Moments of Truth

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From Riverbend Post Acute Care, Kansas City, KS
By Madeana Galler, Therapy Resource

Riverbend nurses and therapists have united forces like never before. The two teams have joined forces to ensure the safety of all of their residents, and all the while gaining a deeper level of appreciation for one another through many Moments of Truth.

Jordanne Gerdes, COTA, and Amy Jacobs, PTA, have owned the shower schedule together with their partner CNAs. They also dried and styled the patients’ hair in preparation for Easter.

On April 9, 2020, TPM Justin Fricke’s church organized a prayer vigil for Riverbend, inviting the community via Facebook to come to the facility and pray over the facility, staff and residents. About 45 cars lined the parking lot, each person stayed in their car, a church member led the crowd in singing three hymns, followed by a short devotional on David and Goliath (overcoming COVID) and concluded with a prayer. There was an overwhelming feeling of support from the community, leaving many employees in tears of joy. Additionally, Justin’s wife’s work donated a truckload full of snacks and drinks to the facility.

Lisa Wainscott, OT, and her mother bought all the residents balloons. Lisa and Justin Smith, PT, personally passed out a balloon to each resident as a way of spreading love and gratitude.

Local restaurant, Mr. GoodcentsSubs, has donated grab-and-go style meals for the staff on a regular basis, and Plowboys BBQ donated meals for an entire week to the facility.

On April 13, 2020, Clinical Market Lead Maureen Purvis’ church family came to the facility and prayed over it.

Maureen Purvis, CML, Justin Fricke, TPM, Cory Schulte, ED and Jackie Brown, HR Resource, have been tirelessly and resolutely working together with the staff.

Facilities within the market sent handwritten posters with words of encouragement.

Sharing Gratitude

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From Agatha Pedro, OT/DOR, Timberwood Nursing & Rehabilitation, Livingston, TX
I have been listening to all of the therapy calls, and I just feel so lucky to be part of this organization because we have leaders like you! You inspire us to be better and to brave the unknown. In the past few weeks, there were days when I wondered if what I’m doing was worth it or if I’m making a difference. Yesterday, at the end of my day, I was reading my OT’s email about a new patient. She said that the patient has vascular dementia and he is slow to respond. He can answer simple commands, but you have to give him time to respond. He lives with his wife. I thought about his wife. She is probably worried not knowing how he is doing or if he is being taken care of. Because of his cognitive deficit, it is harder for her to talk to him over the phone, so that evening, I called her and updated her on how he did that day in therapy. She was so grateful and happy to hear about her husband, and toward the end of our conversation she said, “It is hard for him to express himself; he probably thinks that I abandoned him.” Then she started to cry. Of course that made me cry too, and both of us were quiet for a few seconds.

Sometimes, you think about whether it is all worth it. When patients and their families rely on you to take care of them, you have to give your best. I would want that for my parents. I’m blessed that I have my brother to take care of them while I’m thousands of miles away, that they are safe and healthy. I went home last night with a heavy heart but with joy knowing that we can make a difference.

By JB Chua, PT/DOR, Summerfield Healthcare, Santa Rosa, CA
I would like to encourage everyone to start your week with gratitude. A great leader once told me, “It’s not happiness that brings us gratitude. It’s gratitude that brings us happiness.” Today I am grateful for so many things:
● For my activities director, who asked me to play guitar for our residents last Friday. This helped me feel that I can offer additional support during these times when showing appreciation to your coworkers and patients are limited because of social distancing.
● For my ops manager, who made me realize that I am not alone with my struggles and there is someone out there who is willing to be the first follower and follow the lone nut.
● For my coworkers, who show up every single day, not because they need to but because they want to. One of my therapists was sent home a couple of weeks ago because she had an elevated temperature (99 degrees) and she was upset and crying. And the questions that she asked me as I told her that she needed to go home were: How about my patients? Who’s going to see them? Are you guys (therapy team) going to be alright without me? Those questions still give me goosebumps knowing that she is more concerned about our status than her health.
● For the therapy and clinical resources, the unsung heroes who keep on working day and night to help each and every facility to stay updated with regulations that keep us properly equipped in our daily battles, gathering information that can help us with our day-to-day operation that was affected by some new protocol because of COVID-19, and continue to cheer us on and support us on the sideline to give us the extra push that we definitely need. Mary, thank you for the great coherence exercise last Friday. It is embarrassing but I have to admit, it brought tears to my eyes as I reflected on the message that you gave during that session.
● Most of all, I thank you, DORs out there for keeping me inspired with all the things you do in your facility and community. Each day, I get in my car to go to work and I envision each one of you doing the same, ready to seize the day.

How Full is Your KUP?

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By Jack Rolfe, PT, MNA, CHC, RAC-CT, Senior Compliance Partner for Utah
Jack Rolfe is also the Founder and CEO of the School of Life Foundation (http://schooloflifefoundation.org/index.html). This 501(c)3 nonprofit organization has a mission to increase high school graduation rates. The following article was published in the Saint George Health & Wellness Magazine.

The phrase “my cup runneth over” is a biblical reference to receiving an abundance of blessings in life. I believe one of the greatest blessings we can experience is peace. As my physical body grows older and my hair turns a little whiter, my mind seems to ponder more deeply on all that I have learned. Recently, I spent time pondering the following question: How can we obtain true, ongoing peace in our lives? I would say this has been on my mind due to all of the current commotion in the world. Things are unsettled politically and economically. We hear and read about natural disasters, diseases, failed family relationships, and much more. At no other time in human existence has the world been more advanced in technology, knowledge, and resources, yet we appear to be at a low level with the virtue of peace.

During my reflection on this subject, I determined that the way to spell peace is KUP. For me, this acronym is defined as follows:
K = Kindness
U = Understanding
P = Patience

For the past few weeks, my aim has been to apply KUP in my life more each day. I make a conscious effort to apply these steps in all that I do. When I slip up, I reset and try even harder. Guess what? It has been working! As I apply kindness, understanding, and patience each day, my life is filled with an abundance of peace. Does the strife in the world go away? No, it does not. Does the world around me exude more calmness, tranquility, and order? Yes, it does! Thus, I conclude that increased peace comes into the world through my efforts.

Let’s briefly examine why this happens. First, let’s look at kindness. Did you know that performing acts of kindness lowers your blood pressure, relieves depression, boosts self-esteem, and reduces social anxiety by physically changing the brain? Kindness slows the ageing process by reducing wrinkles and promoting muscle regeneration. As if that wasn’t enough, kindness increases the chances of our relationships lasting, cures stress, and makes our lives happier overall. All this evidence is found in the research of former chemist David Hamilton. In his book The Five Side Effects of Kindness, Hamilton shares the scientifically proven health benefits of kindness and how these benefits can transform your life.

Next is understanding. In his book 7 Habits of Highly Successful People, Stephen Covey explains the benefits of habit #5: “First seek to understand, then to be understood.” According to Covey, as we apply this principle in our lives, we gain true insight into the lives of others and into the circumstances that surround us. Our actions show others that we care. Thus, we build synergy and cause others to desire to understand us.

The final piece of the equation is patience. Numerous articles point to the fact that exercising patience in our lives brings about better mental and physical health, allows us to make better decisions, helps us develop compassion, and teaches us to appreciate the process of growth.

Each one of us may discover that our path to peace through kindness, understanding, and patience is achieved differently. That is okay! The key is to start down the path. So, I invite you to step back and ask yourself, “How full is my KUP?”

“Peace is not absence of conflict, it is the ability to handle conflict by peaceful means.” – Ronald Reagan

Therapy/Nursing Partnership

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Submitted by Paola DeLuna, Therapy Resource
Hope Eaton (DON) and Sunny Chahal (DOR) at Eastview Healthcare in Houston, TX, have worked together for five years as a DOR/DON team. They both started working together while being new and have grown up by making mistakes together and finding solutions as a team. They call each other out on one another’s shortcomings and/or unproductive behaviors, but always make sure they genuinely apologize to one another when saying something inappropriate or something damaging to each other.

Having faith in each other, being honest with each other and building trust between them has allowed them to form a partnership where they can challenge each other. They admit their weaknesses and mistakes; they show “Love one another” by talking positively about each other; they are loyal and care about one another’s personal lives. They have created a partnership where they can push each other out of their comfort zone to initiate new programs that they both feel would benefit the facility and the residents.

Hope’s drive has pushed Sunny to implement programs like: Heart PARC Recovery program, Outpatient Therapy, Contracture Management and Wheelchair Positioning programs. The building had an IJ in the past due to wounds, and Hope partnered with Sunny and guided him to start a Wheelchair Positioning program for the LTC residents. The facility currently has 25% of the LTC residents in customized wheelchairs and have received no harm tags since then. Through accountability and ownership, they are passionate and unguarded in any discussion issues and have shown what a true partnership can accomplish.

Super Heroes at City Creek!

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By Gary McGiven, Therapy Resource, Milestone
The employees at City Creek Post-Acute in Salt Lake City, Utah, truly are superheroes. City Creek has partnered with the state to become a COVID-only building. As part of this partnership, City Creek was required to temporarily place their residents in sister facilities throughout the Salt Lake valley. This was a huge undertaking in and of itself and was the beginning of building something very special at City Creek.

In order to make this venture work, there needed to be some blurring of discipline lines with an “all hands on deck” approach. Those working in the facility needed to be on board with helping these residents in any way that was necessary. This meant therapy staff would spend time performing housekeeping, CNA and other duties in addition to treating patients for their therapy needs.

In speaking with Ray Yarman, the Director of Rehab at City Creek, she has expressed, many times, the appreciation she has gained for our nurses and CNAs as she and her staff have been working alongside them, in the COVID trenches. Ray says she wishes all therapy staff could gain this personal perspective of the amazing things our nurses and CNAs do on a daily basis. This experience will most definitely change the way Ray and her team operate, as they have bonded with the nursing staff and have built long-lasting relationships.

Many thanks to our amazing nurse partners for all that you do to give our residents the quality of life they deserve.

Wound Care During COVID-19

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By Shelby Donahoo, M.S., OTR/L, Therapy Resource – Bandera
We all experience day-to-day (or minute-to-minute!) changes in staffing these days. Pueblo Springs in Tucson, Arizona, found themselves suddenly without a wound nurse for an indefinite time due to illness. With nursing managers working the floor, there was no one to cover this critical task.

So, DOR Josie Gorman, PT, stepped up and volunteered physical therapy to take over most of the wound care program. DNS Paulina Kareko, Josie, and ED Neil Cullen all met to discuss this as a possibility.
The team reached out to Therapy and Clinical Resources, who consulted together to determine if this was viable and considered all options, with the following questions and answers:

  • Is PT qualified for this task? Yes, as verified through licensure, state practice act scope of practice, Ensign job description. Josie had also completed wound care certification training.
  • How will competency be determined? With no wound care Skills Checklist in rehab, PT staff involved in wound care will complete nursing Skills Checklist, to be signed off by nursing leadership.
  • What parts of the wound program will rehab take on? Dressing changes, orders, weekly rounds with MD (via telehealth at this time); nursing to continue admissions assessments, skin checks, etc.
  • Can we add billable therapy wound care services to the POC? Yes, through four avenues: a) Use of Physical Agent Modalities for wound healing per Medicare guidelines for qualifying wounds (training provided); b) Adding pain management standardized assessment and goals as appropriate; c) Including functional goals in the POC pertaining to wounds: positioning, training off loading, bed mobility, therapeutic exercise to increase circulation; d) providing caregiver education and training in regard to above goals.
  • What about documentation? Rehab billable tasks to remain in Optima; for non-billable tasks (weekly rounds, documentation, dressing changes), PT to document in PCC following training from nursing.
  • What about cost allocation? Therapy non-billable wound care tasks to be allocated to nursing cost center.
    What about the exit strategy? PT to relinquish tasks per consistent availability of nursing management and return of wound nurse; IDT discussion bi-weekly.

Hats off to the Pueblo team for thinking out of the box and working together to support patient care! Thanks to awesome Clinical Resources Sheila Summey and Julie Uychiat for collaborating to support nursing/therapy teamwork! And thanks to Pit Crew for input and suggestions.

p.s. Yesterday, a wound-care doc reported progress on a chronic ulcer that’s been plateaued for some time, with patient expressing excitement about this gain. Estim for wounds really does work, y’all, with lots of evidence to support. ☺

Orem OT Medication Reduction

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By Ryan Porritt, OT, Orem Rehabilitation & Nursing, Orem, UT

Occupational Therapy (OT) used non-pharmaceutical mindfulness-based interventions (HeartMath and Acceptance and Commitment Therapy) to support a patient while the physician reduced anxiety medication that she had been on for years. The patient has several mental health diagnoses, including bipolar disorder, PTSD, generalized anxiety disorder contributing to frequent panic attacks and high levels of anxiety. Her independence and quality of life is further complicated by several physical comorbidities that exacerbate the functional impact of her anxiety. She has a history of significant trauma as measured by scoring a 9/10 on the Adverse Childhood Experience scales.


The following are the step-down dosages of clonazepam:
Staring at 1 mg 3x daily
Reduced to 0.5 mg 3x daily on Jan. 21, 2020
Reduced again to 0.5 every 12 hours on Feb. 1, 2020, to present

The OT trained the patient in several meditations to reduce the emotional struggle resulting from her anxiety in order to increase participation in value-based activities. With assistance, the patient identified three value-based activities: writing poems, quilting and facilitating a weekly bible study group for her religious congregation. After 30 years of not writing poetry, she is able to express her pain, anxiety and other emotions through regular poetry writing. She has assumed a leadership position to prepare and facilitate weekly bible study groups, and she is currently being trained to lead a resident-run quilting group in collaboration with Recreation Therapy and the Therapy Department.

While the patient still faces daily challenges resulting from anxiety, she reports the duration and frequency of panic attacks have reduced and that “I am not struggling with my emotions as much anymore.” With less medication, she reports both increased quality of life and increased participation in value-based activities. While significant progress has been noted, she will require continued skilled OT under a maintenance plan due to the complexities of her physical and mental health. As illustrated by this example, skilled therapists are in an ideal position to have a significant impact on both function and quality of life while assisting physicians to reduce medications.

The 5 E’s – The St. Elizabeth Story

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By Dennis Baloy, OT/DOR, St. Elizabeth Healthcare and Rehabilitation, Fullerton, CA

The acquisition of St. Elizabeth Healthcare and Rehabilitation happened in May 2019. The transition was remarkably successful, but it did not come without challenges. Equipped with knowledge and guidance from our resources, we were ready for the speed bumps ahead — from changing guidelines of our managed care partners, new state and federal regulations to the Star Rating Data, onset of PDPM and many more. Our relentless, action-oriented and fearless yet compassionate leaders, Rand (Administrator) and Mady (Director of Nursing), knew that the only way to achieve these things is staying the course toward our true north — that of providing the best individualized care to all our residents while continuing to embody the CAPLICO values toward one another.

Fast forward to January 2020, when the Department Heads of St. Elizabeth decided to jumpstart the year with a team-building/planning event. In this meeting, they picked the brains of all the adroit minds (fueled with everyone’s genuine love and compassion), and the best ideas in each department were laid down on the table to create a blueprint for “greatness” of St. Elizabeth.

From St. Elizabeth to St. E! Yes, plain and simple St. E!

Why the “E”s? We have narrowed down the core values that each St. Elizabeth employee embodies. They serve as our cornerstones and foundations for each intention and action we make when we go to this second home we call “St. E”!

Excellence. Empathy. Extraordinary. Engaged. Empowered …

Our building was undergoing a considerable renovation (front yard, room renovation, repainting) — an extensive overhaul. We also had a series of fun and educational inservices for all the staff. Keeping the blinders on and riding on this momentum, we were set to relaunch “St. E” to the community this May 2020.

Then COVID-19 came, and the world was shaken.

We paused.

It took only a few moments of realization that all our plans and efforts for our big relaunch were perhaps meant for this. Our facility is more prepared, more reinforced and better structured. The staff’s culture and morale are at an all-time high — bonded tighter than ever.

Yes, it is a different calling now, and everyone is well aware of it. The next few days and weeks will be a grueling test of the core values that is St. E. To say it will be a hard battle is an understatement, but united together we will succeed.

Bottom line is, surely now more than ever, nothing can replace the E’s that all the employees of St. Elizabeth/St. E embody: Excellence, Empathy, Extraordinary, Engaged, Empowered.

In-Room Treatments — Creative Therapy Solutions

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Here are some in room therapy treatment suggestions from our Keystone Resources:

● “Boxing” while supine in bed to work on trunk rotation, rolling side to side for bed mobility, UE strength and activity tolerance; add weights if appropriate
● “I Spy” game for word finding/verbal reasoning goals
● Bird identification out the window. Laminate photos of birds/scavenger hunt looking out window
● Cleaning the bathroom mirror
● Decorating or making a calendar for orientation
● Decorating the room
● Drawing, window painting/drawing
● Fall recovery
● Folding laundry
● Game cards and play this while standing to add in cognition component
● Have a therapist in the hallway and have some residents in the doorway and do some deep breathing and gentle exercise! Maybe have some questions to help facilitate conversation.
● Have some pictures ready for them; have them pick a picture from the pile and have them describe it to you!
● Have them tell us a hobby and modify it for them! We are super creative!
● If they have flowers in their room, trim them and replace the water. This can be done sitting or standing. If they are higher level, have them sweep up the fallen leaves and petals.
● Instructing patients in correct hand-washing techniques
● Introduce HRV training to help relieve anxiety during this time
● Item retrieval/transport
● Making the bed
● Making a collage with family pictures
● Making a cool Easter egg balloon with yarn to hang in their room
● Making cards for their loved ones
● Organize closet by colors/season of clothes
● Painting on paper
● Place patient’s clothes around the room at various levels, have them walk around and gather items, make decisions on whether to use reacher or not, manage reacher and RW, energy conservation education regarding rest breaks, etc.
● Plant something in a flower pot to put in the window sill for them to watch grow
● Postural exercises, high/low reaching

Tic Tac Toe technique–turn this into skilled intervention while distancing and sitting and standing.

● Put laundry on hangers and hang in closet (gross/fine motor and reaching)
● Scavenger hunt in room (list of objects to find)
● Small space functional mobility
● Talk about their life while they are rocking their wheelchair back and forth 🙂. They need to feel calm.
● Teaching them how to use the phone, FaceTime, and trying with a loved one … which brings happy tears, messenger on FB has a video chat as well, so setting them up to keep in touch with loved ones. Also, setting up a free music app on their phone, or a simple game like solitaire.
● Wall pushups working on posture
● Washing windows
● Wheelchair mobility “obstacle course” having to navigate around actual items and furniture in room
● Wheelchair pushups (5xSTS test)
Sequencing for sit to stand (brakes on, scoot up to edge of seat, back, hands in arm rest, fwd trunk nose over toes, 1, 2, 3, push up thru arms and LEs!). Get picky; perfect practice is the only way to instill good habits and break bad habits.
Sequencing for stand pivot transfers with assistive device
Standing balance (Romberg test), standing scalp retracts for stability, steps fwd, lateral, retro
Berg/Tinetti/TUG tests can be done in patient’s room and some aspects of them if anything can be worked on like 360-degree turns in place or picking object up from floor, etc.
● Writing letters/cards/postcards to loved ones
● Use AAC device to give instructions on how to set up/decorate the room; use patients’ phones or tablets for higher-level problem solving (e.g., sequencing steps to write a message on a niece’s Facebook timeline); use their phones/tablets to teach them to set up external memory aids (ex- add doctors’ numbers to contact list, set daily alarms for times they need to take meds); help them set up a grocery delivery acct for when they discharge home; use dysarthria (or aphasia or voice!) techniques during functional phone calls (talk to family, pay bills via phone, etc.); use objects in room for receptive language tasks (“Point to the razor THEN pick up the comb”).

Taking Care of Ourselves — Don’t Let Shelter in Place Shelter You from Staying Active

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

Through this difficult time, all of us are doing what we can to pitch in while at the facility, or remotely for those of us who can’t go to our facilities at the moment. With the stress of our jobs, schools being closed, scavenging for groceries, etc., it’s easy for us to forget about taking care of ourselves or make excuses for why we can’t take care of ourselves right now. We tell ourselves “I’m too tired from my crazy day”; “I have to find something for my kids to do”; “The gyms are all closed”; “If I don’t read all of Mary’s COVID-19 emails right at this moment, I won’t be prepared for tomorrow” (yes, people, it’s sarcasm) … well, STOP IT! Yup, a Bob Newhart reference, and if you don’t know what I’m talking about, check out this clip here. I promise, it’ll brighten your day! https://www.youtube.com/watch?v=Ow0lr63y4Mw

As therapists, we know that exercise is one of the best ways we can take care of ourselves, relieve stress and increase our happy hormones! Just STOP IT, and create 15 to 30 minutes for you and your well-being to do some exercise while at home. Here are samples of some simple, basic routines you can try (a quick Google search will give you an idea of how to do the exercise if you’re not sure):

No Weights … No Problem! Body-Weight Circuit It Is!
Perform each exercise in the circuit for 45 seconds at your own pace, with 15 seconds of rest between each exercise. You can increase progression simply by increasing the number of reps you can perform in the 45 seconds or by increasing your work time/decreasing your rest time.

Routine 1
– Squats (modify by how deep into the squat you go)
– Push-ups (modify by performing on your knees or against a wall/table)
– Walking lunges (modify by how deep you lunge)
– Plank
– Side lunges (modify by how deep you lunge)
– Mountain climbers (modify by how high you bring your knee toward your chest)
– Standing scapular retraction (3-5 second holds)

Routine 2
– Diamond push-ups (modify by performing on your knees or against a wall/table)
– Glute bridges
– Crunches
– Triceps dip on a chair (modify by bending your knees in your start position)
– Single leg Romanian deadlift
– Leg raises
– Door-frame rows (modify by body angle)

Feeling frisky? Perform two to three sets of the circuit with two to three minutes of rest between circuits, or grab some of those cans and bottles you bought from the grocery store and add some weight to the routine! (Pro Tip: You can use HeartMath with quick coherence in-between sets to concentrate and slow your breath, re-clarify and refocus for the next set … I know, MIND BLOWN)

But Wait, I Only Have 5 Minutes to Spare … Perfect, Tabatas Only Take 4 Minutes!
Tabata Training is a form of High Intensity Interval Training (HIIT) that requires 20 seconds of high intensity exercise (going all out!), followed by 10 seconds of rest, for eight rounds. This 4-minute method is a fat-burning, metabolism-boosting, sweat-drenching workout that is the equivalent to doing 20 minutes of normal cardio.
– High knees
– Burpees
– Jumping jacks
– Mountain climbers
– 20 seconds of all-out work, 10 seconds of rest between each exercise, repeat for a total of 8 rounds

Not into these types of exercises? Some other things you can try: March in place while you’re reading that book or watching your favorite show; take a few laps up and down your stairs if you’re in a multi-story home; chase that dog of yours around your home for a few minutes; you get the drift. Also, if you are already part of a local gym/fitness club, check in with them. Many companies are offering their members online home training options. The main thing is, don’t concentrate on what you can’t do anymore because of the restrictions in place, but focus on all of the things we can do, and just keep yourself active!