Meet Our New SPARC Award Winners!

SPARC
Congratulations to our most recent SPARC award winners, Catherine Whitlock and Chelsea Shearman! Read their inspiring essays below.
 

Catherine Whitlock, DPT student at the University of Washington, graduating in June 2016

To spark someone’s life is to provide that radiant moment of support and happiness that leaves a bright ember of a memory glowing long after its lighting.

Por favor, ayudenos. Imagine being invited into a home of someone you met less than a week ago, and they’ve asked for help. They speak an entirely different language, and they’re looking for professional guidance and suggestions to improve their daughter’s quality of life. Just over a year ago, I found myself in this exact situation while volunteering for Manos Unidas, the only private, not-for-profit school for Special Education in Cusco, Peru. I was fortunate enough to be traveling with a licensed physical therapist, and three other doctorate of physical therapy students. That day, our physical therapy mentor, I, and my colleague entered the home of one of Manos Unidas’ students with cerebral palsy to experience and better understand her home setup, the care she received, and, we hoped, to answer her mother’s burning questions regarding her continued care.

The house accessibility was notably impressive, with a spacious first floor, and the student had her own room. Her Mom showed us her resourcefulness in creating bolsters to use for exercises and expressed a profound interest in what more she could be doing to aid her daughter. The conversation initially revolved around positioning, sleeping, and demonstrating several new techniques to increase this sweet little girl’s interactions with the environment and people around her. In my mind, the most important exchange that day was between the physical therapist and the student’s mother. It was a challenging conversation concerning maintenance therapy versus improvement from therapy. The mother struggled at times to fully understand the difference between the two when her daughter was predicted to live 2-6 months by one doctor, and was also predicted to walk again by another doctor. These very conflicting prognoses are understandably confusing. She continued to express her frustration with the medical information she had received to date, and essentially asked the physical therapist, “What’s the point of therapy?”

Then came the spark. That blazing, powerful moment of caring connection as the therapist explained how physical therapy enabled the little victories in one’s life. Those two extra seconds of holding her head up and smiling at a loved one. The ability to grasp a favorite toy or point to something that she wants. That brief moment, that brilliant spark, shone a light into her life and the mother found new resolve to continue physical therapy with her daughter for those little victories.

Throughout my lifetime, I have welcomed multiple opportunities to interact with individuals of different social, cultural, and economic backgrounds. Yet it was in the work of this day in my budding career as a physical therapist that I discovered the crux of what inspiration I will bring to my interaction with every patient. My mentor physical therapist showed me through action exactly how to bring a positive light into any situation, and to celebrate the little victories with each person so they may move forward for the better. All of these moments have provided the framework for my career plans and goals, which resonates through the core of my very being. Each day I hope to rise anew to find opportunities to learn, teach, and share my passions and compassion with those I walk alongside on their path of healing. It is with the dedication of my life as a physical therapist that I hope to holistically serve those who are in the most acute need, to inspire others to do the same, and to develop programs that foster relationships and opportunities to serve the global community.

Quality, collaboration, and lifelong learning are a few of the principles at the heart of my interests in physical therapy. Throughout my educational and clinical experiences, I’ve found unwavering passion working with patients in an acute care setting. My drive to provide them with quality, safe, effective, efficient care is insurmountable, and I currently find myself in pursuit of an acute care residency in the hope that I will further develop myself as a clinician to provide the best patient-centered care possible. Intimately collaborating with other like-minded individuals in the field, I will be ever better equipped to utilize the research that develops evidence-based practice as it meets patient case scenarios. This passion for learning is one in which I proactively seek the tools to succeed, not the answers. My academic drive is for mentorship in which I am trusted as a capable colleague. The amount of intentional effort that I pour into this residency will directly correlate with what I gain from it, which impacts the quality of patient care that I can provide. My motivation to earn something through an environment rich with learning opportunities has never been greater.

Once established as a clinician, I hope to embody my passion for learning as a clinical instructor, as well as becoming a part-time instructor within either a physical therapy assistant or doctorate of physical therapy program. In my time as a student of physical therapy, I have continually expressed this deeply held desire to my mentors and have even been granted the opportunity to guest lecture on physical therapy as a piece of the rehabilitation team for the University of Washington’s Speech and Hearing Sciences: 533 Medical Speech Pathology course. Taking this presentation’s feedback in earnest, I intend to practically apply it within the acute care residency. This residency exists as the ideal catalyst for my dream of teaching as it includes the opportunity to be a teaching assistant for two acute care residency courses for a doctorate of physical therapy program. My goal as a teacher is to foster an environment that enables individuals to revel in this meeting of research and best practice, creating a ripple effect among the profession for better patient-centered care.

Beyond the classroom, I find advocacy and equity as essential components to my future contributions to physical therapy. I hope to develop and lead a program that connects physical therapy students and clinicians with other medical disciplines for global service opportunities to advocate for those who are under-resourced. It is a moral and ethical obligation to provide physical therapy services to those without access to care for financial reasons, from a lack of availability of services, or in the event of a disaster.

The spark in my life behind this goal comes from my experience as president of Global Rehabilitation Organization at Washington (GROW). GROW has provided opportunities and structure for me to participate more directly within the global community. These unique learning experiences have enabled me to collaborate with other healthcare students and clinicians, to practice cultural competency, and to transcend border, language, class, race, and ethnicity. Because of this, I know that combining my passion for local service, learning, sustainable international medical efforts, and inspiring best patient-centered care can all be realized through creating or collaborating with programs that cultivate compassion in action through globally aware service-learning opportunities. Organizations that advocate for equitable services on a local and international scale will give back to the global community through the power of physical therapy.

Perhaps then it is Mother Teresa of Calcutta who best encapsulates my deeply held vocational desire to serve as a holistically minded physical therapist — for as she boldly said, “Prayer in action is love, and love in action is service. Try to give unconditionally whatever a person needs in the moment. The point is to do something, however small, and show you care through your actions by giving your time. … Do not worry about why problems exist in the world — just respond to people’s needs. … We feel what we are doing is just a drop in the ocean, but that ocean would be less without that drop.”

There are countless people with physical needs, and my integral role in restoring function, promoting mobility, reducing pain, and preventing disability is but a moment of an individual’s lifetime, a drop in their ocean, a fleeting spark. Yet if I can serve as a shining spark, however small, who joyfully strives every day to bring compassionate, ethical and effective care to contribute to each of my patient’s well-being — that would be more than enough. For in intentionally meeting their needs, the true difference is made in empowering them to share this small positive contribution in turn, and multiply it within their own, greater communities of support and ever further still. It is in holistically healing all persons that physical therapists hold the power to revitalize communities, the spark to change lives we ourselves will never touch. Patient by deserving patient, victory by only seemingly small victory, our care empowers others to heal and better illuminate our world.

Chelsea Shearman, SLP, August 2015 SLP graduate of Northern Arizona University and student intern for Sabino Canyon

“Sister, eat, stop, chase.” These words, given to me in picture symbols, helped shape my life, ignited my spark and fueled my passion for wanting to become a speech language pathologist. My sister, a mere 14 months younger than I, was born with autism and is low functioning. Early in her life, doctors thought she did not have the aptitude to learn language. When my sister turned 4, however, a wonderful speech pathologist saw potential and taught her and me in therapy sessions how to incorporate the Picture Exchange Communication System (PECS) into our lives. Shortly after, this sentence appeared on the table before me and changed the course of our lives. My sister has never stopped learning; neither have I.

My flame grew as I learned to celebrate and embrace the differences in others at a young age. I volunteered in my sister’s classroom and went with her to early intervention therapies, as well as childhood programs for individuals with special needs. I got to know and love amazing individuals whom others considered “special” and how each of them had their own strengths, weaknesses, likes and dislikes. What worked with my sister did not work for them, and I had to learn how to build rapport with each individual and get to know each of them specifically. I shared my insights with those around me as I gave speeches about my sister in local charity fundraisers, went to IEP meetings, doctor’s offices and wanted to learn more about how to help others around me.

I continued my learning when I was 15 and volunteered in an AIDS orphanage serving the people in Uganda, Africa. First, getting there was a challenge. I had to raise money and worked hard to make my goals. The experience there was like nothing I had ever done; for such a short time of being there, I learned so much about life. While going in with the mindset of helping others, I, in turn, learned more from the people I was “serving” than I thought possible. Learning the needs of the people of Uganda and focusing on what was essential for them was way more vital than helping them with what I thought they needed. I was challenged with language acquisition and being immersed in a vastly different culture. Things were so foreign and strange, and I often made lots of mistakes. This taught me that true greatness, success comes only through trial and error. I learned about the importance of culture and background and was blessed with the patience of those Ugandan people who helped me grow.

With this experience I was excited to get a jump-start into my career and started by graduating high school at 16. In college I volunteered in undergraduate research in the “Profiles of Working Memory & Word Learning for Educational Research,” under Dr. Mary Alt. Doing research I learned the importance of asking questions and finding answers for others. I understood the need for proper paperwork and professional accountability. Lastly, I found researching evidence-based practices and working to stay abreast on the latest research findings to be essential in my therapy techniques and overall knowledge.

My lesson during this time was a hard trial I was learning to overcome. I was experiencing intense migraines which were affecting my memory and learning. I had to learn and relearn strategies to help with memory and word retrieval. I wondered if I could still be a speech therapist but I was determined to try. Through a process of elimination I learned what strategies worked best for me and learned the frustration that lies behind losing skills once mastered. I wondered why I needed to go through this and it was not until later that I learned the answer. That knowledge came while I was working with a client who was having issues with memory retrieval. Sensing her frustration, I shared my own experiences and she divulged her internal struggle. She thanked me and let me know my story gave her courage that things could get better; that although she may not return to her old self, becoming a new person was okay. I know it sounds cliché but I think sometimes we go through experiences so we can help and uplift others. I hope I can help others through my experiences — good and bad.

My passion for the area of speech continued to ignite as I received my SLPA license and started working for a clinic where I worked with clients from ages one to 40. I started implementing evidence-based practices, modifying activities to fit each individuals needs, and quickly became a liaison between my clients, their families and other team members. Later, I was accepted into graduate school and continued working full time in the area of speech pathology but changed to school-based therapy. I took techniques I learned in class and constantly changed my approach to therapy with all the knowledge I gained.

For my internship I was blessed to get a position in Ensign’s Sabino Canyon Rehabilitation and Care Center. It was a whole new kind of therapy for me and I tried to sponge all the knowledge I could from my talented and bright supervisor and other therapists. I enjoyed getting to know how to talk with and ask questions from my elders to learn their needs, their stories and how to help their quality of life. Some days it was overwhelming but I got the unique experience to help Ensign in my own way. Ensign opened up a new facility and I got to help with the transition and iPad programming. It may be small but I loved sharing the little knowledge of IT I had to support their skilled employees and got to see what working with Ensign is like — a family.

When I see the faces of the individuals I work with, I think about the love I have for my sister. In my life I have learned everyone is an individual, to set and meet goals, help others in areas of their needs, make mistakes and learn from them, ask questions and find answers, implement evidence-based practices, be a liaison, overcome obstacles, gain knowledge in every area and work as a family with my team. Every day I strive to work with others exactly the way I want others to work with my sister. I am not sure what the future has in store for me as I gain my full certification but I still have more to learn. I have a passion to try and ignite sparks in others; to help others grow beyond limits they or others might have put on them. Only through sparks can fires be set ablaze.

Neuro Gym Sit to Stand Trainer

Sit to Stand Trainer
One of the best pieces of equipment that has changed our facility is the Neurogym Sit to Stand Trainer. We purchased this piece of equipment last December from a Canadian vendor that presented at last year’s DOR meeting, and I highly recommend this trainer to all of our facilities.

http://neurogymtech.com/products/sit-to-stand-trainer/
 

We have had multiple residents who were total assist with bed mobility, transfers and just standing due to prolonged immobilization in the ICU. The first few treatments, the residents would be Max A x 2 for sitting balance, having had other complications that go along with immobility (hypotension, desaturation and poor O2 perfusion, diaphoresis, and muscle atrophy) from being supine in the ICU for weeks. The following example is one of many success stories we have had from the Neurogym Sit to Stand Trainer.

One resident who was completely independent with all ADLs, living by herself in a mobile home with five steps to enter, was admitted to a hospital with respiratory failure, a collapsed lung and CHF exacerbation. When she came to our facility, she could barely roll in the bed or move her extremely swollen legs and had poor sitting balance. This was one of our first residents to try the mobile Neurogym Sit to Stand Trainer, as the resident had a myriad of complications including C-diff that prevented her from coming out of the gym.

Our rehab team wheeled the Neurogym Sit to Stand Trainer to the resident’s room and sat her up on the edge of the bed Max/total A x 2. The therapist set the Neurogym counterweight to 50 pounds to help offset her weight secondary to her morbid obesity, extreme weakness and O2 dependency from being just weaned off a three-week ventilator stint.

I remember telling the resident on the evaluation, “You need to remember how hard this feels and how taxing just sitting on the edge of the bed is to your body, because in a month you are going to walk out of this building.”

She looked at me in extreme disbelief as the sweat was dripping down the front of her face just sitting on the edge of the bed and said, “I hope you are right.”

The first week, we focused on increasing her standing balance time and decreasing the counterweight from the Neurogym. After eight days, she was able to pull herself up to stand in the Neurogym without any counterweight assistance. At day 12, she was able to take 10 steps harnessed in the Neurogym. At day 17, she was able to pull herself to stand with a FWW and walk 15 feet on 3L O2 nasal cannula.

A little over three weeks from the day of evaluation, the resident was able to get herself dressed UB/LB at a SBA and walked with a FWW 175 feet with good reciprocal gait pattern on 3L O2 in a timely manner (appropriate for someone who was just decannulated from three weeks in the ICU doing PROM exercises). At around one month, the resident was discharged out of the facility to an ILF using her FWW.

This one example is a true testament to the desire for the patient to improve; the tenacity and encouragement by the rehab therapists to improve the resident’s overall functional level to leave the facility; and finally the MD, nursing and other ancillary staff members to administer medication and breathing treatments in a timely manner for optimal success.

By Jeremy Nelson, PT, DPT, Director of Rehab, Carmel Mountain Healthcare & Rehabilitation

ICD-10 Coding Corner

Coding Corner: ICD-10 Transition
Continuing the ICD-10 Journey
The good news is that our operations did not grind to a halt on Oct. 1, 2015, as others in the industry; we made it. Many are reporting that the transition from ICD-9 to ICD-10 went smoothly. Overall, everything we did to get ready for ICD-10 paid off. However, with everything new, ICD-10 didn’t come without its challenges. Hot topics were reported to be coding with Excludes 1 notes, the seventh characters for fractures and injuries. Coding accuracy is very important. With all the potential changes to the billing system, we need to have a strong understanding of coding and the coding guidelines. There is still some work ahead of us.

With that said, we need to focus on getting accurate coding not only for billing, but also for reporting and trending. Our BPCI facilities know this more than most. We need to make sure we are all painting that picture the same. For example, when we code for a hip replacement, we need to make sure we are using the most accurate code.

Code Highlight – Replacement Coding

This month’s code highlight is coding surgeries. When you look at a patient/resident recovering from a recent surgery, we need to first ask ourselves why they need our services. Most of time, it is going to be to heal from the surgery, so in that case we need to look at aftercare codes. I know when ICD-10 first came out, we said no aftercare codes; this only applies to our fracture codes. There are times when it is appropriate to code an aftercare code. Then it was said we need to use the other ortho aftercare code. Now with some research we have a final answer. Here are the steps to look up a hip replacement.

Hip Replacement (when coding in Optum)

First, type in “aftercare”; this will bring you to Z47 Orthopedic aftercare. Click on the folder to open more code options.

Next, look at the list of codes you have to choose from, and you will find Z47.1-Aftercare following joint replacement surgery. This the code that fits this case. When you look in the tabular list, the note will tell you to Use additional code to identify the joint (Z96.6). From there, you can see there are codes for:

  • Z96.641, Presence of right artificial hip joint
  • Z96.642, presence of left artificial hip joint
  • Z96.643, presence of artificial hip joint, bilateral
  • Z96.649, presence of unspecified artificial hip joint

Choose the code that is most appropriate to the documentation you have. You will end up with two codes for this one diagnosis, so we want to make sure we go the extra step and get the codes we need.

Coding Challenge

The Coding Challenge is back by popular demand. Each month I will put up coding scenarios that I get from the field and have you code what you think needs to be coded. Then next month, I will have answers to this one and a new one. Send in your tricky coding scenarios to codingpartner@ensignservices.net.

By Casey Bastemeyer RHIT, CCA, CHPS, RAC-CT, AHIMA-Approved ICD-10-CM Trainer

Coding CPT 97532 (Cognitive Skills Development)

CPT 97532 Cognitive Skills Development
It is important to understand the various CPT codes we utilize when reporting the services provided to our patients. One particular code, 97532, has specific parameters to consider before logging this code.

The Definition: This activity focuses on cognitive skills development to improve attention, memory and problem-solving, with direct one-on-one patient contact by the qualified professional, each 15 minutes.

  • This intervention would not be appropriate for patients with chronic progressive brain conditions without the potential for improvement or restoration. Therapy performed repetitively to maintain a level of function is not eligible for reimbursement.
  • Cognitive skills are an important component of many tasks, and the techniques used to improve cognitive functioning are integral to the broader impairment being addressed. Cognitive therapy techniques are most often covered as components of other therapeutic procedures, and typically would not be separately reported.
  • For any services related to the development of maintenance therapies for progressive conditions, code under the most appropriate non-97532.

 

In the PT/OT Novitas LCD, there is additional language on specific use of this code:

“Cognitive skill training should be aimed towards improving or restoring specific functions which were impaired by an identified illness or injury, and expected outcomes should be reasonably attainable by the patient as specified by the plan of care. Therefore, cognitive skills training for conditions without potential for improvement or restoration, such as chronic progressive brain conditions, would not be appropriate. Evidence-based reviews indicate that cognitive rehabilitation (and specifically memory rehabilitation) is not recommended for patients with severe cognitive dysfunction. Cognitive skills are an important component of many tasks, and the techniques used to improve cognitive functioning are integral to the broader impairment being addressed. Cognitive therapy techniques are most often covered as components of other therapeutic procedures, and typically would not be separately reported. Activities billed as cognitive skills development include only those that require the skills of a therapist and must be provided with direct (one-on-one) contact between the patient and the qualified professional/auxiliary personnel. These services are also reimbursable when billed by clinical psychologists. Those services that a patient may engage in without a skilled therapist qualified professional/auxiliary personnel are not covered under the Medicare benefit.
Note: The restrictions placed upon cognitive skills development (refer to the limitations section of this policy) do not apply to vision impairment rehabilitation services as defined in Program Memorandum, Transmittal AB-02-78.”

The SLP Novitas LCD states:

“This code describes interventions used to improve cognitive skills (e.g., attention, memory, problem solving), with direct (one-on-one) patient contact by the clinician. It may be medically necessary for patients with acquired cognitive impairments from head trauma, acute neurological events (including cerebrovascular accidents), or other neurological disease.

As stated earlier, speech-language pathology services are covered when performed with the expectation of restoring the patient’s level of function which has been lost or reduced by injury or illness. There must be an expectation that the patient’s level of function will be restored, or significantly improved, in a reasonable (and generally predictable) period of time. When these interventions are used in the setting of chronic, generally progressive, cognitive disorders, there must be a potential for restoration or improvement of function. Therapy performed repetitively to maintain a level of function is not eligible for reimbursement.”

Remember: Medicare also supports the use of 92507 for cognitive-communication intervention.

By Tamala Sammons, M.A. CCC-SLP, Therapy Resource

Poetry in Motion: A Tribute to the Eden Alternative

Sonny Gonzalez, DOR, and Jennifer Daniels, SLP of Oceanview Healthcare and Rehabilitation in Texas City, Texas, have been participating in a national grant project of the Eden Alternative called Creating a Culture of Person-Directed Dementia Care. The Eden Alternative® is an international, nonprofit 501(c)3 organization dedicated to creating quality of life for elders and their care partners, wherever they may live. Through education, consultation and outreach, we offer person-directed principles and practices that support the unique needs of different living environments, ranging from the nursing home to the neighborhood street.

Both Sonny and Jennifer have each shared poems they’ve penned in response to what they’ve learned. Sonny’s poem, Alone, echoes the message behind Eden Alternative Principle Three, which acknowledges that companionship is the antidote to the plague of loneliness. Click here to read Alone. Jennifer shares Night and Day with us. Her poem reflects the essence of Eden Alternative Principle Five, which names spontaneity and variety as the antidote to the plague of boredom. Read Night and Day.

(Sonny Gonzalez shared the above from the Eden Alternative site at http://www.edenalt.org/inspired-words-make-worlds/)

Helping Respiratory Patients Breathe Easy At North Mountain

Kelly Schwarz article photoNorth Mountain Medical and Rehab Center in Phoenix, AZ has continually had an increase in respiratory patients over the years, making it well known to the community as a premier respiratory facility. The goal of almost every resident coming through our doors is to return to the community, and the Therapy Team chose to implement a Pulmonary Rehab Program designed with specific interventions for these residents, which often means taking a different approach to rehab due to their lower level of activity tolerance. A patient must first meet the criteria to participate in the Pulmonary Rehab Program, and once admitted into the program, we have select guidelines for assessments, treatment plans, educational material, and involving community resources to continue to help our respiratory patients thrive while in our facility and then discharged home.

After a successful 1st quarter kick-off, the team continues to grow the program with new goals. Shannon Dougherty, PT, is working towards a specialized PT Certification in Pulmonary Rehab. Kelly Schwarz, DOR, is getting involved in community education programs through Breathe Easy Arizona. The team has researched the use of different standardized tests to add to their assessments, and will implement the use of manometers and inspiratory muscle trainers to their treatment sessions.

At North Mountain, we are truly taking an interdisciplinary approach to helping our residents “Breathe Easy” on the road to success!!

By Kelly Schwarz. DOR, North Mountain Medical and Rehab Center, Phoenix, AZ

Fast Track to Therapy Leadership!!!

Northbrook Healthcare in Willits, CA, is offering an exciting opportunity for therapists of any discipline who have a passion for leadership. We are opening our Director of Rehab position up to candidates who have not yet had experience as a rehab director and are committed to provide the following support to assist you in being successful:

  • Dedicated mentoring and support by the area Therapy Resource
  • Monthly opportunities to shadow or ask for in-depth explanations in regards to managing staff, billing, documentation, Ensign culture, regulatory requirements, etc., with experienced DOR’s in the cluster
  • Highly experienced facility administrator committed to supporting and mentoring you
  • $1500.00 in external continuing education money
  • $5,000.00 student loan repayment or signing/retention bonus
  • Invitation to attend expenses paid DOR meeting in June 2016 (held in So Cal)
  • Special training in our Abilities Care Approach program

Are You A Contender?

The ideal candidate will be a licensed PT, OT or SLP, have some level of exposure to Ensign’s unique culture (either as a staff therapist or a student during a fieldwork experience) and have demonstrated solid experience in delivering high quality care to adult and geriatric patients in a long term and post-acute rehab setting. In addition, this special therapist will also demonstrate a passion for learning, a love for patients and colleagues, the drive to solve problems and overcome barriers, and the desire to build something great.

For More Information:

Contact Paul Medvenewww-search-therapy-jobs-footer

(949) 230-8384 or pmedvene@ensigngroup.net

Finding Tools for Success at Northeast Nursing & Rehabilitation

Group of Hands Holding TherapyWhen one 70-year-old retired man came to Northeast Nursing & Rehabilitation, he had a range of health concerns, including a recent hospitalization as a result of a colostomy secondary to colon cancer. Furthermore, this patient had an exacerbation of his COPD, along with chronic respiratory failure, diastolic CHF, aortic valve insufficiency, morbid obesity and HTN.

Previously, the patient was living in the community in a first-floor apartment with no steps, was I with managing household responsibilities, I with IADLs, I with transfers and MI with gait, utilizing a cane for household/community ambulation. In addition, this patient had good static/dynamic standing balance and did not use supplemental oxygen.

In the community, this patient made short drives to visit family, go to the grocery store and attend doctor’s appointments. His family members lived close by and were available to provide assistance if needed.

We determined that a combination of physical, occupational and speech therapy would best allow us to help the patient meet various goals:

Physical therapy — PT assisted the patient with progressive therapeutic exercises to increase gross B LE ms strength, thus improving his ability to transfer and ambulate with less dependence upon caregivers and adaptive equipment. The patient’s six-minute walk test improved to 627m, above normal for his age range. PT educated him to use a pedometer so he had visual cues to work on endurance, conditioning and gait distance. Upon discharge, the patient could do greater than 6,000 steps per day.

Occupational therapy — OT assisted the patient with progressive therapeutic exercises to increase gross B UE ms strength (arm curl test improved to 18, rated as average for this patient’s age group), thus improving the patient’s ability to perform UE/LE dressing and general household management. Furthermore, the patient was able to step over a tub and bathe himself independently, along with managing his colostomy bag.

Speech therapy — In coordination with PT and OT, ST worked on training the patient to self-monitor O2 stats through maintaining an 02 level log every hour, when he was without supplemental O2. Eventually, the patient was able to wean off O2, and he had improved volume control and intelligibility of articulation of speech through diaphoretic exercises and in spirometer to facilitate improved respiratory support.

This collaborative approach served the patient well. Through the combined efforts of PT, OT and ST, we were able to equip him with tools to improve his quality of life and more fully enjoy his retirement years.

By Rochelle Lefton, MA, OTR, DOR; Michelle Scribner, MSLP, Heather Cox, DPT,

Susan Garcia, COTA, Jesusa Herrera, PTA

Legacy-Building at Sea Cliff Health Care

Arrangement of color-coordinated scrapbooking itemsPrior research has indicated that older adults treated with four weeks of reminiscence-structured activities to target specific personal memories showed fewer depressive symptoms, less hopelessness, improved life satisfaction and retrieval of more specific life events (Allen, 2009). Toward that end, we wanted to provide rehab patients and/or their caregivers with a value-added service — one that emphasizes a celebration of life and identifies the patient’s volition, rituals and habits through the use of a client-centered legacy-building intervention.

Through legacy-building activities, such as engaging with family members, creating slideshows, creating scrapbooks and creating videos, the patient and family improve existential awareness of their past, present and future. The goal is to improve activity tolerance, facilitate out-of-bed activities and address underlying deficits that influence ADL performance skills.

Partnerships and Collaborations

Our partnership with the Loma Linda University Occupational Therapy department, as well as other higher education institutions, allows us to recruit graduate-level fieldwork students to participate in our legacy-building project. By the end of week 12 (the end of fieldwork rotation), the FW II student presents a facility in-service regarding implementation and outcomes of the legacy-building program.

A Case Study in Legacy-Building

One patient, an 87-year-old woman, was admitted to Sea Cliff Health Care after a hospitalization secondary to generalized weakness, decreased functionality and decreased oral intake that revealed UTI, dementia, dehydration, coronary artery disease, anemia and urosepsis. The patient was evaluated by physical and occupational therapists for intervention once a day, five days per week, from March 24 to May 18, 2015.

Plan-of-care goals had to be modified throughout the process to address the patient’s increased aversive behaviors, outbursts and anxiety with therapy requests. We introduced behavioral modification techniques and legacy-building interventions, such as scrapbook making, a quote book and an interview for personal needs.

Thereafter, the patient met several functional goals and showed increases in other areas of ADL function, including BUE strength, seated balance, UB/LB dressing tasks and hygiene/grooming tasks. With the help of behavioral modification techniques and legacy-building interventions, the patient was able to demonstrate decreased aversive behaviors, confabulations, outbursts and anxiety and increased socialization (she sang more) without the use of psychotropic drugs.

Conclusion: a FW II Student’s View

Is the legacy-building project a valuable interpersonal teaching exercise? Why?

The experience during my level 2 fieldwork with the legacy-building project has allowed me to be a part of making a difference in the life of a patient that otherwise may have not had the means to advocate for their own care or means of participating in meaningful occupations at a vulnerable time in life.

What characteristics should future FW II students possess to be successful in this program?

It was important to be able to use therapeutic use-of-self in order to shape therapy sessions based on the patient’s needs and desires. Patience and empathy were also important characteristics for building rapport necessary to facilitate patient honesty, thoroughness and willingness to reveal personal anecdotes and experiences.

Did the program meet its objectives? The program reached its objectives to create mementos and informative aids for facilitating increased communication between patient and family/caregivers, while creating a product that is meaningful and can be used to maintain the patient’s legacy.

By Kristine Lewis MOT, OTR/L, Sea Cliff Health Care, Hungtington Beach, CA, In partnership with Loma Linda University OT Department

 

Connecting Our Youth With Residents at Park View

Parkview event2I have to share about the beautiful morning I was privileged to be part of at Park View Post Acute Care in Santa Rosa, CA. The Abilities Care team at Park View hosted an event that was a gift to all those who participated, and even to those who observed from the sidelines. A local school has decided to partner with PVPA and will be a part of their Abilities Care team. The students will be part of the iPod music program for the residents, and I am sure the partnership will be rich and rewarding for the students and our residents. This morning was the kickoff event (despite being annual survey). The seventh grade class loaded onto their school bus and came to PVPA to perform a concert for about 25 of our residents in the park at the facility.

Jennifer Raymond, DOR, spoke to the children at their school yesterday, teaching them about the elderly and dementia. She also shared some tips about how to communicate with our residents.

Parkview event1

After the students performed for the residents, the Abilities Care team led the residents in their drum circle. The finale was the students playing “Circle of Life” with the residents playing along on their drums. Following the drumming, the students and residents mingled together.

The residents absolutely came to life, and the intergenerational exchange and engagement between the residents and the students was powerful to experience. The residents didn’t want to go back inside until they had said good-bye and seen the students load onto their bus and drive away.

The surveyors who watched the event told me this was something they would love to see at all facilities. It was clear how moving it was to the staff to see our residents regarded as elders by the students. There wasn’t a dry eye to be found.

Thanks so much to the team at Park View for making this happen despite the business of survey and daily life. It was so very special, and I was blessed to be a part of it.

By Gina Tucker Roghi, Therapy Resource