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By Angela Ambrose, Contributing Writer

When you’re tired of doing the same old exercise routine, it’s easy to make excuses and skip workouts. Only 23 percent of adults meet the 2018 Physical Activity Guidelines set forth by the U.S Department of Health and Human Services. They strongly recommend:

• At least 150 to 300 minutes of moderate aerobic activity or 75-150 minutes of vigorous-intensity aerobic activity weekly
• Strength training of all major muscle groups two or more days per week
• Stretching and mindfulness activities such as yoga, tai chi or qigong
• Balance training to prevent falls

Adding more variety to your workouts can help you meet all of these important exercise guidelines each week. Not only will you find more enjoyment, but you will also be more likely to exercise longer and more consistently. Spice up your exercise routine by trying two or three of the following options:

1. Find a workout buddy — After a long, exhausting day at work, a supportive friend can give you that little nudge you need to get off the couch and get moving. Because you will need to coordinate schedules with your partner, your exercise time will be plugged in to your calendar ahead of time, making it a higher priority. Doing an aerobic workout with a motivating partner has the potential to double your performance, according to a study by the Society of Behavioral Medicine.

2. Try a group fitness class — Even if you’re exercising in a crowded gym, you can still feel lost and lonely if you’re climbing on the stair stepper in a dark corner or lifting weights by yourself. Most health clubs offer group fitness classes taught by nationally certified instructors. The group energy is contagious and can help you push through an especially challenging workout. From barbell and kickboxing to dance and yoga classes, you’ll find a wide range of options to build aerobic endurance, muscular strength and flexibility.

3. Get outdoors — Numerous studies show that exercising in the fresh air and sunshine elevates your mood, reduces tension and motivates you to work out longer and harder than exercising inside.

4. Join a team sport — When you were a kid, you never worried about counting steps or calories. You played catch, kickball or Frisbee simply because you enjoyed being with friends. Make exercise fun again by joining a recreational sports league such as softball, soccer or basketball or by taking up tennis or racquetball. Team sports are particularly beneficial because they create social connections and friendly competition. A study published in Mayo Clinic Proceedings shows that participating in partner and team sports is associated with longer lifespans than exercising alone because they combine the benefits of physical activity with stimulating social interaction.

5. Break it up into smaller portions —“I just don’t have time.” This is the No. 1 excuse for not (Insert Photo 5) working out regularly. Research shows that “exercise snacking” — engaging in small “snack-sized” portions of exercise throughout the day — can be an effective way to increase your physical activity, especially on days when your schedule is jam-packed. Taking the stairs instead of the elevator or walking to the corner restaurant for lunch all count as exercise. Too tired to hit the gym after work? Have an exercise “snack” of push-ups or sit-ups before dinner, instead of that plate of nachos.

6. Listen to upbeat, motivating music — When you listen to fast tempo music with a strong beat, your body naturally wants to follow the rhythm of the music. Energizing music can distract you from discomfort, increase your exercise intensity and increase your endurance as much as 15 percent, according to Costas Karageorghis, Ph.D., a leading expert on exercise and music research. Select music with the tempo or beats-per-minute (bpm) that correspond with the exercise you’re doing. The song’s bpm should mirror your target heart rate, according to the American Council on Exercise. (See chart for recommendations.)

7. Set SMART goals — Setting goals can help keep you motivated, but they work best when they’re clearly defined. For example, if your goal is to lose weight or build more upper body strength, use the SMART guidelines to make it specific, measurable, attainable, realistic and set within a defined time frame. Having trouble coming up with a motivating fitness goal? Sign up with a friend for a community walk, run or bike ride to support a charitable cause.

 

8. Track your progress — Download a free mobile fitness app to record your exercise progress, and wear a fitness tracking device such as a Fitbit or Apple watch to get instant feedback. Wearable technology may motivate you to increase your physical activity and serve as a daily reminder to keep moving.

9. Build up intensity slowly — If you’ve been sedentary for a while, gradually increase the exercise intensity and time you spend working out. Start with exercises like brisk walking, swimming or leisurely biking that pose minimal risk of injury. Enlist the help of a personal trainer, if you would like more guidance and a customized workout plan.

Variety adds more excitement and challenge to your exercise routine. If you’re having fun in your workouts, you’re more likely to log extra steps, burn more calories and go well beyond the U.S. Physical Activity recommendations, as well as your own personal fitness goals.

WELL Challenge! Share your own stories about how you’re adding variety to your workout!

1. If you have Instagram: From your Instagram account, share a picture and caption and remember to hashtag both #CAPLICOwell #CAPLICOnation
2. Or, using your smartphone: Visit EnsignTherapy.com, click “WELL” at the top of the page, then click “Share your Story” from the top of the WELL Site. There you’ll find room to share a short story and upload a picture from your phone.

We look forward to seeing your inspiring stories as a collaborator to our WELL Project.

For more information on this topic or the latest health and fitness news, visit AngelaAmbrose.com or follow Angela on Facebook (@AmbroseHealthyLiving).

In Utah, we are fortunate enough to have a Recreational Therapy Resource, Kami Archibald. Kami is a great partner with our therapy teams to find ways to further enhance the lives of our residents. Through this partnership, our facility Rec Therapists are becoming an integral part of the therapy teams. This all started when they asked to be educated about our “therapy world,” productivity and how Rec Therapy can support us.

We started with Recreational Therapists and Therapy Teams coming together to find ways to partner for group treatments. The groups are then scheduled on the activities calendar. By partnering with recreational therapy, it was an easy “in” for our therapy teams to start integrating group treatment into clinical practice. Additionally, it allowed the therapists to screen participants who are not on therapy caseload for any declines or needs for therapy intervention.

It also created a way for our therapy teams to better understand the role of Rec Therapists and how they are critical to the success of our facilities. Once they understood what Rec Therapy was focused on, they quickly realized that the partnership and designing of tailored activities was a perfect functional maintenance program opportunity. This allowed our patients to maintain functional levels after being discharged from therapy and it gave our recreational therapists tools to have successful participation in groups. A specific example was integrating our Abilities Care Approach with Rec Therapy by being advocates of the life story boards during their activities and groups. It allowed the Rec Therapists to have very specific, meaningful information on each resident to enhance the experience.

As Kami conducts facility visits and training with the facility recreational therapists, she includes the therapy teams and shares best practices. Kami also supports MOCK surveys by doing both resident and resident council president interviews to follow up on the “hot topics” and make sure they are being addressed properly. Having this partnership has definitely improved the quality of life for our residents along with creating a greater appreciation of our recreational therapy partners.

By Mahta Mirhosseini, Therapy Resource

Last month, we talked about the exciting new revisions to our policy regarding Clarification orders. Facilities that are actively using Clinisign, Optima’s physician e-signature feature, do not have to write clarification orders for Part A payers when completing evals and recert if their documents are signed by the MD via Clinisign!

This can be a huge time-saving opportunity, especially since we already did not have to write clarification orders for our Part B payers. This is because Optima’s Clinisign product ensures timeliness of MD participation with therapy POCs/UPOCs. Here you will find some commonly asked questions that come when rolling out CliniSign:

Q: Can PAs/NPs sign our therapy documents via Clinisign?

A: Yes. By putting the PA/NP’s name in the “Clinisign signing Provider” area of the document, they will be alerted to sign the document. This is the signing on behalf of feature and will include the names and NPIs from both the physician and NP/PA on the document.

Q: Do I have to send the invite to a doctor who is already using Clinisign with another facility?

A: Yes, each facility needs to send out a separate invitation so the doctor can start to receive documents from your facility, but the doctor does NOT have to go through the enrollment process each time. Once enrolled, he/she will just get notifications that the facility will begin sending him documents.

Q: How often do physicians get notified?

A: Clinisign will send out a notification ONCE a day at 1 p.m. EST. This notification is sent via email and text (if mobile number has been provided). Physicians have the option to go into their account setting and change frequency and/or time of their notifications.

Q: Can the therapist edit the eval to correct a diagnosis if the doctor has already e-signed the document?

A: Yes, once the therapist goes into the document to make changes, the document will get re-sent to the physician for another e-signature.

Q: Will the MD e-signed document get sent into PCC?

A: Yes, the latest version of the document will get automatically sent over to PCC’s Therapy Clinical Document Report.

Q: Do I still have to scan these MD e-signed documents into the misc tab of PCC?

A: No, because there is an electronic time-stamped record of physician signature both in Optima and PCC.

Q: My medical records director helps monitor therapy document signatures. How will they know which documents are being electronically signed by physicians?

A: Medical records directors have access to “Physician E-Signatures Report” in Optima. Please contact Ensign Support to set up your medical records partners with an Optima user account.

Q: Whom do I contact if I have a question?

A: Please contact your local therapy resource or myself (mmirhosseini@ensignservices.net). You may also contact our Optima Support Team (support@optimahcs.com).

By Keystone Therapy

What started with a team’s desire to find a better way to treat LTC patients, morphed into a two-year ongoing journey, implementing the most recent evidence-based practice for their residents with dementia, leading them to the implementation of the Abilities Care Approach (ACA). ACA is a program that focuses on maximizing caregiver knowledge in dementia care. By doing so, it created a culture change within the facility that sparked an interest from dementia care to dementia design.

Dementia design is essentially a way to create the best environment for maximizing independence for persons living with dementia. In an Intelligent Risk, Legend Oaks-New Braunfels funded several team leaders to study dementia design at the University of Scotland, a world-renowned dementia design university where companies and facilities from all over the world have sought their accreditation and guidance in best practice for dementia design.

The training course began by presenting the increasing prevalence of dementia and the responsibility for those in the field to provide design and practice in accordance with what research has taught us about dementia. Three different models of how facilities operate when providing care to dementia residents were presented: Basic Needs, where only the basic needs of the resident are met; Social Model, where safety and security are the primary concerns; and a Bio-Psychosocial Model, which is an ambitious approach to care in dementia that takes into account individual needs and preferences, best design and care practice, along with needs and security. As they took an honest look into the approach utilized by their building, they were even more motivated to learn and implement the knowledge gained as they realized their building probably falls somewhere between a Basic Needs and a Safety/Security model.

Dementia design was introduced by an interior designer with extensive expertise in the field of dementia. The five primary dementia design principles taught during this session included: supporting individual needs, maximizing independence, reinforcing personal identity, making design orientating and understandable, and providing control and balance. Design features included: familiarity, reduction in stress and anxiety, clear visibility and multiple cues, and minimizing distractions. Design modifications and examples of other facilities were provided that achieve the five dementia design principles and design features. Color, hue and tone were explained in relation to dementia care and how to contrast design within the building to accommodate the deficits that present in dementia residents.

An extensive interactive workshop with the Legend Oaks-New Braunfels team was conducted where the team had to design a room and bathroom with the appropriate colors, hues and tones in accordance with what we had learned about vision deficits and other physical and cognitive deficits present in dementia residents. Extensive education was provided about utilizing familiar designs with dementia care and the evidence surrounding this approach. “More familiar designs mean people with dementia are less likely to need help, that they make fewer mistakes and that they are more satisfied with the process than if the designs are unfamiliar.”

The interior designer was then followed by an architect who specializes in dementia design. It was here the team learned extensive knowledge regarding appropriate lighting in the morning, afternoon and evening hours in accordance with what we know about dementia and brain function during these times. Appropriate lighting for dementia residents provides better performance throughout the day and good sleep routines, which is often difficult to accomplish in residents with dementia. Education regarding flooring consistency and knowledge on how to contrast floors with seating areas in accordance with vision deficits associated with dementia was explained in great detail to significantly decrease residents’ risk for falls and promote independence.

On the last day of training, the Legend Oaks team was able to tour educational rooms designed in accordance with the principles taught in class. These rooms included: bedrooms, bathrooms, hallways, stairs and a hospital. The team was required to inspect each room and “tag” any errors found in accordance with knowledge gained during the courses.

Legend Oaks-New Braunfels is hoping to seek a partnership with the University of Stirling as they begin their next grant that will focus on dementia design and the knowledge gained during their training courses. The team is already laser-focused on next steps and is diligently working to pave the way for dementia design in the United States, as well as provide cutting-edge research and care for residents with dementia.

By Mahta Mirhosseini, Therapy Resource

Have you wondered what it would be like to go paperless with Therapy documentation? You can stop wondering, because our Optima software has features and modules that can help us go paperless today!

Clinisign is Optima’s answer for getting timely and efficient physician signatures for our therapy documents. Facilities that utilize Clinisign do not have to print out any of their therapy documents, because each eval and/or recert is electronically sent to the physician for signature. Once the physician e-signs the document, it is automatically returned to Optima and PCC, thereby getting rid of the need to scan our therapy documents into the Misc tab of PCC!

And that’s not all. Did you hear the great news about the revision to our therapy clarification orders policy? If you joined our last leadership meeting, you also heard that we do not need to write clarification orders for Part A residents whose physicians are using Clinisign. This is because our therapy evals/recerts have all the required fields of a clarification order, and by getting an MD Clinisign signature on our therapy document, we are meeting the requirements for a physician order. This is another huge step toward going paperless while maintaining compliance. Please reach out to me or your local therapy resource if you are not already using Clinisign, or if you want to use Clinisign to its full functionality.

By Chad Long, Therapy Resource

As we close out June, we find ourselves only three months away from PDPM! So how are we doing?

Overall in May we are providing 5% clinically appropriate Group & Concurrent to all Payers and 17% to our Non-PPS Payers.

 

How does each affiliated company stack up? Here are a few stats through May:

Highest percentage for All Payers in May goes to … Monument! Great job last month with 9%!

 

 

 

 

Best performance Year-to-Date for Non-PPS payers goes to … Bandera! They’re consistently delivering over 20% in functional multi-participant therapy programming!

 

 

 

Who has had the greatest increase from January to May? Midwest increased 13% in May compared to the beginning of 2019!

 

 

 

 

Each company has made significant gains in statistical improvement; however, what does that say about quality? Every week, we see emails about highly skilled functional groups from several facilities. Here are a few great examples to follow:

THE SOUTHLAND OCTAGON

The “Southland Octagon” was their creation in order to have functional, skilled and evidence-based group programming. For example, each bar was carefully measured to also allow for functional assessments such as the seated step test.

Additionally, they developed clinical group treatment protocols such as:

Functional Transfer Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale, standard height chair and patient’s own W/C

Purpose:

• To strengthen LE Hip & knee extensor and Hip Abductor/Adductor group of muscles to improve functional transfer
• To promote safe functional transfer technique
• To promote motor learning through repetition
• For the individual to learn, encourage and motivate one another

Procedure:

• Therapists and pts may introduce themselves to each other. Briefly discuss the goal.
• Check and record vital signs, RPE and pulse oximetry.
• Demonstrate the task.
• Patient is instructed to stand up (may utilize arm rest) and hold on to the Southland Octagon bar.
• Make two to three side steps to the next practice chair (return to/from)
• Let the patient repeat as many as possible until they feel fatigue.
• Observe and record the form, smoothness of movement, movement compensation, etc.
• At the end of the last attempt, have the individual sit, take and record BP, HR, RR, PRE and oxygen saturation.

Seated Step Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale,

metronome (set at 60 bpm)

Purpose:

• To strengthen LE Hip flexor and knee extensor group of muscles to improve mobility
• To improve aerobic capacity and endurance
• Suitable for those unable to stand up safely with less assistance
• For the individual to learn, encourage and motivate one another

Procedure:

• Therapists and patients may introduce themselves to each other. Briefly discuss the goal.
• Check and record vital signs, RPE and pulse oximetry.
• If one of your goals is to improve aerobic capacity, determine target heart rate (Karvonen’s formula). Monitor heart rate during the procedure.
• Demonstrate the task.
• Patient is instructed to alternately touch each foot to the edge of the step at the rate of set bpm (metronome) to touch the edge of the step; next beat brings the foot to the floor, and next beat the opposite foot touches the edge of the step.
• Let the patient repeat as many as possible until they feel fatigue.
• Observe and record the form, smoothness of movement, movement compensation, etc.
• At the end of the last attempt, take and record BP, HR,RR, PRE and oxygen saturation.

Progression:

• May progress to 12”, to 18” with UE movement. Right shoulder flexion to 90 degrees when raising right Leg. Repeat with the opposite side.

Sit to Stand Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale

Purpose:

• To strengthen LE extensor group of muscles and improve functional transfer
• To promote motor learning by repetition
• For the individual to learn, encourage and motivate one another.

Procedure:

• Therapists and patients may introduce themselves to each other. Briefly discuss the goal.
• Check vital signs, RPE and pulse oximetry.
• Demonstrate the proper form of doing sit <> stand.
• Patient is instructed to stand up (patient may utilize the arm rest), hold on to the Southland Octagon bar then sit down, doing as many as possible until they feel fatigue.
• Observe and record the form, smoothness of movement, movement compensation, etc.
• At the end of the last attempt, have the individual sit, take and record BP, HR, RR, PRE and oxygen saturation.

Point of Service Documentation: Part 2 in a 2-Part Series, by Mahta Mirhosseini, Therapy Resource

In Part 1 of our Point of Service Documentation (POS) series, we discussed how POS style documentation can have great therapeutic benefits over traditional treating first and documentation at the end of the day. If you missed the first part of this series, click here.

Today’s post on POS documentation will highlight our therapy EMR’s POS platform: Optima’s Point of Care or POC (pronounced “pok”). Let’s see how POC helps with efficient POS documentation.

POC is designed with the treating and documenting therapist in mind. That is why it does not have administrative and reporting features to slow down the system.

POC is many (and I mean many) times faster than traditional Optima, saving our evaluating and treating therapists time, not having to wait for documents and screens to open up.

POC is designed to work on any tablet (iPad, Chromebook and laptops) because it is device-agnostic.

POC can work offline, so once therapists download their caseload onto the device, they are able to complete billing and documentation even in areas of poor connectivity in the facility.

POC has the names of the other disciplines’ therapists that are scheduled with each patient, so no need to constantly refer to the assignment board to find that info.

POC’s documents have an “H” button that offers all historical info that has been added in that field since the day of the eval.

Last but not least, POC has a feature called the “side by side viewer.” Anytime a therapist is working on a document, this feature offers a split screen and instantly loads all prior documents (including TENs) that can be referred to as the therapist completes the current document.

Please reach out to me or your local therapy resource if you would like more information about getting started with POC. Remember that POC can be used on any device, including your existing laptops.

Point of Service Documentation (First of a 2-part series), By Mahta Mirhosseini, Therapy Resource

Traditionally, therapists have approached treatments and documentation in a compartmentalized fashion; a hands-on treatment session was provided, then documentation was done after the session was over, often times at the end of the day. With increasing use of technology and EMR software in healthcare, you may be hearing more talk about Point of Service documentation in our therapy settings. Some therapists wonder whether POS documentation can be done effectively, or if it may take quality treatment time away from patient care. Here, we discuss how POS charting can be an effective adjunct to the therapeutic process when it is done correctly.

• Think of when you were in your therapy school, did you wait till class was over to take notes? It is very similar to our therapy sessions. When you document during treatment, you can ensure that your documents are more accurate and detailed. POS documentation helps to include details that may otherwise be forgotten by end of the day.
• Do you find yourself overwhelmed at the end of the day trying to complete all your evals, encounter notes, or recert documents? POS approach helps the clinician get documentation completed as they go on throughout the day, thereby reducing end of day documentation stress.
• Do you have lots of chicken scribble on your daily activity schedule when recording patient levels and measurements? Our field is driven by objective tests and measures. POS documentation allows therapists to take detailed notes while collecting data during the session, therefore establishing and advancing appropriate goals in real-time. In fact, using EMR for POS data collection may trigger the therapist to perform additional testing to ensure that all relevant areas are addressed.
• Do you worry that POS documentation may affect relationships and quality connections with our residents? Our patient population has been seeing their physicians and healthcare professionals take notes using technology. You might even say that they have come to expect to see their providers actively capture data. The key is to engage your patients in that process and find a balance of documenting data while fostering an active and engaged therapeutic session.

Optima‘s point of service documentation solution is called Point of Care (POC), and unlike its traditional desktop Optima counterpart, POC is designed with the treating therapist in mind. Many of our therapy programs have been reporting great success using Optima’s POC to render point of service documentation. Stay tuned for our next POS documentation post which highlights efficient documentation tools that exist only in Optima’s mobile POC. If you would like to get more information on these tools before the next post, please reach out to me or your local therapy resource.

Deciding the Principle Medical Diagnosis, By Lori O’Hara, MA, CCC-SLP

Although the PDM only affects therapy buckets, determining the most appropriate diagnosis to put in the first position is an IDT Decision. It is meant to reflect the condition that most strongly explains the reason the patient needs to be skilled in the SNF, and sometimes that is not necessarily the condition for which they need rehabilitation (although it will be often!) The DOR and the therapy team should discuss the reasons the patient needs any therapies they’re receiving, and then the DOR discusses that with the IDT to reach a decision.

Here are few decision making examples:

• A patient admits who had a hip replacement, and then while in the acute hospital had a stroke. Both the hip fracture and the CVA are high-needs conditions and either could legitimately be considered the principle medical condition. When this is true, the facility is allowed to select the best prioritization. In this case, selecting the hip replacement is the best choice. While this does mean that we are opting to miss out on a neuro condition for the SLP case mix index, the benefit to the facility is greater from the hip fracture diagnosis. The patient will still need all the aggressive therapy that comes with those two conditions, so selecting the one that aligns best reimbursement with the amount of resources the patient needs is perfectly fine when it’s clear that the choice is well-supported in the record.
• A patient admits with ulcerative colitis. The patient is on immunosuppressants and close diet monitoring. The patient has suffered significant muscle wasting and is severely debilitated. The patient also has a history of Parkinson’s disease for which they’re receiving a Sinemet regiment that is unchanged in three years. While Parkinson’s would land in a more advantageous clinical category (Acute Neuro) than the ulcerative colitis (Medical Management), that decision is not consistent with the CMS requirement that the principle medical diagnosis reflect the reason the patient needs to be in a SNF. So Parkinson’s disease should not be in the first position, but should be listed as a diagnosis in a later slot.
• A patient admits for pneumonia and also has a fractures of the 4^th toe. The patient is still on antibiotics, requires supplemental oxygen and has an order for a follow-up x-ray. In this instance, while the impact of a toe fracture will certainly need rehabilitation, the patient’s management for pneumonia requires markedly more resources and interventions. So in this instance while the toe fracture would create a more financially advantageous case mix impact, it cannot be validly reported as the principle medical condition.