Therapeutic Journey to Success: Mr. R

By Justin Cruz, COTA, The Hills Post Acute Care, Santa Ana, CA
At The Hills Post Acute, we work with our residents across all disciplines to enhance
their quality of life and have them become the best person they can be. We meet a variety of
personalities that always manage to surprise us, keep us humble, and reaffirm our passion for
therapy. As a multidisciplinary team, we believe that mutuality, consistent feedback, and
collaboration between the residents and therapy team helps create the most effective therapeutic

Today, we would like to put the spotlight on one of our long time residents who took our
well intentioned efforts to heart: Mr. R. When Mr. R came to The Hills Post Acute near the
beginning of 2020, he was a very different person. Mr. R experienced a great fall that rendered him very weak, apathetic, and socially withdrawn. However, we did not give up and we continued to bring him to therapy where we provided encouragement and motivation to him almost everyday.

As time passed, our relationship with Mr. R gradually grew and he began to participate in
every activity the therapy team provided him. Mr. R’s condition improved as his strength
increased and he became more sociable with the other residents. He listened to our feedback and
provided us with feedback of his own on what he wanted to focus on.

Currently, Mr. R continues to participate in therapy almost every day with such interest and enthusiasm that it brings a smile to our face and a sense of pride to what therapy can achieve. To us at The Hills Post Acute, Mr. R is our success story.

An Experience that Changed the Way I Look at My Ensign Services Role

By Felipe Bakr, Senior Transactional Legal Resource, Ensign Services, Midvale, UT
Yesterday, I had an experience that changed the way I look at our facilities and my role as one of its Service Center employees. My wife’s friend invited her to an activity at a nursing home; she accepted and asked if her husband and kids could also go. After her friend said my wife’s family was welcome, she promptly accepted and said we were all attending the activity. Days after, my wife told me where we would be going the following Monday. And guess what? It was at Provo Rehabilitation & Nursing. Before becoming a Service Center employee, I have been at that facility twice to help with church services. But at this time, I had a completely different experience. After a message, prayers, and songs, they allowed me to introduce myself – but no one, except my wife, knew about my job, and I didn’t disclose it.

Then, I had the opportunity to talk to some of the residents – and at that very moment, everything changed. I learned their names, stories, struggles, experiences living in the facility, and valuable life lessons.

Let me share one of them: Steven. He’s originally from Olympia, WA. He has six children and twenty-three grandchildren all over the country. He is a mechatronics engineer and loves research. He has been living in the facility since the autumn of 2019 due to Parkinson’s disease. Because of his health issues, he even lost his voice entirely one year and a half ago – living at the facility already – but after a procedure where they put some cartilage on his vocal cords, he can talk again. He also did three other procedures to improve and adjust his voice. He also said how much speech, physical, and occupational therapy and his life at the facility have been helping him to improve his voice and health. He cried happily and thanked God and the facility’s employees for his life improvement – he called it several times a “miracle.” Then, I disclosed I was a legal resource with Ensign Services, and he grabbed my hand, crying, and thanked me for doing my job.

All I do with contracts and licensing got a new sense to me. It’s about people. I was grateful for his life, and my heart was full of gratitude for being part of the work that we do – in other words, the “miracle.” As he said, I thank each of you for doing your job and building together the “miracle” in the life of many people around the country. In fact, we are “through moments of truth, [dignifying] post-acute care in the eyes of the world.”

Capstone Project: Charting Insurance Rules/Guidelines

Submitted by Stephanie Cole, Bandera Therapy Resource – Arizona
In the spirit of Passion for Learning I would like to share an INCREDIBLE Capstone project with all of you. I am hoping you can use some of the tools in your own buildings!

Kyle Higgins, DPT, our fearless DORITO and DPT extraordinaire at Montecito Post Acute Care & Rehabilitation in Mesa, AZ, is the creator. Kyle has been invaluable to our therapy program, demonstrated excellent clinical skills, leadership and dedication to hundreds of our most difficult patients. It is with great pleasure I share his story and all of his hard work. Please feel free to reach out to Kyle directly with any questions about the forms/tools.

In Kyle’s words:
For my project, I wanted to capture all of the fun insurance rules/guidelines that are pertinent to therapists and turn them into an easy chart. In the past year, we have had multiple new hires, with several of them being new grads. I love teaching and helping them in any way I can, but I often caught myself doubting what I was teaching due to insurance guidelines constantly changing and to be honest, just SO many rules. Thankfully, this chart has been helpful for me and even for our therapy vets as a refresher! I hope this project can be as helpful to other facilities and therapy resources as it has been for Montecito.

I have included a general Insurance Guidelines and LTC Insurance Guideline document that captures general rules for various payers that we have been successfully using at Montecito.

Additionally, during this DORITO program, I have created and implemented a PDPM checklist that our evaluators are using (and MDS director loves). I know the therapy portal had several PDPM checklists already. However, most of them did not seem to include consistent information, so I made one that encompassed everything from every checklist.

Lastly, I have created an IDT communication board. Stephanie Cole and I printed/laminated over 300 copies. We hung hooks on the cabinets in every room and hung the hole punched sheet with a ring for each patient. On eval, the evaluator will fill out the sheet with a dry erase marker. As patients progress, whatever therapist that is working with the patient can update the sheet. Hopefully, this will continue to improve the communication between nursing and therapy. But most importantly, hopefully this has improved the safety of our patients

Group Therapy at the Park

By Sarah Scott, DOR, Draper Rehabilitation & Care, Draper, UT
Draper Rehabilitation and Care Center is located one block from Historic Draper Park. Recreational, Physical, Occupational, and Speech therapy have coordinated to hold large group activities at the park every other Thursday through the good weather month. It is an “all hands on deck” effort to get the residents ready, sunscreen coated and over to the park. Why go through this effort? The answer is simple. The residents love it and it is the kind of activity almost everyone throughout their life has participated in and enjoyed. Who has not spent part of a Spring or Summer day enjoying the sunshine at a park?

For this week’s activity at the park, PT/OT/ST all had prepared activities lasting 15 minutes each. The residents were grouped in three shady areas and the therapy teams travelled from group to group in 15 minute intervals so that all had the opportunity to perform each activity. Recreational therapy and selected CNA staff supported all of the residents preparation, attendance, participation at the group. Jeremy Meldrum, ED at Draper Rehab, dragged a cooler loaded with treats and took each resident’s “order” to support a community activity where each resident could select and order a treat using a prepared “menu”.

The Physical Therapy group worked out dynamic balance and upper body strength with a bowling game where residents rolled a ball across the lawn into a basket with different point values depending on the location and difficulty of the roll. Occupational Therapy challenged core strength, proprioception, and upper body function with heated rounds of cornhole. Speech Therapy targeted the essential skill of respiratory support for speech and swallow with bubble blowing and environmental awareness and reasoning skills to identify items around the park. Residents cheered each other’s success and chucked together at misses. Function, Fun, Freedom. We are collectively looking forward to the next group outing to the park!

The OT group enjoyed the fresh air and upper body workout as they launched beanbags for a round of cornhole.

Speech Therapy exercised everyone’s lungs with a bubble blowing activity and mind with identification of items around the park. Respiratory support is essential for speech intelligibility and swallow.
It was a beautiful day for the residents. As one resident stated, “It is so great to get out!” It is always a bit of organized chaos and we collectively learn from each activity. Can’t wait to see the smiles and laughter in two weeks!

Bariatric Psychosocial Group Provides Judgment Free Zone at Osborn

By Tory Lane, Bandera Therapy Resource – Arizona
Osborn Health and Rehabilitation in Scottsdale, AZ specializes in nursing and physical rehabilitation for bariatric patients. Tony Botelho, DOR and CTO, along with his amazing team of therapists have collaborated with nursing and other IDT members to create an effective and enjoyable rehabilitation program catered to the needs of this patient population at Osborn.

The pillar of the program is our weekly bariatric psychosocial group. We gather for direct peer to peer support in a “Safe Place” or “judgment free zone”. Group is focused on a holistic approach where we address relaxation techniques, flexibility and strength, goal setting, barrier identification and coping strategies for success. Through this program members have the benefit of asking questions and giving advice to those in similar situations, celebrating success with people who truly understand the gravity of their accomplishments and the socialization aspect that helps to remind them how wonderful it is to be out in the world and interact and enjoy others company.

In the words of Tony himself, “I have been so moved by the power of these program participants. These individuals, like many of us, have battled demons and traumas. Not always in healthy ways– often leading to things like oxygen dependency, inability to stand and walk, and a plethora of psychological and medical comorbidities. But, to see their mentalities change, their efforts increase day in and day out, and the sheer will to take back their lives is nothing short of inspiring. It is a reminder that no matter how far we fall, we can always work our way back up.”

Tony and his team celebrate their individual progress, and they are so humbled by their perseverance and determination. Thank you to Tony and his team, and their dedication to helping to make this program a success!

(photo caption: Tony Botelho, DOR and CTO and his amazing Bariatric Program Champions at Osborn)

Legend Oaks Celebrates Black History Month

Submitted by Lana Mathis, COTA, Therapy Director, Legend Oaks Healthcare, Kyle, TX
“Fanga Alafia, Ashé Ashé,” meaning “good health and peace to you”—a traditional West African call and response—echoes throughout Legend Oaks Rehabilitation and Healthcare in Kyle. During the month of February, drums could be heard in the halls as residents made their way to the dining hall or some moved in their bed. The message that we want to bring with Black History Month is: welcome, everybody.

Traditional African music was featured every Tuesday. One week, residents learned about famous Black Americans while also being exposed to soul and Cajun food all in honor of Black History Month, the first event of its kind to be held at the facility to benefit residents and employees alike. “In my seven years of working here, this is the first time we’ve ever come together to celebrate Black History Month,” said Christina Johnson, physical therapist assistant at Legend Oaks. “It was a collaborative effort. Because of these guys (other therapists), we’ve got a whole bunch of new staff that have great energy, great ideas and enthusiasm for the people and introducing everything to our residents.”

“The music helped benefit residents and employees alike in a myriad of ways,” said speech therapist Rachel Obstfeld. “Really learning about where we come from and why we do things ultimately just makes us care better overall. The patients actually enjoy it; they get excited about it. If you treat your patient like your friend or someone that you’re actually going to care for, you get better results.” Christina reiterated that the music itself has healing components.

The dancing is so connected to the African drumming in our culture. A lot of hip hop dancing originated from African cultural dancing, so I like to say, “Let the drum speak,” because the drum will bring medicinal feeling; it brings spiritual healing; it brings a connection. “A lot of our residents here have problems with their memory and a lot of them have dementia and other neurodegenerative disorders like Parkinson’s. Some people have had a stroke and a lot of the time, that limits their abilities to communicate and engage with the world around them the same way we do,” Obstfeld said. “Music has a really special way to access parts of the brain that aren’t otherwise active…so we really like to incorporate songs to help them know you have peace in your life and peace in your days.”

Advocating for People with Disabilities

By Danielle Banman, Emerald Therapy Resource – Kansas
Dick Hosty is a 62 year-old resident at The Healthcare Resort of Leawood. Dick is very involved in the community and is passionate about advocating for people with disabilities. He has made several YouTube videos documenting reviews of accessible wheelchair trails. Dick has cerebral palsy with dysarthria and knows the daily challenges dysarthria presents for him and others. Dick worked with his SLP, Madi Hinmon, to prepare a presentation he used during two monthly inservices at Leawood to train all staff on working with people with dysarthria. He has a great sense of humor and shared a funny story about his response to being made fun of for his speech when ordering a pizza by phone. Every attendee laughed throughout the presentation and learned how to better communicate with Dick and other people with communication challenges. As a special treat, my teenage son Jacob who also has cerebral palsy, attended one of the trainings. Jacob loved the presentation and admired Dick’s resilience and passion for advocacy.

We are so grateful for the leadership of our DOR, Camrin Nettey, for growing clinical therapy leaders. We are beyond proud and grateful for Madi for facilitating treatment to improve Dick’s communication skills and supporting Dick through this journey of advocating for himself and others. Dick shared, “I am not just doing this for me, it is not the Dick Hosty show. I am doing it for others who have communication needs.” These are the moments that dignify long-term in the eyes of the world and pave the way for future generations of healthcare professionals to support people with disabilities. Thank you to the incredible team at The Healthcare Resort of Leawood!

Announcing Our Newest CTO in the Endura Market

By Maryann Bowles, Endura Therapy Resource – Colorado
I would like to announce our newest Chief Therapy Officer in the ENDURA Market………..(drum roll please) our Director of Rehabilitation of Colorado Springs, Raquel Weese, OTR/L!
Raquel (Rockie) has been with HCR since opening in 2016 and has been a founding member of HCR being one of the original employees. She was truly a leader since hire in 2016 and had a huge following because of her passion, integrity and her leadership skills. Rockie officially became DOR in April 2021.

The biggest positive change at HCR was when she took the DOR role 😊 She runs the busiest skilled therapy program in the Endura company and is incredibly efficient at doing so. She is the backbone of our therapy program and has been since the facility opened. Rockie has been an essential part of HCR accomplishing the financial goals & FLAG in 2022. She consistently participates in facility wide endeavors. One example of this is when she and her husband came in on a Saturday to help spread mulch to beautify the building! (Rockie is in the middle/purple top). (photo)

Additionally, with the number of Medicare and Managed Care patients we care for, normal processes don’t always work for HCR. Rockie has been instrumental in revamping our Weekly Medicare to meet the needs of the patients while not overwhelming the IDT team. She worked with the Compliance team to develop a new policy and procedure that checks all of the compliance boxes.

Rockie also helps keep our Worker’s Compensation claims to a minimum. She and her team regularly provide education to staff, but then she goes farther than that by meeting with nearly every employee involved in a workplace injury and helping provide direction and evaluation of any potential injury. She has helped keep several employees from going unnecessarily to a clinic for care.

Rockie has been an active part in our cluster and works closely with her PIKES PEAK Cluster. In Sept, Rockie represented Endura at the 2022 Therapy Leadership Summit in Sedona, AZ. She has done educations/ in-services such as the OT programming for Leisure Pursuits at our other buildings and assisted with acquisitions by training the new staff and helping the DOR’s during this time.

Rockie is not one who enjoys being in the spotlight- but she is proud and honored to be our newest CTO!

Pelvic Floor Outpatient Program Success

Submitted by Cara Koepsel, M.S. CCC-SLP, CTO, Keystone Therapy Resource – North Texas
This story was written and shared with me by our DOR and OTR, Stephanie Wentworth, at The Healthcare Resort of Plano in Keystone North:

“I wanted to share a success story specific to our outpatient pelvic floor rehab program. This story is taken from a letter written by the patient about her therapist and her experience with the training!

The patient was initially an inpatient at our facility after a back procedure last January. After her short inpatient stay where she regained her functional independence, she came back for outpatient PT and OT. One of her therapists is an OT assistant who recently completed a pelvic floor rehab course provided by Ensign in order to equip our therapists and grow this very necessary outpatient program.

She writes, I am deeply grateful for the expertise shown to me by my OT who specializes in incontinence training. When I began the program, I was experiencing significant urological incontinence. Upon learning of my therapist’s certification/completion of incontinence training and pelvic floor rehab, she began working with me in this regard. She provided me with a form to log my episodes. In a short time, she developed a plan of care for me and diligently monitored the results of this training. She brought an awareness to me of what key identifiers I might note and then adjusted the training for maximum effect. I continued to log my experiences and gradually the overall pelvic and bladder training she brought to me came to fruition. The full effects of her training took approximately 6-8 weeks, and today I still maintain the effects and benefits of her professional care and appreciate the progress I have made with her guiding me along this journey of incontinence. To date I remain under her OT care.

This success story really highlights the improvement in the patient’s quality of life and the benefits of pelvic floor rehab for an issue that is often not discussed or shared. Pelvic floor rehab is one of our many outpatient programs that we provide and we have several therapists who were trained in the course. What an amazing letter from a patient to show the value of our CEU courses and LTC/OP programming in Keystone! “

A Moment of Hope and Truth

By Shelby Donahoo, Bandera Therapy Resource – Tucson, AZ
This story comes from Villa Maria Health and Recovery in Tucson, AZ. This acquisition July 2022 is a SNF AND a Substance Abuse 30-60-90 day inpatient facility, the first of its kind for Ensign Affiliates. Pictured is James Fleming, current full-time driver for Villa Maria Health and Recovery.

James started as a patient in the Inpatient Recovery Program, spending over 90 days focusing on maintaining sobriety. During his time there James demonstrated the desire to grow as a person, attending daily groups and 1:1 counseling.

James also attended Villa Maria’s Community Reintegration Programs. He participated in resume classes (taught by Therapy Leader Jesus Salazar) and mock interviews with IDT to prepare him for his time outside the sobriety program. He took feedback well and adjusted with each interview.

While still inpatient, James interviewed and got the position as Therapy Volunteer where he had the opportunity to assist the rehab department and be exposed to how PT/OT/SLP help patients in a SNF setting. James assisted with SMIPS (Substance Misuse Inpatient Program) groups, led by OT for patients with history of substance abuse on the Skilled Nursing side. James became a mentor to those patients on the skilled side struggling with addiction, encouraging them to attend the same groups he would attend on campus. James was very passionate about his growth and that of others.

Once discharged from the recovery program, James applied and interviewed for the fulltime driver position and is now part of the Villa Maria team and Tucson community.

Villa Maria is expanding the Inpatient Substance Abuse program from 30 to 60 beds through renovating property on campus. It will be amazing to see the impact they have on the Tucson community as they grow.