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By Nicole King MA, CCC-SLP, Julia Temple Health Care Center, Englewood, CO
Use meal times to your advantage! Not only can you check in on your swallowing patients, but it is a great time to address following directions, sequencing, and attention during simple functional tasks — such as adding cream and sugar to their coffee, hand hygiene, cutting up their food, etc.
It is also a great time to address communication and social interactions. The facility is their home. Tasks that might not be functional for your skilled population are functional and meaningful in LTC and memory care neighborhoods — for example, deciding which snack they want, finding their room, participating in activities, and deciding when and where they will eat.

Partner up with Activities or the Chaplain. They can provide the task, but you can provide the skilled eye, environmental modifications, and dynamic cueing that allows the residents to participate in a meaningful and engaged way. Maybe your restless patient needs to be able to come and go from the area, or certain residents shouldn’t sit near each other. It could be the resident needs parallel involvement that allows them to participate but with less environmental stimuli and/or distractions.

Don’t be afraid to “hang out” in the memory care neighborhood. Using a naturalistic approach allows you to see patterns in behavior, identify triggers of agitation, find other patients to evaluate, and get to know the staff better. I also try to do my documentation there because it provides me with more time to observe and engage.

Take credit for what you are doing! Don’t assume that the intervention or strategy is obvious to everyone. Sometimes the smallest change can make all the difference. At JT, we had a patient who played with her food during meals and it upset nearby residents. After assessing her response to her environment over a few meals and analyzing how she engaged with her surroundings and staff, it hit me. She only played with her food on the days her appetite was low. It was her way of letting us know she was full.

Think outside the box and step out of your comfort zone! Let go of the idea that your therapy should look a certain way. Language and communication opportunities are everywhere. Remember it isn’t always about restoring lost skills/function, but changing the environment or how we interact with them, or creating opportunities for them to succeed based on the skills they still have.

Documentation. We all know documentation is important, but with LTC therapy and skilled maintenance, it is crucial. To an outsider, it might look like you just sat next to a patient during an activity. But what you actually did was “facilitated optimal patient participation during preferred leisure task by incorporating dynamic cueing hierarchy, environmental modifications, errorless learning techniques, and spared skills.” Always document the functions or presentations that you assessed in order to know what to do, and exactly how what you saw guided the interventions you selected. The skill lies in the assessment you performed, and how you acted on that assessment.

Goals. The questions I get asked most frequently are related to setting goals. Here are a few of my favorites:

• Patient will demonstrate ability to use verbal and nonverbal communication to make decisions related to preferences during care tasks and daily routine with MOD A to facilitate highest level of independence on nursing unit
• Patient will maintain ability to complete 3-4 conversational exchanges related to direct and observable topics using multisensory stimuli in order to reduce risk of social isolation and decrease in meaningful interactions
• Patient will maintain current level of cognitive communication function to actively participate (following along with handout, switching between tasks, singing along, etc.) in weekly worship service with MIN-MOD A in order to preserve quality of life and highest level of independence with leisure activities of choice
• And finally, remember that being able to support ongoing therapy for maintaining function requires evidence that only you can do what needs to be done. Once the patient’s function looks consistent, or what you need to do changes very little from session to session then it’s time to phase yourself out and hand over those activities to others.

Submitted by Jessica Foster, Therapy Resource, Bandera, Arizona
What are they saying? (**Definition of PA – Physical Activity)
The Message
The connection between physical activity and a lower risk of depression is well-known, but less is understood about the extent to which higher amounts of PA result in lower risks for depression. Researchers who analyzed the results of 15 studies involving more than 190,000 participants believe they’ve come closer to an answer: Yes, there is a dose-response relationship, they write, but it’s most significant (and predictable) at the lower end of the PA spectrum. Overall, they assert, if less-active adults in the studies had met current PA recommendations, one in nine cases of depression could’ve been prevented.

Why It Matters
Authors believe that establishing the dose-response relationship between PA and depression could be an important tool for health care providers and others in sharing the benefits of even modest amounts of PA, “especially to inactive individuals who may perceive the current recommended target as unrealistic,” they write.

More from the Study
Pinpointing the reasons for PA’s effects on depression were outside the scope of the study, but authors speculate that they could include neuro-endocrine and inflammatory responses, improved physical self-perceptions and more social interactions, and the effects of greater time spent in green spaces. The interplay of these factors needs more study, they add, particularly when considering how individuals with less access to green spaces and greater exposure to noise pollution may experience reduced mental health benefits.

Keep in Mind …
The study is not without its limitations, according to authors. Among them: PA levels were self-reported, data was limited at higher levels of PA, and data was lacking for analysis of demographic subgroups, including those from lower- and middle-income countries.

Submitted by Kari Rhodes, MS, CCC-SLP, Therapy Resource, Keystone West Texas
When the fog lifted from our initial COVID outbreaks in 2020, we breathed a sigh of collective relief. Vaccines were coming, cases were dropping, and visitations were resuming. We thought the worst was over. Small outbreaks here and there were managed, and PPE was easier to find.

Little did we know that the Omicron variant was going to wreak the havoc that it has on our facilities. As we ended 2021 and entered 2022, outbreaks were looming large yet again, affecting residents and more staff than ever before. As we have seen staffing shortages in nursing, we are seeing the effects of unprecedented therapist shortages. As we struggle to find a balance to avoid burnout and meet the needs of our ladies and gentlemen, the Keystone Therapy Markets have worked hard to get tougher!

At a small gathering of Keystone Therapy Resources in San Antonio in December, we talked openly about how we can best support each other in times of need. There were honest conversations about asking for help, text threads with motivating statements, and a lot of loving competition between the recently separated markets. In times of high levels of burnout, it often seems like a contraindication to challenge each other. However, the extra challenges put forth between us and a healthy amount of friendly competition work well to spur us on to do better work for each other, our teams, and our residents. Additionally, the open level of communication allows each member of the team to feel heard and supported, a necessary component of forging onward through the crises at hand. These methods of support then trickle out to our clinical resources, our market leads, and our floor staff.

As we tell the family members of our residents frequently, you cannot care for someone else if you are not caring for yourself! Taking time to rest and surrounding yourself with others who support you are essential for being essential personnel. When times in Keystone are tough, we are tougher because we are better together!

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.