The Last Contract Therapy Facility Goes In-House

Submitted by Cory Robertson, Therapy Resource, Pennant-Idaho
Discovery Rehab and Living in rural Salmon, Idaho, is a smaller facility in a mountainous rural setting that has been using contract therapy for years. Staffing is a large challenge and was seemingly a revolving door of therapy clinicians. Early last year, the contract company brought on a new leader. This leader demonstrated excellent drive and CAPLICO culture but without the same support from the contract therapy company that Ensign-affiliated facilities appreciate. Largely because of this leader, the facility ED Steve Lish, with cluster, market and resource assistance, decided to once again bring therapy in-house. Jolene Hugo, COTA/L, TPM, leads the Therapy team at Discovery Rehab and Living and exemplifies CAPLICO while managing the difficulties of a small rural therapy department like an all-star. Here are some of her reflections on the transition:

“May of this year marked our one-year anniversary for transitioning from contract therapy to in-house therapy at Discovery. When discussing the risks versus rewards of transitioning to in-house a year ago, I was intimidated. I felt nervous because I wanted to be able to prove that our therapy department could perform well. However, during and after the transition, I felt the weight of it all lifted by all of the support that being a part of Ensign Services has to offer our Therapy team and building. Being in-house really helped our Therapy department be part of a team and not just Therapy versus Them. I have a great resource and cluster partners that are readily available to work through difficult moments and the daily challenges. I have amazing opportunities to attend meetings that have helped me grow personally and professionally as a leader. Before being part of Discovery Care Center and our Ensign affiliates, , the challenges of the role really felt heavy, but now I have the resources to confront the challenges confidently.”

Therapy Dream Team Partnership at La Canada Care Center: Leading with Humility and Ambition

Submitted by Shelby Donahoo, Therapy Resource, Bandera-Tucson
Meet Annie Combs, TPM, and Jesus Salazar, assistant TPM at La Canada Care Center. Annie and Jesus were hired into their respective roles at the same time in November 2021. Wanting to strengthen La Canada leadership for the facility and for Rehab, ED Mike Bostwick made the decision to bring on both of them to support each other as first-time department managers.

They were a team from day one: no ego, just respect for each other, sharing new ideas for the department and responsibilities. While Annie had completed the DORiTO program, Jesus had not, and he started in February 2022. Annie made sure Jesus was applying and doing the DORiTO lessons in real-time at the facility as they occurred. Jesus said this made a world of difference in his learning experience.

The facility was having some issues with Nursing and Rehab communication, impacting group and LTC treatment sessions. Missed visits, low group, productivity, and tension affecting morale were issues. Brainstorming with Annie for his Capstone project, Jesus created a structure for scheduling and communicating individual and group sessions. He involved Nursing in patient goals and group participation. From February to May, productivity, group and concurrent, and most importantly GG outcomes improved tremendously.

Recently, Annie and Jesus took it upon themselves to go out to their Alma Mater, Pima Community College, and market for every single building in Tucson, not just their own. And they had a blast doing it! While learning herself, Annie supported her partner in his success, thereby multiplying leadership growth. By being a humble leader, she showed what true leadership qualities look like.

Moments of Truth

Submitted by Angie Taylor, COTA/TPM, Shawnee Post Acute Care, Overland Park, KS
Moments of truth come in all shapes and sizes. Sometimes it can be a moment of truth that shines through in our normal day-to-day job duties and roles that we have. As therapists, we are constantly advocating for our residents, but sometimes this advocacy goes above and beyond others. Our PTA Buddy Eblen did that for one of our residents. Kacie came to us initially with a fracture, then developed COVID pneumonia and had a long road to recovery to return back home with her Mom and daughter. Due to all these conditions, Kacie had a slow recovery where, at times, we were not sure if she would rehab home.

Buddy was the voice and champion who kept fighting for Kacie and encouraging her not to give up. He was able to consistently work with her to make the functional progress with stairs and ambulation that she needed to achieve to return home. It is hard to put into words how far she came from dealing with her clinical issues, depression, anxiety and fears. Buddy was the one constant voice of encouragement, drive, motivation, and compassion that she needed to overcome all those issues.

We all need someone to be that voice for us. Buddy was that voice for Kacie, and the result was she was able to rehab to the point of returning home, something she felt early on she would not achieve, in large part due to the relationship between Buddy and Kacie with his insight and dedication to be her champion! We are blessed to have a therapist like Buddy who truly embraces his ability to positively make a difference in people’s lives and has the strength and determination to work through challenges and never give up on others.

Flag Celebration: Meadowview Nursing and Rehabilitation

Submitted by Dominic DeLaquil, PT CEEAA, Therapy Resource, Idaho & Nevada

Meadowview Nursing and Rehabilitation in Nampa, Idaho recently celebrated winning the facility’s first Flag!

Prior to acquisition in May 2017, Meadowview (formerly Midland Care Center) was struggling. The reputation in the community was poor, culture in the facility was lacking, and Therapy was contract and had a strong “us versus them” mentality. Since then, Meadowview has undergone a complete transformation. The building has been remodeled, and an 18-bed skilled unit was added with a new and improved therapy gym. Therapy moved in-house, the culture throughout the building is one of the best throughout the organization, and Meadowview is now a facility of choice in the community.

In addition, Meadowview has become a leadership development powerhouse. Two of the nurses have gone on to become DONs in cluster facilities, and another nurse has become the ED at a cluster facility!
At the recent Flag ceremony, it was a true celebration. The ED, Melissa Truesdell, thanked the staff for all of their hard work and dedication. The DON, Jeremy Withers, gave a heartfelt speech where he kept coming back to how incredible the staff has been at “loving on the residents” and how that has been the driving factor in Meadowview’s transformation and success. And Tess Hurley, Physical Therapist, asked for a minute with the mic so she could heap praise on their DOR, Kristen Bailey. She thanked Kristen for supporting the therapists in being creative with treatments and growth ideas as well as positively challenging them to always be the best versions of themselves.

It was a touching celebration and even included the ED Melissa trying her hand at ice-sculpting under the tutelage of another ED in the market that is an accomplished ice-sculptor! Congratulations, Meadowview!

IDDSI Diet Training Keeps on Giving

Photo: Kyle Hosman-ST; Karin Martindale-Assistant Dietary; Sarah Lanning-ST

Submitted by Angie Taylor, COTA/TPM, Shawnee Post Acute Care, Overland Park, KS

We usually get to see the beginning stages of new trainings, but it is so important to see that training carry over at the facility level. Shawnee PARC has done an outstanding job of rolling out the IDDSI program and, most importantly, fully collaborating with the Dietary department and Nursing staff to roll out the program completely with ongoing training and reinforcement to ensure accuracy.

It started after our IDDSI diet training from the resources that sparked a full IDT discussion and from collaborating on what strategies would ensure that we roll out a successful program. This included Speech Therapy, Dietary Management, Dietary staff and Nursing staff. The best strategy we determined was establishing a consistent, reliable line of communication. The team decided the easiest and most efficient way was to establish a Tiger Text account that was set up for dietary communication only. We included dietary management/staff and Speech Therapists, and they utilize that platform to request specialty trays to trial, ensure correct diets, communicate specific resident wants/needs, or any pertinent changes.

The IDT then decided to carry over correct diet level for snacks: the Speech Therapist labeled and s/u snack trays in each dining room, clearly labeling the correct diet level and ensuring the appropriate snacks were placed in each bin. This established consistent carryover and facility-wide understanding of the levels. We have enjoyed seeing the collaboration and processes develop, but more importantly, we realized that establishing a partnership and seeing that partnership grow into a strong and sustainable program would have never happened without the training and support the resources provided.

Fall Prevention Program

By Angela Anderson, PT, DOR, Gateway Transitional Care, Pocatello, Idaho
Therapy at Gateway has been honing in on fall prevention for several months now and has implemented many therapy interventions that are fairly standard in fall prevention. We have the therapists focusing on fall risk and fall prevention during the evaluations and recommending assistive equipment or strategies to prevent falls at that time. We had found that many of the falls were happening in the first day or two and that the therapy POCs weren’t having time to affect the outcomes. So, Therapy and Nursing developed some tools to help implement interventions as preventative measures when the admission nurse does the intake.

The admission nurses are already doing a fall risk assessment on intake. Our PT, David Cox, helped develop a 48-hour falls checklist that gives the admission nurse a list of areas to focus on and questions to ask that may help decrease the likelihood of fall, such as, “Have they been trained to use the call light and remote?” and “Is the clutter put away?” He also developed potential interventions for low-, medium- and high-fall-risk patients, depending on the result of the falls risk assessment tool. These lists give the admission nurse more interventions to choose from that may be applicable based on why the patients are triggering for higher falls risk.

This also helps demonstrate that we are proactively looking at fall precautions and putting interventions into place, checking them off and signing the form that can be scanned into PCC. The therapists can then reinforce the interventions that are put into place, modify if necessary, and focus CNAs on these interventions in addition to the traditional Therapy fall preventions.

David and Brooke (ADON) came up with some notification magnets for the doorways of patient rooms that identify high-fall-risk patients (for frequent checks), for patients with unstable vitals and orthostatic hypotension, to identify risks that help alert CNAs and staff to issues that need increased attention. Admissions is reporting that the program has potential to help and she can see the efficacy.

#APEXStrong

By Amber Thompson, Market Leader, Keystone – Texas
Reaching the Highest Peak Is What Drives Us, But Reaching It Together Is What Matters
We would like to cordially invite you to be a part of the APEX challenge. Our focus over the past year has been on building leaders and transforming the way we serve our staff and residents. How do we create strong relationships within our IDT that are built on trust, accountability and love for one another? Performing physical challenges together as a team will create bonds between people that last a lifetime. The post COVID world has been a struggle for a lot of our operations. Employees are tired, some feel hopeless and some are lost in a spiral and can’t find their footing.

As a market, the team decided to change our name in January 2022 to APEX. The context behind this was…how will we inspire our teams to get to the top of the mountain even when we are tired and feel as if we have no more to give? We are struggling with agency usage, retention, lower reimbursement rates and the cluster rigor. The market has refocused and recommitted to growing leaders and inspiring their teams to turn their visions into reality.

On April 22, 2022 a team of our leaders rented a passenger van and drove 8hrs to Guadalupe Peak National Park. Guadalupe Peak is a rewarding, although strenuous, 8.5 mile round trip hike with a 3,000 foot elevation gain. It took a total of 8 hours to complete and was much more difficult than we anticipated. The following day we piled back up into the van and drove 8 hours back to New Braunfels. Squeezing into a passenger van after completing a grueling hike seems like it would be horrible but it was one of the best rides ever! We had fun blasting music, reminiscing about the death march we completed and just bonding in general.

This trip was one of the most amazing and transformational experiences I have ever had. Each of us came with a set of strengths and weaknesses and a varying ability to hike the course. We had some that could have run up the mountain (well, maybe just one clinical resource), some who walked at decent pace and some who had a very difficult time making it to the summit. The part that inspired me the most was how everyone helped each other out. We had stronger hikers in the back helping the ones who were struggling a bit. We had hikers leading the pack to encourage everyone to keep going and letting them know it was possible to make it to the top. Not one team member was left behind. The bonds and true friendships that were built that day are irreplaceable.

This experience can be tied to all of our goals as a market. The stronger operations help the struggling operations. The struggling operations are not scared to admit they are struggling and reach out to ask others for help. They are able to do this because they have relationships with each other that are built on trust. Every leader knows they will not be left behind. An activity we have decided to do as a market involves climbing peaks/hiking trails in Texas as a team. In essence, each climb is designed to challenge personal growth and ultimately help transform the way we serve our staff and residents.

Our question to you is…. What will your market’s challenge be? What “mountain” will you climb? If you come to TX and hike Guadalupe Peak, we will send you a medal. If you would like, we will come hike it with you!

If every market creates a challenge and a medal for those who complete it, we can motivate the clusters and teams to seek the medals together. Every adventure trip is priceless time with your team members having fun and hyper-focused to accomplish something extremely difficult. When they come back they are never the same again—what could this do for your buildings? Unity, loyalty, humility, perseverance, sacrifice…the list is endless in applications. Remember…the joy is in the journey!

APEX CHALLENGE:

  1. Pick your challenge (it has to be physical) and create excitement around it
  2. Create a medal
  3. Send pics of your challenge
  4. Update us on how your team responded (did this strengthen relationships? Etc)
    Move those mountains!! Conquer your challenges!! Build your teams!!
    CONTEST: Teams who submit a picture and a summary of how this impacted your team will be put into a raffle to win a prize!!

New Hire Coffee Connection

By Denny Davis, Therapy Resource – Bandera – Arizona
Bandera East had its first New Hire Coffee Connection Meeting to help with retention, education, communication and culture. DOR Kathleen “Katie” Deichert, OT from Mission Palms, started this on the east side on April 29. We had three new hires (all new grads) and two current students (hopefully new hires in the future!) who attended, and it was a great success! They were very excited to meet other therapists and form relationships and connections with others within the organization.

We made it fun by playing two games to get to know each other, such as Left, Right, Center (which had a $15 grand prize!) and a Kahootz quiz covering a little bit of everything, including some background on Bandera, CAPLICO, billing, documentation and some general PDPM information to help introduce some different topics. The things they love about our company are the culture, the support and the feeling of belonging! We are doing a great job loving on our new staff and students!

I am very excited to be a part of the growth these new hires (and hopefully the students if they come back to us after they graduate) will go thru and see the great things they will bring to the company in the future as they learn, continue to develop their skill set, and become more confident therapists and leaders! I see great things coming!

Our next meeting in May will be with Matt Pecora at Chandler Post-Acute. 😊

Giving Purpose to Life

Submitted by Ryan Hough, Therapy Resource, Nebraska
Staci Slater, OT at Omaha Nursing & Rehabilitation, shared this great story about giving purpose to life and her support to further her patients’ education.

JG is a 27-year-old male who sustained a C3-4 SCI when he was 24 years old secondary to a MVA. This patient has a high school degree and enlisted in the U.S. Navy for three years following high school. He is residing in LTC following acute rehab. His goal is to return to his mother’s home following home modifications.

JG has a power TNS wheelchair that he is able to maneuver using head control. He enjoys playing X-Box using Quad Stick mouth control, and he has a head control mouse that he uses to control his phone and computer. His computer is also accessible with the use of Dragon Naturally Speaking in combination with the use of his head mouse.

When JG transferred to Omaha Nursing & Rehab, OT assisted the patient with high educational pursuit. OT assisted the patient with verifying options for financial assistance and education:
● Cleared out student loans
● Applied for FAFSA (financial assistance)
● Verified VA benefits
● Applied to the community college and was accepted
● Contacted community college accessibility department to be able to participate at a college level within the range allowed by physical limitation

JG had to take placement exams (completed online) and signed up for classes. He completed English class online and is now planning to take the math placement exam and continue with his pursuit of education. Through furthering his education, JG hopes to explore future career options.

Nursing, Wound Care & Physical Therapy

By Dustin Rex, PT, DPT, MS, CEEAA, DOR, Cedar Pointe Health and Wellness Center, Cedar Park, TX
Our wound care systems at Cedar Pointe, led by Tiffany Delafosse, RN, DON; Nikki Alvarez, LVN/LPN, ADON; and Elise Mixson, LVN/LPN, are consistently managing our wound care systems successfully and effectively. When he started, Ricardo Cacho, one of our physical therapists, expressed a specific passion for learning about wound care. The combination of clinically talented and motivated team members facilitated our discussion of Nursing and Therapy collaboration within this system.

During the third week of October, we identified a resident with a persistent, complicated wound and began supplementing our standard wound care approach with Closed-Pulse Irrigation (CPI) treatments performed by Ricardo. Through clinical leadership from our Nursing partners, our wound care team, and Dr. Pat Marasco, developer of the CPI system, our resident experienced abrupt differences in wound size and discomfort. By the middle of December, seven-and-a-half weeks, our team had healed their first wound: complete closure from an initial size of over 7 cubic centimeters (7 cm3). We expanded our use of CPI with other residents and have had similarly significant results. The course of healing is always an ongoing, multifactorial process; but, to date, our team has facilitated healing of a combined area of 7.5 cm length x 6.6 cm width x 5.3 cm depth in stage IV wounds in our resident population. All of the success starts with our Nursing partners, who have used their expertise to support and streamline the addition of therapy as a part of the wound care system.

Presently, in addition to CPI, we are participating in a pilot trial with an ultrasound mist wound care program. We have found benefits with both approaches, which allows us to expand our ability to help our residents; expanding our skills means more opportunities to make a difference. It has been a great experience collaborating to maximize the talents of our interdisciplinary team to directly influence our residents’ quality of life.