News

Being a Director of Rehabilitation at an Ensign-affiliated facility is a unique and rewarding experience. Our organization is not bogged down with layers of middle management and corporate red tape. Instead, our therapy leaders have the freedom to make choices based on what is best for their patients as well as their therapy and facility teams. This freedom is paired with exceptional support from our Therapy Resources and Service Center team. One of the rewards for our therapy leaders is our annual DOR meeting, an event usually held in Southern CA just steps away from the beautiful beaches. We are fortunate to have amazing speakers with thought provoking presentations, great food, and lots of goofy fun with a team of great people who really enjoy each other.

We currently have leadership opportunities in the following locations: Victoria, TX and Clarion, IA. For details please click on the links above or contact Jamie Funk at (877) 595-0509 or e-mail jfunk@ensignservices.net.

Click here for more information about the PT job opening in Ukiah and to apply online, or contact Jamie Funk, 877-595-0509, jfunk@ensigngroup.net

As one of our busiest home health operations, Puget Sound Home Health is actively recruiting for therapy professionals to treat in homes throughout a 30 mile radius of Tacoma. Enjoy a flexible but stable work schedule, a great team of nursing and therapy clinicians to work with, great hourly pay and full benefits at 32 hours/week.

To learn more, click on a discipline that interests you: OT and PT

The PulseCare Medical Closed Pulse Irrigation™ system was founded by Dr. Patrick Marasco, an American Board Certified physician specializing in wound cleaning and care and reconstructive plastic surgery. The result is a unique Closed Pulse Lavage/Closed Pulse Irrigation™ system that allows patients to receive wound care by physical therapists at bedside. The system includes products that enable wounds to be safely sealed and isolated while they are irrigated by trained clinicians. PulseCare has been proven to reduce bacteria (biofilm) from the surface of wounds by 86.9 percent. PulseCare products eliminate the possibility of contamination through aerosolization and splash back, and they enable all byproducts of wound irrigation to be safely collected and disposed.

Advantages of using PulseCare as part of the wound care program:

• Removes necrotic tissue and slough
• Reduces biofilm by 86.9 percent with each treatment
  • No other wound treatment can selectively debride, cleanse and remove bacterial biofilm with the same level of efficiency and safety.
  • Biofilm can regenerate within 48 hours. This procedure is an essential selective debridement for removal of biofilm that sharp debridement cannot combat.
• Portable — can be used in skilled nursing facilities without risk of contamination
• Safe — eliminates aerosolization and splash back
• Cost-effective — eliminates cost and time of operating room debridement, because PulseCare can be safely administered at bedside
• Uses physical methods to eliminate biofilms (MRSA, PS, MDR-AC) without harming normal tissues
• Can be used to eliminate biofilm in conjunction with Negative Pressure Dressings (Wound Vac^TM and Blue Sky^TM), Hyperbaric Oxygen Treatments
• Well-tolerated with minimal discomfort during treatment
• Daily treatments by a physical therapist for enhanced wound bed preparation

A variety of patients can benefit from this wound intervention, including but not limited to patients with acute or chronic (non-healing) open wounds (surgical, vascular and pressure); patients with contaminated or infected wounds, including: MRSA (Methacillin Resistant Staph Aureus) and MDRB (Multi-Drug Resistant Bacteria).

Find demonstration videos and product information at http://www.pulsecaremedical.com/.

James Anderson is a physical therapist for Horizon Home Health & Hospice, and he brings to us a wealth of knowledge and experience in postural restoration. In his former practice at ProActive Physical Therapy in Burley, Idaho, one of the first clinics in the country to be designated a Postural Restoration Certified Center, James attained clinical excellence in the nonsurgical treatment of back, hip, knee, shoulder and neck pain. Through a combination of extensive continuing education and collaborative research, James has become an authority on postural restoration and now teaches national courses for the Postural Restoration Institute®.

Over the years, James has provided course instruction and consultation to thousands of physicians, physical therapists, athletic trainers and strength and conditioning professionals nationwide. His expertise with biomechanics has led to invitations to serve as a sports performance consultant for a wide variety of collegiate and professional athletic organizations. These include regular consultation with athletes, trainers, and strength and conditioning professionals in the PGA, MLB, NFL, MLS, WNBA, UFC and several NCAA Division I men’s and women’s collegiate athletic programs. James’ passion for educating students, clinicians and other medical professionals has led to appointments as clinical instructor for several graduate programs and guest lecturer for a wide variety of local, regional and national events.

James received his Master’s Degree in Physical Therapy from the University of Nebraska Medical Center in Omaha in 1998. He completed his undergraduate studies at the University of Nevada Las Vegas, where he majored in kinesiology. He has been a faculty member for the Postural Restoration Institute for the past eight years.

James was a member of the first class to earn the designation of Postural Restoration Certified (PRC) as a result of advanced training, extraordinary interest and devotion to the science of postural adaptations, asymmetrical patterns, and the influence of polyarticular chains of muscles on the human body as defined by the Postural Restoration Institute®. We are pleased to welcome James to the Ensign family!

A Word on Postural Restoration

Postural restoration recognizes the unique asymmetry of the human body, whose intricate neurological, respiratory, circulatory, muscular and ocular systems differ on each side of the body. It is these differences, in fact, that work to balance the body — for instance, the torso is balanced with a liver on the right and a heart on the left.

Through exercise programs, therapists such as James who are trained in postural restoration are able to identify and correct imbalances that may result from the dominant overuse of one side of the body and the resultant system overuse on the other. These therapists also understand how the two hemispheres of the brain affect the balance of the body and incorporate reciprocal function to balance muscle activity around the sacrum (pelvis), the sternum (thorax) and the sphenoid (middle of the head).

To learn more about postural restoration, please visit http://www.posturalrestoration.com/.

On July 10^th CMS hosted a National Provider Call that focused on the goal of improving dementia care in nursing homes. This National Partnership is focused on care that is person-centered, comprehensive, and interdisciplinary. During the call, care approaches that are person-centered and individualized were highlighted, and facility systems and tools to enhance care were discussed.

Shari Ling, Deputy Chief Medical Officer at CMS, stated that the partnership promotes the 3 “R”s to providing quality dementia care:

Rethink – rethink our approaches to dementia care

Reconnect – reconnect with people using person-centered care approaches

Restore – restore good health and quality of life in nursing homes across the country

CMS will measure our success in making these critical changes during our survey process, and by measuring our use of psychotropic medications in persons with dementia. Dementia care and psychotropic use is sure to be a focus for our annual surveys as our industry raised the bar to provide a higher quality of care for this fragile population.

During this inspiring National Provider Call, Dr. Laura Gitlin, a researcher at John Hopkins University and the Director of the Center for Innovative Care on Aging, presented findings on the use of an OT driven treatment intervention called a Tailored Activity Program (TAP). Recent research has shown that the Tailored Activity Program was effective in reducing behavioral symptoms in persons with dementia. The process is very similar to what we have put into place in some of our facilities using our integrated cognitive care approaches. In the next edition of the Flag POST, we will be sharing how some of these integrated care programs are coming to life in our facilities as we work with our clinical partners to individualize the programs for each facility.

Can a pet improve the quality of life for a human? Those of us who own pets know they make us happy. But growing scientific research is showing that our pets can also make us healthy, or healthier. That helps explain the increasing use of animals — dogs and cats mostly, but also birds, fish and even horses — in settings ranging from hospitals to nursing homes.

Nursing homes were one of the first settings to graciously open their doors to the concept of pet therapy, which was developed by Therapy Dogs International (TDI) more than 30 years ago. Today, therapy dogs and cats are registered from all types of breeds, and many are rescue animals. In 2012, there were roughly 25,000 therapy dogs registered. All therapy dogs and handlers are volunteers and are located in all 50 states. The typical therapy dog is at least 1 year of age, and each dog must pass a temperament evaluation and demonstrate appropriate behavior around people with the use of some type of service equipment (e.g., wheelchairs or crutches) in order to become a therapy dog.

It is profoundly moving to see how dogs and cats have the ability to help calm and soothe agitated individuals while lifting the spirits of those who are sad and lonely. They provide a medium for physical touch and display unconditional affection for those who may live isolated lives. Therapy pets elicit responses from some nursing home patients who are typically withdrawn and limited in their abilities. Stroking the back of a dog leads to more movement from the patient and, consequently, increased physical activity. The introduction of dogs and cats increases interaction among individuals and promotes a positive change in self-esteem.

Over the last several decades, multiple studies have measured aspects of human interactions with pets (Katcher, Friedman, Goodman & Goodman, 1998; Millot & Filatre, 1986; Stallones, Marx, & Johnson 1990) and demonstrated validity and reliability. Evidence suggests that pets may enhance self-esteem in patients/people and may assist them in socializing with one another (Zimmer, 1996). Several studies report positive social behavior changes after introducing an animal into the nursing home environment or hospital. The Australian Joint Advisory Committee on Pets in Society conducted a six-month study of the interaction of 60 nursing home residents with a dog. Using pre- and post-test questionnaires, they found positive behavior changes in interest and conversation and an increase in participation in activities of daily living (Salmon, Hogarth-Scott & Lavelle, 1982).

Studies show that pets can aid in relaxation, lower one’s blood pressure, promote healing and prolong life. With the addition of a well-trained handler/health-care worker, the mere presence of a dog may facilitate therapeutic intervention with the non-communicative patient, assist in recall of memories and help sequence temporal events in patients with head injuries or chronic degenerative diseases of the brain such as Alzheimer’s disease, as well as teach appropriate behavior patterns to those with emotional disabilities (Brickel, 1991). According to the National Institutes of Health, among older people, the ownership of pets does not help the general illness status but does act in combating depression. Pet therapy has had a more positive response in nursing homes in comparison to arts and crafts or visitors coming in for the day. Indeed, visits with therapy pets encourage reminiscence and social interaction and result in stress relief and incidental physiotherapy (Island, 1996).

Furthermore, Lynch, Thomas and Weir (1993) examined marked physiological responses in patients who had a dog to pet. The heart rate of a patient with dementia decreased by five beats per minute when he was introduced to a dog and was allowed to pet him. Even managed care organizations are studying the idea of price breaks for pet owners. In a prospective yearlong study of 938 Medicare Advantage enrollees, beneficial effects of pet ownership on the general health of senior citizens were suggested (Siegel, 1990). Improvements in the quality of life in nursing homes have been suggested by a survey of the effectiveness of a pet therapy program with monthly visits to nursing homes in Florida. Commonly reported effects of the visits included shared experiences among residents and greater socialization among residents, and it gave them something to anticipate. A pet therapy program appeared to improve the quality of life for some residents (Yates, 1987).

The scientific evidence is plentiful that pet therapy is a great adjunct to improve the quality of life of older adults. It may not be possible to have a therapy dog or cat that lives at every facility, but it might be possible to have a therapy dog visit your facility periodically. Luckily, Therapy Dogs International (TDI) has 25,000 U.S. dog/handler teams whose purpose is to provide comfort and fulfill this need of therapy pets for each facility. A visit by a therapy dog/handler is absolutely free, and TDI will work with an individual facility to identify the best days and times for visits. TDI also provides liability and accident insurance to its volunteer teams. The teams have been carefully tested by qualified evaluators to ensure the well-being of those being visited, and all dog records are reviewed continuously and updated as recommended by the American Animal Hospital Association.

To request a TDI dog/handler team visit, send a request on facility letterhead with information about the facility and the type of visits you are seeking. Include a contact name and number. Fax to (973) 252-7171. Therapy Dogs International , 88 Bartley Road, Flanders, NJ 07836, Phone: (973) 252-9800, Email: tdi@gti.net, website: www.tdi-dog.org

By Jon Anderson, PT, Keystone Therapy Resource

Congratulations, Alta Vista Rehabilitation and Healthcare Center, on recently being published in the Winter 2012–13 • Vol. 36 .No. 4 issue of Journal of the American Society on Aging!

The article highlights the Alta Project at Alta Vista’s facility in Brownsville, Texas. Led by Medical Director Dr. Lorenzo Pelly, the project focuses on patient accountability and delivering the highest-quality care before, during and after a patient’s admission. Dr. Pelly continually works with and trains staff to enable them to exceed standard care practices, using the following program goals as a guide toward delivering exceptional care:

• Improve resident care
• Reduce the number of rehospitalizations related to errors by 20 percent in less than two years
• Reduce miscommunication at all levels of the care process
• Improve healthcare professionals’ decision making through staff education and checklists
• Increase understanding of criteria for admissions to the nursing home from the hospital
• Avoid futile care (that which does not improve the illness or quality of life)
• Promote awareness of highly detailed screening and the cross-referencing network for each resident

With the introduction of the new tools and processes below, the Alta Project offers an industry benchmark through which facilities nationwide can enhance their patients’ care.

Resident Admission Checklist

This checklist, completed by two nurses, reminds the nursing staff to place the new resident close to the nurse’s station and ensures the complete transfer of vital clinical information for each resident. The extra checks and balances enable staff members to obtain all of the information required to prevent rehospitalizations, while also allowing for a seamless transition for the patient from acute care into the facility.

Alta Individual Care Plan

This plan, tailored for each resident, offers complete instructions on the short- and long-term needs of residents, including a detailed analysis of medications, special needs, and timelines for treatment and improvement.

Alta Prevention Cart

This mobile cart is stocked with all of the essential medications and equipment needed to intervene in the event of a medical crisis, such as C-paps, B-pap technology, emergency box with IVs, antibiotics and fluids. By facilitating treatment at the Alta Vista facility, the cart helps to prevent patient rehospitalizations.

The Hospital Re-Admission Log

With this tool, the nursing staff and medical director can instantly identify residents who are most at risk for returning to the hospital in 30 days. It incorporates a tracking log spreadsheet that charts patients from high-risk to manageable status within 30 days.

The Resident Discharge Checklist

This innovative checklist includes a traditional medication reconciliation list and “tracker” designed to assist residents and their families in understanding the care requirements upon patient discharge. The document describes the patient’s common clinical conditions, symptoms and signs to watch for as well as special medical equipment in use. In addition, it provides caregivers with pre- and post-tests that enable caregivers to understand fully the expected level of care for their loved ones.

Alta DOT System

As a complement to the other systems, the DOT System consists of large colored dots placed outside a resident’s room that visually define his or her condition or need for special observation.

Through the Alta Project, residents are offered uninterrupted care as they move from one institution to another — whether from acute care into Alta Vista or from Alta Vista to home or hospice care. All staff members, including certified nursing assistants, nurses, dieticians and pharmacists, are equipped with the education and resources they need to provide seamless transitions — as well ongoing quality care throughout each resident’s stay.