Ensigntherapy.com

29222 Rancho Viejo Rd, Ste 127

San Juan Capistrano, CA 92675

July 2020

As mid-March was approaching and COVID-19 was spreading, I stopped at a facility in the Momentum market and there was a temperature checkpoint. I knew we were in for some changes. For a while, I carried on as best I could, but I kept thinking there must be more I can do to help. Then, I received a call from Tali Gerassi, DOR at Grossmont Post-Acute (GPAC) in the San Diego market. They had suddenly lost their long-time SLP and desperately needed help. 

 

At first, I just tried to do what we SLPs do: find patients who need us and treat them. But soon I realized this wasn’t going to be an ordinary experience. This team was like no other I have met before, and I wanted to tell our whole organization how special they are.   Read On...

Keystone North decided social distancing wasn’t going to stop them from having a DOR meeting in June, so they had their first virtual Zoom meeting! It was so exciting to see everyone’s faces, hear their voices, and collaborate on ideas. As one DOR said, “We know everyone is just a phone call or email away, but it’s different being able to actually see them.”

The meeting was limited to two hours, and the DORs were encouraged to find a quiet space and really be able to be engaged the whole time. They had guest speakers about growing their outpatient programs, had compliance explain the new Skill in Place audit tool, and then had interactive and lively discussions on DOR productivity, digging for Skill in Place patients, and bringing back the fun factor! It was so helpful to hear what others are doing and take that information back to their own teams and facility. They even threw in some “top banana” awards to celebrate their successes in different metrics! This group plans to continue these meetings, even after the pandemic has eased. It is so beneficial for us to feel that connection and support and keep us motivated. As one DOR said afterward, “Thank you! This meeting was so needed. Always lights a fire under me!”

An interview with Tom Chan COTA and Cristina Amansec SLP

Brookfield Healthcare Center in Downey, CA is made up of some pretty amazing and selfless therapists. These heroes have truly shown their true colors during this time. At the start of the pandemic, Tom was one of those kind hearted individuals that bought N95 masks and goggles for the CNAs and our front desk out of his own money. He was one of the first people to dedicate himself to treat the COVID patients. Indeed a very courageous individual. Cristina was 4 months pregnant when the pandemic started. Despite her condition, she continued to fight and treated patients with COVID infection. She is courageous and a fighter. She also dedicated her own time to get extra supplies of masks, sanitizer, and reusable gowns. We got all the help we needed to win the fight because of her. After all the initial craziness died down, she focused her energy on getting us free food and goodies. She fed the whole facility for a total of 10 lunches overall. We are so thankful for her because she exemplifies the true meaning of Brookfield culture—being selfless and always looking out for others before herself.  Read On...

As we continue our journey with this pandemic, some say that we are getting used to the “new normal,” but I honestly think that this delivers the wrong message, as if this situation will last forever. Anxiety levels and fear remain high and are only heightened once we hear the words, “It is confirmed, we have (+) cases in the building.” When I received the news of a positive case at our facility over the weekend, I immediately tried to gather my thoughts on how I would want to share such news with my staff. I knew breaking down or panicking was not an option.

As a leader, I’ve always wanted to be transparent with my peers. I didn’t know how they would respond as I also felt vulnerable. So I sent a group text, to inform them of the situation and our plan as a facility moving forward as we tackle the new challenge we were now faced with. Magnolia has gone through a lot over the past couple of years, and we were always able to beat the odds as we believed in each other and worked together to get our flywheel going. Since the onset of COVID-19, we have made great strides in making Magnolia relevant. Some thought that we were lucky to have a good month, but we just kept going and improving.

The response I got back from my text was so positive and brought a smile of relief to my day! Instead of complaining or being wound up and nervous, we reassured each other and found a common theme in how to keep ourselves calm and composed knowing that we will get through this. Once we had a solid plan in place for Monday, rather than spending time worrying, we instead sent pictures of our pets. We “liked,” “loved,” “emphasized” every picture. I thought I was going to dampen their spirits, but we found a way to support each other. I continue to believe that this TEAM has what it takes to make a difference. And it feels so good to come to work knowing that! #MagnoliaRising

During this COVID pandemic, many residents are limited to their rooms and haven’t been able to have visitors from any family or friends. In order to help connect families using technology, Jennifer Raymond, Therapy Resource, took the lead on applying for a grant for the Northern California market in Flagstone to obtain 15 video callers free through https://www.covidtechconnect.com/ . They arrived at the end of June — about three weeks after the application was submitted. Jennifer will work with each facility to get them set up for rehab and activities departments in order for the residents to be able to communicate with their families both during therapy and with activities.

L to R: Kendra Ruzicka, PTA/Director, Sara Kiedinger, SLP, Andrew Davie, PT

At JTOPS, we created a working relationship with ALFs in our community by providing fall prevention programs/screenings, trainings to staff members, group exercise classes and participation in resident council meetings. This allows us to care for and improve the quality of life for all residents at the ALFs. JTOPS has built a strong relationship with referring providers at ALFs and within the community by providing quality care with positive outcomes to demonstrate the effectiveness of our therapy services along with constant communication, follow-up calls and check-ins during the pandemic to offer support. Over 65% of our referrals come from this working relationship with ILFs and ALFs. On average, we receive two to four referrals per week from the providers we have developed this with. The JTOPS team created the following videos to assist patients with their exercise programs:   https://www.youtube.com/channel/UCJcgUr2bzFaJibdf-X0pjAw

Of the many exciting and challenging things our therapy teams look forward to doing every day, it is probably safe to assume documentation is not at the top of anybody’s list! Yet, in spite of the wonderful work that is done in our gyms, patients’ rooms and hallways — what we choose to document about those services may result in a denial of payment for your facility down the road.  

Some of the most common reasons for claim denials include:

The best defense for these types of denials is a good offense. We must proactively document the medical necessity and skilled interventions provided by our therapy staff.  Read On...

On June 6, we organized a virtual continuing education course on cardiopulmonary rehab, including physiology, anatomy, treatment interventions, medications, and vital sign parameters crucial to those with cardiopulmonary illnesses such as COVID-19. It was a six-hour live webinar that was attended by over 200 therapists across the organization, allowing us to secure a rate of only $37.50 per therapist. It received great feedback from participants, and there was so much interest that we had round two on July 11. Please encourage your therapists to register for future classes at www.ensigntherapy.com/courses , as we continue to further the education and expertise we can bring to wellness in our industry. 

By late March, therapy students across the United States were dismissed from their onsite clinical affiliations. The wave of COVID-19 created an unprecedented level of displacement for so many therapy students, especially those in the SNF setting. One can only imagine the feeling of despair felt by those who needed just two more weeks to fulfil their affiliation requirements to graduate. 

Intelligent risk taking remains one of my favorite core values because it is through that core value that progressive ideas are imagined and crafted into programs that transcend into the next level of care. It was through unified brainstorming that the Virtual Student Program was imagined. After several weeks of discussion with our University partner, we drafted a proposal to the Commission on Accreditation in Physical Therapy Education (CAPTE). We successfully received approval to provide a two‐week/80‐hour virtual clinical learning program to 10 students who were dismissed from their clinical site secondary to the COVID‐19 pandemic. We have officially become the first SNF organization to offer this level of experience to therapy students.  Read On...

We have a new and more comprehensive understanding of how we can truly “dignify long-term care” by taking care of the residents that live in our facility. We decided to question some old patterns and beliefs that were preventing us from truly delivering the best possible therapy services to our long-term residents — our extended family. 

The change did not happen overnight, but with education and support of our resources, our therapists began to truly understand the extraordinary differences they could make in the lives of residents by addressing many basic needs. We started looking at quality of life rather than waiting for a fall or a decline. We began education on programs including Percutaneous Tibial Neuromodulation (PTNM) for urinary incontinence and Abilities Care for dementia, and although we were improving quality of life, we were still missing something. We were discharging our residents to restorative, but they were still showing declines after therapy ended. How could we make a more permanent impact on their lives?  Read On...

The I-tool is the first “6th vital sign 3-in-1 tool.” Due to the ongoing pandemic, which requires social distancing and isolation, our goal was to bring the evidence-based practice into the patient’s room. Validated standardized tests can be utilized as part of the treatment strategy at the same time. The 3-in-1 tool covers the full spectrum of the patient’s functional skills from low functioning to high. It can be utilized to conduct three standardized tests: 

The tool is made of PVC pipes that are carefully measured and fitted to allow for quick assembly and disassembly. The kit’s quick setup process support productivity and encourages therapists to consistently integrate standardized tests. Each part is color-coded, which can be completed in 30-40 seconds. Read On...

At the Orchard Post-Acute Care, the rehab department is utilizing gardening as an occupation to promote wellness and recovery. We have faced many changes due to the COVID-19 pandemic, but the one impacting our residents the most is the restriction on everyday activities once enjoyed such as communal dining and group activities. At The Orchard we have found that utilizing gardening has provided our residents with a means to prevent feelings of emotional and physical isolation, all while enjoying the outdoors as they participate in something recreational and therapeutic.  



Through their participation in OT, residents utilize raised garden beds that our administrator’s son built for his Eagle Project as a Boy Scout last year. The beds are at a height that accommodate residents both while standing or seated in a wheelchair. Residents use tools to plant, dig and water our garden of seasonal flowers and vegetables like tomatoes, bell peppers and herbs. 

Gardening allows residents to work on both physical and cognitive challenges, such as balance, posture, coordination, problem solving, sequencing and planning. Gardening is also a fun, purposeful and meaningful activity that can promote relaxation and reduce stress and anxiety, all while fostering curiosity, hope and wonder as we help our residents get through this pandemic together. 

Meet Matthew Wayne, our newest therapy leader in Idaho! He will be joining our Bennett Hills team in Gooding, ID, next month and brings with him several years of experience as a PTA in three of our Pennant operations.  

A graduate of Idaho State with degrees in Physical Therapy Assistant and Health Science, Matt is looking forward to expanding his leadership experiences. He was inspired to pursue a career in physical therapy when he had the opportunity to shadow several brilliant PTs through a career exploration class in high school. Prior to that, he possessed a passion for helping people through personal training, and combining this training with his new knowledge of physical therapy shaped how he wanted to interact with people and their health through therapy.

Matt looks for positivity in his colleagues and practices that quality in his own profession. “I figure if I try my best in all things and give encouragement to others to do their best, then I have given all that is possible. It feels so much easier to make advancements in challenging circumstances when we have strong support and have positive words spoken around us and our situation.”  Read On...

One of the newest members of our therapy team here at Paramount Health & Rehabilitation, Salt Lake City, UT, is Rebecca “Becky” Hopkins, OT. Becky comes to Paramount with a unique perspective as a clinician and a unique skill set. Becky was previously involved in a motor vehicle accident that resulted in months of difficult rehabilitation. She has sacrificed and worked very hard to get to where she is today. Many things that Becky requires of her patients, she herself has lived through. This has allowed each patient to trust her and form a special bond. Becky has a unique understanding of the difficulties and hardships involved in rehabilitation, both continence in personal dignity and quality of life. Overcoming incontinence has become a passion and focus for her in her Occupational Therapy career. In the pursuit of that lofty goal, Becky has established an incontinence program, together with Gia Deeb her COTA, here at Paramount.  Read On...

The pandemic has changed so many things in our daily rituals, and at Legend New Braunfels the facility quickly found itself with less referrals, resulting in decreased skilled and overall census. The facility is known in this quaint community for its fast-paced rehabilitation program and more recently unique treatment approaches surrounding memory care. In an effort to collaborate and ensure patients in the facility avoid the hospital, the facility implemented the Stop & Watch Tool along with Grand IDT Rounds. 

 

The Stop & Watch Tool allows any employee to document a change in a patient, providing a direct line of communication to the nursing team for further assessment. Bob Said, RN, DNS reports that initially this was looked at as perhaps creating more work for the nursing team, and there were questions surrounding whether a non-nurse would be able to utilize the tool effectively and appropriately. However, it has been quite the opposite. The nursing team provided training to all clinical staff, including the therapy department, on how this tool can be used to effectively capture an early change in condition.  Read On...

Over the last six months, the nine Washington facilities have been focused on improving our Quality Measures for improving the care of our residents and eventually impacting overall Casemix. With amazing efforts from our entire interdisciplinary teams, all of our WA buildings have significantly improved our Quality Measures as well as our PNSD. We couldn’t do this without strong MDS and DOR partnerships committing to the process and continually challenging each other in order to help our residents improve. 

Mountain View Rehab in Marysville, WA, has been challenged with a COVID outbreak, but it has not stopped the dynamic duo of Patrick Amar, DOR, and Betty Waech, MDS, to continue to work together though video and phone meetings, even completing visits as needed via video in order to not miss therapy sessions. .  

Another dynamic duo at Pacific Care, Lou Antiquiera, DOR, and Cheryl Reed, MDS, have worked together to also greatly improve QMs. Lou is new in his DOR role since February and has been a quick starter to learning PDPM, casemix, while leading a team through new COVID CMS guidelines. He attributes a lot of the improvement in casemix to the OT psychosocial programming and having a great MDS partner in Cheryl. Thank you, Cheryl and Lou! 

The interdisciplinary team at The Courtyard in Victoria, TX, decided that May would be the month to come together and turn around results. Our MDS Resource (John Adigun), our Clinical Resource (Arlene De La Cruz) and myself (Therapy Resource) partnered and spent an entire day with the IDT team training on PCC reports for SIP, COC, Skilled documentation, NTA’s case mix, CMI- Medicare/Medicaid and QMs. I stayed at the facility three days during the week to be their treating ST, which gave me firsthand awareness of how we could better partner together. 

Together, we dove deep into how we could train the entire team on capturing everything we were doing for our patients on the MDS. We also identified every way that we could keep patients happy and healthy and out of hospitals. As a result, we had our best clinical and financial performance of the year! This really goes to show what can happen when the entire IDT comes together and works to turn results around. Below are the results for May and the celebration we did together as partners for the team for having excellent results. It was a very emotional celebration full of love and joy, and we were so proud to see them succeed, especially in these times. They allowed us to be part of their team (family) and took our support and were receptive to our advice and produced results. They are a true inspiration! 

Last week, The MDS nurses and I held multiple small group training sessions for all the CNAs and nurses in our facility. The overall goals included: understanding ADL performances, understanding how to appropriately document level of assistance, how to determine the best level of assistance to provide for a resident, and what to do when a resident demonstrates a change in performance. We specifically reviewed the late loss ADLs that were flagging on our quality measures — in our case, eating, toileting, bed mobility, locomotion and transfers. We utilized educational boards, demonstrations and a quiz with written scenarios. We wanted this experience to empower our staff to take ownership and accountability of their documentation procedures and their approaches to care.

We found ourselves in a very interactive environment with lots of questions and good discussion. We defined and reviewed the differences between total, extensive, limited, supervised and setup assist levels. We were able to discuss the impact of enabling a resident’s best performance potential. We discussed how therapy and nursing can work together when a resident would benefit from intervention in order to identify, maintain or improve participation with ADLs. 

We expect to see improved quality and accuracy of documentation as a result of this training. In turn, we would anticipate to see this quality and accuracy reflected in our care outcomes. We hope that this also opened a channel of communication for future problem solving and a support system for our CNAs. And ultimately, it is our residents who benefit the most when we are doing our best!

During this challenging time, one of the unintended consequences may be increased falls due to fewer group activities, more residents staying in their rooms, and residents with increased confusion due to changes to their normal routine. 

We can be important team members in the quest to decrease falls. We are uniquely trained to assist in prevention and reduction in our facilities. As Speech-Language Pathologists, we can assess the cognitive-communication abilities and identify impairments.

A study looking at falls at 32 SNFs found that more than 80% of falls were related to cognitive-communication impairments or changes. Much of the time, the resident had a need and they were unable to communicate that need. Next, they stood up, resulting in the fall. As SLPs, we can look more closely at the communication needs of these residents and work to make environmental, compensatory or restorative changes to provide the resident with a system to communicate needs to caregivers before the fall can occur. Consider evidenced-based therapies, such as spaced retrieval, errorless learning, vanishing cues, attention training, and use of non-verbal communication systems. 

As you and your teams expand your programs and look to provide functional and needed help for your residents, consider utilizing your SLPs in your fall prevention program! If you have questions, feel free to reach out to Elyse Matson, SLP Resource, at [email protected]. 

Some of this information was taken from www.medslpcollective.com . 

Submitted by Maryann Bowles, Therapy Resource, Colorado

At Arvada Care Center in Arvada, CO, our 98-year-old resident had big plans to go to Hawaii this month with his family. (He was doing two days per week at the gym getting “beach bod ready.”) That trip had to be canceled for obvious reasons, so the therapists decided to bring Hawaii to him.  

The Speech Department at Golden Acres Rehabilitation in Dallas, TX, didn’t want a resident’s 100th birthday to go by without a celebration, so they made signs, wore party hats, and sang to her from outside her isolation room window! So sweet!

One of the COTAs at Golden Acres, Vinnie Guevara, has been giving haircuts to some of the residents since they can’t go out and the hairdresser can’t come in.

These aren’t even patients on his schedule, but he brings them down in front of the windows so they have a nice view while they get a trim! When we saw this, his response was, “I gotta take care of my guys!” Made my heart happy!

Ben Pack, a 94-year-old WWII Vet, spent two years quarantined with TB and now survives COVID-19! View the celebration here: https://www.10news.com/news/local-news/el-cajon-veteran-who-survived-covid-19-gets-socially-distanced-homecoming.

When Ben's daughter tells her dad that he is her hero, he replies that the true heroes were the doctors, nurses and therapists who cared for him!

Throughout my time as a therapy resource for Premier Care Center of Palm Springs, Tim has demonstrated attributes that embody a level 5 leader. Tim exemplifies the core values of CAPLICO in his daily work. Tim offers his full support and has been absolutely committed to helping Premier Care Center raise its standard of performance. He is not afraid to make any changes and is willing to step out of his comfort zone for the benefit of the residents and staff at Premier. 

Tim has played a pivotal role in Premier’s recent financial success. Overall, Tim has taken complete ownership of his department and of the entire facility. He has treated Premier Care Center as if it is his own business. It is my privilege to see Tim recognized as a CTO. He has the skills, discipline and dedication required to become an effective business partner for Touchstone 2.0. Congratulations, Tim!

Congratulations to Mark Kao, DOR, Whittier Hills, for earning CTO. Mark has been employed at Whittier Hills Healthcare Center since December 2017, and during that time he and the therapy team have become one of the strongest performing teams in the market. The team not only rallies around Mark, but also is very driven to win the Ensign Flag. Mark implemented weekend therapy programs; increasing therapy services from a Monday-Friday provision to every day. This immediately boosted outcomes, satisfaction from patients, family members, staff members, and community patient care providers. Mark also works with local schools to provide opportunities for students to complete their fieldwork trainings. There have been over ten students within the past two years, and there are several volunteers who have ambitions for healthcare careers that have done their volunteer hours. Mark has always striven for the therapy department to be part of the solution and has invited his therapy team to be more inclusive to the whole IDT process to improve patient care through participating in meetings and discussions to facilitate management in wound care, weight variance, fall prevention and management, patient’s psychology/mental wellness, infection control, care planning and appropriate discharge planning. 

Carlos has earned his Geriatric Specialist Certification through a rigorous program and examination process provided by the APTA. For more details: http://www.abpts.org/Certification/About/

Thank you for always inspiring us to be the best version of ourselves!  

Left to Right: Almira Rabaca, PT; Gianna Lincoln, Rehab Aide; Nicolette MacLeod, SLP/DOR; Ossie Ogiamien, OT; Celeste Gray, PTA; Jarrod Arlich, PTA; Jeffrey Montesclaros, COTA

The Cloverdale Healthcare Therapy Team enjoyed a special trip kayaking on the river to celebrate our Outstanding Therapy Award. We have managed to keep COVID-19 out of our facility so far, but the weight and worry is still there. It was nice to step away from the facility for a minute to restore our minds. We are so grateful for our good health and supportive team leaders. A beautiful day begins with a beautiful mindset. Proud to be a therapist!

An Award & Goal Setting meeting today brought together Colorado DORs to set key indicators goals for 2020 and clinical programming goals. We shared best practices with skill in place, D/C GG code accuracy for QMs, and OP/telehealth.

2019 brought on growth with PPNSD, productivity and significant improvement in mode of treatment. Awards were given to the following facilities for clinical, financial and culture achievements:

 

● The Healthcare Resort of Colorado Springs

● Arvada Care Center

● The Villas at Sunny Acres

● Englewood Post Acute

● Rock Canyon 

● Sloan’s Lake Rehabilitation

● Julia Temple

● Littleton Care and Rehab

● Medallion Post Acute

ENDURA also exercised our CAPLICO and had an amazing MDS & DOR celebration.  MDS’s & DORs celebrated our collaboration efforts toward clinical accuracy for Medicaid Casemix.