2016 Leadership Summit
Each year, outstanding leaders in therapy are selected to attend a therapy leadership summit based on performance in several key areas, including financial results, clinical results and outstanding culture. The Summit is a chance for the best of the best to come together and celebrate, rejuvenate and learn. This year, our Therapy Leadership Summit took place in beautiful Sedona, Arizona, in a retreat-like setting using leadership development materials from the book  Contagious Culture. The book takes a deep dive into the impact that our presence has on how others respond to us. When we become aware of how we are "showing up"  for every interaction, we have the ability to create a culture that allows our teams to thrive. The selected leaders continue their learning and influence from the Summit in the form of a leadership counsel, where they work in smaller clusters to provide feedback and recommendations to our therapy leadership throughout the year.
by Mary Spaeder
Compliance Corner
Are You a Leader?
By Jack Rolfe, PT, MNA,CHC,RAC-CT
Lead Compliance Partner, Milestone & Endura
"If your actions inspire others to dream more, learn more,do more and become more, 
you are a leader."  ~ John Quincy Adams
My  first memory  of the image of leadership  was formed  when I was eleven  years old. I  was with a group of  my peers  participating in a scouting activity  at our  church.  My father was also in  attendance as one  of the scout group leaders. The individual in charge of the meeting  was at the  front of the room conducting the function. This person asked if everyone in the room would move closer to the front row. I  remember looking at my buddies and we were  all frozen with the  thought "this would not be cool to do what the leader had asked us to do."  Then a sharp impulse  came into my mind. I stood up promptly  and stated,  "come on  guys, let's move up."   Everyone  followed and the task was completed. Upon returning home that evening my father  said to me,  "That was amazing  what  you did today."had no  clue what he  was talking about and stared  at him like only  an eleven  year old could do. He repeated to me what he witnessed in the simple act of moving with my  friends to the front of the class. He  stated, "You  are a leader." His statement  touched my soul deeply and has remained with me throughout my  life.

....So, I extend to you an opportunity to express your leadership gene. Here is the challenge...
Cardiac Specialty Programs:
Why Should They Matter to You?
Research shows that most hospitals have a cardiac diagnosis within their top five admitting diagnoses. CMS has identified heart failure and MI as two of the most expensive diagnoses for Medicare, and new cases are increasing at a rate of 550,000 annually.
The next bundled payment being considered by CMS  is cardiac conditions.
Where Does the SNF Fit Into All of This?
Clayton South, Executive Director
Four Reasons Why Cardiac Post-Acute Rehab Care Fills the Gap between Hospital and Home
Monte Vista Hills, Pocatello, ID
Published online by The Idaho State Journal, Nov. 4, 2016

Every 42 seconds, a person suffers a heart attack. Despite the fact heart disease remains the leading cause of death in both men and women in this country, the incidence of death because of heart disease is declining. And if you are one of the more than 30 percent who survived a heart attack last year, consider yourself lucky. Your second chance at life is about to get better, and the staff at Monte Vista Hills Health Care Center is here to help.
"I've seen this Heart PARC (cardiac post-acute rehab care) program help numerous lives for the better," said Clayton South, executive director for Monte Vista Hills. "It has provided excellent outcomes throughout the industry, and I'm excited about its implementation here at Monte Vista."

Heart PARC Case Study
Park View Post Acute Care, Santa Rosa, CA
Heart PARC (post-acute rehab care) is a multi-disciplinary approach to working with patients who have cardiac diagnoses. The therapists and nurses work closely to partner with cardiologists in the community so that they can fine-tune established protocols for cardiac care. Many patients are not yet ready to return home with home health services after a cardiac surgery or a cardiac episode, and the program is the bridge to get them home safely. The Heart PARC program uses evidence-based approaches and is outcomes-based. A great example of excellent results from this program comes from Park View Post-Acute Care (PVPA) in Santa Rosa, California.   
Learn More 
(L) Franco Estacio, DOR,  with Dr. Hani Bashandy
Clinisign Q&A With Dr. Hani Bashandy
Victoria Healthcare Costa Mesa

At Victoria Healthcare Costa Mesa, we conducted a Q&A with one of our doctors, Dr. Hani Bashandy, about our newest Optima product, called Clinisign. Victoria Healthcare is one of the pilot facilities of Clinisign. So far, we have signed up three doctors to this program. Dr. Bashandy has been a huge supporter of Clinisign, and he was kind enough to share his thoughts about the product. Click here for the interview.
Surf's Up!
  Life Rolls On
By Sam Baxter and Amanda Marsella, Therapy Resources-Signum
"Founded by world champion quadriplegic surfer Jesse Billauer, "Life Rolls On" is dedicated to improving the quality of life for young people affected by spinal cord injury. Believing that adaptive surfing and skating could inspire infinite possibilities beyond paralysis, "Life Rolls On" began as a splash into the unknown on Sept. 11, 2001; achieved 501(c)(3) nonprofit status in 2002; and now touches the lives of hundreds of thousands ( www.liferollson.com )."
Essentially the event helps individuals with special needs to be able to surf. Each person is given 30 minutes and assigned a team. In the picture, you will see just one team. All those people were helping that one surfer.
Sharing Therapy Strategies 
Therapy Summer Olympics
By Maresa Madsen, DOR, Pinnacle Nursing & Rehab, Price, UT
In August, the Pinnacle Therapy team and other staff put on a Therapy Summer Olympics for all short- and long-term residents. Residents had the opportunity to participate in many different events, including: six-minute marathon, shot put, discus, 6 meter dash, strongest legs, strongest arms, grip strength, olympic ring toss, dexterity, cycling, golf, shooting, fencing, and soccer. Therapy utilized standardized tests in these events; for example, the 6 meter dash is the Timed Up and Go test (TUG), and strongest arms is the arm curl test
Community and IADL Reintegration Toolbox
Kathryn Case,OTR/L, Magnolia Post Acute Care, 
El Cajon, CA

In the post-acute rehabilitation setting, we see many different types of patients from different socioeconomic backgrounds, ethnicities and cultures, as well as different prior levels of function. As occupational therapy professionals, it is our job to identify the needs of our different patient populations and address a treatment plan that allows for a safe return to prior levels of function. Oftentimes, this includes our independent activities of daily living in our community-dwelling older adult population. I strongly feel that while basic ADLs definitely have a role in the SNF setting...IADLs have been largely overlooked...

Tai Chi at Holladay Healthcare
By Jeremy McCorristin, PT/DPT and DOR, Holladay Healthcare, Salt Lake City, UT
Holladay Healthcare has been developing programs to assist people with Parkinson's disease. We currently provide both the LSVT BIG and LSVT LOUD therapy treatment approaches by licensed and certified PTs, PTA and SLP. These approaches focus on improving amplitude of motor movements and voice projections, due to the decrease of these processes associated with Parkinson's disease.
To go along with our LSVT therapy, Holladay Healthcare started providing tai chi classes to the community last year. We have been working with the Mountain West Parkinson Initiative (formerly known as the Utah Parkinson Association) to help increase awareness of these classes.

Using Bundled Payments for Care
By Dora Alvarez, COTA/L Therapy Program Manager
Sabino Canyon Rehabilitation and Care, Tucson, AZ

Sabino Canyon Rehabilitation & Care Center is always working to create a sense of community. Our dedicated, compassionate staff strives to exceed expectations and make a difference in the lives of those we serve by providing exceptional care and service and remembering they are the reason we are here. As part of this commitment to our community, we opted to participate in the Bundled Payments for Care program on Oct. 1, 2015.
The BPCI initiative is comprised of four broadly defined models of care, which link payments for the multiple services that beneficiaries receive during an episode of care. For example, Sabino Canyon's focus is on medical non-infectious orthopedic and major joint replacement of the lower extremity. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare.
Somerset Subacute Nursing and Rehab, El Cajon, CA
By Michelle Worth, PT, DOR  
At Somerset Subacute Nursing and Rehab, it's not just a job for our rehab team; we also enjoy each other's company. We always find time to eat and celebrate!
At the same time, our therapists are always working diligently to find the best ways to support our patients through rehab. Click below for some of the highlights of our rehab team's efforts.
An IDT Approach to Therapy
By   Craig Chang OTR, Scott Judd PT, & Kristen Weaver OTR
Rosewood Rehabilitation Center, Reno, NV
Time and again, we see the benefits of an interdisciplinary approach to therapy with our patients at Rosewood Rehabilitation Center. Take,for instance, the case of our patient who was hospitalized due to Guillan-Barre Syndrome with symptoms of progressive weakness and impaired coordination. Our combination of physical and occupational therapy created a pathway for success with this patient.
Prior to the hospitalization, the patient was living with a spouse in a country home and was independent with all ADLs, IADLs and functional mobility without an assistive device. We recognized the following factors as being critical to the patient's success at our facility.

Total Hip/Total Knee
 Clinical Outcomes
Palm Terrace Skilled Nursing Facility, Laguna Hills, CA
In the post-acute rehabilitation setting, we see many different types of patients from different socioeconomic backgrounds, ethnicities and cultures, as well as different prior levels of function. As occupational therapy professionals, it is our job to identify the needs of our different patient populations and address a treatment plan that allows for a safe return to prior levels of function. Oftentimes, this includes our independent activities of daily living in our community-dwelling older adult population. I strongly feel that while basic ADLs definitely have a role in the SNF setting...IADLs have been largely overlooked...

Kazoo Choir at North Mountain Rehab: Helping Residents Breathe Better One Note at a Time 
By Kelly Schwarz, DOR, North Mountain Medical and Rehab Center, Phoenix, AZ
Question: What do you get when you combine group therapy and pulmonary rehab at North Mountain?
Answer: The North Mountain Kazoo Choir!
The Kazoo Choir, introduced by Shannon Dougherty, DPT, is a fun way to incorporate breathing exercises with residents who have goals to increase respiratory capacity. Residents are encouraged to improve their breathing techniques by humming/breathing tunes that have long notes, such as today's choice of "The Star Spangled Banner." Other fun groups have included such games such as "Name That Tune."
Pulmonary rehab and the Kazoo Choir are making North Mountain a more harmonious facility, one breath at a time!

Building Your Own Elevated Garden Box
Gardening is one of the most popular pastimes for Americans.  And creating a meaningful treatment incorporating a purposeful treatment activity such as Gardening can leave our patients feeling good in spite of their health conditions which may limit movement (such as arthritis) or cause fatigue. With a few strategies, gardening can be a great reinforcement for patients to practice their modifications within the context of a pleasurable and safe activity.  According to the AOTA, occupational therapy professionals take an holistic approach and develop strategies to help people do the things they want and need to do no matter their limitations, disability, disease or condition.  Using gardening as the therapeutic modality can make a treatment very meaningful to a patient.   

One of the environmental modifications which helps make gardening a more accessible modality for our patients is the Elevated Garden Box, such as the one shown in the picture.  Therapy Resource Curtis Hoagland hand-crafted this gardening box for the Occupational Therapy Department at Richland Hills Rehabilitation and Healthcare in Fort Worth. By combining his love of building with wanting to help fill this need for the therapy team, Curtis brought a smile to the face of Jaclynn Stolfus, our OTR at Richland Hills pictured here standing with her newly delivered Elevated Gardening Box.  
Abilities Care in Action
Person-Centered Dementia Management--A Montessori-Inspired Program
By Marisa Parker, MS, CCC/SLP/DOR, Legacy Rehab and Living, Amarillo, TX, 
At Legacy Rehab and Living, the protocol is a referral to therapy for any patient with a dementia diagnosis, a decline in function, and/or increased adverse behaviors with a goal to reduce psychotropic medications.
With these patients, we complete a comprehensive Life History Profile to develop personalized activities that tie in to the resident's interests. We also administer the Allen Cognitive Level Screen/Allen Diagnostic Module to determine the resident's cognitive levels and cognitive capabilities.

Music & Memory at Park Manor Rehabilitation Center
Santa Rosa, CA
"Music is the art which is most near to tears and memory." - Oscar Wilde
One of the reasons the link between music and memory is so powerful is that it activates so many portions of the brain at the same time. For example:  
  • Tonality processes in the pre-frontal cortex, the cerebellum and the temporal lobe.
  • Lyrics process in the Wernicke's and Broca's area, as well as the visual cortex and the motor cortex.
  • Rhythm processes in the left frontal cortex, the right cerebellum and the left parietal cortex.
  • The medial pre-frontal cortex is responsible for music processing and music memories. Most importantly, the prefrontal cortexis among the last regions of the brain to atrophy. 
The Abilities Care Approach®
Cloverdale Healthcare Center, Cloverdale, CA
Do your residents experience excess disability, negative behaviors, isolation or boredom, or decline in function? Modifying activities to match abilities can have positive effects. Using an Abilities Care Approach®, we begin with individualized activity prescriptions that allow us to:
  • Identify remaining abilities
  • See the person within
  • Modify the activity
  • Teach successful strategies
Based on Claudia Allen's Cognitive Disabilities Model, we incorporate evidence-based non-pharmacologic intervention and stage-specific individualized intervention. 

Our Abilities Care Work Groups include Nursing, CNA, Activities, Social Services, Occupational Therapy, and Speech and Language Pathology. Through the Abilities Care Approach, we have seen reduced behaviors, increased staff satisfaction, increased resident engagement, and improved resident and staff interaction.     
Using Life Story Boards to Assist Residents 
With Dementia
At Park View Post Acute Care in Santa Rosa, CA, the use of Life Story Boards has helped caregivers promote independence, provide appropriate cueing techniques and decrease negative behaviors in residents with dementia. We've found these boards to be resident-centered, efficient, economical and creative communication tools in our facility.
What Do Life Story Boards Do?
Life Story Boards share information about the resident gathered in the Life History Profile with caregivers, family and visitors. Each board identifies the stage of dementia via a facility-based color-coding system. Not only do the boards communicate meaningful information about residents in an easy-to-understand format, but they also provide opportunities for residents to have quality interactions with staff throughout the day.
A Contracture Management Case Study
St Joseph Villa, SLC, UT
In March 2016, 43 Milestone therapists and assistants attended "Clinical Pathways for Successful Orthotic Contracture Management Therapy" taught by John Kenney. The course included instruction in NeuroStretch, a technique that stimulates the Golgi tendon organ at the muscle-tendon junction and creates an inhibitory effect on the muscle.
This technique can be used effectively with neuro-contractures where there is a neurological opposition to stretch and adaptive tissue shortening. 
Creating Client-Centered Functional Tasks
Julie Hebert, OTR, OTD, 
Carrollton Health and Rehab Center, Carrollton, TX
Research indicates that older adults treated with a "client-centered" focus and approach show positive results in meaningful engagement, socialization, activity tolerance, UB/LB strength, ADLs, IADLs, balance, emotional well-being, motivation, participation and overall quality of life (Law, 2002). Our goal is to improve the overall quality of life for Carrollton Health and Rehab residents by including meaningful functional activities of choice in our clients' treatment plans.
Progressing a Bilateral BKA Patient to Ambulation
Coral Desert Rehabilitation, 
St. George, UT
Mark (name changed), a 66-year-old male, presented at Coral Desert Rehab with pneumonia, COPD, diabetes mellitus, hypertension, and most notably, bilateral BKA. He had previously been admitted to an acute hospital following surgery resulting in L BKA, but he checked back into the hospital after coming down with pneumonia, after which he came to Coral Desert.
In his initial evaluation, physical therapists noted the patient's goal to return to living independently with functional transfers and household ambulation and noted his "good rehab potential." The task ahead was monumental, as the patient had fallen twice in the last year, was unable to complete any functional tests or measures, and was Max-to-Mod Assist on all transfers.  
Rehabilitation and Focused Dementia Care Survey
The Courtyard Rehabilitation & Healthcare Center, Victoria, TX
The Courtyard Rehabilitation & Healthcare Center is a 56-bed facility that has been selected to participate in pilot of a Focused Dementia Care Survey, which examined dementia care in nursing homes. The survey examined the processes for prescribing antipsychotic medications and was later expanded to look at standards of care along with over utilizations of antipsychotic medications.  The Courtyard was selected for this pilot program due to a high census of people with dementia diagnoses. A survey was conducted in March 2016, and it was determined that 49 out of 51 residents had a dementia diagnosis.  We selected five residents who had a diagnosis of dementia (Alzheimer's, Lewy body, vascular disease and other dementias) and required different levels of assistance with ADLs.
Learn More
Dementia Care Programming: 
A Person-Centered Approach
Oceanview Healthcare & Rehabilitation, Texas City, TX
  "Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around." - Leo Buscaglia
Our Dementia Care Program was established to improve the quality of life of each person living with dementia entrusted to our care at Oceanview Healthcare & Rehabilitation. Our goal is to steadily increase the well-being of those we affect directly, while becoming an influential model within the community for a widespread shift in how we view dementia as a culture.

The Use of Baby Dolls for Behavior Management
Aimee Bhatia MSOTR/L, PAM, Glenwood Care Center, Oxnard, CA
Our IDT Falls Committee initially discussed the implementation of baby dolls for some of our long-term care residents with a high incidence of falls and elopement and who were difficult to redirect during care. We identified four residents for a trial use of baby dolls as a means of providing the residents with a sense of purpose and to redirect positive attention during their daily routine.
Each resident was screened with both the FAST and GDS to determine cognitive staging. 

Developing a Community Reintegration Program for Older Adults
Nicole Veniegas, MS, OTR/L, DOR; Kathryn Case, MOT, OTR/L; Harini Desai, MPT, Magnolia Post Acute Care, El Cajon, CA

At Magnolia Post Acute Care, there has been an increasing number of community-dwelling adults admitted to our facility with high prior level of function who are discharging back to the community. An interdisciplinary approach with both occupational therapy and physical therapy was used to identify appropriate assessment tools applicable to community reintegration and to use the indications from these tools to guide treatment interventions.
The assessment tools chosen focused on safety and fall risk as well as sit or stand balance, distance of ambulation or wheelchair mobility, safe functional reach, and overall safety awareness in the presence of high sensory demands in the community. 
Applying Research on Cues to Reduce Freezing of Gait to WC Propulsion for People With Parkinson's Disease
Amanda Call, MA, OTR/L, Draper Rehabilitation & Care Center, Draper, UT

At Draper Rehabilitation & Care Center, we admitted a 79-year-old male patient with advanced Parkinson's disease, referred to OT for wheelchair mobility. The patient recently obtained a power-assist lightweight manual wheelchair but has been unable to propel functional distances (to nursing station, dining room, activities, etc.). He demonstrates movements reminiscent of freezing of gait wherein he does not move for several seconds or minutes and appears stuck in place despite his efforts to initiate movement.    
Research on FOG reveals applications for WC mobility because freezing occurs in a variety of motor tasks, and UE kinematics have been shown to improve with the use of auditory cues. 

Learn More
Solutions for Oral Care: A Joint Project With Nursing and Speech
Carmel Mountain Rehabilitation and Healthcare, San Diego, CA

Oral care in our facilities is most often thought of as a nursing measure, likely performed by the nursing assistant. Due to time constraints and other factors, oral care may be overlooked by staff. In addition, patients often do not ask for oral care in the same way they may ask for assistance with other ADLs, such as toileting or dressing.  As we sought solutions for this critical issue, we needed to consider the following factors:

How to Accurately Enter a Diet Order Into PCC
Presented at the 2016 DOR Meeting by Legend Oaks - Katy, TX
Congratulations to Our Newest SPARC Award Winners!
The Ensign Therapy SPARC (Scholarship Program And Recognition Campaign) is inspired by its namesake and the sense of liveliness and excitement that therapy students and new graduates bring to our facilities and in-house therapy programs. With this $2,000 quarterly scholarship program, we are deliberately seeking out those individuals who ignite a desire for excellence in themselves, their patients, their colleagues and co-workers. We congratulate Julie Dunn and Janelle Leyone, our new scholarship winners!