29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
September 2019

Add Heart to Your Teams!
Heart Rate Variability (HRV) training using HeartMath devices continues across our markets. By learning how to bring your body to a state of neurological coherence, you can interrupt the stress response, and actually bring order to the nervous system. The biofeedback devices that the therapy teams are using give real-time feedback on achieving and sustaining coherence. The training has a cumulative effect on the nervous system, and can essentially “reset” our stress responses. Our heart-brain interactions have a profound impact on overall health and vitality. With each beat, the heart transmits information to the brain and the entire body. Learning how to tap into the power of the heart can not only change our stress levels, but can impact our overall health. Our teams are using the personal devices to improve resilience, and they are also using the devices with patients to improve function, reduce pain, and increase the ability to tolerate treatment sessions. The most recent team to be trained was our HCR Plano team in Plano, Texas. Here is just one of their success stories:
WELL (We Embrace Living|Loving Life!) — It’s Time to Get Outside! 
Meet Angela Ambrose. Angela is our latest partner contributing to our WELL Project and is a freelance writer with more than 30 years of writing experience. She is also an ACE-certified group fitness instructor and yoga teacher. When she’s not writing or teaching classes, Angela enjoys hiking, running and cooking up healthy Mediterranean-style meals for her family. Born and raised in Chicago, Angela moved to Phoenix 20 years ago and has settled comfortably into her home in the sunny Southwest. For the latest health and fitness news, visit AngelaAmbrose.com or follow Angela on Facebook (@AmbroseHealthyLiving)....The benefits of exercising and spending time outdoors are well-established, and when you combine the two, they have the potential to dramatically improve your physical and mental health by elevating your mood, strengthening your immune system, improving your sleep and increasing production of the essential vitamin D3.  Read On...
Therapist Profile: Andy Miyyapuram 
Meet Andy! Satyanand Miyyapuram, better known as “Andy,” is an amazing PT at our Golden Acres building in Dallas.

Andy has been a Physical Therapist for 16 years and has spent the last four of them with Ensign. Golden Acres is an older, sprawling campus with primarily long-term care residents, including a locked dementia unit. Andy spends each day truly living our core values and fulfilling our goal of dignifying long-term care in the eyes of the world. He spends every day finding what will help make the residents’ quality of life better. He uses his clinical skills to find the abilities of the residents, and he builds on those, creating a successful and elevating experience. He keeps them smiling and laughing, and many patients will agree to therapy "to only work with Andy.”   Read On....
Highlights on Nursing and Therapy Partnership
Collaboration at Camarillo Healthcare    
By Julia Schmutz, CTO/DOR, Camarillo, CA

Marge Fatima-Cruz, DON (L), and I work hand in hand — a process that has developed over time. The foundation is mutual respect, communication and a genuine love for one another. We learn together and listen to each other. We are not afraid to disagree or hold one another accountable. We try and let our individual gifts complement each other, and we celebrate together. We collaborate.

Basically, Marge and I are a team and approach our patients, their care and our administrative considerations together. For example, we review census to identify patients who could benefit from Part B programming. Therapy has done training with CNAs, and we also do RNA training and weekly check-ins to get feedback on patients. We collaborate with the treatment nurse on the most appropriate seating for patients with wounds. We have worked with activities and CNA on abilities care. We have also collaborated with Nursing for the incontinence program.
In addition, this year, I have tried to work on culture outside therapy by incorporating the following:
        Games with all staff
        Monthly appreciation days
        Interdepartmental 5K walk for Meals on Wheels
        Therapy also celebrated the nurses on nurses week by giving gifts and cards to all our licensed nurses
By taking a collaborative approach to both patient care and team culture in our facility, we are able to build an environment of mutual respect, appreciation and accountability. I look forward to working alongside Marge for many years to come.   
Bringing the Renaissance Fair to Englewood
By Mary Ann Bowles, Therapy Resource
A resident at Englewood Post Acute Care really wanted to go to the Renaissance festival, but due to medical reasons, that was not possible. Tori Darker, the ED, decided to bring the festival to the resident and really the whole facility, and they incorporated a therapy jousting group!    
“I think we made someone’s last days with us very special. I’m so entirely grateful for this team of people we have the privilege of working with. We pulled together a festival in less than five days, and we snuck a therapy group for wheelchair jousting into it!” — Victoria (Tori) Darker, ED, Englewood, CO .
ARDs and Section GGs
By Lori O'Hara MA, CCC-SLP, Therapy Resource - ADR/Appeals/Clinical Review
Setting the ARD    
The purpose of the lookback period is to capture those conditions and characteristics that impact the patient’s treatment plan in such a way that they can 1) be reported to oversight agencies and 2) calculate a reimbursement rate.
Under PDPM, since the whole premise of the rate is that it is commensurate with how complex the patient is, it’s then essential that the lookback period capture as many of those things as possible. And it may be that capturing hospital activity is important! If a patient received IV hydration or nutrition while in the hospital, it can impact our Nursing case mix. This makes sense — patients who were dependent on an enteral delivery of fluid or calories are quite fragile in the period after this treatment concludes. The lookback on this item is seven days and includes delivery while in the hospital.  Read On... .

Section GG Reconciliation
Mythbuster time! Therapy should not be the only source of data for Section GG. One of the sources, sure! But not the only one.
Data sources should include therapy evaluations, nursing documentation and the MDS Coordinator’s observation of CNA care. All of this data should be recorded in the record, and then the IDT’s job is to reconcile this through the Section GG UDA.    
What is IDDSI?
By Elyse Matson, MA CCC-SLP, SLP Therapy Resource
IDDSI stands for International Dysphagia Diet Standardization Initiative. The purpose of the initiative was to create standards across all environments so that the foods and liquids have the same texture or viscosity.
For example, when a patient arrives to your facility on nectar liquids, how do we determine if the hospital’s version of nectar is the same as ours?

The IDDSI framework consists of a continuum of 8 levels (0-7), where drinks are measured from Levels 0–4, while foods are measured from Levels 3–7. There are specific testing methods to determine the levels, including a flow test with use of a 10 ml syringe and a fork test to determine food particle size and food softness. Read On...
Using Occupational Profiles to help with Trauma-Informed Care
By Tamala Sammons, MA CCC-SLP, Senior Therapy Resource
We have become aware of Requirements for Participation, or ROPs. An area that we might not think about from a rehab perspective is the new Phase 3 requirement of trauma-informed care. This requirement is part of Quality of care:     
§483.25 Quality of care.
Trauma-informed care: Trauma survivors must receive culturally-competent, trauma-informed care in accordance with professional standards of practice, accounting for residents’ experiences and preferences to eliminate or mitigate triggers that may cause re-traumatization.

Currently, trauma is defined as singular or cumulative experiences that result in adverse effects on functioning and mental, physical, emotional or spiritual well-being. Trauma co ntributes to mental health and functional difficulties. Individuals with multiple adverse experiences are more likely to engage in health-risk behaviors and are more likely to be obese, and have higher rates of heart disease, stroke, liver disease, lung cancer, chronic obstructive pulmonary disease, and autoimmune disorders than the general population (Oral et al., 2016). There are five primary principles for trauma-informed care. Read On...
TheraTrooper Spotlight
Meet our Occupational Therapist TheraTrooper, Ebony Prater! Ebony joined our organization almost one year ago and has enlightened us with her passion for people! She has helped to fill needs all throughout Texas and has helped us with building our LTC Dementia programs.    
Ebony enjoys combining her work with travel, but she also enjoys giving of her heart.
In June, Ebony participated in a Mission Visit to Haiti, and she shares the story of her inspiring Haiti experience here: 
Four years ago, FSRL University (an Episcopalian University in Haiti) started a Physical Therapy (PT) and Occupational Therapy (OT) program. This year FSRL will have their 1st graduating class of PTs and OTs. FSRL is making history this year as their Fall 2019 OT graduates will be the first Occupational Therapy graduating class in the country of #haiti. I am honored and grateful to have been able to play a role in this history in the making as both a clinical instructor for the 4th year students at Hospital Sainte Croix and as a professor for the 3rd year students for FSRL University. FSRL has created a great OT and PT program and has very motivated, determined, and knowledge-seeking students. I want to thank the university, hospital, Dean, staff, and students for welcoming me with open arms. Spending almost a month in Haiti was an experience like no other. I look forward to witnessing the growth of both programs and to my return to Haiti in the near future.

NOTE: A TheraTrooper is a therapist employed by TheraTroopers, Inc., an Ensign-affiliated entity. TheraTroopers, Inc. is designed to share therapists with your facility as an interim solution to a therapist need you have. Our goal is to provide a temporary solution for urgent full-time or part-time temporary therapist needs, at a competitive cost compared with an outside traveling company or registry.
Group Therapy
Defining Group and Concurrent
by Ciara Cox, Therapy Financial Resource
As you may have already heard, the Centers for Medicare and Medicaid Services (CMS) are changing their parameters for Part A group therapy in SNFs. Under PDPM, a Part A therapy group can have two to six clients per therapist/assistant.
Q: If I am seeing two clients at a time, how will I know if I am providing group or concurrent treatment?
 A: For Part A, CMS defines concurrent treatment as two clients being treated at the same time who are not performing the same or similar activities, and CMS defines group treatment as clients being treated at the same time who are performing the same or similar activities. In both cases, clients are working on their individual goals, and in group therapy they are doing so around a shared activity. Both group and concurrent are efficient adjuncts to individual treatment and provide an added bonus of increased interaction with other clients.
Holladay Healthcare Spends the Day at TopGolf by Jeremy McCorriston, DOR, Holladay Healthcare, Salt Lake City, UT
Holladay Healthcare was able to combine group therapy with activities to be able to take a small group of patients/residents to TopGolf at the end of August. The DOR coordinated this group with the Activities Director to be able to provide a group therapy session while having fun golfing. 

This group therapy activity was able to incorporate community ambulation, balance, coordination and general mobility while monitoring pain. This was well-accepted by the participants; one resident had never been golfing before but continues to talk about going and how much fun he had. Another resident loves to golf and really enjoyed getting out golfing again. This may be something that Holladay Healthcare will have to continue doing because of the fun all of us had and the joy we got getting these people out into the community.
Designing the Facility Around Dementia Care By Keystone Therapy
What started with a team’s desire to find a better way to treat LTC patients, morphed into a two-year ongoing journey, implementing the most recent evidence-based practice for their residents with dementia, leading them to the implementation of the Abilities Care Approach (ACA). ACA is a program that focuses on maximizing caregiver knowledge in dementia care. By doing so, it created a culture change within the facility that sparked an interest from dementia care to dementia design. 

Dementia design is essentially a way to create the best environment for maximizing independence for persons living with dementia. In an Intelligent Risk, Legend Oaks-New Braunfels funded several team leaders to study dementia design at the University of Scotland, a world-renowned dementia design university where companies and facilities from all over the world have sought their accreditation and guidance in best practice for dementia design. Read On...

By Mahta Mirhosseini, Therapy Resource
Last month, we talked about the exciting new revisions to our policy regarding Clarification orders. Facilities that are actively using Clinisign, Optima’s physician e-signature feature, do not have to write clarification orders for Part A payers when completing evals and recerts if their documents are signed by the MD via Clinisign! 
This can be a huge time-saving opportunity, especially since we already did not have to write clarification orders for our Part B payers. This is because Optima’s Clinisign product ensures timeliness of MD participation with therapy POCs/UPOCs.
 Click here to find some commonly asked questions that come when rolling out CliniSign.
Congratulations, TJ Petty, on Receiving the CTO (Chief Therapy Officer) Award!
By Denny Davis, Therapy Resource

Tyler (TJ) Petty, DOR at Montecito Care in Mesa, AZ, was presented with this award on Aug. 20 with his team at Montecito along with his market partners. I cannot say enough great things about TJ and what he brings to Bandera. He is truly the owner and leader that we all strive to be. Congrats, TJ, on becoming a CTO!
Tyler (TJ) Petty DOR (L) and Karl Cooper CEO at Montecito
Congratulations, Rosewood Rehabilitation, Reno, NV!
Rosewood received the Gold Endeavor award from the Perry Foundation, an award given to the top-performing facility in the state of Nevada in Quality Measures.
CHCA Spotlight of Excellence for Therapy
Patty Fantauzzo, DOR at Julia Temple, Englewood, CO, was selected as one of three finalists for the Colorado Healthcare Association spotlight on excellence for therapy. The winner will be announced at the CHCA conference dinner on October 2. Several other nominations within ENDURA were Carolyn Pluta, DOR for Arvada; Paula Reyes, DOR for Medallion; and Beth Powell of Riverwalk. 

Patty's nomination letter included the following tribute:
This nomination is to recognize an individual who is changing the lives of our most fragile population. They have dedicated the greater part of their career taking care of, and even more importantly, teaching others, how to take care of patients with Dementia. While some care givers may see a person with Dementia as a challenge, this individual sees the opportunity. They focus on what the patient CAN do and helps develop an individualized plan for each patient’s success.........

Congratulations Patty - we are cheering for you! 
First Keystone EEF Barbeque!
 By Jon Anderson, Senior Therapy Resource
Keystone had their first Therapy Employee Emergency Fund BBQ fundraiser at The Villages of Dallas. (Thank you, Flagstone, for the awesome idea! We may have signed up more at our facility, but who’s counting?! Go Keystone!). We had the incredible opportunity to feed the staff and some visitors, too.

I was absolutely floored by the giving of the staff at Villages of Dallas. We added 30 new EEF participants today ! What a feat! A special thank-you for making this event amazing goes to Barbara Mohrle, Marti Miller, Sandra Spurrier, Primo Arredondo and Charles Ward.
How Do You Measure Ownership? By Chad Long, Therapy Resource
Recently I had the privilege of participating in a Market Meeting in IA. After great presentations about Case Mix and PDPM from our Service Center subject-    matter experts (thank you, Matt Stevenson and Rob Ady), we reviewed therapy metrics. One facility, Hillcrest Healthcare Center, has been demonstrating some very interesting results. The Market Leaders asked Cassie Nielson, DOR, and CJ Rickard, ED, to present on the “secrets” of their improvements. Instead of discussing programs that were developed, or what type of accountability conversations happened with staff, Cassie simply discussed the challenge of being an “owner.” Read on....