Reuniting Families and Friends

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By Joyce Koyama, OTR/L, The Orchard Post Acute Care, Whittier, CA

On March 13, 2020, President Trump declared a national emergency, citing an outbreak of COVID-19. On that same day, CMS strictly restricted in-person visitation to only compassionate care situations in skilled nursing homes in order to prevent the introduction of COVID-19 to our most vulnerable population: the elderly with pre-existing medical conditions.

Like many seniors, our residents at The Orchard thrive on the opportunity to spend time with their loved ones. They look forward to having lunch with their spouse, to catching up with friends, to seeing their grandchildren grow. For many months, they were deprived of these meaningful visitations, or at least reduced to visits virtually or done outside their window. While many families tried to make the most of the situation by attempting to talk through glass, decorating their windows with signs and balloons, or even bringing singers to sing for their loved ones to bring cheer, it just was not the same.

As we gained a better understanding of COVID-19 and infection numbers locally were declining, our facility came up with a plan to build a visitation area as a way to help reunite our residents with their families and friends. Plexiglass was added to three sides of our existing gazebo against a side entrance. Just weeks later, the Activities Department was able to bring residents out into the sanitized area at a designated time where family and friends would await them on the other side of the glass.

At last, a clear view of each other from head to toe. Sounds of cheer, laughter and tears of joy can be heard and seen from the visitor area. Hands held up to glass, face-to-face conversations, and a heart-warming feeling with a hello and good-bye. Our resident Sandie described seeing her family for her birthday as “uplifting,” as she has felt lonely after not being able to see them for months. Resident Rosita said she felt happy seeing how tall her granddaughter had grown. It was unanimous that our residents felt overwhelmingly happy and loved after seeing their family and friends again.

While there is nothing that can really replace the warmth and value of a real hug or a held hand, for now, this is a wonderful and sweet way to reunite our residents with their loved ones. For families on the other side of the visitation area, they feel relief to see their loved ones doing well. And for our residents, they are given hope and joy — a goal we have accomplished here at The Orchard Post-Acute Care.

Let’s Keep Doing the Important Work

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By Cara Koepsel, M.S., CCC-SLP, DOR, Golden Acres Health and Rehabilitation, Dallas, TX

Here at Golden Acres in Dallas, Texas, we love our long-term care residents. They are the heart and soul of our facility, and we wouldn’t have it any other way. One of our residents passed away recently, and it never gets easier. The family reached out to myself, the DOR, and the social worker in hopes of getting a copy of her grandmother’s life storyboard that was created during therapy with one of our amazing speech therapists. Her granddaughter wanted to utilize this resident’s life storyboard to aid in writing her obituary. To think that the Abilities Care Approach Program could, in such a trying and upsetting time, bring joy and meaning to a grieving family is truly amazing.

What an important program this is, and what a reminder that what we are doing in therapy every day matters maybe more than it ever has before. The Abilities Care Approach Program is a program widely utilized across our Ensign facilities that is evidenced-based, and essentially allows the therapists to work with family members and residents to develop a life storyboard that paints a picture of our residents’ likes, dislikes, family history, and abilities they have within their communication and self-care activities through their changing stages of dementia.

For our family members to be involved in their loved one’s care through the stages of dementia is so important, especially right now as they cannot see their loved ones as they are used to. Our therapists, through this program, can work with our families to give them peace of mind that during a pandemic, their loved ones are being loved and cared for so well. Our long-term care programming continues to be so important right now! Let’s remind ourselves that we continue to make a huge difference in our residents’ lives!

A Home Run to a Strong Partnership Created with Utilization of Grand Rounds and Stop & Watch Tool

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By Jon Anderson, PT, Senior Therapy Resource

The pandemic has changed so many things in our daily rituals, and at Legend New Braunfels the facility quickly found itself with less referrals, resulting in decreased skilled and overall census. The facility is known in this quaint community for its fast-paced rehabilitation program and more recently unique treatment approaches surrounding memory care. In an effort to collaborate and ensure patients in the facility avoid the hospital, the facility implemented the Stop and Watch tool along with Grand IDT Rounds.

The Stop and Watch tool allows any employee to document a change in a patient, providing a direct line of communication to the nursing team for further assessment. Bob Said, RN, DNS reports that initially this was looked at as perhaps creating more work for the nursing team, and there were questions surrounding whether a non-nurse would be able to utilize the tool effectively and appropriately. However, it has been quite the opposite. The nursing team provided training to all clinical staff, including the therapy department, on how this tool can be used to effectively capture an early change in condition.

Over time, the recidivism rate was impacted, which created less work for the nursing team. Bob was quick to point out to the team of nurses he supports how much time was saved by having to do fewer orders and assessments as part of the discharge/readmission process, while keeping the patient happy, healthy and out of the hospital by identifying these subtle changes. Jayna Owens, SLP, DOR for New Braunfels, agrees that this strong collaborative clinical approach has led to breaking down silos: “By leading in a way that it’s OK to step on each other’s toes, and even encouraging to do so, we are able to partner early and address clinical issues rather quickly.”

Both Jayna and Bob, along with Amber Thompson, PTA, LNHA, have also shared the importance of doing daily grand clinical rounds on every patient in the facility. Bob reports, “At first it’s a huge undertaking and can quickly eat up your day. Our first grand round took three hours to complete, and you question if this is efficient. But like anything new, you create a process, and over time it becomes faster. We now have it down to about 1.5 hours.”

Jayna and Bob both agreed that the time spent upfront at the start of the day has paid off, we now actually have more time later in the day because we already addressed the majority of the clinical issues in the morning. “You have a better understanding of all the patients,” says Bob. “You know the care plans are being followed because you look at it daily, and whether we knew it or not, we were elevated in the eyes of the front line staff because they see you on the floor daily in every resident’s room. No one’s left behind.” Amber, Jayna and Bob all agreed that these two new things are here to stay, even after the pandemic. ”We have really been pushed as leaders, and this has allowed us to better support the ladies and gentleman, along with creating more open lines of communication with the staff.”

Introducing Our New Southland I-tool Collection

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By Carlos Pineda, DOR, Southland Care Center, Norwalk, CA

The I-tool is the first “6th vital sign 3-in-1 tool.” Due to the ongoing pandemic, which requires social distancing and isolation, our goal was to bring the evidence-based practice into the patient’s room. Validated standardized tests can be utilized as part of the treatment strategy at the same time. The 3-in-1 tool covers the full spectrum of the patient’s functional skills from low functioning to high. It can be utilized to conduct three standardized tests:

1. The “seated step test,” a low-level aerobic test for frail individuals or those who cannot stand or walk
2. The “2-minute step test,” an assessment of aerobic capacity for those who have concern with walking space
3. “Gait Speed,” or the 6th vital sign, which predicts the patient’s health status including hospitalization, functional decline and even the discharge location

The tool is made of PVC pipes that are carefully measured and fitted to allow for quick assembly and disassembly. The kit’s quick setup process support productivity and encourages therapists to consistently integrate standardized tests. Each part is color-coded, which can be completed in 30-40 seconds.

The attached photos show all of the following pieces.
Needed supplies (all under $50)
4 – PVC pipes ½ x 10
4 – Cross PVC ½
8 – PVC tee ½
1- PVC coupling ½
2- PVC elbows ½
1 – container of PVC glue
3 – different spray paint colors

Now that you have seen the photos and supply list, are you intrigued as to how this all works? The team at Southland put together a live video on how to assemble and use the tool. Contact Carlos Pineda (capineda@ensignservices.net) for more information.

Building LTC Programs at Legend Oaks Fort Worth

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By Kari Rhodes, MS, CCC-SLP, Therapy Resource/DOR, Legend Oaks Health & Rehabilitation, Fort Worth, TX

We have a new and more comprehensive understanding of how we can truly “dignify long-term care” by taking care of the residents that live in our facility. We decided to question some old patterns and beliefs that were preventing us from truly delivering the best possible therapy services to our long-term residents — our extended family.

The change did not happen overnight, but with education and support of our resources, our therapists began to truly understand the extraordinary differences they could make in the lives of residents by addressing many basic needs. We started looking at quality of life rather than waiting for a fall or a decline. We began education on programs including Percutaneous Tibial Neuromodulation (PTNM) for urinary incontinence and Abilities Care for dementia, and although we were improving quality of life, we were still missing something. We were discharging our residents to restorative, but they were still showing declines after therapy ended. How could we make a more permanent impact on their lives?

One of the things I love most about Ensign is the way we work together to make each other better. While attending a Keystone therapy resource meeting, I began hearing more and more about skilled maintenance programming. A light bulb went off in my head. This is what we had been missing! I invited Tiffany Bishop from Keystone North to provide an in-service to my market. She came to Fort Worth and provided the education we needed to implement skilled maintenance programming in Fort Worth. As a team, we were energized! We saw a wonderful way to continue providing quality of life services and keeping our ladies and gentlemen from declining. It was a win-win situation! We added staff to meet these needs. Residents were happier because they were not declining! As therapists, we were relieved to be able to continue providing services to those who needed it the most!

To me, this is one of the ways in which it is easy to see that when you provide as much loving care as you possibly can to these ladies and gentlemen who deserve the best possible quality of life, in ways that may involve thinking outside of the box, the rewards are extraordinary! Our fresh ideas and programming has truly been a game changer for our residents. They are thriving now more than ever!

Brookfield Pandemic Heroes

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By Lito Ortiz, Therapy Resource/DOR, Brookfield Healthcare Center, Downey, CA

An interview with Tom Chan COTA and Cristina Amansec SLP.

Brookfield Healthcare Center in Downey, CA is made up of some pretty amazing and selfless therapists. These heroes have truly shown their true colors during this time. At the start of the pandemic, Tom was one of those kind hearted individuals that bought N95 masks and goggles for the CNAs and our front desk out of his own money. He was one of the first people to dedicate himself to treat the COVID patients. Indeed a very courageous individual. Cristina was 4 months pregnant when the pandemic started. Despite her condition, she continued to fight and treated patients with COVID infection. She is courageous and a fighter. She also dedicated her own time to get extra supplies of masks, sanitizer, and reusable gowns. We got all the help we needed to win the fight because of her. After all the initial craziness died down, she focused her energy on getting us free food and goodies. She fed the whole facility for a total of 10 lunches overall. We are so thankful for her because she exemplifies the true meaning of Brookfield culture—being selfless and always looking out for others before herself.

Tom Chan, COTA
How long have you been with the company?
This August will be my 10th year. I started as per diem and was able to see the atmosphere, culture, and dedication of the rehab. The leadership was also strong so I could onboard full time.

What is the meaning of teamwork for you?
Teamwork is the ability of a group of people to come together to accomplish specific goals. The key is to have a shared vision to keep the group motivated and competitive but also provide a safe space where egos are set aside so people can rise and take the lead in some situations but be OK to step back and allow others to step up when their skill set will better serve that particular situation.

How has this pandemic affected you and your team?
The pandemic has affected how I view the frugality of everything that we have. One microscopic being can put the world at a standstill; can destroy families; end businesses and completely change the word normalcy as we know it. But it has also allowed many to take a step back and appreciate what they have, push harder to protect others and give me faith that humanity still exists.

How the pandemic affected the team is taking us through a roller coaster of emotions?
From anxiety, to fear, to relief, to sadness, to acceptance among many, many other feelings. It has forced us to say farewell to some residents, and compelled us to shed more tears as a group and as individuals than necessary. But it has also bonded and reinvigorated the rehab team. We have a trust within each member that we have each other’s back. It’s a good feeling when you know that there are 11 other people keeping an eye on you when you come to work.

Cristina Amansec, SLP
How long have you been with the company?
4.5 years

Why Ensign?
With Ensign, I felt it was a company that would offer the support — clinically and personally — in order for me to grow as a clinician. It took me time to ultimately decide to be full-time with Ensign, but I’m so happy I made the leap!

What is the meaning of teamwork for you?
Teamwork for me means a collaboration not only with my wonderful rehab team, but also with our nurses, kitchen, housekeeping and maintenance personnel. It’s the ability for all our separate job titles to foster together as one entity. As a united front, we are all so equally important and powerful in making a difference in our patients’ lives and experiences here in Brookfield.

How has this pandemic affected you and your team?
This pandemic has definitely brought our rehab team closer together! It has been mentally and physically challenging, but I am so proud and humbled by the feats our team has endured and our perseverance to push through the fear of the unknown. I am so grateful for the familial protectiveness and doting that we all equally provided each other — I couldn’t fathom what I would have done in this pandemic without such a loving and compassionate team.

When Life Gives You a Pandemic, You May Find Something Amazing

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By Elyse Matson, MA CCC-SLP, Speech Therapy Resource, Ensign

As mid-March was approaching and COVID-19 was spreading, I stopped at a facility in the Momentum market and there was a temperature checkpoint. I knew we were in for some changes. For a while, I carried on as best I could, but I kept thinking there must be more I can do to help. Then, I received a call from Tali Gerassi, DOR at Grossmont Post-Acute (GPAC) in the San Diego market. They had suddenly lost their long-time SLP and desperately needed help.

At first, I just tried to do what we SLPs do: find patients who need us and treat them. But soon I realized this wasn’t going to be an ordinary experience. This team was like no other I have met before, and I wanted to tell our whole organization how special they are.

GPAC is a busy post-acute facility with a rehab staff of nearly 20! The entire team has been so wonderful to me and helped me find my way. Most mornings I work with our general population patients. I watch the more experienced PTs and OTs build rapport with their patients and use innovative methods to get their patients back home. They play music and engage in personalized therapy sessions, and it is clear they want the best for their patients.

In the afternoon, I move to the observation unit where many of the therapists are brand-new grads. What a fantastic crew they are. I have learned so much from these young PTs and OTs! I have seen some of the best evidenced-based therapy from both PT and OT and a sense of teamwork that warms my heart.

Tali, DON Abigail Angeles and ED Katherine Oh have taken great measures to ensure the entire staff and I feel safe during this uncertain time, including meetings, frequent communications when policies change, and systems so that the staff can continue to be successful in caring for the patients.

I went to GPAC to help out, but I have received so much more in return!

To The Lifters

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Submitted by Tiffany Bishop, DOR/Therapy Resource, Legend Healthcare & Rehabilitation, Greenville, TX

Our amazing ADOR George Palin and his wife have been working tirelessly to provide the entire building (and a few to our sister buildings) with cloth masks, and they are now working on gowns to keep us all safe. Today the team wanted to say a special thank-you to him. One of our other amazing PTAs, Heidi Carmichael, thanked George for providing her with a more comfortable mask (pictured — you gotta laugh sometimes, right?) and read the following poem as a thank-you. I thought this is so true of George and so many others who are going above and beyond to take care of each other and our residents.

There are just two kinds of people on earth today,
Just two kinds of people, no more, I say.
Not the rich and the poor, for to count a man’s wealth
You must first know the state of his conscience and health.
Not the humble and proud, for, in life’s little span,
Who puts on airs is not counted a man.
Not the happy and sad, for the swift counting years
Bring each man his laughter and each man his tears.
No, the two kinds of people on earth I mean
Are the people who lift and the people who lean.
Wherever you go you will find the world’s masses
Are always divided in just these two classes.
And oddly enough you will find, too, I ween,
There’s only one lifter to twenty who lean.
In which class are you? Are you easing the load
Of overtaxed lifters who toil down the road?
Or are you a leaner who lets others bear
Your portion of labour and worry and care?
by Ella Wheeler Wilcox

Update from City Creek

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By Jared MacDonald, Operations Manager, City Creek Post Acute Care, Salt Lake City, UT

May 15 marked our one-month mark of becoming a COVID-only building. We are excited at where we’ve been and where we are going.

First off, thank you! Thank you for all the calls, the messages, the food, the signs, the support, the staff, the prayers, and most of all thank you for helping us see what it truly means to love one another. We know it sounds cheesy but honestly, there have been many things in the past month that have brought us to tears of gratitude for your help and support. We could not be where we are today without your help, so thank you.

In the past month, we have admitted 55 patients and discharged 21. Thanks to our remarkable clinical team, both those on site and those from other buildings, we have a live to date hospital readmission rate of 3.63% and a mortality rate of 3.63%. Those numbers are remarkable in comparison to both the state and national average. This truly shows that on the clinical front, we are succeeding. This plan is making a difference, and we thank you for your support in helping us be what and where we are today.

We’ve started a tradition of ringing bells and cheering as our residents are brought down the hall and sent outside to meet family and friends. We will never forget holding the hands of an 87-year-old as we cheered for her successful discharge back home. Tears streamed down her face as she thanked each one of us for helping her fully recover. We hope you know, especially all you DONs, that you were just as much a part of that successful discharge. Thank you!

Thank you to all of you who have rallied your staff, conducted interviews, and spoken with your friends and families.

Today we had a call with members of the state and local task force. They expressed their appreciation for what we are doing. Dr. Spaulding from Intermountain Health said that this was one of the best teams he has ever worked with. We have and we will continue to attribute our success to the support we’ve received from the market. They know of your greatness and of the countless hours you’ve spent in helping make City Creek what it is. Thank you from the bottom of our hearts!

COVID Update from Victoria PARC

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by Dawn Thompson, DOR, Victoria Post Acute Care, El Cajon, CA

Victoria Post Acute (VPAC) is one of the few skilled nursing facilities accepting COVID-19-positive residents from hospitals in San Diego and El Centro. Like other buildings with positive COVID cases, the beginning stage was certainly an upheaval from “normal” daily routines, as we were thrown into a world of unknowns with ever-changing directions and recommendations, coupled with fear. Schedules were slim, admissions were down, and stress was high. The rehab gym became a room with social distancing markers and a storage room. Hallways turned into PPE stations.

During this time, the rehab staff jumped into every and all support roles necessary (maintenance, dietary, CNA, etc.). They did this without asking and without hesitation, day in and day out, and continue to be heroes to this day. During this time, multiple rehab staff members were out sick, testing positive for COVID. As a team, we focused on “scared is what you’re feeling, brave is what you’re doing” and really went out of our way to emotionally support one another. We had daily emotional check-ins, both as group and individually.

This was a time of great loss in the building, where almost all sense of “normalcy” at VPAC and in the rehab department was absent. Grasping to maintain some normalcy and trying to keep our well patients well, we were able to work with Kaiser to evaluate and treat all appropriate Kaiser LTC residents in the non-COVID unit to maintain strength, activity tolerance and functional status. As our in-house COVID-19-positive patients stabilized medically, rehab jumped in and worked side by side with our new respiratory therapist. We were able to assist in positioning for postural drainage and help her hear true lung sounds of our ill patients.

We have learned a tremendous amount from our experiences treating COVID-positive patients (pay attention to those vital signs!) and have grown in confidence. The fear has dissipated and has been replaced with pride. This transformation was one of the most rewarding experiences we’ve had together as a team. I believe this shift was guided by transparent and efficient communication between IDT members and floor staff. While we seem to have our footing right now, this is an ever-changing process and we are continuously learning, growing and adapting.

As the days and weeks pass, admissions are starting to return, PPE requirements are changing, and barrier placements are being removed. Through it all, VPAC has remained resilient and together. Despite the loss and havoc of the first few weeks, we’ve found reasons (many, many, many reasons) to smile and celebrate. We have celebrated resident successes/discharges, birthdays, a retirement (DON), bridal shower, nurses week/nursing home week, Tuesdays and each other. We have been able to celebrate a COVID-19-positive patient (the husband of one of our charge nurses) being discharged home, walking out hand in hand with his wife after a month of hospitalization/rehabilitation including intubation.

Thank you all for the support, friendship and love over the last several weeks. It was needed and is much appreciated. I continue to be the proudest team leader.

Stay safe, wash your hands and keep your hands off your face!

With much love and gratitude,
Dawn ☺