News

By Kelly Alvord, Therapy Resource, Sunstone UT
The Sunstone DONs and DORs recently participated in a combined meeting. This meeting of minds was designed to make sure we understand the challenges and initiatives of each other’s departments and to really collaborate where we could to help each other meet goals and obtain great clinical results.

Key partnership topics discussed:

• We first pulled the “Rehab Screen Consultation F TAGs” POSTette from the portal. Each DOR presented on an F-tag from the POSTette and how the Therapy team will support and take the ownership of these tags for survey. For example, F Tags F684, F676, F677, and F810 all have to do with Activities of Daily Living (ADLs). The teams addressed their strategies for therapy partnership with ADLs for this group of F Tags. We discussed specific actions and roles Therapy has to support the DONs to prepare for survey. The DONs learned how their DORs are truly their clinical partners. This discussion was very interactive. The DONs were excited to know we “have their back” when it comes to involvement with patients to prevent decline and help with survey results.
• Deb Bielek introduced our Excellence in Programming and Clinical Care (EPIC) Programs. EPIC programs. The DONs and DORs all committed to collaborating and establishing an EPIC program for each of their facilities based on clinical needs and trends.
• Clay Christensen presented on the 5 Dysfunctions of a Team, which focused on establishing trust, being vulnerable, and not fearing conflict. This information was further validation of power of a strong DON and DOR partnership.
• We also had fun together and had cluster competitions with an offsite activity.

With these dynamic partnerships with DONs and DORs, Sunstone is unstoppable!

I think most of us would answer yes to this question!

I wanted to share a cool program that Adina Gray, SLP/DOR, and her team at Lake Village have started to meet the needs of their residents and see great improvements in this area:

At Lake Village in Lewisville, Texas, the therapy department saw a need for residents who either: didn’t enjoy showers, refused showers, had a decline in personal hygiene, and/or could benefit from some modifications and adaptations to their daily wash routine.

The OTs started by identifying the residents, and then we went about finding inexpensive but functional shower caddies (the Target College Essentials ones were perfect). They then talked to the residents and their families, and obtained the items that the patients would utilize and enjoy specific to them. For example, some families brought nice-smelling body wash, specific hair products for different hair textures,, good shavers and shaving cream for the men, etc. Items were labeled as necessary to help with carryover and ease of use.

We also established grooming and hygiene routines with laminated visual schedules for those who could follow them for doing things such as daily teeth brushing, washing their face and combing hair. And when OTs have established the routines and a patient is demonstrating good independence with the program, we then refer to ST in order to continue with carryover and use of visual aids and daily schedule to complete tasks as independently as possible.

Feel free to reach out to Adina (adhill@ensignservices.net) or your therapy resource with any questions!

Submitted by Barbara Mohrle, OTR, Therapy Resource, Keystone North

By Brian del Poso, OTR/L, CHC, RAC-CT and Tamala Sammons, MA, CCC-SLP, Therapy Resources
Sensory Integration (SI) Therapy was originally invented by OT, Jean Ayres, in the 1970s to help children with sensory processing problems. Although less prevalent, SI techniques and theory used to modulate the sensory and proprioceptive systems can also be used with the adult population.

We’ve had a few questions recently around the appropriate use of the 97533 Sensory Integration CPT code. In general, this is an allowable code and covered by our MACs. However, since we know SI is predominantly used with the pediatric population, if utilizing this code as part of therapy intervention with the adult population, it is important that we use evidence-based practice, research, and have clear supportive documentation to demonstrate that sensory processing/modulation is a cause of functional deficits and that the interventions being billed truly fall within SI intervention strategies.

Here is the Sensory Integration 97533 code descriptor:
This activity focuses on sensory integrative techniques to enhance sensory processing and to promote adaptive responses to environmental demands, with direct one-on-one contact by the qualified professional, each 15 minutes.
From AOTA:
“Occupational performance difficulties due to sensory modulation challenges or poor integration of sensation can result from difficulties in how the nervous system receives, organizes, and uses sensory information from the body and the physical environment for self-regulation, motor planning, and skill development. These problems impact self-concept, emotional regulation, attention, problem solving, behavior control, skill performance, and the capacity to develop and maintain interpersonal relationships. In adults, they may negatively impact the ability to parent, work, or engage in home management, social, and leisure activities.”
From the AOTA article: Sensory Integration Use with Elders with Advanced Dementia
“Research of current approaches in treating older adults with dementia to decrease negative symptoms and increase quality of life, revealed the trend of using a multi-sensory protocol designed for this population (Chitsey, Haight, & Jones, 2002; Knight, Adkison, & Kovach, 2010; Kverno et al., 2009; Lape, 2009; Letts et al., 2011; Padilla, 2011). Kverno et al. (2009) noted in their literature review of non-pharmacological treatment of individuals with dementia that “individuals with advanced levels of dementia benefited to a greater extent from nonverbal patterned multisensory stimulation” (p. 840). Multisensory stimulation incorporates the use of tactile, visual, auditory, olfactory, and gustatory sensory pathways, along with movement, to help the individual interpret his or her environment (Lape, 2009).”
The occupational therapy evaluation and treatment plan is designed to “structure, modify, or adapt the environment and to enhance and support performance” (American Occupational Therapy Association, 2015, p. 6913410050p1), in order to re-engage patients.

Adding sensory integration as a treatment approach starts with assessing any comfort or discomfort when a patient is participating in: ADLs (grooming, dressing, bathing, etc.); Meals; Upper extremity movement; Functional transfers; Seating and positioning.
Goals can be developed around any identified areas of discomfort by creating situations to increase episodes of comfort with those tasks.

What do the MACs say? Here is the language from the Novitas as an example:
Sensory Integration 97533
This activity focuses on sensory integrative techniques to enhance sensory processing and to promote adaptive responses to environmental demands, with direct one-on-one contact by the qualified professional, each 15 minutes.

The patient must have the capacity to learn from instructions. Utilization of sensory integrative techniques should be infrequent for Medicare patients.

For more resources, documents, and tools to help provide information to you and your staff, please see the Sensory Integration section under Therapy > Clinical Programming on the Portal.

By John Patrick Diaz, DPT, DOR, Magnolia Post Acute Care, El Cajon, CA
We all know that the mental health of our residents has been directly (through a specific medical condition) or indirectly (via communal isolation or psychological stresses) affected by this pandemic. Any type of interaction, whether it be through Facetime, window visits, regular phone calls, or even texting our loved ones, makes a huge difference in getting them through their day.

As part of Celebration and Loving One Another, Caitlin Dablow, SLP, and Jacalyn Leigh, COTA, guided a group of local community kids in creating Valentine’s Day cards for our residents at Magnolia Post Acute. The parents of the kids were so supportive in getting them together and designing simple but meaningful cards.

The cards were distributed to each resident with the assistance of our kitchen staff during their lunch meal. As each resident read their card, it was such a great sight to see that everyone had a smile on their faces while others became teary-eyed. Everyone appreciated the gesture knowing that the community cares. We may not be able to celebrate together as a group, but we for sure have felt the love and positive vibes within the facility.

Submitted by Shelby Donahoo, Therapy Resource, Tucson, AZ
When Sara Mohr, CFY at Sabino Canyon in Tucson, Arizona, was a SLP graduate student at the University of Arizona, the reality for those on modified diets became clear. Often a diagnosis of dysphagia brings confusion and worry. Getting modified diets right seems obvious, but actually can be quite hard. Options seemed few: mashed potatoes, blended meat and yogurt. She found few resources out there for patients in terms of appealing and tasty recipes with easy instructions for cooking and modifying.

She and her colleague, Louisa Williams, had an idea. What if they created a food blog to improve accessibility to quality information on modified diets?

So they established realmealsmodified.com and began creating recipes and posting foods that meet texture requirements of the International Dysphagia Diet Standardization Initiative (IDDSI) while looking appetizing and tasting flavorful!

Sara says her goal with modified diet recipes is that “it should be good enough to bring to a potluck, share with the group, and not be embarrassed.” They do the cooking, test the recipes in various consistencies, and essentially take the guesswork out of modified diets.
If a recipe doesn’t work well modified, they don’t post it. Last year, Sara was working on a potato salad recipe using cauliflower (potatoes would just end up mashed) but reported it was “too soupy, too vinegary.” She’s recently perfected it and it will post the recipe soon.
Recipes include items such as Chicken Pot Pie Puree, Sopa Azteca, Chocolate Chip Banana Bread, Minced Pancakes and Salmon! Portions can be made for individuals or the whole family.

Sara and Louisa are planning a “puree road trip” this summer, with the goal of finding options for those on modified diets to eat when traveling.

What a great resource for our SLPs to share with clients and families!

By Razan Malkawi, M.S., CF-SLP, Rose Villa Healthcare Center, Bellflower, CA
Research indicates a clear link between oral hygiene and the overall health of patients. Poor oral hygiene can contribute to new arising medical conditions, and it may worsen the existing disease and interfere with the outcomes of treatment. Continuous education and awareness in oral hygiene are essential in our facility. We hold weekly, if not daily, in-services to discuss preventative measures collaboratively. Members of the interdisciplinary team, including but not limited to the speech therapist, occupational and physical therapists, CNAs, nurses, and the administrators, are all involved in providing evidence-based resources to assure a high quality of life for our patients here at Rose Villa Healthcare Center.

Causes of poor oral hygiene may be related to genetic, developmental and environmental factors. Most of our patients receive medications that may have side effects. For example, Xerostomia (i.e., extremely dry mouth) is a common problem that contributes to poor oral hygiene; causes include drugs, smoking, radiation therapy, diabetes Mellitus, etc. (Kapoor et al., 2014). Our role is to assist with and provide instructions and education regarding the different mouth care approaches for our patients. Mouth cleaning and care, including brushing teeth, mouth wash, and the use of sponge sticks, are all vital behaviors to prevent the existing disease’s escalation and the emergence of new ones. A speech therapist often works with patients who suffer from swallowing problems (i.e., dysphagia), as swallowing dysfunction may cause the entry of food or drink particles into the airways, and bacteria from the mouth may reach the patient’s lungs and cause aspiration pneumonia (Shun-Te HUANG, 2020). Safe swallowing strategies like posture adjustment, proper oral care, and motor-exercises contribute to treating dysphagia and reduce the prevalence of aspiration pneumonia (Shun-Te HUANG, 2020).

In a recent in-service, we discussed the necessity of providing oral care to NPO patients as a preventative measure. Education in this area is essential; one may think that if patients do not eat or drink, mouth cleaning is not a priority! Well, this is not true; NPO patients are at risk for infections, aspiration pneumonia, Xerostomia, and dehydration if oral care is neglected (Liddle, 2014). The state of NPO, along with the presence of dysphagia, may cause aspiration or pulmonary pneumonia if appropriate oral hygiene regimens are not in place. The patient may still aspirate on his/her own saliva; commonly, such incidences occur at nighttime when HOB (i.e., head of bed) is minimally elevated. As healthcare providers, let us all take the initiative to provide our patients with the highest quality of life by spreading awareness.

Refer to our SLP Dehydration Risk Free Water Protocol, for additional information including an Oral Health Assessment Tool (OHAT) for non-dental professionals.

By Cory Robertson, Therapy Resource, Idaho

Temple View Transitional Care Center in Rexburg, Idaho, Therapy led by Susie Swetter, DPT, DOR, joined the organization in the fall of 2019 during the transition from PPS to PDPM. One area in particular they have been focused on is improving their Self-Care GG scores. The challenge to improve was brought to the team, and their new OT, Neil Marion, stepped up to own it.

The team met to review their GG scores and their coding process. Neil looked at the metrics and said, “I want Temple View to lead the market in the self-care increase score.” At the time, Temple View was behind several other buildings in the Market in self-care. However, within several weeks of continued improvement in self-care scores, Temple View grabbed the top spot in percentage improvement in self-care scores for the ID/NV market.

When asked how Neil did it, his response to getting the top spot was amazing:

“Thanks for all the congratulations! I appreciate that, and when Susie asked me to respond about what I did to increase self-care scores, I simply said, ‘I’m just doing my job as an OT. Don’t hide your skills as an OT or COTA; we can offer so much to the people we care for, from the core self-care tasks with adaptations or full restoration of their skills, positioning in bed or w/c, home assessments, splinting/orthotics, neuro-rehab, cognitive rehab as it relates to ADLs, IADLs, fine/gross motor training, power w/c assessment, and strengthening of the specific muscles to increase independence and so much more! Don’t lose who you are as an OT; that identity is important … what makes us different than PT or ST? My answer: so, so much, and it’s our job to proudly proclaim who we are and show our facilities what we can do.”

Thank you, Team Temple View and Neil, for your ownership of this important measure and ensuring your patients get the very best care!

By Kathey Perez, Therapy Resource – Keystone South Central, TX

Outpatient On Demand is a great way to look at ways to expand our delivery of outpatient services. Many of our patients are afraid to leave their home due to the pandemic, or can’t leave due to transportation issues, or maybe they are fearful to leave our facilities worried about failure when they go home. Outpatient on Demand helps us overcome some of these concerns while meeting the needs of our community. We can help those that may not be homebound by home health standards but have a need for services, and help the successful transition of patients back into their home by being able to provide education and training in the area they need to thrive. Once the patient is able to come to our facility, we can transition them to Outpatient at the facility as well. Patient identification should start with care planning upon admission to our facility. We can also identify them by doing home evaluations prior to discharge.

Home eval prior to discharge:
• What allows us to provide therapy in the home?
o Medicare specifies four locations from which a provider can provide outpatient physical therapy. Medicare Part B pays for outpatient physical therapy services when furnished by: a provider to its outpatients in the patient’s home; in the facility’s outpatient department; to inpatients of other institutions

• What is it and Why Now?
o Therapy services (PT, OT, ST) offered that meet the patients where they’re at, focusing on what matters most, being able to function in their actual home/community environment.
o COVID related shutdown, limitations, and resident declines created a shortage of therapy and a need more than ever

• What differentiates this from Home Health Services?
o Residents are not required to be certified as home-bound to participate in our services. On average, we are able to provide MORE therapy than is typically seen in HH settings. Maintenance programs are a big part of our outpatient programs

Submitted by Esther Allmond, DOR, The Cove at La Jolla, CA

The Cove volunteered to be a pilot site and is now entering their 3rd month for the EPIC program: CODE SEPSIS. Dr. Pouya Afshar handpicked our facility to trial this pilot program to help prevent sepsis in-house by carefully monitoring vitals throughout the day. Throughout this time, we have gained a new appreciation and respect for taking vitals before, during and after therapy treatment sessions. Rehab has taken a more active role in vital signs at The Cove, and I just wanted to share with all of you a little bit more about EPIC, CODE SEPSIS, and our current protocol at our facility.

EPIC (Excellence in Programming and IDT Care): Programs dedicated to taking IDT action with a QAPI approach in order to provide the most excellent care possible for our patients.

CODE SEPSIS MISSION: Early identification of sepsis to improve patient outcomes.

WHY: Sepsis is the leading cause of readmissions to the hospital in 2019 (20% of Medicare readmission!). With every hour that treatment is delayed for sepsis, the mortality rate increases by 8%.

CODE SEPSIS PROTOCOL: Taking vital signs early and often for each of Dr. Afshar’s patients. Nurses take vital signs Q shift (or more often). and therapists take vital signs before each treatment session and enter it into PCC. Notify charge nurse immediately with any one of the following triggers:
1. Temp > 99.5F
2. SBP < 100
3. HR > 90

CODE ACTIVATION/METRICS:
• Clinician identifies patient meeting criteria (initiation, time stamp)
• Notify charge nurse (5 minutes)
• Verify/repeat vitals (5 minutes)
• Nurse activates code (5 minutes)
• Code team clinician contacts on call MD/NP (5 minutes)
• Response back from on call MD/NP (10 minutes)
• Total time spent: 30 minutes
• Reassess at the end of each 30-day cycle
• Duration of phase 1: 90 days

CODE SEPSIS was triggered several times in the past two months, allowing us to implement interventions in a timely manner and preventing re-hospitalization for our patients! As we close the last 30 days of Phase 1, we hope to remain consistent and vigilant in monitoring vital signs for our patients, providing the most EXCELLENT care possible for patients and improving outcomes. Please feel free to reach out to me at any time if you have any questions, comments, feedback, or interest in implementing CODE SEPSIS at your own facilities!

Carl Meyer, PT
Marquette University, Milwaukee, WI — Grad Date: 05/08/2021
In the midst of the current health crisis and social justice demonstrations, I see a world needing communities to be filled with sparks, small bright lights that the darkness cannot overcome. Indeed, as I examine my own education, talents, and abilities, I know that it is not just an opportunity, but my responsibility to step into my community as this light, and I write this encouraged, knowing that I have been equipped by those who have come before me to be that exact spark in the community I call home.

As a physical therapy student at Marquette University, my work at the local Milwaukee Rescue Mission as the Sports and Recreation Coordinator has been a foundational piece of my education. My time at the Mission has opened my eyes to the health disparities in the inner city of Milwaukee; particularly among young African-American men and in the communities they call home. The first time I drove one of my high school students to his home in north Milwaukee, I encouraged him to get his ankle examined, as he had badly sprained it that day at our Youth Center. Laughing, and shaking his head, he told me that he’d never been to the doctor before, and he wouldn’t even know where to find one. As I watched him limp to his door, the reality of Milwaukee’s environment settled in and my passion was sparked, leading me to choose a career in the medical sciences to reduce health disparities in the impoverished communities of Milwaukee.

My passion for impoverished communities and my calling to these areas of need started long before Milwaukee. Growing up in Albuquerque, New Mexico, I was a minority in the diverse and ethnic landscape of New Mexico, often witnessing the hardships of my classmates, and the health disparities experienced by Native American and underserved classmates from the reservations and poor communities of the southwest. These childhood experiences became the foundation of my mission to serve the poor by reducing health disparities, and led me to Colorado State University.

In my time at Colorado State, I was able to experience leadership as an Intern for the Office of Admissions, as an Academic Success Coordinator for the Department of Health and Exercise Science, and as a Resident Assistant. Most importantly, however, was my undergraduate thesis, which was titled “Project Play: A Mission to Study and Improve Areas of Need for Health and Wellness in Homeless and Underserved Youth Populations.” My work was written after spending a semester working with youth at the Matthew’s House, an organization that provided programming for homeless and immigrant families in northern Colorado. If my foundation was forged in New Mexico, my vision was truly carved during my time in Colorado. After graduating as a cum laude Honors student with Dean’s List distinction, and
with the Myron Ludlow Brown and Eddie Hanna Awards, my experience at the Matthew’s House led me directly to Milwaukee, and into the ZIP code with the highest rate of incarceration for men in the nation.

At the Milwaukee Rescue Mission, I provide exercise and leadership programming for homeless youth at the Mission, as well as for local students. I have frequently witnessed the impact of health education on the outcomes of the inner city youth that I work with, and this service has given me the vision of how to use my education to be a part of the outreach in Milwaukee, with an emphasis on communities with health disparities due to socio-economic divisions. I was able to start a local mentorship program for area youth at the Mission, and as my education has progressed, my vision of how to make this goal a reality beyond graduation has coalesced. I see an incredible opportunity for physical therapy to provide low-income healthcare, at clinics with high accessibility, leading to the training that can make
community mentorship a reality.

My first year at Marquette only enhanced my awareness of these disparities through my work as a Student Physical Therapist at Marquette’s Pro Bono Clinic for the uninsured. Like the Mission, I have seen the hard realities of limited access to healthcare, including one gentleman who visited our clinic after suffering from crippling pain for years and came to our clinic as a last resort. Bringing access and resources to communities that lack both has the power to drastically improve quality of life, making the reduction of health disparities not simply an opportunity, but a matter of justice. As a service-oriented University, I found further opportunity at Marquette to practice leadership by being elected Vice President of my class, and as a WPTA Emerging Leader Nominee.

Given my experiences, without the traditional corporate limitations of healthcare, I truly believe that physical therapy can reduce health disparities in a unique and practical way. My vision is to supplement my clinical practice with an initiative called The Friday Project, a project crafted during my time at the Rescue Mission. Supplementing normal clinical income with grants, those physical therapists partnered with the initiative would be able to offer community health screens every Friday, along with youth mentorship activities, including job shadowing for local students and scholarship assistance. As experts in musculoskeletal conditions among a population in which millions suffer from chronic pain, I believe we carry the education to refer high need patients, and to economically help and treat all others, bringing equity to the communities that need it most. As doctors face increased demands on their time, in which patients get less and less time, physical therapy offers the opportunity to partner healthcare with the mentorship needed to truly treat the disparities we see in the clinic.

My connections to Marquette and the communities of Milwaukee have given me the passion and platform to increase healthcare access for those who are underserved, and this is why I am applying for the SPARC scholarship from Ensign Therapy. From my experiences, my hope is that you can see my desire to use any financial assistance with the gratitude and humility worthy of such generosity. While such generosity is not intended for repayment, if I am selected, you can be sure I would pay it forward. For this reason, I believe I would make an excellent candidate for your scholarship program, as my vision and action to reduce health disparities in the Milwaukee community are already being enacted in my education as a physical therapy student at Marquette University, and as I actively live out service
in the Pro Bono Clinic and at the Milwaukee Rescue Mission.

In this way, I do not have the opportunity, but rather the responsibility to use my education to be a spark for the communities of Milwaukee. This is why I chose my profession. It gives me the chance to be a light in the community I call my own. My passion for leadership and service centers on my belief in the power of education to help those who need it most, and my learning has been supported and guided by the power of a calling found and a goal pursued. This is the legacy and strength of the many leaders who have come before me, and they continue to teach me how to translate potential into selflessness Indeed, it is the first spark that brings the light.

“If I have been able to see further, it is because I have stood on the shoulders of giants.” ~ Isaac Newton