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

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Dear Therapy Friends,
I want to offer some words of encouragement as the barrage of challenges and unrest surround us both inside our buildings and now outside in many of our communities. Leadership requires us to dig deeper and deeper into our hearts, and today, more than ever, it calls on us to be a calm and resilient presence for our teams. Many are hurting, many are unsure how to express themselves, many are deeply tired of these turbulent times. A simple acknowledgment of the pain can bring light to the darkness. We all went into therapy with the love of healing others; most likely we didn’t realize how many different ways we would be asked to heal. Just as you are caring for your teams through the pandemic, remember to love one another and be the presence of peace through the community unrest. Together, we are strong and powerful healers. I have seen us grow exponentially through our 2020 challenges. Incorporate your heart-centered breathing to magnify the love. Let’s show how our Ensign-affiliated therapy programs stand in unison for light, love, and peace. 
Love to all of you.
Darkness cannot drive out darkness, only light can do that. Hate cannot drive out hate, only love can do that. --  Martin Luther King Jr. 
A number of my students and readers have asked if there is a particularly pertinent idea from our research that might be helpful in the uncertainty of the moment, as we face so much that is out of our control. I think first of The Stockdale Paradox, which has given me much solace and guidance over the years.

Stockdale Paradox: You must maintain unwavering faith that you can and will prevail in the end, regardless of the difficulties, and at the same time, have the discipline to confront the most brutal facts of your current reality, whatever they might be.

I’ve recorded a video from my home library to share the story of the Stockdale Paradox, and to remind people of this powerful approach to reframing what I learned from Admiral Stockdale. You can find the video on our YouTube channel by searching for “Stockdale Paradox” or by clicking this direct link .

Still looking forward, always forward.
#STAYStrong Updates
Love One Another in These Challenging Times
By Ruben Torres, PT/DOR, Atlantic Memorial Healthcare, Long Beach, CA
My heart calls me, from a place of faith and love, to see those who live in incessant unrest and shower them too with love. I am moved to feel compassion and love for the looters, the violent, the oppressed, and the hurting. They deserve our support and our spirit of giving.  We are reminded to love one another in these times of mutual challenge. We are also reminded to love those that we do not fully understand. Such as in the way we treat our beloved patients and residents. We look to our deeper understanding of humanity through the cultural experiences we gain in living, reading, and studying to gain awareness of conditions outside of our own understanding; we develop skills in reaching outside of ourselves to understand their geriatric experience. Similarly, we see that the experience of others in our communities are not the same and we can choose the same perspective we feel toward our patients and residents toward them.

In Long Beach, we love our City. We treasure its rich history (some positive, some not), its diversity, its shared essence of difference. We love our work too, and come in to our facility with pride and courage ready to face this pandemic as a team that is certain we will overcome. The team at Atlantic is little more than half the normal size, but our hearts have grown 3 sizes!  We send all of our Ensign affiliated partners love and gratitude for support, patience, and kindness. We also hope to make you proud.
Returned and Ready at Julia Temple!
By Patty Fantauzzo, TPM, Julia Temple Healthcare Center, Englewood, CO
Julia Temple therapists (L to R): Patty Fantauzzo, COTA, Andrew Davie, PT & Colleen McComish, PT)
Even how frightened we all were of the COVID-19 virus, the therapy team at Julia Temple continued to show up. We provided therapy to help keep our residents calm, moving safely and eating in order to help lessen the risks associated with contracting COVID-19. We were also treating/skilling residents with active COVID-19 in order to help lessen the effects and medical/physical deterioration, and to help with recovery. In addition to providing therapy, therapists were filling in for every department helping with everything from activities and restorative programs, to sitting with and comforting sick residents whose family members were unable to come visit.

Physical Therapists Andrew & Colleen as well as myself (Therapy Program Manager) all contracted COVID19 and thankfully have recovered and are back at work. Fighting COVID19 was no joke, it was at times scary, painful, and debilitating. I am grateful for all the love and support I received from our therapy resources, DORs, and colleagues. It gave me hope and helped throughout my recovery, especially while I was struggling with not being able to be with my team and Julia Temple family of colleagues and residents. Having recovered from COVID19 personally, I have an even better understanding of the benefit therapy can provide pre, during, and post COVID 19 DX. I’m so proud of my team, and all of the therapists out there for the great work they are doing during this pandemic. Therapy is necessary, important, and makes a difference. Keep up the great work everyone!
Update From Victoria PARC
Submitted by Dawn Thompson, DOR, Victoria Post Acute Care, El Cajon, CA
Victoria Post Acute (VPAC) is one of the few skilled nursing facilities accepting COVID-19-positive residents from hospitals in San Diego and El Centro. Like other buildings with positive COVID cases, the beginning stage was certainly an upheaval from “normal” daily routines, as we were thrown into a world of unknowns with ever-changing directions and recommendations, coupled with fear. Schedules were slim, admissions were down, and stress was high. The rehab gym became a room with social distancing markers and a storage room. Hallways turned into PPE stations. 

During this time, the rehab staff jumped into every and all support roles necessary (maintenance, dietary, CNA, etc.). They did this without asking and without hesitation, day in and day out, and continue to be heroes to this day. During this time, multiple rehab staff members were out sick, testing positive for COVID. As a team, we focused on “scared is what you're feeling, brave is what you’re doing” and really went out of our way to emotionally support one another. We had daily emotional check-ins, both as group and individually.  Read On...
Millennium Strong!
Millennium Post-Acute Rehab, West Columbia, SC
Administrator: Tara Johnson; Therapy Program Manager: Drew McQuillen 
Millennium is a facility in South Carolina with a brand new ED, and a fairly new therapy director. When it was time to confront the COVID-19 virus in our facility, we had a steep learning curve, and we knew we had to all pull together quickly to handle the challenge. Some of the key changes we implemented were: 
  • Created a strict and detailed PPE protocol
  • Broadened housekeeping cleaning areas to include disinfecting common areas to 3x per day, as well as deep cleaning of all residents’ rooms 1x per day 
  • With some of our residents showing a decrease in appetite, the dietary department offered extensive hydration throughout the day to include readily available soups, Gatorade and cranberry juice 
  • When our Nurse Practitioner contracted COVID-19, she continued to see all her patients through Telehealth daily 
“Through this time of crisis, I have watched this team come together in ways I could not have imagined. Our clinical systems have improved, our PDPM and risk meetings have improved, and we have all gained a better appreciation for our core values of CAPLICO as we are living them now more than ever,” says Tara Johnson, Administrator.
Update from City Creek
Submitted by Jared MacDonald, Operations Manager, City Creek Post Acute Care, Salt Lake City, UT
May 15 marked our one-month mark of becoming a COVID-only building. We are excited at where we’ve been and where we are going. First off, thank you! Thank you for all the calls, the messages, the food, the signs, the support, the staff, the prayers, and most of all thank you for helping us see what it truly means to love one another. We know it sounds cheesy but honestly, there have been many things in the past month that have brought us to tears of gratitude for your help and support. We could not be where we are today without your help, so thank you.
In the past month, we have admitted 55 patients and discharged 21. Thanks to our remarkable clinical team, both those on site and those from other buildings, we have a live to-date hospital readmission rate of 3.63% and a mortality rate of 3.63%. Those numbers are remarkable in comparison to both the state and national average. This truly shows that on the clinical front, we are succeeding. This plan is making a difference, and we thank you for your support in helping us be what and where we are today. 

We’ve started a tradition of ringing bells and cheering as our residents are brought down the hall and sent outside to meet family and friends. We will never forget holding the hands of an 87-year-old as we cheered for her successful discharge back home. Tears streamed down her face as she thanked each one of us for helping her fully recover. We hope you know, especially all you DONs, that you were just as much a part of that successful discharge. Thank you! Read On...
Rock Canyon is Staying Strong!
S ubmitted by Cathy Bowman, OT/DOR, Rock Canyon Respiratory & Rehabilitation, Pueblo, CO
Slowing the Spread at Chandler
Submitted by Matthew Pecora, DPT/DOR, Chandler Post Acute Care,
Chandler, AZ 
Chandler Post Acute has made therapy carts to help with infection control and efficiency.

Tracy Carrier, our wonderful OT, is just in love with her cart. Her cart has any necessary equipment to deliver therapy and keep all disinfectant materials handy between visits. If we can't bring our residents to the gym, we will (safely) bring the gym to them. She could not stop showing me everything that she was carrying around.

She said she is never giving this cart back, even after COVID. Great to see smiling eyes during this time (I say eyes since we can’t see their mouths)!
PPE Support From Our Service Center Submitted by Tyler Hoopes, Market Leader - Sunstone/Utah
I thought this would help us all see the magnitude of support we're getting from the Service Center. We’re a blessed group to work with the people we do. These pics are of the Service Center shipping out PPE to our markets
Rosewood Appreciation Gift Bags
Submitted by Dominic DeLaquil, Therapy Resource , ID/NV
Whitney Wilding, DOR, and her Rehab team at Rosewood wanted to show their appreciation to their nursing partners.  SLP Carly Peevers led the team in putting together some custom gift bags for every nurse! The nurses LOVED them!  

The bags included:
• Homemade cookies in the shape of a heart
• Homemade mask
• Pen
• Lotion
• Essential oils
• Thank you card
Virtual Cooking Class at Orem Rehab
By Kelly Alvord, Therapy Resource, Sunstone/Utah
At Orem Rehabilitation, they held several weekly cooking groups that were led by the OT, and thoroughly enjoyed by patients. When COVID-19 changed our practices, the OREM OTs knew they had to get creative if they wanted to continue this therapy intervention. 

The OTs have created a "cooking class/group" via technology. The OT is now working one-on-one with a patient to do a cooking activity, but they broadcast it to the other patients in their rooms so they can see what they are cooking. Rec Therapy and the rehab aides are going to the different rooms and logging everyone on to the virtual feed. After OT and the patient are done cooking, they send the finished product for everyone to enjoy! This creates a great way to provide skilled intervention to one patient while keeping everyone connected and safe.
Earn CEUs Through Our Online Courses
Submitted by Sacchin Bhatia, Therapy Resource, Flagstone/California
On May 2, we had a CEU online course through Summit Education on wheelchair seating and positioning, with 108 therapists in attendance. It was a 6 CEU course that went over in great detail how to visually assess positioning, how to properly take measurements of key body landmarks and angles of movement, how to accommodate for impaired postural alignment, and how to use positioning equipment to improve posture and allow for improved pressure relief. We received great feedback on the course, and many facilities are already incorporating the information learned into addressing positioning with both their skilled and long-term residents. 

We have additional online CEU courses available for you to earn CEU credits. Click here to view and sign up for them at www.ensigntherapy.com/courses
Moments of Truth
Olympia Patients and Staff Share the Love Submitted by Patrick Creegan, PTA, Olympia Transitional Care, Olympia, WA
Recently, a staff member at Olympia Transitional Care lost their home and cat to a house fire. Some patients along with therapists Varina Duffy, COTA, and Suzanne Simko, SLP, at Olympia created some baked goods to help lift the staff member’s spirits and help her during this difficult time. Creative treatment ideas along with love one another!   
Broadway Villa's Patient Success Story Submitted by Jennifer Raymond, Therapy Resource, Northern CA
Shell was first admitted to BWV on Nov. 29, 2019, following a devastating CVA. At that time, she was nonverbal due to severe expressive aphasia, NPO on a feeding tube and had significant sensory disturbances. She was unable to follow a very simple command, required max to total assist to perform basic self-care and was unable to ambulate at all. 

Prior to the stroke, Shell had been independent with all of her mobility, ADLs and communication and lived with her daughter. She had an extensive course of skilled care with all three disciplines and made impressive gains. However, she did not acquire the level of independence necessary to return home, so she was discharged from therapy to RNA and considered a long-term care placement at Broadway Villa.

As a true advocate, DOR Shobha Neupane-Gautam is always looking for ways that therapy can make a difference. During her daily rounds in April, she interacted with Shell and saw positive changes in her and the potential for her to do more. OT re-evaluated and began to see marked improvements during their treatments such that PT and ST also started new courses of care a month later. Read On...
To The Lifters
Submitted by Tiffany Bishop, DOR/Therapy Resource, Legend Healthcare & Rehabilitation, Greenville, TX
Our amazing ADOR George Palin and his wife have been working tirelessly to provide the entire building (and a few to our sister buildings) with cloth masks, and they are now working on gowns to keep us all safe. Today the team wanted to say a special thank-you to him. One of our other amazing PTAs, Heidi Carmichael, thanked George for providing her with a more comfortable mask (pictured — you gotta laugh sometimes, right?) and read the following poem as a thank-you. I thought this is so true of George and so many others who are going above and beyond to take care of each other and our residents. Read On...
Don't Be A Wheelchair Therapist
Submitted by Madeana Galler, Therapy Resource, Emerald/Kansas
I want to share a beautiful poem written by Angie Taylor, our Therapy Program Manager at Shawnee PARC. She is a very passionate therapist/leader and was moved this morning to write this poem. The message is so powerful!  


        Please don’t be a wheelchair therapist.
        You see, my life before was nothing like this.
        I rely on you to bring me back to norm
        Not stay sedentary like I am all the other times before. 
        Bring me out of my shell and push me further
        Show me your skills, trust, and strength and know I do not mean to be a burden. 
        I depend on you to see me how others do not
        You see my fear, weakness, and pain along with the life that I lost.
        I am still a person, whole and complete
        Remove me from this restriction, give me that peace.
        You know who I once was and still have the potential to be,
        Don’t be a wheelchair therapist, use your love to set me free.      
                                                                -Angie Taylor
Respiratory Rehab Using E-Stim
By Cory Robertson, Therapy Resource, Idaho
Did you know that electrical stimulation can be used for more than a really fun demonstration in high school physiology class? Yes, it is great for that, but the evidence-based applications of electrical stimulation are myriad. A recent meta-analysis (yes, a meta-analysis, the king of the hierarchy of scientific evidence) concluded that e-stim effectually strengthens quadriceps and enhances exercise capacity in moderate to severe COPD patients. 

A large barrier to therapy for those with respiratory conditions is their tolerance. They fatigue quickly and get short of breath and struggle with dyspnea. That is in part due to the changes in muscles when the ability to deliver oxygen to them decreases. There is an increased reliance on less fatigue-resistant muscle fibers. One method to address that barrier is the use of neuromuscular electrical stimulation to activate those muscles most important to functional activities. But how do you do it? Read On...
In-Line PMVs With Vent Patients
By Victoria (Tory) Lane, DOR/Speech Therapist, Sunview Respiratory and Rehab, Youngtown, AZ
Click here for a poster presenting methods for improving quality of life for ventilator-dependent patients by using in-line PMVs (Passy-Muir Valve). The use of an in-line PMV with patients who are vent-dependent can not only increase QMs for the facility, but also offer an overall improvement in quality of life. The ability to communicate basic wants and needs is essential to our patients, especially our most acute patients. not because they need to but because they want to. 
Congratulations to Lydia Chen, DOR, and the Rehab Team at Ukiah Post Acute, 2019 Flagstone Rehab Team Award Winners! 
 “Never underestimate the heart of a champion”
Congratulations to JB Chua, DOR, and his Superhero Rehab Team at Summerfield Healthcare, 2019 Flagstone Therapy Team Award Winners!
Faster than a speeding bullet, able to leap tall buildings in a single bound …
Please clap, cheer, elbow bump and smile for Milena Milenkovic, DOR, and the Park View Post Acute Therapy Team for being 2019 Flagstone Therapy Team Award Winners!