Congratulations, Jacob Barnes, Bandera’s Newest CTO

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By Shelby Donahoo, Therapy Resource, Tucson, AZ
We are proud to honor Jacob Barnes, PTA, TPM, at Park Avenue Health and Rehab in Tucson, AZ!
Jacob has been with Ensign at Park Avenue since 2013 and truly exemplifies CAPLICO culture. Jacob’s ED, Jordan Monson, says Jacob “is like salt: He’s sprinkled into every nook and cranny that is Park Avenue.” In other words, while Jacob leads a large rehab team with strong outcomes clinically and operationally, his ownership over the years is way beyond the Rehab department.

2020 led to some exceptionally tough times for all, but Jacob’s leadership shined through in this pandemic. In between serving meals, moving beds, and working all hours to support the facility, he quadrupled long-term care revenue, increasing margin by 8%. This was accomplished by concerted and thoughtful implementation of holistic programming to meet the growing needs of Park’s residents. He developed leaders in his team, such as our Bandera Abilities TEACHA, and created a designated long-term care lead and team. He helped facilitate support and communication with market DORs as challenges arose during COVID.

So here’s a perfect example of why Jacob is CTO: December 18 was his surprise CTO celebration. While facility staff, folks from all over the market, and even DORs from Phoenix (who drove two hours) congregated outside, Jacob’s co-worker was to distract him and then bring him out to “go to lunch” once he was texted that all was ready. The text to come went out, and we waited, poised with confetti — and waited some more. Finally we got a text back — Jacob was busy giving a resident a haircut! After another 15 minutes, the text came that he was done and they were headed outside. And we waited. Another text came from the co-worker: Jacob was stopping to answer call lights on the way. True and awesome story.

Thank you for all you do for your residents, facility, Bandera and the full organization, Jacob! And for your unwavering wit and humor along the way.

Transitioning Our STOP AND WATCH Program into a True Conversation

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By Kari Rhodes, MS, CCC-SLP, Therapy Resource – Keystone – West, TX
At Legend Oaks of Fort Worth, there have been a fair share of ups and downs in communication. As with most skilled nursing facilities, there are some struggles to get nursing and therapy on the same page, especially regarding changes in a patient’s condition. However, a recent change in structure for daily morning meetings has made a significant impact on both communication and patient care.
Initially, staff were encouraged to complete paper STOP AND WATCH forms that were turned in to the charge nurse. This was helpful in reporting noted changes, but it did leave room for improvement. Papers were misplaced, the change was forgotten, or multiple forms may be completed on one resident.

Staff were then trained in entering the STOP AND WATCH forms on the clinical dashboard in PCC. This improved the chance that the alert was seen by more people and addressed by a clinician. Unfortunately, the electronic alerts also were, at times, inadvertently left unaddressed by a busy nurse or well-meaning staff member.

Fortunately, what has been an amazing change for the team at Legend Oaks Fort Worth was a very simple addition to the morning meeting. In addition to reviewing metrics and culture topics, our ED implemented a review of the daily STOP AND WATCH alerts for the whole team to address. Each alert is discussed by the team. What condition or behavior caused the alert? What was done to address the change? How is the resident doing on a daily basis? This has significantly increased the topic of conversation regarding change in condition.

Here at Legend Oaks of Fort Worth, we are continuing to strive for improved care and communication. This simple change in a system that was already in place has opened the door for more conversation, increased discussion regarding change of condition, and decreased discharges back to the hospital.

Celebrating Success at Beacon Harbor

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By April Trammell, SLP, DOR, Beacon Harbor Health & Rehabilitation, Rowlett, TX
Jimmy arrived at Beacon Harbor on April 13, 2020. He was in a very devastated state following a spinal fusion, which was compromised, leaving him with hemiparesis from the chest down. Because he was unable to feel his legs and feet, he was having frequent falls, required a hospital bed with assist rails in order to maneuver in and out of bed, and was wheelchair-bound. “I was brought to Beacon Harbor for my last days on earth to be comfortable and to give my wife Dianne a respite.”

Plans for Jimmy were to transition here to Beacon Harbor long-term care. But Jimmy had other plans in mind. He was successfully determined to wean off of all pain medication. “Then I started doing therapy — that wore me out — but I had it in my head that I wanted to recover.” Jimmy and his team of therapists were determined to help him gain his independence. “Day after day, week after week, I started improving not just a little bit — a lot! No explanation ‘why’ except my therapy and my willingness to do what is asked of me. They have challenged me on so many things, and they are holding me up, allowing me to improve.” He progressed to being able to transfer independently in and out of bed, and to be able to complete basic self-care such as dressing, bathing and toileting independently. “I feel like I am being rebuilt. There’s something about this place that draws it out of you.”

Jimmy and his therapists continued to focus on neuro re-education, and he slowly began to regain full sensation in his body. “I am able to feel hot water and take a hot shower for the first time in over 35 years!” He did not give up; Jimmy continued to thrive in therapy and began walking with a walker for the first time in 10 years. “I started taking control of my life slow, but every day it was a very hard road to walk down — for myself, for my wife and family. I would say Beacon Harbor is just one of the best rehab centers that I’ve ever been in in this nation, and I have been in quite a few from state to state over the years. The bottom line, Beacon Harbor: You have an amazing PT, OT, ST and Nursing staff. I’m getting ready for my second phase of taking my life back. I’m going to move into assisted living, and from there, back home. Thank you for a second chance at life.”

Happy News from EPAR

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By Paula Voorhis, PTA, DOR, Englewood Post Acute & Rehabilitation, Englewood, CO

In recent weeks, Englewood Post-Acute and Rehab has been handling the COVID outbreak with as much grace as possible. I just wanted to take a moment to share some photos of our celebrations of success.

This is our first group treatment since October, which is when we went into full lock-down, outbreak mode. It was organized by two of the most compassionate therapists I know, Emily White, PTA, and Wendy Garrison, OTA. The residents had a blast!

This is Ron; he was in a catastrophic car accident in 2019, which brought him to us. He received prosthetic training and was set to go home in early November, when he tested positive for COVID. Plans to DC home were postponed, but he made it, and has made it back home to Nebraska.

This is Jessica, the Clinical lead and head cheerleader for team Ron. We all cried like babies when he finally went home.

 

 

 

As a compromised patient, Glenna should not have survived, according to all our knowledge of the virus, but she did. What a happy day it was to move her off of the COVID wing back to her own room.

This was our very first survivor. She didn’t even know she was sick and was happily confused about all the fuss we were making over her. We are all truly thankful for the opportunity to celebrate with her. (photo of thankful I beat COVID)

While we all have the heartbreaking stories we carry in our hearts about those who didn’t make it, and the effects of long-term isolation and burnout as we care for our people, it remains good practice to reflect on joy and the many successes we all share to move forward. It is powerful medicine for the wounded and heart-sick amongst us.

Therapist Profile - Dennis Baloy

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By Jamie Funk, Therapy Recruiting Resource
Dennis Baloy is one of our more recent additions to the Ensign affiliated therapy leadership team. As the Director of Rehabilitation at St. Elizabeth Healthcare & Rehabilitation Center, Dennis immediately recognized our unique culture: “I just want everyone to know how lucky I feel to be part of this wonderful organization that truly embodies the value of Customer Second, where we as therapists and employees are celebrated, valued and appreciated. I am even more humbled to be surrounded by really bright, talented and passionate leaders. Everyone is so inspiring in their unique ways. Collectively, this is what truly sets us apart!”

Dennis has been a therapist for 15 years and a Director of Rehabilitation for the past eight years. He graduated with his Bachelor of Science in Occupational Therapy in the Philippines and later completed his Clinical Doctorate in Occupational Therapy with Geriatric Certification in the United States. As a child, Dennis always wanted to become a doctor and thought therapy might be a stepping stone to that career. However, as he immersed himself in his first OT internship, Dennis realized that OT was it for him — a career that would allow him to care for others, be creative and be human. Dennis has two brothers who are his biggest inspiration and mentors: Paul and Kirby. “They are the biggest reasons why I am where I am with my career,” Dennis says.

During the Ensign transition at St. Elizabeth, Dennis saw that culture was a top priority. “It was refreshing to see how involved all employees are in the facility. No longer does each department feel separate from one another. Every staff member is valued equally and has a voice. The support from our resources and Service Center is always present when you need it — this was definitely a big change in mindset for me coming from a corporate hierarchical structure,” Dennis remembers.

Dennis says that his biggest challenge has been being new in our company, new in his role and then having relentless COVID outbreaks in the community to deal with. “It has been stressful at times, but for the most part it is just a big challenge that I am willing to face. I feel like I don’t know a lot of things and that I still need to learn a lot of technical items, but I am excited to listen and grow. There is a huge sense of fulfillment if you know you can be of service to others and spread positive and enriching influence.”

Dennis has shown himself to be a wonderful leader. He loves being able to see his colleagues go out on their own and feel like they can do their jobs well because they feel valued, appreciated, empowered and loved. “Nothing beats the feeling of knowing that they love coming to work, they love their patients and their profession, and they can provide for their families and be themselves,” Dennis explains, “My favorite core value is Love One Another. Love at its core is selfless — the moment we think less of ourselves and more of the betterment of others. This allows us to build a community of trust, and this trust allows us to better serve our facility, our patients and our community.”

Dennis finds mentors throughout his facility. “I see everyone in my facility as my mentor,” he says. “I learn so much from each of the department heads and especially my administrator and DON — they all have strong attributes that complement each other and the whole facility.” Dennis also loves his nursing team and treats them like family. He has been able to build strong relationships with nursing through honest and genuine communication.

In his off-work hours, Dennis is passionate about photography and videography. He owns his own company, and pre-COVID, was very busy providing those services at weddings and other events. He still spends a lot of time taking photos and creating videos for fun. Dennis has also fallen in love with the world of triathlons and has set a goal to complete an Ironman competition in 2021. Favorite movies include “Braveheart,” “50 First Dates,” “Memento,” “Crash,” “Into the Wild” and a variety of Disney movies that he watches with his family.

As for the future, Dennis is focused on both family and work. “I would just love to see my daughter grow to be a nice kid — a good, smiling and happy kid. I want her to get to be who she wants to be and be happy doing that and being helpful to others. I have a goal to spend more quality time with my wife at home and hopefully some future trips together.” Dennis is looking forward to seeing his facility GROW. His goal is to serve more residents with inpatient and outpatient services and be recognized in the community as a skilled nursing facility that provides excellent clinical care that is warm, loving and inviting. He would also love to help spread this to the other Ensign affiliates in his area.

It always seems like something magical and wonderful has happened when a great therapist finds a great place to work and grow. Magic is definitely happening at St. Elizabeth!

Think Thin! Collaboration in Flagstone

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Morgan Nebo
Aggie Smith

Morgan Nebo, Dietary Supervisor at Victoria Post-Acute, and Aggie Smith, Flagstone Dietitian, provided a great presentation to the Flagstone DORs and SLPs on best practices for therapy and dietary collaboration with emphasis on ThinkThin!

Key takeaways from this presentation:
1. CMS — Quality of Care Intent: “To the extent possible, MAINTAIN or IMPROVE before complications arise.”

● Resident HYDRATION is the key (and the challenge) with thickened liquids.
● F692, Quality of Care Nutrition and Hydration, requires that a resident is offered sufficient fluid intake to maintain proper hydration and health.
● As a general rule, most residents will require 1500–2000 cc daily under “normal” circumstances — SLP collaboration.

2. Nutritional Assessment and Risk Identification: Collaboration with SLP and Food/Nutrition to assess a variety of areas.
3. Become familiar with using the information in PCC: i.e., Nutritional Assessment UDA along with CNA input/output reporting.
4. Collaboration is super important during quarterly assessments
5. Become familiar with the facility menu system in the affiliate you are servicing. Review the diet manual standards and follow facility nomenclature. If a facility-wide change is needed, collaborate!

The training was so successful, the LMS team is working on a recording so everyone in the organization can benefit from the great information and have continued collaboration for Think Thin!

Sharing Vital Sign Tips

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

Over the last several months, Victoria Post Acute Care [VPAC] has honed in on vital sign monitoring as part of our daily practice in both nursing and therapy. I’ve been nominated to lead our vital signs committee, and during the next few weeks I’d like to share some of the best practices and education that assisted us through COVID and landed VPAC Vital Sign Grand Champions.

We’ll start with the vital sign we’re all monitoring daily, body temperature. After 8 months of daily screening, you’ve probably noticed a pattern and can guess your morning temperature within a few tenths of a degree; you’ve established your baseline temperature.

Do you know your residents’ baseline temperature? Would you be able to identify a fever and assist in early recognition of an infection?

Regularly measured body temperature is used to establish a baseline temperature and define the threshold temperature for fever. The elderly are noted with a lower baseline body temperature and a shift of 2.4*F above baseline is a fever, even when falling below definition of a fever at 100.4*F.

At VPAC, once a baseline temperature has been established, it is then added in special instructions in the Care Profile in PCC [See photo below]. This baseline temperature can then be used to assist in identifying any potential infection or COC with our residents.

Please don’t hesitate to reach out with any questions. (DawnThompson@ensignservices.net).

 

CAPLICO Moment: Momentum Therapist Spotlight

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By Paul Emerson L. Baloy OTD, OTR/L , DOR, The Hills Post Acute Care, Santa Ana, CA

Denise Del Cano, COTA, ADOR, has dedicated her career in The Hills Post Acute. An alumnus of Santa Ana College, she earned her associate’s degree in Occupational Therapy Assistant 12 years ago and has been with the facility since then. She was promoted to Assistant Director of Rehab last year and completed the DORITO program this year. Denise did her internship here at The Hills. She was supervised by Vonda Gaier, COTA, who then became her colleague. She is a Filipino American born in Los Angeles, California, the eldest of five and a loving mother to her 16-year-old daughter, Elizabeth. Interestingly, Denise was introduced to the field of therapy when her daughter received therapy for several years. Denise saw the importance and relevance of Occupational Therapy and has been an advocate ever since.

Customer Second: Residents approach her knowing that she will listen and immediately respond to their requests. She will ask any of our facility staff how well each one is doing and how she can assist them to make their day better.

Accountability: She assists her supervisor in creating daily schedules and follows up on department needs and requests.

Passion for Learning: She is seeking ways of learning new things, being receptive to new information and understanding, and embracing the Hills Post-Acute way of doing things.

Love One Another: She genuinely cares for the staff. She will hand you a cookie or any treat to perk up your day.
Intelligent Risk Taking She will listen and learn our new way of doing things. Willing to unlearn past habits, think outside the box and develop better and efficient new systems.

Celebration: She will bring in breakfast or lunch to celebrate the day’s hard work, keeping each one’s morale in check and in good shape. She will celebrate birthdays or becoming a new member of the team.

Ownership: She demonstrates ownership by making everything personal because she believes in her heart that this is her second home and that her co-workers are her family.

Code Sepsis: Pilot Program

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Submitted by Esther Allmond, DOR, The Cove at La Jolla, CA

The Cove volunteered to be a pilot site and is now entering their 3rd month for the EPIC program: CODE SEPSIS. Dr. Pouya Afshar handpicked our facility to trial this pilot program to help prevent sepsis in-house by carefully monitoring vitals throughout the day. Throughout this time, we have gained a new appreciation and respect for taking vitals before, during and after therapy treatment sessions. Rehab has taken a more active role in vital signs at The Cove, and I just wanted to share with all of you a little bit more about EPIC, CODE SEPSIS, and our current protocol at our facility.

EPIC (Excellence in Programming and IDT Care): Programs dedicated to taking IDT action with a QAPI approach in order to provide the most excellent care possible for our patients.

CODE SEPSIS MISSION: Early identification of sepsis to improve patient outcomes.

WHY: Sepsis is the leading cause of readmissions to the hospital in 2019 (20% of Medicare readmission!). With every hour that treatment is delayed for sepsis, the mortality rate increases by 8%.

CODE SEPSIS PROTOCOL: Taking vital signs early and often for each of Dr. Afshar’s patients. Nurses take vital signs Q shift (or more often). and therapists take vital signs before each treatment session and enter it into PCC. Notify charge nurse immediately with any one of the following triggers:
1. Temp > 99.5F
2. SBP < 100
3. HR > 90

CODE ACTIVATION/METRICS:
• Clinician identifies patient meeting criteria (initiation, time stamp)
• Notify charge nurse (5 minutes)
• Verify/repeat vitals (5 minutes)
• Nurse activates code (5 minutes)
• Code team clinician contacts on call MD/NP (5 minutes)
• Response back from on call MD/NP (10 minutes)
• Total time spent: 30 minutes
• Reassess at the end of each 30-day cycle
• Duration of phase 1: 90 days

CODE SEPSIS was triggered several times in the past two months, allowing us to implement interventions in a timely manner and preventing re-hospitalization for our patients! As we close the last 30 days of Phase 1, we hope to remain consistent and vigilant in monitoring vital signs for our patients, providing the most EXCELLENT care possible for patients and improving outcomes. Please feel free to reach out to me at any time if you have any questions, comments, feedback, or interest in implementing CODE SEPSIS at your own facilities!

Huge Shout-Out to Emblem Hospice

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By Doug Haney, CEO/ED, Bella Vita Health & Rehabilitation Center, Glendale, AZ

I wanted to recognize this very special “Moment of Truth-esk” gesture that the entire staff of Bella Vita experienced recently. A couple weeks back, our staff was pretty worn down and experiencing a wide range of emotions dealing with the effects felt from this coronavirus. Everyone was especially hurt when we lost several of our long, long-term residents we all called family. We loved each and every one of those we lost and needed some serious support for those who knew them well.

Out of the blue, Michael and Mitch stepped in, offering a memorial service to honor and remember those we lost over the past several months. They set everything up, even though I knew their services were widely needed during that time. I can honestly tell you we cried and held each other a lot during that time. We were grateful for Emblem’s offering and kindness when we needed it the most. One of them brought a grill on wheels (not sure whose it was, but it is pretty sweet) and cooked up burgers and hot dogs for all the staff over a four-hour period. It was hot outside, but Michael didn’t seem to mind it — it was 115 that day.

At 2 p.m. in our main dining room, staff joined together and were allowed to share special memories about their lost friends and then place a leaf with their name on a potted tree. It was good to get together to reminisce, reflect, and realize we were blessed to be a part of their lives.

On behalf of the entire Bella Vita Team, THANK YOU MITCH, MICHAEL AND EMBLEM HOSPICE. You truly made our day!