Classroom DOR Meeting

DORs Meet at Service Center

Building Therapy Leaders News

Classroom DOR Meeting

The DOR meeting held June 23 and 24 was the first large group to use the newly renovated training room at the Service Center. The two days were a great experience jam-packed with fun, creative and informative lectures. Some of the highlights included:

Culture Training—Dave and Mike

MDS 3.0/RUGs IV—Carol Maher

FallPROOF—Debra Rose

Groups: A Dynamic Approach to Patient Care

Three DORs presented strategies they’ve implemented in their facilities for group treatment: Gina Tucker-Roghi, Park View Gardens, Mary Egbert, Draper Rehab & Care, Sonya Taylor, Park Manor Rehab Center
The Group Therapy Committee, led by Lorraine Finnegan, distributed a binder of great group therapy ideas!

Ensign Company Update—Christopher

Creating Solutions Through Modalities—ACP

Employee 1st: Systems for Recruiting, Hiring and Retention—Carissa Podesta, Jamie Funk and Carol Elassad (DOR, Desert Terrace)

Team building “Beach Games” were held Tuesday evening at Doheny State Beach in Dana Point.

Draper Wins Pinnacle Award

Draper Wins Pinnacle Award

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Draper Wins Pinnacle Award
Congratulations to Draper Rehab and Care Center who has garnered the Best in Class Award from Pinnacle Insight for the second consecutive year! Founded in 1996, Pinnacle Insight exclusively serves the health care industry and primarily works with senior and long-term care providers. They serve more than 1100 health care providers in 45 states, as well as some parts of Canada. Pinnacle rates different categories such as nursing care, rehab care, food service, cleanliness of facility, etc. with a ranking system of 1 to 5… 5 being best in class.

Pinnacle Insight believes that patient satisfaction is the key to success in the health care industry. They also believe that a good patient satisfaction process should not only measure key areas of satisfaction, but also provide feedback and direction on how to improve these areas.

Pinnacle conducts actual one-on-one interviews on a monthly basis designed to draw out candid, detailed feedback from the patients and their families. Draper Rehab and Care Center rehab department has consistently received high scores. Draper is so proud to have received the Pinnacle Insight Best in Class award for its dedicated rehab team. They continue to strive for excellence both in therapy outcomes and patient satisfaction.

Group Game Therapy

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Group Game Therapy
Linnea Laufer and Laura Hessig, COTAs at Park View Gardens, joined their creative talents to create an OT treatment game that we frequently use with our patients. They created the game about two years ago in response to a request that the department increase the use of group treatments. Not only did they come up with a great idea, but they managed to include the patients in the creation of the game itself, which added to the overall experience!

The game is played as a board game with up to four players. Each player has a marker for the game board, and there is one large die. The spaces on the game board include a wide variety of tasks that the players are asked to perform. If a player lands on a task that they are unable to perform due to their level of disability, they are asked to pick an alternate card, which typically defines a cognitive/social task to perform. Some of the tasks included in the game are: changing a pillow case, picking up five bean bags with a reacher, donning a hospital gown, stacking cones positioned at a therapeutic distance, and doing exercises with a weight bar or stick. The activities can be graded in difficulty by having them perform from a seated or standing position as appropriate. The alternate questions that are used when a task seems inappropriate include memory questions like naming the other players at the table, telling what they had for breakfast, and stating the date. There is also a card that asks them to give a compliment to the person on their right, and one that asks what they are to do with the wheelchair before standing.

We keep the supplies all together so there is no time spent gathering items when a therapist wants to use the game. The supplies for the tasks we use in the game are a dressing stick and reacher, theraband, hospital gown, empty pill bottle and beans, five cones, two towels, five bean bags, a pillow and pillow case, ball, and a cane or weighted stick.

To create the game, Linnea and Laura had patients help with tasks while working on fine motor skills and standing activities:

Cutting out the shapes for the game board spaces and alternate cards
Gluing the shapes on the pages
Hole punching the pages.
Tying the pages together

The pages were laminated and tied together to create a game board that folds down to the size of a single piece of paper. When the board is laid out on a table, it is large enough for all the patients to reach it, and the therapist can turn it to face whichever patient is having their turn.

The patients have great fun and encourage each other during the game. The socialization and camaraderie are also a great benefit to our patients!

Group Therapy at Desert Terrace

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Group Therapy at Desert Terrace

At Desert Terrace, we began doing groups for 3 reasons:

1. Increase patient motivation with therapy;
2. Improve efficiency on days with meetings;
3. To have more fun at work!

We perform several groups. On Fridays, our occupational therapy department has cooking groups. Each patient has a preparation task and a clean-up task to perform. They typically do a cooking breakfast group starting at 6:30 a.m.; although, we have also had groups making salsa, cookies, and salad.

The physical therapy department has multiple physical activity groups. We play volleyball, have obstacle courses, basketball toss, static and dynamic balance, and gait groups. Because we are an inner-city facility with many patients who use public transportation, we coordinate real-life community integration groups. The building gives each patient participating $5. We use public transportation and go to a nearby Wal-Mart or pharmacy to practice real-life community interactions.

We have discovered that our groups, especially the volleyball and basketball toss, motivate patients to stand and participate at a higher level than they would with traditional 1:1 therapy. We give prizes to the winners, which is another great motivator!

One idea we have for a future group is to obtain some fishing poles since we have a canal that runs behind our building. Our plan is to put weights on the fishing lines and just let folks “fish” for relaxation, balance, standing endurance, and upper extremity strength and mobility. In the next 90 days, we are also planning on starting a gardening group and a diabetic group. The diabetic group will include nursing, dietary, and physical therapy to discuss the importance of following a diabetic diet, and weight bearing and skin care orders to prevent and help heal diabetic wounds.

We have also found a book with some games that will help us come up with even more groups. Future plans include putting (as in golf), bowling, dart ball, and ring toss. Speech therapy has discussed beginning a card group on Friday afternoons.

We are excited to begin looking for other ways for our patients and for ourselves to have fun in therapy. We would love to hear what others are doing and will be glad to share information anyone may need.

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Fall Proof

Fall Proof

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Fall ProofA Comprehensive Balance and Mobility Training Program

Congratulations to the following therapists in Milestone who have completed the FallProofTM program and have become Certified FallProofTM Balance and Mobility instructors:

Mary Egbert, DOR
Draper Rehabilitation and Care

Sam Baxter, DOR
Orem Rehabilitation and Nursing

Scott Crider, DOR
Pinnacle Nursing & Rehabilitation Center

Jill Schuette, DOR
Pocatello Care and Rehabilitation Center

The FallProofTM Certificate Program is the first program of its kind to be offered in the United States. FallProofTM was founded by Dr. Debra Rose, Professor in the Department of Kinesiology at California State University, Fullerton, Director of the Center for Successful Aging and Co-Director of the Fall Prevention Center of Excellence. Dr. Rose is nationally and internationally recognized for her work in the area of fall risk reduction programming.

Fall ProofThe FallProofTM program was created to provide professionals the knowledge and practical skills necessary to implement an evidence-based balance and mobility training program for older adults. It is designed for community dwelling and residential care setting populations. This provides our therapists and facilities the opportunity to outreach into our surrounding communities and offer a needed service. The program is taught in a group setting; twice a week over several weeks. Dr. Rose is currently developing and tailoring this program for the more frail and higher fall-risk individuals.

The certification course is divided into two sections. Students complete the didactic portion by completing seven learning modules via the internet, including video or audio-base lectures, learning labs and case studies.
The second portion is a three-day on-site training where the FallProofTM faculty provide instruction and feedback. Students who participate are given a Pass, Conditional Pass or Not Pass score following a practical exam.

Therapists who are Certified FallProofTM instructors have more “tools in the bag” to tailor the knowledge and skills learned from this program to provide more creative and pertinent treatment in individual and group settings.

Clinical and field tests were taught to provide our therapists ways to objectively assess, document and determine improvement within our clientele. These tests include the Fullerton Advanced Balance (FAB) Scale, Berg Balance Scale, 30-foot walk, Senior Fitness Test, 8-foot Up and Go Test, and the Walkie-Talkie test.

Group Therapy at Park View Gardens

Group Therapy at Park View Gardens

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Group Therapy at Park View Gardens

The changes we anticipate coming from Medicare in October 2010 are approaching fast and challenging us to think out of the box. At Park View Gardens we have decided to get busy practicing some strategies that will help us bring fresh treatment ideas into our practice while maintaining the department’s financial stability. We believe regularly scheduled groups will help us achieve this goal. We expect that group treatments will help us manage our productivity in light of billing changes when treating concurrently. We also think our groups will enrich the treatments our patients receive, and will be advantageous to us in highlighting the many skills of our therapy staff. We would like to share our experience in making this transition to group treatments with the hope that you can learn from some of our experiences.

Facility Profile:

We have 114 beds and are well staffed in rehab with a stable and devoted team of therapists. We typically run 25-35 skilled patients at any given time, with a 20-25% HMO caseload. We have a newly remodeled rehab gym, which is very busy during much of the day and can be loud and crowded. We have 1 full-time and 1 part-time rehab aide. In the past, we have used group as a treatment enhancement around holiday times and based on the interests of given patients or therapists (usually OTs).

Our Challenges (aka excuses):

1. We were hesitant to make a big change. Frankly, the task of changing our method of delivering our therapy services felt a little daunting. The planned implementation date came at a time when facility census was high. It was a real challenge to think about creating changes when we were so busy.

2. How can we fit a group into our crowded gym? We felt we had space issues.

3. We felt disorganized. We usually found that when we did groups, the amount of time saved in the group was somewhat offset by the time needed to gather materials and sufficiently plan.

Our assets (what we have going for us):

A stable and devoted team. Our team is always up for a challenge and generally has a can-do attitude when presented with a challenge. We also have a devoted rehab aide who helps our well-oiled operation run.

Facility support. The department head team was open to trying something new and helped me find solutions to our space and scheduling needs.

Time. Because we are getting a headstart on this, we feel we have time to prepare ourselves and the facility so we don’t set ourselves up for failure.

Planning. Goals and an implementation schedule help to keep us on track.

Communication. Staff meetings to give and receive feedback are vital.

A large enough caseload and varied case mix that allows us to easily group patients with like needs together.

The Planning Phase:

I was pleasantly surprised by the positive and upbeat response of the therapy team. They were initially given a task to brainstorm group treatment ideas and come up with a group they would like to lead as well as the material they needed to do the group. We had some great ideas generated and there was a lot of buzz in the department!

I met with the activities director to discuss the use of the activity rooms during times when they are not in use. We outlined the times available for therapy groups throughout the week, and I had the beginnings of a schedule. I also met with our nursing scheduler who was gracious in taking on the task of communicating to the CNAs regarding the daily therapy group schedules.

Implementation:

We were looking for ways to more efficiently run a group. One of the issues identified was that the gathering of materials was time-consuming. We decided to create kits for our groups. As an example, our lower body dressing group kit includes oversized clothing that patients are able to don over their clothing as well as adaptive equipment. (We decided to keep this separate from the other department supplies to avoid the need to hunt for equipment right before the group.) The kit also includes patient handouts on hip precautions and other adaptive dressing techniques. It is kept together and labeled as a dressing group kit. This way, the therapist can just grab it and go.

Another important part of making groups run smoothly is to schedule them out in advance with the time, location, and patient names. This information is completed for the next week on Friday, with a copy given to the therapists and nursing. This helps the CNAs and therapists plan their day with the patients.

We decided to use our “caught in the act” program to thank CNAs who bring patients to group in a timely manner. When a patient is brought to the group on time, the CNA who assisted the patient is given a card that is later entered into a drawing. It is also important that all therapists in the department have a copy of the weekly list so they can plan their treatment times around the group schedule for the day.

Future Goals:

We are currently running 3 groups per week for OT and three groups per week for PT. SLP has also added one dining group per week. We plan to hold steady with this schedule for the next month while we complete our supply kits and while the facility acclimates to our new group schedules. After this period of adjustment is complete, we will add one more group for OT and PT per week as census allows.