Functional maintenance Programs (FMP’s) are clinical programs that can be designed to augment or maintain a residents functional status and wellbeing.  It includes therapy services that seek to prevent disease, promote health, and prolong and enhance quality of life or maintain or prevent deterioration of a chronic condition. Medicare regulations and guidelines provide for this service as “skilled” (covered within the framework of functional maintenance therapy in the Medicare Benefit Policy Manual). The specialized skills, knowledge and judgment of a therapist are required to establish the functional maintenance (FMP) plan, ensure resident safety, provide training to the resident and their caregivers, and periodically reevaluate the plan for effectiveness.

Regulatory components include intensity, frequency and duration appropriate to positively impact the residents functional status and documentation must support skilled services i.e. training, compensatory strategies, assessment of adaptive devices/equipment, and/or environmental modifications, etc.

Goals of a Functional Maintenance Program—

• Maintain the residents functional capacity
• Improve quality of life
• Decrease caregiving assistance and increase dignity
• Improve or maintain resident safety
• Decrease potential for physical/medical complications

Residents appropriate for a Functional Maintenance Program—

• Those on active therapy caseload who will continue to require specialized interventions after being discharged from skilled services
• Residents at high risk for development of further medical complications/functional loss due to progressive disease process
• Residents who require frequent cues to perform at optimal levels of independence
• Residents who require frequent re-positioning, assistance with self-feeding, assistance with W/C mobility, contracture management/splinting, safe ambulation, transfers, toileting, etc.
• Residents that require assistance to communicate effectively within their environment
• Residents that may need instruction to establish compensatory strategies to enable them to  perform functional tasks with optimal independence

Remember that the key component of supportive documentation for a FMP includes documentation of all caregiver/resident/family training that occurs, daily. Observation of caregiver skills, results of training with return demonstration, and objective measures against baseline data is needed to support the skilled service. Document when training is complete and when caregivers demonstrate competency to carry out the intended program. Remember that re-evaluation to maintain therapeutic gains through a maintenance program is recognized by Medicare as a skilled service” and crucial to ongoing independence of the resident.