So You Want to Hire a CFY?

MP Learn

By Elyse Matson, MA CCC-SLP, SLP Resource
One of our initiatives for 2021 is to increase our SLP programming, thus providing a more cohesive and multi-disciplinary approach to care. Hiring SLPs can be challenging depending on the market. One way to increase the number of candidates for SLP positions is to consider hiring a newly graduated SLP, also referred to as a CFY.

What is a CFY? CFY stands for Clinical Fellowship Year. Think of it like a residency. It is a mentored experience to better transition SLPs from student to licensed and certified clinician. In order to hire a CFY, a licensed and certified SLP needs to agree to mentor for approximately nine months if it is a full-time position. This involves some supervision and guidance of the CFY, depending on the state regulations. In addition, the licensed SLP needs some training in supervision. These regulations vary by state.

There are numerous benefits to hiring a CFY. The new grad is likely to be motivated to learn, eager to build a caseload and willing to accept guidance. A CFY is not a student. If you hire a new grad SLP, they are a regular employee. The only difference is they require some supervision from another SLP. During the COVID-19 pandemic, ASHA is allowing tele-supervision. The mentor needs to be licensed in the state where the CFY will be working. See the changes for 2020 here: 2020 requirements ASHA SLP Crosswalk.

If the new grad will be the only SLP in the facility, make sure to talk with them about how they will handle that challenge so they are clear on what their role in the facility will look like. To help with recruiting efforts, consider stating in the position “CFY accepted,” which will help let new grads know they can apply. Whether they will join a team of SLPs or be the sole provider, hiring a CFY might be just what’s needed to invigorate your SLP programs.

Please feel free to reach out to me if you need assistance with interviewing and decision making with CFYs. Click here for more information from ASHA : https://www.asha.org/certification/completing-the-clinical-fellowship-experience/

Caitlin Colteryahn, OT, TEACHA at The Healthcare Resort of Leawood, KS

MP Celebrate

By Danielle Banman, DOR, The Healthcare Resort of Leawood, KS
Caitlin Colteryahn is our lead occupational therapist here at The Healthcare Resort of Leawood and has been with us for four years. Caitlin graduated from Rockhurst University in 2014. She has been married for 10 years and has two boys. She loves spending time outdoors and traveling, especially with friends and family.

Caitlin is an outstanding occupational therapist and is passionate about developing programs for maximizing independence for our residents with dementia. She received advanced training in dementia care in March 2020 to earn the title of Therapy Expert for Abilities Care Holistic Approach (TEACHA). Caitlin has developed an amazing program here at our facility and enjoys teaching other occupational therapists in our market about this program to improve the quality of life for all individuals with dementia that we have the privilege to serve.

Caitlin says this of our program: “I believe it is incredibly important, now more than ever, that we as clinicians use the tools available to us and our clinical knowledge to help develop and implement strategies based on our residents’ functional cognition and strengths to reduce their risk of decline, promote engagement, and for overall quality of life. I love and it is an honor to work with this population, as we have the resources to really get to know who our residents are, what makes them the person they are today, and then to use that knowledge to help them achieve their goals. As a TEACHA, the pandemic has complicated the ability to be able to go into other facilities to help implement programming. However, I have been able to collaborate with other clinicians in and outside of our market through email/phone in order to help support them to utilize the Abilities Care strength-based programming to help reach the needs of their residents.”

Jihan Antipolo-Baldonado, Rehab Aide: The Secret Sauce

MP Celebrate

By Carlos Pineda, CTO/DOR, Southland Care Center, Norwalk, CA
“Teamwork is the ability to work together toward common vision. The ability to direct individual accomplishment toward organizational objectives. It is the fuel that allows common people to attain uncommon results” – Andrew Carnegie. It is fascinating to watch an organization continue climbing up and inspiring the members to be the best they can be despite unpreventable hiccups. As you dissect this great phenomenon, you will always find those who are the concrete and steel of the institution. They are usually the quiet, humble but full-of-smiles individual or group that is sitting behind. You can feel their presence in any space and even more when they are not around. They are culture lovers. They are the catalyst for innovation. They spark love among individuals.

When the Momentum market gave me an opportunity to manage two great buildings, Southland Care Center and Downey Post-Acute, there was one person who stepped behind me and whispered, “This opportunity is best for our patients and therapists.” She did not see the struggle that I was heading into, but the opportunity of spreading our core values. I always feel proud, with teary eyes, every time I brag about this person to my colleagues when they ask about our best practices. My answer is that our secret sauce is Jihan Antipolo. She has been in Southland Care Center for 17 years, consistently doing great things over and over again, like the hedgehog. I do not consider her as our rehab tech but a “Resource” for all the departments of both facilities. There was a time during the beginning of the pandemic where everyone was so stressed out about where to secure PPE. Jihan did not waste a second to begin reaching out to different organizations giving donations, like PPE, hand sanitizer, alcohols, food, vitamins, etc. Instead of feeling the uncertainty, we felt the sense of being blessed. These were also shared with our sister facilities.

As I witnessed how both buildings experienced their bumpy road and how they continued to drive toward greatness, there is only thing that I know: We have Jihan Antipolo weaving every strand of the web to make it stronger and purposeful over and over again. Thanks, Jhie. We love you!

Jessica Ballera, COTA, St. Elizabeth Healthcare and Rehabilitation, Fullerton, CA

MP Celebrate

By Dennis Baloy, OTD, OTR/L, DOR/Therapy Resource, CA
All in the Family
Jessica’s career as a therapist in an Ensign-affiliated facility was inspired from way back. When she was a little girl, she distinctly remembered how her grandmother was being taken care of by therapists of an Ensign affiliated facility. To this date, she vividly remembers her grandma’s smile after every therapy session. She reminisces about this image of her grandmother all throughout her life.

Her family is also not new to the therapy world. Her mom, Jasmine, is also an Occupational Therapist Assistant working with our company. Together with her Mom’s guidance and Jessica’s love of therapy, Jessica eventually obtained her degree as a Certified Occupational Therapist Assistant from Stanbridge University in 2018. She worked as a part time employee to explore her options and eventually was hired full time at St. Elizabeth Healthcare and Rehabilitation in Fullerton, CA.

“I find that the greatest part about the St. Elizabeth team is how they give me the ability to shine and grow in my specialties. I feel supported in all of my out-of-the box ideas.” Jessica explained when asked what she loved about being part of the organization. She also added that what truly motivates her are the “Moments of Truth” she encounters on a daily basis. She looks forward to making a difference in someone’s life, to give them hope, and to help create a purpose for her patients. This for her is the greatest selfless joy she experiences and constantly looks forward to.

Jessica is also always available to help out other facilities around our area. She is well-liked by her peers and patients. She always brightens any room she enters and even more so the lives she touches. All of these attributes lead the Therapy Resources to choose her to be a part of the Momentum Culture Committee whose mission is to help facilitate and promote culture within the clusters. Not to mention, “O” for Ownership is her favorite CAPLICO value! Her inclusion will certainly tap her potential to further her positive influence to other therapists in the market.

Jessica is truly a gem of St. Elizabeth and our Ensign-Affiliated Facilities!

Keller Oaks: The Culture is in the Details (#startamovement)

MP Share

Submitted by Jon Anderson, DPT, Therapy Resource
“KO Let’s Go, Let’s Go KO!” This is the rally cry at Keller Oaks in Keller, Texas, and it is a commonly heard anthem when you visit the facility. In a year that has been difficult at best in healthcare, the culture has done nothing but improve at Keller Oaks. When you look deeper to see what is in the air at Keller Oaks, it goes far beyond COVID.

Kristin Ryther, the therapy program manager at Keller, has been a breath of fresh air in a very trying year at a facility that has been hit hard by COVID on multiple occasions. We asked her to share a bit of her best practices and were blown away by what is developing there.

Starting with onboarding, Keller embraces culture by conducting group interviews and hiring only those people who the team agrees can be grown into great leaders. They agree on all hires and then make sure that the process does not stop there. According to Kristin, “Love is in the details.” She ensures that the new employee is greeted with everything that they need to be successful. She has their log-ins ready, an itinerary for their first day, and a team member assigned to them as a mentor. Kristin provides them with a bit of “swag” and has a ready-made reference form entitled “KO NEED TO KNOW” that includes everything from door codes to restroom locations to documentation tips and PCC locations of interest.

Culture at KO does not stop at onboarding. The team meetings incorporate music and moments of gratitude. Kristin has become a champion of championing others. She works to identify strengths in each of her team members and then assigns responsibilities appropriately. Each member has a strength; slow down and find it! It may be that they have special attention to individual treatments; they may be strong at scheduling, growing programs, or even leading the infection control of the gym. List them out and recognize them.

Ensure that you are communicating everything to your team. Utilize dry erase boards, address at team meetings, keep up-to-date information in binders. Use all means necessary to ensure that your team members have the communication they need to do their best work! Don’t forget to prioritize individual communication. Get to know your therapists and be transparent as well as approachable. Don’t be afraid to just listen and allow them to be heard.

Set clear goals and expectations. Kristin sets goals for “2 week sprints.” Some programs are short projects. She assigns a leader and assists with facilitation but allows for teamwork so they meet their goals. She posts the sprints on the communication board, writes about it, takes pictures and then celebrates it. Short-term goals like this make it manageable, and then the challenge is less likely to be pushed off down the road.

Celebrate the wins! Find the team member who loves to do this and assign it to them. Celebrate the day-to-day achievements and find 10 positives for every negative. Make sure the team feels appreciated and celebrated.

That is not to say that there will not be challenges. There will always be hurdles. When that happens, keep your positive vibes on! Start with yourself, and look in the mirror. Stay consistent. Be transparent. Don’t expect others to do something you wouldn’t do yourself. Hold them accountable after you have asked yourself, “Did I educate? Did I communicate? Did I reinforce?” Maintain accountability and expectations, but never be afraid to give each other grace. Most importantly, be yourself! Your team will recognize the authenticity and appreciate the transparency. Let them know it is okay to enjoy your work and have fun while you are doing it!

Why Take the Vaccine?

MP Share

By Patrick Amar, DOR/PT, Mountain View Rehabilitation & Care, Marysville, WA
Here at Mountain View, we’ve experienced close to 100% facility staff vaccinations, and attribute our success to a couple of key reasons: the scars left on our minds and hearts as we reflect back over the past 13 months that we never want to repeat again, and communication, communication, communication. Looking back, we never thought the virus would hit so close to home. We heard about it in the news from China, but that’s a world away. We were taken by surprise when the first case of COVID-19 in the United States happened here in our backyard in January 2020. Shortly after, the first outbreak also happened in our area; it was just across the county line. Suddenly we were thrust into the epicenter of the virus, and it seemed the whole world was watching how we managed.

We quickly saw the virus spread in a nearby facility, then in another facility, and then in our community, like an uncontrollable wildfire. In June of that year, it finally came on our doorstep. We knew it was just a matter of time. I think the only positive thing about this pandemic is that it brought our team together even closer. We’ve seen the impact that the virus has had on our patients — their health, their emotions, their psyche and not just them, the family members, too, and the staff. This was the main reason why our staff was so determined to do something about this pandemic by way of getting vaccinated.

Another factor in the success of our vaccine rollout was having good education and communication from the get-go. Once the news of the vaccine was even hinted at, Clayton, our ED, was already preparing the staff for its arrival. Information quickly disseminated from the IDT to floor staff. We knew people would have questions, concerns and even doubts. Educational efforts ensued in huddles, staff meetings and therapy meetings. Even our medical director was involved in the education.

I’d also like to thank our clinical partners for the research and the materials provided for our educational efforts. It helped, too, to hear support for the vaccine not just from us, the IDT, but also from other specialists and healthcare providers who are experts in their field. Questions were welcomed freely and answered objectively. I really believe that our staff understood the common goal. The communication and education, coupled with what we’ve been through, were the driving factors of this success — for our patients, our families and our community.

Outpatient On Demand

MP News

By Kathey Perez, Therapy Resource – Keystone South Central, TX

Outpatient On Demand is a great way to look at ways to expand our delivery of outpatient services. Many of our patients are afraid to leave their home due to the pandemic, or can’t leave due to transportation issues, or maybe they are fearful to leave our facilities worried about failure when they go home. Outpatient on Demand helps us overcome some of these concerns while meeting the needs of our community. We can help those that may not be homebound by home health standards but have a need for services, and help the successful transition of patients back into their home by being able to provide education and training in the area they need to thrive. Once the patient is able to come to our facility, we can transition them to Outpatient at the facility as well. Patient identification should start with care planning upon admission to our facility. We can also identify them by doing home evaluations prior to discharge.

Home eval prior to discharge:
• What allows us to provide therapy in the home?
o Medicare specifies four locations from which a provider can provide outpatient physical therapy. Medicare Part B pays for outpatient physical therapy services when furnished by: a provider to its outpatients in the patient’s home; in the facility’s outpatient department; to inpatients of other institutions

• What is it and Why Now?
o Therapy services (PT, OT, ST) offered that meet the patients where they’re at, focusing on what matters most, being able to function in their actual home/community environment.
o COVID related shutdown, limitations, and resident declines created a shortage of therapy and a need more than ever

• What differentiates this from Home Health Services?
o Residents are not required to be certified as home-bound to participate in our services. On average, we are able to provide MORE therapy than is typically seen in HH settings. Maintenance programs are a big part of our outpatient programs

Vestibular Function

MP Learn

By Evette Ramirez, DPT, DOR, Legend Oaks of Waxahachie, TX
All information taken from the Vestibular course given by Ann H. Newstead, PT, DPT, PhD, GCS, NCS, CEEAA (https://www.ahnewphysicaltherapy.com/)

As we age, there is a greater incidence of falls. Many factors play a role in these falls; some external and some internal. Some risk factors include medications and resulting side effects, cognitive impairments, lower extremity disability including loss of sensation and/or foot deformities, balance abnormalities, dizziness, orthostatic hypotension as well as increased dependence on visual cues for ability to achieve and maintain balance.

Vestibular function is an area that we as clinicians can address to help reduce potential falls. As 30% of older adults develop vestibular dysfunction, knowledge of when and how to treat as well as when to refer to a specialist is a needed skill. As we age, vestibular changes begin at age 40 with reduced number of hair cell in the inner ear as well as a decreased number of nerve fibers, which lead to decreased to increased difficulty with competing visual and somatosensory input.

Definitions to know:
Vertigo: an illusionary sensation of motion of either the self or the surroundings in absence of true motion.

Oscillopsia: a visual illusion of oscillating movements of stationary objects. This can arise with lesions of the peripheral or central vestibular systems.

Receptor: a patch of hair cells projecting into a gelatinous membrane

Otoconia: calcium carbonate crystals that rest on top of the macula and are floating on tome of the gelatinous membrane. (Gravity and shearing forces occur with acceleration and deceleration and deflection of the hairs.

Semicircular Canals (SSC): ring shaped, fluid filled canals set at 90 degree angles to each other on each side of the head as functional pairs. These work as the push / pull mechanism. Ex. Increased firing of RSSC when turning head to the right will decrease on left.

Vestibular Nuclei: There are four vestibular nuclei in the CNS. These are located in the floor of the 4th ventricle between the medulla and the pons. Visual and somatosensory inputs are integrated here with information entering bilaterally. Information is sent to the brain, cerebellum and to the spinal cord via CN VIII.

The vestibular system has three main functions: 1) Gaze stabilization which refers to ocular stability. This keeps images stable by moving eyes in response to head movements. 2) Postural control which detects position and movement of head in space; along with sensory and proprioceptive systems. 3) Perception of motion which helps to distinguish eye movements from head movements (internal) and head movements from exocentric (environmental) movements. The vestibular nuclei, cerebellum and reticular formation all receive input form visual and somatosensory systems. The output form these areas influence oculomotor control and spinal motor control. The central pathways for these systems are separate, therefore, both systems are examined and treated separately.

A vestibular exam will typically consist of:
• Acquiring a history
• CN testing
• Eye head coordination
• Positional testing
• Postural control
• Functional testing
• Locomotion

Other assessments include: Visual vertigo analog scale (VVAS)
Dizziness Handicap inventory/index (DHI)
Activity-specific Balance Confidence (ABC) Scale

Clinical decision-making model and differential diagnosis includes:
• Acute symptoms – Possible BPPV, labyrithinitis, stroke , fall and concussion
• Episodic – possible Meneire’s, postural hypotension
• Chronic – Possible Mal debarquement, hair cell loss, aging, long term CNS injury

Exam:
By taking our clients through various positional changes and movements of the head, we can elicit symptoms and this will help to determine where the lesion/dysfunction is originating and lead us to the best protocols to reduce symptoms. Following the steps below, one can observe ocular movements and fluidity of movements, lag in response to positional changes or presence of nystagmus (ticking of eye movements horizontally or vertically). Always take note of direction of the “beat”/tick as well as how long it lasts. Always assess the client’s perception of severity of vertigo on 0-5 scale with 5 being severe.

Visual field deficits: Normal: superior 60 deg; inferior 75 deg; tamporal 100 deg; nasal 60 deg.
Eye / head coordination: Eye range of motion – rectangular; eye coordinated, conjugate motion with head steady.
Smooth pursuit – smooth eye movement at less than 60 degrees per second; eyes tracking moving object
Saccadic eye movements – rapid eye movements between two targets
Vestibular Ocular Reflex (VOR) – gaze stability during rapid head movement
In-phase – eyes fixed on object; heading moving
Cervical Ocular reflex (COR) – rotation of body under head – keeping head stationary
Gaze Stabilization – Optokinetic system
• Combination of saccadic and smooth pursuit system
• Stimulated by repeated movements across a subject’s visual field (an object moving across the stationary visual field or by a person passing by a stationary visual field)
Nystagmus – non-voluntary rhythmic oscillation of eyes; fast and slow components beating in opposite directions; named by the fast component.
• Pathological nystagmus – appear with or without external stimulation in patients with vestibular disorders
• Spontaneous – present with head erect and gaze centered
• Positional – induced with changes in head position
• Gaze evoked – induced by change in eye position
Peripheral Vestibular lesion:
• Jerk nystagmus (named for the fast component: away from the lesion: either up or down beating) Side of lesion is opposite the quick motion (jerk)
• Pendular nystagmus (right or left beating; or up or down beating)
• Rotary nystagmus (named for direction of spin e.g. Upward and rotary)
• Result of asymmetry of right and left vestibular systems.

Head thrust test (HTT) or head impulse test (HIT) – clear neck AROM and carotid artery first
• Fixation on near target then far target ( 6 ft away)
o Slow head movements
o Fast head movements

• Watch for saccades – re-fixate on target (nose)
o Peripheral or central vestibular lesion – unable to maintain gaze
o Bilateral peripheral vestibular lesion – re-fixation to both sides

Head Shaking nystagmus test
• Eyes closed; head tilted downward to 30 deg (places horizontal canals // to ground)
• Turn head passively side to side 20x (2Hz)
• Check for nystagmus using frenzel lenses
o Unilateral peripheral lesion – asymmetrical nystagmus – slow phase toward involved (hypo-functioning) side
o Normal – no nystagmus
o Central lesion – vertical nystagmus

Clinical dynamic visual acuity test (DVAT-N)
• Measures functional VOR or ability for person to stabilize gaze during head movement
• Read visual acuity chart on wall 4 m away
o Lowest line read seated
o Lowest line read while head is passively oscillated in horizontal direction at 2Hz
*Vestibular hypofunction of >3 line change in visual acuity
Monofilament testing plantar sensation
Sensory levels 1= 1g Normal sensation
2= 10 g Protective sensation
3= 75g Loss of protective sensation
4= No perception
Motion Sensitivity quotient (MSQ) – Measures individual response to positional changes. (I.e. quickly supine to side lying R and L; supine to sit and return; wait for response
• Establish baseline of symptoms of vertigo/dizziness, nystagmus at rest
• Monitor symptoms of vertigo/nystagmus
Dix-Hallpike Maneuver
• Quick movement from sitting to sidelying with head rotated 30 deg away from downside ear
• Caution: check for neck AROM and vertebral artery prior to any quick motions of neck on older people
• Watch for nystagmus and direction
• Record duration and intensity of nystagmus and vertigo 0 (none) – 5 (severe)
o Nystagmus directional perponderance:
 Horizontal canal – nystagmus will occur with fast component toward the floor (Horizontal geotropic meaning, toward the earth) or Ageotropic – away from the earth
 Anterior canal – torsional and DB (down beat)
 Posterior canal – torsional and UB (upbeat)
The most common peripheral lesion is BPPV of the posterior canal. With testing, one will typically see and upbeating, torsional nystagmus. (There may be a 30 second delay in nystagmus). Short term is <2 minutes if BPPV. This will usually improve in one treatment. Allow rest and re-test for symptoms.

Evaluation and interpretation of findings
With evaluation, Peripheral lesions/dysfunctions will present with BPPV, nystagmus, short duration vertigo, possible hearing loss and/or tinnitus. While Central dysfunctional will present with head trauma, concussion, stroke, MS. Symptoms will include nystagmus vertically, long lasting, lateropulsion and head tilt.

Mechanical Dysfunctions to look for
• Benign Proxysmal Positional Vertigo (BPPV), with typically be a result of cupulolithiasis or canalithiasis. Symptoms will typically include vertigo with changes in head position, nausea with/without vomiting, disequilibrium
• Right Posterior Cupulolithiasis will typically present with a persistent upbeat nystagmus and right torsion. Canalithiasis will typically present with transient upbeat and right torsion.
• Left anterior Cupulolithiasis will typically present with persistent downbeat and right torsion. Canalithiasis will typically present with transient downbeat and right torsion.
• Horizontal cupulolithiasis will typically present with persistent upbeat nystagmus, while canalithiasis will typically present with downbeat nystagmus

Identification of Semicircular Canal if peripheral lesion:

Canal Involvement Primary nystagmus: right Hallpike-Dix Reversal nystagmus: Right Hallpike-Dix Nystagmus: return to sitting
Right posterior Upbeat and right-ward torsion downbeat and left-ward torsion Downbeat
Right Anterior Downbeat and right torsion Upbeat and left torsion upbeat
Horizontal Horizontal opposite horizontal direction opposite horizontal direction
Left Anterior Downbeat and left-ward tornsion Upbeat and right-ward torsion upbeat

Treatment
In most instances, the techniques presented below will significantly decrease or stop symptoms within 1-2 treatments. Once, vertigo symptoms are addressed, balance, advanced gait and strengthening can be addressed as well as accommodation techniques which will become more complicated/advanced as the client accommodates. These will involve increasing eye, head and body movement as the client improves.

Canalith Repositioning Technique: CRT-Posterior SSC (Canalithesis BPPV) Treating Left side.
• Turn head left 30 deg from midline
• Maintaining 30 deg head turn, move to supine position
• While in supine, turn head to opposite side (right), 30 deg from midline
• Have client roll to onto right side while still maintaining 30 deg head turn to the right
• Transition back to upright position while maintaining 30 deg head rotation

Cupulolithesis (for posterior SSC) Treating Right side
• With client in sitting position, rotate head 30 deg right
• Move to side lying right, maintaining head rotation
• Keeping head at 30 deg rotation from midline, have client sit up and move to side lying Left
• Then move back to sitting. Head will be in original 30 deg to Right.
*once head rotation 30 deg from midline is achieved initially in sitting, this head position is maintained throughout the maneuver.

Cupulolighesis BPPV (for anterior SSC) Treating right side
• Have client in sitting position, turn head 30 deg to left
• Transition to side lying right (with head maintained in 30 deg rotation – head rotation will be up toward ceiling)
• Then move to left side lying while maintaining rotation 30 deg to left – head rotation will be toward the floor)
• Then have client move back to upright sitting, maintaining head rotation to left 30 deg.

Horizontal Canals – Roll Test
• With pt in supine, to test right side, have client rotate head to the right
• To test left side, have client rotate head to the left
*Alternative position can be performed with client’s head on a pillow or wedge

Canalith repositioning technique: CRT – Horizontal SSC
• Start with client in side lying with “bad” ear down
• Roll to supine
• Then move to opposite side lying position with “bad” ear up
• Then move to quadruped position with head // to the floor

Habituation Techniques:
• General habituation technique for posterior SSC BPPV. In sitting position, rotate head 30 deg Left, move to side lying left, then back to sitting, repeat on opposite side. Remain in position 30 sec or until vertigo stops. Perform 10-20 x TID.
• Gaze stability – looking at a fixed object and turning the head slowly from side to side.
o Turning body under the head with head fixed
o Body/head fixed looking at a central object, moving eyes only look to objects above, below, laterally and diagonal to central object/point
o Balance activities – stepping over objects, around objects.
o Gait activities with head movement

The activities outlined above are just a starting point. Be creative and always create an individualized program for each client based on symptoms, persistence of symptoms and each client’s specific deficits, their specific goals and activities and hobbies each client wants to return to.

Congratulations, Jacob Barnes, Bandera’s Newest CTO

MP Celebrate

By Shelby Donahoo, Therapy Resource, Tucson, AZ
We are proud to honor Jacob Barnes, PTA, TPM, at Park Avenue Health and Rehab in Tucson, AZ!
Jacob has been with Ensign at Park Avenue since 2013 and truly exemplifies CAPLICO culture. Jacob’s ED, Jordan Monson, says Jacob “is like salt: He’s sprinkled into every nook and cranny that is Park Avenue.” In other words, while Jacob leads a large rehab team with strong outcomes clinically and operationally, his ownership over the years is way beyond the Rehab department.

2020 led to some exceptionally tough times for all, but Jacob’s leadership shined through in this pandemic. In between serving meals, moving beds, and working all hours to support the facility, he quadrupled long-term care revenue, increasing margin by 8%. This was accomplished by concerted and thoughtful implementation of holistic programming to meet the growing needs of Park’s residents. He developed leaders in his team, such as our Bandera Abilities TEACHA, and created a designated long-term care lead and team. He helped facilitate support and communication with market DORs as challenges arose during COVID.

So here’s a perfect example of why Jacob is CTO: December 18 was his surprise CTO celebration. While facility staff, folks from all over the market, and even DORs from Phoenix (who drove two hours) congregated outside, Jacob’s co-worker was to distract him and then bring him out to “go to lunch” once he was texted that all was ready. The text to come went out, and we waited, poised with confetti — and waited some more. Finally we got a text back — Jacob was busy giving a resident a haircut! After another 15 minutes, the text came that he was done and they were headed outside. And we waited. Another text came from the co-worker: Jacob was stopping to answer call lights on the way. True and awesome story.

Thank you for all you do for your residents, facility, Bandera and the full organization, Jacob! And for your unwavering wit and humor along the way.

Transitioning Our STOP AND WATCH Program into a True Conversation

MP Share

By Kari Rhodes, MS, CCC-SLP, Therapy Resource – Keystone – West, TX
At Legend Oaks of Fort Worth, there have been a fair share of ups and downs in communication. As with most skilled nursing facilities, there are some struggles to get nursing and therapy on the same page, especially regarding changes in a patient’s condition. However, a recent change in structure for daily morning meetings has made a significant impact on both communication and patient care.
Initially, staff were encouraged to complete paper STOP AND WATCH forms that were turned in to the charge nurse. This was helpful in reporting noted changes, but it did leave room for improvement. Papers were misplaced, the change was forgotten, or multiple forms may be completed on one resident.

Staff were then trained in entering the STOP AND WATCH forms on the clinical dashboard in PCC. This improved the chance that the alert was seen by more people and addressed by a clinician. Unfortunately, the electronic alerts also were, at times, inadvertently left unaddressed by a busy nurse or well-meaning staff member.

Fortunately, what has been an amazing change for the team at Legend Oaks Fort Worth was a very simple addition to the morning meeting. In addition to reviewing metrics and culture topics, our ED implemented a review of the daily STOP AND WATCH alerts for the whole team to address. Each alert is discussed by the team. What condition or behavior caused the alert? What was done to address the change? How is the resident doing on a daily basis? This has significantly increased the topic of conversation regarding change in condition.

Here at Legend Oaks of Fort Worth, we are continuing to strive for improved care and communication. This simple change in a system that was already in place has opened the door for more conversation, increased discussion regarding change of condition, and decreased discharges back to the hospital.