OT and SLP Co-Treatments in a Skilled Nursing Facility

OT SLP
Occupational therapy and speech-language pathology co-treatment sessions provide comprehensive intervention and could fill a research gap on the benefits of this collaborative approach to advance patient outcomes in a SNF setting. Due to ever-changing and restrictive regulations, clear and effective documentation is necessary to ensure reimbursement and to expand the opportunities currently limited by billing protocols.

A review of current literature identifies information on the benefits of OT and SLP co-treatment sessions in a pediatric setting, but it fails to include outcomes of this collaboration in geriatric environments. The same hierarchy of skills addressed in the pediatric field often needs to be re-addressed as a natural part of the progression of aging. The skilled nursing facility presents multiple diagnoses impacting ADL/IADL performance, which could best be addressed by this underutilized interdisciplinary approach.

Literature Review

OT and SLP collaborations can provide comprehensive interventions during self-feeding, ADLs and general therapeutic activities. Planned meal-time co-treatments can include an OT assessment of wheelchair/seating positioning, ROM, strength and coordination for both hand-to-mouth and utensil manipulation, while an SLP assesses labial seal, oral motor control and other dysphagia concerns.

When an OT is providing skilled education and assistance to increase patients’ independence with ADLs, an SLP can assist by highlighting the necessary cognitive processes to complete the task and provide education and cues for improved carryover of learning.

This interdisciplinary support can also occur when IADLs and community reintegration are appropriate in a patient’s discharge plan. Additionally, increasing the cognitive demand and executive function components during therapeutic activities incorporating standing tolerance, dynamic balance, fine/gross motor coordination, safety, functional mobility and community needs can provide a more holistic approach to patient care (Ellenbaum, 2010).

Methods and Assessments

  • Identify patients with varying diagnoses appropriate for skilled OT and SLP treatment
  • Discuss treatment plan of each discipline and identify goals appropriate to address during scheduled co-treatment sessions
  • Identify appropriate assessment tool/standardized measure to assess patient outcomes pre- and post-certification period with consistent co-treatment sessions

Potential OT Assessments

  • Barthel Index
  • Daily Activities Questionnaire
  • Functional Assessment Scale
  • Present Functioning Questionnaire
  • Allen Cognitive Level Screening Assessments and Modules
  • Safety Assessment of Function and the Environment for Rehabilitation (SAFER)

Potential SLP Assessments

  • CLQT, MOCA-B, RIPA-G, SLUMS
  • MASA, Bedside Swallow Evaluation, MBS/VFSE
  • Determine the effectiveness of treatment interventions performed during reporting period including co-treatment sessions using pre- and post-test scores
  • Compare pre- and post-test scores of patients with similar diagnoses not receiving co-treatment interventions
  • Gather additional qualitative data using daily documentation of co-treatment sessions to determine effects more directly related to this approach

Intervention strategies include but are not limited to:

  • ADL sessions
  • PENS electrical stimulation protocols
  • Therapeutic activities
  • Community reintegration
  • NMES electrical stimulation protocols
  • Synchrony
  • Meal assessment
  • Diet texture analysis

Documentation

Co-treatment is not suitable for all residents. Therefore, the decision should be made on a case-by-case and even day-to-day basis and needs to be well-documented for each session (Ensign Services, 2016).

According to a joint position statement from AOTA, APTA and ASHA: “Co-treatment is appropriate when coordination between the two disciplines will benefit the patient, not simply for scheduling convenience. Documentation should clearly indicate the rationale for co-treatment and state the goals that will be addressed through this method of intervention.”

“Co-treatment sessions should be documented as such by each practitioner, stating which goals were addressed and the progress made. Co-treatment should be limited to two disciplines providing interventions during one treatment session” (Ensign Services, 2016).

Conclusions

Co-treatment sessions are intended to increase therapy intensity by cohesively targeting multiple goals with the same functional activity and an opportunity to provide increased services that may otherwise be limited by patient fatigue level or willingness to participate. Co-treatments are meant to be planned prior to scheduled treatment to highlight goals being addressed by each discipline and identify his/her role during the session.

A skilled need for a co-treatment approach should be identified before any treatment planning begins. Additionally, clear and effective documentation is the key for conveying the insight and skilled need for providing this service.

By Stacia Kozidis, OTR/L & Caitlin Timmins, MA, CCC-SLP, Clarion Wellness and Rehabilitation Center, Ensign Group & HCR Manor Care Waterloo

Happy Feet Effect on Quality of Life

As the efficacy of medical treatments increases, the average life expectancy has also increased. Geriatric populations are getting older. The life expectancy of a person born in the United States in 1900 was 49 years, which has significantly increased to 78.8 years as of 2014.

As longevity increases, an important factor to consider is an individual’s quality of life. Quality of life is multidimensional and has been measured by the CDC using the health-related quality of life (HRQOL) and the Healthy Days Measure.

The HRQOL measures quality of life considering physical health, mental health and an individual’s ability to perform activities of daily living (ADLs). Another questionnaire used by the CDC is called the Healthy Days Measure, which asks individuals how their last 30 days have been affected by different factors such as pain, sadness, anxiety, sleep and energy.

Studying the Happy Feet Effect

About five or six years ago, Pinnacle Rehabilitation and Nursing had a program called Happy Feet. Residents were brought to the nurses’ station, and then music was played while residents were assisted down the hall to the dining room, either walking or riding in the wheelchair according to their abilities. This program has not been implemented in the past four or five years.

At Pinnacle Nursing and Rehabilitation, we recognize the importance of quality of life and hope that the care the residents receive has a positive impact on their quality of life. The purpose of this study is to see if the implementation of Happy Feet will improve the residents’ quality of life and to see if the number of residents coming to the dining room increases.

To evaluate the effectiveness of Happy Feet on the residents’ quality of life, the residents were asked subjective questions from the HRQOL and Happy Days Measure prior to Happy Feet and then 30 days later. Initial surveys were taken the week of April 17, 2017, and ending surveys taken the week of May 22, 2017. Happy Feet intervention occurred Monday through Friday in the interim. Attendance in the dining room for brunch varies with changes in census.

On April 21, there were 12 residents in the dining room, and 10 regularly attended breakfast and would be in Pinnacle a month later. Of the 10 regular residents, eight were cognitively able to answer the first question and six were able to fully answer the questionnaire. Questions were asked such as: Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?

Results

Regarding general health of the eight residents surveyed, on average the health improved from good to very good. On average in each survey, the number of “not good” days decreased.

In the healthy days questionnaire, in all areas the number of unhealthy days also decreased. There was a significant change in unhealthy days related to pain, worry and amount of sleep. The last question asks how many days they felt full of life, and on average this amount went up from 11.7 to 15.8 days.

When the first survey was completed, 12 residents were attending the dining room, and after the second survey, there are now 16 residents at brunch in the dining room.

Conclusions

We cannot say definitively that we improved the quality of life of all the patients who participated in Happy Feet. However, on average, there was an improvement in all areas. Also, during Happy Feet, the residents were usually smiling or expressing that they were having a good time, the staff enjoyed having a change in their day, and we feel it improved the culture in the building. Additionally, the number of residents attending the dining room at brunch increased. Residents also reported that they enjoyed doing Happy Feet and would like to continue to participate in it on their way to brunch.

By Maresa Madsen, DOR, and the Pinnacle Therapy Team, Pinnacle Nursing and Rehabilitation, Price, UT

View Full Poster Here: Happy Feet Effect on Quality of Life – Pinnacle

Initial Responses to Using an Alter-G Treadmill at Parklane West

At Parklane West, we posited the following problem/question: Would our physical therapy patients feel the Alter-G treadmill will benefit them long-term after the initial use? We hypothesized that they would, due to research about the Alter-G treadmill provided to each patient before initial use.

Project Overview

Our definition of initial use is that it follows completion of the first trial in Alter-G and is before the second use. Our population includes participants ages 65 and older, and we used convenience sampling to choose patients for the trials. All patient data was used; no data was discarded.

Patients were informed of the risks and benefits of using the Alter-G treadmill as well as the process of getting in and out of the treadmill. Visual demonstrations were given upon request. The patient tried the machine for a single trial before using it for multiple sessions.

After the initial session, patients were given a survey on whether they feel it would benefit them long-term, along with their personal subjective feedback after their first trial in the machine. Information was then analyzed.

Variables/Research

Controlled variables

  • The same Alter-G machine is used
  • The same survey is given to each patient
  • The survey is given after initial use in the machine

Independent variable

  • The amount of weight taken off the patient in the initial use of the treadmill

Dependent variable

  • This might call for future research based on weight taken off
  • Measurement will be on yes or no satisfaction rate

Materials

Survey for Initial Use in Alter-G Treadmill

Do you feel the Alter-G Treadmill will benefit you long-term after your first use? Circle one.

YES/NO/UNDECIDED

Explain why: __________________________________________________

Data/Observations

Fifteen patients agreed to participate and be surveyed following initial use and before second use. Here are the results:

  • 11 felt it would benefit them long-term
  • Two felt it would not benefit them long-term
  • One reported nausea after initial use, two reported increased back pain after initial use, and another patient reported feeling confined
  • Two were undecided

Results

  • 73.33% felt the Alter-G treadmill would benefit them long-term after just one use, as indicated above by the blue area
  • 13.33% of patients felt the Alter-G was not going to work in their rehabilitation process, as indicated by the green area above
  • 13.33% were undecided, as indicated above by the yellow area

Conclusion

A majority of the patients participating in physical therapy at Parklane West felt the Alter-G treadmill would benefit them long-term. They came to this conclusion due to the elimination of gravity, which allowed them to extend the amount of time they were able to walk and to increase their speed compared to when walking with gravity.

Further research would need to be conducted to include follow-up surveys at one, three and six weeks of Alter-G treatment sessions to further justify initial research. In addition, further research regarding the amount of weight taken off in initial use will need to be conducted for comparison on satisfaction rates.

By Heather Smith, DPT, PT; Rosa Benade, COTA; Jennifer Henderson, OTR, DOR, Parklane West,

San Antonio, Texas

Everybody’s On Board the Energy Bus!

Surviving a Transition Through Use of the Energy Bus

By Jennifer Ybarra, OT, DOR, McAllen Transitional Center, McAllen, Texas

Last year brought on many changes for me and my team at McAllen Transitional Care Center. We were a part of the huge Legend acquisition that happened on May 1, 2016, and with that came many new, exciting and challenging times. We got through it with the help, support and guidance of way too many people to name individually, but among those are Maricela Garcia, Jon Anderson and Deb Bielek. Thank you, all!

Let’s sprint forward to October 2016. I had been so focused on learning new policies, documentation procedures and compliance standards, as well as tracking new metrics, that I was beginning to feel it was all a bit too robotic and that I was missing the personal connection with my staff, which includes 25 full-time therapy team members.

Thanks to social media, I was introduced to a book by Jon Gordon titled The Energy Bus. Wow! I read it in a day, and I immediately decided to inject positive energy and re-energize myself and my team! But how? We mobilized a plan, and over the next six weeks, I was determined to share my newfound excitement and energy! The following is an overview of the book and of the activities used to get my team on the bus.

You’re Invited to Come on Board!

Jon Gordon presents 10 Rules to fuel your life, your work and your team with positive energy, and that’s exactly what these rules did! I started this journey by sharing my vision and goals for our team. I am the driver of my bus! I laid out a roadmap of where we were headed and how they all play a vital role in that plan. I asked my team to also think about their own vision, not only for work, but for their life as well. After all, you can’t get to your destination if you don’t have a vision of where you want to go!

I used The 10 Rules as a guide for our journey. I jumped over Rules #1 to #5 and started with Rule #6.

Rule #6: No Energy Vampires Allowed!

An energy vampire is a person who literally sucks the positive energy out of a person, out of a situation and eventually out of the team. I thought that establishing this concept early on in our journey would set the tone for the rest of our trip.

There are many instances in life in which we feel like we don’t have a choice — such as paying taxes and adhering to work and family schedules. But we can always choose our attitude, and we can always choose our energy.

At the end of our first meeting, we broke up into small groups and had a little friendly competition with prizes awarded to the winning team. Then, I formally invited all my team to join me and climb aboard my bus. Each was handed a bus ticket and was asked to sign it as an acceptance to my invitation. All were returned signed, and everyone was on board my energy bus!

“Being a positive person doesn’t mean you won’t have negative thoughts. The key is not to listen to them. Just keep moving forward.” — JonGordon.com

It’s All About the Energy!

Our journey continued a couple of weeks later, and we all gathered again after lunch over some ice cream and started in with the next rules on the list. We explored the ways that thoughts are powerful and are loaded with energy. There is an energy to thought and we need to mobilize the energy to create the life we want.

Rule #2: Desire, Vision and Focus Move Your Bus in the Right Direction

We’re winners, not whiners! Positive energy will keep moving the bus forward: trust, faith, enthusiasm, purpose, joy and happiness. The positive energy will help inspire and lead others.

Rule #3: Fuel Your Ride with Positive Energy

Remember, where there is a negative charge, there is also a positive charge. Fuel up with positive thoughts! Toss the negative energy. Choose to think positive even in difficult situations. When work is piled sky-high, be thankful you have a job and are healthy enough to work. When family life is hectic, be blessed to have a family. When you’re stuck in traffic, be thankful that you have a car to drive. Choose to be positive.

The team-building activity chosen for this week’s bus ride was my favorite. Every team member was asked to write a positive comment about each of their colleagues. It could be personal or work-related. The sheets were not big enough for all the positivity that was bursting out! We don’t use compliments enough, and it was great to see the team acknowledging each other for great work or for personal attributes.

Let’s Keep Moving Along

The McAllen Transitional Bus was moving along! We wanted to keep moving and spread our message, bringing us to Rule #4.

Rule #4: Invite People on Your Bus and Share Your Vision for the Road Ahead.

The more people we pick up along the way, the more positive energy that we create during the ride. The idea is to share what we have learned and to ask others to join. The worst they can say is no, but if you don’t even ask them, they won’t know to get on board. Negativity is the enemy. Negativity not only kills productivity, but also kills teams, companies and people.

Rule #5: Don’t Waste Your Time on Those That Don’t Want to get on Your Bus

Some will get on and others won’t. If you want to succeed, you need to be careful about who is on your bus. Some people will increase your energy while others will drain it. These Energy Vampires (previously discussed) will suck the life out of you and your goals. They will cause an engine leak, make your ride miserable or, even worse, slash your tires.

You have to be firm enough to say that negativity is not allowed on your bus. You give people a chance to change, and if they don’t get it, then you need to kick them off your bus or they will ruin your ride and the ride of all your passengers as well.

Trust That Great Things Are Happening

For our last meeting, I made a promise to my team: My positive energy and vision will be greater than anyone’s negativity. My certainty must be and will be greater than anyone’s doubt.

Drive your bus with heart. The heart is your power center. It is where contagious, positive leadership and attitude come from.

Rule #7: Enthusiasm Attracts More Passengers and Energizes Them During the Ride

The simple truth is that when you’re excited, people get excited about where your bus is going and that makes them want to get on and stay on your bus.

The most successful teams have enthusiasm. Every team wants it, but very few have it. It starts with you and me. When you have it, everyone else will see it and want it, too.

Rule #8: Love Your Passengers

Love is a process, not a goal. We are all valuable. Let’s help each other find and recognize the value in ourselves. Enthusiasm and positive energy will get people on your bus, but love will keep them on. (Side note: Rule #8 fits nicely in with our Core Values of CAPLICO!)

Rule #9: Drive With Purpose

Purpose is the ultimate fuel for our journey through life. When we drive with purpose, we don’t get tired or bored and our engines don’t burn out. Burnout is something that I think we have all had to deal with at some point, either with our staff or with ourselves.

Drive with purpose today, and cultivate that in our team every day. Everyone stays on the bus when it’s cruising along, but I also need everyone to get off and push when the bus breaks down.

Rule #10: Have Fun and Enjoy the Ride

Simple. Today, the Energy Bus is still moving forward, and it’s filled with positive and energetic passengers. Each one is excited about the future, and are willing to work together to achieve the goals and the vision laid out.

Many other facility staff members have asked and inquired about all the fun that the therapy department seems to have every couple of weeks. I have gifted several books to other members of our McAllen Transitional Team with hopes that they, too, will get on The Energy Bus!

Leave a legacy. Leave a world that has been impacted and touched by your presence, your joy and your positive actions.

SPARC Therapy Scholarship

Congratulations Q2 SPARC Winners!

SPARC Therapy ScholarshipWe congratulate Avenlea Gamble and Kellye McKee, our new scholarship winners for this quarter! Read their awesome essays below:

Avenlea Gamble, SLP Student at University of the Pacific, Stockton, CA, Grad Date: December, 2017

The opportunity I was afforded as a student clinician at the Pacific Speech, Hearing and Language Center was a formative experience to my education and cemented my interest in serving the adult population in the field of speech/language pathology. University of the Pacific has provided me the ability to work across a lifetime of demographics during the short time I’ve been here, but my favored clinical experience was within the adult clinic. There I was able to work with individuals who truly inspired me as a clinician. I believe the most rewarding aspect of working with an adult demographic is that you are returning a voice or supporting the ability to communicate with a group of individuals who could freely communicate prior to the incident or diagnosis that changed their lives.

Reading a textbook provides a limited academic view into the disorders and the individuals in which we will see these disorders realized. Actually working in the clinic brought a humanity to our field that a classroom can’t provide, and challenged me as a developing clinician to take static information and apply it to the improvement of my clients’ lives. I was working with individuals who were struggling or lost their jobs because of their communication problems; clients who had given up on past times or lifelong interests because of the deficits they now faced; or even people who couldn’t tell their family that they loved them.

I was raised in skilled nursing facilities, visiting one when I was three days old and returning regularly since then. My mother began working in the local skilled nursing facility in our rural hometown of Willits, California, when she was 17, and I started working there when I was 16. I worked under the social services department as a Care Partner, a position in which I was tasked with providing psychosocial support to the residents. One aspect of my job was attending residents’ appointments with them, and I began regularly taking one resident to his speech-language pathology appointments at the local hospital. Watching the clinician work with my resident lead to the realization that I could see myself in that position, fulfilling that role of returning and supporting the communicative abilities of my community members, and seven years later, here I am at University of the Pacific, in my final year of schooling to do just that.

I was also employed in the social services, dietary, human resources, compliance, and administrative departments at the nursing facility. My experience in the adult clinic at Pacific, as well as the different departments of the skilled nursing facility, have given me a unique and collaborative insight into the needs of the adult and geriatric populations that speech-language pathologists often serve. I want to improve the quality of life of individuals with dysphagia using the dietary and speech-language pathology experience I have gained, as well as bolster the cognitive-linguistic support for individuals with different neurological disorders or disorders secondary to brain injury or cardiovascular injuries. My personal goals lie in dementia capable care, aphasia therapy with couples or in the group setting, and stronger collaboration between the dietary staff, registered dietician, and SLP to provide a better quality of life for individuals on specialized or thickened diets. The adult and geriatric population are a precious resource to us because of their life experience and wisdom, and they must be respected and provided the highest quality of life they may receive during the golden years towards the end of their lives.

I supported clients who presented with different aphasias, voice disorders, dysarthria, apraxia, and a laryngectomy. A chart review gives the clinician a very limited view into the client – every client is incredibly unique, and no two people with aphasia present the same. It’s a continuous challenge which allows clinicians to continue growing and learning throughout their careers.

My combined experience at the skilled nursing facility and adult clinic at Pacific have fostered an empathy and compassion in me for the adult population that I will carry with me throughout my career and life. As long as I have the ability to serve, I have a duty to support the communication needs of this population and my community as a whole using my education and clinical experiences.

I come from a small community, a town of about 4800 individuals, so when a patient passes through my door, they are not a stranger. They are a community member, a friend, a member of the family. My wonderful education, clinical experience, and lifelong growth within skilled nursing facilities will allow me to be that spark for my patients, because serving this population has been what has defined my life thus far, and what gives me the deepest satisfaction that I have known.

Kellye McKee, PT Student at Rocky Mountain University of Health Professions, Provo, UT, Grad Date: December 2017

Go across the floor leading with your bones. Come back by moving your muscles. The words of my college dance professor resonated through my head as I attempted to move my body forward, leading with my pelvis and allowing the rest of my body to follow. Unbeknownst to me, that class and its concentration on dance anatomy would determine the focus of my college education. Ultimately, it sparked my passion for the human body and how it moves and works, leading me to pursue a career in physical therapy.

Dance allows me to comprehensively explore my body and the intricacies of its movements. Performing as a professional dancer from 2007 until 2015 gave me the opportunity to express my love and knowledge of dance. As a performer, I love envisioning and understanding the muscles, ligaments, and tendons that allow me to twist, bend, and leap across the stage. That connection to, and awareness of, my own body has facilitated a passion for kinesiology and anatomy, as well as a deeper understanding of how the body heals and recovers from injuries. After thoroughly enjoying a human anatomy course, I began exploring career paths centered on the human body and health care. This is when I discovered physical therapy.

My strongest draw to the profession of physical therapy was the opportunity to use my education and training to spark a passion in my patients and to empower each one. When patients gain insight into their diagnoses and deficits, they can use that education to help themselves improve and heal. Knowledge is power, and knowledge concerning one’s own body sparks a lifelong motivation to continue working toward a healthy body. Another passion of mine that is rooted in body awareness is working as an instructor for The Dailey Method barre exercise class. Being a TDM instructor has given me the opportunity to help people build strength and flexibility through education, encouragement, and hands-on adjustments.

The Dailey Method approach is centered around proper body alignment and controlled, non-impact movement that engages the body deeply. It has been rewarding to help people reach their physical and mental goals. That lifelong love of learning has contributed to each client’s well being. Of course, people coming on their own to The Dailey Method classes are motivated in a different way than some physical therapy patients, including patients in a skilled nursing facility. Sparking a patient’s desire to improve requires flexibility and a positive attitude, as well as knowledge and training in the importance of physical activity.

My appreciation for the human body has grown during my eight-year career as a professional white water raft guide. Being a raft guide provides me with extensive experience working with a diverse group of customers, each with his or her own individual needs, thoughts, and personalities. Rafting gives me the opportunity to accept and appreciate diversity as well as provide an environment for my interpersonal skills to flourish. These skills are essential for working as a physical therapist. My ability to communicate with a wide range of people, combined with my desire to facilitate healing, allows me to work collaboratively and effectively with patients and other health professionals. Being a raft guide has to do with safety first, and providing a safe trip often has much to do with the guide’s ability to motivate customers to dig in, work hard, and paddle together as a team. These skills are certainly transferable to the world of physical therapy. Creating a safe run down rapids require setting goals and planning how to achieve that success.

Creating success for a patient involves their help in setting their own goals and their involvement in planning for their own long-term and lasting success. Freedom to spend more time with each patient, beyond corporate limitations, would create a more patient-centered approach. Having that freedom was would allow the flexibility and time to try different evidence-based approaches. My physical therapy career choice was further affirmed at the beginning of the 2014 rafting season. I had begun the season with back pain that was not responsive to my usual stretching and strengthening regimen. I had also begun seeing a chiropractor and acupuncturist but had little relief. One of the guests on my first rafting trip of the season happened to be a physical therapist and was more than happy to help me. She explained what she believed was causing the pain and recommended several daily exercises. She also listed motions and movements that I should try to avoid, as these motions would have a negative impact on my back. I followed her advice and in just a few weeks I was feeling better than I had in months. It was inspiring to discover that a few physical therapy exercises and stretches could make such an impact. I strive to pass along that same knowledge: understanding and respect for the human body. I also want to be able to help others with their physical ailments the way this therapist had helped me.

As a student of physical therapy, I learned so much about the human body, what it is made up of, how it works and why, and what can go wrong. I found this education fascinating, and I am inspired to learn more everyday. Now that I am an intern and able to spend time with patients, I love to pass on my knowledge and hope to inspire everyone I encounter. I have worked with many patients who were unmotivated to participate in physical therapy. One that stands out was a male in his 30s who had been in a bad car accident ten years prior and had been living with severe back pain ever since. He was prepared to spend the rest of his life with limited activity and in severe and constant pain, but he decided to give physical therapy a chance. He did not particularly enjoy the first few treatments, but he was compliant with the home exercise program I prescribed, and he continued to come in for his appointments. After three treatment sessions, he reported a decrease in back pain, and by the fifth visit claimed to feel the best he had felt in ten years. By the end of our visits, the patient was able to participate in every activity that his pain levels had kept him from enjoying. He was so thankful for the help and education that he had received. I was inspired by the improvements he was able to make, and his profound appreciation for the successful treatment resonated deeply with me. This gratitude will serve well as a reminder throughout my career as a physical therapist that even the most unmotivated patients can be helped.

Witnessing firsthand the interactions between Ensign physical therapists and their patients, I am continually inspired by the communications I witness, the improvements the patients make through therapy, and the compassion shown by the physical therapists. Using my background as a professional dancer, raft guide, and as an instructor at The Dailey Method, it is my goal is to inspire each and every physical therapy patient I have the privilege to treat.

Introducing: Thera-Troopers!

Did you know we have an exciting new opportunity with Ensign? We are starting our very own internal travel program! What? Yes, we’ll have our own internal team of travelers who will go and serve in any of our communities. We have been asked by several DORs and EDs for the past several years when we could start something like this … well, here we go!

It’s a brand-new program, and we’re starting it from the ground up. Holy smokes! Sounds crazy and overwhelming, right? It definitely is, but it is much-needed and well worth the efforts. We are spending millions of dollars each year on outside contractors, registry, travelers or whatever you want to call them. It’s a huge financial and cultural burden. With a typical contractor, we invite strangers into our communities and expect them to act like family, without much training on our core values. They are not invested in our people and often don’t understand our culture.

On the other hand, what if we could save our Ensign facilities just a little of that burden — what would that do for our employees and patients, let alone our bottom lines? Think about it. What would it mean to have our own Ensign family members go into facilities and serve where they are needed most? What would it do for us to enlist someone who already has CAPLICO ingrained in them, can lead in clinical excellence, and who is passionate and team-oriented? The implications are huge!

We are calling these elite therapists Thera-Troopers. They will be part of a team of special forces (OT, PT and SLP) who will be called to serve our new builds, our most staffing-challenged or newly acquired facilities. We understand this is not a typical travel job, where therapists get to call recruiters and say, “Hey! I want to go to Sacramento for three months!” and the recruiters say, “Hey! OK!” Instead, it’s more like, “Hey! We need you to go to Reno for three weeks until our new therapist starts! Then Sonoma for two to cover a vacation!”

We realize that this opportunity to serve our company is challenging and is not for everyone. For others of you reading this, you may be getting excited with possibilities of leadership opportunities, exploring our great countryside, networking and building lifelong relationships, and learning new settings and environments in which to hone your therapy skills.

As a full time Thera-Trooper with Ensign, you are considered family and are treated accordingly. We are looking for those special therapists who feel compelled to serve wherever the greater need. It is not an easy task at hand, but with lots of love and support, and a few extra goodies gently placed in a care package, it is an opportunity worth exploring!

Contact Tara Brown if interested: tarabrown@ensignservices.net, 816-516-0985.

New National Long Term Care Survey Process to Roll Out in November 2017

Currently, you will find different variations of the survey process based on the state where you operate. Depending on where your facility is located, you find yourself preparing for the Traditional Survey process or a Quality Indicator Survey (QIS). However, the Centers for Medicare and Medicaid Services (CMS) will implement a new survey process nationwide during Phase 2 (effective Nov. 28, 2017) of the three-phase implementation schedule for the new regulations released in the CMS final rule entitled Medicare and Medicaid Programs: Reform of Requirements for Long Term Care Surveys.

At the first national American Association of Directors of Nursing Services in September 2016, Evan Shulman, CMS Deputy Director in the Division of Nursing Homes, Survey and Certifications Group, stated: “There are positive and negative aspects to both survey processes. The QIS is computer-based and can seem regimented. The traditional process allows the surveyor a little more flexibility. The new survey process leverages practices of both.”

According to the recent CMS slide deck and speaker notes previewing the upcoming changes to the long-term care survey process, the new survey process is an innovative computer-based, resident-centered process that balances structure and surveyor autonomy. Individuals who currently operate in a Traditional Survey environment will find surveyors utilizing a tablet or a laptop PC throughout the entire survey process and inputting their findings into a new software system. While this is current practice for QIS states, this is vastly different in our Traditional Survey states, where surveyors can be found walking the halls with clipboards and colored pens in hand.

In the new survey process, sample size selection will be based off of the facility census. Seventy percent of the total sample is MDS-preselected residents, and 30 percent of the total sample is survey-selected residents. Yes, you read that last sentence correctly: 30 percent of the total sample will be handpicked by the surveyors. Surveyors will pick their sample size based off of their observations, interviews and a limited record review.

Off-site preparation includes surveyors reviewing the Casper report as well as other facility history information. When surveyors hit the door, they will request a completed matrix for new admissions, an alphabetical resident census list, and a list of residents who smoke as well as the facilities’ designated smoking times. The surveyors will then begin observations with no formal tour process mandated by the new survey.

Observation will commence along with observations and limited record reviews. CMS has determined surveyors will take approximately eight hours on average for interviews, observations and screening. Surveyors now have the ability to ask questions to the residents however they deem most appropriate, whereas in the QIS survey process, surveyors were required to not deviate from the CMS-provided interview script.

Investigations, facility tasks and closed record reviews will be completed for the remainder of the survey using Critical Element Pathways to guide the investigations. Surveyors will now be required to participate in a Resident Council meeting with the active members within the committee as well as review previous council minutes.

According to CMS, active testing and validation is occurring throughout the country by contracted surveyors. Training on the new process for surveyors will begin at the regional offices level and then trickle down to the front-line state agency surveyors. Training for surveyors is occurring through various webinars and in-person training sessions. As of today, implementation of the survey process on a national level will occur on Nov. 28, 2017.

Providers can submit questions about the new survey process to the NH Survey Development mailbox at NHSurveyDevelopment@cms.hhs.gov. Information about the survey process and implementation can be found at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

References: New Long-term Care Survey Process – Slide Deck and Speaker Notes [PPTX, 8MB]

By Christine Aliberto, Director of Clinical Services, Mission Viejo, CA

Congratulations to our Q1 SPARC Winner!

It Only Takes a Spark

By Leandra Stuckey, PTA Student

Metropolitan Community College – Penn Valley, Kansas City, MO

Grad Date: May 2017

Leandra Stuckey, PTA, on winning the SPARC award and passing her boards on the same day!

Italian poet and moral philosopher Dante penned the following words in his magnum opus,The Divine Comedy, “A mighty flame followeth a tiny spark.” Today this quote can be translated as, “from the little spark bursts a mighty flame.” Though there are many ways to create a fire, there always needs to be a spark to ignite a flame. As a Girl Scout, I learned that a conventional fire requires three elements to ignite: oxygen, a heat source and fuel. If any of these three elements are missing, you will not be able to start a fire. Through my clinical and work experiences, I have learned there are three ingredients needed to create a spark and eventually a mighty flame in my patients’ lives. They are empathy, passion and a commitment to excellence and on-going professional development.

To create the initial spark needed to build a fire, it is important to build a rapport and have empathy for my patients. The role of a physical therapist assistant is multifaceted; I am what my patient needs me to be. One of my instructors described the role of a change agent as a chameleon wearing a referee’s shirt, a priest’s collar and a used car salesperson’s plaid jacket. I think his example provides a blueprint on how to be an exceptional therapist. The chameleon shows that even though my message may be the same to multiple patients I am able to change the appearance in order to reach each of my patients. As the referee, I am an honest broker between different groups, like family and the healthcare team. As the priest or counselor, I listen to my patient hearing problems and accepting suggestions. Finally, the salesperson’s plaid jacket is used to represent my ability to analyze a patient and give a sales pitch about my treatment plan and why it may work for them. Being a therapist that exemplifies this chameleon challenges me to consider my patient’s life before their illness. In order to provide a holistic treatment plan, I have to build a rapport and figure out what their physical and recreational goals are and come up with a way to help them attain those goals while working within the framework my supervising physical therapist provides.

My job as a rehab tech gives me the opportunity to work with a diverse group of patients and diagnoses. During a shift, I was assigned to passively range a patient who had recently suffered a spinal cord injury when he fell out of a tree during work. I went into the patient’s room cheery and excited to practice the skills I was learning in school. The patient looked at me and asked why I was there. When I told him I came to stretch his upper extremities, he gave me an obstinate look and said, “No.” Though I was taken aback by his response, I did not let my disappointment show. Instead, I asked if I could do anything for him while I was there. He asked for a drink of Pepsi and if I could fix his covers. As I proceeded to make him comfortable in bed, I talked with him about his family, life and work. I took note of the personal decorations he had hanging in his room and talked with him about those, not once mentioning therapy. When I was getting ready to leave, he asked if I still wanted to stretch his arms. I eagerly agreed and continued to talk with him while doing passive range of motion. If I had not taken the time to make him comfortable and assess his needs as a person, as well as the needs of the patient, I do not think I would have had the opportunity to work with him. He was going through a hard transition in his life, trying to get used to the idea of never being able to walk again and wanted someone to listen to his worries. I learned more about empathy with that patient than I have in any situation prior.

The spark that began with total patient care needs to be nourished and protected before it can be coaxed into a flame. Getting up at 5:30 am in the morning each day is not natural for me. However, while I was completing my clinical, it was easy for me to wake up each morning at that time because I was excited for the things I would learn and the new challenges I would face. I am passionate about physical therapy and the things it makes possible. This passion is the spark that gives me a drive to work hard, the energy to get through the day, and the ability to be more creative with my treatments. I will use my passion to meet and eventually overcome the intrinsic and extrinsic barriers my patients are dealing with. To protect the spark in my patient, I may need to deal with intrinsic barriers they may be facing like depression, self-limiting behaviors, and maintaining reasonable goals. To address these influences I will need to meet each area head on, listen to their concerns and search diligently for solutions. Sometimes, I may be able to find a therapeutic answer and other times I may have to consult my supervising therapist to help me find a way to break down the barrier. The extrinsic factors may affect self-esteem and ability to work with therapy. It is then that I need to figure out ways to bring therapy to them. This could mean starting therapy in their room until my patient is able to come to terms with a new amputation or bringing family on board to encourage and motivate my patient to keep pushing through their fatigue to reach their goals.

Even though I have not had a traumatic injury or needed physical therapy, I can still relate to my patients by sharing with them my stories of failure. Losing my high school student council election taught me to be transparent with my intentions, vision and goals when convincing others to follow me. Not getting into a doctorate of physical therapy program the first time I applied made me find another path to accomplish my goal. Failing a test and a practical on the same day showed me, that I must be prepared in order to be successful. My stories may be small in comparison to a traumatic injury, but losing something is a blow to the ego no matter what was lost. I believe this will help me coax a flame in my patients because each of my failures has set me on the path to be a better physical therapist assistant and leader, just as each of my patients’ failures in therapy will help them to improve their quality of movement and be one step closer to reaching their goals.

Finally, maintaining the flame I worked to create throughout the continuum of care requires me to be a life-long learner. Having empathy and passion will only get me so far if I am not willing to put in the effort to continue growing and raising the bar on the care I provide. I have a commitment to continue gathering more knowledge and sharing that with my team so that we can improve the level of care we are able to provide to our patients. When a patient presents with a challenge that seems too big or beyond my abilities, I search diligently for solutions consulting my mentors, classmates, textbooks and the Internet for ideas to get the desired outcome. I plan to continue taking CEU’s and would eventually like to become certified in neurologic physical therapy. I still have much to learn but each new patient I get relights the spark and passion that I have for this field, and I hope that I am able to initiate a spark in them.

As a Girl Scout, I learned that I do not need a blowtorch to create a fire; from a tiny spark bursts a mighty flame. For me, I want to use empathy, passion and my willingness to learn throughout the continuum of care to create a spark in the lives of my patients. In order to optimize movement and improve each patient’s outcome, it will be important to use all of my experiences to shape the treatment plan as there is simply no “one size fits all” regimen. My passion dares me to be the spark that ignites a mighty flame to motivate my patient down the road to recovery. I can continue to bring a spark to my patients by being an innovative physical therapist assistant that is committed to using all of my skills to care for the whole person.

Our 4th Qtr SPARC Winner!

How my experiences will provide my future clients with a spark to their lives and bring hope to their futures

Connie Wyatt learns she won the SPARC Award!

By Connie Wyatt, OT Student, University of Puget Sound, Grad Date 12/17

The word spark provides two types of definitions: a noun and a verb. The noun defines spark as “a small fiery particle thrown off from a fire, alight in ashes, or produced by striking together two hard surfaces such as stone or metal” while the verb defines spark as “to ignite.” Other definitions include: “a sense of liveliness and excitement,” “a small bright object or point,” and “a trace of a specified quality or intense feeling.” I love the simplicity of the verb, ‘to ignite.’ It is an action word which requires one to choose to do something. I like the implicit progression inherent in verbs. Verbs never stay in one place and as a future therapist, I want to constantly be moving towards a better, more glimmering (if you will) therapist. I have had many, many people ask me why I am always so smiley and happy all the time. I cannot help but realize that I have an incessant itch to ignite my life with kindness. I want to make others happy; I love the saying a ‘glimmer of hope’ because it implies that there is always a slight chance that something positive will happen. I rely on that saying each and every day of my life. I look for all the glimmers of hope from each day to provide me with a reason to wake up and give others with the glimmers they need to keep on progressing. My career as an occupational therapist relies on the notion that I will bring this spark into practice with each client; it is an energizing force and I feel eager simply writing about it. My future is bright and full of the kind of sparks that my future clients so desperately need from me. I am going to make a difference as an occupational therapist, but the difference I hope to make is one that each of my clients will believe they accomplished all on their own!

My focus on occupational therapy (OT) has been a constant in my ever-changing life. Although my life history is diverse, my attention always drew towards OT. In the last eight years, I spent my time doing many meaningful activities than some don’t get to do in a lifetime. Every job or opportunity I have taken is one that pushes me closer to my career. My eyes gravitate towards my co-workers, clients, or students who need this type of therapy in their lives.

Through the years, I have sought out many opportunities to grow and develop my skills as a compassionate mentor, friend and aide. Soon I will have the opportunity to use the skills I have been developing in my career as an occupational therapist. I have no doubt that lives will be changed and have been changed; if no one else’s, my own has been enriched. I hope my experiences in the following excerpts will help Ensign Therapy to understand the spark that will certainly transform the lives of those I work alongside with.

BRANDON

Is there anything that can bring more passion to an individual than personal experience with the person most dear to you? At the early age of 14, I developed the desire to become an OT. 11 years ago my older brother and best friend, Brandon, was hospitalized with a traumatic brain injury. It shattered my whole world. Initially, Brandon was only able to mutter `lil, lil, lil, lil’ when asked who I was. His brain function and actions were not collaborating. I had already witnessed a plethora of injuries, addictions, abuse and fights by this age with my older siblings, but this incident hit even closer to home (if that is possible). I couldn’t fathom the possibility of a best friend I couldn’t rely on like I did before. During those difficult weeks, I was given the time to relive memories with Brandon. I remembered a lot of good times and hoped that more were to come. Today, he is fully independent and has 95%+ brain function back. This experience gave me the ability to relate to the despair and grieving of family members, who are also our clients. It

also taught me the significance of time. Although, the rehab team was not in the forefront of my mind, I now realize that immediate intervention with OT is ideal and pertinent. OT clients will be much more likely to recover, the earlier they start working towards their goals. Brandon had to work with an OT, PT, speech pathologist, doctors, and nurses to successfully recuperate; teams are vital in rehabilitation and even my 14-year-old self realized that. I want to be a part of a team like the one that worked with my brother so I can change lives, every day, for the rest of my life.

HOME EVALUATIONS

As an OT student, I had the opportunity to take a trip to the Methow Valley in Central Washington where many individuals enjoy retirement. A group of us were given the opportunity to practice our home assessment skills in the homes of some of these individuals. I fell in love with the opportunity to provide recommendations for a safer, more livable space and was surprised by the knowledge that I, a mere graduate student, had to offer our clients. I immediately fell in love with working in the home and having the opportunity to quickly connect with people. Following this incredible experience, my entrepreneurial spirit led me down a series of networking paths and I have had the opportunity to advocate for my profession. I have connected with a well-known Certified Aging In Place instructor, Steve Hoffacker, and I have had the opportunity to connect with a seasoned OT who decided to open an Occupational

Therapy consulting business. My research caused me to stumble upon a bill that has not yet been passed which would provide a $30,000 tax credit for anyone over 65 who wants to install home modifications to prepare for aging in place. This information led me to work with my AOTA representative for the state of Washington to bring this bill to the attention of AOTA. Our hope is that this bill will be revised to include OT services, so the home modifications are assisting the special needs of each client. As occupational therapists we have a special ability to connect the home environment inevitable life events, but I am particularly eager about the opportunity to be a part of something bigger than myself. Many of the baby boomers would like to age in place and preventing falls and other incidents early on will provide more healthy opportunities for them to age in place. Sometimes the initial spark of my many creative ideas eventually fade (I have many entrepreneurial ideas), but I am sure that the deep meaning that this project has in my life will give me the motivation I need to carry out each step. I am passionate about the happiness that a safe home can provide for people.

BOB

Bob is my life coach in understanding the ins and outs of the emotional and physical difficulties individuals with SCI’s deal with. How lucky was I to stumble upon an ad he posted for a trainer. He needed someone to ride with him on his tandem bicycle designed for and by him. He himself is the survivor of a fall, which resulted in an iSCI and has lived with this condition for 25 years. Bob is helping me to develop empathy, understanding and love for people I have yet to meet. He is developing in me a very real mindset of putting myself in his shoes. Bob offers me opportunities to feel what it feels like to be him; he is honest, he is open and he is blunt. Not only do I get to go grocery shopping and biking with Bob, but also, more importantly, I get the life knowledge that he has obtained and offered me. I often write down his words so I can remember them during future encounters with clients. His willingness to help me will surely have a ripple effect for the rest of my life. Bob has further added to my purpose as an OT and my desire to enlighten lives with understanding.

REHAB WITHOUT WALLS

When Carol Decker came to our program last spring, I was forever changed by her determination to live her life to the fullest. She is a beautiful mother of two young girls although she has never seen her youngest daughter before. During her second daughter’s birth she experienced ample complications, which resulted in blindness, neuropathy in one hand, two below the knee amputations and the amputation of her left hand. Her words inspired me and still do to this day. She began to talk about her rehabilitation when she got back home and she began to realize the obstacles she was going to have to overcome. She was discouraged and depressed (for good reason)! Rehab Without Walls came in and worked in her home and community and she talked about how the team collaborated with her to try anything that might aid in her independence. She admitted it was a long road, but attributed much of her success to her team at Rehab Without Walls. I was touched, so I obviously decided to call Rehab Without Walls the next day. After a few months, I was given the position as a rehab specialist. I get the opportunity to work one-on-one with individuals who are further along in their recovery and require less attention from licensed therapists. The opportunity to work independently has taught me incredible amounts about myself as a future therapist along with my ability to rely on team members when I need their advice and help. I have learned to jump right in and not be afraid of social stigmas in the community and I have learned from my mistakes. I have learned about how much I care about my clients and how much their happiness matters to me. This continued experience has solidified my desire to eventually work in the home as an OT.

UNIVERSITY OF PUGET SOUND

The OT professors at University of Puget Sound are some of the best. They have taught me many important skills, but mostly they have provided me with the skill set to find the answer to any question that might arise in my future career. They have taught me to trust my clinical reasoning, but have also helped provide me with the skills I need to find evidence-based research to back up my practice. They provide hands-on experiences daily and have collaborated with us since our first day; I have envied my professors ability to increase our competence while simultaneously trusting our ideas and thoughts; this has enlarged my confidence as a future therapist (something I greatly lacked prior to graduate school). If there is one thing I have learned, it is that in occupational therapy it always depends on the person, the day, the environment, or the context. There is no black and white answer to any challenge and we must treat our clients as individuals. I am thrilled to use my creativity and education from UPS to better the lives of my future clients.

I know all of the experiences that I have cited (and so many more) have helped prepare me for a successful career in occupational therapy. I could not have jumped into this profession without the plethora of experiences I have in my tool belt. Luckily, these experiences continue to build upon one another and I will continue to grow as a therapist for the rest of my career. I will never be fully prepared for every situation, but I can continue to learn and become the spark that someone needs to get over the hurdles that they face. I already love my career as an occupational therapist and I know that I will make a difference. I cannot wait!

Compliance Corner

Compliance Corner: Are You a Leader?

By Jack Rolfe, PT, MNA, CHC, RAC-CT

Lead Compliance Partner, Milestone & Endura

If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” ~ John Quincy Adams

My first memory of the image of leadership was formed when I was eleven years old. I was with a group of my peers participating in a scouting activity at our church. My father was also in attendance as one of the scout group leaders. The individual in charge of the meeting was at the front of the room conducting the function. This person asked if everyone in the room would move closer to the front row. I remember looking at my buddies and we were all frozen with the thought “this would not be cool to do what the leader had asked us to do.” Then a sharp impulse came into my mind. I stood up promptly and stated “come on guys, let’s move up.” Everyone followed and the task was completed. Upon returning home that evening my father said to me “That was amazing what you did today.” I had no clue what he was talking about and stared at him like only an eleven year old could do. He repeated to me what he witnessed in the simple act of moving with my friends to the front of the class. He stated, “You are a leader.” His statement touched my soul deeply and has remained with me throughout my life.

In his book, “Executive Instinct,” Nigel Nicholson of the London Business School suggests that there may be a leadership gene — that some people are just driven to be in charge. But the University of Michigan’s Noel Tichy — in his book, “The Leadership Engine” — declares that leadership style and abilities emerge from experiences. I propose that leaders emerge from a combination of both these declarations. I add one additional idea for you to ponder. I believe that inside each one of us there is a leadership gene and it takes experiences to bring it out. Have you discovered your leadership gene?

In the movie “Facing the Giants” actor, Alex Kendrick, plays the role of high school football coach, Grant Taylor. In one scene Coach Taylor is instructing his team and specifically counsels his player, Brock, to remember he has been gifted with leadership so do not waste it! I have concluded through my life experiences that there is one sure way to develop leadership. This is accomplished by assisting others to become leaders in their own lives. When you facilitate someone finding and using their leadership gene then yours blossoms.

As we move into the year 2017, will you become a leader of your rehab team in attaining additional knowledge in regard to Compliance? Will your rehab team become the leader of Compliance in your facility? Will your facility become the leader of Compliance in your Market? Will your Market become the leader of Compliance for the Ensign organization? It can all begin with you!

As Compliance Partners go onsite when conducting the annual Medicare Systems Compliance Audit (MSCA) much of our focus on the therapy program is governed by two areas. First, is the Medicare Policies and Procedure for our organization. Second, is rule and regulation found in the Medicare Benefit Policy Manual, Chapter 8 – Coverage of Extended Care (SNF) Services. We find the successful buildings to be those who are most educated on what is expected by the Medicare Program and then they apply that education.

So, I extend to you an opportunity to express your leadership gene. Here is the challenge…Develop a creative way to present/discuss one item from the above mentioned Medicare resources each week in your rehab team meeting. Use specific policy/procedure and rule/regulation. Then create a way to spread that format to your building, your Market, and onto the Ensign organization. You can become a leader in attaining and sharing knowledge with your peers and beyond. I am eager to see the results. Will you accept the challenge?

“A leader is one who knows the way, goes the way, and shows the way.” ~ John C. Maxwell