29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
Jan/Feb 2022
Click Here for a printable copy of The FlagPOST
The Happy Bar Concept
By Jon Anderson, DPT, Senior Therapy Resource
We truly have heroes working in every department, making miracles happen each day despite tremendous odds. Here in Keystone our Therapy Resources decided that one way to give back is to spread joy with our Happy Bar!

Happy Bar Concept
As healthcare experts, we give a “prescription” for health and happiness along with sweet treats, coffee, tea, or any other goodies. On the prescription, we can have 10 things...Read On
Combatting Retention at Osborn
Submitted by Stephanie Cole, Therapy Resource, Bandera, Arizona
Osborn Health and Rehabilitation is combatting staff retention! January 7, 2022, kicked off their first Staff Retention Committee meeting. Objectives include targeting tired staff and decreasing turnover. Program material covers culture, interdepartmental collaboration, quick chats with new staff, fun and interesting facts about Osborn, staff photo walls, photo week, staff appreciation, staff feedback inquiries, accountability, annual reviews, and scrutiny of staffing systems. 

Attendees included the ED, DON, HR, Marketer, Resources, and Therapy. Osborn is lucky to have their very own DORiTO, Wendy Aburto, as a member. Wendy’s Capstone project addresses improving Therapy and Nursing partnerships. It is wonderful to have Wendy bring her positive energy and creative ideas to the committee!

Way to go, Osborn, for gaining momentum with staff retention. Way to go, Wendy, for being a true leader. 
Managed Care
Rally Cry for 2022 
Submitted by Madeana Galler, OT, Therapy Managed Care Resource
The Managed Care Resource team is passionate that Managed Care is the future, and the future is changing! To be successful in the future, we need to create a mindset change around Managed Care. So, the Managed Care Resource team created a rallying cry with a cool logo for 2022: Manage your Future, Care to Make a Change! I challenge you to hear our cry, and together we can make a change for our future! 

Managed Care Fun Facts:
  • Did you know that 42% of Medicare-eligible recipients are enrolled in a Medicare Advantage Plan (Managed Care Plan)? 
  • Did you know that in 2021, 49.6% of our Skilled ADC was Managed Care? 
  • Did you know that is up from 42.1% in 2020? Managed Care ADC is growing!
  • Did you know that it's projected that 51% of Medicare-eligible recipients will be enrolled in a Medicare Advantage Plan (Managed Care Plan) by 2030?
Legacy of Leadership
Recognizing Jon Anderson, DPT, Senior Therapy Resource, Keystone, TX
By Deb Bielek, Therapy Resource

When I think about Building Therapy Leaders and our organizational focus, one of our amazing partners comes to mind. I first met Jon Anderson in May 2009 when he responded to our “Hotshot PT” recruiting advertisement. Of course, he responded to that ad because Jon is an innovator, and, as an innovator, he was attracted to the creative approach for a Physical Therapist position that was designed to function like a “Hotshot Firefighter”… someone to go to the front lines where the greatest needs are to help fill a gap.  

After meeting some of our local leadership and getting to know our shared set of values, Jon accepted our Hotshot PT position for Texas. He was our first recruit and would go on to give life and form to the position in a manner beyond anything we ever imagined. Jon would travel from one small town to another sharing his clinical expertise, getting to know the facilities and spreading his passion for his profession and his love of the patients and residents we serve. After a little over a year with making us stronger in Physical Therapy throughout the facilities he served, he began to naturally fill a need to support our cluster of facilities in South Texas. He helped the leaders in South Texas find ways to staff their programs with high-caliber therapists; create partnerships between Nursing and Therapy to develop stronger collaboration on patient care; and provide CEU programs that helped to not only strengthen the clinical skills of our therapists, but also attract therapists from all over South Texas with a desire to work for one of our affiliated facilities in the area.  

In our organization, leaders create that path that naturally fits their professional passions and the greatest needs in the organization. Within a few short years, our market leaders, clinical leaders and president in Keystone were asking for Jon’s expertise and support with a variety of areas. His vision for what therapy could be in Keystone and his ability to create lasting and impressive results with every touch that he made naturally found us wanting more of Jon at every turn. Twelve years later, he’s only just begun. His drive never ends. His heart continues to grow. And, Jon continues to produce amazing results with each touch that he has, while making everyone around him… all of us…better.  
Homegrown Therapy Leader in Idaho: Sarah Prough 
By Dominic DeLaquil, Therapy Resource, Idaho/Nevada
Way back in 2007, an 18-year-old high school girl was looking for her first job. There was an opening at the SNF in her small hometown of Emmett, Idaho, so Sarah Prough became a nursing aide at River’s Edge Rehabilitation and Living Center. As she became familiar with the rehab staff, the DOR, Steve Balle, saw potential in Sarah and encouraged her to consider a career in therapy. Sarah was intrigued, and she enrolled in a nearby COTA program.
  
Once Sarah earned her COTA license, she had to scramble to pick up PRN work in and around the Treasure Valley in southern Idaho. She was keeping herself busy at various PRN gigs, even going as far away as Burley, nearly three hours from her home in Emmett, to help with an Ensign-affiliated building there, Parke View – Burley. Through her hard work, good rapport with patients, and willingness to be available, she was eventually able to find full-time work at Owyhee Health & Rehab in Homedale, Idaho.  Read On...
A Great Outpatient Story from Villa Maria By Aimee Bhatia, Therapy Resource, and Brent Jensen, DOR, Villa Maria Post Acute Care, Santa Maria, CA
Villa Maria was having difficulty with the interdisciplinary team’s lack of understanding of speech therapy services. An Assisted Living resident was referred to speech services for cognitive deficits, and the ALF staff was having difficulty understanding the needs of the resident

Ashley Stanizek, our new CFY and outpatient ST champion, found out that the patient had a developmental disability that the staff and administrator never knew about. Ashley then in-serviced and coached the caregivers on the most effective way to communicate with this resident. The caregivers are now able to better communicate with this resident and meet her needs. The administrator was so impressed that she continues to send us ST referrals! Ashley continues to attend the weekly rehab meetings with the administrator and advocate for the Speech Therapy program. 

By the way, Ashley received the highest new-hire documentation review score I’ve seen so far in my time. Her documentation is great, she is a huge advocate for ST services, and she is passionate and dedicated to building the outpatient SLP caseload. We’re very proud of her! 
Introducing Jace Briggs PT, DPT, DOR, Temple View Transitional Care Center, Rexburg, Idaho
 Submitted by Cory Robertson, Therapy Resource, Idaho
Jace has been DOR at Temple View since October 2021 after being a staff PT at Gateway Transitional Care Center in Pocatello with Angela Anderson PT, DOR, who prepped him for leadership. Jace stepped in and hit the ground running and is such a pleasure to work with. He has a growth mindset and exemplifies CAPLICO. He is loved everywhere he goes and we are so fortunate to have him. He recently gave some perspective about some of the great things about being a PT in skilled nursing and specifically at an Ensign-affiliated facility: 

I had no intention of working in a SNF through school. I, like many students who enter PT school, had every intention of working an outpatient ortho-type job. COVID-19 made that very difficult. When I graduated, I spoke to two OP clinics and one pediatric clinic who had some interest in me working with them, one of them a specialized manual therapy clinic that really interested me, but the general response was “We don’t know what our caseload will look like right now with COVID-19; we will get ahold of you in a few months.” I took a job at Gateway in the meantime, as it was the only interview that had offered me the job and there was no contract if I did leave earlier. I even did accept a job at the manual clinic part time for just a few days and quit to stay at Gateway. Read On...
Happy New Year!
By Patty Fantauzzo, TPM, CTO, Julia Temple Healthcare, Englewood, CO
As I get ready to head out today, my heart is full of gratitude, hope, love and anticipation for all to come in 2022. I made a small picture collage of a few of my favorite memories from 2021 to share. If I were more tech-savvy, I could have prepared a slideshow with around 200 photos in it! I wish I had more pictures from the DOR gatherings. Those are some great memories as well. When I asked my therapists for a few “favorite memories” from JT 2021, their responses included: Sing-a-longs on Lavender, Top Golf Team Celebration, 4 Wheel Drive RIDES, MOTs for LTC Residents, JT SWAG, CNA/Nursing Secret Valentines, Staff Appreciation, and Giving Tree & Resident’s reactions.
 
I’m feeling blessed to be surrounded by a group of such amazing caregivers and friends. I am excited to see how much our teams grow and all that we accomplish together in 2022. May you all embrace the new year with an open heart and abundance of faith, hope, love and courage.
Therapist Profiles
Chris Rowe, OT, DOR, Estrella Health and Rehabilitation, Avondale, AZ
Submitted by Jessica Foster, DPT, CLT, Bandera Therapy Resource, Arizona
We would like to welcome Chris Rowe as the new DOR at Estrella Health and Rehabilitation in Avondale, AZ! Chris comes to us with a diverse clinical background as an Occupational Therapist and considerable experience as the former ADOR at Sunview Health and Rehab. While he was completing the DORiTO program, Chris also helped champion many programs at Sunview Health and Rehab, including their LTC program, with a focus on contracture/tone management and their wheelchair fitting program as well. In his spare time, Chris has had his hands full with DIY projects for his new home and enjoys spending time with his girlfriend and his dog. Chris is such a great asset to the team and we are lucky to have him!
Ben Fisher, PT, DOR, Desert Mountain Care Center, Indio, CA
Submitted by Aimee Bhatia, NCI Therapy Resource, California
We welcome Ben Fisher to one of our newest acquisitions: Desert Mountain Care Center in Indio, CA. Ben is a DPT who graduated from Loma Linda University, and has been practicing for 10 years with a passion for balance and vestibular rehab. He started out in outpatient therapy, worked in the prison system, and has more recently been working in skilled nursing since COVID hit. Ben has been DOR and the only PT at Desert Mountain for 10 ½ months. He leads a small but mighty team here and continues to seek staffing to help serve the residents at Desert Mountain Care Center. Ben is originally from Southern California, and although he lives in the desert, he loves the water. He loves outdoor activities, water sports, and anything that takes him out in nature. He has a calm demeanor, positive attitude, and has embraced the first day of transition with a smile. We look forward to getting to know Ben and his team as we move forward, and we are excited to grow Desert Mountain staffing in order to better serve the community.
COVID Clocks
Submitted by Maryann Bowles, Therapy Resource, Endura, Colorado
Julia Baux, SLP-CCC from the Health Care Resort of Colorado Springs, has been doing her own case study. She has identified COVID patients with no other pre-existing co-morbidities that cause cognitive dysfunction and is conducting cognitive assessments. 

Julia said, “When looking at research data, I found various studies indicating global cognitive impairment post-COVID ranging from 15% to 80%. Of those patients who were hospitalized for COVID, it appeared about 70% experienced cognitive impairment. I was noticing what appeared to be a higher percentage and noticed specifically visuospatial deficits. Therefore, I began collecting clock drawings of patients whose only diagnosis/reason for admission had to do specifically with COVID. Of the 16 patients, 14 have experienced or are experiencing visuospatial and other cognitive impairments.”
A Beautiful Act of Care at Southland 
Submitted by Keeli Anti, DOR, Southland Rehabilitation, Lufkin, TX
We honored the residents who had passed away in 2021 with our memory tree. We took down the ornaments yesterday, and pictured is what I am sending the family. 
I wrapped the ornament in some tissue paper and enclosed a picture of the memory tree with the following note:
Christmas time can be challenging for those who have lost loved ones.
Just as you thought you had opened that last Christmas gift, we have one more for you. Although this small handmade gift will not replace your loved one, please know they are remembered. Thank you for allowing Southland Rehab to be a part of your loved one's life.  
Sometimes, the smallest of things can have such an impact in a person’s life.
Gift Bags Say Thank You for
Keeping Us Safe  
Submitted by Amanda Marsella, Therapy Resource, San Diego, CA
The Therapy Department at Victoria Post Acute Care in El Cajon, California, delivered gift bags to their environmental services staff the week of Christmas as a thank-you for keeping all of us “safe, clean and clothed.” The Rehab department covered all shifts to distribute bags and ensure all staff members were recognized. The gift bags included hand sanitizer, hand soap, hand cream, Chapstick, gum/mints, gift cards, a drink tumbler, and notes of gratitude from the Rehab department. 
Pictured ( center) is Maria Morales, housekeeping dept., receiving her gratitude bag from the team
REDOC—A New Doc System for JTOPs Submitted by Kendra Ruzicka, Julia Temple Outpatient Services, Englewood, CO
REDOC is specifically designed for outpatient services. It’s been an interesting transition but, overall, a good move from Optima/ROX/NetHealth LTC-focused documentation system. REDOC allows collaboration between multi-disciplinary therapists to support holistic care of patients and uses a patient-centered approach to guide outpatient treatment documentation. This system has the ability to be personalized to meet all outpatient needs.

(Picture of Kendra doing Triple Check)
Gratitude for the Team at Opus 
Submitted by Sharon Merritt, TPM, Opus Post Acute Care, West Columbia, SC
Here are just a few of the sweet faces of my hardcore therapy staff that keep me sane and make sure the magic keeps happening!! 💗💗
L to R: Brittany Gantt DPT, Jennifer Schmauder COTA, Kimmie Kyzer PTA,
Meagan Yount OT
Living CAPLICO at Legend Oaks South Submitted by Ashlei Jackson, OTR/DOR, Legend Oaks Healthcare & Rehabilitation, San Antonio, TX
Legend Oaks South is a great workplace with a unique culture of its own. We emphasize love one another, teamwork, and ensure our residents get the best care with love. Legend Oaks South opened a COVID unit to help and serve the San Antonio Metro area.

We want to recognize our own HealthCare Hero from the Rehab department, Liz Banuelos, COTA. Liz offered her services to COVID residents by providing fun activities that created a positive environment in the COVID unit. This is a true example of selflessness and loving one another. Not to mention, we also had a couple of Nursing staff who did the same in our COVID unit. Legend Oaks South lives CAPLICO. 
Therapy / Nursing Partnership
Bridging the Gap at Copperfield 
Submitted by Kai Williams, Therapy Resource, Keystone East, TX
The Copperfield team is at it again! They continue to create a bridge between Therapy and Nursing by having dedicated activities for all to enjoy together. The Therapy Department spearheaded this most recent event. Loretta Johnson provided a beautiful description of the event and why it was so very much needed.
Bridging the Gap represents a means for the Nursing and Rehab departments to bring together diverse individuals with different skills and areas of expertise to develop and generate new ideas and unique solutions to enhance team performances.. Read On...
Teamwork Makes the Dream Work 
Submitted by Aaron De La Torre, Therapy Resource, Keystone Borderstone Market, TX
Having a decline in health can be an extremely challenging time for the individual and their family members. Typically, individuals who are admitted to the hospital can expect to be discharged to a skilled nursing facility, where they will receive therapy and nursing care and then be discharged home, where they will be serviced by a new set of therapists at home. At McAllen Transitional Care Center, the team has specialized in helping individuals receive an excellent continuity of care to assist them in their journey to return to their prior level of function. Jennifer Ybarra, DOR, and Ediel Barrera, ED, have worked hard to create a culture where patients are cared for from the time they are referred to McAllen Transitional Care Center until they have returned to their desired environment. Read On...
Veranda’s Fun Group Thursday 
Submitted by Aaron De La Torre, Therapy Resource, Keystone Borderstone Market, TX
Providing therapy services during the COVID-19 pandemic has been more essential than ever to improve the outcomes of the residents we serve. With all the social distancing mandates that have been implemented to keep our residents safe, our interdisciplinary teams have been hard at work to ensure that therapy is provided in a safe and efficient manner. However, with social distancing also comes more time alone, which can lead to unwanted consequences. 

If you were to visit Veranda Rehabilitation & Healthcare in Harlingen, Texas, on Thursday morning at approximately 10 a.m., you would witness the amazing way they encourage safe socialization while improving residents’ functional skills. You would find several groups of residents playing an adapted version of volleyball, where residents are holding pool noodles and working on their dynamic reaching and core strengthening as they hit a balloon over the net. Do not be surprised if you see some friendly competition between residents and therapists! Read On...
When the Going gets Tough, Keystone Gets Tougher
Submitted by Kari Rhodes, MS, CCC-SLP, Therapy Resource, Keystone West TX
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! Read On...
Therapy/Activities Partnership at Westover Hills
Submitted by Andy Cisneros, Therapy Recruiting Resource
At Westover Hills in San Antonio, Texas, Therapy has taken a front seat role in planning and facilitating the operation of resident activities so they can become more geared toward a therapeutic approach. There are a variety of activities that can have a positive impact on our patients' health, touching all elements of their wellbeing. However, many of these activities require more manpower to achieve than a single Activities Coordinator can handle, and that is where the Therapy department can help. Therapists can provide skilled group therapy as well as identify appropriate activities for residents based on their functional and cognitive levels. Our Activities Director has a more robust menu of activities to offer when our therapists partner with this department. 

Many people do not realize the importance that activities play in the SNF setting. The main objective of activities is to improve the quality of life for our residents psychologically, socially, spiritually, and physically. The ED at Westover, Jerry Hoyler, understands this and challenged the Rehab staff to take a greater role in the activities programming: “Rehab has the ability to take what is considered a normal activity and enhance it to something therapeutic that will benefit the resident tenfold and provide a stronger clinical outcome.”
Assisting Nursing with Skin Integrity  
Submitted by Sara Speller, OT/DOR, Heritage Park Healthcare and Rehabilitation, Roy, UT
(Pictured are Heather Lovelady, PTA and Whitney Perry, RN)
A patient was admitted to Heritage Park Healthcare and Rehabilitation with extensive wounds below the knee on his LLE. The MD recommended a BKA as a result of the lack of healing and extensive tissue damage. Complicating factors were his history of AKA on the other side and his lack of insight into the severity of his status. His ALF indicated that they would be unable to take him back without having his leg completely healed 2/2 due to the risk of change of condition with the wounds in place.  

At this time, Heritage Park’s therapy team had initiated a program that focused on assisting nursing with skin integrity, including positioning and education regarding those individuals for which this is crucial in their healing processes. Therapy focused on splitting sessions up throughout the day and returning to his room for repositioning and education to him and to staff in order to improve circulation and avoid pressure and/or other complications. In conjunction with an excellent in-house wound nurse and external wound care team of practitioners, Heritage Park was able to fully heal the patient’s leg and he was able to begin discharge planning to his ALF. 

This is a good example of therapists being able to utilize our knowledge and therapeutic use of self in order to supplement and/or replace some of the nursing department’s efforts while having a positive impact on health and function. 
Pets for Seniors 
Submitted by Arjun Dutt, DOR, Ukiah Post Acute Care, Ukiah, CA
Adjusting to life in a nursing home can be difficult, particularly for seniors who have lived independently. Transitioning to a nursing home can mean separation from family, friends, routine activities and social gatherings, especially during COVID-19. The transition and resulting loneliness can be offset with the addition of a therapy pet. Recently at UPA, we had Beaumont and Brighty, miniature donkeys, visit our residents. Evidence suggests pet therapy greatly benefits patients with dementia, and our residents had a dramatically improved outlook and engagement with the animals. 
 
Pets are proven stress relievers for seniors and also promote social interaction. Some of the health benefits include reduced blood pressure and risk of cardiovascular disease as well as triggers for cognitive development. We strive to create a homier and livelier environment for our seniors at UPA. Special thanks to Lynnae Cummings, LPTA, for arranging the visits.
Pacific Care Flood 2.0 
Submitted by Scott Langdale, Therapy Resource, Pennant, WA
Pictured are Lou Antiquiera, DOR/CTO and his rehab/moving team

Earlier this month, Washington state received record rainfall. Pacific Care had undergone a full closure and remodel a few years ago due to flooding, so all were nervous and anxious to see how the new improvements would hold up. All hands were on deck to move patients safely to the dry areas of the building, and luckily, all the residents were able to shelter in place without having to evacuate. Pacific Care is now in the rebuilding phase again for several rooms, but luckily the remodel from the first flood reduced the impact. Big thanks to all the Pacific Care employees and cluster partners who helped! 
Celebration!
Apex (formally Keystone North Central) is Managed Care Excited! 
Submitted by Stephanie Winkler, M.A. CCC/SLP, Therapy Resource, Central Texas
We have had some wonderful training from many Resources from our Managed Care Team. The fabulous Paola DeLuna, Therapy Resource for Keystone, has been helping us building by building in the Apex Market! She is also helping us identify the correct payers so they import correctly into PCC. Many times we think we have it correct, but with all the changes lately, we needed to refocus on this!  

We are now holding more in-depth discussions on the clinical picture of the patient, and as result, we are able to ensure that the acuity of the patient matches the Level of Care that we are reimbursed for. Apex wants to thank all the Managed Care Team and Resources that have helped us refocus to get these conversations going!  
Congratulations, Mark Walker, DPT, DOR, Orem Rehabilitation, Orem, UT 
Mark Walker quietly won the Alter G best practices PT award — this was a national competition! He was nominated without even knowing. How cool is that?

Let’s celebrate the good out there and make the seemingly small things HUGE! We all need the boost! 
Congratulations Mike Cons,
Bandera’s Newest CTO 
Submitted by Kelly Schwarz, Therapy Resource, Bandera, AZ
Please help me in congratulating Mike Cons, MOT, OTR/L for becoming Bandera’s latest CTO! Mike has been DOR at Lake Pleasant Post Acute Rehabilitation in Peoria, Arizona, for three years. During this time, Mike has grown two DORs who are in Phoenix and Texas, not to mention Mike is grooming his next DOR already!  

Mike has played an integral part in the Lake Pleasant IDT, including PDPM, BIMS, and focusing on QMs to help the facility maintain 5 stars QM. Mike has worked to increase programming for LTC patients to enhance their quality of life.. Mike continues to strive to be the best and has plans to grow Outpatient, including developing a worker’s comp program and continuing to grow his Therapy team.

When Mike is not working, he is spending time with his wife, his 2-year-old twin daughters and 4-year-old son. Mike is also impressing Bandera with his golden touch on sports betting!
Congratulations to Our Newest SPARC Winner!
Aubrey Clement, OTA, Grad Date: May 2022, Salt Lake Community College,
West Jordan, UT
Read her awesome essay below:
Growing up, we always had a wood stove for heat. I learned that sometimes because of different factors, the fire would go out, but by applying a spark in the right place and by bringing the fuel together with others, the spark could reignite the fire and soon a cheerful fire could be created, generating the heat to warm us all. I envision my education and training, combined with compassion, will be able to provide a spark in the lives of my patients and help them reignite the fire for life as they are able to develop independence. I can accomplish this through a passion for continued learning, accountability and applying evidence-based practice in my daily routine with patients. Read On...
Welcome!
Touchstone Market Welcomes Two New Facilities
By Nelson Layos, Therapy Resource, Touchstone, CA
Effective February 1, 2022, the Touchstone market will add two new facilities to their family of Ensign affiliates: Arrowhead Springs Healthcare in San Bernardino, California, and Desert Mountain Care Center in Indio, California.
 
Special thanks go out to Touchstone DORs and especially to Tim Middick (L) and Don Blomquist (R) from Premier Care who assisted with interviews of possible DORs and staff, following up with therapists daily and recognizing what equipment was needed. Thank you to all Touchstone DORs who will assist the staff during their first week.