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For patients with excessive pannus, whereby the skin on the lower abdomen hangs down due to rapid weight loss, there are multiple complications that can arise. The condition increases the risk for excessive external hip rotation contracture, skin breakdown due to trapped moisture and decreased lower-extremity strength and range of motion.

Patients with no medical complications might choose to have the excess skin surgically removed. However, for some patients, such as Patient G.D. at Wellington Place Living & Rehab, surgery is not an option and we must find alternative treatments.

G.D. is an older woman who had lost a significant amount of weight, resulting in a pannus that would sit in between her legs. She was scheduled to have surgery to have the pannus removed, but due to some co-morbidities, she was unable to proceed with the surgical procedure. The patient’s health declined, and she was no longer able to transfer herself. That’s when she joined us at Wellington.

We initially used a sheet to address G.D.’s pannus complications, which included rashes and candidiasis, but the sheet was quite cumbersome, and the patient was unable to self-release from it quickly. The sheet also made G.D. overly warm, thus increasing the moisture to her perennial area and the top of her thighs.

Next, we tried a wheelchair security belt with a padded area meant for the stomach. We secured the belt to her bed rails with cable ties, which we then used as positioning devices for bed mobility. The quick-release button made it easy for G.D. to release from the belt, and the padded belt was smaller, cooler and more comfortable for her.

By consulting with our PM&R physician, DOR, Physical Therapy and Nursing, we created a treatment plan for G.D. that addressed her various needs. As a result of our collaborative efforts, G.D. is now able to complete a HEP to maintain strength and range of motion in both lower extremities. She also has increased leg adduction, is able to keep neutral hip positioning while at rest in her bed, and is no longer experiencing rashes or discomfort due to excess moisture. Most importantly, G.D. is happier and healthier now that we’ve found a solution that works for her particular needs.

Reprinted with permission from the Paris News, Paris, Texas, published April 13, 2014
By Lauren Corbell

Visitors walking through the doors of Stillhouse Nursing and Rehabilitation immediately notice there is something different about the facility. However, it isn’t the technology that makes Stillhouse different from other similar rehabilitation centers. It’s the people.

“Our equipment isn’t different from anybody else’s, though we’re planning to purchase some innovative equipment soon,” said Deb Lookingbill, occupational therapist and director of rehabilitation. “The difference is our team and our mindset. We truly care about patients’ wellbeing. We’re in it to get them well.”

Selina Louis, assistant director of nursing, agreed.

“We have a different way of thinking here and a different approach to care,” she said.

Two physical therapists, two therapist assistants, one occupational therapist, two occupational therapist assistants and a speech therapist comprise the cheerful rehabilitation team.

Physical therapist April Boles, left, and speech pathologist Brittany Brown, right, assist Ruth Morris as she slides rings across a shoulder arc that improves shoulder motion.

“All together, we have 70 years of experience,” Lookingbill said. “Some of our team members have worked together for 12 years, others for six. We are a family.”

Mike Reese, operations manager, tributes part of the facility’s success to the CAPLICO mission the employees follow.

“The C stands for ‘customer second,’” Reese said. “That sounds strange to people, but it emphasizes our belief that our employees’ skills and training allow us to provide the highest level of care.”

Each of the points in the code — accountability, passion, love one another, intelligent risk-taking, celebrate and ownership — contribute to the upbeat, family-like atmosphere that, employees said, helps patients recover quickly.

And, it seems to work.

Each of the staff members interviewed told of success stories. One woman came in on a stretcher having been told she would never walk again. Two months later, she was released, and recently she walked through the front doors to visit and say hello. Another woman had broken her hip three times, and each time, she chose to go back to Stillhouse for rehabilitation.

“It’s a testament to the service here,” Reese said. “There are plenty of options in the area, but our patients decide to come back to us.”

Patient Dr. Geoffrey Grubb said he had a stroke 17 years ago followed by another small one in December. After two months at the center, he was preparing to go home.

“I’m in better shape now than I was before the stroke,” said Grubb, who had already made arrangements to teach a Sunday school class at First United Methodist Church following his release.

Another patient, Michael Dollins, told how he had come to the facility unable to stand or walk, using a feeding tube and weighing 500 pounds. He now weighs 320 pounds and is able not just to take care of himself, but he also volunteers to help around the center, making coffee, washing dishes and folding towels. Employees gave him a staff shirt, which he wears with pride.

In his honorary staff shirt, patient Michael Dollins, front left, stands with the physical therapy team, including, front from left, Deb Lookingbill, Brittany Brown and Cara Duncan; back, Ruth Moseley, April Boles and Karina Smith.

“The patient has to put their effort into it,” Dollins said of physical therapy. “Everyone has to work together to make therapy and rehabilitation work. It takes encouragement to do your best.”

When patients are not in physical therapy sessions, the staff provides a number of activities to keep spirits high, including outings to antique car shows, restaurants and movies.

Cari Johnson, director of marketing, said one of the most popular events at the center is when the Good Ole Boys perform, which usually brings 50-60 people from the community to the facility to listen and dance.

Church services and Bible study are also available, along with a beauty shop and menu choices that include homemade dishes.

“We also emphasize communication,” Johnson said. “We give out our cell phone numbers, so there is always someone to contact 24/7.”

“We plan to continue to grow and improve,” said Reese. “We try to be the best resource for information on insurance, while providing emotional and educational support for patients and being a fun place for employees to work.”

Members of the Stillhouse Nursing and Rehabilitation staff are, front row, from left, Lisa Sillivan, Deb Spencer, Jennifer Thornton, Deb Lookingbill, Glenda Neisler, Connie Musick and Selina Lewis; back row, Rhonda Sisson, Danica Simmons, John Brazile, Michael Reese, Cari Fortenberry, Rocky Watley and Cari Johnson. Not pictured are LeAlandra Chandler and Charlotte Winton.

April is Occupational Therapy Month, providing a perfect opportunity to address the question on the mind of anyone who is unfamiliar with the profession: What does an occupational therapist do? AOTA provides consumers and healthcare professionals with this explanation: “OT is a profession that helps people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities. OT’s holistic and customized approach to evaluations, interventions, and outcomes help a child with disabilities participate in school and in social situations, assist a person recovering from injuries to regain skills, aid an older adult to stay as independent as possible, and offer the specialized support and services to people of all ages and in all circumstances that only occupational therapy can provide” (AOTA, April).

One OT in Colorado decided that OT month was a great time to help her coworkers, patients and family understand just what an OT does and how she can help them. Hannah Stillings, OTR, has been an OT for a little over a year and with Ensign at Littleton Care and Rehab for about six months. Hannah put together a plan throughout the month to spread awareness of OT. She began by hanging posters and articles in the gym and the main entrance explaining OT’s role in skilled nursing facilities. She brought cupcakes to her coworkers with “OT” on them. She spoke with staff, describing her role in the facility and how she could support her team members. Finally, the rehab team organized a facility-wide OT potluck in the gym area where everyone could view the posters and articles. Thanks to Hannah, the team members at Littleton Care and Rehab now appreciate the unique role of OT in their setting.

Are you interested in promoting and celebrating OT Month next year? The AOTA has lots of ideas for you! Click below for 10 simple ways to spread awareness at your facility and in your community:

Ten Things You Can Do To Celebrate Occupational Therapy Month

We Are Going Good to Great!

“We Are All in This Together”

Our Willow Bend Rehab team is, in my opinion, the best of the best. Currently on full-time staff, we have seven in the PT department, six in the OT department, two in the ST department, one Floor Tech/Wellness Tech, 1.5 Administrative Techs/Wellness and one Home Health and Outpatient Coordinator. We all work together for the benefit of our patients.

Current Services/Programs:

The Willow Bend Rehabilitation department provides a variety of unique services that are made available to our patients. Current services provided include outpatient, home health, skilled therapy, rapid recovery, long-term care (LTC) and wellness services.

The wellness program was designed for several purposes to keep our LTC residents at their most optimal level, to reduce falls, to have declines of our LTC noted more quickly, and to provide customer service by enhancing our patients’ rehabilitation experience.

• Phase 1: Wellness Classes, meeting twice a week to work on improving functional mobility skills such as gardening, playing cards, Wii games, etc. It is usually attended by our Rapid Recovery patients.
• Phase 2: Contracture management. After receiving training for our therapists, the Wellness techs oversee the application of all devices by training CNA floor staff and monitoring applications daily under the supervision of our licensed therapists.
• Phase 3: Walking program used for our LTC residents and our rapid recovery residents. After receiving training from the PT, the techs are able to walk with residents one time, five times a week.

Our outpatient services are offered to patients who may have completed their episode of care at the facility but are still in need of skilled therapy services as well as community referrals. This program works to continue the plan of care set up while the patient was at WBNR in an effort to maintain the patient’s current level of function while always striving to meet the patient’s highest potential for success.

We have worked diligently to implement our Home Health program. We started from scratch by signing contracts to developing protocols for treatment and billing purposes. The goal is to provide a continuum of care from the moment a patient admits to WB skilled services, to home health, to outpatient. We signed one contract in July 2013 and recently signed another in September 2013, allowing us to utilize two different vendors in an effort to reach as many community members as possible.

Upcoming Services:

We strive to meet the needs of each and every one of our patients. There are several upcoming programs that are being developed in an effort to reach patient-specific populations. The first upcoming service is the outpatient balance program, which will consist of evaluating core stability; the vestibular system; sensation; and developing a patient-specific treatment program to address balance exercises and activities designed to increase muscle strength, improve sitting and standing balance, and improve overall functional mobility in order to enhance each patient’s quality of life and reduce his or her risk for falls.

A second upcoming program is the Cardiac Wellness program, which will consist of continuous assessment of the patient’s vitals throughout each therapy session, as well as specific exercises that focus on improving endurance and activity tolerance in order for the patient to achieve his or her prior level of function. A standardized test by OT/PT will be administered weekly. Education on cardiac precautions, nutrition and energy conservation will be provided.

What Sets Us Apart?

There are several factors that set us apart from others, including the extensive list of unique programs and services provided to patients at this facility as well as in their own homes. We have a team of compassionate and skilled therapists with a combined 160 years of experience. Our program officers help develop and implement new protocols that range from staff spirit to compliance with documentation. Together, we can accomplish anything! “We Are All In This Together!”

By Anna Boone, DOR, and Kelsey Hendrix, PTA Student, Willow Bend Nursing and Rehabilitation, Mesquite, TX