Celebrate

Our patient Polly Bee had not walked in 20 years, but our therapy team did not let that stop them from helping Polly follow her dream of walking again. Some of the approaches used by Lake Village therapists with Polly Bee included:

• Barihab utilized for balance, proprioception and standing tolerance
• Mobilization techniques to facilitate muscle flexibility for knee
• Muscle energy
• Joint mobility
• Standing activity tolerance
• Custom shoe for leg-length discrepancy
• Adaptive equipment for ADls/self-care training
• Postural alignment
• Home evaluation for environment modifications

Here, in her own words, is Polly Bee’s story.

It was a cold, wet morning 23 years ago when my life ended, as it was, in an accident that kept me in a wheelchair from then on. While riding in my mobile home, I was forced off the road by a tractor trailer. This broke my left femur in half, and my right foot yanked completely off by getting hung between the door and the step of my mobile home. Before we could get the wheels of the mobile home back on the road, we hit a 6-foot ditch, nose down, making it into an accordion.

The accident happened at 4:30 a.m., and I was taken to the emergency room, where I waited until 2:30 p.m. before I was operated on. Infection took over my left femur during that waiting time, and 32 surgeries later, I had lost not only my femur, but my whole left leg bone. My last surgery left me with a titanium bone from my left ankle to my pelvis. My knee cap was left on top of my internal prosthesis, floating and getting caught in the hinge of my knee, causing very severe pain. Ever since then, I have been in a wheelchair suffering with this pain, living life the best I could.

Two months ago, at 9:30 p.m., I fell off the bed and landed on my left knee, causing me to end up in the hospital for pain control. After getting my pain under control, I was forced to come to Lake Village Nursing & Rehabilitation Center in Lewisville, Texas, because I had no one to care for me at home. My only consolation of coming to Lake Village was that it was very close to my youngest daughter’s home.

At Lake Village, they have an excellent therapy department! I started off exercising my legs, which I had done many times in several rehab centers. But this time, one of my therapists, Addie, actually listened to me and addressed the problem that was causing the pain. She mobilized my kneecap to its proper position with use of slight pressure and used Biofreeze to massage my leg muscles to increase flexibility and facilitate joint movement.

I started to practice standing from there, because my pain was finally under control. I realized that I needed a built-up shoe that would lengthen my internal prosthesis leg to match the length of the normal leg. Once I received my custom shoe, I had overcome all the barriers. Before I knew it, I was walking over 100 feet on my walker! This was the first time I had walked or even taken a single step in 23 years!

This was not only a huge accomplishment for me, but also for Addie, Chris, Ellen and Eric. Hats off to the greatest therapists in the United States! This is the eighth rehab that I have been in since my accident. They all helped me make many accomplishments, but none as great as Lake Village. I always had a dream to walk again, but 10 years ago, I gave up on it and had no hope of ever standing on my own two feet, much less walking. Now I see some light at the end of the tunnel. I will be moving to my daughter’s home soon, and as I get stronger, my long-term goal is to be able to go back to my home in Colorado. All of this is due to the great therapists at Lake Village Nursing & Rehabilitation Center.

Johnny Johnson, age 71, has been here at Lake Village Nursing & Rehabilitation Center for about five or six months. He is one of our star patients who has come a long way.

Initially, Johnny would not participate in therapy services, until therapy was presented as an elite exercise club not offered to everyone, with a membership card that was marked off after each exercise session. Once the card was completed, then he moved up to the next level. He chose his membership gift, a steak dinner, and Therapy took him to a local diner for chicken-fried steak with his daughter.

Some of the approaches used by Lake Village therapists included:

• Barihab to increase standing tolerance/weight bearing
• SciFit for endurance and total body conditioning
• Safety awareness
• Functional activity tolerance
• Gait training
• Strength training

We would like to share Johnny’s story, because everyone loves a happy ending! Here is a summary in his own words of his experience at Lake Village.

Back in January, at my country house in Arkansas, I was out hunting for deer on a cool, crisp morning. I fell out of an 18-foot metal deer stand. As I was falling, I remember, I was face-first, but somehow I made myself turn over in the air and land on my back. I laid on the ground for about an hour because I just couldn’t get up. Slowly, I crawled to my four-wheeler and drove home.

I could hardly walk because of the pain, so my wife took me to the Wadley Hospital in Texarkana. It turned out I had trouble with my vertebrae and a head injury. I knew I needed rehab, so my wife asked around and heard great things about Lake Village in Lewisville. It was a good option because my daughter lived here.

I don’t remember much about this time at the Wadley Hospital or even my first few weeks at Lake Village. I was extremely sick and partly crazy. I was cursing more than a sailor, wouldn’t take my medication and wouldn’t do anything they wanted me to. They were needling me all the time with a bunch of pain meds, so I just was out of it.

When I finally felt better, I joined the rehab exercises with a Basic membership. I finally started to walk, build strength and work my mind. I was upgraded to the Gold membership, which focused on even more walking. Now, I’m almost done with Gold, so I’ll be getting a steak dinner. Next, I’ll do the Platinum and Diamond until I’m ready to go home.

The staff here are just wonderful, especially the ones in the fitness center. It’s a nice facility; everybody works with you and gets along with you. I’ve been real satisfied with this place.

I want to give a big shout-out to all the DORs to remind you that you are not alone out there. Every DOR in every Ensign facility shares your struggles and wants to celebrate your successes. We do our best to be strong leaders for our teams, but we also need to remember to lean on each other when times are tough.

What makes a strong leader? The dictionary defines a leader as one who inspires and guides others. He or she must possess certain qualities such as honesty, confidence, a good sense of humor, a positive attitude, good communication skills and intuition for reading people.

As a leader, you set the mood every day when you enter the office. Staff members feed off of the energy you exude; whether it is positive or negative is entirely up to you. Remember to take a moment before you walk through that door to put on your game face for the day. You get what you give.

You are probably the first one in the door in the morning and the last to leave at night. You try to lead by example, but not everyone realizes the time and effort it takes to stay on top of productivity, census, compliance audit updates, case mix, clinically appropriate RUGs, staffing challenges, continuing education and great outcomes in patient care. You are always on call. If you are truly honest, I bet you have worked on your computer while on vacation! (I know I am guilty.)

You work your hotlist daily and spend time analyzing reports to make sure everything is done on time. You hold your therapists accountable for their treatment minutes, paperwork, productivity and outcomes while never forgetting to provide each and every one of them with respect and encouragement, for a job well-done. One of the things I enjoy the most with my team is setting team goals together and then celebrating together as each goal is met. The importance of celebration can’t be overstated!

Remember, your therapy team is a group of highly educated professionals who can help you in your daily tasks if you delegate appropriately. Allow them to be creative in their treatment approaches, provide monthly continuing education, explore their career interests, and find new ways to assist them in advancing patient care to new levels in your facility. Ask their opinion on goals for the department in the coming year. Have them discuss the group strengths and areas for improvement. These educated people are a strong resource for all DORs when you are feeling stuck. Set your goals as a team, and your team will shine.

By Donna Black, DOR, The Courtyard Rehabilitation and Healthcare, Victoria, TX

 

For over 75 years, May has been designated as Better Hearing and Speech Month — a time to raise public awareness, knowledge, and understanding of the various forms of communication impairments to include those of hearing, speech, language, and voice. Communication impairments often affect the most vulnerable in our society — the young, the aged, and the disabled.

Helen Keller once noted that of all her impairments, she was perhaps troubled most by her lack of speech and hearing. She elaborated that while blindness separated her from things, her lack of speech and hearing separated her from people — the human connection of communication.

For a fun way to share some common speech disorders – click here for a video with our favorite Looney Tunes characters!

https://youtu.be/UASW6zSuXaE?list=PL6GgE3NLyHD6WlIsVXhi-rThjkF25f8E0

For more information on Better Hearing and Speech Month: http://www.asha.org/bhsm/

Littleton Rehab’s OT team once again promoted OT Month in their facility to educate residents, staff and families. They not only hung a large informational and colorful board in the hallway, but each of the Littleton staff was given a small gift with a message about occupational therapy. The message was written by AOTA president Ginny Stoffel: “Occupational therapy addresses real, down to earth, everyday life issues. We are true to our profession when our practice results in helping people reengage in everyday life activities that hold meaning, purpose and value for them.”

What is Occupational Therapy? Spread the word!

Occupational therapy is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent-or live better with-injury, illness, or disability. Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment and/or task to fit the person, and the person is an integral part of the therapy team. It is an evidence-based practice deeply rooted in science. Learn more at:http://www.aota.org/Conference-Events/OTMonth/what-is-OT.aspx#sthash.of9qsny6.dpuf

For the first time ever, Willow Bend Nursing and Rehabilitation Center has won the most elite 2014 Ensign flag award! We are so honored and blessed to work here.

Willow Bend Nursing and Rehabilitation is a 162-bed skilled nursing facility in the heart of Mesquite, Texas. Willow Bend has been voted the best rehab in Mesquite for two years in a row. We pride ourselves on improving year after year in almost every significant measurement.

We have overcome many major hurdles, such as: 1) A brand-new skilled nursing facility opened up in between our number one referring hospital and us, and 2) We have taken on rising costs, such as hiring an additional case manager, increasing our MDS nurses from two to three and strengthening the number of employees involved in the admissions process. Despite these challenges, we have been able to increase our EBITDAR Margin. We have implemented many new programs this year to increase our employee and resident satisfaction, and we truly continue to grow as a staff. We are always striving to meet the needs of our community to remain the best SNF in our community.

Our leadership team is phenomenal! We have all directly impacted the course and future of our building and its programs:

Allen Mall, Director of Nursing: Allen became Willow Bend’s DON in 2013 and has led our facility to extraordinary clinical results. With Allen’s excellent leadership, we were able to improve our staff’s skills and education to enable us to complete our January 2015 Survey with only one low-level nursing tag. Allen has channeled his passion for nursing and the Ensign way to drive our team to strive for the excellence of an Ensign flag facility.

Allen has challenged every employee to be the very best they could be. Under his leadership, Willow Bend has been able to create a hard-working and dedicated team that truly cares for each other and our residents. Allen has helped to create a desire in employees that no matter how difficult the journey may be, we should strive to not only be one of the best within Ensign, but also the best in our community. Allen’s passion is infectious, and Willow Bend is truly blessed to have him as our DON. We are sure in the years to come that he will help our facility continually shine as a proud part of the Ensign Group.

Linda Herndon, Director of Marketing: Willow Bend is blessed to have Linda Herndon as the Director of Marketing since 2008. Willow Bend has been in the Mesquite area for over 50 years, and it did not have a good reputation. This is where Linda’s difficult job of transforming Willow Bend began. The community was not receptive because of Willow Bend’s past reputation, so Linda started developing relationships with physicians in the community. It took time to gain their confidence and give us a chance to show the level of care of which Willow Bend is capable.

The reputation began to develop and vastly improved as a result of Linda’s relationships and the great team that worked together to prove we provide quality, loving care. We all shared our peaks and valleys together, which proved to our residents, families and referral sources that the care we provided is of the highest standards. We gradually grew our skilled census from an average of less than seven residents to an average of 60 skilled residents.

Three years ago, we opened a state-of-the-art rehab unit known as The Lodge at Willow Bend, which has private rooms, private baths, and an atmosphere that encourages residents to relax and enjoy their rehab stay. Voted the best rehab in Mesquite two years in a row, we are the preferred provider for numerous physicians, churches, case managers and insurance companies. From day one, our administrator and Linda always had the vision that we would be the best in Mesquite. Our leadership team is one-of-a-kind, and we all work together as a family unit. We have all stood by each other through the ups and downs, showing what it takes to build a successful team.

Anna Boone, Director of Therapy Programs: Anna brings 22 years of experience to the Willow Bend family. Anna is a member of the Ensign Leadership Council. As a member of this elite group, she is able to help pave the path along which Ensign Therapy is moving. She is also the chairperson for the Ensign CEU committee, which focuses on the education of our therapists.

Anna leads our Rehab team to excellence in clinical, customer service and financial outcomes. Willow Bend consistently rates in the top 3 percent on the weekly trend report. Our Rehab department is unsurpassed in delivering quality patient care. Being a therapist at Willow Bend means a commitment to excellence and a devotion to continuing education, which allows us to provide the highest level of innovation to our treatment approaches.

Through our continuum-of-care approach, our therapy department follows patients from their discharge from the hospital, through their skilled stay, continuing to home health and finally outpatient services. Our unique pet therapy program puts a smile on everyone’s face. Our goal as a rehab department is to keep our residents as independent as possible for as long as possible. We own it, believe it and live it. We are blessed to have the opportunity to make a difference in people’s lives every day.

Diane Shilt, Case Manager: Willow Bend was able to create a new Case Manager position distinctly designed to grow our HMO census. Diane has been able to work with our Director of Marketing and Admissions team to grow and build relationships with Case Managers at the insurance carrier level as well as the hospital referral level. Diane has extended the networking system to increase referrals by educating and reminding fellow case managers about the unique skilled services that Willow Bend can offer.

Diane has impacted the reputation that Willow Bend has with most of the major HMO insurance carriers to be positive and support their needs. Humana has designated Willow Bend as being a Star Provider of SNF services. Before Diane was the Nurse Case Manager at Willow Bend, the average HMO census was 20 beds, and since then, the HMO census has averaged as much as 36 beds in the first year that this position was created.

Most recently, Diane has taken on the Case Manager role for all of our VA contract residents. She has ensured that Willow Bend has kept within the VA guidelines and helped obtain long-term contracts to obtain continued census. Diane has been able to impact the appeals process on a local level by researching denials on HMO carriers that need to have medical necessity in order to pay correctly. Diane has impacted the outcome studies with HMO reporting for Willow Bend and promoted the managed care guidelines of service for our facility that are necessary to ensure that we are competitive as healthcare providers in today’s market.

Yolanda Reason, MDS Coordinator: Yolanda has been able to work persistently with Willow Bend’s two other MDS nurses, Ashley Jackson and Nicole Campbell, to ensure that we capture the services rendered to our residents. Their exceptional leadership is thorough, educating our floor staff on proper documentation.

Ongoing education is necessary in efforts to capture our services provided. Yolanda recently completed a staff in-service to educate and reinforce accuracy when documenting ADL care. During our daily standup meeting, the IDT receives daily reminders about the importance of timely completion of their section(s) of the MDS. Accuracy of the MDS process is evident in our routine compliance visits. Our MDS team has worked diligently to manage as many as 62 skilled residents and 147 residents overall. Our MDS team continues to play a vital role in the financial success of Willow Bend.

Mindy Rhodes, Business Office Manager: Mindy has been Willow Bend’s Business Office Manager since March 2013. She has worked diligently with her fellow business office team members, Sheryl Porter and Rebekah Martin, to completely turn our business office around at Willow Bend for the better.

We have the highest volume of HMOs in Texas. Often, more than half of all Texas Keystone HMOs are in Willow Bend at any given time. It takes longer to collect money from HMOs than it does from other payers, such as Medicare or Medicaid. We have put systems in place to stay on top of our HMO companies to ensure follow-up happens in a timely manner so that payments can be made promptly to Willow Bend. In 2013, our percentage collected was 97 percent, and in 2014, our percentage collected was 98 percent. As a team, we have dropped our bad debt percentage from 1.89 percent in 2013 to 1.51 percent in 2014. We also had an average DSO in 2013 of 47.84. In 2014, we were able to drop this percentage to an average of 42.65; this number, when adjusted for the percentage of HMOs, represents one of the best in Keystone in the Dallas area. We strive to help our family members and residents understand everything regarding the financial portion of their stay and make the financial process as easy as possible.

Sharon Wheeler, Director of Admissions: Sharon has been with Willow Bend since March 2012. We were able to see her great potential the moment she walked through our doors, and she has gradually moved from Customer Relations Specialist and Accounts Payable to one of our most successful directors of admissions.

Willow Bend has utilized Sharon’s background and marketing and her love for organization to make our admissions process as smooth and comfortable as possible for residents, family members and employees. Sharon ensures that our up to 75 admissions a month are able to call Willow Bend their home away from home, as pain-free as possible. Sharon is aware that entering a skilled nursing facility can be scary and unnerving for many residents and families. Her excellent communication skills have helped make sure that our residents are comfortable from admit to discharge. That’s saying a lot, as we had over 750 admissions in 2014.

Waylon Howard, Director of Operations: Willow Bend is blessed to have a unique Director of Operations. Waylon began as our Director of Maintenance in 2012. Since then, he has met the facility need in several areas of administration. Waylon has morphed his Director of Maintenance position into our exceptional Director of Operations.

In addition to his Maintenance Department and Life Safety/Building Safety training duties, Waylon ensures that we are in compliance with all of our Ensign U trainings, and he facilitates our Daily PPS meetings, Weekly Skilled Medicare and Part B meetings, and Triple Check meetings. Waylon is called on daily to be our Mr. Fix-It and operates as the information source for all operation needs. Waylon is a true team player and willing to do whatever is needed for Willow Bend to be successful day in and day out.

Kevin Niccum, Executive Director: Willow Bend has been privileged to have Kevin Niccum as our Administrator since 2008. Not only has he helped our facility improve financially, but he also has instilled the idea of teamwork into our department heads and leads by example for all employees.

In 2014, Willow Bend department heads finished reading as a team The Five Dysfunctions of a Team. CAPLICO has been taught many times to our leadership team and staff, and we are excited to begin studying leadership principles. Kevin has helped ensure that Willow Bend has improved year after year in almost every significant measurement. Without Kevin’s excellent leadership, the clinical and financial outcomes could not have been achieved in 2014.

Other details of note at Willow Bend include the following:

• We were at over 100 percent of our BHAG Goal at the end of December 2014.
• Our facility completed our most recent Annual State survey on Jan. 9, 2015, with some of our best results yet. We have an expectation of two low-level tags.
• We love our residents. It shows by the fact that almost all of our bread is baked fresh daily by our kitchen staff, and our vegetables are fresh, not canned or frozen.
• We love our employees, too! Promoting culture is a way of life at Willow Bend. We hear “Benders Unite” from Kevin frequently, reminding us that we are all part of one big family working together toward the same outcomes.
• One of the ways in which Willow Bend has addressed culture is in rewarding the staff who goes above and beyond their duties when it comes to resident or staff needs. We use a system called the WOW program to recognize our staff’s unrelenting hard work and dedication. WOW stands for Witnessed Outstanding Work, and we have cards readily available around the building so that staff, residents and families can help acknowledge the visible hard work in our building. When a staff member receives a WOW card, he or she is then invited to an employee recognition lunch where the cards are read, and the employees are thanked and congratulated and presented with a WOW card to be placed with their name badge so that everyone in the facility knows they were recognized.
• We have expressed culture through staff and resident talent shows, using staff to assist in the decorating of common areas to create a feeling that is more like home for both the staff and residents. During our monthly all-staff meeting, we present culture in the form of in-service or games, such as the one you will find attached. Correct answers are rewarded immediately to the answering team in the form of a gift or candy to generate excitement.
• We have a wall full of Moments of Truth, and we have an annual more prestigious award called the Pineapple Award that recognizes those who constantly show moments of truth in their everyday actions.

Here are some things we have done to promote our culture:

• We have created neighborhoods and communities within our facility where our residents live in “households” rather than living in certain “wings” or “floors,” organized around a nurse’s station. No one is called a “patient”; rather, they are called residents.
• Residents can wake up and go to sleep on their own schedule.
• You’ll see our staff knock on doors before entering a resident’s room.
• Residents have decorated their own rooms with selected belongings from home.
• You’ll find therapy dogs coming through the home for our residents to pet, birds chirping in clean cages, aquariums in the lobby and plants placed throughout the facility.
• Our residents order from menus.
• We have gathering places scattered throughout the facility so residents can read, visit with each other, watch television, play games or just sit and enjoy the ambience.
• We believe that relationships among our staff, residents and families must be continually nurtured and are vital to quality care.

Happy Halloween!

Seacliff Therapy Team

Summerfield Therapy Team

Palomar Vista in Escondido, CA, was recently praised in an article published in U-T San Diego, written by a former patient and freelance columnist, Agnes Herman. Agnes shares her experience and feelings about the exceptional care and team support she received at Palomar: “Each therapist is dedicated to helping us avoid pitfalls in the environment, to strengthen muscles, increase range of motion and learn to walk safely and be comfortable in our own skin. These young folks who are professionals enjoy working together to create an atmosphere of ‘can do.’ They do not finish each other’s sentences, but they could. … When we fall, there is fear and apprehension along with pain. A caring environment and dedicated teamwork can cushion the impact of any fall.” Read the full story.

L to R: Jimmy Manalang, OTR/L; Rino Aquino, PT/DOR; Patricia Kaiser, rehab aide; Ria Olaes, COTA; Bernard Villaseca, PTA; Dennis Pulangas, PTA

Nerida Gerona is the Director of Rehabilitation in Lemon Grove, CA, and her partnership with local universities for ongoing student internships is legendary in Southern California. In the past 12 months, the Lemon Grove center has taken 15 students from six different schools, with two new schools being added in the early summer. What makes her student programs stand apart is how the Lemon Grove team embraces our Core Values and incorporates them into their students’ experience. The students truly become part of the team and have the experience of being part of a dynamic interdisciplinary rehab program. The team celebrates their successes and ensures that each student gets the opportunity to work with a variety of different diagnoses and disciplines. Because of the extraordinary feedback that the students have about their experience at Lemon Grove, Nerida was one of the clinical educators who were asked to be a part of the certification process for a new Physical Therapy Program at San Diego State University. In addition, four of the therapists at Lemon Grove are now certified instructors. Way to go, Team Lemon Grove!

The extraordinary therapy team at Atlantic Memorial Healthcare Center in Long Beach allowed me to spend the day with them yesterday, and it was a pleasure and an honor. My goal was to capture on video the culture and spirit of this team to use as a therapy recruiting tool on the web. While we certainly have showier, newer and bigger well-equipped facilities, I have watched something magical happen with the team at Atlantic Memorial over the past three years – something that I believe defines and demonstrates Ensign culture at its best. An added bonus was getting to leave 110 degree Phoenix and hang out in So. Cal for the day!

I am hoping that the video we produce is able to impart at least a fraction of the truly cool things about this group. Atlantic Memorial’s rehab director is a perfect example of a level 5 leader. In response to any compliment about her terrific program, she pointed right back to her team, sharing their individual strengths and how lucky she feels that they chose to join her. She has empowered each therapist to use their personal talents and passions to enhance the care they provide to their residents and they all demonstrate intense accountability for and ownership of their therapy program.

Among other things that I am probably missing, the Atlantic team is comprised of a semi-professional dancer, a hugely talented photographer, several staff who have a passion and special ability for nurturing students and new graduate therapists, individuals with incredible organizational skills, an adaptive specialist who can create therapy tools out of almost nothing, a pediatric specialist who also loves geriatric patients and brings a sense of fun and play to this busy gym, and several therapists who are driven to build a great outpatient program. Add to this a facility administrator who lives and breathes Ensign culture and loves and supports his therapy team all day, every day – and viola – a superstar therapy program has evolved.

Our videographer for this project was a twenty-something hipster skateboard guy whose other film gigs include chronicling the X-games and working with some pretty well known musicians, rappers and skateboarders. I had the impression that ours was probably the first nursing home shoot he had been involved in, and I felt like he was a little bit out of his element. One of the many highlights of my day was watching him watch these therapists and listen to their stories about what they are most proud of and what they love about the work they do. At the end of the day, he sincerely thanked everyone for the time he was able to spend at Atlantic and kept saying what a “rad” place this was – that he had no idea that this is what a nursing home was like. I was just so proud of the gang at Atlantic Memorial and wonder if they know how much they impact the people they touch every day – even the ones who aren’t their patients!