29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
August 2020

The collage of faces of surprised people on colored backgrounds. Happy men and women smiling. Human emotions_ facial expression concept. collage of different human facial expressions_ emotions
Does the idea of happiness seem elusive during our turbulent times? Do you find yourself waiting for things to get better in order to be happy? According to Harvard researcher and author Shawn Achor, happiness, despite the adversities around us, is actually the key to lifting the worry and depression and opening doors to greater success and joy in life. The Happiness Advantage describes some simple practices that you can put in place with yourself and your teams today! They may seem like tiny steps, but make no mistake about it, every tiny push on the flywheel can have profound long-term outcomes for the wellbeing of you and your team. 

1.    Notice and (even better) write down 3 new things you are grateful for each day. By training your mind to scan the environment or circumstances around you to look for the positive, you eventually start looking for the good in your life each day. You may even try a dry erase board in your department with 3 new things every day. 

2.    Journal or discuss something good that happened to you or someone you love. Kindly dismiss yourself from conversations that focus on anything negative about yourself or others. 
Heart shape hand for volunteering_ love_ kindness and friendship concept
3.    Find 2 minutes a day to do HeartMath. Well, technically Achor says to find 2 minutes to meditate, but sometimes people mistakenly think they don’t know how to meditate. When we teach HeartMath techniques, we simply ask that you find 2 minutes to slow your breathing down, shift your awareness to your heart, and bring to mind a feeling of gratitude/joy/appreciation or love. Feel the shift in your focus as you slowly breathe in and out. 

4.    Do a little bit of silly cardio! Of course regular cardio counts, but have you ever tried silly cardio with your team? Try jumping up and down for 30 seconds and you can’t help but smile! What about duck-duck-goose? Kids are the best at silly cardio because they innately know it makes them feel good. 

5.    Commit Conscious Acts of Kindness. Countless research articles point to the positive benefits of doing something kind for others that is unexpected, and perhaps even anonymous. This is the beauty of our Emergency Fund! Our anonymous donations go to help hundreds of our employees through the most difficult circumstances. Brainstorm with your team on how you can commit Conscious Acts of Kindness in your facility and see the love that grows.  

We would love to hear if you put any of the above in place! We can start our own Happiness Column with our amazing teams and stories. 
Make It Happen Note Meaning Take Or Action
Action Needed!
Contact Congress to Stop Proposed Therapy Cuts!
The Centers for Medicare & Medicaid Services seeks comments on its proposed rule, which includes an estimated 9% reduction to payment for PT, OT and SLP providers in 2021. Please use the links below from our respective professional websites to stop payment cuts for therapy services. 
OTs Use this Link: to stop payment cuts for Medicare services!

PTs - APTA Members Use this Link: Email Congress Today
Non-APTA Members Use this Link: Tell Congress to act to stop Medicare cuts

SLP’s Use this Link: Email your members of Congress today!
Let's Keep Doing the Important Work
By Cara Koepsel, M.S., CCC-SLP, DOR, Golden Acres Health & Rehabilitation, Dallas, TX
Here at Golden Acres in Dallas, Texas, we love our long-term care residents. They are the heart and soul of our facility, and we wouldn’t have it any other way. One of our residents passed away recently, and it never gets easier. The family reached out to myself, the DOR, and the social worker in hopes of getting a copy of her grandmother's life storyboard that was created during therapy with one of our amazing speech therapists. Her granddaughter wanted to utilize this resident’s life storyboard to aid in writing her obituary. To think that the Abilities Care Approach Program could, in such a trying and upsetting time, bring joy and meaning to a grieving family is truly amazing. Read on...
Outpatient Opportunities!
By Barbara Mohrle, OTR, Therapy Resource, Keystone North, TX
We have an amazing opportunity right now to build our outpatient programming with our Assisted Living and Independent Living facilities. In all likelihood, these residents are also feeling the impact of COVID, whether they have had it in the past, or are suffering due to isolation and lack of activity. We can partner with a local ALF in our community (does not need to be an Ensign affiliate) and provide Physical, Occupational and Speech Therapy services.
Let’s get our marketers out to local ALFs and see what needs they may have, and how we can be the ones to fill those needs! We’ve developed some great talking points to get them on board.
There are a few guidelines:
  1. The patient cannot be receiving Home Health Services; we cannot bill outpatient and Home Health at the same time.
  2. The patients may be seen in their home. For residents of an AL/IL their home would include the confines of their own apartment, corridors and ingress/egresses of the building. Our SNF Provider Type does not allow us to lease space, or to use therapy-designated space, or to set up a “satellite” location.  You may not use AL/IL Gym Space, Activity Rooms, pools or dining rooms for therapy.  
  3. The usual outpatient paperwork must be completed by the patient.
  4. Our Business Office will complete the benefits verification process to ensure that they have an insurance plan with which our facility is in contract.
  5. Each ALF/ILF will have their own policy on who can enter/screening processes for COVID that we need to honor.
And don’t forget, even if the AL/IL doesn’t want us coming in right now, we can still do TeleHealth therapy! Please let me know how we can help get this program started in your area!
Treat Yo Self!
By Barbara Mohrle, OTR, Therapy Resource, Keystone North, TX
We were trying to think of a way to help our therapists take care of themselves, and we came up with a Treat Yo Self 2020 Day! (a phrase from “Parks & Rec”). The therapists can take home facial masks, bath bombs, and/or shower bombs (and, of course, some good chocolate) to treat themselves at home!
Happy Birthday to Me!
Submitted by Alton Ragsdale, COTA/TPM, Legend Oaks Healthcare, Ennis, TX
I thought it would be appropriate if I shared one of my favorite birthday presents with some of the most awesome people I know. What makes this gift special to me is a backstory I want to share. 

We had a skilled admit a few years back who came to us with a serious fall in the community resulting in multiple spinal cord injuries, with symptoms that continued to exacerbate post acute. As the patient’s condition fluctuated in a mostly downward spiral, our Rehab team fought like no other to get the interventions inside and outside the facility, despite many others losing hope in the patient’s ability to recover. Our patient spent 100 days on skilled and many more months on Part B, busting her behind as the rehab team supported her in her progress and assisted her in the transition to her new norm as a functioning quad. 

I’m sharing a birthday card from the patient I spoke of. It moves my heart that not only do our patients thrive due to the determination of our rehab teams, but it also blesses me right to the core. I share my birthday gift/story with each of you because I feel you are as much a part of this success story as anyone. I am constantly inspired by the ongoing miracles that are occurring under your amazing leadership and by the example you are to those you serve. I am better and our clients are thriving because of YOU!  
Thinking Outside the Box
Submitted by Kelly Alvord, Therapy Resource, Sunstone (UT)
I wanted to share how Kirk Player, DOR/PT, brought a new approach of therapy to Pinnacle Nursing and Rehabilitation Center in Price, Utah. He brought in one of his horses and had a great time having the residents interact with his horse. Great therapy intervention took place with sitting and standing balance, ROM, etc. Thanks, Kirk, for thinking outside the box and helping the residents thrive at Pinnacle. 
Therapist Profile
Submitted by Jamie Funk, Therapy Recruiting Resource
Meet Avenlea Gamble (pictured Left), a second-generation Ensignista who is the Director of Rehabilitation at Northbrook Healthcare Center in Willits, California. Avenlea has been coming to Northbrook since she was three days old, which may sound strange unless you know that her mom, Shawndee Gamble (pictured Right), is the facility administrator there.

This story is about Avenlea, but it is woven tightly with the story of her mother. Shawndee began working at both our Ukiah and Willits locations when she was 17 years old, first as a CNA, then in medical records, and then as an activities director. Avenlea would help out with bingo and one-on-one activities with the residents and developed a lasting love for the long-term care setting. Shawndee later entered the AIT program and has been the facility administrator at Northbrook for 13 years.  Read On...
3d render of leadership concept presented with child toys blocks
Therapy to ED Leadership
Submitted by Brian del Poso, OTR/L, CHC, RAC-CT, Therapy Resource 
As you all know and have heard, our organization considers itself a “leadership development company that happens to be in healthcare,” and we are always looking to develop the best and right leaders. On previous Therapy Leadership calls, we’ve had guest speakers who were former DORs who took on the challenge of becoming EDs, quite successfully we might add! Our organization recognizes how special our therapists and therapy leadership are and the potential that many of you possess.  
In a continuing effort to tap into that potential and to foster and grow any thoughts you may have or have had about becoming an ED, we are starting a series of interviews with our former therapists/DORs turned ED, to get some further perspective. Here’s the first of the series from Stephanie Anderson out of Rock Creek of Ottawa in Kansas. Read On...
Congratulations Cathy Bowman!
Congratulations to our newest HeartMath facilitator, Cathy Bowman! Cathy is an OT and our DOR at Rock Canyon in Colorado, and with her HeartMath certification, she will serve as a resource to our Colorado facilities.
What's So "Vital" About Vital Signs?
Submitted by Tamala Sammons, M.A., CCC-SLP, Therapy Resource, Flagstone, Pennant, Sunstone, Milestone, Endura, Monument 
Vital signs are the objective measurements of temperature, pulse, respirations, and blood pressure as a clinical means to assess general health. Additionally, many include Pain and Gait Speed as the fifth and sixth vital signs. Vital signs are critical indicators of patient status, both at rest and during exercise/activity.

Therapists treat patients with many complicating conditions, such as: 
  • Respiratory conditions — pneumonia, COPD/chronic bronchitis, emphysema, asthma, atelectasis, etc. 
  • Cardiovascular conditions — CHF, hypertension, etc. 
  • Metabolic conditions — renal failure, diabetes, etc. 
  • Infection conditions — sepsis; Systemic Inflammatory Response Syndrome (SIRS), etc. 
Taking consistent vital sign measurements will help ensure therapists have good data related to respiratory function, cardiovascular function, endurance, and a patient’s ability to tolerate functional activity. As clinicians, it’s not only important to take vital signs, but also measure them against exercise/activity. Read On...
Thank You, DORITO Program!
By Tali Gerassi, MS, OTR/L, DOR, Grossmont Post Acute Care, La Mesa, CA
I just wanted to acknowledge the greatness of the DORITO program and its participants. I had to take an unexpected two-week leave of absence, and only had one day to prepare. My two DORITOS (Laura (L) and Sydney(R)) stepped up, and I feel like the department is in capable hands with them.
Documenting Justification of Skilled Therapy Services
Part 2
By Lisa Harvey, M.S./CCC-SLP, Documentation Review Resource
Symptomless CVAs?
A pattern that our PDPM deep diving partners have found is hospital document and/or therapy documentation that reports a history of CVA that then goes…nowhere. Despite this history, no residual speech, language, swallowing, cognitive or neuromotor findings are reported in the therapy assessments (or anywhere else). Yet according to the National Stroke Association, only 10% of people who have a stroke will make complete neurological recovery. This means that many individuals with long-term sequela are going unidentified in our setting.

According to the CDC, the most common long-term symptoms after a CVA include hemiplegia, cognitive impairments, speech and language impairments, dysphagia, incontinence and depression. Most of those symptoms, when properly identified and managed, will trigger PDPM components. Read On...
Congratulations to Our New CTOs!
Celebrating John Diaz, CTO, PT, DPT, CEEAA, RAC-CT
Submitted by Matt Oldroyd, Operations Mgr., Parkside, El Cajon, CA
John has been a leader for Parkside since February 2015 and additionally Magnolia since December 2018. He came into a difficult situation at Parkside where the building was relatively unknown in the community and accepted very difficult patients with skilled needs. John didn’t give up and developed new programs to benefit the residents of a special population.  

At Magnolia, John again jumped into a situation where the building was culturally wavering, as they had very few skilled patients and high ED/DON turnover. John was coming into a broken team and was met with heavy resistance toward any changes/improvements. But soon, John was able to mold the team through regular one-on-one meetings with each of his staff and consistent staff meetings centered on patient care. Since then, the Therapy team has become one of the closest teams in the market and Magnolia is thriving. The team rallies around John and his phenomenal LTC program development & PDPM — which has greatly impacted the facilities’ financial performance. The thing that stands out about John is how passionate he is for his teams and the overall success of Magnolia & Parkside. We are all proud of you, John, and are honored to be your partner. Congratulations. 
Celebrating Tina Bond, CTO/COTA
Submitted by Kelly Schwarz, CTO MA OTL, Therapy Resource, Bandera
Tina has been TPM at Peoria Post Acute, Peoria, AZ, since April 2018 and has grown the team with an addition of six full-time therapists, an increase in Skilled Rehab patients from 10 to over 40-50! Tina has helped Peoria Post Acute build a Respiratory program, now accepting trach/vent admissions, as well as grow LTC programming.

Tina is well-known for her outrageous energy and is often seen excitedly RAISING THE ROOF! Pictured is the T-shirt her Administrator purchased for the whole facility to wear on the day Tina’s CTO was announced! Congrats, Tina, well-deserved!
Celebrating Tory Lane, CTO/SLP/DOR at Sunview Respiratory and Rehab in Youngtown (Phoenix AZ)!
Submitted by Kelly Schwarz, CTO MA OTL, Therapy Resource, Bandera
Tory has been with Bandera in a DOR role since June 2011 at Desert Terrace in Phoenix AZ, then started at Sunview September 2016, and was also DOR at Lake Pleasant Jan-Dec 2018. Tory has built an amazing team at Sunview Respiratory, and has played an integral part in Sunview flying the Flag for 4 years! Tory is an amazing SLP, and supervised several CFY’s in Bandera. She loves to take students and grow the Sunview Speech program while being an amazing DOR/Leader. She has applied for and attended the Leadership Summit for the past 2 years. Congrats, Tory! 
Celebrating Jeremy Osmond, PT/DOR, Newest CTO in the Sunstone Market  
Submitted by Tyler Hoopes, Market Leader, Sunstone (Utah)
Jeremy has been working toward this achievement for a couple years and taken feedback from partners to ensure he became a CTO. We are excited to announce that Jeremy has performed like an owner at Provo Rehab and in the Sunstone Market. The scorecard is strong this past year especially, and Provo is on its way to the best financial year ever. In addition, Jeremy is part of the clinical improvements as well.

Thank you, Jeremy, for pushing to make Provo Rehab a top-performing facility.
Celebrating Erin Huddock, PT/DOR, Newest CTO at Vista Knoll
Submitted by Clay Gardner, Executive Director, Vista Knoll, Vista, CA 
Erin has been with Vista Knoll since early 2017 and has made a positive impact in our facility since day one. She stepped into the DOR position during a challenging time after a failed survey and when our clinical leadership team was in transition. This didn’t deter Erin, as she quickly started to focus on the areas where her department and the facility could improve. 

Vista Knoll had a good therapy department when Erin started, but there were many opportunities to do much better. Whatever area Erin has decided to focus on, we have seen positive results and improvement. Progress with Part B, OT, CPM, Margins, Productivity and PDPM are just a few examples of the influence she has had on some of the key metrics at Vista Knoll.  

Before COVID, our outpatient program exploded and was still on the rise thanks to her vision of what it could become. Not only have our numbers improved in many important areas, but Erin has also become a consistent leader to our management team, making sure we are in step with all new regulations, changes and opportunities. She does her best to learn all she can to be a resource to the rest of the team and the market and readily makes herself available to anyone who needs support. She is a true partner to our DON and the clinical team and is always involved in finding solutions that will improve the care we provide. Thank you, Erin, for the true ownership you show as a partner in our organization and for always striving to make us better.