Share

The strength of a team can truly be powerful when everyone sees and feels the vision. Employee culture and retention has been at the top of the initiative list. How can we improve this area and create an environment that truly embodies Customer Second? Well let me introduce you to the M.E. committee. I spent time with one of the M.E. committee members, Loretta Johnson, PTA, to get a better understanding of what this committee has to offer.

As explained by Loretta, the Copperfield Healthcare and Rehab facility created the M.E. Committee (Motivating Employees), with a purpose to engage, support and reward their fellow coworkers. They have designed and cultivated strategies to build interpersonal skills, through exciting team-building exercises. This level of cultural promotion encourages open communication, challenges employees with friendly competition, and assists with facilitating a healthy work-life balance.

The M.E. committee has put together a calendar of events that caters to employee engagement. As Loretta put it, “An employee who enjoys coming to work is a worthy investment, and a good day at work fuels the desire to be better the next day. This feeling of happiness at work will spill over into the love and care that we provide to our patients.”

Most recently, the M.E. committee hosted a Coloring Contest. All employees were asked to color a picture of a butterfly. Each butterfly was judged by the panel of patients, employees and visitors. The grand prize winner received a beautiful, laundry-themed gift basket. Other events included: Chili Cook-Off, World Water Day, and National Laugh Day. The time spent together is intentional, and it has allowed new-hires to comfortably blend in with the team.

The Copperfield Healthcare and Rehabilitation facility leadership team includes:
Noni Gill, ED; Unnati Patel, DON; Shayla Goode, M.Ed CCC-SLP

Submitted by Kai Williams, Therapy Resource, Keystone-East

The Rehab team at McCall Rehab and Care Center in McCall, Idaho, has had a vision of providing community-based outpatient therapy in people’s homes since the facility became part of the Pennant-ID/NV market in 2018.

McCall’s DOR, Jenny Sowers, DPT, couldn’t ever seem to find the consistent time to grow an outpatient program, so she decided she should find a therapist willing to take on that challenge. In September of 2020, Jenny hired Ellie Toscan, DPT, with the goal of Ellie building their Community-Based Outpatient program.

Ellie has shown tremendous ownership of the program, from marketing to clinical to financial. She independently tracks the financials weekly and monthly to ensure the program is financially viable. Executive Director Kurt Holm’s main goal for the program is to build relationships and reputation in the community. A recent admission gives clear indication that Kurt’s goal is being realized. Ellie was working with a patient in her home. She had a change of condition, went to the hospital, and was referred to McCall Rehab. Because of the relationship that Ellie built with this patient, she readily agreed to the discharge plan. The patient is now receiving skilled therapy and nursing services in our facility. Thanks Ellie for this great example of the power of our core value of ownership!

If you are looking to grow your community based outpatient program, please consult your therapy resource or Deb Bielek for regulatory help specific to your state.

Submitted by Dominic DeLaquil, Therapy Resource, Idaho/Nevada

Submitted by Stephanie Argyle, COTA and Kyle Fairchild, OTR, ADOR

Whether a patient comes to St. Joseph Villa for a rehab stay due to a fall, a recent injury, a surgical procedure or other medical conditions, we aim to include each individual in our discharge planning group as they approach discharge. Our goal is to educate our patients in ways to improve safety, improve energy conservation and improve self-awareness as they prepare to return home. Each group member is given a packet of written information, which includes a home safety checklist, pictures of adaptive equipment and links for ordering, and home exercises. We change our handouts based on the needs of our patients at the time.

Our DC Planning Group objectives are as follows:

• To identify barriers to discharge with a focus on current functional barriers
• Education in home safety, home modifications, DME needed for safety in the home
• Education in community resources for home safety
• Education in self-awareness and techniques to facilitate relaxation and awareness of your body at rest
• Education in the purpose of home health services and benefits of continuing therapy at home and as an outpatient

So many of our patients have expressed gratitude and appreciation as they learn from one of our OTs or COTAs AND from one another about adaptive equipment, techniques and strategies to improve their lives. One patient commented after attending the group, “I was so worried about falling in my bathroom. What you’ve taught me will make things much safer and easier — it will change my life!” We have allowed family members to attend our group, which has helped them learn how to better care for and support their loved ones. Overall, this education group has been a valuable addition and rewarding experience for both our patients and therapists!

Submitted by Loupel Antiquiera, DOR, and Laura Kramer, COTA/L, Pacific Care Center, Hoquiam, WA

Laura Kramer, OT, provided the following exercise to promote OT month.

Residents are provided with a yoga ball placed on a base (like a round laundry basket) and a pair of drumsticks with instructions to follow the leader in a set of coordinated movements with lively music that has a strong musical beat. The variations of instructions may be tailored to the residents’ limitations and therapeutic goals. It can be upgraded or downgraded to tolerance throughout the task, with the therapist monitoring signs of fatigue or pain, cueing residents to rest if needed.

As the therapist, I may begin by explaining the benefits of the activity, which can include increased circulation, cardio exercise, targeted joint range of motion, music appreciation and most of all fun, but I always preface with “If it hurts, don’t do it.” Coordinated movements may include:

• Elbow flexion only while drumming on the ball; downgrade to just wrist flexion if necessary to tap out the rhythm of the music
• Knee up both right, then left
• Reaching far right/far left, targeting shoulder abduction and trunk stability
• Hands up with crossing drumsticks
• Drumming to the beat, either slow or medium or double speed
• One-handed (one-sided)

Overall, the benefits I’ve observed are promising, with most patients demonstrating very good attention and following directions, and some will even become happy to lead a set of instructions and take turns to try out their own combination. Some find the activity too simple and ask to leave, and one resident commented she thought it “felt like kindergarten, but it was still fun I guess.” However, this same resident actively participated again and was observed having fun. One resident required closer observation d/t asthma; her O2 sats dropped too low, and she was returned to her room with nursing notified for breathing tx’s. One pt reported BUE shoulder pain d/t OA.

By Calli Carlson, OTR/L, DOR, North Mountain Medical & Rehab, Phoenix, AZ

“Oh it’s just basic range of motion. That patient doesn’t require therapy anymore.” I’m embarrassed to think of how often I have said these words, and I wonder how many therapists may relate to this same perception.

Previously in our facility, patients who were non-responsive or minimally responsive were transitioned from our skilled physical and occupational therapy to restorative nursing programs for passive range of motion, typically for three days a week. Over time, we began to notice that patients were demonstrating difficulty maintaining their current range of motion, while restorative nursing was likewise reporting increased tone and increased difficulty working with our more medically complex patients.

For patients with complex brain and spinal cord injuries, hypertonicity can worsen with time causing an invariable decline in range of motion as well as increased difficulty for restorative members performing their range of motion treatments and increased difficulty for certified nursing assistants performing basic tasks such as dressing and peri care. With this in mind, the dialogue began to shift from therapy could be involved in these patient cases to therapy should be involved in these patients cases to provide the best possible outcomes and improve quality of life.

Given the depth of therapists’ schooling on anatomy, neuroanatomy, kinesiology, positioning, and modalities, it seemed that therapists could provide enormous benefit simply by increasing their involvement and time with these clinically complex patients while also educating and instructing restorative nursing assistants, certified nursing assistants, and additional floor staff as needed.

A physical therapist at North Mountain Medical Center, Shannon Dougherty, took initiative and recently developed a program titled, “No pressure, no pain, no problem,” focused on improving the health and quality of life of long-term care residents in the facility. The 3-part program encompasses the following:

Part 1: No Pressure: Reducing likelihood of pressure injuries through bed positioning
Part 2: No Pain: Reducing pain through manual techniques, modalities, contracture management
Part 3: No Problem: Identifying ‘problem’ patients and completing CNA/RNA training for improved techniques, removing burden from RNA for especially complex patients that require additional assist.

The program is currently just beginning here at North Mountain, but we have already been surprised and encouraged by results we have seen thus far. One of our patients, in particular, presents with significant hypertonicity and accompanying flexion of upper and lower extremities at rest, placing this patient at high risk of developing contractures without appropriate intervention. Restorative nursing members have reported that this patient is typically averse to passive range of motion and that they have difficulty knowing how to properly complete this task. A formal therapy evaluation and subsequent treatment sessions identified that this particular patient responds well to simple verbal/tactile cueing, gentle massage of the hypertonic muscles, slow and prolonged stretch, as well as stretching muscles in isolation rather than combing several stretches at once (such as hip/knee extension). Therapists have begun educating restorative nursing members on these techniques as well as analyzing non-verbal pain responses such as diaphoresis, increased flexion posturing, facial grimacing, or increased heart rate in order to provide the best quality, patient-centered care.

The plan of care may differ for individual patients. For example, therapy might decrease restorative nursing visits to two times per week and see that patient once or twice per week to supplement their treatments, or therapy might work with that patient five days per week and discontinue restorative nursing at that time while they work to get a baseline and treatment ideas to share with the rest of the staff. Regardless of the method and scheduling, it is important that therapists see the value of their knowledge and skillset, restorative nursing members feel empowered and capable when working with these patients, and patients receive the best quality of care to improve their health and well-being while under our umbrella of care.

By Angelica Reyes RN, DON and Paul Baloy OTD, OTR/L, DOR, The Hills Post Acute Care, Santa Ana, CA

What is a nursing & rehabilitation partnership? Nursing is defined as a collaborative care of individuals that promotes overall health and prevents illnesses. Rehabilitation is the process of restoring and regaining the lost skills caused by an illness or injury.

Although nursing and therapy are two different disciplines, when both work together harmoniously, they become an effective and powerful tool that is deemed vital to our residents’ health advancement and recovery.

At The Hills, nursing and rehab departments collaborate on a daily basis to be able to provide an individualized resident centered care plan. We have developed an effective fall management system, wherein nursing and rehab teams visit residents at bedside for a more direct and involved plan of care, and diligently analyze and discuss which interventions will benefit the resident the most. Other recommendations are also solicited from the other members of the interdisciplinary team and continuously evaluated for their effectiveness.

In addition, we have recently conducted a successful CNA skills fair with the help and support of our Resource team, that encompasses the “customer second, passion for learning, and celebration” of the CAPLICO values. This event, “We Got Skills at The Hills,” allowed us to revitalize and strengthen the skills set of our front liners and bedside care providers for a safer care experience of our residents. Our very own rehab team demonstrated and shared their expertise in transferring, positioning and lifting our residents using bio-mechanically correct and safe techniques and approaches.

We will always have the opportunity to excel individually. It is when we start believing and behaving differently—collaboratively and seamlessly working together—that the magic starts to happen, exponentially multiplying our successes to meaningfully change the lives of those we care for as we continue our quest in dignifying long term care in the eyes of the world.

By Sarah Scott, MS CCC SLP, Pointe Meadows, Lehi, UT
On our last call, IDDSI implementation was a shared struggle. With the help of our students and in collaboration with nursing and dietary, we have implemented a new system for IDDSI consistency. On the next call, we can report on any success or challenges with our system.

We have had several inservices with Nursing across the last two weeks. Every nurse will attend training. We completed training with the dietary staff. Each training was an hour long and covered IDDSI, the modified liquids and solids, preparation and testing.

We created a patient identification system for diet modifications. We used the IDDSI colors and round dot stickers for each level in addition to a water droplet sticker for a water protocol. We are placing dots on the doors for easier in-room identification and on a wrist band, which we are placing on the patient’s walker and/or wheelchair for easier identification outside the room and in the dining room.

We created an admission protocol for each nursing station so the admitting nurse can find the diet and place the DOTs with the help of the CNA processing the admission. ST has the same materials so we can change the identification when we change a diet. The key is posted by all of the med carts, nursing stations, gym and dining room.

We also created nice-looking official thickened liquid stations. We have been having difficulty with liquids being the wrong thickness, the spoon being stored in the thickener, and no date on the thickener. Each station is clearly marked and has instructions on laminated cards to support where to get the thickener and how it and the spoons should be stored, specific instructions for our brand of thickener, the quick key to perform a test if needed, and the IDDSI levels.

Our kitchen has ordered single-serving liquids to go out on trays, and each nurse’s station also has a gel pump to support the nurses with ease of thickening amid their many responsibilities.

By Suzanne Estebo Simko, M.S. CCC-SLP, Olympia Transitional Care, Olympia, WA
Kathy came to us in early February 2021 due to progressive weakness. When she first arrived at OTC, although she was alert, she had difficulty having the energy to even keep her eyes open. Kathy stated she was first diagnosed with Parkinson’s disease in 1992, but was able to maintain her productive life. After her diagnosis, she continued to work for an additional 10 years as an executive assistant for the WA Army and National Guard. She stated she and her husband are very social in nature and loved to entertain.

During her initial speech evaluation, Kathy was concerned about her vocal volume being recently diminished. She shared that she used to “sing all the time…in the shower, choir, car, and karaoke nights,” and now, “I squeak out.” It also upset her that her condition was affecting communication with loved ones: “My husband can’t understand me at all when I call him on the phone from here,” she said.

SLP Suzanne Simko recently took a CEU course on strength training for the respiratory system. Her patient Kathy seemed like she could really benefit from the information and techniques learned in this course. Due to Kathy’s breath support weakness, she was not able to complete all the recommended repetitions on The Breather device in her first session. However, both ladies were astounded at the noticeable difference in Kathy’s speech intelligibility at the end of the first session! Her vocal volume was much louder, and she had enough air support to produce sentences versus her baseline one- to two-word responses. The next day when seen for treatment, Kathy’s baseline speech was still more intelligible than previous sessions and almost as important, she was smiling and enthusiastic to go to speech therapy and resume her respiratory system training. Kathy now asks for handouts to help her remember oral/motor and breath support exercises to do when she’s not in ST. She stated she feels “hopeful for the future.”

Submitted by Dominic DeLaquil, Therapy Resource, ID/NV

Carly Peevers is an SLP out of Rosewood Rehabilitation in Reno, Nevada. Carly is passionate about giving great clinical care and has recently taken on an educational role within the Pennant, Idaho/Nevada, market.

Carly has been an employee at Rosewood since 2015. In her first year at Rosewood, she worked collaboratively with the kitchen team to revamp the menus so that the diet recommendations match with the diets provided by the food services company. Since then, she has worked hard to train new and existing kitchen staff on diet restrictions and make sure they are comfortable with the administration of current diet orders. She has also worked with CNA and nursing staff to communicate actively when diets change to ensure the entire team is collaborating with regard to patient care.

Carly, along with the entire speech team at Rosewood, believes passionately in upgrading patients to thin liquids as quickly and safely as possible. Carly leads this initiative by educating staff on current lists of patients on thickened liquids and directing care in such a way that they are upgraded as quickly as possible. At any given moment, Rosewood never has more than a few patients on thickened liquids. She also recently trained the SLPs in her cluster on the value of reducing thickened liquids.

When the International Dysphagia Diets Standardization Initiative (IDDSI) was released in May 2019, Carly championed the transition by talking with the kitchen managers and Registered Dieticians and educating nursing staff on the levels to prepare us for the change. She attended trainings with speech therapists from all over the city to create a collaboration through the SLP network of acute, Rehab, SNF and Home Health SLPs.

Carly is truly a dedicated therapist, and Rosewood is so proud of all of her hard work!

 

By Calli Carlson, OT/DOR, North Mountain Medical & Rehabilitation, Phoenix, AZ
In the fall of 2020, two of North Mountain Medical Center’s therapists, Tyler Lieberman, COTA/L, and Calli Carlson, OTR/L DOR, spent 145 hours over the course of three weekends to become certified lymphedema therapists. Calli received a brief introduction to lymphedema management in her occupational therapy graduate program but knew there was still a great deal to learn in order to provide the best possible care to residents. Tyler also expressed interest in becoming certified, particularly after observing many residents with edema/lymphedema and the subsequent joint stiffness and skin changes that resulted. North Mountain’s CEO, Jason Postl, and Director of Nursing, Jacque Green, were extremely supportive in providing the means for training and were equally as committed to providing the highest quality, holistic care for residents.

Lymphedema itself is historically ill-understood in clinical practice despite affecting 90 to 250 million people worldwide. Lymph node removals, trauma, surgeries, medications, genetics and obesity are just a few of the contributing factors to disruption of the lymphatic system, which can result in protein-rich fluid in the interstitium and cause a cascade of adverse reactions. Physically, patients may experience extreme heaviness in limbs, itchiness, skin infections, and, in later stages, dermal fibrosis, skin papillomas, and trophic skin changes. Psychologically, physical changes can create anxiety, depression, reduced quality of life, and impaired participation in functional tasks of choice.

Lymphedema management focuses on clearing edematous fluid from the interstitium via manual lymphatic drainage, compression, and/or decongestive exercises with additional focus on skin care and self-care management. Therapists use precise measurements to obtain the volume of the edematous limb and track over time to determine the effectiveness of treatment. At North Mountain, Tyler and Calli have noticed significant improvements in total limb reduction with the use of volumetric measurements, and patients also report that their limbs feel lighter and easier to move.

For patients with decreased alertness, staff members are trained for the continuation of techniques to ensure carryover from skilled therapy. The ultimate goal of lymphedema therapy is to improve patients’ overall skin integrity, movement, health, and quality of life by moving unwanted fluid from the interstitium back into the lymphatic system to be excreted by the body. It is an area of therapy that is not often explored in the realm of skilled nursing but has the potential to improve patients’ movement and tolerance to standing activities in physical therapy, reduce risk of developing decubiti by increasing blood flow, improve patient’s self-esteem and quality of life, prevent fibrotic changes that can occur from stagnant protein-rich fluid, and overall increase patients’ participation with self-care and functional tasks of choice. It requires interdisciplinary communication and engagement to create lasting results for the patient.

Though not often explored by therapists, Tyler and Calli would strongly encourage anyone interested in better identifying/managing lymphedema to become lymphedema certified to gain the valuable skills required for effective lymphedema management.