Therapist Profile: Joe Pergamo, PT/DOR, Puyallup, WA

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Submitted by Jamie Funk, Therapy Recruiting Resource
Meet Joe Pergamo (pictured top left), the Director of Rehabilitation at Rainier Rehabilitation in Puyallup, Washington. Joe joined our organization in March 2019 and has become a huge part of the Pennant Washington team, not only as a stand out leader in his own facility, but also as someone who pitches in for any of our Washington facilities if they need help. He has even driven five hours (one way) to Walla Walla on a repeat basis when they were short a physical therapist.

“Joe is a remarkable leader! He has been instrumental in increasing the awareness amongst the staff at Rainier’s rehab team of the benefits of providing therapy services to residents to maintain their optimal function,” says Brett Watson, the ED at Rainier Rehabilitation. “He has demonstrated through his leadership how to improve the quality of life of our residents through consistent rehab interventions and skills. Joe is patient, kind and long suffering. He is not only supportive of his therapy team, but he gets in and supports nursing, activities, and business office staff with their needs. He does this while maintaining a strong productivity percentage.”

“Joe leads with humor, kindness, and the altruistic belief that therapy changes lives for the better. He is humble and leads by example with true ownership of his program,” says Mira Waszak, the Therapy Resource for Washington.

Joe was inspired to become a therapist because he wanted to work in health care and enjoyed working out and fitness. Initially, he obtained his PTA degree but went back to school to earn his Master’s Degree in Physical Therapy. He heard about a DOR opening at Rainier from a former supervisor who put him in contact with Mira to learn more. “I had spoken to Mira several times, and she was very helpful and encouraged me to become a rehab director. She provided excellent mentoring to ease me into the role. I met Brett and Stacy (the ED and DNS at Rainier) along with several RCMs, and I believed it was an excellent opportunity for me to be a director. I was impressed with Brett and Stacy’s approach and style and the way they cared for long-term care residents,” Joe remembers.

Joe’s favorite Ensign core value is Ownership. “I believe when employees take pride and responsibility in and for their work, it elevates everyone’s quality of care. Pride and ownership are contagious. When you are around other people who have ownership, it makes the ‘work’ more rewarding. You don’t want to let yourself, your co-workers or residents down. I feel that there are many owners at Rainier in the therapy department and throughout the facility and we all feed off of that positive energy.”

This affinity for ownership is not going unnoticed by the facility administrator. “Joe is faced with multiple challenges in caring for residents that have many needs. Joe is providing care to residents who need airway support — patients who need a level of care that is unique and challenging. He has not been afraid to get in and learn how to provide services to these individuals that have benefited these folks in many ways,” says Brett Watson.

Joe loves his facility and team because the entire facility is very devoted and dedicated to their residents. They practice holistic and selfless interaction with their patients. Joe is a strong believer in co-treatments and collaborative care and he works hard to be mindful of recommendations from all disciplines. “I always try to be open to opportunities to provide therapy services to improve residents’ quality of life,” Joe says. ”I believe all residents are therapy candidates and we just have to be open to all opportunities.”

When not working, Joe is spending time with his wife, son and three dogs. He is in the midst of a home and yard renovation and also makes time to exercise. He loves living in Washington, which he feels is the perfect mix of metropolitan life and breathtaking nature, home-town charm and cultural diversity. For any of you science fiction buffs out there, Joe’s favorite movie is the “Back to the Future” series.

“I call Joe my diamond in the rough,” says Mira. “He is very introverted but he doesn’t let that impact his effectiveness as a leader. I have had the privilege to treat patients with him side by side, so I have first- hand experience of his clinical excellence! On top of everything else that has been thrown at our leaders this crazy year, Joe has gone through some serious personal challenges but continues to show up 150% every day – #belikejoe!”

The feeling is mutual. “Mira is an excellent mentor and resource,” Joe says. “She provides motivation and encouragement every time we interact. Although I have only known her for just over a year, it seems like we have been friends for many years. Mira provides hard truth, sound advice, humor and truly listens to my concerns.”

Bringing Compassion to the Team

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April Trammell from Beacon Harbor in Rockwall, Texas, recently joined our Compassionate Hearts Team. She shared some ways she is bringing compassion to her team:

A personal goal of mine is to be more present for my team. This means both physically present and to develop a greater awareness of my team’s individual strengths and needs. I decided to give them all a survey with questions that captured our CAPLICO values
1. Provide an example of a teammate’s compassion
2. Provide an example of a teammate’s accountability
3. Provide an example of a teammate’s effective treatment technique/out of the box thinking
4. Is there a topic/area of interest for your personal goals?
5. Provide a characteristic/trait you value in a teammate, in a leader, in yourself
6. What are your professional goals/leadership interests?

The responses from my team were overwhelming! I am reviewing one question’s responses per week in our team meeting so that each staff can see/hear the great things they have to say about each other/see in each other. Here are the examples of Compassion shared by my team:

  • Kristen and Tibitha checking in on me while I was out for surgery. They have been extremely understanding. Receiving a very nice bag of thoughtful health products from April when returning from surgery.
  • Reggie’s ability to make the residents feel more at home /at ease.
  • Blair always goes above and beyond to make sure her patients are well taken care of and that they have everything that they need.
    Blair brought in a warm outerwear garment for a resident to wear who is cold all the time.
  • OT taking time to have a video call for patients with family members
  • Esther always has nice things to say about a patient or co-worker no matter how challenging that person’s attitude is. Even when everybody gave up on Resident SH, Esther was still attentive to her needs.
  • Being kind to patients even when they are difficult and stubborn
  • Jessica! She is always willing to help in any situation. She is very passionate about each and every patient and is willing to learn.
    Reggie is always checking on each patient and making sure they always have what they need.
  • Rhonda- always eager to help.
  • One of our therapists going above and beyond their responsibility by providing shoes to a patient to help them ambulate.
    Neeraj going the extra mile and caring about patient’s pressure sores and mental health.
  • Reggie and Neeraj going above and beyond to help our patients.
  • Kristen Erickson was very compassionate on the COVID unit. She ran around each day going out of her way to get the patients clean and anything they needed.
  • All of the current team members are compassionate and have demonstrated it during COVID times.

Needless to say, COVID was our Moment of Distinction with so many Silver linings that came out of it. We are a stronger team because of it. This survey has been a moment of distinction for me personally and professionally. This has been a great team-building activity—some squeals of delight when names were heard, giggles, heads nodding in confirmation. Hearts are filled here!

Evacuating from the Fires in Northern CA

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Patients lined up to get in the transportation vehicle

By JB Chua, DOR, Summerfield Healthcare, Santa Rosa, CA
October 9, 2017, and September 28, 2020 two dates that are significant to Summerfield Healthcare Center. These are the days that we, the Summerfield family, had to evacuate our patients out of our facility and send them temporarily to another place that is not their home. Their limited choices were either in a relative’s home, another skilled nursing facility and worst, evacuation centers. These were definitely one of the most stressful events that Summerfield had experienced. Staff worried about their homes, patients worried about their safety and patients’ families worried about their loved ones. The sky seemed to empathize with the situation with its gloomy hue and the air felt like a snake coiling around your body making it so hard to breath and the smoky air threatens to cut off your oxygen. Definitely not something anyone wants to experience during their lifetime.

Paramedics in action

As we received the orders to evacuate, text messages and phone calls started to flood my phone. Messages that even I, who holds my team to a very high standard, was surprised to receive… “I’m on my way and Schuyler (my OT’s boyfriend) also wants to know if he can help.”… “Michael (my PT’s fiancée) and I will be there in a little bit.” and many more similar messages, there were some of my staff who were evacuated, on vacation and have younger children who came in to help. Literally, all hands on deck. As the evacuation progressed, each and every patient was assisted in getting dressed and back up on their wheelchairs, we served them breakfast and helped some residents eat, some helped them back to their room to use the bathroom, the therapy room was converted into a calming room where we played soothing music on our phones (power was down so we were not able to use our therapy music player) and some staff were trying to re-assure our residents that everything is going to be fine, even though there were some doubts if it really was going to be. When the transport arrived, we started to roll our patients out towards a safer place. Even with worried hearts and uncertainty, the staff continued to re-assure our patients, waved them good bye and told them that they were going to see them again when everything was all over.

October 19, 2017 and October 4, 2020 two more dates that will be remembered as well, not because of any tragic event, but because of what these dates unconsciously signify to each and every individual at Summerfield Healthcare Center. It signified opportunity, growth and most importantly hope. Opportunity for each one of us to hit the reset button and start anew. The building was deep cleaned by the staff members, from therapists, nursing, administration, you name it, and you got it. Each and every single one looked for opportunity rather than focusing on the misfortunes and tragic events. Growth was experienced from overcoming challenges such as having to go to another facility to help out with our residents, finding new ways so that we can still provide for our residents and staff even when our resources were not as readily available during normal times and finding a new homes for those who had lost theirs. Lastly, hope; hope that everything we had gone through this year was fully addressed so that we will be better prepared both physically and mentally should these type of events happen again.

As I write this article, there are multiple times that I have had to hold back my tears, not because of sadness but because of how I was humbled with what I had seen and lived through. It reminded me of a saying about how a person’s character will really show up during tough times. On behalf of the therapy team I observed my therapists showing great devotion to our patients and to our facility. They were there from evacuation, helping other facilities, cleaning up the facility and welcoming our patients back. During these difficult times I was mostly impressed with the support they gave each other. I have read a lot of success and inspiring stories that gave me chills as I read them. Having to experience one, is quite overwhelming and humbling. Every now and then, even before this experience, I would send a message to my therapists that I am proud to be a part of our team. As I sent another message to them, after we received the announcement that we can get our patients back in our facility, those same words felt insufficient to really express how I felt. I know deep in my heart, that if the same thing happens in the future, Summerfield Healthcare Center will rise to the occasion once again, because that’s who we are.

Defining Moments in Times of Evacuation

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By Milena Milenkovic, OT/DOR, Park View Post Acute, Santa Rosa, CA
I was at home, in my pajamas, when I got the text message from our DON on Sunday 9/27 at 11pm, “We need all hands on deck to prepare packets for the potential evacuation.” I slowly jumped out of my bed and headed straight for the espresso machine while my partner read Twitter and Nixel alerts aloud regarding the location of the fires, direction of the winds, and latest evacuations orders.

When I arrived to Park View around 12:30am, the power was off, the building was running on a generator, several members of our leadership team were already busily doing various prep work while the rest of the building was quiet, patients and residents sleeping, nurses and CNAs attending to their tasks. While making copies of patient’s charts in our long-term section, I heard various residents snore, some waking up from sleep, asking for help, and hearing CNAs quickly attending to the resident, comforting them from a bad dream, helping them fall back asleep.

Soon enough, it was nearly 4am and I found myself taking a quick nap in the middle of the therapy gym, listening to the NOC shift sounds of med carts, occasional call lights, and staff’s footsteps. I anxiously napped, waiting for 5am so that I can send a text to my therapists. I worried about what to say to them, worried about those that had to evacuate, worried that many may not show up, that this is just too much, and that we may not have enough support in the morning if we had to evacuate. As 7am rolled-around, the shift-change happened, all my therapists showed up (some much earlier than usual), more staff rolled-in, and our building came to life. As our sister facility, Summerfield, started evacuating, it was our turn to continue “cold-calling” all SNFs within the Bay Area to ask them to accept our patients in the case of evacuation. Ash was falling from the sky as we secured beds for all of our patients. We were ready.

By 2:30pm on Monday 9/28 (32+ hours of being awake), after a near fall from exhaustion and pizza for breakfast, I knew it was time to go home and sleep. The sight of so many alert, awake, kind, calm, and composed Park View staff showing up in the morning brought the comfort, sense of security, and sense of overwhelming connection that we would OK, no matter what. Everyone became a leader by supporting one another, one hour at a time.

During these times, it has been so difficult for many of us who are unable to see our families and close friends. Some of our families and friends live in places that we cannot travel to, some are part of the vulnerable population, and some are no longer with us on this Earth. While napping in the middle of the gym, listening for evacuation alerts, hearing the flow of the NOC shift, I felt a sense of gratitude and acceptance that this, Park View and its staff and what we do as a team, is my family and this is where I am meant to be. That moment of exhaustion combined with team unity, trust in others, and the sight of our staff leading with patience and love is what I always look back on when I need a reason to continue fighting through the challenges that continue coming our way. Together, one day at time.

 

Fire Evacuation on 9/28/20

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Submitted by Shoba Neupane-Gautam, DOR, Valley of the Moon, Sonoma, CA
It was Sept. 28, 2020. I was excited to attend my very first annual Therapy Leadership Virtual meeting. As I was working from my home office that morning, I heard from our therapy resource and DOR team that the Santa Rosa area had a bad fire and residents were being evacuated from our sister facility, Summerfield.

I called Summerfield DOR, JB Chua, to offer some help. I realized JB was remaining calm but was disappointed that with the evacuation he may not be able to attend our annual meeting that day. As soon as I heard many residents were being transferred from the Summerfield facility to Broadway Villa Post-Acute, JB and I coordinated with Ensign IT to grant me Summerfield Optima and PCC access.

JB helped evacuate his facility and still arrived at my place around 1:30 pm to attend our virtual meeting together. We both were able to attend the meeting peacefully. As soon as the meeting was over, we coordinated with the nursing/ admission team to identify the residents who were being transferred to Broadway Villa Post-Acute. Then I reached out to my team and requested that they visit those residents, provide them comfort and reassure their safety. After we identified 18 residents who were transferring from Summerfield (SF) to Broadway Villa (BW), we reviewed each and every resident’s needs and coordinated staffing between our two facilities.

Both SF and BW rehab staff were highly cooperative, cohesive and willing to assist residents. As a result, all 18 residents were able to receive skilled rehab services in a timely manner.

Thanks to both home teams’ cooperation, this situation was managed calmly. I was still able to attend all three days of the therapy virtual meeting. I am beyond thankful to my team at Broadway Villa, our therapy resource Jennifer Raymond, the Summerfield Rehab Team and JB’s leadership.

 

Reuniting Families and Friends

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By Joyce Koyama, OTR/L, The Orchard Post Acute Care, Whittier, CA

On March 13, 2020, President Trump declared a national emergency, citing an outbreak of COVID-19. On that same day, CMS strictly restricted in-person visitation to only compassionate care situations in skilled nursing homes in order to prevent the introduction of COVID-19 to our most vulnerable population: the elderly with pre-existing medical conditions.

Like many seniors, our residents at The Orchard thrive on the opportunity to spend time with their loved ones. They look forward to having lunch with their spouse, to catching up with friends, to seeing their grandchildren grow. For many months, they were deprived of these meaningful visitations, or at least reduced to visits virtually or done outside their window. While many families tried to make the most of the situation by attempting to talk through glass, decorating their windows with signs and balloons, or even bringing singers to sing for their loved ones to bring cheer, it just was not the same.

As we gained a better understanding of COVID-19 and infection numbers locally were declining, our facility came up with a plan to build a visitation area as a way to help reunite our residents with their families and friends. Plexiglass was added to three sides of our existing gazebo against a side entrance. Just weeks later, the Activities Department was able to bring residents out into the sanitized area at a designated time where family and friends would await them on the other side of the glass.

At last, a clear view of each other from head to toe. Sounds of cheer, laughter and tears of joy can be heard and seen from the visitor area. Hands held up to glass, face-to-face conversations, and a heart-warming feeling with a hello and good-bye. Our resident Sandie described seeing her family for her birthday as “uplifting,” as she has felt lonely after not being able to see them for months. Resident Rosita said she felt happy seeing how tall her granddaughter had grown. It was unanimous that our residents felt overwhelmingly happy and loved after seeing their family and friends again.

While there is nothing that can really replace the warmth and value of a real hug or a held hand, for now, this is a wonderful and sweet way to reunite our residents with their loved ones. For families on the other side of the visitation area, they feel relief to see their loved ones doing well. And for our residents, they are given hope and joy — a goal we have accomplished here at The Orchard Post-Acute Care.

Documenting Justification of Skilled Therapy Services, Part 2

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Symptomless CVAs?
By Lisa Harvey, M.S./CCC-SLP, Documentation Review Resource

A pattern that our PDPM deep diving partners have found is hospital document and/or therapy documentation that reports a history of CVA that then goes…nowhere. Despite this history, no residual speech, language, swallowing, cognitive or neuromotor findings are reported in the therapy assessments (or anywhere else). Yet according to the National Stroke Association, only 10% of people who have a stroke will make complete neurological recovery. This means that many individuals with long-term sequela are going unidentified in our setting.
According to the CDC, the most common long-term symptoms after a CVA include hemiplegia, cognitive impairments, speech and language impairments, dysphagia, incontinence and depression. Most of those symptoms, when properly identified and managed, will trigger PDPM components.

Step 1: Identify the sequela.
Obvious hemiparesis, dysphagia or aphasia will seldom be overlooked. But even minimal impairments can affect a patient’s balance, skin integrity, weight, mood and cognition. It’s critical that when a CVA history is present that the most sensitive assessments are completed to ensure that subtle impairments in symmetrical strength, righting response, complex reasoning, word retrieval, mood or swallowing are not missed.

Step 2: Identify how the patient is impacted.
It’s very unlikely that a long-term residual sequela doesn’t impact the patient’s function, the therapy treatment plan, or both. In addition to therapeutic interventions that may be need to be incorporated into the specific therapy treatment plans, the ways they impact a patient’s function should be part of the patient’s comprehensive care plan. Here are some examples:
• Hemiparesis that affects gait stability or righting response should be careplanned under fall risk management.
• Hemiparesis that affects sensation should be careplanned under skin intergrity.
• Hemiparesis that causes joint instability should be careplanned under risk for injury.
• Apraxia can affect ADL function, gait stability or speech and should be careplanned in the appropriate area.
• Aphasia or dysarthria that effects either comprehension or expression should be careplanned under risk for communication breakdown.
• Dysphagia that requires any degree of adaptation (including supervision or compensatory swallowing technique) should be careplanned under nutritional risk.

The better the assessment, the better the patient’s therapy and care plan can be customized to their needs. The more patient-focused the care, the better the patient will respond to it. And an extra bonus is that CMS recognizes the impact that long term neurologic sequela have on a patient’s care and they’ll reimburse accordingly. So we call that a win!

What’s So “Vital” About Vital Signs?

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Submitted by Tamala Sammons, M.A., CCC-SLP, Therapy Resource, Flagstone, Pennant, Sunstone, Milestone, Endura, Monument

Vital signs are the objective measurements of temperature, pulse, respirations, and blood pressure as a clinical means to assess general health. Additionally, many include Pain and Gait Speed as the fifth and sixth vital signs.

Vital signs are critical indicators of patient status, both at rest and during exercise/activity.

 

Therapists treat patients with many complicating conditions, such as:

  • Respiratory conditions — pneumonia, COPD/chronic bronchitis, emphysema, asthma, atelectasis, etc.
  • Cardiovascular conditions — CHF, hypertension, etc.
  • Metabolic conditions — renal failure, diabetes, etc.
  • Infection conditions — sepsis; Systemic Inflammatory Response Syndrome (SIRS), etc.

Taking consistent vital sign measurements will help ensure therapists have good data related to respiratory function, cardiovascular function, endurance, and a patient’s ability to tolerate functional activity.

As clinicians, it’s not only important to take vital signs, but also measure them against exercise/activity. In other words, vitals should be taken:

  • Before the exercise (to establish a baseline);
  • 6 to 8 minutes in the exercise; and
  • 5 minutes after the exercise (recovery).

This information will allow clinicians to determine if target heart rates are being attained, any changes in condition, and/or if treatment adjustments need to be made, etc.

Consistent vital sign measurements also help detect medical condition changes. For example:

Sepsis early warning signs (these changes need to be reported immediately):

  • Temperature higher than 100.4° F or lower than 96.8° F
  • Heart rate greater than 90 beats per minute
  • Respirations greater than 20 breaths per minute

Respiratory rehab considerations:

  • A resting HR > 100 bpm is a relative indicator of patient instability.
  • If lower than 90%, there is an inadequate oxygen supply, and less than 70% is life-threatening.
  • Normal resting respiratory rate is 12-20 breaths per minute. “Normal” respiratory rate for an individual with pulmonary disease may fall outside these parameters. It is important to establish what is “normal” for each patient. Respiratory rate needs to be monitored before, during and after exercise.

Using vital signs to determine exercise termination:

  • Significant blood pressure changes
    • o BP>200/110
    • Lightheadedness; BP drops >20 mmHg
    • No more than an increase of 20mm Hg with activity
    • Oxygen saturation <90%
  • Severe shortness of breath
  • Noticeable change in heart rhythm

It’s important to know the normal ranges for each vital sign along with considerations for an aging population. Additionally, it’s also important to know what medications patients are taking and if those medications may interfere with vital sign measurements.

For example:

  • The medicine digoxin used for heart failure and blood pressure medicines called beta-blockers may cause the pulse to slow.
  • Diuretics (water pills) can cause low blood pressure, most often when changing body position too quickly.

Take time to ensure every member of the Therapy team is taking vital signs consistently and throughout treatment sessions as recommended. Consider hosting a training lab if any skills need to be refreshed. Ensure team members have access to vital sign equipment (consider vital sign kits for each team member).

For more information on the details of vital signs, please refer to the Vital Signs POSTette, Pain Management POSTette, and Clincally Complex POSTette.

For training tools, check out these resources:

• Training video on taking blood pressure: https://www.youtube.com/watch?v=UGOoeqSo_ws
• Training video on all vital signs: https://www.youtube.com/watch?v=JpGuSxDQ8js
• LMS video available on Vital Signs: How to Measure Vital Signs REL-PAC-0-HMVS 1 hour

Therapy to ED Leadership

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Submitted by Brian del Poso, OTR/L, CHC, RAC-CT, Therapy Resource

As you all know and have heard, our organization considers itself a “leadership development company that happens to be in healthcare,” and we are always looking to develop the best and right leaders. On previous Therapy Leadership calls, we’ve had guest speakers who were former DORs who took on the challenge of becoming EDs, quite successfully we might add! Our organization recognizes how special our therapists and therapy leadership are and the potential that many of you possess.
In a continuing effort to tap into that potential and to foster and grow any thoughts you may have or have had about becoming an ED, we are starting a series of interviews with our former therapists/DORs turned ED, to get some further perspective. Here’s the first of the series from Stephanie Anderson out of Rock Creek of Ottawa in Kansas.

Thanks for taking the time to check out this interview, and if you want to talk further or have questions about becoming an ED or the AIT program, we encourage you to take the next step and start talking to folks. There are many ways to get more information and insight, such as your ED, Market, therapy resources, Clay Christensen, and/or any of the former DORs who are now successful EDs. If you’d like to talk further with Stephanie or any of our other former DORs, let us know and we’ll get you their contact info!

Question: What is your favorite part about being an ED?
Stephanie: I love that I am able to really take the time to focus on staff and residents. I get to spend my day “people-ing,” as I like to call it. Being on the floor, problem solving, getting to know the staff and residents on another level, and really driving the culture and vision I have for the building all make my day so enjoyable. The impact I can have as an ED in taking our building to the next level is what motivates me each and every day.

Question: As a DOR, you were in a good place in your career. What kinds of things were you thinking about when the thought of being an ED came up?
Stephanie: Can I really do this? Do I want to do this? How will my relationships change with my peers and team if I make this switch? I love this building, as it is in my hometown and I’ve seen the changes that have happened over the years. I joined Rock Creek of Ottawa during the acquisition in November 2018. Prior to the acquisition, the building didn’t have the best reputation, so I love that I can be part of fixing that. I took the DOR job with every intention to change the reputation here. As the ED, I feel I have more impact and push to continue to change. Me stepping into this role allows the community to continue to build trust in us.

Question: How did you come to the decision to push forward into the AIT/CIT program?
Stephanie: Our market lead actually approached me about the idea. My ED at the time had been telling me for a while that I would make a great ED someday, but that day came faster than I was anticipating! It was a little unconventional as I still served as the DOR while I was going through the AIT and I was able to complete the AIT in my home building. There were long days, but I was able to make my AIT experience a positive one. You really are the one responsible for making your AIT program great. My therapy department was operating well and I felt like I needed more. I was also able to connect with other EDs within Ensign that were DORs previously and went through AIT.

Question: You’ve been transitioning to this role during this rough time of the pandemic. Are there qualities or characteristics you took from being a DOR that have helped you with your transition during this time?
Stephanie: How to enhance culture across departments, clinical skillset as far as infection control and isolation room practices, implementing strategies to enhance residents’ quality of life and functional abilities, LTC programming, creative ways to drive revenue, seeing the business side of how the operation works, building a strong team and having the right people on your team to be successful, driving culture.

Question: What advice would you give to a therapist if they are thinking about becoming an ED or even just about the ED role in general?
Stephanie: I’ve been told that DORs who transition to EDs are the most successful. ☺ If you’re considering making the jump, I encourage you to reach out to people who have done it and gain perspective. The beauty about Ensign is that our culture and processes allow awesome things like this to happen!

Therapist Profile - Avenlea Gamble, DOR/SLP, Northbrook Healthcare

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Submitted by Jamie Funk, Therapy Recruiting Resource

Meet Avenlea Gamble (pictured Left), a second-generation Ensignista who is the Director of Rehabilitation at Northbrook Healthcare Center in Willits, California. Avenlea has been coming to Northbrook since she was three days old, which may sound strange unless you know that her mom, Shawndee Gamble (pictured Right), is the facility administrator there.

This story is about Avenlea, but it is woven tightly with the story of her mother. Shawndee began working at both our Ukiah and Willits locations when she was 17 years old, first as a CNA, then in medical records, and then as an activities director. Avenlea would help out with bingo and one-on-one activities with the residents and developed a lasting love for the long-term care setting. Shawndee later entered the AIT program and has been the facility administrator at Northbrook for 13 years.

Avenlea began her healthcare career at 16 when she became a care partner for Northbrook residents under the Department of Social Services. She also served as a dietary aide, helped with HR, and basically filled in on any odd job that was needed. She loved helping her small, tight-knit community. Willits has a population of approximately 5,000, so Avenlea cared for many of her friend’s parents and grandparents over the years.

Avenlea loved growing up in a small town, and her graduating high school class had only 18 students! She knew from early on that she wanted a career in therapy and wanted to return to Willits to help alleviate the ongoing shortage of qualified medical professionals there. She ultimately chose speech therapy because it allowed her to support communication and give people a voice.

The University of Pacific is where Avenlea obtained her undergraduate and graduate degrees in Speech Language Pathology, and also where she met her now husband, Jan. An interesting fact is that UOP had the same number of students as the entire town of Willits. Despite the crowd, Avenlea loved her experience there and had great clinical exposure with patients beginning in her junior year.

Jan took Avenlea’s last name when they married since the family history meant so much to her (and she is the namesake for her family). Jan is an opera singer as well as an audiologist and works in a clinic in Santa Rosa. He has a passion for music but also for science, so audiology was a perfect combination of the two. You can find his music and online choir on YouTube. Avenlea says their home is filled with a variety of instruments and full of music most of the time. Her two cats, Belle and Jasper, are happy residents and can be found enjoying a view of the beautiful foothills through a sunny picture window in the Gambles’ house.

After graduating with her Master’s Degree in Speech Language Pathology, Avenlea worked in an acute care hospital setting in Stockton to complete her clinical fellowship year and earn her CCCs. It wasn’t long before a speech therapist position became available back home and she convinced Jan to join her in moving back.