Moment of Truth: Truly Demonstrating Our Amazing People

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Submitted by Devin Bodily, PT, Cedar Health & Rehabilitation, Cedar City, Utah

During the month of August, Cedar City received a large amount of rain within a very short span of time, including over 6 inches during a 24-hour period in the mountains above town. A frightening amount of muddy water, logs and boulders came crashing down Coal Creek, out of the canyon, and right through town. This eventually clogged a main floodwater-diverting channel, which caused the water to rush into, and overflow, the canal in the western part of town. Many homes were flooded and surrounded by several inches of water and mud without warning.

Our Director of Nursing, Trent Nielsen, has a home in this area and had been keeping tabs on how the flooding was going throughout the morning. To complicate matters, Cedar Health and Rehabilitation was undergoing state survey, which made it difficult for Trent to adequately prepare for any flooding at his home.

Just before noon, Trent was made aware that the water had crossed the road and was quickly traveling across the field toward his house. Without knowing how much time there was to spare, Devin Bodily, PT; Jake Holm, OT; and Braden Wiscombe, AIT, quickly rearranged their schedules and left to help Trent and his family. They were able to quickly obtain sandbags and shovels to create a wall to divert the floodwaters from reaching Trent’s home. If they had arrived minutes later, Trent’s home would have been flooded and permanently damaged.

They stayed for several hours into the evening to help maintain the wall. Community members eventually came along with skid steer loaders and mini excavators to build a dam and divert the water around the neighborhood. Ty Liston, COTA, and Eric Brown, Director of Maintenance, joined later in the evening and late into the night to help with the efforts of having an adequate water pumping system in his backyard. Having these pumps in place was instrumental to saving his home as heavy rains returned that night and broke the dam, pushing floodwaters within inches of Trent’s home before they finally subsided.

The effort to save Trent’s home was bolstered by the many facility staff members, regional nursing resources, and Executive Director, Spencer Eaton, who helped fill in for Trent’s duties during the state survey process so he could focus on saving his home through the night and into the next day.

The response to help Trent and his family was automatic as several employees demonstrated the core values of “Love One Another” and “Customer Second.”

Golden Acres Outpatient at ABBA Healthcare

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By Cara Koepsel, M.S. CCC-SLP, DOR/CTO, Golden Acres Living and Rehabilitation, Dallas, TX
Golden Acres began a partnership with this ALF at the beginning of March 2021. It all started with a cold call from the DOR to the facility, in which the administrator agreed to a Webex with her team and me. I was able to really sell the services of what my team has to offer and show why a partnership would benefit their facility.

We started day one with two screens that turned into PT/OT/ST evaluations. Pictured is my team that accompanied me on day one! We came prepared to be flexible and assess as many patients as they wanted. I sat on the couch in their dining room and communicated with my BOM to run payer sources, check for home health, find primary MD to obtain orders, etc. These items were certainly a barrier, but all things that, with patience and persistence, we were able to work through.

Since day one, we have established six to seven patients on caseload for all three disciplines, and we visit the facility with a team that is there all day to treat these patients three days a week. We are a part of their daily routine, and they absolutely love our presence there. Also pictured is our group therapy we have initiated with the patients as well, which they love! Currently, we are working on partnering with this ALF to host an event at their facility to assist them in building their census after COVID. They are pleased to be able to tell prospective families and patients that Golden Acres’ rehab team will be a part of their loved one’s stay at their facility and their potential new home.

There may be hiccups and barriers as you start these partnerships, but once you get in the door and show these facilities what your team is capable of, I guarantee you they will want to partner with you for life! Keep pushing that flywheel even when it seems tough, because an ALF partnership is so worth it.

Abilities Care Approach for a Win-Win

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By Tiffany Bishop, Therapy Resource, Keystone North, TX
For those of us in the therapy world, we all know the value that the Abilities Care Approach can bring to our residents in the form of increased independence, decreased behaviors, and increased ability to function in the environment. Just this past week, our most recent Therapy Experts in the Abilities Care Holistic Approach (TEACHA) team had a brief check-in call. One of the items we identified as a potential for growth is partnering better with our clinical partners to integrate our ACA programming throughout residents’ whole intervention plan.

In a time when our partners are already stretched thin, we identified the need for making any recommendations for our clinical teams more manageable to follow. There were several suggestions that were shared, and Elyse Matson is leading the charge to collect any more that have been effective and putting those ideas in an easy-t- distribute format. Below are some of the tips and tricks that were identified during our call.

● Make sure that we are working around their schedules when training
● Include these caregivers in the process of developing and implementing any adaptive strategies/tools so they can provide input along the way and have ownership in the intervention
● Empower our frontline partners as caregivers to be able to follow through with the day-to-day implementation of any interventions
● Be specific
● Be frugal in our expectations
● Be strategic in when/how we train; consider utilizing Skills Fairs to train common interventions
● Identify and stress how any intervention can be a win for them; how will it decrease their daily burden?

Stay tuned for more details to come from the Long Term Care Think Tank, and if you have any ideas that have worked well in your facility, please reach out to Elyse Matson.

Student Interns Share Transfer Reference Guide

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Submitted by Gary Pearson, OT/DOR, Pointe Meadows, Lehi, UT
Here at Pointe Meadows, we had some wonderful students this past summer, including three physical therapy students from the University of St. Augustine. The students are Zachary Dreyer, Austin Jenson and Antonino Russo. In collaboration with these three students we made a Transfer Reference Guide, which is an easy-to-follow pamphlet with hints and tips on multiple techniques for transfers and other precautions related to weight-bearing and gait belt use. Also included are QR codes with links to videos on specific transfer techniques and bed mobility.

Quick Reference Transfer GuideDownload

As DOR, I have incorporated this pamphlet into my portion of new-hire orientation utilizing the information to guide my transfer training for all new employees with the onboarding process. It has also been presented at two all-staff meetings and a nursing/CNA specific training.

As we are working hard on retention and showing our wonderful staff support in these hard times, our therapy department is attempting to provide expertise in training to all staff in our building. We are trying to support our clinical partners in any way possible and have had good feedback from staff on improved confidence and understanding with the process of transfers throughout our building.

Please let me know if you have any questions or would like more information. I feel this is a way our therapy teams can support our nursing and CNA partners in our buildings.

Teaming Up in Supporting Our Nurses

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By Hannah Allen, SLP, St. Joseph’s Villa, Salt Lake City, UT
The Milestone Market SLPs get together for an SLP call once a month to share clinical ideas. During our last call, I was able to lead a discussion about considerations to include in our clinical thinking process when we recommend alternative forms of medication administration due to dysphagia. My husband is a clinical pharmacist who works in the ICU setting and is often involved in determining appropriate adjustments made to medications when patients are not able to take them orally, or not able to take them whole with liquid. He was able to share some great information that can be very helpful in our SLPs teaming up with and supporting Nursing with medication administration.

For example, we discussed how recommendations for crushed medications, or medications taken in any alternative forms, may be affecting the efficacy of the patient’s medication management if appropriate adjustments are not made by a pharmacist. Many medications are OK to be crushed, but some are not. If we crush them, this may make the Therapy of the medications ineffective or less effective. In some cases (such as in the case of seizure medications), we may also have the potential to cause harm. In other cases (such as Parkinson’s medications), we may be making their medications ineffective or less effective, which may decrease the actual therapeutic benefit they get from any of their PT/OT/SLP interventions.

The best option is to make sure we (or someone) is consulting the pharmacist to ensure medications are compatible with crushing. If they are not, a pharmacist may have suggestions on adjustments or changes to medications that will facilitate the safest form of delivery while maintaining medication efficacy. Some of us may have something like this in place in our facilities already, but some of us may not. This may be a process to build into our practice and the procedures of our facilities as we recommend alternative medication administration methods for our patients with dysphagia.

Below are some of the resources that were shared:
Podcast Episode: Swallow Your Pride Episode 173 — Crushing Meds: What’s an SLP to Do?
http://file.lacounty.gov/SDSInter/dmh/1042766_MedicationsDoNotCrushList.pdf
ISMP Do Not Crush List:
http://file.lacounty.gov/SDSInter/dmh/1042766_MedicationsDoNotCrushList.pdf
Blog Post by Karen Sheffler all about Pill Dysphagia
https://swallowstudy.com/trouble-swallowing-pills-what-to-do-for-pill-dysphagia/
Attached items:
-Article on effects of thickened liquids and puree on medication absorption

21020-Article Text-54199-1-10-20140505 – CopyDownload


-PILL-5 Questionnaire, a patient-reported outcome measure; may be a good measure to utilize when we get consulted specifically for patients struggling with medications.

PILL-5-Screening-QuestionaireDownload


-Show Notes for the Podcast episode with many of the same resources and a quick rundown of the episode in written form

173 – Swallow Your Pride Podcast Notes – CopyDownload

Community Outreach Efforts at Eastview

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Submitted by Sunny Chahal, PT/DOR, Eastview Healthcare and Rehabilitation, Houston, TX
Sanikqu Maire became our Interim DON in March 2021. She had gained experience in our sister facility at Legend Oaks Northwest as an ADON prior to stepping into a DOR role at Eastview. Late in May, she transitioned from an LVN to an RN and stepped into the DON position on a full-time basis. With little experience at the building or as a DON, she helped lead the building through our annual state survey in April2021 with only two minor deficiencies. With the state survey and MSCA completed, the big 5 at our building decided on some initiatives and goals for the building for the rest of the year. One thing that Sanikqa really pushed was to get our facility name and face more visible in our community.

Since March 2020, due to the COVID pandemic, our building had been largely in lockdown and restricted for visitation from resident families and the surrounding community. In 2021, we wanted to get out and reestablish and develop our ties into the surrounding East Houston area. In addition, one of our goals for 2021 was to develop an outpatient program where we could follow our discharged skilled residents and also look to develop relationships with assisted living facilities (ALFs) and independent living facilities (ILFs) where we could partner up and offer our services to the residents.

We have targeted three large ILFs within a 5-mile radius of the building, and have already set up and completed health fairs at two of those three facilities. At the career fair, we have representatives from the Admission/Marketing, Dietary/Nutritionist, Nursing, and Therapy present at separate booths. For two hours, residents from the facilities go booth to booth to perform screens and receive education.

At the dietary and nutritionist booth, the residents were educated on proper foods to eat and other preventative health tips. Next they would go to the Nursing section and get their blood pressure and O2 saturation readings. After that, they would go to the Therapy booth, where they would get their height/weight and BMI calculated. They would also do a single limb stance test and test their grip strength. They would be educated about our new mobile outpatient program and screens performed.

It was a success, as we obtained four to five therapy referrals from each career fair we completed. We have since gone on to exponentially grow our outpatient program over the past three months. Sanikqa’s energy and vision for community outreach and willingness to partner with Therapy and other departments in the building has been very instrumental to the success of our mobile outpatient program.

Therapy and Nursing Work Together to Prepare for COVID Outbreaks

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By Dominic DeLaquil, PT, Therapy Resource Pennant – Idaho/Nevada
Just a couple of months ago, you could almost hear the collective sigh of relief as we were looking forward to a return to a more normal routine in our facilities. 2020 was a difficult year, as we were constantly pivoting to adapt to changing protocols in each building as outbreaks occurred, settled down, then surged again. The beginning of summer 2021 was bright with promise, most of our residents had been vaccinated, COVID case rates were dropping, and hope was in the air. Then the Delta variant showed up.

As one DOR in Idaho said, “As much as I’d like to bury my head in the sand about it, it does make sense to start preparing now.” So the Infinity and Lady Luck clusters in Idaho/Nevada asked the market Infection Prevention nurse, Clinical Resource Kristin Mumford, to join their next DOR call. The DORs and Kristin had a robust conversation, discussing topics such as how to manage therapist movements in a building, the importance of therapy to the psychosocial and physical well-being of residents when they have to stay in their rooms, the value of Therapy helping out our Nursing partners throughout the building in various “non-therapy” ways when extra help is needed on the floor, and other topics.

The conversation was an important early step to prepare for the worst, while we hope for the best. The conversation was productive for nursing and therapy, and the DORs left the call with agreements to their cluster partner DORs to each set up meetings with their DONs and EDs to discuss the plans in their buildings and how Therapy can help Nursing, serve the residents, and partner to ensure the best infection prevention protocols.

Responsibly Responding to the Needs of our Community

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By Paul Emerson L. Baloy OTD, OTR/L, DOR, The Hills Post Acute, Santa Ana, CA
Angie Reyes, RN and DON at The Hills Post-Acute recently shared this with our team: “A lot of hospitals are reaching out and asking for us to help the community. This is a challenging decision and yet a great opportunity for us to do what we do best — for most of us, this is the epitome, this is the WHY we work in a healthcare field…we have a chance to dignify long-term healthcare in the eyes of the world. But this time, we are equipped with more knowledge and experience on how to deal with this COVID situation. Rest assured that I will be in this together with you all, and we will do our best to ensure that our residents, families, and staff are safe.”

Angelica “Angie” Reyes has responsibly responded to needs of our community. With the increasing occupancy of positive COVID-19 infection in our acute hospitals, The Hills Post Acute management team has collaborated with our local department of public health officials to open up a Heroes’ Zone to alleviate our hospital partners and provide continued comprehensive care to those affected by the pandemic. Angie partnered with Maria Navarro, community liaison, and closely coordinated with the following individuals to ensure that all the critical components are in place to provide optimal care delivery to the vulnerable members of our community:

● Arlene Mendoza, LVN, Infection Perfectionist Nurse
● Ana Huante, LVN, Director of Staff Development
● Noemi Tinajero, RN, MDS coordinator
● Maria Pulido, AIT
● Willmer Fernandez, Central Supply Director
● Martha Torres Magallon, Director of Activities
● Eunice Rosado, Medical Records Director
● Robyn Caleb, LVN, Director of Case Management
● Amado Miguel, Maintenance Director
● Kritsana Liamkrajang, Business Office Manager
● Chris Smit, Social Services Director
● Issela Gonzalez, Human Resource Manager
● Edgardo Lopez, Dietary Supervisor
● Jose Fajardo, Admissions Coordinator
● Darren Bake, NHA, Facility Administrator

“When what you are deeply passionate about, what you can be best in the world at and what drives your economic engine come together, not only does your work move toward greatness, but so does your life. For, in the end, it is impossible to have a great life unless it is a meaningful life. And it is very difficult to have a meaningful life without meaningful work. Perhaps, then, you might gain that rare tranquility that comes from knowing that you’ve had a hand in creating something of intrinsic excellence that makes a contribution. Indeed, you might even gain that deepest of all satisfactions: knowing that your short time here on this earth has been well spent, and that it mattered.” Jim Collins, Good to Great

Celebrating Deanna Rodriguez, DON

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Submitted by Kai Williams, Therapy Resource, Keystone East, TX
We love our nurses! They bring so much clinical strength and leadership to our market! We see them tirelessly tending to the needs of patients, providing updates to family members, providing oversight/guidance to their CNAs … the list goes on and on. We wanted to take the opportunity to introduce you to Deanna Rodriguez. Although her cape is invisible, she wears it with such grace and humility.

The clinical journey for Deanna did not happen overnight! She began as a LVN in 2002 and she received her RN in 2010. She found a passion in leadership and developing leaders and became a DON in 2012. She has built her experience throughout the year, and we are so privileged to have her on our team. She currently serves as the DON at the Courtyard. She came in with such a fun and energetic spirit and quickly implemented several clinical systems that have produced extremely positive results at the facility. When COVID entered the facility last year, she was such a rock and solid support to those that she encountered. What is most noticeable is that she extends her support beyond her facility. She is a familiar face in several of her cluster facilities. She takes the time to assist with other facilities’ EMPR, UDAs and Risk Management. She has become a true owner of this process and loves celebrating and empowering accountability.

Take a look at this picture below. Deanna was getting ready to head over to a sister facility to provide support, and her team just couldn’t bear to have her leave. It was a great shot that captured some of her Nursing team, having a little fun, holding her “hostage.”

Recently, Deanna voluntarily stepped up to take the interim DON position at one of her cluster facilities due to the departure of the previous DON. The facility needed clinical leadership, and she stepped up! She has been able to successfully take that facility through full book and a few state pop-up visits. With the support of her partners, she helped them to open their COVID unit, and they have safely accepted patients from other sister facilities as well as the hospital. Deanna has put such a wonderful level of investment into her ADON and nurse partners in her local facility that she is able to physically step away without any clinical disruption occurring. s
Thank you, Deanna, for all you continue to do!

Nhu De Vera, Clinical Systems Resource, Caught on WebEx Camera!

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By Deb Bielek, Therapy Resource
It’s been an interesting year as we are all well aware. Because of a significant reduction in travel, in-person meetings have been greatly reduced, with the majority of our meetings being held through Webex, resulting in only one or two opportunities to hug this lady in the past 12 months. I am truly grateful for the virtual meetings where I can see her smiling face and spend time learning and growing from her clinical wisdom. I feel blessed to have an amazing clinical partner, COO Nhu DeVera.


The majority of our work together this year has centered on our Excellence in Programming & Interdisciplinary Care (EPIC) initiative and many additional side-projects, which have spiraled out of a focus on clinical quality initiatives. Not only does Nhu bring a field-driven brilliance and clinical wisdom to our projects, butu she is the definition of a true partner and service-based leader. I originally met Nhu in person in 2018 when Marivic Uychiat, Director of Clinical Services, asked her to join the Service Center team as the Clinical Systems Resource. We served on the Service Center IDT committee together. Nhu helped develop and provide the trainings to support the transitions to PDPM and the new CMS RoPs (Requirements of Participation), which rolled out in 2019. Prior to her current role, Nhu served as the clinical leader alongside Rich Jorgensen and Therapy leader Daisy Aranguren, DOR and Therapy Resource. Thank you for all that you do to make all of us better, Nhu. #Grateful #AmazingCLINCALpartner #NhuROCKS