27101 Puerta Real, Suite 450
Mission Viejo, CA 92691

By Willow Dea, Leadership Development
The land swelled below the wing of the plane in gentle shades of green and brown, revealing ample squares defining crops, and the perimeter of a small community where various creeks meander through town before combining to become the Walla Walla River, which drains into the Columbia River about 30 miles west of town. Park Manor Rehabilitation Center is nestled in the farmlands of eastern Washington.

One sweltering hot morning, Sonya, DOR and Zewdi, DON and the IDT team calmly evacuated over two dozen residents to the dining area to preempt any issues with dehydration in a seamless flow of activity. The team identified that the temperature in one wing was too high for the medical well-being of their residents and made the decision as a group during the morning Standup Meeting. Within minutes, people self-organized to provide a pleasant alternative to the overheated area of the building for the patients in the affected wing. Soon the residents were seated comfortably in the dining room, offered beverages and provided with activities to engage them for the morning. Being a part of this particular morning left me with a powerful experience of Ownership, a core value for us at Ensign.   Read On....

B y Mary Spaeder, Director of Therapy Services
I experienced the power of team coherence when I walked into Brookfield Healthcare Center this year for their Independent Review Organization (IRO) audit. Not only was the team calm, smiling, and prepared, but the love and reverence that they expressed toward one another and their patients was palpable. Octoavio Zepeda, our COTA and certified HeartMath facilitator, had just led the team through a “heart lock-in” technique to synchronize their heart rhythms, reduce stress, and create harmony among the team. Using the HeartMath techniques is a simple and quick way to bring your teams closer, reduce overwhelm, and increase resilience. Reach out to your therapy resource if you want a presentation on how to bring this to your team!
Heartrate Variability Training — The Resilience Advantage
By Sonya Taylor, OTR/L, Park Manor Rehabilitation Center, Walla Walla, WA
You Experience the World By How You Feel!
       What is your filter/emotional soundtrack?
       You can rewire your brain by listening to your heart. Read On.. .
The Two-Minute Denial Reflector
Evaluation vs Treatment Notes
By Lori O'Hara , MA, CCC-SLP, Therapy Resource - ADR/Appeals/Clinical Review
CMS doesn’t define a lot of requirements for what needs to be in a daily note. Understanding that it’s what happens during the session drives the content. But one of the places where they do define a requirement is on the day of the evaluation. Because evaluation minutes don’t count towards the calculation of a RUG score, but treatment minutes do count, they want to be able to see easily that those things were different when they occur on the same day. That means a narrative entry is always required when treatment occurs on the day of the evaluation.   Read On...
Compliance Corner
Updates! A Look Back, What’s Happening Now and a Look into the Immediate Future
By Brian del Poso, Associate Compliance Partner
With just about three-fourths of the year completed, it’s a good time to provide an update on where we stand compliance-wise and what’s on the horizon for the rest of the year. Therapy documentation and technical accuracy has come a long way, so kudos to all of you. There are still a few areas, however, that we can pay closer attention to. These items will sound familiar as they have been identified in years past and have improved, but we definitely still need to consistently get better at:

  1. Physical agent modalities documentation
  2. Co-tx documentation
  3. Personalized clinical assessment in Progress Reports
  4. Documentation and justification for billing patient education, especially when residents are difficult and/or refusing treatment

Again, there has been improvement in these areas, but there’s definitely a high ceiling for growth. I encourage you all to seek further education and training in these documentation areas. The easy way out would be to look at some of these things and just say, “Well, we just won’t do co-tx anymore,” or “We don’t use physical agent modalities often, so…,” but the easy way out isn’t who we are. Let’s invest in each other and in the spirit of our core value of PASSION FOR LEARNING, and utilize the therapy resources, POSTettes, and compliance partners we have at our disposal to move ourselves forward.  Read On.. .
The Shawnee PARC therapy team celebrated their successful completion of the on-site IRO visit with an evening at Top Golf. We had a great time sharing appetizers, laughs and personal experiences with each other. Many therapists shared their thoughts and feelings about the IRO visit, and all agreed that although the preparations were stressful, the amount of knowledge they gained was invaluable. In the end, they all were thankful for the experience and appreciated the professional growth! I truly believe this experience has brought the team closer together and has paved the way for greater communication and dialog between therapists and departments.

Congratulations to all facilities who passed their IRO audits! Here are some recent celebrations:
Brookfield Healthcare, Downey, CA
The Healthcare Resort of Colorado Springs, CO
Rehab Center of Des Moines, IA
Heritage Park Rehab & Healthcare, Roy, UT
Golden Acres, Dallas, TX
Legend Oaks - Kyle, TX
Redmond Care & Rehabilitation, Redmond, WA
First Annual Dragon Boat Race!
In July of this year, a team of Southern California therapists and nurses competed in their first Dragon Boat Competition in Long Beach, California. They competed against well-established teams from hospitals and industries across the country and surprised everyone when our rookies placed fifth! The competition is one of the largest in the country and attracts all levels of athletes. Dragon boat racing has its roots in ancient China dating back over 2,000 years. A dragon boat is a long, colorful boat, and each boat is propelled by 20 paddlers, a drummer and a steer person. This year, our Team Captain was Peter Cruz (Mission Care DOR) and Team Leader Edwin Fermin (Brookfield Lead OT). Contact Lito Ortiz ( ROrtiz@ensignservices.net ) if you have interest in joining his team or forming one of your own! 
By Jordynn Knipp, DOR, The Healthcare Resort of Olathe, Olathe, KS
I wanted to officially introduce our newest Kansas Rock Steady Boxing Coaches: Jill Casey Weyer – COTA, Valerie Briggs – OT, Nik Kalinichenko – PTA! They have had their new titles for one week and had 5 calls for patients ready to start the program. We are super excited for what’s to come!

Rock Steady Boxing (RSB), a 501(c)3 nonprofit organization founded in 2006, gives people with Parkinson’s disease (PD) hope by improving their quality of life through a non-contact, boxing-inspired fitness curriculum. RSB’s mission is to empower people to “fight back” against Parkinson’s disease and enriches both individuals and the community by improving the wellness of older adults. Read More Here....
Pictured L to R: Jill Casey Weyer – COTA, Valerie Briggs – OT, Nik Kalinichenko – PTA
Passion for Learning!
Contact Nelson Layos, nlayos@ensignservices.net , for information on the Pelvic Floor Rehab course (pictured above).

Madeana Galler is conducting a lunch and learn on the new Patient Driven Payment Model at each facility in the Emerald Market — only two have been completed thus far, but she has all facilities scheduled — using the PDPM slides from Deb Bielek's most recent IDT training webinar. Initially she planned to just present to the therapists; however, the DORs have invited the ED, DON, MDS and Physiatrist. It has been a great success thus far. On Monday evening, Aug. 27, Elyse Matson conducted 1:1 training and a CEU course for the SLPs.

Sam Baxter, Therapy Resource for Signum-San Diego, reports that they had a two-day course in San Diego on Visual Rehabilitation & Neuro Handling After a Neurological Incident … Concepts for Function, presented by Michelle Mioduszewski, MS, OTR/L. The course presented concepts of the physical care and evidence-based principles to create results in clinical interventions for stroke, hemiplegia, brain injury, spasticity and general motor control issues. The course will focus on perception and oculomotor deficit remediation and compensation after a neurological event. Click the following link for more information.

Therapy Resources Kelly Alvord and Dominic DeLaquil are presenting at the AACVPR annual meeting in September in Louisville, Kentucky. The title is, Innovating with Unexpected Partners: How to Identify and Work with Quality Skilled Nursing Facilities to Increase Participation in Your Cardiac Rehab Program.
Sharing Therapy Strategies
Willow Bend Increases Quality of Life with Jobs 
By Barbara Mohrle, Therapy Resource and DOR , Willow Bend Nursing & Rehabilitation, Mesquite, TX
At Willow Bend, we are thrilled with a new program that our speech therapist, Chandler Lemaster, has started wherein she has been training some of our LTC residents in “jobs” to do around the facility. “There’s a correlation between having jobs and increasing quality of life,” Chandler explains. “They feel like they have a purpose, and it can increase cognition and decrease depression.”

Some of the jobs include: door greeter, folding towels for laundry, rolling silverware and setting dining room tables. The job assignment all depends on residents’ interests and cognitive level. The gentleman below was an engineer, so we taught him how to fix wheelchairs. We have never seen him smile so big as when he fixed the brakes on his own for the first time! The positive response from the other therapists who observed his excitement made me feel like this program is the beginning of something great at our facility!
Better Than Tape!
By Dominic DeLaquil, Therapy Resource - Idaho
Owyhee Health & Rehab in Homedale, Idaho, installed a new gym as part of an 18-bed addition in July.

Instead of putting tape on the floor to do their TUG testing, the rehab team at Owyhee requested to have 10-foot and 20-foot strips of lighter floor color.  
Parkinson Disease Program
By Madeana Galler, Therapy Resource - Emerald Market, Kansas
The Emerald Market has been focusing on building a partnership with the Heartland PD Foundation in an effort to enhance and grow our facility programs. Initially we met with the Foundation’s Community Program Manager, Kim Nitz, to inquire if they had any unmet needs and to discuss how we could possibly meet those needs. Her first response was sponsorship of their fundraising and awareness events like The Moving Day PD Walk and secondly providing meals after their weekly exercise class to both participants and their caregivers.

As a Market, we became a Bronze Sponsor — as shared in a previous FlagPOST. Beginning in May, the Healthcare Resort of Kansas City, Riverbend PARC, the Healthcare Resort of Leawood, and the Healthcare Resort of Olathe started providing lunch for 25 participants and their caregivers on a monthly basis. The focus was more on building relationships rather than heavily marketing our programs/facilities per the request of the Foundation.  Read On....
Motion-Guided Laser
By Tamala Sammons, Senior Therapy Resource
Our innovative Brookfield team from Downey, California, is at it again! They are using The Motion Guidance laser feedback system to add fun to ROM and functional movement exercises for patients with all levels of function.
The laser pointer is mounted on any limb or even around the head. The patient then uses the laser beam to trace patterns for increasing movement and/or balance. This pioneering team, led by Lito Ortiz, is always looking for ways to keep therapy fresh and creative to achieve amazing outcomes!
2018 Poster Presentations
Thank you to all who presented posters at the recent DOR Leadership Meeting! If you did not have the opportunity to view the awesome activities our therapy teams are working on, check them out below!
“URINE” for a Surprise
The Introduction to Percutaneous Tibial Neurostimulation at Parklane West for Urinary Incontinence
By the Rehab Team at Parklane West, San Antonio, TX
What is PTNS?
Percutaneous Tibial Neurostimulation (PTNS) is a procedure in which a 34 gauge needle is inserted into the tibial nerve pocket of a patient, connected to the NURO™ device. Read On...
Emojis of Care
By Elizabeth Brewer, OTR/ADOR and Tawaine Vigers, CCC-SLP/DOR, Legend Oaks, Katy, TX
Elizabeth Brewer, Lead Occupational Therapist and Assistant Director of Rehab, has served the Legend Oaks Katy community for over six years. Beth is passionate about developing programs to enhance a patient's overall quality of life. From this passion, Emojis of Care was born! Read On...
Camarillo Healthcare Center Presents “The Chalkboard”
By Julia Schmutz, DOR, Camarillo Healthcare Center, Camarillo, CA

If you have $50 and some wall space, you can implement this creative idea in your department. Have Fun!
Genius is making complex ideas simple…Albert Einstein.
Therapy Abroad With Hearts in Motion (Corazones en Movimiento)
By Carolyn Pluta, DOR/OTR/L, Arvada Care and Rehabilitation, Arvada, CO
Hearts in Motion provides medical care and social programs for individuals ranging from infant to older adults to complement resources already in place in the United States and Central and South America. Read On...
LSVT Big/Loud for Parkinson’s Disease
By Jared Lundquist, PT/DOR, Monte Vista Healthcare, Pocatello, ID
LSVT focuses on increasing the amplitude! ... The principles of the LSVT program train clients on first recognizing the sensory component of PD and then how to think and be bigger/louder...People with PD can get better. Read On...
Tai Chi for Parkinson’s Disease: A Case Study
By Jeremy McCorristin, DOR/PT, DPT, Holladay Healthcare Center, Salt Lake City, UT
..Exercise can improve many PD symptoms. The Parkinson’s Outcomes Project shows that people with PD who start exercising earlier and a minimum of 2.5 hours a week experience a slowed decline in quality of life compared to those who start later.   Tai Chi is becoming increasingly popular as a treatment  Read On...
Seating and Positioning 
By Todd Burgener, DOR/PT, DPT, CBIS, Paramount Health & Rehabilitation, Salt Lake City, UT
Paramount has documented improvement in skin integrity, decreased pain and overall quality of life. Patients now have renewed independence and ability to access their environment with significantly less pain or discomfort. Read On...
Wheelchair Safety & Mobility
By MaryJo Walker, DOR, Coronado Healthcare Center, Phoenix, AZ
On March 19, 2018, one of our LTC residents was struck by a car and killed while crossing the street in the crosswalk in his electric wheelchair... As a result, our IDT team met and decided that we needed a plan to help ensure that all our residents, who were allowed on passes to leave the building, whether by electric or manual wheelchair, walker, cane or without a device, were as safe as possible. Read On...
Creating a Dementia-Friendly Environment
By Patty Fantauzzo, TPM/COTA/L, Julia Temple Healthcare Center, Englewood, CO
...The goal of modifying neighborhoods where residents with cognitive impairments live is to enhance the physical and social environments, which in return can improve quality of life and possibly reduce the need for psychotropic medications and the frequency of negative behaviors. Read On...
Building Your Next One Up
By Jennifer Kuehn, DOR/PT, DPT, WCC , The Villas at Sunny Acres, Thornton, CO
Let’s Build a Solid Backup
      Recognize who has that potential - Delegate responsibilities and see who rises to the occasion...Yes, this may create more work for you initially, but the investment is well worth it.
Today, the Purpose Is to Have Fun!
By Rachel Thompson, DOR/OT
Millennium Post Acute Care, Rockhill, SC

What do you do when you see your team or someone on your team who seems frustrated, disconnected, exhausted or just needs a pick-me-up? What if I told you all you had to do was get them to have some fun? .... Luckily, we can trick our brain into creating a feel-good cocktail  .
Student Program Development
By Asa Gardine, DOR/OT, Coral Desert Rehab,
St. George, UT

Local Therapists Save the Day
How two therapists (Lindsay Rankin DPT and Edwin Stevenson PTA) changed the landscape of Coral Desert’s student program in under six months. Read On...
Can Students Impact Programming? 
By Abby Marschman, DOR/PT, Horizon Post Acute & Rehabilitation, Glendale, AZ
Our team consists of three PTs, two PTAs, two OTs, 3 COTAs and one SLP. However, we take an average of six students per year who add additional value to our team. The students include every discipline. 
Utilizing Our Rehab Aides
By Mark Walker, DOR/PT, DPT, Orem Rehab and Nursing, Orem, UT
Our rehab aides/techs are the lifeblood of many of our departments and are an integral part to helping the department run efficiently and effectively. The rehab aide/tech can help with a multitude of tasks, which may include: Read On...
I DT: Collaboration Between Disciplines 
By Brandon Larson, SLP-CCC and Cathy Bowman, DOR/OTR, Rock Canyon Respiratory and Rehabilitation, Pueblo, CO

The only skilled nursing facility South of Denver with a comprehensive respiratory unit available 24/7, Rock Canyon utilizes an interdisciplinary approach, modern equipment, and up-to-date, evidence-based practices...   Read On...
Abilities Care Approach Program — Its Beginning Stages
By Katie Case MOT, OTR/L, Jemelie Koda SLP, Nicole Veniegas, DOR/MS, OTR/L , Magnolia Post Acute Care, El Cajon, CA
Although we have an activities department to assist with group activities, we were noticing how many residents were unable to participate due to the activity being too low/high level or it not being of interest to the resident In addition, some patients who were not engaged in activities were demonstrating behaviors such as anxiety or agitation. Read On...
Abilities Care Approach: Life Story Boards
By Amanda Grace, OT, Cloverdale Healthcare, Cloverdale, CA
The Life History Profile is completed to gather information about interests, retained abilities and past meaningful and positive experiences and memories. Read On...
Abilities Care Expert (ACE) Training Program
By Jennifer Raymond, Therapy Resource/SLP, Park View Post Acute Care, Santa Rosa, CA
Park View Post Acute Care Team’s long-term program goal is every staff member in the facility will:   Recognize the meaning of the four color-coded dementia levels,   Understand the associated strengths, problems and care strategies associated with those levels,   Implement that knowledge expertly in providing resident-centered and abilities-driven care. Read On...
New Fitness App for Amputees
By Gina Martinez, SPT, Sonterra Health Center, San Antonio TX
...as the prevalence of lower amputations continue to rise, what can we as healthcare providers do to prepare and prevent re-amputations from occurring? T he “Fitness for Amputees” app is a free app that contains several easy-to-follow exercises ... Read On
Going Alarm-Free
By Nicole Onizuka, DOR/SLP, Broadway Villa Post-Acute, Sonoma, CA
Staff was showing “Alarm Fatigue” (desensitization to alarms due to a high rate of false alarms resulting in ignoring or a delay in addressing alarms) ... Read On
Advanced Tissue Closure Protocol for Therapy
By Kyle Hazen, PTA, RPM, Englewood Post-Acute and Rehabilitation, Englewood, CO
At Englewood Post-Acute and Rehabilitation, we pride ourselves on having a 100 percent success rate with all the Advanced Tissue Closure patients we have been fortunate enough to take care of. Following protocol and an interdisciplinary approach of care is what makes us so successful. Read On...
A Case Study: Neuroplasticity & Functional Outcomes 
By Karen Swisher, PTA & Jeremy Osmond, DOR/DPT, Provo Rehab and Nursing, Provo, UT
        The brain can change its own structure and function through thought and activity.
        A damaged brain can often reorganize itself so that when one part fails another can substitute. Read On...
Want to Go Home?  
By Tyler Petty, DOR/PT, Montecito Acute Care and Rehabilitation, Mesa, AZ
Acknowledgements: Montecito Therapy Team, Caitlin Seifert
Our team of three PTs, six PTAs, two OTs, five COTAs and two SLPs invested in a collaborative effort to improve function enough in some of our LTC patients to enable them to discharge to a lower level of care. Read On...
T he Big Picture Mindset 
By Joseph Chua, PT, Cloverdale Healthcare Center. Cloverdale, CA
Understanding the continuity of care in a long-term care setting is the first step in developing a big picture mindset. It will start when a patient is referred to therapy for a certain problem that skilled therapy intervention can address. 
Dysphagia Precautions
By Kagran Franco, M.S., CCC-SLP Calias Dull, B.A. Armando Cruz Jr, PTA, TPM, La Canada Care Center, Tucson, AZ
We as an Interdisciplinary Team were facing a challenge when communicating between Therapy, Nursing and Dietary staff diet textures and understanding risks involved with Dysphagia and aspiration precautions. We noticed a lack of knowledge when it came to diet textures, dysphagia and aspiration precautions.  Read On...
Lifestyle Redesign – Promoting Health and Well-Being Through Occupation
By Diana Brown, MOT, Gateway Transitional Care Center, Pocatello, ID
Acquiring health-promoting habits and routines in daily life enhances health and psychosocial well-being, through use of meaningful occupations (cultural and personal meaningful activities of daily life). Read On...
Fifty Grades of Shea (PARC)
Submitted by Shea Post Acute Care, Scottsdale, AZ
The MSCA experience at Shea PARC created a building block for culture that has organically spread throughout the entire management team and all of Shea PARC. With a culture embodied in CAPLICO, Shea PARC has experienced incredible growth in both census and financials. Read On...
Vestibular Rehab Therapy
By Jen Wintle, Therapy Resource/DOR, PT, DPT, Sloan’s Lake Rehabilitation Center, Denver, CO
Vestibular Rehab Therapy (VTR) is defined as the systematic progression of exercise protocols which reduce or extinguish hallucination of motion, exaggeration of motion or after-motion. Read On...
Increasing Concurrent Treatment Delivery
By Larissa Osio, DOR/ MS OTR/L, Granite Creek Health &Rehabilitation, Prescott, AZ
How to get your team to buy into concurrent/group treatments? Read On...
Group Therapy: Putting the FUN in FUNctional
By Haylee Rollins, COTA, Kelsey Martindale, DPT, Lisa Brook, PT/DOR and Mina Jelen, PTA, St. Joseph Villa, Salt Lake City, UT
Why do we do group therapy at St. Joseph Villa?  Read On...
CMI: The New DOR Metric
By Andy Cisneros, TPM/PTA, Legend West San Antonio, San Antonio, TX
CMI-case mix index is a metric that is typically driven by the MDS nurse or the MDS resource. My hypothesis is that if the DORs are the owners of the process that there will be an increase in building CMI.  Read On...
Sexuality and Healthcare: A Manual for Occupational Therapy
By Courtney Jacobson, MOTR, and Cathy Bowman, DOR/OTR, Rock Canyon Respiratory & Rehabilitation, Pueblo, CO
The topic of sexuality has not been addressed in its entirety within the profession of occupational therapy in literature or practice. Sexuality has been identified by patients as a topic that needs to be addressed in order to receive comprehensive and holistic care  .