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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

By Lisa Brook, DOR, St. Joseph Villa, Salt Lake City, Utah
Lisa Brook, DOR at St. Joseph Villa, recently shared their new therapist/new employee training and mentorship process. As COVID continues to de-escalate, their team is beginning to focus again on leadership development and believe this process starts from the very beginning of employment at St. Joe’s. They are attempting to be more intentional about onboarding and training of new therapists as their skilled census grows and they are expanding their outpatient programing as well as their LTC programing. The therapy team at St. Joe’s is being more intentional about the hiring process with improved communication with Jamie Funk, involvement of key staff in the interview process and then setting more specific plans for the onboarding and training process. In order to grow leaders we must start with growing good therapists, mindful of their treatment approaches, seeking to make the most of their time. Lisa walked us through their onboarding process:

Day 1: NetHealth email sent to the staff early in the a.m. of the first day of a new therapist’s arrival that introduces him/her so that everyone knows the person by name. On this day, the new therapist is assigned to a therapist of the same discipline just to observe. This is planned ahead of time so the therapists are aware they will have someone shadowing them that day. We encourage the new therapist to take notes as we go through the login process for NetHealth, PCC, tour the building, meet members of the leadership team, observe the pace of things, etc. The first day is usually only a half day.

Day 2-3: Again, these are usually not full days. The new employee treats two or three patients on our skilled rehab unit. Their schedule is loaded with patients who will cooperate and give them a “win” for the day. The goal is to feel comfortable with the patients and just be a therapist! At the end of those treatments, they will spend time verbally reviewing the treatment, patient response to treatment, and potential documentation with the same therapist they shadowed with on Day 1. They do their billing, write their TENs, and then the therapist reviews and they discuss necessary corrections.

Day 4 and on: As the new therapists get more comfortable, more patients are added to their caseload. They treat patients on our skilled rehab unit and start to initiate point of service documentation. Time is scheduled with their “mentoring” therapist to answer questions and review documentation and goals. This process has been helpful for new employees, and they look forward to it as it gives them an opportunity to get all their questions answered in a more in-depth manner.

Next Steps: Next steps are really driven by the new team member. We initiate writing progress notes during week 2 for a new graduate and then add other necessary documentation as they begin to have success. As the DOR, Lisa said she checks in with them each day, but this process allows the experienced staff to take ownership of our training/onboarding process, and it seems to be working! Lisa said that even if they hired an experienced therapist rather than a new grad, there is still a lot of mentoring that we need to provide. They consider the confidence level of the therapist and tweak the process as needed. As they add more patients to their caseload, we have ongoing conversations.

Variables to Consider: New grads often require more mentoring. However, experienced therapists, part-time/PRN staff should always be provided an opportunity to receive mentorship as needed. Consideration must also be given to the confidence level of the individual. It often takes as much “coaching” for a seasoned therapist to get acclimated to treatment approaches, writing appropriate goals and skilled TENS because there are some differences in documentation in each subset of our programming (skilled rehab, skilled maintenance, outpatient, sub-acute respiratory, LTC).

Lisa said we need to allow our therapists time to grow. If we are going to create leaders, we need to be intentional about onboarding and training. We want them to be confident in their skills and critical thinking and be leaders among their peers in the building. Jamie added that Lisa has done an amazing job! St. Joseph Villa has a reputation in the community of empowering their therapists in establishing plan of care and treatment approaches to fit the needs of the community. She has heard from candidates that they know how great it is to work at St. Joseph’s, and all of the tools Lisa shared with us are having an enormous impact in growing therapists to be outstanding clinicians, leaders in St. Joe’s and then leaders beyond St. Joe’s.

By Dominic DeLaquil, PT, CEEAA, Therapy Resource, ID/NV
Steve is a LTC resident at McCall Rehab being treated by Speech Therapy for cognitive/communication deficits. He has a history of alcohol abuse and dementia. With winter in the mountains and COVID restrictions, his behaviors had become a real problem. He was initially refusing to get OOB and staying in a dark room, but as the weather began to turn to spring, he began excessive wandering, wanting to get out of the facility. He was agitated and confused and began urinating in sinks and trash cans.

Using the ACA approach, SLP Cassie Johnson took him outside and listened. He was remarking on all of the things around that building that might need repair or upkeep after the long winter. She asked him what he would do, and one thing led to another, and she got some sandpaper and he started working on refinishing a wooden patio table at the facility. Another resident became interested, and they worked on the table together. They have since formed a friendship and seek each other out. All of Steve’s behaviors have ceased and he is more motivated to improve his abilities and hopes to discharge to an ALF. As an additional benefit, other residents became interested and the furniture sanding became a group activity!

In addition, his SLUMS score in February, when he was depressed and his confusion was worse, was a 13/30. Tested recently, after finding some purpose and satisfaction, his cognition actually shows improvement and he scored a 22/30!

Danielle Kistler, OTR/L, is a new CLT at Holladay Healthcare. We are so excited to have a CLT at our facility, and we are already seeing some great successes with her interventions. We have an LTC resident that had LE skin tears that developed into stasis ulcers. The nurses were providing wound care for about six months with the patient being on and off antibiotics due to infections, with the ulcers being unable to heal.

At the same time Danielle became certified in lymphedema management, the patient was referred to a wound clinic for further wound treatment. With Danielle being able to provide appropriate compression wraps at the same time the patient was attending the wound clinic, his stasis ulcers are now healed. The nurse manager received multiple calls from the wound clinic on how well his legs were being wrapped and how impressed they were with the healing of his wounds. This patient also has aphasia and has difficulty communicating with his caregivers. We have seen a change in this patient, with signs of reduced pain, increased participation in ADLs, decreased outbursts, and improved quality of life.

Submitted by Jeremy McCorristin, DOR, Holladay Healthcare, Salt Lake City, UT

Our long-term care population is now fully vaccinated, and it seems as if we are entering, dare I say it, a post-pandemic environment. We made it, but now what?

During the pandemic, we have seen our residents’ version of normalcy altered. Those who used to spend most of their day in the dining room, in activities or the therapy gym, and visiting with their friends and family now are found sleeping in more, not eating as much or as healthy as before, and no longer have the desire to engage in social activities. When they do feel like getting out of their room, seeing them use a wheelchair is more common. Some of them are COVID-recovered and have never fully bounced back after fighting the virus.

Our therapists opened their minds to different therapy approaches and gained the skills that it takes to truly dignify the lives of long-term care residents. We knew these effects of illness and quarantine isolation would take a toll on our vulnerable population, and we did everything we could to combat them in real time with preventative therapeutic approaches. In a pre-COVID world, our building was predominantly a rehab-to-home facility, and it was uncomfortable at times for our therapists to develop long-term care treatment plans. The pandemic highlighted the necessity for our services, and now it is hard to imagine not being this involved with them.

Our Speech Therapists, with multidisciplinary collaboration, hosted a new program this month called “Rise and Dine.” This program began as a nutrition and hydration-based club that requires participants to get out of bed and engage cognitive and communication skills in choosing meal preferences for the event. “We are all very passionate about our residents’ quality of lives and saw this as an opportunity to meet our residents’ nutritional and social needs. The excitement and feedback of our residents really fueled the idea and brought our entire dietary and therapy staff together to make this such a successful event!” — Breean Ludwig, HCRO Speech Therapist

As excitement grew, we realized this program could address almost all the abilities we have seen deteriorate. We ordered T-shirts to encourage dressing and hygiene before the event, and all our therapists came in to facilitate transfers, self-care routines, and mobility to and from the dining room. We also were able to treat goals related to self-feeding, dynamic standing, and sitting tolerance and positioning.

“We saw such a negative impact after so many in-room isolations during the COVID pandemic. Our Residents were discouraged, losing weight, not socializing, showed physical and cognitive changes, and did not want to come out of their rooms. We wanted to do something to bring excitement back into their lives while still being able to target our goals in therapy. This program offers an opportunity for all disciplines (PT/OT/ST) to participate.” — Ke’ren Grimaldo, HCRO Speech Therapist.

Although we are striving to return our residents back to “normal,” I am proud to say our Therapy team has established a new norm as well, and we are not looking back. Just as preventative interventions were important during the pandemic, how we move forward now is just as crucial. 85% of our long-term care residents got out of their rooms to participate in this program. We owe a big thank-you to our dietary manager and her team for being as excited for this program as we were. Our team has a seasonal themed event planned for the rest of the year, and we can hardly wait!
Remember, every county and state Department of Health has specific guidelines for re-opening, so always consult with your DNS with your “back to normal” plan.

Submitted by Elizabeth Munford, PTA/TPM, The Healthcare Resort of Olathe, KS