Tomah VA Medical Center

Navy Veteran Charles Oness using a 30-foot Liko ceiling walking track while holding on to an Eva walker. Assisting him are Arthur LaBerge and Deanna Lowe – restorative nursing assistants and Jenelle Hayden, Restorative Nursing Care Coordinator.

Having the ability to restore health, strength, or a feeling of well-being is the definition of restorative. The Tomah VA Medical Center’s Veteran-centric care in Restorative Care focuses on just that.

“One of the main things we really focus on is preventing functional decline,” said Jenelle Hayden, Restorative Nursing Care Coordinator at the Tomah VAMC. “So, what you really want to make sure is that you are not having anybody starting to not do as much as they can with their activities of daily living.”

Restorative Care is a nationwide program driven by nursing in collaboration with rehabilitation services, consisting of interventions and programs that focus on residents who have become de-conditioned due to acute illness, or chronic debilitating disease, and or prolonged inactivity. A focused program of restorative care involves planned interdisciplinary interventions to improve the Veteran’s functional status, and facilitates transition to home or a less restrictive level of care. Restorative care is provided primarily in CLC by nursing staff, in collaboration with therapy services staff who may serve as consultants.

To assist the Veterans’ ability to attain their maximum potential, the nursing intervention must exceed routine nursing care and be provided by clinical staff such as a RN, LPN, RPN, assistant or aid. Six criteria must be addressed:

• Does the nursing intervention exceed routine nursing?
• Are measurable objectives and specific interventions documented in the plan of care?
• Are the procedures or techniques carried out by, or under the direction/supervision of, licensed nursing staff (RN, LPN/RPN)?
• Have the clinical staff who are carrying out the interventions been trained in the specific techniques required for the nursing rehabilitation/restorative care program?
• Has a licensed nurse (RN, LPN/RPN) evaluated and documented the resident’s progress toward objectives at intervals that follow nursing standards of practice?
• If the resident is participating in an exercise group, are there 4 or fewer residents per group leader?

“You need to hit the guidelines for them to qualify for the program. So, there are specific qualifications that Veterans need to have so that we can actually work with them,” said Hayden who primarily works the Long-Term Care Facility Veterans. 

The Restorative Care includes range of motion (passive and active), splint or brace assistance, bed mobility, transfer, walking, dressing and grooming, eating or swallowing, amputation or prosthesis care, communication and others.

Hayden, an Army Veteran, has worked at the Tomah VA for nearly 10 years and spent the last four in the Restorative Nursing Care position. She realizes the impact the program has on her fellow Veterans.

“I came in and assessed to see where they were and what I consistently did was is made sure they stayed at their baseline or improved. We really homed in on walking and range of motion. That was pretty huge,” she said. “We had multiple Veterans who had not walked in quite a while, in the program starting out, we could really give them that one on one attention and their walking just got so much better. They walked so much further just because of us saying ‘hey, let’s take that time to really focus to get there’ and they hit their goals.”

According to data provided by Barbara Iwanowicz, Associate Chief Nurse of Extended Care, the distance Veterans walk has increased, and more programs have been completed.  Also, group exercise classes are held four times a week and average six Veterans.

“We also do exercise groups multiple times a week which is really nice to have the Veterans have interaction with each other and keep up their range of motion so you can just really get that cohesiveness feeling,” added Hayden.

More Veterans are taking advantage of the program. In December 2017, two restorative nursing assistants, positions new to the facility, were hired.

“It is super beneficial. Allowing Veterans to do what they can for themselves. It is them actually participating in their care. It is what is going to keep them active and keep them independent. The goal is to make sure the Veterans can do for themselves.”