy and documenting attempted approaches.
- Assess resident participation level and tolerance in ordered restorative tasks.
- Identify refusal causes such as pain, fatigue, fear, or misunderstanding.
- Monitor for objective mobility or ADL decline suggesting inadequate plan carryover.
- Report persistent refusal and functional decline risks to nurse/therapy team.
Nursing Interventions
- Implement ordered restorative activities consistently (ambulation, ROM, ADL participation, device use).
- Encourage respectfully and reapproach at a better time if initial refusal occurs.
- Involve trusted family or therapy staff to reinforce benefits when motivation is low.
- Report pain signs promptly for assessment/treatment before retrying activity.
- Document participation, refusals, and interventions attempted objectively.
Functional Regression Risk
Failure to deliver ordered restorative care can lead to avoidable decline in mobility and independence.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| analgesics | Activity-associated pain contexts | Adequate pain control can improve participation in restorative tasks. |
| antidepressants | Low-motivation mood contexts | Mood symptoms may reduce restorative engagement; monitor and report participation trends. |
Clinical Judgment Application
Clinical Scenario
A resident who completed rehab now refuses daily ambulation and reports fear of falling, with gradual decline in transfer ability.
Recognize Cues: Repeated refusal and measurable functional decline. Analyze Cues: Fear and deconditioning are undermining restorative plan adherence. Prioritize Hypotheses: Immediate priority is preventing further decline while respecting autonomy. Generate Solutions: Reapproach at calm time, coordinate pain management, involve family/therapy reinforcement, and use graded activity goals. Take Action: Implement modified restorative session and document response. Evaluate Outcomes: Participation improves and function stabilizes.
Related Concepts
- the-rehabilitation-process - Defines when transition from rehab to restorative care occurs.
- members-of-the-therapy-team - Team collaboration guides restorative plan implementation.
- promoting-independence-during-adls - ADL participation is a core restorative strategy.
- promoting-joint-mobility-and-activity - Mobility promotion supports maintenance goals.
- documenting-and-reporting-data - Restorative activity documentation is required for continuity and reporting.
Self-Check
- How does restorative care differ from rehabilitation in goals and daily execution?
- What should be documented when a resident declines restorative activity?
- Which barriers commonly reduce restorative participation and how should they be addressed?