27101 Puerta Real, Suite 450
Mission Viejo, CA 92691

This month we introduce a new format of the FlagPOST which should be easier for all to read on mobile devices as well as your computer! We also introduce two new columns for updates on ADR/Appeals and professional growth.
A Season of Change!
Happy family on the beach. People having fun on summer vacation. Father mother and child against blue sea and sky background. Holiday travel concept
SUMMER!! It’s the season of the year when we celebrate sunny days, spending time at the beach or outdoors boating, camping, barbecuing with family and friends and we plan family vacations, while the kids are on break from school. 

For those of us who serve as therapy and nursing providers in skilled nursing, summer also carries with it another meaning. Each year and usually on the last Friday in April, the SNF Notice of Proposed Rule Making (NPRM) is made public by the Federal Government.  While we often have ideas about some of the proposed regulations we may find in the NPRM, we also eagerly await the public notice so we can dive in to see if it contains any surprises.  We then spend time processing, analyzing and putting together thoughtful comments for the Federal Government to consider before releasing the SNF Final Rule, which is typically published sometime in August. The Final Rule directs our next season of reimbursement and regulatory requirements.
The Two-Minute Denial Reflector
Making E-Stim Bulletproof
By Lori O'Hara , MA, CCC-SLP, Therapy Resource - ADR/Appeals/Clinical Review
One of the most common reasons for denials in both the Medicare and managed care areas is removing e-stim minutes because the documentation doesn’t support a skilled service.
Reminder! No one pays the machine, so the amount of time the machine is running has nothing to do with how much time is billed. What is reimbursed are the minutes that required a skilled brain — so clearly describing the minutes when the brain was engaged is critical!  Read On...
Are You Uncomfortable?
By Willow Dea, Therapy Resource
Comfort is not the objective in a visionary company. Indeed, visionary companies install powerful mechanisms to create discomfort — to obliterate complacency — and thereby stimulate change and improvement before the external world demands it.  - James C. Collins  

We take tremendous care to achieve our mission every day: To dignify and transform long-term care in the eyes of the world. We do that by enacting a pledge to our core values, which foster a culture of integrity and compassion for our patients and their families.

These commitments ask everything of us. They require each of us to explore a profound, and continuously evolving understanding of leadership. Every Ensign affiliate is a leader; it’s part of the agreement we made when we accepted our respective positions. As partners in this endeavor, we are offered an opportunity to be part of something much greater than ourselves. It’s in this context that I find myself wondering how to be a better partner to each of you and a better leader, especially in practical terms. What does it actually look like, as a set of behaviors and outcomes, to be a leader? Read On...
Compliance Corner
Your Friendly Neighborhood Compliance Partner
By Billye J. Lee, PT, GCS, RAC-CT
Therapy Compliance Partner — Keystone
My family recently went to see the new “Avengers” movie, being Marvel comic fans and all. Action flicks are a rare treat for our busy family, and the latest in the series did not disappoint. In one intense scene where young Spiderman decides he will stay and fight alongside his team, he states, “You can’t be a friendly neighborhood Spiderman if there’s no neighborhood!” Now, I’m not saying Compliance is nearly as cool as Spiderman, but I would agree with his premise: We are nothing without those we serve. This statement is so true throughout our Ensign family and is a common thread within our CAPLICO culture. Without our employees, there would be no “who,” no bus to drive. Without our residents, there would be no purpose or “what,” no mission. And for Compliance, without our facilities and markets, there would be no team, no momentum.

As much as I would love to get high-fives, slow clapping and gasps of relief when I enter a building (Yay, Spiderman is here!), I know in reality, Compliance visits are not always joyous events. However, we would love to challenge that perception!   Read On.. .
Congratulations to Our Newest SPARC Award Winner!
Sarah Gromko, SLP Student
Grad Date: July 2018
Southeastern Louisiana University

Music and language both are universal and innately human, develop at the same time, and are culturally dependent. Speech, in particular, utilizes pitch, rhythm, and timbre — all elements of music (Smith, 2011). Because of these significant areas of overlap, music and speech carry a natural relationship. But most obviously, music moves people. The right song can bring back the fondest of memories. Hearing the sweet sounds of the right melody can turn a hopeless situation into hopeful. Singing, in particular, reverberates the music inside one’s body. In these ways, I hope to use music to spark energy, motivation, and happiness into the lives of my patients. Read On....
Sharing Therapy Strategies
Six Simple Steps to Launch a Successful Heart Math Program  By J en Farley, Therapy Resource & DOR, Sea Cliff Health Care Center, Huntington Beach, CA
Kristi Rosales PTA is completing the certification program and will be recognized as the team lead
At Sea Cliff Health Care Center, the therapy team actively incorporates Heart Math techniques into daily treatments. Heart Math is a highly effective, multifaceted program that has had a positive impact on the majority of our patient population. Self-regulation is recognized as a key factor to assist in recovering from illness and improve functional performance. Listed below are the six steps used to implement the Heart Math system.  Read More Here....

Kristi Rosales, PTA, will lead the HeartMath program at Sea Cliff
Life Story Board at Cloverdale Healthcare
By Gina Tucker-Roghi, Therapy Resource, Northern CA
Here is a briefing of how the Cloverdale team is using the Life Story Board. 
  • RG is a recent LTC resident, initially referred to OT to ease transition into LTC. Challenges included safety concerns, fall risk (had several falls at home prompting LTC admission), and agitation behaviors during care and with offers for assistance to promote continence and supervised mobility.  
  • Early Stage dementia, ACL 4.4-4.6 on LACLS-5. 
  • OT found that rapport-building that included acknowledgement of RG’s personal accomplishments facilitated acceptance of offers of assistance and caregiving. Resident was noticeably more receptive to discussion of topics that had previously triggered agitation, such as safety cues, toileting schedule, and the use of a call light to request supervised mobility to prevent falls during initial rehab stay. 
  • Caregiver education has included use of life story prompts to build rapport with a short conversation prior to offers for assistance or reminders to use the call light to make any requests or notify staff when he needs to get up and walk to the bathroom. 
  • Staff reports that RG has been more receptive to their offers of assistance with familiar caregivers and caregivers who “get him.” 
  • RG says he feels “settled” and is very appreciative of the opportunity to share his contributions, personal history and experiences.  
Stop Managing Incontinence. Start Treating It! Here's How
By Jon Anderson, Senior Therapy Resource, Texas
If you or a loved one has bladder control issues, you’re not alone. Millions of people in senior living facilities are in the same situation. In fact, more than 70 percent of long-term care residents are not in complete control of their urinary bladder function.

Bladder control problems, such as overactive bladder (OAB), are not a normal part of aging. OAB is not something one has to accept. OAB can limit social life, making it harder to share meals, play cards and stay active in the community.   There are also serious health risks associated with this condition, from urinary tract infections and poor sleep to skin problems and falls.   OAB is a treatable condition and can be treated in the long-term care facility by a physical therapist. Read On....
Our Emerald Market Joins PD Supporters in Kansas
By Madeana Galler, Therapy Resource
The Heartland Parkinson’s Foundation Moving Day walk on June 9   in Kansas City was a great success! We were all so busy networking! Because we were a Bronze sponsor, our name was on the Passport Card. The Passport Card was like a bingo card with 15 or 20 squares with each Bronze or higher sponsor's name on it. When the participants visited the sponsor's booth, they would receive a sticker. Once the Passport Card was full, they were put in a bin for various drawings for free prizes. This created a lot of traffic to our booth; I mean, who doesn't want a chance to get free stuff? We visited with at least 100 people about the Healthcare Resorts and Riverbend. It was great! They asked for our cards, took our brochures/freebies and asked so many questions. It was encouraging and exciting to share our facilities with the PD community. We had representatives from Olathe, Leawood and Kansas City! Such a blessing and a great time to bond and develop relationships with each other outside of work! 
Bariatric Success Story
By Tony Bothelo, Director of Rehabilitation, Osborn Health and Rehabilitation
Julie is a motivated 39- year-old woman who began her weight- loss journey by undergoing b ariatric s urgery. After surgery, she transferred to Osborn Health and Rehab for aftercare. She had taken the first step with surgery and was now ready to begin skilled rehab as the next step of her journey.

Julie was severely dependent and required 5 Liters of o xygen. She required total assistance with all ADLs; she could not get out of bed or walk and required a Hoyer to transfer into the W/C. However, thanks to the dedicated Rehab team and Julie’s own personal drive to improve, her progress has been nothing short of miraculous! Julie was seen six times a week between OT and PT, with a strong focus on functional therapy interspersed with a customized therapeutic exercise program combined with compensatory strategies. As a result, Julie no longer needs continuous oxygen, she gets in and out of bed on her own without the use of the Hoyer Lift, and she is walking over 100 feet with a FWW. Julie has a personal goal to return home with her husband, and the rehab team is committed to supporting her on her journey back home and back to Independence! 
Shout-Out to Keystone East!
by Kate Lake, Therapy Resource, Keystone East
Legend Oaks East Houston
Sunny Chahal, DOR, and his team consistently provide amazing student affiliation experiences for PT and PTA students. He takes PT students from St. Augustine and PTA students from San Jacinto College. They are looking at taking OTA students as well. The experiences enrich the lives of residents, staff and students. We're hopeful that the current PT student will contribute to a poster presentation for the annual therapy leadership meeting. They make us better.
Southland, Lufkin, TX
Tracey Wild, Speech therapist, does an exceptional job of supporting student affiliations. She is recognized by professors from Stephen F. Austin who told me what a wonderful job Tracey does supervising students at Southland. They let Richard Johnson, our Therapy Recruiter for Texas, know at TSHA that her work and dedication is very much appreciated. Tracey also has helped to reinvigorate the dementia program and started a cool LTC program. She has created a functional maintenance program for patients who are having frequent falls primarily associated with cognitive impairments. The treatment sessions focus on cognitive focus training, such as sorting tasks and problem solving to promote engagement and external stimulation. Tracey really focuses on directing the goals to what the patients are most passionate about and what is most appropriate within their dementia scale. 
Showing the O in CAPLICO!  
 by Maryann Bowles, Therapy Resource, Colorado
The therapy team at Villas at Sunny Acres (VASA) in Thornton, Colorado, united and took on the task of painting their new gym space in the healthcare center! They came in after work and covered quite a few very tall walls. So proud of this team!