HCR OLATHE IS ROCK STEADY EXCITED!!!!

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Pictured L to R: Jill Casey Weyer – COTA, Valerie Briggs – OT, Nik Kalinichenko – PTA

I wanted to officially introduce our newest Kansas Rock Steady Boxing Coaches (see photos)! They have had their new titles for one week and had 5 calls for patients ready to start the program. We are super excited for what’s to come! Pictured: Jill Casey Weyer – COTA, Valerie Briggs – OT, Nik Kalinichenko – PTA

Rock Steady Boxing (RSB), a 501(c)3 nonprofit organization founded in 2006, gives people with Parkinson’s disease (PD) hope by improving their quality of life through a non-contact, boxing-inspired fitness curriculum. RSB’s mission is to empower people to “fight back” against Parkinson’s disease and enriches both individuals and the community by improving the wellness of older adults.

RSB is the only organization in the world well-positioned with an effective, replicable model to address the quality of life needs of men and women dealing with Parkinson’s disease today. Bring RSB and hope to your community by becoming an affiliate of Rock Steady Boxing.

As an affiliate of Rock Steady Boxing you will have the benefit of brand marketing, training support, website presence, startup materials and online certification training. Read More…RSB Benefits of Affiliation

By Jordynn Knipp, DOR, The Healthcare Resort of Olathe, Olathe, KS

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Stop Managing Incontinence. Start Treating It! Here’s How…

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By Jon Anderson, Senior Therapy Resource – Texas

If you or a loved one has bladder control issues, you’re not alone. Millions of people in senior living facilities are in the same situation. In fact, more than 70 percent of long-term care residents are not in complete control of their urinary bladder function.

Bladder control problems, such as overactive bladder (OAB), are not a normal part of aging. OAB is not something one has to accept. OAB can limit social life, making it harder to share meals, play cards and stay active in the community. There are also serious health risks associated with this condition, from urinary tract infections and poor sleep to skin problems and falls. OAB is a treatable condition and can be treated in the long-term care facility by a physical therapist.

What Is OAB? OAB is a common condition that prevents you from controlling when and how much you urinate. People living with OAB may experience any of the following:

  • Urgency — the sudden sensation of needing to use the bathroom
  • Frequency — using the bathroom more than eight times per day
  • Urge incontinence — unexpected small or large leaks

Physical therapy can treat OAB through utilization of Medtronic NURO system. How does this therapy work? Medtronic Bladder Control Therapy delivered by Medtronic NURO system restores bladder function by stimulating the tibial nerve through an acupuncture-like needle placed near the ankle.

The therapy is delivered during a 30-minute session, once a week for 12 weeks, by a licensed physical therapist and is covered by Medicare and most insurance providers. This therapy is proven to significantly improve the symptoms of OAB, reducing urgency, frequency and daily urge incontinence episodes. Several recent studies have shown the therapy to decrease OAB type symptoms by 40 percent. At Ensign Affiliates, we are currently piloting this therapy at Legend Oaks San Antonio West and are looking to expand the pilot in the coming months. The most common side effects of PTNM are temporary and include mild pain and skin inflammation at or near the stimulation site. Rest assured, the stimulation is gentle on the patient. It is not painful, although your patient may feel a slight tingling in their heel or the base of their foot. For full prescribing information, see professional.medtronic.com/NURO.

Six Simple Steps to Launch a Successful Heart Math Program

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By Jen Farley, Therapy Resource & DOR, Sea Cliff Health Care Center, Huntington Beach, CA

At Sea Cliff Health Care Center, the therapy team actively incorporates Heart Math techniques into daily treatments. Heart Math is a highly effective, multifaceted program that has had a positive impact on the majority of our patient population. Self-regulation is recognized as a key factor to assist in recovering from illness and improve functional performance. Listed below are the six steps used to implement the Heart Math system.

Step One: Get Trained

Contact Mary Spaeder or your local Resource to plan for a hands-on training experience. Generally, the train

Kristi Rosales, PTA, will be the team lead for the HeartMath program at Sea Cliff

ing is completed in an hour. Invite IDT members, EDs, cluster partners and marketers to a Lunch & Learn training. IDT member education highlights the benefits of Heart Math programming. Additional training provided by Dr. Timothy P. Culbert, M.D., is available for advanced certification. Sea Cliff has identified a PTA for completing the certification program and will be recognized as the team lead.

Step Two: Identify Your Target Resident Population

An effective treatment plan includes an evaluation and four to six treatment sessions, 30 to 45 minutes each, within two to four weeks. Collaborate with the resident and the family in setting up a consistent treatment schedule. Sea Cliff has incorporated the emWave Stress relief system with Heart Math techniques. Sea Cliff’s resident population has a broad scope of medical diagnosis. Participating residents have experienced a significant reduction in hypertension, pain, poor sleep, anxiety and depression.

Step Three: Establish Your Treatment Location

A quiet environment is recommended. Sea Cliff consolidated two work offices into one, and the benefit is now a quiet treatment room. Team members collaborated on room design, color and furnishings. Therapists initiated and purchased a pre-owned, low-cost high-low mat. Extra seating is available for family members to attend the treatment sessions.

Step Four: Provide Consistent Follow-Through

Follow-through is both the greatest challenge and the greatest opportunity for therapists as they work to achieve successful treatment outcomes. Scheduling treatment times in a quiet environment enhances the resident’s experience. It is important for the DOR to review the treatment goals and progress. Residents, caregivers and family members appreciate the opportunity to participate.

Step Five: Get Reimbursement

At Sea Cliff, we include billing under Therapeutic Activities or Self Care. For example, charting may include “Heart Variability training to address SOB, fatigue and low endurance to increase activity or ADL tolerance.” Therapists will want to write a specific goal. Documentation should focus on how the use of Heart Math Variability training can increase focus and decrease anxious behaviors to increase safety and participation in self-care and therapeutic activities.

Step Six: Have Fun!

Share your success stories at the Annual Therapy Meeting, the quarterly DOR Meetings and the Monthly Cluster Meetings. Other pathways to highlight this unique program include marketing events, facility tours, IDT care plan meetings and community outreach. When Therapy has fun, everyone has fun!

An IDT Approach to Contracture Management

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We hosted the CE at our Legend West Houston facility. Nursing and rehab must be cohesive to a have a strong contracture management program. I sent an email out to our DONs and they welcomed the idea of including our RNAs. John even provided them with certificates. They loved it.

Thank you to those who were able to make it to the Contracture Management Course on Saturday. We had a great turnout from several of your therapists/assistants as well as your RNAs. The course speakers had an opportunity to visit the Katy and West Houston facilities, the day before the course, and provide face-to-face assistance. Tawaine and Brittany gave very positive reviews and stated that several patients were identified for therapy services that were previously overlooked.

Below, you will find the names and contact information of the speakers. Both are available to provide telemedicine support. What does that mean to you? If you have a patient you are considering for an orthotic and/or you need recommendations on the best splints, they are available by phone or FaceTime to provide guidance. They are also available to assist with verification of orthotics (especially for our managed care part B residents). All you need to do is send them the patient’s face sheet, and they will take care of the rest. Please take advantage of this available resource. We have several patients within our facilities with contractures, and our obligation is to provide the best quality of care available. Special Ensign pricing is available to us.

OCSI: Ongoing Care Solutions, Inc.

John Kenney: 949-702-2828 neuroflexjk@gmail.com

Regan Ponto: 970-978-1284 regancap@msn.com

Submitted by Kai Williams, Therapy Resource, Texas

The Power of Creativity: One OT’s take on the Dementia Care Program

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Beth Brewer, OTR/ADOR at Legend Oaks Katy, is known to most of us by her acquired moniker, MacGyver. What she creates with “a little bit” of duct tape, PVC pipe and pool noodles is magical! So when we decided to make dementia care one of our focal clinical programs, it came as no surprise that she would create something great.

This is when the Dementia Care Activity Box was born. Using guidelines from Teepa Snow’s The Gems®: Brain Change Model, Beth created Dementia Care Activity Boxes based on various dementia characteristics (gems). All facility staff have received an initial in-service/training on the purpose and use of the activity boxes, which are accompanied by a matching resource binder with descriptors for each gem; dialogue cheat sheets to engage residents in eating, bathing and dressing tasks; as well as general information about dementia. In addition to the activity boxes, Beth also recently piloted a four-resident Dementia Feeding Program using red plates and bowls to increase self-feeding and po intake. So far, we’ve seen a 10 percent to 25 percent increase in po intake depending on the resident’s level of dementia.

Our Dementia Care Program is in its infancy stages; however, with “MacGyver” Beth at the helm, I know that our residents are destined for greatness!

Submitted by Tawaine Vigers, DOR, Legend Oaks of Katy, TX

Accountability and Skilled Documentation

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“Employees want to know why they have to produce and deliver services by using certain methods. To be good at holding your staff accountable, you must be good at teaching. Teach about the consequences.” — Crucial Accountability

Did you know that poor documentation quality has a bigger financial impact than productivity does? It’s true! In general, while you save $0.02 for every 1 percent productivity increase, billing minutes pulled out during an audit will have a much greater financial loss:

RUC x 14 days (647.94/day = $9,071.16)

RVC x 14 days ($555.85/day = $7,781.90)

In conclusion, one billing minute removed due to unskilled documentation could result in a $1,289.26 loss.

DOR Role

What is the role of the DOR? We define it as follows:

  • Commit to auditing documentation
  • Set expectations at the interview
  • Give positive feedback as often as constructive feedback
  • Audit evaluations and MD orders to catch errors and monitor trends
  • Initiate a “standardized test” day
  • Include standardized test in “precautions” on POCs, to ensure staff re-test
  • Monitor progress notes to look for trends

UR prep and care plans must:

  • Create effective care plan process
  • Frequently attend care plans to review weekly documentation
  • Prep for UR using the “weekly status report”
  • Ensure therapists are testing goal-related areas and that discharge dates are
  • appropriate
  • Report standardized test scores/ADL score during UR

Teach the Why

In order to hold staff accountable for skilled documentation, it’s important to engage your team in dynamic thinking about the “why” behind what they do. That is, educate them as to why quality documentation is important, as it not only reflects their clinical skill, but also ensures we can be billed for services and therefore has a financial impact. Finally, provide lists of commonly used skilled terms descriptive of therapists’ actions.

MSCA Data

Skilled documentation is a critical part of our systems at Granite Creek Health and Rehabilitation. By implementing training in this area, we saw an improvement in the MSCA therapy score and a decrease in the financial error rate:

By Larissa Osio, DOR, MS OTR/L, Granite Creek Health and Rehabilitation, Prescott, AZ

View full poster here: Accountability and Skilled Documentation -Granite Creek

Oral Hygiene Program

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At Grand Terrace Rehabilitation and Nursing, we have implemented an Oral Hygiene Program with great success for residents. The purpose of the program is multifold:

  • Decrease potential for complications from oral bacteria
  • Increase resident level of independence and dignity
  • Improve quality of life
  • Develop restorative nursing programs and decrease caregiver assistance

Methods

  • Identify appropriate residents (G-tube, dementia, bed-bound, cognitively impaired, high-risk aspiration, etc.)
  • Create individualized oral hygiene box including: toothbrush, toothpaste, cup, mouthwash, oral swab, etc.
  • OT addresses processing, sequencing, grasp, UE strength and coordination, postural control and compensatory training
  • ST addresses oral desensitization, risk of aspiration, oral-motor coordination and strength, oral functions and cognitive abilities
  • Provide daily visual schedule for oral hygiene in restroom for appropriate residents
  • Provide caregiver education to nursing staff and family members
  • Refer to Restorative Nursing Program for carryover

Results

As a result of the program, our residents have gained an improved quality of life and decreased caregiver dependence. We have increased CNA productivity due to residents requiring less assistance, while also decreasing hospitalizations due to medical complications associated with poor oral care. In addition, we have seen increased interdisciplinary team communication.

The oral hygiene program has benefited residents, caregivers, therapy and the facility. Not only have we boosted awareness of the importance of providing good oral care, but we have also enhanced residents’ self-efficacy.

By Grand Terrace Rehabilitation and Nursing, Therapy Department, McAllen, TX

Navigating and Surviving the Managed Care Jungle

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Our skilled population has gradually shifted from traditional Medicare Part A to Managed Care Part A. Therefore, our treatment focus has had to shift as well. We are no longer focusing on progressing to prior level of function, but rather progressing to next level of care.

Methods

With the goal of reducing the length of stay, we determined that we needed to aggressively treat at onset of stay. To jumpstart our therapists and create a routine for the patients, we implemented the following days:

  • Training Tuesday — We schedule patient families to come in on Tuesdays, and we provide training on transfers, functional ADLs and HEP.
  • Working Wednesdays — On this day, we focus on all of the household tasks that patients require as they return home. We have patients sweep, mop, cook and clean the kitchen, dust, do laundry and simulate vacuuming. We have them “shop” at our stocked pantry for grocery store management.
  • Functional Fridays — The focus on this day is all functional tasks, such as bathing/toileting, car transfers, tub transfers, dressing and fall recovery.

Results

Since the implementation of our protocol, the length of stay has decreased on our managed care from 18.4 days to 15.6 days. Reviewing the length of stay of our Medicare A patients, it has dropped from 30 days to 27.9 days. During the course of review, which was a six-month period, we had 196 Managed Care patients and 58 Medicare A patients.

Conclusion

Our goals include the following:

  1. Manage the length of stay while obtaining better outcomes. Goal effective May 2017 is less than 14 days length of stay regardless of payer sources.
  2. Finish development of the theme for Monday and Thursday. Manic Monday will be a crossfit-based day, and Relaxation Thursday will be leisure activities to promote a more active lifestyle.
  3. With the measures in place, we will have increased customer satisfaction of both the MCO and the patient.
  4. Utilize our preferred status with the Managed Cares to convert our discharging patients to become outpatients to better serve our community.

By Andy Cisneros, PTA, Therapy Program Manager, Legend Oaks, West San Antonio, TX

ADL Billing Versus Self CARE Item Set Change

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At Mountain View Care Center, we questioned whether there is a correlation between the amount of activities of daily living (ADLs) the occupational therapy staff has been providing to patients with changes in their’ functional level upon discharge. We chose to compare this by analyzing the percentage of ADLs billed in the facility with the change in CARE item set from admission to discharge.

Methods

We gathered Optima reports from all Bandera facilities to determine service code usage of self CARE ADLs (97535) as a percentage of total billable services for a three-month time period. Functional Outcomes report containing the change in OT Self CARE item assessment was obtained for the same three-month time period. These two reports were analyzed to determine if there was a correlation between the two sets of data.

Results

The amount of billing of 97350 seemed to equate with the amount of change in CARE. However, upon closer statistical analysis, this was not found to be the case. There was no correlation found between use of ADL billing code (97535) and improvement in CARE item set. Billing of the code 97110 had a negative correlation with the improvement in ADL scores.

Data

  1. CARE item set and billing of ADL (97535) code
  2. Correlation between usage of billing codes and change in CARE item set

 

 

 

 

 

 

 

Conclusion

We concluded the following:

  1. The overuse of therapeutic exercise in OT treatment plans has a negative impact on patients’ improvement in functional levels.
  2. Occupational therapy should minimize treatments that involve purely therapeutic exercise in their daily treatment sessions.
  3. It would be more beneficial for the patients to address strength deficits through the use of ADLs and therapeutic activities than using upper body ergometry or tabletop activities.

In the future, we’d like to further our analysis by performing a study using a change in ADL levels instead of CARE to decrease concerns about CARE not being an accurate measure of improvement. Furthermore, after educating the staff on the increased use of ADLS as a modality, we’d like to perform the same analysis to determine if there was an increase in CARE item assessment as a result of increased ADL usage.

By Tonya Haynes, PT, DOR, Mountain View Care Center, Tucson, AZ