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By Carlos Pineda, DOR, Southland Care Center, Norwalk, CA

The I-tool is the first “6th vital sign 3-in-1 tool.” Due to the ongoing pandemic, which requires social distancing and isolation, our goal was to bring the evidence-based practice into the patient’s room. Validated standardized tests can be utilized as part of the treatment strategy at the same time. The 3-in-1 tool covers the full spectrum of the patient’s functional skills from low functioning to high. It can be utilized to conduct three standardized tests:

1. The “seated step test,” a low-level aerobic test for frail individuals or those who cannot stand or walk
2. The “2-minute step test,” an assessment of aerobic capacity for those who have concern with walking space
3. “Gait Speed,” or the 6th vital sign, which predicts the patient’s health status including hospitalization, functional decline and even the discharge location

The tool is made of PVC pipes that are carefully measured and fitted to allow for quick assembly and disassembly. The kit’s quick setup process support productivity and encourages therapists to consistently integrate standardized tests. Each part is color-coded, which can be completed in 30-40 seconds.

The attached photos show all of the following pieces.
Needed supplies (all under $50)
4 – PVC pipes ½ x 10
4 – Cross PVC ½
8 – PVC tee ½
1- PVC coupling ½
2- PVC elbows ½
1 – container of PVC glue
3 – different spray paint colors

Now that you have seen the photos and supply list, are you intrigued as to how this all works? The team at Southland put together a live video on how to assemble and use the tool. Contact Carlos Pineda (capineda@ensignservices.net) for more information.

By Elyse Matson, MA CCC-SLP, Speech Therapy Resource, Ensign

As mid-March was approaching and COVID-19 was spreading, I stopped at a facility in the Momentum market and there was a temperature checkpoint. I knew we were in for some changes. For a while, I carried on as best I could, but I kept thinking there must be more I can do to help. Then, I received a call from Tali Gerassi, DOR at Grossmont Post-Acute (GPAC) in the San Diego market. They had suddenly lost their long-time SLP and desperately needed help.

At first, I just tried to do what we SLPs do: find patients who need us and treat them. But soon I realized this wasn’t going to be an ordinary experience. This team was like no other I have met before, and I wanted to tell our whole organization how special they are.

GPAC is a busy post-acute facility with a rehab staff of nearly 20! The entire team has been so wonderful to me and helped me find my way. Most mornings I work with our general population patients. I watch the more experienced PTs and OTs build rapport with their patients and use innovative methods to get their patients back home. They play music and engage in personalized therapy sessions, and it is clear they want the best for their patients.

In the afternoon, I move to the observation unit where many of the therapists are brand-new grads. What a fantastic crew they are. I have learned so much from these young PTs and OTs! I have seen some of the best evidenced-based therapy from both PT and OT and a sense of teamwork that warms my heart.

Tali, DON Abigail Angeles and ED Katherine Oh have taken great measures to ensure the entire staff and I feel safe during this uncertain time, including meetings, frequent communications when policies change, and systems so that the staff can continue to be successful in caring for the patients.

I went to GPAC to help out, but I have received so much more in return!

By Jared MacDonald, Operations Manager, City Creek Post Acute Care, Salt Lake City, UT

May 15 marked our one-month mark of becoming a COVID-only building. We are excited at where we’ve been and where we are going.

First off, thank you! Thank you for all the calls, the messages, the food, the signs, the support, the staff, the prayers, and most of all thank you for helping us see what it truly means to love one another. We know it sounds cheesy but honestly, there have been many things in the past month that have brought us to tears of gratitude for your help and support. We could not be where we are today without your help, so thank you.

In the past month, we have admitted 55 patients and discharged 21. Thanks to our remarkable clinical team, both those on site and those from other buildings, we have a live to date hospital readmission rate of 3.63% and a mortality rate of 3.63%. Those numbers are remarkable in comparison to both the state and national average. This truly shows that on the clinical front, we are succeeding. This plan is making a difference, and we thank you for your support in helping us be what and where we are today.

We’ve started a tradition of ringing bells and cheering as our residents are brought down the hall and sent outside to meet family and friends. We will never forget holding the hands of an 87-year-old as we cheered for her successful discharge back home. Tears streamed down her face as she thanked each one of us for helping her fully recover. We hope you know, especially all you DONs, that you were just as much a part of that successful discharge. Thank you!

Thank you to all of you who have rallied your staff, conducted interviews, and spoken with your friends and families.

Today we had a call with members of the state and local task force. They expressed their appreciation for what we are doing. Dr. Spaulding from Intermountain Health said that this was one of the best teams he has ever worked with. We have and we will continue to attribute our success to the support we’ve received from the market. They know of your greatness and of the countless hours you’ve spent in helping make City Creek what it is. Thank you from the bottom of our hearts!

by Dawn Thompson, DOR, Victoria Post Acute Care, El Cajon, CA

Victoria Post Acute (VPAC) is one of the few skilled nursing facilities accepting COVID-19-positive residents from hospitals in San Diego and El Centro. Like other buildings with positive COVID cases, the beginning stage was certainly an upheaval from “normal” daily routines, as we were thrown into a world of unknowns with ever-changing directions and recommendations, coupled with fear. Schedules were slim, admissions were down, and stress was high. The rehab gym became a room with social distancing markers and a storage room. Hallways turned into PPE stations.

During this time, the rehab staff jumped into every and all support roles necessary (maintenance, dietary, CNA, etc.). They did this without asking and without hesitation, day in and day out, and continue to be heroes to this day. During this time, multiple rehab staff members were out sick, testing positive for COVID. As a team, we focused on “scared is what you’re feeling, brave is what you’re doing” and really went out of our way to emotionally support one another. We had daily emotional check-ins, both as group and individually.

This was a time of great loss in the building, where almost all sense of “normalcy” at VPAC and in the rehab department was absent. Grasping to maintain some normalcy and trying to keep our well patients well, we were able to work with Kaiser to evaluate and treat all appropriate Kaiser LTC residents in the non-COVID unit to maintain strength, activity tolerance and functional status. As our in-house COVID-19-positive patients stabilized medically, rehab jumped in and worked side by side with our new respiratory therapist. We were able to assist in positioning for postural drainage and help her hear true lung sounds of our ill patients.

We have learned a tremendous amount from our experiences treating COVID-positive patients (pay attention to those vital signs!) and have grown in confidence. The fear has dissipated and has been replaced with pride. This transformation was one of the most rewarding experiences we’ve had together as a team. I believe this shift was guided by transparent and efficient communication between IDT members and floor staff. While we seem to have our footing right now, this is an ever-changing process and we are continuously learning, growing and adapting.

As the days and weeks pass, admissions are starting to return, PPE requirements are changing, and barrier placements are being removed. Through it all, VPAC has remained resilient and together. Despite the loss and havoc of the first few weeks, we’ve found reasons (many, many, many reasons) to smile and celebrate. We have celebrated resident successes/discharges, birthdays, a retirement (DON), bridal shower, nurses week/nursing home week, Tuesdays and each other. We have been able to celebrate a COVID-19-positive patient (the husband of one of our charge nurses) being discharged home, walking out hand in hand with his wife after a month of hospitalization/rehabilitation including intubation.

Thank you all for the support, friendship and love over the last several weeks. It was needed and is much appreciated. I continue to be the proudest team leader.

Stay safe, wash your hands and keep your hands off your face!

With much love and gratitude,
Dawn ☺

By Therapy Resources Brian Del Poso, OTR/L, CHC, RAC-CT and Jon Anderson, PT
In our last article (check out it out here), we talked about taking care of ourselves while we are adhering to Shelter in Place rules and fitness facilities are closed. Now I know we want to be optimistic about the beginning phases of re-opening businesses in our areas, but we, more than anyone else, are aware of the fight we still have ahead of us. So, let’s continue to stay active at home and be smart about social distancing with outdoor activity.
Let’s face it, with the challenges working in today’s era of COVID-19 healthcare, the amount of heart, physicality and emotion you pour out during a work day can get downright exhausting! This is why more than ever, even if exercising isn’t your thing, we encourage you to start and take care of your bodies … so if and when the time comes, your body will take care of you!

Previously, we focused on body weight exercises, but I know that might get old fast with some of you and you’d like some variety! Today we’ll provide some simple equipment ideas that you can DIY at home to take your workouts to the next level!

Slosh Pipe:

This is a 4 to 5 foot pipe filled halfway with water (1 gallon of water = about 8.3 lbs). The movement of the water creates an “unstable” weight. Performing movements using a slosh pipe will get your nervous system firing like crazy as you try to balance and stabilize the pipe while performing movements! Pro Tip: After you try it, think of the possibilities and effect a smaller version of this can have on neuromuscular re-ed for our patients!

How to make:
o Things you’ll need: 3 or 4 inch diameter PVC pipe, PVC pipe caps, and PVC glue from any big box home improvement store; a saw.
o Cut the pipe down (you can use a hacksaw for this) to 4 or 5 feet in length.
o Follow the instructions for the PVC pipe glue and glue 1 cap to an end of the pipe.
o Fill the pipe up about halfway with water (obviously A greater diameter and length of pipe will provide more weight).
o Glue on the other cap and slosh away!

What can I do with it? A TON of stuff, but to start you can do:
o Back squats
o Front squats
o Overhead presses
o Bicep curls
o Lunges
o Chest press from floor
o Trunk rotation (trunk twists, pipe swings, single oar rowing motions, etc.)

Medicine Ball/Slam Ball:

This is great if you have broken or unused basketball or soccer balls laying around.

How to make:
o Things you’ll need: Basketball or soccer ball, sand, exact-o knife, a funnel, duct tape.
o Take your ball and cut about a 2-3 inch circle with an exact-o knife, but DON’T completely cut out the circle! Leave some room so it’s still connected, but you can lift up the “flap.” Alternatively, you can cut an “X” into the ball to create an opening.
o Stick your funnel in your opening and fill with sand to your desired weight.
o Take your duct tape and thoroughly wrap around the ball in multiple directions to seal off your opening.

Things you can do:
o Ball slams
o Ball tosses
o Russian twists
o Anything you’d normally do with a medicine ball!

Weighted Backpack: You don’t have to be a workout warrior to take advantage of the health benefits of resistance training. This one is easy, adding weighted resistance to something as simple as walking will increase your strength and endurance.
How to make:
o Things you’ll need: A backpack and anything you can stuff in it!
o Take your backpack and stuff it with things to make it heavier (cans, clothes, your wonderful leadership books) … Ummmm, yea, and that about sums it up.
Things you can do:
o Cinch it up tight to your body and pretty much do ANYTHING moving … ’nuff said.

Buckets:

Got a bucket or 2 lying around the house? Well, fill them up with stuff (like sand, or you know, those leadership books again) and get to work!

Things you can do:
o Farmer’s walks
o Single arm shoulder presses
o Biceps curls
o Overhead triceps extensions
o Bucket swings (kettlebell swings) — Just make sure you use a smaller bucket, preferably with a lid!

Here’s a great example of a bucket workout using a 5-gallon bucket from our very own Jon Anderson:
Squat Curl to Press: A full body exercise.
Push-up With Feet Elevated: Exercise focusing on the pectoralis major of the chest while increasing the load by elevating the feet.

Lateral Lunge with Curl: Combination exercise targeting lower body muscles in a lateral movement as well as the biceps.

Bent Over Low Row: Exercise focusing on the latissimus dorsi of the back.

Deadlift: Exercise focusing on the hamstrings and gluteus maximus of the lower body.

Chopper Raise: A full body exercise.

Close Grip Tricep Push-up: A push-up alternative that puts greater emphasis on the triceps.

Reverse Lunge with Torso Rotation: Lower body exercise that also challenges balance and core strength.

Back Extension: Exercise focusing on using the erector spinae for stabilization of the spine.

Alternating 1 Leg Deadlift: Exercise that provides an increased load to the hamstrings and gluteus maximus of the lower body because it is performed on a single leg, which also adds a balance challenge.

A variety of other exercises could also be added or substituted using a bucket. Regardless of the exercise, perform each movement with special attention to proper technique. If starting out, consider creating and using a moderate weight that does not jeopardize form and feels like an exertion rating of a 5-8 on a scale of 1-10. Start by performing 1-2 sets of 10-15 repetitions, and as fitness increases, add additional sets.

From Riverbend Post Acute Care, Kansas City, KS
By Madeana Galler, Therapy Resource

Riverbend nurses and therapists have united forces like never before. The two teams have joined forces to ensure the safety of all of their residents, and all the while gaining a deeper level of appreciation for one another through many Moments of Truth.

Jordanne Gerdes, COTA, and Amy Jacobs, PTA, have owned the shower schedule together with their partner CNAs. They also dried and styled the patients’ hair in preparation for Easter.

On April 9, 2020, TPM Justin Fricke’s church organized a prayer vigil for Riverbend, inviting the community via Facebook to come to the facility and pray over the facility, staff and residents. About 45 cars lined the parking lot, each person stayed in their car, a church member led the crowd in singing three hymns, followed by a short devotional on David and Goliath (overcoming COVID) and concluded with a prayer. There was an overwhelming feeling of support from the community, leaving many employees in tears of joy. Additionally, Justin’s wife’s work donated a truckload full of snacks and drinks to the facility.

Lisa Wainscott, OT, and her mother bought all the residents balloons. Lisa and Justin Smith, PT, personally passed out a balloon to each resident as a way of spreading love and gratitude.

Local restaurant, Mr. GoodcentsSubs, has donated grab-and-go style meals for the staff on a regular basis, and Plowboys BBQ donated meals for an entire week to the facility.

On April 13, 2020, Clinical Market Lead Maureen Purvis’ church family came to the facility and prayed over it.

Maureen Purvis, CML, Justin Fricke, TPM, Cory Schulte, ED and Jackie Brown, HR Resource, have been tirelessly and resolutely working together with the staff.

Facilities within the market sent handwritten posters with words of encouragement.