S ending Warm Holiday Greetings and a Wish for Many Blessings in the New Year!

Tuning In to the Intelligence of the Heart to Change Lives
Did you know that there is a simple way to measure and reduce the stress response in our bodies? The variability in the heartbeat from beat to beat is called heart rate variability (HRV), and HRV is a powerful indicator of overall health. HRV essentially measures the stress response in our bodies, and through the use of biofeedback, we can actually train our stress response and improve our health! Dozens of our therapy programs across the country are using sophisticated biofeedback devices developed by our partners at HeartMath┬« in order to reduce personal stress, and to help our patients improve function and reduce anxiety. 
Compliance Corner
2017 IRO Lessons Learned
By Brian Del Poso, Associate Compliance Officer
Hi everyone! Year 4 IRO is in the books, and the results are in. First off, to the facilities that were selected this year (Atlantic, Camarillo, Carrollton, The Cove, Ennis, Mt. Ogden, Palomar Vista, Provo, San Marcos, Shawnee, Upland, Victoria Healthcare in Ventura, CA), the organization can't thank you enough for your hard work and diligence during this process and making this another successful year! This was our first year with NO facility fails!

The on-site Therapy systems audit conducted in August was one of the cleanest, if not THE cleanest, on-site audits we've had as a collective group. The remote billing audit was also one of our best, with the organization's total financial error rate coming in at a low 0.85 percent. As well as we did, there are always opportunities we can take away from experiences like this. Here are some of the general IRO therapy findings and lessons we can learn from moving forward:
  • Modification of therapy goals when there is no progress or indication that treatment is necessary to prevent deterioration.
  • Over-delivery of therapy frequency.
  • Clear documentation of the skilled service you may be providing/billing for when a patient is partially refusing services.
  • Clear and measurable therapy goals in sync with the treatments being provided.
  • Residents discharging to LTC can be a red flag for auditors. Strengthen the therapy documentation that supports why skilled interventions are still necessary.
  • Documentation for co-treatments that demonstrates: 1) Support for the need of the co-treat, and 2) That the focus of treatments were different for each discipline involved during the co-treat activity.
  • Helping to ensure MDS ADL accuracy. Did you know that therapists can play a big part with the MDS late loss ADL scoring? Communication amongst each other and our nurses can help ensure that the help needed for our residents to perform Bed Mobs, Transfers, Toileting, and Eating (the four Late Loss ADL's) is accurate and justifiable.
None of these IRO findings should sound unfamiliar, as these are things that your therapy resources have been educating you on and your compliance partners may have found in your MSCAs. So folks, the other major takeaway from this year: Stay diligent and be the standard! In an ever-changing healthcare world, your therapy resources and compliance partners are working to give you the tools and knowledge to be successful. If you don't understand the results and info that come from your MSCA results or that is given to you by your resources, let us know and we'd be happy to help!
Introducing the Chief Therapy Officer (CTO) Award
Do you have it in you to be a CTO? We are excited to introduce a brand-new program to honor and recognize our best DORs through a Chief Therapy Officer (CTO) award. The CTO designation is an elite award to distinguish the therapy leaders who demonstrate excellence 
in leadership, culture, clinical programming, business management, and community partnership. Your therapy resource would be happy to review the criteria with you. 
Let's make 2018 the year for the CTO award! 
Igniting a Spark for Excellence!
We are always amazed by the enthusiasm and excitement that our student programs bring across the country. Our Scholarship Program and Recognition Campaign (SPARC) award was implemented to award students who ignite a desire for excellence in themselves, their patients, and their colleagues and coworkers. Each quarter, students submit applications for the SPARC award. A committee of therapists then selects the winner based on academic performance, volunteer and other extracurricular activities pertaining to healthcare, academic and character references, and how well the essay portion of the application demonstrates individual excellence.

This quarter, we had more applicants than ever before! Congratulations to the winner, Kristi Crozier from Midwestern University in Glendale, Arizona! A big THANK YOU to all of our 2017 clinical instructors and students! We asked our therapy programs to describe a favorite characteristic of their student this year, and this extensive list describes what makes them special: Ethical, Confident, Genuine, Gracious, Smile, Contagious, Compassionate, Active Learner, Empathetic, Knowledgeable, Eager Learner, Devoted, Reliable, Patient-Focused, Professional, Positive, Grace, Maturity, Hard Working.

Congratulations, Kristi!
Kristi is an occupational therapy student at Midwestern University in Glendale, Arizona, and graduated in November 2017. 

Students Give Supplies for Hurricane Harvey Families 
By Jon Anderson, Therapy Resource, Texas
The University of St. Augustine-Austin,Texas campus held a week-long drive for supplies for our employees in the Houston area that were affected by Hurricane Harvey. They collected over 24 boxes of the most needed supplies that families were requesting, such as sheets, bedspreads, towels and pillows. It was truly remarkable to see a partner come through and help our employees like this. 

The Power of Creativity
One OT's take on the Dementia Care Program
By Tawaine Vigers, DOR, Legend Oaks of Katy, Texas

Beth Brewer, OTR/ADOR at Legend Oaks Katy, is known to most of us by her acquired moniker, MacGyver. What she creates with "a little bit" of duct tape, PVC pipe and pool n oodles  is magical! So when we decided to make dementia care one of our focal clinical programs, it came as no surprise that she would create something great. 

This is when the Dementia Care Activity Box was born. 

Giving Back at Olympia
By Mira Waszak, Therapy Resource, Washington

The occupational therapist at Olympia, Sarah Koning, wanted to create a way for our residents to give back to the community as well as have a meaningful occupation. She started a community outreach committee, co-chaired by our SLP Megan Bennett, and included the Activities and Admissions director.  
The first project was quilt-making. Each square was put together by one of our residents. When it's finished, we will display it in the facility.  They also completed a blanket gift wrapping to give to those in need.  Other ideas are in the works such as a pen pal program, cards for children in hospitals, care packages for soldiers and more.
Milestone Trains Neuro-IFRAH Therapists
By Kelly Alvord, Therapy Resource, Utah
We had a successful weekend and want to thank all the therapists for coming and participating in the Neuro-IFRAH course! Thanks to our administrators and DORs for supporting this course and allowing us to participate. We can market and share that we have Neuro-IFRAH trained therapists as we continue to build our neuro programs. We have awesome therapists and know we will continue to lead our markets in patient care and outcomes!
Student Resource Manual for the Clinical Instructor
By Asa Gardine, DOR, Coral Desert Rehabilitation, St. George, Utah
What was initially simply a continuing education experience for two therapists has inspired a brand-new program here at Coral Desert Rehabilitation. Recently, a Coral Desert physical therapist, Lindsay Rankin, and a physical therapist assistant, Edwin Stevenson, attended a course to become credentialed clinical instructors. They both enjoy having students, so they were excited to go. After attending the course, they came back with a desire not only to improve their own abilities, but also to help revamp the student program at Coral Desert. 
The program was loosely managed before and not standardized from one therapist to the next, so the students often had varied experiences and subjective learning/feedback depending on the therapist. Lindsay and Edwin decided to set a BHAG together to create and implement a better student program based on the principles and recommendations of the course they attended. 
Just One Tx for Vestibular Disorder = Success!
By Matt Scott, DOR, The Springs at Pacific Regent, San Diego, California
We recently held a vestibular course in San Diego in August. I attended with Brittany Marvin and Carrie Johnston, two other physical therapists from the Springs. Just this week, Carrie noticed that her new patient was displaying S/s consistent with benign paroxysmal positional vertigo (BPPV). This patient was in a MVA and the car flipped several times, but the doctors told her the dizziness was from a concussion. Well, Carrie assessed her for a vestibular disorder and successfully treated her in one treatment. So this patient, who has had severe dizziness and imbalance for almost 10 days, is now symptom-free!

An IDT Approach to Contracture Management 
Kai Williams, Therapy Resource, Texas

We hosted the CE at our Legend West Houston facility. Nursing and rehab must be cohesive to a have a strong contracture management program. I sent an email out to our DONs and they welcomed the idea of including our RNAs. John even provided them with certificates. They loved it.
Thank you to those who were able to make it to the Contracture Management Course on Saturday. We had a great turnout from several of your therapists/assistants as well as your RNAs. The course speakers had an opportunity to visit the Katy and West Houston facilities, the day before the course, and provide face-to-face assistance. Tawaine and Brittany gave very positive reviews and stated that several patients were identified for therapy services that were previously overlooked. 
North Mountain Medical and Rehab Introduces "The SPOT"
By Kelly Schwarz, DOR, North Mountain Nursing & Rehabilitation, Phoenix, AZ
The North Mountain Therapy Department specializes in Pulmonary Rehab, encouraging a multi-disciplinary approach to meet our respiratory patients' goals of being decannulated, which typically is dependent upon the patient's ability to return to a regular diet. In an effort to contribute to the greater independence of our patients, the Therapy Department created the SPOT (Speech Pathology Occupational Therapy), a holistic approach to a specialized dining experience to facilitate independence with safe swallow techniques and self-feeding. 
Creative Therapy at SJV
By Gary McGiven, Therapy Resource, Utah
Since the CMS ruling on group therapy we haven't been utilizing group as a mode of therapy much.  In an attempt to increase creativity with therapy delivery, Lisa Brook and the St Joseph's Villa therapy team have been working to bring the fun back to therapy.  

For a group activity, the SJV team did pumpkin painting for those needing to sit and pumpkin golf for those with the ability to stand. Lisa carved the pumpkin (pictured) the night before, and she and the team put on a great activity for their patients. 

Therapist's Got Talent!
Making Therapy Fun at Sea Cliff
By Jennifer Farley, DOR, Sea Cliff Healthcare, Huntington Beach, CA

Undoubtedly, therapy is fun when treatment is individualized with a creative approach. That's why we are so grateful for "Jay" Jerez Jupillo, COTA, at Sea Cliff Healthcare. Jay has handcrafted a life-size "Connect Four" game for our residents. Thanks to his awesome workmanship and creativity, Sea Cliff residents are able to enjoy the unique game, while achieving therapeutic gains in dynamic balance, functional reach, visual/perceptional skills and cognitive retraining.

We actively integrate Jay's unique tools and equipment into our therapy treatments. We love to showcase his talent!

Highlighting Dustin Rex, ADOR, DPT
By Stephanie Winkler, DOR, Wellington Place, Temple, TX

Not only is Dustin an outstanding physical therapist, but he also has great management skills and brings wonderful culture to our Rehab Team and throughout Wellington. Here are some of his highlights:
  • He is the lead with our CJR program, and he communicates daily with the hospital program manager.
  • He has helped lead Wellington to have the lowest LOS within the CJR program in our area.
  • He is able to step up for all responsibilities when the DOR is out of the building.
  • With the changes in the Tri-Care billing, he has stepped up and helped arrange coverage (which is usually him) when weekend coverage has been needed.
  • He is great with families, and when emotions are running high as they sometimes do, he is able to redirect them and calm them in a professional way.
  • When an error is made, he is quick to accept responsibility and find ways or processes to help them from happening again.
  • He displays CAPLICO every day!
  • He has been able to define the ADOR role well, as we have not had one before. He is flexible and is a quick learner. He has been able to manage the short-term side, which has allowed me to work on our long-term programming.
  • He has been a CI for many of our PT students, and many of the students who thought they wanted outpatient settings have actually enjoyed their SNF setting so much that they have changed their minds about their career path.
Team Wellington has enjoyed Dustin on both a professional and personal level. I am so proud to highlight Dustin for this edition of the FlagPOST!
Park Avenue Tests New Overhead Track System
Jacob Barnes, DOR, and  Ali Vandeloo, their newest OT, demonstrate the use of the new overhead track system at Park Avenue in Tucson, AZ.
Having Fun with Curling and Exercise at  Bandera DOR Meeting
The therapy teams of Bandera in Arizona celebrated the holiday with a Curling/Team Building celebration at their recent DOR meeting. 
Introducing CAPLICOnation, our new Instagram Account! Be sure to follow us for more photos of our therapy teams and their activities!