“Driving on the Healing Pass”

(Photo of June with therapists Joseph Zaldua, OT, and Camille Navata, OTA)

Submitted by Donald Millares, TPM, Glenwood Care Center, Oxnard, CA
Today, we celebrated with one of our outpatients who successfully drove herself to the facility, something she could have not done in the last six months. Our Occupational Therapy Assistant who mainly has her for sessions cried in joy with our patient, celebrating her achievement. Words cannot describe the emotion that was seen as the whole rehab department clapped in joy.

Our patient June has been coming to our facility for Occupational Therapy Outpatient Services to work on both of her hands to regain function and take her life back into control. Prior to coming, she was one of our in-person residents who then discharged out of our facility and became our very first outpatient. During her stay, she developed a strong bond with the nursing staff, housekeepers, and our amazing Occupational Therapy Assistant Camille Navata and Occupational Therapist Joe Zaldua. She regained her ability to do her daily routines while wearing a soft cast that covered all the way up to her PIP joints of her fingers. Once the soft cast was removed and she was cleared for discharge, she declined to attend other outpatient clinics in the area that were recommended by her MD and decided to work with Camille and Joe once again for our outpatient services.

June knows how they work and established a great client/therapist relationship and entrusted their expertise on her road to recovery. Working together, they were able to break down scar tissue to allow her to regain strength for functional grasp patterns and increased ROM for both hands and upper extremities. With the constant intensive Occupational Therapy sessions, June was able to complete her main goal of driving her car again – something she could have not done ever since her incident that left her hands immobilized for quite some time.

Now with the regained ability, June has the freedom to go places and not have to rely on others to drive her. Camille and Joe’s dedication shows exactly why we do the things we do and celebrate the achievements of our patients – to better our patients and guide them on the healing path of independence.

More Love to Celebrate

By Marci Woehler, TPM/CTO, Wayne Country View Care & Rehab, Wayne, NE

I’ve been meaning to share with you one of the most amazing couples I will ever have the pleasure of knowing and treating. Meet Clair and Lura Stoakes. Clair is 101, and his wife, Lura, is 96. They celebrated their 80th(!) wedding anniversary back in August. This amazing couple has been with us for over two years, and we try to honor their anniversary in a special way each year.

When Clair and Lura were dating, Clair drove a Model-A car that he would shine up for his dates with Lura. Being in a small town, we knew someone with a Model-T, and we reached out to see if he would be willing to give the couple a ride for their anniversary. His was only a two-seater, but he called a former NE senator from Lincoln two hours away who has a “touring Model-T.” Our local Ford dealership then got involved and arranged to have that vehicle trailered here for Clair and Lura to take a tour around town.

While Lura is quite mobile, Clair requires a little more assistance. After measuring thresholds, we found out the step to get into the vehicle was 29’’with a running board at 19’’off the ground. For weeks prior to the anniversary, our therapy team worked with Clair to be able to manage a 10’’ step all while keeping the secret of their anniversary surprise; at times he thought we were crazy.

When the day came, Clair was able to manage the steps to get into the Model-T and take a drive with his sweetheart while driving off to their song “Too Young” by Natalie Cole. There were three news stations and our local town paper that showed up for the event to interview our amazing couple and watch them drive away. The look on their face when Clair saw the car was priceless as happy tears were shed. If you have a moment, see this news article.

Outpatient Success Story at Patriot Heights

Submitted by Alyssa Santamaria, Rehab Aide, Patriot Heights, San Antonio, TX

In the late months of 2020, Gracie contracted the virus, COVID-19, which changed her life completely. From being very socially active and full of life, her life was turned upside-down. She was in the fight of her life and recalled hearing “Echale Ganas! Echale Ganas!” which is Spanish for “Give it your all!”

That was what Gracie kept hearing throughout her fight. And, she did. With time, she was cleared of the virus but continued to have symptoms. Because she was continuing to have symptoms, our Therapy team at Patriot Heights worked with the approval of Dr. Ramon Reyes, to create a plan to help her recover. That plan included getting her back into doing the activities and groups she loved, such as playing the accordion, participating in her church, and always helping all those around her.

Since Gracie has been a part of the community here at Patriot Heights, it was easier for her and our team to create a unique plan to try and get her to the best version of herself. With all odds against her, she did not give up. Gracie worked long and hard with our Physical Therapist, Occupational Therapist, and Speech Therapist to get back to a normal life. Our team worked together on different aspects of her body and muscles, cognitive memory, oral motor skills, balance, and giving her the support she needed. They were able to get Gracie back on her feet and become the best version of herself, even better than where she was before.

“They are the best. They helped me a lot and now I am able to move again. I can move my fingers to play my accordion and move my arms and legs to participate in fencing. Therapy went the extra mile. They are my extended family. They are professional and work hard to help me achieve my goals. I am independent, confident on my feet, and happy to be able to live my life how I’m supposed to. Dr. Reyes, thank you for approving my therapy. They helped get me to where I am now, and that is something I did not believe I’d be able to achieve,” Gracie says.

Gracie has now graduated from all three therapy programs. Since gaining her independence back, she has been able to play her accordion and has added fencing as one of her hobbies, which she started doing as soon as she was able to walk and move again. Not only our Therapy team, but our whole family here at Patriot Heights are ecstatic about being able to work together to give Gracie her independence and confidence back, giving her the opportunity to keep living and enjoying her best life. With all she has accomplished, she has inspired and motivated many others to keep pushing forward. She also recommends therapy to her friends and those around her.

Gracie, we are so proud of you for what you have been able to accomplish. Sigale echandole ganas!

Giving a Reason to Live Through Music

Submitted by Kelly Schwarz, Therapy Resource, Bandera, AZ
Johnathan Kingsley, DPT at Horizon Post Acute and Rehab in Glendale, Arizona, has enjoyed sharing his musical talents of song writing, guitar and singing with residents at work and has been able to touch the residents’ lives in many ways with his creativity. Recently, the team found it challenging to motivate a particular resident (Alex). Johnathan was inspired to not give up on Alex and really wanted to give him a reason to live.

Johnathan came up with the idea of helping Alex find a reason to give back to the facility and the other residents to help motivate him. After spending time together, it was discovered Alex really wanted to learn to play guitar; however, due to loss of function of his left-hand s/p CVA, this was not a feasible goal. Johnathan started having Alex sing along with him as he played guitar, and Alex started writing lyrics to songs. Whenever Johnathan practices singing/lyrics with him, Alex is in the standing frame, which is a difficult task for him. However, he often comes to the gym on his own now, asking to work on standing and singing.

Alex spent time on songwriting and made new lyrics to the song “Islands in the Stream.” The plan was to play/sing the song to the facility after much rehearsal. With Halloween approaching, Johnathan had the idea of taking the plan one step further. The therapy band, which consists of Johnathan (vocals and guitar); Kayleen Bennett, OT (vocals); Zakk Montgomery, PTA (drums); and Alex (vocals), dressed up as famous musicians. They made sure Alex was dressed for the occasion as well, and the whole facility was entertained!

#PIVOT for Nursing

By Dominic DeLaquil, PT, Therapy Resource, Pennant Idaho/Nevada

#PIVOT is the rally cry for Summit, which comprises the markets in Utah, Idaho, Nevada and Washington. It stands for Proactively Identifying Vital Opportunities in Therapy, and in September, the DORs in Idaho/Nevada decided to apply #PIVOT to support their Nursing partners. Here are some of the ways Therapy has been helping Nursing:

Monte Vista — Therapy is “donating” one hour per day to Nursing to answer call lights, pass trays, train on hoyer lifts, decorate the halls, etc. and it rotates among the Therapy staff, which helps the nurses and aides get to know the Therapy team better.

Owyhee — Therapy is doing the showers for skilled patients and they are also doing the assisted feeding in the RNA dining section at breakfast and lunch two days each week. They are also helping by doing larger groups, even with many non-skilled patients, so that the aides have that me to actually take their full breaks.

Meadowview — Therapy is lending their Rehab Tech to nursing to work on the floor and the Therapy team is giving more attention to call lights.

Rosewood — They are helping nursing to pass trays at mealtimes.

Creekside — Therapy has a PT assisting with ADLs on the COVID unit, and Therapy is doing resident showers on the skilled side of the building.

Bennett Hills — Daily Post-Stand Up Huddle with floor staff, led by Therapy to discuss admissions, discharges, appointments, room changes, and family visitation schedules. Monthly CNA meeting led by Therapy Program Manager to discuss opportunities for collaboration, education, ways to better support one another, and develop trust. Monthly recognition of specific CNAs that embody the CAPLICO culture, awarded with plaque and T-shirt.

The response has been extraordinary so far, and these are just the starting points! The DOR clusters are having an ongoing dialogue to share ideas and inspire each other to continue to find more ways to support their Nursing partners. Great job, Idaho/Nevada DORs. #PIVOT for Nursing!

Moment of Truth: Truly Demonstrating Our Amazing People

Submitted by Devin Bodily, PT, Cedar Health & Rehabilitation, Cedar City, Utah

During the month of August, Cedar City received a large amount of rain within a very short span of time, including over 6 inches during a 24-hour period in the mountains above town. A frightening amount of muddy water, logs and boulders came crashing down Coal Creek, out of the canyon, and right through town. This eventually clogged a main floodwater-diverting channel, which caused the water to rush into, and overflow, the canal in the western part of town. Many homes were flooded and surrounded by several inches of water and mud without warning.

Our Director of Nursing, Trent Nielsen, has a home in this area and had been keeping tabs on how the flooding was going throughout the morning. To complicate matters, Cedar Health and Rehabilitation was undergoing state survey, which made it difficult for Trent to adequately prepare for any flooding at his home.

Just before noon, Trent was made aware that the water had crossed the road and was quickly traveling across the field toward his house. Without knowing how much time there was to spare, Devin Bodily, PT; Jake Holm, OT; and Braden Wiscombe, AIT, quickly rearranged their schedules and left to help Trent and his family. They were able to quickly obtain sandbags and shovels to create a wall to divert the floodwaters from reaching Trent’s home. If they had arrived minutes later, Trent’s home would have been flooded and permanently damaged.

They stayed for several hours into the evening to help maintain the wall. Community members eventually came along with skid steer loaders and mini excavators to build a dam and divert the water around the neighborhood. Ty Liston, COTA, and Eric Brown, Director of Maintenance, joined later in the evening and late into the night to help with the efforts of having an adequate water pumping system in his backyard. Having these pumps in place was instrumental to saving his home as heavy rains returned that night and broke the dam, pushing floodwaters within inches of Trent’s home before they finally subsided.

The effort to save Trent’s home was bolstered by the many facility staff members, regional nursing resources, and Executive Director, Spencer Eaton, who helped fill in for Trent’s duties during the state survey process so he could focus on saving his home through the night and into the next day.

The response to help Trent and his family was automatic as several employees demonstrated the core values of “Love One Another” and “Customer Second.”

Golden Acres Outpatient at ABBA Healthcare

By Cara Koepsel, M.S. CCC-SLP, DOR/CTO, Golden Acres Living and Rehabilitation, Dallas, TX
Golden Acres began a partnership with this ALF at the beginning of March 2021. It all started with a cold call from the DOR to the facility, in which the administrator agreed to a Webex with her team and me. I was able to really sell the services of what my team has to offer and show why a partnership would benefit their facility.

We started day one with two screens that turned into PT/OT/ST evaluations. Pictured is my team that accompanied me on day one! We came prepared to be flexible and assess as many patients as they wanted. I sat on the couch in their dining room and communicated with my BOM to run payer sources, check for home health, find primary MD to obtain orders, etc. These items were certainly a barrier, but all things that, with patience and persistence, we were able to work through.

Since day one, we have established six to seven patients on caseload for all three disciplines, and we visit the facility with a team that is there all day to treat these patients three days a week. We are a part of their daily routine, and they absolutely love our presence there. Also pictured is our group therapy we have initiated with the patients as well, which they love! Currently, we are working on partnering with this ALF to host an event at their facility to assist them in building their census after COVID. They are pleased to be able to tell prospective families and patients that Golden Acres’ rehab team will be a part of their loved one’s stay at their facility and their potential new home.

There may be hiccups and barriers as you start these partnerships, but once you get in the door and show these facilities what your team is capable of, I guarantee you they will want to partner with you for life! Keep pushing that flywheel even when it seems tough, because an ALF partnership is so worth it.

Community Outreach Efforts at Eastview

Submitted by Sunny Chahal, PT/DOR, Eastview Healthcare and Rehabilitation, Houston, TX
Sanikqu Maire became our Interim DON in March 2021. She had gained experience in our sister facility at Legend Oaks Northwest as an ADON prior to stepping into a DOR role at Eastview. Late in May, she transitioned from an LVN to an RN and stepped into the DON position on a full-time basis. With little experience at the building or as a DON, she helped lead the building through our annual state survey in April2021 with only two minor deficiencies. With the state survey and MSCA completed, the big 5 at our building decided on some initiatives and goals for the building for the rest of the year. One thing that Sanikqa really pushed was to get our facility name and face more visible in our community.

Since March 2020, due to the COVID pandemic, our building had been largely in lockdown and restricted for visitation from resident families and the surrounding community. In 2021, we wanted to get out and reestablish and develop our ties into the surrounding East Houston area. In addition, one of our goals for 2021 was to develop an outpatient program where we could follow our discharged skilled residents and also look to develop relationships with assisted living facilities (ALFs) and independent living facilities (ILFs) where we could partner up and offer our services to the residents.

We have targeted three large ILFs within a 5-mile radius of the building, and have already set up and completed health fairs at two of those three facilities. At the career fair, we have representatives from the Admission/Marketing, Dietary/Nutritionist, Nursing, and Therapy present at separate booths. For two hours, residents from the facilities go booth to booth to perform screens and receive education.

At the dietary and nutritionist booth, the residents were educated on proper foods to eat and other preventative health tips. Next they would go to the Nursing section and get their blood pressure and O2 saturation readings. After that, they would go to the Therapy booth, where they would get their height/weight and BMI calculated. They would also do a single limb stance test and test their grip strength. They would be educated about our new mobile outpatient program and screens performed.

It was a success, as we obtained four to five therapy referrals from each career fair we completed. We have since gone on to exponentially grow our outpatient program over the past three months. Sanikqa’s energy and vision for community outreach and willingness to partner with Therapy and other departments in the building has been very instrumental to the success of our mobile outpatient program.

Responsibly Responding to the Needs of our Community

By Paul Emerson L. Baloy OTD, OTR/L, DOR, The Hills Post Acute, Santa Ana, CA
Angie Reyes, RN and DON at The Hills Post-Acute recently shared this with our team: “A lot of hospitals are reaching out and asking for us to help the community. This is a challenging decision and yet a great opportunity for us to do what we do best — for most of us, this is the epitome, this is the WHY we work in a healthcare field…we have a chance to dignify long-term healthcare in the eyes of the world. But this time, we are equipped with more knowledge and experience on how to deal with this COVID situation. Rest assured that I will be in this together with you all, and we will do our best to ensure that our residents, families, and staff are safe.”

Angelica “Angie” Reyes has responsibly responded to needs of our community. With the increasing occupancy of positive COVID-19 infection in our acute hospitals, The Hills Post Acute management team has collaborated with our local department of public health officials to open up a Heroes’ Zone to alleviate our hospital partners and provide continued comprehensive care to those affected by the pandemic. Angie partnered with Maria Navarro, community liaison, and closely coordinated with the following individuals to ensure that all the critical components are in place to provide optimal care delivery to the vulnerable members of our community:

● Arlene Mendoza, LVN, Infection Perfectionist Nurse
● Ana Huante, LVN, Director of Staff Development
● Noemi Tinajero, RN, MDS coordinator
● Maria Pulido, AIT
● Willmer Fernandez, Central Supply Director
● Martha Torres Magallon, Director of Activities
● Eunice Rosado, Medical Records Director
● Robyn Caleb, LVN, Director of Case Management
● Amado Miguel, Maintenance Director
● Kritsana Liamkrajang, Business Office Manager
● Chris Smit, Social Services Director
● Issela Gonzalez, Human Resource Manager
● Edgardo Lopez, Dietary Supervisor
● Jose Fajardo, Admissions Coordinator
● Darren Bake, NHA, Facility Administrator

“When what you are deeply passionate about, what you can be best in the world at and what drives your economic engine come together, not only does your work move toward greatness, but so does your life. For, in the end, it is impossible to have a great life unless it is a meaningful life. And it is very difficult to have a meaningful life without meaningful work. Perhaps, then, you might gain that rare tranquility that comes from knowing that you’ve had a hand in creating something of intrinsic excellence that makes a contribution. Indeed, you might even gain that deepest of all satisfactions: knowing that your short time here on this earth has been well spent, and that it mattered.” Jim Collins, Good to Great

Onboarding New Therapy Team Members

By Lisa Brook, DOR, St. Joseph Villa, Salt Lake City, Utah
Lisa Brook, DOR at St. Joseph Villa, recently shared their new therapist/new employee training and mentorship process. As COVID continues to de-escalate, their team is beginning to focus again on leadership development and believe this process starts from the very beginning of employment at St. Joe’s. They are attempting to be more intentional about onboarding and training of new therapists as their skilled census grows and they are expanding their outpatient programing as well as their LTC programing. The therapy team at St. Joe’s is being more intentional about the hiring process with improved communication with Jamie Funk, involvement of key staff in the interview process and then setting more specific plans for the onboarding and training process. In order to grow leaders we must start with growing good therapists, mindful of their treatment approaches, seeking to make the most of their time. Lisa walked us through their onboarding process:

Day 1: NetHealth email sent to the staff early in the a.m. of the first day of a new therapist’s arrival that introduces him/her so that everyone knows the person by name. On this day, the new therapist is assigned to a therapist of the same discipline just to observe. This is planned ahead of time so the therapists are aware they will have someone shadowing them that day. We encourage the new therapist to take notes as we go through the login process for NetHealth, PCC, tour the building, meet members of the leadership team, observe the pace of things, etc. The first day is usually only a half day.

Day 2-3: Again, these are usually not full days. The new employee treats two or three patients on our skilled rehab unit. Their schedule is loaded with patients who will cooperate and give them a “win” for the day. The goal is to feel comfortable with the patients and just be a therapist! At the end of those treatments, they will spend time verbally reviewing the treatment, patient response to treatment, and potential documentation with the same therapist they shadowed with on Day 1. They do their billing, write their TENs, and then the therapist reviews and they discuss necessary corrections.

Day 4 and on: As the new therapists get more comfortable, more patients are added to their caseload. They treat patients on our skilled rehab unit and start to initiate point of service documentation. Time is scheduled with their “mentoring” therapist to answer questions and review documentation and goals. This process has been helpful for new employees, and they look forward to it as it gives them an opportunity to get all their questions answered in a more in-depth manner.

Next Steps: Next steps are really driven by the new team member. We initiate writing progress notes during week 2 for a new graduate and then add other necessary documentation as they begin to have success. As the DOR, Lisa said she checks in with them each day, but this process allows the experienced staff to take ownership of our training/onboarding process, and it seems to be working! Lisa said that even if they hired an experienced therapist rather than a new grad, there is still a lot of mentoring that we need to provide. They consider the confidence level of the therapist and tweak the process as needed. As they add more patients to their caseload, we have ongoing conversations.

Variables to Consider: New grads often require more mentoring. However, experienced therapists, part-time/PRN staff should always be provided an opportunity to receive mentorship as needed. Consideration must also be given to the confidence level of the individual. It often takes as much “coaching” for a seasoned therapist to get acclimated to treatment approaches, writing appropriate goals and skilled TENS because there are some differences in documentation in each subset of our programming (skilled rehab, skilled maintenance, outpatient, sub-acute respiratory, LTC).

Lisa said we need to allow our therapists time to grow. If we are going to create leaders, we need to be intentional about onboarding and training. We want them to be confident in their skills and critical thinking and be leaders among their peers in the building. Jamie added that Lisa has done an amazing job! St. Joseph Villa has a reputation in the community of empowering their therapists in establishing plan of care and treatment approaches to fit the needs of the community. She has heard from candidates that they know how great it is to work at St. Joseph’s, and all of the tools Lisa shared with us are having an enormous impact in growing therapists to be outstanding clinicians, leaders in St. Joe’s and then leaders beyond St. Joe’s.