Ensigntherapy.com
29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
October, 2019



Goodbye RUGs - Hello PDPM!
The therapy leaders in Momentum and Touchstone are ready for PDPM!  
Here at Rock Creek in Kansas City, we are “chasing rabbits,” looking for diagnosis codes and things we can capture under the new PDPM model. We do sometimes feel like it’s unicorns we’re looking for though! We also have our GG police Vanessa in MDS who is always on the patrol to ensure we’re completing our GGs and accurately reporting. 
Caught in the act this morning at Wellington Place in Temple, Texas:
The DOR Dustin Rex, PT, bought donuts for his team. Take a look at what he wrote on the box. We just loved it! 
As “Celebration” played in the background, the therapists at Willow Bend DESTROYED our 720-minute shark! ☺  
RIP RUGS!
At Sloan’s Lake in Denver, Colorado, having a little fun appreciating our MDS queen and rolling out PDPM! 
In memory of PPS leaving us and PDPM arriving, Shawnee PARC held a memorial service and wrote on the balloons what they would not miss from PPS and what they are looking forward to with PDPM. Lots of tears — of joy, that is! 
Camarillo Rehab Toasting the End of RUGS and the Dawn of PDPM
Our CMLs Preparing for PDPM
Sharing Best Practices to Improve Skilled Documentation
By Marivic Uychiat, Director of Clinical Services
I wanted to share what Donna’s CML shared with us — great idea, Donna! We would love to hear more initiatives and best practices to improve skilled documentation from all of you!

“Donna Smith, MDS Resource, did a fantastic job with PDPM training. She printed out several skilled notes from our facilities. We each had to read the notes and explain the diagnosis we would choose and why, based off the daily skilled note. Then she shared what they were actually skilled for and what we were at risk to lose with PDPM as a result of inadequate documentation. DONs were engaged and had great questions and feedback.”

Susan also shared what Mel and the Endura team have been doing to Keep it Simple. It’s spreading like wildfire across all our states! Thank you all for embracing and owning the solutions on how we can improve skilled documentation!
Updates
The New and Improved PDPM Projection Screen 2
By Mahta Mirhosseini, Therapy Resource

Projections 2.0 screen is loaded with helpful features and functionality to help make projecting and tracking minutes more simple. Let’s have a look:

Launching Projections 2.0
Projections 2.0 was created especially for PDPM. To launch Projections 2.0, C lick here to follow these steps
Jumping Into the Deep End of the MDS
By Rob Ady and Lori O'Hara
Historically, therapists have a unique background and experience related to many of the items on the MDS that influence reimbursement. Mastering the connection between —and balance of—clinical and financial is an essential skill for success in the MDS field. Those same connections are what drive the dynamic communication and interaction between the MDS and Therapy teams throughout all the stages of assessment for both our short- and long-term residents.

Therapist education and clinical training, when applied to the IDT process of the MDS, creates a unique ability to hear, discuss and learn many of the coding conventions incorporated into the MDS, which makes transition from Therapy into MDS a viable option to explore. Transitioning from Therapist to MDS is a unique opportunity to facilitate "both sides," enabling you to offer new perspectives to the Interdisciplinary Team while still maintaining a connection to your home expertise as a Therapist.
Can Heart Rate Variability Be Improved in Those with Heart Failure Through Gratitude Journaling?
By Cory Robertson, PT, DPT, Therapy Resource
According to a study out of the University of California, San Diego, the answer is no, and yes. How can that be, you ask? Keep reading to get the details and the findings of the study: A pilot randomized study of gratitude journaling intervention on HRV and inflammatory biomarkers in Stage B heart failure patients.
 
Patients with Stage B heart failure are those who have a structural abnormality of the heart but have not yet developed symptoms. Thus this stage is a therapeutic window of opportunity to deliver interventions to prevent the progression of the disease and to maintain quality of life. Studies suggest a strong connection between gratitude and well-being. The area of behavioral cardiology is increasing focus on positive psychology like gratitude and how it affects physical health.  Read On...
WELL
(We Embrace Living|Loving Life!)
9 Ways to Break Out of Your Boring Exercise Rut
By Angela Ambrose, Contributing Writer
When you’re tired of doing the same old exercise routine, it’s easy to make excuses and skip workouts. Only 23 percent of adults meet the 2018 Physical Activity Guidelines set forth by the U.S Department of Health and Human Services. They strongly recommend:
  • At least 150 to 300 minutes of moderate aerobic activity or 75-150 minutes of vigorous-intensity aerobic activity weekly
  • Strength training of all major muscle groups two or more days per week
  • Stretching and mindfulness activities such as yoga, tai chi or qigong
  • Balance training to prevent falls
Adding more variety to your workouts can help you meet all of these important exercise guidelines each week. Not only will you find more enjoyment, but you will also be more likely to exercise longer and more consistently. Spice up your exercise routine by trying two or three of the following options:  Read On....

WELL Challenge! Share your own stories about how you’re adding variety to your workout!   
  1. If you have Instagram: From your Instagram account, share a picture and caption and remember to hashtag both #CAPLICOwell #CAPLICOnation
  2. Or, using your smartphone: Visit EnsignTherapy.com, click “WELL” at the top of the page, then click “Share your Story” from the top of the WELL Site. There you’ll find room to share a short story and upload a picture from your phone. 

We look forward to seeing your inspiring stories as a collaborator to our WELL Project.  For more information on this topic or the latest health and fitness news, visit AngelaAmbrose.com or follow Angela on Facebook (@AmbroseHealthyLiving). 
Productivity Corner
By Ciara Cox, Therapy Financial Resource
Q: What are group minutes?
a. They are life-changing moments of love (also known as treatment minutes) delivered more efficiently and with increased opportunities for socialization for our clients.
b. They are recognized by AOTA, APTA , ASHA and CMS as a method of skilled therapy delivery.
c. They may not be appropriate for every client.
d. They are supported in the OT, PT and SLP literature as an effective way to achieve outcomes.
e. All of the above

And the answer is … e. All of the above

Passion for Learning
A Dry Needling Success Story
By Evette Ramirez, PT, DPT, Keystone Therapy Resource/DOR Legend Oaks, Waxahachie, TX
Dry needling is a technique that has many uses, although it is often confused with acupuncture, which follows the principles of Chinese medicine. Dry needling is a technique in which varying lengths and gauges of acupuncture needles are used at nerve roots, nerve pathways, homeostatic points, muscle bellies, scars and/or the area of motor endplates as treatment areas.

The dry needling technique follows the rules and knowledge of the human anatomy and has a background derived from traditional medicine. It has been shown to help promote physiological homeostasis and allow the body to maximize self-healing of soft tissue dysfunction by creating a small lesion in the tissue, triggering an inflammatory process and healing. Dry needling should be practiced by a clinician who has had thorough training in needling techniques, has a strong knowledge of the human anatomy, and knows and understands precautions and contraindications so as to avoid doing harm. Read On....
LSVT Live in Colorado
By Maryann Bowles, Therapy Resource
The ENDURA Market in Colorado gathered 10 of their physical and occupational therapists to complete their LSVT BIG live training together at the Villas at Sunny Acres. The group spent a full day going through treatment and practice of the　evidence-based neurologic patterns and movements for the treatment of　symptoms associated with Parkinson's disease.

Specifically, research shows that LSVT BIG treatment can lead to faster walking with bigger steps and arm swings, better balance and more ability to twist at the waist. Clinicians also report that LSVT BIG often helps people with buttoning their clothes, writing and other smaller-movement ("small motor") tasks, as well as large ("large motor") movements like dressing, getting up from a seat and getting into bed.
From Therapist to Executive Director:
The Why and the How
By Chad Long, Therapy Resource
Post-acute health care is making a massive shift this October with Medicare’s change to the Patient Driven Payment Model (PDPM), where patient clinical characteristics drive the reimbursement and functional outcomes determine success. Along with the payment model changing, we are in the midst of a significant population shift (often referred to as the Silver Tsunami) in which we have a growing number of older people, many of whom need a greater number of health care services.
"The Silver Tsunami is already rolling in and projections from the U.S. Census Bureau point to 2030 as a milestone year in which older people will actually outnumber children for the first time in history."
Tom Sullivan, March 15, 2019
"As the number of senior people rises in many economies of the world, the need for long-term care and aging-in-place services will increase."
Reenita Das, Aug 11, 2015
So who will help champion the changes in health care delivery and ensure clinical and operational success in Post-Acute? Why not Therapy Professionals?! As licensed therapists and therapy assistants, we have a unique opportunity to move into Skilled Nursing Operations (Nursing Home Administrators, Executive Directors, CEOs, etc.) and work in a new capacity within the Interdisciplinary Team. Read On...
Keystone Student Programs:
A Record-Breaking Year 
By Kai Williams, Therapy Resource
Passion for learning is an actionable term that many of our therapists and therapist assistants display throughout their day-to-day. This can be evident through your engagement in learning from others and teaching. Oftentimes, we have clinicians who shy away from accepting a therapy student due to fear of it affecting their productivity, or they may have insecurities in their ability to provide expert clinical training. From the perspective of many students, they truly value the time they are able to spend with clinicians. Didactic work only takes students so far; it is the true clinical experience that produces the confidence and backing of their clinical capabilities.

Keystone has developed a student program that not only provides students an opportunity to intern at our facilities, but also allows us to forge purposeful relationships with our local university and community college partners to aid in the enhancement of our profession. So far in 2019, Keystone has had a total of 58 students of a variety of disciplines and from a variety of academic institutions.  Read On...
Therapist Profile: Kelsey Martindale 
Submitted by Jamie Funk, Therapy Recruiting Resource

I am pleased to introduce Kelsey Martindale, a physical therapist who has been a key member of the therapy team at St. Joseph Villa in Salt Lake City for the past two years. “Kelsey is passionate about making the lives of our LTC residents better. She loves to work with neuro patients, especially those with Parkinson’s disease and other movement disorders. She takes our core value of celebration seriously and likes to plan events and parties for our team outside of work. She is flexible, kind, giving, generous and considerate. She is part of what makes me want to come to work every day,” says Lisa Brook, our dedicated and passionate rehab director at SJV. Read On...
DOR Profile: Michelle Mitev, OT
DOR, Rock Hill Post Acute Care, Rockhill, SC
Submitted by Heather Bjernudd, Therapy Resource
What an inspiration! Before we get into Michelle’s incredible story, let’s get to know her a bit. Michelle has been an OT for nine years. When we acquired Rock Hill Post-Acute Care Center back in January 2016, we were lucky enough to keep her as our lead OT. About a year and a half later, when the DOR position opened up, Michelle stepped up and took on that role.
Michelle is from Ontario, Canada, and came down to South Carolina for college and to pursue her Occupational Therapy degree. Her passions have included playing and coaching soccer to young kids, enjoying her two dogs and spending time with her husband, Simon. Michelle has faced numerous challenges at her facility but has continued to push that flywheel and has seen incredible results in the past few months. Her love for the residents and her therapy team shines through every day.
A few months ago, Michelle’s college roommate and dear friend found out her newborn son, Camden, would need a liver transplant in order to survive. Michelle immediately got tested to see if she was a match. On Aug. 28, Michelle donated 1/3 of her liver to save this incredibly strong 3-month-old boy’s life. She still has a bit of recovery ahead of her but is doing great, and the baby is thriving and back at home with his family!
Partnership with Recreational Therapy
In Utah, we are fortunate enough to have a Recreational Therapy Resource, Kami Archibald. Kami is a great partner with our therapy teams to find ways to further enhance the lives of our residents. Through this partnership, our facility Rec Therapists are becoming an integral part of the therapy teams. This all started when they asked to be educated about our “therapy world,” productivity and how Rec Therapy can support us.

We started with Recreational Therapists and Therapy Teams coming together to find ways to partner for group treatments. The groups are then scheduled on the activities calendar. By partnering with recreational therapy, it was an easy “in” for our therapy teams to start integrating group treatment into clinical practice. Additionally, it allowed the therapists to screen participants who are not on therapy caseload for any declines or needs for therapy intervention. 
TheraTrooper Spotlight
Introducing TheraTrooper Travel Partners, Jared and Jennifer Cullifer, Occupational Therapists
Jared and Jennifer met during OT School, and after marrying, the two of them decided to embark on an adventure as husband and wife, which found them combining their passions of Occupational Therapy and travel! Their modest home is a travel trailer, which they can easily pull along with them to each of their TheraTrooper locations! They love being able to have the freedom to explore as they travel along the way to their destinations.

Since starting with our TheraTroopers program just about one year ago, the dynamic duo have been making a difference and leaving a trail of positive energy each place they visit. While in Tucson, Arizona, last year, Jennifer filled a significant void at our Catalina Post-Acute and Rehabilitation facility. Our OT of eight years had decided to move, and it took a while to find the right person to take her place. Jennifer was able to come into the program and help elevate our OT services right away. Lori Mitchell, DOR, described her as a breath of fresh air and a positive contributor to the program immediately. She definitely has CAPLICO in her, and it is so amazing to watch it flow into her work as she melds right into the team. 

Jared is filled with the spirit of our values as well. During his recent assignment in California, he saw an opportunity to give some love to a set of stairs, which were unsafe to use and set aside. Jared asked the administrator if he would buy the supplies, and Jared rebuilt the stairs on his own time, which was just one aspect that led to him also receiving the “Core Values Champion of the Month.”

We are so grateful for the value you each bring to our organization! Thank you for including TheraTroopers as you enjoy living your passions!  
Congratulations!
Congratulations to Our Newest Bandera CTOs
(Chief Therapy Officers)
By Denny Davis, Therapy Resource
Brad Heal, OT and DOR at Desert Terrace in Phoenix, AZ
Brad is a humble leader who lives CAPLICO day in and day out. He is a true teacher and has taught most of us who have had the pleasure of working with him. Brad leads with a calm, laid-back demeanor, resulting in top-notch outcomes in all areas! Congratulations on this very well-deserved award!
Erik Sullivan, OT and DOR at Shea Post Acute Care in Scottsdale, AZ

Erik brings positivity, ownership and leadership to Bandera, making us better overall. His sensitivity and ability to relate to others makes him an extremely passionate and caring leader that others want to follow. Congrats, Erik — you deserve this!
Congratulations to our “Cool Ranch” DORITOs –
our third graduating class this year! 
Congratulations Patty Fantauzzo, TPM/COTA, Julia Temple, Englewood, CO

Patty was runner up for first place at the CHCA Spotlight on Excellence Award banquet! Way to represent ENDURA, Patty! We are so proud of you!
Celebrating our Dietary Teams in Endura!! 
Three of our dietary teams competed in the Colorado Health Care Chef competition and took 1 st and 3 rd Place….so cool!!  
A Tale of Two Cities: Pueblo Facilities Unite! 
These two buildings are across the street from each other in Pueblo, Colorado. We acquired them five years ago. They worked as separate operations with two separate therapy teams, led by one DOR, Cathy Bowman, OTR. Finally, after five years, the campus will become one and work under one license.

The Pueblo merger required intense work with both facility teams, working to discharge all the patients at Riverwalk and admit them all to Rock Canyon. The therapists are excited for the merger, which has been five years in the making — but it’s work as usual. This is the Riverwalk and Rock Canyon staff united!