Group Therapy at the Park

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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!

Capturing the Dimensions of Wellness

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By Shelby Donahoo, Bandera Therapy Resource, Tucson, Arizona
Jordan Monson, ED at Park Avenue Health and Rehabilitation in Tucson, Arizona, attended a breakout session at the Arizona Health Care Association meeting on Wellness Programming. The training was modeled after the “Dimensions of Wellness” concept by the International Council on Active Aging.

The seven dimensions of holistic wellness include: Physical, Social, Spiritual, Vocational, Emotional, Environmental, and Intellectual. Jordan was inspired to expand opportunities for quality of life for those within his facility and quickly assembled a committee consisting of Leaders from Activities, Therapy, and Social Services. The team created a calendar of activities using the dimensions of wellness to ensure comprehensive programming.

Above is an example calendar of events at Park Avenue. Options include Yoga, Tai Chi, Gardening Club, Memory Joggers, Aromatherapy, Poker, Baking Club, Spiritual/Religious Services, Coffee Bar, Drumming, Artistic Expressions, and Seasonal Celebrations.

With Activities and Rehab leading the groups, skilled and long-term care residents participated. It was as though the facility woke up from a long sleep that was COVID. Patients were asking to get up, as they were able to find meaningful activities to motivate them. Residents began forming “friend groups.” People began to have fun nicknames for each other. Quoting therapy staff, “The residents love it. They are happier than they’ve been in a long time.”

As with all new endeavors, the facility had to stick with it, working out the kinks. For Therapy, it was another ”mindset change” on how to deliver services. This program allows Park Avenue to be ahead of the curve in terms of providing functional therapy to patients who have limited resources now and in the future.

Shout-out to Jacob Barnes, TPM, CTO, and Simone Nakfoor, OTR/TEACHA, for their continued contribution to the Wellness Program.

May is Mental Health Awareness Month

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By: Jon Anderson, PT, Therapy Resource
We had such an incredible video shared by some of our colleagues at the Annual Therapy Leadership Meeting as it relates to their journey/struggles/wins in facing mental health challenges. Let’s not lose momentum around the importance of understanding/recognizing mental health issues. Awareness has become an increasingly important topic in recent years, as people have started to recognize the impact that mental health can have on their overall well-being. Mental health is just as important as physical health, and taking care of your mental health is essential for leading a fulfilling life.

One of the most important things you can do for your mental health is to be aware of it. This means understanding the signs and symptoms of mental health issues and knowing when to seek help. It also means being aware of the stigma that is often associated with mental health and working to break down those barriers.

Self-care is an essential component of mental health awareness. Self-care refers to the actions that you take to care for your physical, emotional, and mental well-being. Here are some ideas on things you can do to practice self-care:

  1. Practice mindfulness: Mindfulness is the practice of being present in the moment, without judgment. This can help reduce stress and anxiety and improve overall well-being. Try incorporating mindfulness into your daily routine by practicing meditation or deep breathing exercises.
  2. Get enough sleep: Sleep is crucial for mental health. Lack of sleep can lead to irritability, anxiety, and depression. Make sure you are getting enough sleep each night, and try to establish a regular sleep routine.
  3. Exercise: Exercise is not only good for your physical health, but it can also have a positive impact on your mental health. Exercise can help reduce stress and anxiety and improve your mood. Try to incorporate exercise into your daily routine, even if it’s just a short walk around the block.
  4. Connect with others: Connection with others is essential for mental health. Make time to connect with friends and family, and consider joining a support group or seeking out counseling if you are struggling.
  5. Take breaks: It’s important to take breaks throughout the day to recharge and rejuvenate. This can be as simple as taking a few deep breaths, going for a walk, or taking a short nap.
  6. Practice self-compassion: Be kind to yourself. Practice self-compassion by treating yourself with the same kindness and understanding you would offer a friend.
  7. Limit social media: social media can be overwhelming and contribute to feelings of anxiety and depression. Consider limiting your social media use or taking a break from it altogether.

Remember, mental health is just as important as physical health. Practicing self-care and being aware of your mental health can help you lead a happier, healthier life. If you or someone you know is struggling with mental health issues, don’t hesitate to seek help. There are so many resources available within the organization, and you don’t have to go through it alone. Check out all of our Wellness Resources available at: https://www.ensignbenefits.com/health-wellness/mentalhealth

Welcome to our New Flagstone Facilities

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Submitted by: Roxie Maceda, Lead MDS Resource of Flagstone
February 1, 2023 was a very special day for Flagstone. It was the day when 17 new facilities joined our growing bigger and happier family. Apart from celebrating with them, we made sure we did education activities. Even before 2/1, we already had some boot camp sessions with their ED’s, DON’s and Therapy. We also had 4 PDPM Basic Workshops last February 15, 16, 17 and 28. The workshops included the Facility IDT, and these were hosted by the Flagstone MDS, Clinical, Therapy, AR Resources and Compliance partners. Our topics included PDPM in a Nutshell, MSCA and CCA Audit preparedness, the different roles each IDT member plays in PDPM, To IPA or not IPA and Waiver updates. Since they joined us, we’ve introduced the many great and handy PDPM tools and Tips sheets with them. We also did some fun ice breakers in between topics. To make it a full circle, after the PDPM Workshops, they all then participated in the IDT Master Class.

One month has passed since our new facilities have joined us and looking at their metrics and performances, we are proud to say, despite the hiccups here and there, the overall transition was a very big success. This successful outcome is due in major part to the collaboration of all the Resources and openness of our 17 new members. There were many partners throughout the organization who travelled all the way to the Golden State and from the Flagstone family, we Thank each one of you!

Welcome to our Family!

  1. Grand Terrace Health Care Ctr in Grand Terrace, Ca. (59 beds)
  2. Palm Terrace Care Center in Riverside, Ca. (75 beds)
  3. Garden View Post-Acute Rehab in Baldwin Park, Ca. (97 beds)
  4. Ramona in El Monte, Ca. (148 beds)
  5. Lake Balboa Care Center in Van Nuys, Ca. (50 beds)
  6. Chatsworth Park Health Care in Chatsworth, Ca. (128 beds)
  7. Danville Post-Acute Rehab in Danville, Ca. (53 beds)
  8. Pacifica Nursing & Rehab Ctr in Pacifica, Ca. (68 beds)
  9. Fairfield Post-Acute Rehab in Fairfield, Ca. (99 beds)
  10. Fairmont Rehabilitation Hosp in Lodi, Ca. (59 beds)
  11. Beachside Nursing Center in Huntington Beach, Ca. (59 beds)
  12. Coventry Court Health Center in Anaheim, Ca. (97 beds)
  13. New Orange Hills (Orange Coast) in New Orange, Ca. (145 beds)
  14. Alamitos-Belmont Rehab Hosp in Long Beach, Ca. (94 beds)
  15. Broadway by the Sea in Long Beach, Ca. (98 beds)
  16. Edgewater Skilled Nursing Ctr in Long Beach, Ca. (81 beds)
  17. Lomita Post-Acute Care Center in Lomita, Ca. (71 beds)

Presenting the First CMO Award for Endura

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By Maryanne Bowles, Endura Therapy Resource, Colorado
Back in January 2021, I presented on the resource call about thinking outside of the box on what therapy could do to help Clinical and opportunities we could take. I presented on an MDS coordinator position being held by a therapist. The position works closely with the nursing team and completed MDS are reviewed and signed by a nurse. In this situation our therapist MDS coordinator has her work signed off by her MDS coordinator Apollonia Williams, RN, MDS Coordinator

This week, we presented Carolyn Pluta, OTR/L, CMC, MDS coordinator at South Valley Post-Acute, with the first CMO award for Endura. As the MDS Resource Appy Williams, RN wrote: “Carolyn, thank you for all of your hard work and dedication. You’ve helped pave the way in MDS for Endura, and we are so grateful for all you have done.”

Carolyn began her career as an OT at Julia Temple Specialized Care in 2015 as a staff OT and clinical lead. Carolyn wanted to grow as a leader in therapy. Carolyn then became the DOR at Arvada Care Center in 2017 through 2021 and was a therapy Summit attendee in 2019. Carolyn wanted to grow within the company she loved and with the population she adored, so she expressed interest in the MDS coordinator position with her supervisors and colleagues. “People can’t support you or let you know of opportunities if they don’t know what you are striving for,” she notes. She applied at our Acquisition building South Valley Post Acute and grew to become the first cluster lead MDS coordinator and a mentor for new MDS coordinators. She truly has helped to hold the facility accountable to reach its goals each quarter. We are proud of Carolyn and where she has gone with her desire to achieve this honor in her role. Congratulations — what a great success!

From NBCOT News Release: Certified Occupational Therapy Assistant Wins Prestigious NBCOT Impact Award

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Congratulations Patty Fantauzzo, CTO/COTA/L, TPM, Julia Temple, Englewood, CO

Gaithersburg, MD: The National Board for Certification in Occupational Therapy, Inc. (NBCOT®) announces Patricia “Patty” Fantauzzo, COTA/L, a certified occupational therapy assistant from Castle Rock, CO, has won the 2022 NBCOT Impact Award. This award recognizes certified occupational therapy (OT) practitioners who demonstrate exceptional professional commitment through their dedication, hard work, and outstanding OT skills to improve their clients’ overall life satisfaction.

Patty received the NBCOT Impact Award because of her dedication to providing services for people with Alzheimer’s disease and other dementias. Patty’s colleague Malissa Sanchez, COTA/L, nominated her for the award. At Julia Temple Healthcare, Patty created a therapy program that uses the Abilities Care Approach to ensure long-term care residents who have Alzheimer’s and dementia progress through the disease process with dignity and comfort while maintaining their highest practicable level of cognitive and physical function. Prior to Patty’s involvement, long-term care residents with cognitive impairments at Julia Temple were less likely to receive skilled therapy services. Patty’s approach to providing care is to focus on the residents’ remaining abilities instead of their deficits and to consider what the resident can do or may do based on their preferences. Patty’s team of therapists embraced this philosophy and as a result, they completely transformed the therapy department and the facility as a whole. Through this approach, therapists and physicians also have a better understanding of each resident’s individual abilities and needs, which has enabled them to interact with residents in a more meaningful way. Several program outcomes can be partly traced back to Patty’s work, including a reduction in resident altercations, increased resident independence with certain tasks, and fewer prescriptions for psychotropic medications.

Patty earned her national OT certification in 1995. She is the Therapy Program Manager and Chief Therapy Officer (our highest designation for a Therapy Leader) at Julia Temple Healthcare in Colorado. Patty has shared her knowledge on dementia programming at Colorado Occupational Therapy Association’s annual conference and to dementia support groups and practitioners at Julia Temple. She also assisted two sister facilities in introducing dementia programming to their long-term care services. Patty has received several awards for her work, including the Agatha Jackson COTA Award of Excellence from the Colorado Occupational Therapy Association and the COTA of the Year award from the Arizona Occupational Therapy Association.

For more information about the NBCOT Impact Award, visit www.nbcot.org/awards.

The Hills Got Skills 2.0

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By Sadaf Roodbaei, NHA, MS CCC-SLP; Angelica Reyes, RN, DON; Paul Emerson Baloy OTD, OTR/L, DOR
The Hills Post-Acute held its second annual skills fair for our nursing staff on Thursday, Sept 15, 2022. This year’s theme was cunningly conceptualized as Circus Carnival. Our leaders Sadaf, ED and Angie, DON, with the support of all the department heads, creatively put together the circus carnival, themed Passion for Learning, as an experience for all our nursing staff to enjoy. No details were forgotten. They had everything from cotton candy machines, candy claw machine, hotdog warmers, lots of balloons, popcorn maker, circus decor, food and games, which were all set up to make the most of the clever and innovative event.

With the unwavering support from vendor and cluster partners, as well as resources, booths were assigned to discuss, educate and demonstrate specific information on skills to refresh and revitalize our nursing staff’s clinical competencies, which translates into continuing to provide of quality, top-notch care to our residents. The skills training content and competency checklist were strategically based on past survey opportunities, facility assessment and current device and equipment training. This ambitious feat was once again satisfactorily completed for the books! A testament in the pursuit of elevating post-acute care in the eyes of the world.

Let’s Talk Long-Term Care Programming: Tips and Tricks for SLPs working with Dementia

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By Nicole King MA, CCC-SLP, Julia Temple Health Care Center, Englewood, CO
Use meal times to your advantage! Not only can you check in on your swallowing patients, but it is a great time to address following directions, sequencing, and attention during simple functional tasks — such as adding cream and sugar to their coffee, hand hygiene, cutting up their food, etc.
It is also a great time to address communication and social interactions. The facility is their home. Tasks that might not be functional for your skilled population are functional and meaningful in LTC and memory care neighborhoods — for example, deciding which snack they want, finding their room, participating in activities, and deciding when and where they will eat.

Partner up with Activities or the Chaplain. They can provide the task, but you can provide the skilled eye, environmental modifications, and dynamic cueing that allows the residents to participate in a meaningful and engaged way. Maybe your restless patient needs to be able to come and go from the area, or certain residents shouldn’t sit near each other. It could be the resident needs parallel involvement that allows them to participate but with less environmental stimuli and/or distractions.

Don’t be afraid to “hang out” in the memory care neighborhood. Using a naturalistic approach allows you to see patterns in behavior, identify triggers of agitation, find other patients to evaluate, and get to know the staff better. I also try to do my documentation there because it provides me with more time to observe and engage.

Take credit for what you are doing! Don’t assume that the intervention or strategy is obvious to everyone. Sometimes the smallest change can make all the difference. At JT, we had a patient who played with her food during meals and it upset nearby residents. After assessing her response to her environment over a few meals and analyzing how she engaged with her surroundings and staff, it hit me. She only played with her food on the days her appetite was low. It was her way of letting us know she was full.

Think outside the box and step out of your comfort zone! Let go of the idea that your therapy should look a certain way. Language and communication opportunities are everywhere. Remember it isn’t always about restoring lost skills/function, but changing the environment or how we interact with them, or creating opportunities for them to succeed based on the skills they still have.

Documentation. We all know documentation is important, but with LTC therapy and skilled maintenance, it is crucial. To an outsider, it might look like you just sat next to a patient during an activity. But what you actually did was “facilitated optimal patient participation during preferred leisure task by incorporating dynamic cueing hierarchy, environmental modifications, errorless learning techniques, and spared skills.” Always document the functions or presentations that you assessed in order to know what to do, and exactly how what you saw guided the interventions you selected. The skill lies in the assessment you performed, and how you acted on that assessment.

Goals. The questions I get asked most frequently are related to setting goals. Here are a few of my favorites:

  • Patient will demonstrate ability to use verbal and nonverbal communication to make decisions related to preferences during care tasks and daily routine with MOD A to facilitate highest level of independence on nursing unit
  • Patient will maintain ability to complete 3-4 conversational exchanges related to direct and observable topics using multisensory stimuli in order to reduce risk of social isolation and decrease in meaningful interactions
  • Patient will maintain current level of cognitive communication function to actively participate (following along with handout, switching between tasks, singing along, etc.) in weekly worship service with MIN-MOD A in order to preserve quality of life and highest level of independence with leisure activities of choice
  • And finally, remember that being able to support ongoing therapy for maintaining function requires evidence that only you can do what needs to be done. Once the patient’s function looks consistent, or what you need to do changes very little from session to session then it’s time to phase yourself out and hand over those activities to others.

Educational Nugget: Association Physical Activity and Risk of Depression

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Submitted by Jessica Foster, Therapy Resource, Bandera, Arizona
What are they saying? (**Definition of PA – Physical Activity)
The Message
The connection between physical activity and a lower risk of depression is well-known, but less is understood about the extent to which higher amounts of PA result in lower risks for depression. Researchers who analyzed the results of 15 studies involving more than 190,000 participants believe they’ve come closer to an answer: Yes, there is a dose-response relationship, they write, but it’s most significant (and predictable) at the lower end of the PA spectrum. Overall, they assert, if less-active adults in the studies had met current PA recommendations, one in nine cases of depression could’ve been prevented.

Why It Matters
Authors believe that establishing the dose-response relationship between PA and depression could be an important tool for health care providers and others in sharing the benefits of even modest amounts of PA, “especially to inactive individuals who may perceive the current recommended target as unrealistic,” they write.

More from the Study
Pinpointing the reasons for PA’s effects on depression were outside the scope of the study, but authors speculate that they could include neuro-endocrine and inflammatory responses, improved physical self-perceptions and more social interactions, and the effects of greater time spent in green spaces. The interplay of these factors needs more study, they add, particularly when considering how individuals with less access to green spaces and greater exposure to noise pollution may experience reduced mental health benefits.

Keep in Mind …
The study is not without its limitations, according to authors. Among them: PA levels were self-reported, data was limited at higher levels of PA, and data was lacking for analysis of demographic subgroups, including those from lower- and middle-income countries.

Introducing LSVT eLOUD Speech Therapy Program

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Submitted by Elyse Matson, MA CCC-SLP, SLP Resource
Carmel Mountain Rehabilitation and Healthcare Center in San Diego, CA, announces the launch of their new LSVT eLOUD outpatient speech therapy program via telepractice! (have photo)

On Saturday, April 9, the Parkinson’s Association of San Diego (PASD) hosted their 20th annual Step-by-Step 5K Walk. This event funds PASD to provide thousands of critical resources to individuals with Parkinson’s locally. Including over 1,000 participants and 40 exhibitors and sponsors, this event was an incredible testament to the strength and dedication of the Parkinson’s community here in San Diego.

Carmel Mountain Rehabilitation and Healthcare Center had the opportunity to sponsor this event through promotion of their new LSVT eLOUD telehealth outpatient program pioneered by Speech-Language Pathologist Emory D’Andrea.

LSVT eLOUD is clinically proven to be as effective in improving vocal loudness and overall speech intelligibility in individuals with Parkinson’s as when the program is provided in person. The difference? eLOUD is provided via zoom.com.

Throughout the pandemic, our skilled nursing facilities have phased in and out of outbreaks and “red zones.” This has not only made it challenging for therapists to provide outpatient therapy, but more importantly, has deterred individuals with comorbidities from traveling to a clinic due to the risk of exposure. The goal of LSVT eLOUD via telepractice is to break these barriers by increasing accessibility, enhance feasibility (intense dodge 16 one-hour sessions in one month), increase frequency of long-term follow-up, and diminish the physical and mental burden of traveling to clinics.

Through LSVT eLOUD, we are excited to empower more people with Parkinson’s disease to live LOUDER and BETTER lives! Contact: THINKeLOUD@gmail.com