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

February is American Heart Month!
Did you know that our heart does not beat like a metronome? Our heart has healthy beat-to-beat variations called Heart Rate Variability (HRV). High HRV is associated with reduced risk for many adverse health conditions, including cardiovascular disease, and is also associated with greater resilience to stress. We can improve our HRV through both exercise and biofeedback training. Many of our therapists and nurses are now trained in a method of biofeedback training developed by HeartMath ( www.heartmath.com) in order to improve their overall health and reduce stress. By activating the power of the heart to balance our nervous systems, we can greatly reduce our risk for many diseases while improving our emotional well-being. Talk to your therapy resource about getting trained in HeartMath today!
Watch for more information coming on our WELL HeartMath challenge this month! 
Leadership Corner
What Makes a Good Leader?
Submitted by Jennifer Sowers, DOR, McCall Rehabilitation, McCall, ID
LEADERSHIP written on a white background and colour pencils. Business concept.Top view.
I believe leadership is a position earned and appointed by those who have taken recognition of your ability to follow, listen, try harder to be a better person, think outside the box and be willing to learn. 

Jocko Willink, a retired Navy Seal Commander, has written several books on leadership that are all worth the read if you want to be a better leader. Several truths to live by jump out in his books and podcasts, and the one that speaks loudly is: Discipline equals Freedom. What does this mean? First, why do we need discipline as a good leader?

In a leadership role, we are being watched. Our team is watching us; even those not on our immediate rehab team are watching us. The cooks, the CNAs, the Activity Director, not to mention our ED and the DNS. They are watching our attitude, our behavior, how we react in conflict or under pressure. Are we late for meetings? Do we roll our eyes? Did we yawn? How are we dressed? A full-time employee in our facility told me recently, “The rehab team is like the cool kids in high school — everyone wants to be like them and hang out with them.” At first it was a compliment, but then I started to think, why are we a separate “click” outside the big team? Do other employees think we are above reproach in the building? That’s when it really struck me how important it was that we as a team, and especially me as a leader, must demonstrate excellent leadership. We are in a spotlight. And we all know that with great power comes great responsibility, and as a leader, we are in a position of power.  Read On...
Birds of Different Feathers  --Improving Work Relationships 
Submitted by Tim Middick, TPM, Premier Care Center, Palm Springs, CA
Are you objective, analytical, and logical? Are you a natural team player? Are you lively and entertaining? Are you a natural born leader? The answer to these questions and more may help you to better understand your work style, but more importantly, the work style of your coworkers.
We all have unique personalities and different learning styles. What you appreciate about your work may be different from what others appreciate about their work. What do you think a lot about, value in others, enjoy or dislike? What you have trouble dealing with may be unique to your work style. Knowing and understanding what makes you and your coworkers unique may better strengthen your relationships.

Recently at Premier Care Center, we began a distinctive training style to identify ourselves and our work style. We then share with our coworkers each other‘s work styles in an attempt to strengthen our work relationships. The therapy department took on a fun adventure to better understand our own traits and those of us on our team and how we may improve. We were introduced to a training course called “Birds of Different Feathers.” It is a quick Personal Work Style Self-Assessment. Once everyone has completed the assessment they use the score on the assessment to identify their own ‘Bird Style.’ Once you know your bird, you may read the course information that identifies your unique characteristics. Knowing more about yourself is only half the fun. Once everyone shared their own unique ‘Bird Style’ with the group, we were all able to discuss and learn about each other. 

...So what kind of a bird are you? 
Are you an Owl - a data collector? Are you a Dove - a collaborator? Are you a Peacock – an artist/creator? Are you a Hawk - a decision maker? Find out your own unique ‘Bird Style’ and how you may better influence your communication with your team or coworkers. Click here to take the training on Birds of Different Feathers.
The Beauty of PDPM
What Might Be There
 By Lori O'Hara, MA, CCC-SLP, PDPM Resource
One of the miraculous things about PDPM is that we are incentivized to go learn things! And … we have the patient with us, 24/7, sometimes for weeks! There is no other provider — not the acute, not home health, not outpatient, not anyone who gets to have their arms around the patients as closely as we do and who are also told to go learn absolutely as much as we can. 

Just us, baby!

So this presents an incredible opportunity to be the best assessors, the best investigators and the best, most impactful providers a patient will come into contact with. This means that if we work superficially — if we’re content with just the diagnoses on the transfer list and just the treatments that come to us — that we’ll miss out on the potential for incredible impact to a patient, which, super conveniently, is pretty reimbursable when we do it.

So part of being a PDPM Ninja is knowing where the arrows are pointing. What conditions tend to come in clusters? What treatments should we be advising the MD that we can do? What low-impact, non-invasive interventions could have a big payoff for this patient if we just think about doing them? So here’s an exercise for you.
Highlights on Nursing and Therapy Partnership
I’m Cathy Champlin, the DOR here at Cedar Health and Rehab in Cedar City UT. My counterpart is Trent Neilson, the DON here. Cedar was a new acquisition on Jan. 1, 2019. I initially came on board at that time to assist with the transition, with the intention of returning to my home facility after a few months. The DON at acquisition had already given her notice prior to Jan. 1, and the position was temporarily filled by Jeremy Wood, our resource until May when Trent came on board. By the end of January, I had decided to transfer here as DOR and was working closely with Jeremy (and Spencer our ED) on helping to bring CAPLICO to Cedar. 

When Trent came on in May, it was a very smooth transition. Perhaps because neither Trent nor I had a long history at the building and were both new in our roles, we were able to help each other without any territorial disagreements. We just put our heads together, bounced ideas off each other and got to work. We have worked hard to ensure that there is no “That’s Nursing’s job” or “I’m the therapist — I don’t do that.” The nurses here are very open to listening when Therapy notices a change in condition, and Therapy does not hesitate to toilet and answer call lights when able.   Read On...
DON/DOR/ED: “The Transformational Triad”
Submitted by Jennifer Raymond, Therapy Resource - Flagstone, North CA
trans·for·ma·tion·al/tri·ad/  “able to produce a big change or improvement in a situation; “a group of three connected people or things

The objective of a triad is to create a peer-to-peer-to-peer relationship to accomplish a mutual purpose. “Triads are based on core values and mutual self-interest.”

A triad is not just three people meeting together. It is a relationship where each person is responsible for the quality of the relationship between the other. It is where each person has the other’s back. It’s “I’ve got your back and you’ve got mine” or “All for one and one for all.”

We have traditionally had one-on-one ED/DON relationships in the facilities as the leadership core. By adding that third person, the DOR, the power of the group is enhanced, the exchange of ideas and perception increased, it ensures faster and more accurate communication with the rest of the leadership/facility, it provides support and even friendship to the three members, it allows this core team to grow in their trust of one another, and it provides a place to be honest and safe when dealing with issues big and small.   Click Here for some transformational triad opportunities to achieve amazing things together!
Nursing Therapy Partnership: Water Protocol for Skilled Maintenance Program
Submitted by Jon Anderson, Therapy Resource -Keystone
The Power of Two: Recovery and rehabilitation require a comprehensive team working together to achieve a common goal. These goals cannot be accomplished by Therapy or Nursing alone, but a combined effort of a united team between departments. The efforts of nursing staff and therapists working together as a joint task force has brought incredible success stories within skilled maintenance programs.

Skilled maintenance programs are designed to maintain a patient’s current level of function and prevent unnecessary declines. A new skilled maintenance program Speech-Language Pathologists have implemented is a Free Water Protocol for residents on thickened liquids to decrease the resident’s risk for dehydration and increase their quality of life. The program was successful at safely decreasing resident’s risks for dehydration as well as increasing resident’s quality of life, but also provided unexpected success stories in other areas of dysphagia.  Read On...
Therapist Profiles
Meet Dora Alvarez , a quiet Tucson superstar who prefers to be out of the spotlight! Dora has been with Sabino Canyon Rehabilitation & Care Center for eight years and loves being able to oversee the wonderful work and dedication her team demonstrates in helping one patient at a time. According to Shelby Donahoo, Tucson therapy resource, Dora has really come into her own in the past year and is one of our strongest therapy leaders in the Tucson market.

Dora was inspired to pursue a career in therapy after her mother’s terminal illness. She wanted to be able to help her mom have the best quality of life possible in the time she had remaining, and therapy was a way in which to accomplish that goal. As a leader, she emphasizes CAPLICO in her department by working with her therapists, facing all challenges as a team and helping her team believe in what they do to help improve the lives of others.   Read On...
Welcome Shobha Neupane , originally from Nepal, a graduate from Newman University in Wichita Kansas, OTR by trade, who recently joined our organization as the DOR for both Broadway Villa and Valley of the Moon facilities in Sonoma, California. She has held herself and her team to the highest level of accountability from the moment she joined. Shobha has worked in leadership roles in other organizations as a clinical resource, multi-facility operations manager, teacher and trainer. She is very passionate to provide direct hands-on patient care, and she loves to be a role model in managing clinically/medically and mentally challenging patients. She treats everyone with the highest dignity, respect and integrity and consistently sends a message to others: “Through love, anything is possible.” Forever a patient advocate, she lives by the mantra, “Every patient must be treated like our family member.” Outside of her work, she enjoys spending time with her family, especially with her beloved son and husband. She also loves hiking, traveling, reading and communicating with her friends/mentors/seniors.
Welcome Paula Voorhis , PTA, to our ENDURA team of therapy leaders. Paula started working with ENDURA at Villas at Sunny Acres and then moved to a full-time treating position at EPAR. Once Paula started, she took on the task of group and concurrent therapy at EPAR and got the whole team on board. She scheduled and improved the percentage of group significantly and consistently. Paula has also taken upon herself to improve the working rapport with CNAs and other interdisciplinary team members. She demonstrates great passion and caring and exemplifies the concept “love one another” very well!

Paula is excited, motivated and very driven, and she also comes with a lot of great ideas and the support from her existing team members. We are excited to see what Paula can bring to the IDT team and EPAR as a whole!
Utilizing the Drum Circle at Palomar Vista
Submitted by Amy Pot, PT, DOR, Escondido, CA
The sound of light drumming and laughter filters down the hallway as the residents and patients start to assemble for drum circle. "I like chocolate cake, that's the beat we're going to play," instructs Amy Pot, Director of Rehab, and Lulu Matos, Director of Activities, to a group of residents and patients at Palomar Vista Healthcare Center. They are drumming along on Turbano drums to I Love Rock and Roll by Joan Jett.

Pot and Matos are passionate about providing opportunities to improve the lives of the residents at Palomar Vista and worked together to build a wellness program using music as a vehicle to address many health aspects. The drum circle was a perfect medium to bridge the goals of each department. "It's so simple anybody can do it and have a good time. We really wanted to work together to provide a dynamic program that would include everyone," said Pot. Every week, the drum circle continues to grow. Residents and patients who were hesitant to participate become involved because the buzz is so infectious and the experience can be tailored to address their individual needs.  Read On...
The Communication Cube
A material developed by Stephanie Lyle MS, CCC-SLP, Rainier Rehabilitation, Puyallup, WA
I work in a trach and vent facility where a majority of our caseload is not able to speak verbally, or with their voices. In Speech therapy, we often have to “think outside the box” for solutions to serve these patients. Alternative and Augmentative Communication (AAC) typically includes expressing wants and needs with pointing to a board with multiple symbols or words. For some patients with severe motor apraxia, forming a point is difficult — also, there is a level of dependency for caregivers to hold up the boards, so the patients can use their functioning arm to point. In addition to that, there are usually concomitant attention or visual deficits, making multi-symbol boards overwhelming for patients to process.

I received a patient who fit this description. She was able to read, when presented one word at a time. However when presented with six words on a board, she could not functionally read or point to a word to express her need. She could not form a point with her hand, and when given a pointing tool, she would unintentionally bring it to her mouth like a utensil.

“There must be a solution!” I thought, as I searched through my friendly OT’s closet. I found a six-sided foam cube and wrote a single word on each side. I presented it to my patient and had her identify a word by turning the cube over until the target word was face-up. She repeated this one-handedly for six out of six words. When given the cube, she independently expressed her needs or symptoms with nursing and activities’ staff as well! Due to the high level of success, I made her a cube for other contexts, such as beverage and food choices. A dry erase version was used for “on the fly” opportunities to express choices and preferences, such as choosing what movie she wanted to watch. I hope the “communication cube” can help other patients with motor apraxia as well! 
WELL (We Embrace Living/Loving Life)
Skip the Fast Weight Loss Diets and Go for Long-Term Health
By Angela Ambrose, contributing writer

With a wide array of diets on the market, it can be tough to weed out all the fad diets and find a nutritionally well-balanced diet that is rooted in sound science and also simple to follow over the long haul.

“It’s easy to be overwhelmed, but don’t get sucked in by all the fad diets,” says Katherine Beals, associate clinical professor of nutrition and integrative physiology at the University of Utah. “Sticking to the tried and true research-based recommendations is the best way to go. It’s pretty basic – fruits, vegetables, whole grains, lean sources of protein and low-fat or non-fat dairy.” These nutrition recommendations stand the test of time and are summed up in the U.S. government’s “Dietary Guidelines for Americans” that have been around for decades.  Read On...
Thirst Quencher: The Free Water Protocol for Patients with Dysphagia
By Elyse Matson, MA CCC-SLP, SLP Resource
The Free Water Protocol is one option SLPs may utilize to help counteract the adverse effects of thickened liquids and/or tube feedings. What is it? How should it be used in your facilities? What are the risks for aspiration pneumonia? 

The (Frazier) Free Water Protocol was named after Frazier Hospital. In 1984, Frazier Hospital began to give all patients unlimited bedside water and/or ice chips. They found that fewer residents had UTIs and dehydration. They also found that when paired with proper positioning and oral care, there were no incidents of aspiration. Although it has been referred to as the “Frazier Water Protocol” in the past, the proper name is “ The Free Water Protocol.”  It is best used with patients on thickened liquids or patients who are NPO and on tube feeding. 

The free water protocol is not appropriate for all patients. The table shown below can be used by the SLP to help determine the risk for pneumonia in each patient. As you might imagine, the higher the clinical complexity of the patient, the less likely a Free Water Protocol should be implemented. Remember that a patient on ice chips or free water has not been deemed free of aspiration on these textures; rather a determination is made that the benefits of free water outweigh the risk of pneumonia.   Read On...
Optima Update
Why Clinisign?
By Aimee Bhatia, OT, DOR, Glenwood Care Center, Oxnard, CA
When we were given the challenge to get our physicians signed up for Clinisign, it seemed daunting. We had tried several years ago with no success and a lot of push-back. After our quarterly meeting in Las Vegas, I came back determined to make a change. I presented in QA that we would be switching to Clinisign and highlighted how much it would cut down on being hunted down for signatures, how much less work it would be for the facility to coordinate signatures and clarification orders to remain in compliance, and how easy it would be to do at their convenience.

I gave the physicians a deadline, and with Mahta Mirhosseini’s help, I got three of our main physicians signed up within a week. Two of our doctors preferred to have their nurse practitioners sign, and that was perfectly acceptable. Setting up the doctors also allowed sister facilities in the area to more smoothly transition to Clinisign because the doctors were already in the system.  Read On...
Outpatient at Vista Knoll
By Erin Huddock, PT, DPT, DOR, Vista Knoll Specialized Care, Vista, CA
When looking at what programs haven’t been tapped into, my ED and I decided to focus on outpatient and what we could do differently to get our program back up and running again. Outpatient at Vista Knoll Specialized Care has always been something that was never really focused on and was getting by with minimal referrals over the past few years. To start, we looked at our outpatient census and how we could gain more referrals. With that, we decided to make our rehab tech, Diana, the outpatient champion.

We first looked closely at our referral sources. A great way to start was to look into those referrals from patients who are currently in-house. We are already developing a great rapport with the patients and family members; they are comfortable with our therapists and it would provide a smoother continuum of care. And guess what? We can also keep a look-out for our patients who may be struggling or potentially be at risk for readmissions to the hospital and let our admissions coordinator know. It’s a win-win.    Read On...
The Vista Knoll team in their outpatient clinic
How You Win the FLAG for Five of the Last Six Years
By Jeremy Nelson, DPT, DOR, Carmel Mountain Rehab and Healthcare, San Diego, CA
How do you put yourself in a position to apply and win the FLAG year after year? Consistency, commitment to results, passion and the tenacity to never accept anything less than your best effort. My drive and will gets me to where I want to go, and the gratitude I have for my team each day allows me to get there with grace. My commitment and passion for my rehab team is not only driven by results, but also by vulnerability and humility. I understand that alone I can do very little, and together with my team we can achieve so much — such as winning the FLAG year after year. Believe me, it comes with a sacrifice, but I believe the things most important and worthwhile in life come with mastering the discipline and sacrifice necessary to break free of being ordinary.

We work as a team at Carmel Mountain to make sure every employee understands their part in making a difference. The Nursing staff, the CNAs, the therapists and other departments show up each day to truly live our mission: “Through moments of truth, we will dignify long-term care in the eyes of the world.” The small mistakes or failures we may make along the way only help us learn and get better. One of my favorite quotes is by the French military leader, Napoleon Bonaparte: “The reason most people fail rather than succeed is they trade what they want most for what they want at the moment. Remember what you want most!” Remembering what we want most at Carmel Mountain means continuing to get better at all we do day after day and year after year. We never settle for our prior achievements. 

There is something magical that happens when everyone is on the same page supporting each other, striving to learn, challenging one another, and showing up with a great attitude. Want to win the Flag? Set big goals in each department, challenge each team member to find a way to be 1% better every day, be a great listener, and have the discipline to not let everyday distractions keep you from your goal. Obtaining the Flag is not a competition; it is a journey of will.
Moments of Truth
Herschel's Service at Cloverdale
Healthcare Center
Submitted by Jennifer Raymond, Therapy Resource, Northern CA
Recently Cloverdale had a resident pass away who was a proud veteran. He had lived at the facility for a very long time and was the unofficial “mascot” of the Therapy department, spending much of his time there even when he was not on active caseload. When he died, he had no friends or family, and the Cloverdale team partnered with the local Patriot Guard to make sure he had a full Veterans service and Honor Procession to his burial site in Dixon, CA.
The town of Cloverdale closed roads and lined the streets with flags as his procession went by. Nicollette Macleod and her Rehab team joined the rest of the facility staff in preparing his service and honoring his memory.
The Benefits of Group
Submitted by Jeremy Osmond, DOR, Provo Rehabilitation, Provo, UT
We have been really embracing group therapy here at Provo Rehabilitation, and every once in a while we have little “Group Miracles.”

We have a short-term patient here currently who has no family and no friends and is scheduled to be discharged soon. She has been very down because she has really enjoyed her time here and will miss the social interaction she has had, especially during her group sessions. Today she was talking with one of our long term residents during group with whom she has become very close. The long term patient is now going to be visiting her at her home since she lives close to our facility. This short term patient now has someone who can visit her and give her the social support that she needs when discharging home. It may be a small, insignificant story to some, but to these two patients, this group interaction, potentially changed their lives. Keep up the good work with group therapy and giving these patients the best quality care, even if it is beyond ambulation distance or ADL performance. At the end of the day, it all makes a difference in their lives. 
Congratulations to Our Newest SPARC Winners!
Congratulations, Jarrett Henderson, First Place Winner, and Primo Arredondo, Runner Up! Read their awesome essays here
Jarrett Henderson, OT
Grad Date May 2020, University of Utah, Salt Lake City, UT
Primo Arredondo, PTA
Grad Date: December 2020, Navarro College, Midlothian, TX