Therapy News

Super Heroes at City Creek!

May 6, 2020May 7, 2020 MP Celebrate

By Gary McGiven, Therapy Resource, Milestone
The employees at City Creek Post-Acute in Salt Lake City, Utah, truly are superheroes. City Creek has partnered with the state to become a COVID-only building. As part of this partnership, City Creek was required to temporarily place their residents in sister facilities throughout the Salt Lake valley. This was a huge undertaking in and of itself and was the beginning of building something very special at City Creek.

In order to make this venture work, there needed to be some blurring of discipline lines with an “all hands on deck” approach. Those working in the facility needed to be on board with helping these residents in any way that was necessary. This meant therapy staff would spend time performing housekeeping, CNA and other duties in addition to treating patients for their therapy needs.

In speaking with Ray Yarman, the Director of Rehab at City Creek, she has expressed, many times, the appreciation she has gained for our nurses and CNAs as she and her staff have been working alongside them, in the COVID trenches. Ray says she wishes all therapy staff could gain this personal perspective of the amazing things our nurses and CNAs do on a daily basis. This experience will most definitely change the way Ray and her team operate, as they have bonded with the nursing staff and have built long-lasting relationships.

Many thanks to our amazing nurse partners for all that you do to give our residents the quality of life they deserve.

Wound Care During COVID-19

May 6, 2020May 7, 2020 MP Learn

By Shelby Donahoo, M.S., OTR/L, Therapy Resource – Bandera
We all experience day-to-day (or minute-to-minute!) changes in staffing these days. Pueblo Springs in Tucson, Arizona, found themselves suddenly without a wound nurse for an indefinite time due to illness. With nursing managers working the floor, there was no one to cover this critical task.

So, DOR Josie Gorman, PT, stepped up and volunteered physical therapy to take over most of the wound care program. DNS Paulina Kareko, Josie, and ED Neil Cullen all met to discuss this as a possibility.
The team reached out to Therapy and Clinical Resources, who consulted together to determine if this was viable and considered all options, with the following questions and answers:

Is PT qualified for this task? Yes, as verified through licensure, state practice act scope of practice, Ensign job description. Josie had also completed wound care certification training.
How will competency be determined? With no wound care Skills Checklist in rehab, PT staff involved in wound care will complete nursing Skills Checklist, to be signed off by nursing leadership.
What parts of the wound program will rehab take on? Dressing changes, orders, weekly rounds with MD (via telehealth at this time); nursing to continue admissions assessments, skin checks, etc.
Can we add billable therapy wound care services to the POC? Yes, through four avenues: a) Use of Physical Agent Modalities for wound healing per Medicare guidelines for qualifying wounds (training provided); b) Adding pain management standardized assessment and goals as appropriate; c) Including functional goals in the POC pertaining to wounds: positioning, training off loading, bed mobility, therapeutic exercise to increase circulation; d) providing caregiver education and training in regard to above goals.
What about documentation? Rehab billable tasks to remain in Optima; for non-billable tasks (weekly rounds, documentation, dressing changes), PT to document in PCC following training from nursing.
What about cost allocation? Therapy non-billable wound care tasks to be allocated to nursing cost center.
What about the exit strategy? PT to relinquish tasks per consistent availability of nursing management and return of wound nurse; IDT discussion bi-weekly.

Hats off to the Pueblo team for thinking out of the box and working together to support patient care! Thanks to awesome Clinical Resources Sheila Summey and Julie Uychiat for collaborating to support nursing/therapy teamwork! And thanks to Pit Crew for input and suggestions.

p.s. Yesterday, a wound-care doc reported progress on a chronic ulcer that’s been plateaued for some time, with patient expressing excitement about this gain. Estim for wounds really does work, y’all, with lots of evidence to support. ☺

Orem OT Medication Reduction

April 2, 2020April 3, 2020 MP Learn

By Ryan Porritt, OT, Orem Rehabilitation & Nursing, Orem, UT

Occupational Therapy (OT) used non-pharmaceutical mindfulness-based interventions (HeartMath and Acceptance and Commitment Therapy) to support a patient while the physician reduced anxiety medication that she had been on for years. The patient has several mental health diagnoses, including bipolar disorder, PTSD, generalized anxiety disorder contributing to frequent panic attacks and high levels of anxiety. Her independence and quality of life is further complicated by several physical comorbidities that exacerbate the functional impact of her anxiety. She has a history of significant trauma as measured by scoring a 9/10 on the Adverse Childhood Experience scales.

The following are the step-down dosages of clonazepam:
Staring at 1 mg 3x daily
Reduced to 0.5 mg 3x daily on Jan. 21, 2020
Reduced again to 0.5 every 12 hours on Feb. 1, 2020, to present

The OT trained the patient in several meditations to reduce the emotional struggle resulting from her anxiety in order to increase participation in value-based activities. With assistance, the patient identified three value-based activities: writing poems, quilting and facilitating a weekly bible study group for her religious congregation. After 30 years of not writing poetry, she is able to express her pain, anxiety and other emotions through regular poetry writing. She has assumed a leadership position to prepare and facilitate weekly bible study groups, and she is currently being trained to lead a resident-run quilting group in collaboration with Recreation Therapy and the Therapy Department.

While the patient still faces daily challenges resulting from anxiety, she reports the duration and frequency of panic attacks have reduced and that “I am not struggling with my emotions as much anymore.” With less medication, she reports both increased quality of life and increased participation in value-based activities. While significant progress has been noted, she will require continued skilled OT under a maintenance plan due to the complexities of her physical and mental health. As illustrated by this example, skilled therapists are in an ideal position to have a significant impact on both function and quality of life while assisting physicians to reduce medications.

The 5 E’s – The St. Elizabeth Story

April 2, 2020April 3, 2020 MP Celebrate

By Dennis Baloy, OT/DOR, St. Elizabeth Healthcare and Rehabilitation, Fullerton, CA

The acquisition of St. Elizabeth Healthcare and Rehabilitation happened in May 2019. The transition was remarkably successful, but it did not come without challenges. Equipped with knowledge and guidance from our resources, we were ready for the speed bumps ahead — from changing guidelines of our managed care partners, new state and federal regulations to the Star Rating Data, onset of PDPM and many more. Our relentless, action-oriented and fearless yet compassionate leaders, Rand (Administrator) and Mady (Director of Nursing), knew that the only way to achieve these things is staying the course toward our true north — that of providing the best individualized care to all our residents while continuing to embody the CAPLICO values toward one another.

Fast forward to January 2020, when the Department Heads of St. Elizabeth decided to jumpstart the year with a team-building/planning event. In this meeting, they picked the brains of all the adroit minds (fueled with everyone’s genuine love and compassion), and the best ideas in each department were laid down on the table to create a blueprint for “greatness” of St. Elizabeth.

From St. Elizabeth to St. E! Yes, plain and simple St. E!

Why the “E”s? We have narrowed down the core values that each St. Elizabeth employee embodies. They serve as our cornerstones and foundations for each intention and action we make when we go to this second home we call “St. E”!

Excellence. Empathy. Extraordinary. Engaged. Empowered …

Our building was undergoing a considerable renovation (front yard, room renovation, repainting) — an extensive overhaul. We also had a series of fun and educational inservices for all the staff. Keeping the blinders on and riding on this momentum, we were set to relaunch “St. E” to the community this May 2020.

Then COVID-19 came, and the world was shaken.

We paused.

It took only a few moments of realization that all our plans and efforts for our big relaunch were perhaps meant for this. Our facility is more prepared, more reinforced and better structured. The staff’s culture and morale are at an all-time high — bonded tighter than ever.

Yes, it is a different calling now, and everyone is well aware of it. The next few days and weeks will be a grueling test of the core values that is St. E. To say it will be a hard battle is an understatement, but united together we will succeed.

Bottom line is, surely now more than ever, nothing can replace the E’s that all the employees of St. Elizabeth/St. E embody: Excellence, Empathy, Extraordinary, Engaged, Empowered.

In-Room Treatments — Creative Therapy Solutions

April 2, 2020April 3, 2020 MP Share

Here are some in room therapy treatment suggestions from our Keystone Resources:

● “Boxing” while supine in bed to work on trunk rotation, rolling side to side for bed mobility, UE strength and activity tolerance; add weights if appropriate
● “I Spy” game for word finding/verbal reasoning goals
● Bird identification out the window. Laminate photos of birds/scavenger hunt looking out window
● Cleaning the bathroom mirror
● Decorating or making a calendar for orientation
● Decorating the room
● Drawing, window painting/drawing
● Fall recovery
● Folding laundry
● Game cards and play this while standing to add in cognition component
● Have a therapist in the hallway and have some residents in the doorway and do some deep breathing and gentle exercise! Maybe have some questions to help facilitate conversation.
● Have some pictures ready for them; have them pick a picture from the pile and have them describe it to you!
● Have them tell us a hobby and modify it for them! We are super creative!
● If they have flowers in their room, trim them and replace the water. This can be done sitting or standing. If they are higher level, have them sweep up the fallen leaves and petals.
● Instructing patients in correct hand-washing techniques
● Introduce HRV training to help relieve anxiety during this time
● Item retrieval/transport
● Making the bed
● Making a collage with family pictures
● Making a cool Easter egg balloon with yarn to hang in their room
● Making cards for their loved ones
● Organize closet by colors/season of clothes
● Painting on paper
● Place patient’s clothes around the room at various levels, have them walk around and gather items, make decisions on whether to use reacher or not, manage reacher and RW, energy conservation education regarding rest breaks, etc.
● Plant something in a flower pot to put in the window sill for them to watch grow
● Postural exercises, high/low reaching

Tic Tac Toe technique–turn this into skilled intervention while distancing and sitting and standing.

● Put laundry on hangers and hang in closet (gross/fine motor and reaching)
● Scavenger hunt in room (list of objects to find)
● Small space functional mobility
● Talk about their life while they are rocking their wheelchair back and forth 🙂. They need to feel calm.
● Teaching them how to use the phone, FaceTime, and trying with a loved one … which brings happy tears, messenger on FB has a video chat as well, so setting them up to keep in touch with loved ones. Also, setting up a free music app on their phone, or a simple game like solitaire.
● Wall pushups working on posture
● Washing windows
● Wheelchair mobility “obstacle course” having to navigate around actual items and furniture in room
● Wheelchair pushups (5xSTS test)
Sequencing for sit to stand (brakes on, scoot up to edge of seat, back, hands in arm rest, fwd trunk nose over toes, 1, 2, 3, push up thru arms and LEs!). Get picky; perfect practice is the only way to instill good habits and break bad habits.
Sequencing for stand pivot transfers with assistive device
Standing balance (Romberg test), standing scalp retracts for stability, steps fwd, lateral, retro
Berg/Tinetti/TUG tests can be done in patient’s room and some aspects of them if anything can be worked on like 360-degree turns in place or picking object up from floor, etc.
● Writing letters/cards/postcards to loved ones
● Use AAC device to give instructions on how to set up/decorate the room; use patients’ phones or tablets for higher-level problem solving (e.g., sequencing steps to write a message on a niece’s Facebook timeline); use their phones/tablets to teach them to set up external memory aids (ex- add doctors’ numbers to contact list, set daily alarms for times they need to take meds); help them set up a grocery delivery acct for when they discharge home; use dysarthria (or aphasia or voice!) techniques during functional phone calls (talk to family, pay bills via phone, etc.); use objects in room for receptive language tasks (“Point to the razor THEN pick up the comb”).

Taking Care of Ourselves — Don’t Let Shelter in Place Shelter You from Staying Active

April 2, 2020April 3, 2020 MP Share

By Brian del Poso, OTR/L, CHC, RAC-CT, Therapy Resource

Through this difficult time, all of us are doing what we can to pitch in while at the facility, or remotely for those of us who can’t go to our facilities at the moment. With the stress of our jobs, schools being closed, scavenging for groceries, etc., it’s easy for us to forget about taking care of ourselves or make excuses for why we can’t take care of ourselves right now. We tell ourselves “I’m too tired from my crazy day”; “I have to find something for my kids to do”; “The gyms are all closed”; “If I don’t read all of Mary’s COVID-19 emails right at this moment, I won’t be prepared for tomorrow” (yes, people, it’s sarcasm) … well, STOP IT! Yup, a Bob Newhart reference, and if you don’t know what I’m talking about, check out this clip here. I promise, it’ll brighten your day! https://www.youtube.com/watch?v=Ow0lr63y4Mw

As therapists, we know that exercise is one of the best ways we can take care of ourselves, relieve stress and increase our happy hormones! Just STOP IT, and create 15 to 30 minutes for you and your well-being to do some exercise while at home. Here are samples of some simple, basic routines you can try (a quick Google search will give you an idea of how to do the exercise if you’re not sure):

No Weights … No Problem! Body-Weight Circuit It Is!
Perform each exercise in the circuit for 45 seconds at your own pace, with 15 seconds of rest between each exercise. You can increase progression simply by increasing the number of reps you can perform in the 45 seconds or by increasing your work time/decreasing your rest time.

Routine 1
– Squats (modify by how deep into the squat you go)
– Push-ups (modify by performing on your knees or against a wall/table)
– Walking lunges (modify by how deep you lunge)
– Plank
– Side lunges (modify by how deep you lunge)
– Mountain climbers (modify by how high you bring your knee toward your chest)
– Standing scapular retraction (3-5 second holds)

Routine 2
– Diamond push-ups (modify by performing on your knees or against a wall/table)
– Glute bridges
– Crunches
– Triceps dip on a chair (modify by bending your knees in your start position)
– Single leg Romanian deadlift
– Leg raises
– Door-frame rows (modify by body angle)

Feeling frisky? Perform two to three sets of the circuit with two to three minutes of rest between circuits, or grab some of those cans and bottles you bought from the grocery store and add some weight to the routine! (Pro Tip: You can use HeartMath with quick coherence in-between sets to concentrate and slow your breath, re-clarify and refocus for the next set … I know, MIND BLOWN)

But Wait, I Only Have 5 Minutes to Spare … Perfect, Tabatas Only Take 4 Minutes!
Tabata Training is a form of High Intensity Interval Training (HIIT) that requires 20 seconds of high intensity exercise (going all out!), followed by 10 seconds of rest, for eight rounds. This 4-minute method is a fat-burning, metabolism-boosting, sweat-drenching workout that is the equivalent to doing 20 minutes of normal cardio.
– High knees
– Burpees
– Jumping jacks
– Mountain climbers
– 20 seconds of all-out work, 10 seconds of rest between each exercise, repeat for a total of 8 rounds

Not into these types of exercises? Some other things you can try: March in place while you’re reading that book or watching your favorite show; take a few laps up and down your stairs if you’re in a multi-story home; chase that dog of yours around your home for a few minutes; you get the drift. Also, if you are already part of a local gym/fitness club, check in with them. Many companies are offering their members online home training options. The main thing is, don’t concentrate on what you can’t do anymore because of the restrictions in place, but focus on all of the things we can do, and just keep yourself active!

Sharing the SLP Love

March 5, 2020March 5, 2020 MP Share

Submitted by Jennifer Raymond, Therapy Resource — Northern CA

In January, Elyse Matson, MA CCC-SLP, Speech Language Pathology Resource/Ensign Services, provided an onsite half-day training course for the Flagstone NorCal Market Speech Language Pathologists and DORs.

The training content focused on how PDPM has changed SLP practice, including review of PDPM and SLP case mix, use of group and concurrent therapy, clinical documentation for both skilled and LTC patients, coding/goal writing, standardized testing, Medicare Part B utilization, dementia treatment utilizing Abilities Care, and the latest evidence-based practice and treatment techniques.

Since all of the SLPs in the NorCal market work independently in their facilities and many of them are geographically far apart, these therapists rarely are able to collaborate with each other in person. The course was an opportunity for them to meet face-to-face (some for the first time), share a meal, ask questions and discuss best practices with their colleagues, and update their learning together.

The course was enthusiastically received by our SLPs, as demonstrated in their comments below:

“I feel more confident in documenting skilled services, great use of resources”
“I have more tools now for providing abilities-based care”
“I have learned new coding and documentation skills”
“I feel more comfortable treating patients with dementia”
“Now I really understand the increased role of SLP with PDPM”
“Going forward, I know how to make my goals more specific on my POC”
“Wonderful learning and networking afternoon; can we please do this at least every six months?”

In addition, by inviting the non-SLP DORs, it provided an opportunity for our OT and PT leaders to have a better understanding of the broad range of available ST clinical services, documentation requirements and processes specific to PDPM and LTC interventions for their SLP programs.

JB Chua, PT/DOR for Summerfield, shared:

“Attending the SLP training course gave me tools on how to support my SLP in growing our program. It gave me insight on what to look for during our Daily Technical Meeting. Triggers that will make me ask my SLP to screen a particular patient to help us capture an accurate clinical picture of our patients. Lastly, it also helped me understand words/phrases that SLPs use that a PT seldom or never uses in their documentation. Overall, this training course is highly recommended not only for our awesome SLPs, but most especially for DORs without an SLP background.”

Thank you, Elyse, for this opportunity to exercise our Passion for Learning in NorCal!

A Journey for a Passion for Learning

March 5, 2020March 5, 2020 MP News

By John Patrick Diaz, DOR/DPT, CEEAA, RAC-CT, Magnolia Post Acute Care, El Cajon, CA

My journey with Ensign started five years ago when my current ED, Matt Oldroyd (shoutout for recently achieving the title of CEO) gave me the opportunity to be part of his team. Parkside was part of the huge acquisition that occurred in 2014 here in San Diego, where part of the transition was to hire new staff to complement previous staff who stayed on. He gave me a start date, which I begged to delay for a week as I was planning to attend the American Physical Therapy Association’s (APTA) Combined Sections Meeting (CSM) that was to be held in Indianapolis. This has been an annual commitment that I have made since being a member of the association and the Academy of Geriatrics. When he allowed me to start after my trip, this gave me the reassurance that I did make the right decision, considering that I would be working with an ED who supports my passion for being a lifelong learner in pursuit of clinical excellence.

Every year since then, I have consistently stayed true to my commitment, but this year almost didn’t happen as the annual surveys for the facilities that I have been supporting were delayed. We only had a week left before the 2020 CSM, and I was torn if I would still attend the event or just cancel my trip altogether. We do have very strong and supportive partners, with one of our therapists being experienced who could step up on short notice. I told Stew, ED at Magnolia, on a Monday that I wished for them to come this week so we could get it done and start working on the goals that we were planning for this year. Lo and behold, Tuesday morning comes and I get nonstop text messages indicating that the surveyors have arrived at not one but two of the facilities that I have been supporting. The next message I got was from Stew who said, “Well, you got your wish. LOL.” I replied to him, “I know!!! We got this. This is the start of our journey for the FLAG.” It was such a relief, but a rewarding experience to have simultaneous surveys and to get triple check done in a week.

I got the chance to attend the event the following week, and being at such a gathering never gets old. Networking and meeting old peers, students, presenters/speakers, authors, vendors, etc. with a common goal of learning just makes it so rewarding. This year’s event was more meaningful to me, as the Academy of Geriatrics rebranded and created a video depicting the importance of the population we serve. With the changes that have occurred since October 2019, we all have tried to embrace and change our mindset on how we can meet the needs of our long-term population. I firmly believe that we all have the foundation to make a difference and be influential in making aging an intentional and meaningful experience for our patients. Gone are the days where aging was considered as something passive with the stigma of, “Once I enter the nursing home, that’s it for me.”

With our mission of transforming and dignifying post-acute care in the eyes of the world, gray does matter and we have to help our residents age on. I encourage everyone that if you have that opportunity to be active with your own organizations, please take it. Whether you are a regular member, part of a committee or even a special interest group (SIG), you will still learn a lot and it will show in your practice. The benefits of having the passion for learning are endless. Having different titles at the end of your name is not what’s important, but what matters most is the information you get (and how you use and share the information in your practice) in earning such credentials and certifications. Be open to change. Don’t limit yourself to what you learn in books, because we have to realize that it takes three to five years to even publish a book, and once we get ahold of it, the information may no longer be up to date. Who would have thought that teaching an 80-year-old to plank is now being practiced, or using a pillow under the knee of a patient with a TKR is now recommended in the acute phase of a patient’s recovery?

As movement specialists, make a difference in helping the community and change our mindset to realize that gray does matter. Let’s all come together to develop a passion for learning.

Cluster Meetings - DOR Involvement

March 5, 2020March 5, 2020 MP Share

By Rachel (Ray) Yarman, DPT/DOR, City Creek Post Acute, Salt Lake City, UT

Roughly 1.5 years ago, the Seal Team Cluster from Utah started to include the DORs in cluster meetings. As the most novice DOR in our market, I was honored to be invited and to learn in a real cluster approach. I am lucky to have two other very strong and knowledgeable DORs in my cluster. Prior to our cluster meetings, I had a very difficult time coordinating learning from other DORs, or physical therapists in our market or cluster.

Our cluster meetings started out with mostly timidness from our DORs: learning, listening and digesting information. We all review therapy outcomes with our resource and have discussions about our building with the influence of DONs/EDs. We additionally review facility outcomes across the milestone market as a means of accountability. Learning about the financials of the building and seeing how therapy plays a role in the success of the buildings allowed us to have some crucial conversations. Our meetings have fostered a large amount of trust with one another. The trust that we now have is the building block of being able to have discussions at the table to celebrate, challenge and think big together to work to dignify long-term care.

I personally feel so grateful for the added support and learning from our clusters EDs and DONs. The cluster really feels like such a support team. We continue to push forward with thinking big for our staff members, which ultimately results in better care for our residents. Learning from numerous sources is always better than learning from just one source. As we share our successes and opportunities for improvement, I feel a greater sense of ownership for not only my building, but also our cluster as a whole. I relish the times that our buildings get to come together, and I get to learn from other sources and return to City Creek with that knowledge.

I can honestly say that my ownership and accountability have grown exponentially from having the cluster support. I cannot recommend enough having DORs sit at the table to discuss progress and growth of our buildings, to ensure that we are all on the same page in achieving our mission to dignify long-term care.