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

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

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

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

When the Going gets Tough, Keystone Gets Tougher

Submitted by Kari Rhodes, MS, CCC-SLP, Therapy Resource, Keystone West Texas
When the fog lifted from our initial COVID outbreaks in 2020, we breathed a sigh of collective relief. Vaccines were coming, cases were dropping, and visitations were resuming. We thought the worst was over. Small outbreaks here and there were managed, and PPE was easier to find.

Little did we know that the Omicron variant was going to wreak the havoc that it has on our facilities. As we ended 2021 and entered 2022, outbreaks were looming large yet again, affecting residents and more staff than ever before. As we have seen staffing shortages in nursing, we are seeing the effects of unprecedented therapist shortages. As we struggle to find a balance to avoid burnout and meet the needs of our ladies and gentlemen, the Keystone Therapy Markets have worked hard to get tougher!

At a small gathering of Keystone Therapy Resources in San Antonio in December, we talked openly about how we can best support each other in times of need. There were honest conversations about asking for help, text threads with motivating statements, and a lot of loving competition between the recently separated markets. In times of high levels of burnout, it often seems like a contraindication to challenge each other. However, the extra challenges put forth between us and a healthy amount of friendly competition work well to spur us on to do better work for each other, our teams, and our residents. Additionally, the open level of communication allows each member of the team to feel heard and supported, a necessary component of forging onward through the crises at hand. These methods of support then trickle out to our clinical resources, our market leads, and our floor staff.

As we tell the family members of our residents frequently, you cannot care for someone else if you are not caring for yourself! Taking time to rest and surrounding yourself with others who support you are essential for being essential personnel. When times in Keystone are tough, we are tougher because we are better together!

Walla Walla, Washington is a Hidden Gem!

Walla Walla Valley has much to offer its residents and visitors. Miles of road and mountain biking trails are available for cyclists of all abilities. For those who like to move fast or experience speed from the bleachers, head out to the local drag racing strip. In the winter, Bluewood Ski Area is a gathering place for many of the locals who enjoy skiing and snowboarding on a less crowded mountain. There are 120 wineries in Walla Walla Valley. You can go on tasting tours, drive through the vineyards for spectacular views, or head out to the many restaurants that serve wines from the local wineries. Many city parks including a dog park are available to residents and visitors. Lakes in the area provide places for hiking, camping, fishing, and paddle boarding. This truly is a wonderful place to live and work. 

Another great place In Walla Walla is Park Manor Rehabilitation Center. A skilled nursing facility that some residents of Walla Walla call home or come for a short time to recover before heading back home. Park Manor has a strong nursing and therapy team and are looking for a Speech Language Pathologist to join the them. Come see what Walla Walla and Park Manor have to offer!

Pacific Care - Grays Harbor Now Hiring!

What do Kurt Cobain (Alternative Rock Star), Bryan Danielson (WWF wrestler Daniel Bryan) and Peter Norton (Norton Anti-Virus) have in common? They are all from Aberdeen WA, Grays Harbor county. Grays Harbor is also known for its history in the lumber industry, top surfing spots on the Washington coast, amazing cranberry bogs, and some of the best offshore fishing and clamming in Washington State. Only an hour away from Olympia on the scenic Olympic highway. Quaint communities make up all of Grays Harbor and the residents love living in and being from the area.

Among these communities in Hoquiam, WA, Pacific Care and Rehabilitation is a skilled nursing facility that provides the best therapy and nursing services in the area. The staff at Pacific Care love their residents and live their mission to dignify long-term care and skilled rehab in the eyes of the world.

They have an opening on their in-house therapy team for an Occupational therapist. The facility is locally owned and operated with decisions made by local leaders. Let your voice be heard and be able to practice at the top of your license. Be a part of amazing clinical development, career growth, and leadership training opportunities. Come be part of something great! 

Pacific Care is currently offering an amazing career opportunity for an Occupational Therapist. Find out more about this amazing opportunity and browse our complete list of therapy job opportunities.

Revitalized Vital Signs! The Winners Are…..

By Tamala Sammons, M.A. CCC-SLP, Senior Therapy Resource
A huge thank-you to everyone who submitted information on how vital signs in therapy are being integrated at their facilities. We had amazing entries from across the organization. We were blown away by how vital signs have become such an integral piece of therapy services. We read the most clinically comprehensive documentation and saw how decisions around care were driven by vital signs during therapy sessions. We also were impressed on how vital signs data collected in therapy was used for IDT communication to ensure the very best collaborative care.

Overall we want to thank everyone – whether you submitted something in or not – for your focus on providing the best care using all resources, including integrating vital signs.

Here are this year’s Revitalized Vital Signs champions! Please join me in congratulating and celebrating the following facilities:

Vital Signs Grand Champions

● Shawnee PARC – Angie Taylor, Therapy Leader
● The Oaks at Lakewood – Glenn Aricaya, Therapy Leader
● Keystone Ridge – Tara Meyerpeter, Therapy Leader
● Cedar Pointe – Dustin Rex, Therapy Leader
● Legend Oaks Waxahachie – Evette Ramirez, Therapy Leader
● City Creek Post-Acute – Ray Yarman, Therapy Leader
● San Marcos Rehab – Ashley Keenan, Therapy Leader
● Rowlett Health and Rehab – Dana Pike, Therapy Leader
● Hays Nursing and Rehab – Reed Edwards, Therapy Leader
● Victoria Post-Acute – Dawn Thompson, Therapy Leader
● Kirkwood Manor – Heidi Gulley, Therapy Leader

Vital Signs Champions

● Legend – Gladewater – Jason Goza, Therapy Leader
● Northern Oaks – Sarah Adams, Therapy Leader
● Legend – Greenville – George Palin, Therapy Leader
● Windsor Rehab – Augustus Gray, Therapy Leader
● McCall – Ellie Toscan, Therapy Leader
● Rose Villa – Loren Penuliar / Lito Ortiz, Therapy Leaders

Vital Signs Honorable Mentions

● Hunter’s Pond – Sonia West, Therapy Leader
● Mesa Springs Health Care Center – Monica Sharpe, Therapy Leader
● Cambridge – Kapil Thakkar, Therapy Leader
● Legend – Paris – Quinn Hall, Therapy Leader

Therapy and Nursing Work Together to Prepare for COVID Outbreaks

By Dominic DeLaquil, PT, Therapy Resource Pennant – Idaho/Nevada
Just a couple of months ago, you could almost hear the collective sigh of relief as we were looking forward to a return to a more normal routine in our facilities. 2020 was a difficult year, as we were constantly pivoting to adapt to changing protocols in each building as outbreaks occurred, settled down, then surged again. The beginning of summer 2021 was bright with promise, most of our residents had been vaccinated, COVID case rates were dropping, and hope was in the air. Then the Delta variant showed up.

As one DOR in Idaho said, “As much as I’d like to bury my head in the sand about it, it does make sense to start preparing now.” So the Infinity and Lady Luck clusters in Idaho/Nevada asked the market Infection Prevention nurse, Clinical Resource Kristin Mumford, to join their next DOR call. The DORs and Kristin had a robust conversation, discussing topics such as how to manage therapist movements in a building, the importance of therapy to the psychosocial and physical well-being of residents when they have to stay in their rooms, the value of Therapy helping out our Nursing partners throughout the building in various “non-therapy” ways when extra help is needed on the floor, and other topics.

The conversation was an important early step to prepare for the worst, while we hope for the best. The conversation was productive for nursing and therapy, and the DORs left the call with agreements to their cluster partner DORs to each set up meetings with their DONs and EDs to discuss the plans in their buildings and how Therapy can help Nursing, serve the residents, and partner to ensure the best infection prevention protocols.

north mountain rehab hiring

Who Wouldn’t Want To Work For North Mountain? -WE’RE HIRING!

Calli Carlson is our dynamic rehab director at North Mountain Medical & Rehabilitation Center in Phoenix.  She started out as a staff Occupational Therapist here and feels privileged to now lead this team.  She says she has always been amazed by this group – they are compassionate, hard-working, ethical, intelligent and fully committed to helping patients reach their maximum independence.  The North Mountain team gets to work with a diverse and interesting group of patients since the facility accepts trach, vent or dialysis patients who are very medically complex and have spent a lot of time in a hospital setting. When the team first evaluates a patient, it is not uncommon for the patient to require full, two-person assist just to sit up at he edge of the bed for a few minutes.  It is incredible and rewarding to see those same patients eventually stand, walk, dress themselves, and return home to their families and lives that they love.  “Our therapists see the potential in our patients and help motivate and inspire them even when they cannot see the potential in themselves.  It is really a special thing,” says Calli.

North Mountain has become well known for their potluck celebrations and takes advantage of any opportunity to celebrate.  In addition to a dynamic and dedicated therapy team, the facility has a wonderful interdisciplinary team where there is mutual respect and accountability between departments and a high level of communication between all members of the team.  They hold themselves and their colleagues to a very high standard.

Calli and the therapy team have had uncountable meaningful experiences with their patients over the years.  A recent one involved a patient who had suffered a stroke six months prior to coming to North Mountain and had been residing at a different skilled nursing facility.  He had been in bed for the past six months, had very little strength, and was very depressed.  Within the first two weeks, the North Mountain team had him up in a wheelchair and standing with two therapists, a bilateral knee block and grab bars when he face timed his wife.  His wife was crying tears of joy and he was smiling – the first smile the therapy team had seen from him.  You could just feel that he finally had hope.  This patient continue to work with therapy and progress – and his wife is so pleased that our therapists were able to see his potential when others did not. 

Calli is excited for the future of the therapy department at North Mountain and expects the team to continue to grow.  Because of recent additions to the team, they are able to incorporate sensory stimulation, communication boards, fine motor/gross motor activities to improve engagement, edema management and bed/wheelchair positioning to maximize patient’s well being and healing. “I am eager to work with even more patients as we grow our therapy family!”

Intrigued? North Mountain Medical & Rehabilitation Center is currently offering an amazing career opportunity for a full time Physical Therapist. Find out more about these amazing opportunities and browse our complete list of therapy job opportunities.

Congratulations Kevin Moon, Our Newest SPARC Winner!

Kevin Moon, SLP, Graduated from Loma Linda University, Loma Linda, CA

Read his awesome winning essay below:
Dr. Atul Gawande, the author of Being Mortal, once said “We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being.” This quote is powerful and is a philosophy I want to implement to be a spark in the lives of the patients I will be working with.

One way is to provide patient-centered, evidence-based treatments that move towards accomplishing the patient’s goals and wishes. This type of care is what has been emphasized in my training during my externship with Ensign Services and at Loma Linda University. Trying to step into a patient’s world, understand where they are coming from, respecting the patient’s wishes/goals, and delivering inclusive and culturally appropriate treatments are all things that can help better treat patients holistically. In addition, applying the core values of my school which include compassion, excellence, humility, integrity, teamwork, and wholeness of care in conjunction with the training I received during my externship will enable me to provide speech therapy to patients at the highest levels.

The populations that reside in skilled nursing facilities (SNF) are one of the most vulnerable, susceptible, and most in need of our support and skilled help. With the combination of my education and training, I hope to bring speech therapy that not only treats disorders such as cognition, swallowing, speech, and language but also provides patients with exciting, evidence-based therapy using the principles that my university has taught me such as compassion and humility. Hopefully, if I can use my passion for speech therapy to deliver engaging sessions to treat patients and I hope to inspire patients to want to get better. When going into each session during my externship, my goal is to treat the patient as a person first and a patient second. Because these patients are in such a vulnerable stage in their lives, treating them as a person first with humility and respect allows them to keep their dignity and self-worth intact during their stay at the facility. Doing this can really help me get to know my patient and really optimize therapy sessions as well as provide motivation and increase participation. In a setting such as SNFs, there are opportunities to really get to know the patients, and I want to use everything I can (e.g., personality, knowledge, training, rapport, and understanding of the patient) to inspire them so that they want to be in therapy and be an active participant in their recovery process. For example, most recently, I worked with a patient that needed swallowing therapy, but because of her physical and mental state, she had a difficult time participating in sessions and displayed major decreased activity tolerance. Over our first few sessions, I learned that music was a huge part of her life. I discovered her love for R&B
and oldies. Once I learned this about the patient, we incorporated music into our session and got better results. Prior to using music, when her pain was high, we had to stop for a prolonged amount of time or even end sessions. Once we incorporated music into her sessions, we sang her favorite songs when she felt pain and this was able to get her back into focus and continue the session. Sometimes, she would even smile amidst all of her pain.

Another example from my externship was a speech and language patient that I worked with. He was a farmer from Mexico and only spoke Spanish. This language barrier posed to be a problem during our first session together. Although I knew some Spanish phrases for swallowing therapy, my abilities in Spanish, in general, were not up to par. When interacting with this patient, I was able to see that the language barrier was causing some frustration and decreased engagement with the patient. In order to deliver functional and personalized therapy, I started to study Spanish. To start, I learned Spanish related to farming, fruits, and vegetables to work on word finding and circumlocution strategies. After learning words and phrases that were related to things that were familiar to the patient, we started to work on speech and language. The patient’s level of engagement immediately increased while frustrations decreased. At times, the patient would tell stories or go on tangents, and I could see his face light up when reminiscing about his past. He even used language that was more complex than he usually used, thus improving his speech and language while brightening up his day with positive and happy thoughts.

With the benefit of being able to develop relationships with patients, my goal is to foster a culture where therapy provides functional and motivating activities for patients that they are motivated to do. I would love to get to a point where patients smile and want to get to sessions because of the spark I have tried to instill in them. More importantly, the passion that I bring will help improve the quality of life for residents. To ensure that this happens, the therapy delivered must be evidence-based and patient-specific. This is the way I envision delivering therapy.

Evidence-based practice is composed of three components: the best external evidence, clinical expertise, and patient preference. To ensure that true evidence-based therapy is delivered, each component must be fulfilled. By tapping into the desire to continually learn, I can find the best, most up-to-date research through avenues such as continuing education, self-research, and collaboration with others. This ensures that patients receive well-documented, well- researched methods of therapy. The patient’s preference is also paramount to finding the right treatments for therapy. This is done by really listening to what the patient and their families have to say. The patient should not be a passive participant in the rehabilitation process, rather, an active participant in their healing process. This is one of the biggest things that can keep me accountable. By keeping the patient in the driver’s seat of their journey, the patient and their progress are the factors that will ensure I stay accountable. My purpose is to help patients and I plan to keep myself accountable to them. Clinical expertise is the last component of having evidence-based practice. I have built a strong foundation with my experience as an extern at Ensign and building my clinical experience will be an ongoing journey because clinical learning should not stop.

Finding my meaning in evidence-based practice and how to deliver it is one of the biggest things I learned during my 10-week externship at Brookfield Healthcare Center and Downey Post-Acute facilities. I also learned many other things that will help me deliver evidence-based, patient-centered, and holistic therapy to the patients I will be working with. One lasting lesson I have learned about working in SNFs, which I will take with me throughout my career, is best stated by Mark Parkinson: “Instead of just keeping your residents alive, give them a reason to live.” This plays hand in hand with Dr. Gawande’s ideas about enabling well-being rather than just ensuring health and survival. Instead of pursuing the sole goal of extending someone’s life, giving patients dignity and purpose to residents during their stays at SNFs is something that was emphasized during school and my externship. This can not only have an impact on the patient’s treatment, but it can have an effect on other aspects of their lives such as mental health and overall well-being. Thus, providing therapy that is beyond just doing exercises is very important. It requires giving respect, dignity, and purpose combined with therapy exercises to deliver high-quality treatment to patients.

Many times in therapy, the patient’s therapy needs are siloed into their respective disciplines (OT, PT, SLP). Rather than focusing on only the specific treatments that need to be provided by each specific discipline, by looking at the person and their lives as a whole with an interdisciplinary lens, treatment can be designed to promote purpose, engagement, and collaboration. This opens up a world of avenues where the different disciplines of therapy can work together to not only help with the patient’s deficits but to promote well-being and give them more motivation to keep pushing forward. Furthermore, this idea can be used to promote efficiency by finding ways to provide different therapies the patient needs in one session using an interdisciplinary approach. Using a strategy that can increase therapy efficiency across the different disciplines along with increasing quality of life for patients provides benefits to both the patient and the business. And in this way, it gives me opportunities to make a difference and create a spark in any way possible. Even a smile, a simple gesture, a kind word, a listening ear, or an honest compliment has the potential to create a spark in patients and give them dignity. When this happens, everybody wins.