MP

The strength of a team can truly be powerful when everyone sees and feels the vision. Employee culture and retention has been at the top of the initiative list. How can we improve this area and create an environment that truly embodies Customer Second? Well let me introduce you to the M.E. committee. I spent time with one of the M.E. committee members, Loretta Johnson, PTA, to get a better understanding of what this committee has to offer.

As explained by Loretta, the Copperfield Healthcare and Rehab facility created the M.E. Committee (Motivating Employees), with a purpose to engage, support and reward their fellow coworkers. They have designed and cultivated strategies to build interpersonal skills, through exciting team-building exercises. This level of cultural promotion encourages open communication, challenges employees with friendly competition, and assists with facilitating a healthy work-life balance.

The M.E. committee has put together a calendar of events that caters to employee engagement. As Loretta put it, “An employee who enjoys coming to work is a worthy investment, and a good day at work fuels the desire to be better the next day. This feeling of happiness at work will spill over into the love and care that we provide to our patients.”

Most recently, the M.E. committee hosted a Coloring Contest. All employees were asked to color a picture of a butterfly. Each butterfly was judged by the panel of patients, employees and visitors. The grand prize winner received a beautiful, laundry-themed gift basket. Other events included: Chili Cook-Off, World Water Day, and National Laugh Day. The time spent together is intentional, and it has allowed new-hires to comfortably blend in with the team.

The Copperfield Healthcare and Rehabilitation facility leadership team includes:
Noni Gill, ED; Unnati Patel, DON; Shayla Goode, M.Ed CCC-SLP

Submitted by Kai Williams, Therapy Resource, Keystone-East

The Rehab team at McCall Rehab and Care Center in McCall, Idaho, has had a vision of providing community-based outpatient therapy in people’s homes since the facility became part of the Pennant-ID/NV market in 2018.

McCall’s DOR, Jenny Sowers, DPT, couldn’t ever seem to find the consistent time to grow an outpatient program, so she decided she should find a therapist willing to take on that challenge. In September of 2020, Jenny hired Ellie Toscan, DPT, with the goal of Ellie building their Community-Based Outpatient program.

Ellie has shown tremendous ownership of the program, from marketing to clinical to financial. She independently tracks the financials weekly and monthly to ensure the program is financially viable. Executive Director Kurt Holm’s main goal for the program is to build relationships and reputation in the community. A recent admission gives clear indication that Kurt’s goal is being realized. Ellie was working with a patient in her home. She had a change of condition, went to the hospital, and was referred to McCall Rehab. Because of the relationship that Ellie built with this patient, she readily agreed to the discharge plan. The patient is now receiving skilled therapy and nursing services in our facility. Thanks Ellie for this great example of the power of our core value of ownership!

If you are looking to grow your community based outpatient program, please consult your therapy resource or Deb Bielek for regulatory help specific to your state.

Submitted by Dominic DeLaquil, Therapy Resource, Idaho/Nevada

Submitted by Stephanie Argyle, COTA and Kyle Fairchild, OTR, ADOR

Whether a patient comes to St. Joseph Villa for a rehab stay due to a fall, a recent injury, a surgical procedure or other medical conditions, we aim to include each individual in our discharge planning group as they approach discharge. Our goal is to educate our patients in ways to improve safety, improve energy conservation and improve self-awareness as they prepare to return home. Each group member is given a packet of written information, which includes a home safety checklist, pictures of adaptive equipment and links for ordering, and home exercises. We change our handouts based on the needs of our patients at the time.

Our DC Planning Group objectives are as follows:

• To identify barriers to discharge with a focus on current functional barriers
• Education in home safety, home modifications, DME needed for safety in the home
• Education in community resources for home safety
• Education in self-awareness and techniques to facilitate relaxation and awareness of your body at rest
• Education in the purpose of home health services and benefits of continuing therapy at home and as an outpatient

So many of our patients have expressed gratitude and appreciation as they learn from one of our OTs or COTAs AND from one another about adaptive equipment, techniques and strategies to improve their lives. One patient commented after attending the group, “I was so worried about falling in my bathroom. What you’ve taught me will make things much safer and easier — it will change my life!” We have allowed family members to attend our group, which has helped them learn how to better care for and support their loved ones. Overall, this education group has been a valuable addition and rewarding experience for both our patients and therapists!

Submitted by Loupel Antiquiera, DOR, and Laura Kramer, COTA/L, Pacific Care Center, Hoquiam, WA

Laura Kramer, OT, provided the following exercise to promote OT month.

Residents are provided with a yoga ball placed on a base (like a round laundry basket) and a pair of drumsticks with instructions to follow the leader in a set of coordinated movements with lively music that has a strong musical beat. The variations of instructions may be tailored to the residents’ limitations and therapeutic goals. It can be upgraded or downgraded to tolerance throughout the task, with the therapist monitoring signs of fatigue or pain, cueing residents to rest if needed.

As the therapist, I may begin by explaining the benefits of the activity, which can include increased circulation, cardio exercise, targeted joint range of motion, music appreciation and most of all fun, but I always preface with “If it hurts, don’t do it.” Coordinated movements may include:

• Elbow flexion only while drumming on the ball; downgrade to just wrist flexion if necessary to tap out the rhythm of the music
• Knee up both right, then left
• Reaching far right/far left, targeting shoulder abduction and trunk stability
• Hands up with crossing drumsticks
• Drumming to the beat, either slow or medium or double speed
• One-handed (one-sided)

Overall, the benefits I’ve observed are promising, with most patients demonstrating very good attention and following directions, and some will even become happy to lead a set of instructions and take turns to try out their own combination. Some find the activity too simple and ask to leave, and one resident commented she thought it “felt like kindergarten, but it was still fun I guess.” However, this same resident actively participated again and was observed having fun. One resident required closer observation d/t asthma; her O2 sats dropped too low, and she was returned to her room with nursing notified for breathing tx’s. One pt reported BUE shoulder pain d/t OA.

By Calli Carlson, OTR/L, DOR, North Mountain Medical & Rehab, Phoenix, AZ

“Oh it’s just basic range of motion. That patient doesn’t require therapy anymore.” I’m embarrassed to think of how often I have said these words, and I wonder how many therapists may relate to this same perception.

Previously in our facility, patients who were non-responsive or minimally responsive were transitioned from our skilled physical and occupational therapy to restorative nursing programs for passive range of motion, typically for three days a week. Over time, we began to notice that patients were demonstrating difficulty maintaining their current range of motion, while restorative nursing was likewise reporting increased tone and increased difficulty working with our more medically complex patients.

For patients with complex brain and spinal cord injuries, hypertonicity can worsen with time causing an invariable decline in range of motion as well as increased difficulty for restorative members performing their range of motion treatments and increased difficulty for certified nursing assistants performing basic tasks such as dressing and peri care. With this in mind, the dialogue began to shift from therapy could be involved in these patient cases to therapy should be involved in these patients cases to provide the best possible outcomes and improve quality of life.

Given the depth of therapists’ schooling on anatomy, neuroanatomy, kinesiology, positioning, and modalities, it seemed that therapists could provide enormous benefit simply by increasing their involvement and time with these clinically complex patients while also educating and instructing restorative nursing assistants, certified nursing assistants, and additional floor staff as needed.

A physical therapist at North Mountain Medical Center, Shannon Dougherty, took initiative and recently developed a program titled, “No pressure, no pain, no problem,” focused on improving the health and quality of life of long-term care residents in the facility. The 3-part program encompasses the following:

Part 1: No Pressure: Reducing likelihood of pressure injuries through bed positioning
Part 2: No Pain: Reducing pain through manual techniques, modalities, contracture management
Part 3: No Problem: Identifying ‘problem’ patients and completing CNA/RNA training for improved techniques, removing burden from RNA for especially complex patients that require additional assist.

The program is currently just beginning here at North Mountain, but we have already been surprised and encouraged by results we have seen thus far. One of our patients, in particular, presents with significant hypertonicity and accompanying flexion of upper and lower extremities at rest, placing this patient at high risk of developing contractures without appropriate intervention. Restorative nursing members have reported that this patient is typically averse to passive range of motion and that they have difficulty knowing how to properly complete this task. A formal therapy evaluation and subsequent treatment sessions identified that this particular patient responds well to simple verbal/tactile cueing, gentle massage of the hypertonic muscles, slow and prolonged stretch, as well as stretching muscles in isolation rather than combing several stretches at once (such as hip/knee extension). Therapists have begun educating restorative nursing members on these techniques as well as analyzing non-verbal pain responses such as diaphoresis, increased flexion posturing, facial grimacing, or increased heart rate in order to provide the best quality, patient-centered care.

The plan of care may differ for individual patients. For example, therapy might decrease restorative nursing visits to two times per week and see that patient once or twice per week to supplement their treatments, or therapy might work with that patient five days per week and discontinue restorative nursing at that time while they work to get a baseline and treatment ideas to share with the rest of the staff. Regardless of the method and scheduling, it is important that therapists see the value of their knowledge and skillset, restorative nursing members feel empowered and capable when working with these patients, and patients receive the best quality of care to improve their health and well-being while under our umbrella of care.