Recognizing St. Joseph SLPs for their Outstanding Clinical Outcomes

Submitted by Lisa Brook, PT/DOR, St. Joseph Villa, Salt Lake City, UT
Susan Roubian, Hannah Allen, Katie Paulsen and Taylor Schweitzer comprise the St. Joseph Villa Speech Therapy team. This program has grown significantly, going from 1 1/2 SLPs to four full-time SLPs over the last two years! These SLPs have made an effort to collaborate with interdisciplinary teams in our facility to change the way we care for our residents and improve their therapy and quality of life. We have been developing programs in the areas of AmpCare, Think Thin!, Oral Care, Speak Out!, Abilities Care, and high-level cognitive groups for our residents with mild cognitive impairment.

L to R: Taylor Schweitzer, Hannah Allen, Susan Roubian, Katie Paulsen

During our COVID outbreaks, our SLPs played a crucial role in managing change in condition and aspiration risk and significantly changed our outcomes. They are now utilizing The Breather with our Respiratory Muscle Strength Training program to meet the growing needs of post-COVID respiratory insufficiency impacting communication and swallowing.

We have also been developing programs to improve outreach to our ALF, ILF and outpatients from the community! Beginning in June, we will begin FEES training in preparation for an in-house FEES program, increasing access to instrumental evaluations by the treating therapists. Our trained SLPs will be facilitating mentorship of others seeking to be FEES certified in our market.

Our SLP team is recognized by our IDT team for their outstanding clinical outcomes, their care of our residents, and their outstanding communication with providers. This team of exceptional therapists are dedicated to providing high-quality care to our residents and are excited to keep expanding and optimizing care for those we serve!

SLP Helps Resident Find Purpose and Decrease Behaviors

By Dominic DeLaquil, PT, CEEAA, Therapy Resource, ID/NV
Steve is a LTC resident at McCall Rehab being treated by Speech Therapy for cognitive/communication deficits. He has a history of alcohol abuse and dementia. With winter in the mountains and COVID restrictions, his behaviors had become a real problem. He was initially refusing to get OOB and staying in a dark room, but as the weather began to turn to spring, he began excessive wandering, wanting to get out of the facility. He was agitated and confused and began urinating in sinks and trash cans.

Using the ACA approach, SLP Cassie Johnson took him outside and listened. He was remarking on all of the things around that building that might need repair or upkeep after the long winter. She asked him what he would do, and one thing led to another, and she got some sandpaper and he started working on refinishing a wooden patio table at the facility. Another resident became interested, and they worked on the table together. They have since formed a friendship and seek each other out. All of Steve’s behaviors have ceased and he is more motivated to improve his abilities and hopes to discharge to an ALF. As an additional benefit, other residents became interested and the furniture sanding became a group activity!

In addition, his SLUMS score in February, when he was depressed and his confusion was worse, was a 13/30. Tested recently, after finding some purpose and satisfaction, his cognition actually shows improvement and he scored a 22/30!

Millennium Post Acute Rehab’s SLP Superstar Team

By Heather Bjernudd, Therapy Resource, South Carolina
Our speech therapists at Millennium Post Acute Rehab in West Columbia, South Carolina, are incredible! When this facility started taking ventilator-dependent patients this year, these ladies jumped in and have had incredible results.

Here is a highlight on a current patient: 32-year-old male admitted with severe trauma, left hemi craniotomy that affected all function and ventilator-dependent. Swallow response was absent; silently aspirating, NPO, PEG; mild/moderate aphasia with decreased ability to communicate via trach. Cognition impaired, BIMS score of 7. Forty days since admission. Patient able to tolerate Passy Muir Valve up to five hours at a time. Swallow trials with ice chips showing improvement, improved swallow initiation and laryngeal function. Patient is able to follow multi-step directions for swallowing maneuvers and functional tasks. Able to complete diaphragmatic breathing exercises with min assists. Patient has been weaned off of the ventilator and has a real possibility of being weaned off of the trach.

Growing SLP Programs

By Jeremy Osmond, DOR, Provo Rehabilitation and Nursing, Provo, UT
Dot Stuart, SLP at Provo Rehabilitation and Nursing, decided to focus on education related to growing SLP programs for her Director of Rehab in Training Ops (DORiTO) capstone project. The information was so impressive that I asked her to present at a Sunstone DOR meeting to help other therapy leaders really understand all the things SLPs can do in our setting.

She highlighted that the SLP needs to be committed beyond the patients that they receive orders for on admits and really focus on all residents in their facility to make sure their highest level of function is being attained. Her training focused on SLP support for PDPM, including completing the BIMs; identifying NTAs such as malnutrition and SLPs’ role in intervention; and ensuring SLP swallow assessments are reviewed for accurate Section K reporting.

She focused on the importance of really knowing each payer plan and what that means for intervention. SLPs need to manage their program efficiently based on payers and authorizations along with clinical presentations. They need to be a partner to the DOR to ensure clinical outcomes even with reimbursement challenges.

She addressed how SLPs can help so many LTC patients, including what tools we have in place to help quickly identify any changes of condition; long-term modified diets; etc. Many SLPs and DORs are not as familiar with the available reports in PCC to help with patient identification. She also trained on the importance of being present in the facility and making sure the IDT members, clinical team and other therapy disciplines really understand how they can help with patient care. Click below for a summary of helpful reports in PCC for SLPs.

Dot also emphasized the importance of strong student programs to help future SLPs really understand their value and how they can make a difference in a patient’s life in the Post-Acute and LTC setting.

Provo has trended increased treatment hours and need for more SLP staff with the help of Dot’s focus and drive to ensure every patient’s needs are met.

Lymphedema Success Story

Danielle Kistler, OTR/L, is a new CLT at Holladay Healthcare. We are so excited to have a CLT at our facility, and we are already seeing some great successes with her interventions. We have an LTC resident that had LE skin tears that developed into stasis ulcers. The nurses were providing wound care for about six months with the patient being on and off antibiotics due to infections, with the ulcers being unable to heal.

At the same time Danielle became certified in lymphedema management, the patient was referred to a wound clinic for further wound treatment. With Danielle being able to provide appropriate compression wraps at the same time the patient was attending the wound clinic, his stasis ulcers are now healed. The nurse manager received multiple calls from the wound clinic on how well his legs were being wrapped and how impressed they were with the healing of his wounds. This patient also has aphasia and has difficulty communicating with his caregivers. We have seen a change in this patient, with signs of reduced pain, increased participation in ADLs, decreased outbursts, and improved quality of life.

Submitted by Jeremy McCorristin, DOR, Holladay Healthcare, Salt Lake City, UT

LTC Programming: Rise and Dine

Our long-term care population is now fully vaccinated, and it seems as if we are entering, dare I say it, a post-pandemic environment. We made it, but now what?

During the pandemic, we have seen our residents’ version of normalcy altered. Those who used to spend most of their day in the dining room, in activities or the therapy gym, and visiting with their friends and family now are found sleeping in more, not eating as much or as healthy as before, and no longer have the desire to engage in social activities. When they do feel like getting out of their room, seeing them use a wheelchair is more common. Some of them are COVID-recovered and have never fully bounced back after fighting the virus.

Our therapists opened their minds to different therapy approaches and gained the skills that it takes to truly dignify the lives of long-term care residents. We knew these effects of illness and quarantine isolation would take a toll on our vulnerable population, and we did everything we could to combat them in real time with preventative therapeutic approaches. In a pre-COVID world, our building was predominantly a rehab-to-home facility, and it was uncomfortable at times for our therapists to develop long-term care treatment plans. The pandemic highlighted the necessity for our services, and now it is hard to imagine not being this involved with them.

Our Speech Therapists, with multidisciplinary collaboration, hosted a new program this month called “Rise and Dine.” This program began as a nutrition and hydration-based club that requires participants to get out of bed and engage cognitive and communication skills in choosing meal preferences for the event. “We are all very passionate about our residents’ quality of lives and saw this as an opportunity to meet our residents’ nutritional and social needs. The excitement and feedback of our residents really fueled the idea and brought our entire dietary and therapy staff together to make this such a successful event!” — Breean Ludwig, HCRO Speech Therapist

As excitement grew, we realized this program could address almost all the abilities we have seen deteriorate. We ordered T-shirts to encourage dressing and hygiene before the event, and all our therapists came in to facilitate transfers, self-care routines, and mobility to and from the dining room. We also were able to treat goals related to self-feeding, dynamic standing, and sitting tolerance and positioning.

“We saw such a negative impact after so many in-room isolations during the COVID pandemic. Our Residents were discouraged, losing weight, not socializing, showed physical and cognitive changes, and did not want to come out of their rooms. We wanted to do something to bring excitement back into their lives while still being able to target our goals in therapy. This program offers an opportunity for all disciplines (PT/OT/ST) to participate.” — Ke’ren Grimaldo, HCRO Speech Therapist.

Although we are striving to return our residents back to “normal,” I am proud to say our Therapy team has established a new norm as well, and we are not looking back. Just as preventative interventions were important during the pandemic, how we move forward now is just as crucial. 85% of our long-term care residents got out of their rooms to participate in this program. We owe a big thank-you to our dietary manager and her team for being as excited for this program as we were. Our team has a seasonal themed event planned for the rest of the year, and we can hardly wait!
Remember, every county and state Department of Health has specific guidelines for re-opening, so always consult with your DNS with your “back to normal” plan.

Submitted by Elizabeth Munford, PTA/TPM, The Healthcare Resort of Olathe, KS

Motivating Employees—Meet the M.E. Committee at Copperfield

The strength of a team can truly be powerful when everyone sees and feels the vision. Employee culture and retention has been at the top of the initiative list. How can we improve this area and create an environment that truly embodies Customer Second? Well let me introduce you to the M.E. committee. I spent time with one of the M.E. committee members, Loretta Johnson, PTA, to get a better understanding of what this committee has to offer.

As explained by Loretta, the Copperfield Healthcare and Rehab facility created the M.E. Committee (Motivating Employees), with a purpose to engage, support and reward their fellow coworkers. They have designed and cultivated strategies to build interpersonal skills, through exciting team-building exercises. This level of cultural promotion encourages open communication, challenges employees with friendly competition, and assists with facilitating a healthy work-life balance.

The M.E. committee has put together a calendar of events that caters to employee engagement. As Loretta put it, “An employee who enjoys coming to work is a worthy investment, and a good day at work fuels the desire to be better the next day. This feeling of happiness at work will spill over into the love and care that we provide to our patients.”

Most recently, the M.E. committee hosted a Coloring Contest. All employees were asked to color a picture of a butterfly. Each butterfly was judged by the panel of patients, employees and visitors. The grand prize winner received a beautiful, laundry-themed gift basket. Other events included: Chili Cook-Off, World Water Day, and National Laugh Day. The time spent together is intentional, and it has allowed new-hires to comfortably blend in with the team.

The Copperfield Healthcare and Rehabilitation facility leadership team includes:
Noni Gill, ED; Unnati Patel, DON; Shayla Goode, M.Ed CCC-SLP

Submitted by Kai Williams, Therapy Resource, Keystone-East

Outpatient/Inpatient Synergy at McCall Rehab and Care Center

The Rehab team at McCall Rehab and Care Center in McCall, Idaho, has had a vision of providing community-based outpatient therapy in people’s homes since the facility became part of the Pennant-ID/NV market in 2018.

McCall’s DOR, Jenny Sowers, DPT, couldn’t ever seem to find the consistent time to grow an outpatient program, so she decided she should find a therapist willing to take on that challenge. In September of 2020, Jenny hired Ellie Toscan, DPT, with the goal of Ellie building their Community-Based Outpatient program.

Ellie has shown tremendous ownership of the program, from marketing to clinical to financial. She independently tracks the financials weekly and monthly to ensure the program is financially viable. Executive Director Kurt Holm’s main goal for the program is to build relationships and reputation in the community. A recent admission gives clear indication that Kurt’s goal is being realized. Ellie was working with a patient in her home. She had a change of condition, went to the hospital, and was referred to McCall Rehab. Because of the relationship that Ellie built with this patient, she readily agreed to the discharge plan. The patient is now receiving skilled therapy and nursing services in our facility. Thanks Ellie for this great example of the power of our core value of ownership!

If you are looking to grow your community based outpatient program, please consult your therapy resource or Deb Bielek for regulatory help specific to your state.

Submitted by Dominic DeLaquil, Therapy Resource, Idaho/Nevada

St. Joseph Villa OT Discharge Planning Group

Submitted by Stephanie Argyle, COTA and Kyle Fairchild, OTR, ADOR

Whether a patient comes to St. Joseph Villa for a rehab stay due to a fall, a recent injury, a surgical procedure or other medical conditions, we aim to include each individual in our discharge planning group as they approach discharge. Our goal is to educate our patients in ways to improve safety, improve energy conservation and improve self-awareness as they prepare to return home. Each group member is given a packet of written information, which includes a home safety checklist, pictures of adaptive equipment and links for ordering, and home exercises. We change our handouts based on the needs of our patients at the time.

Our DC Planning Group objectives are as follows:

  • To identify barriers to discharge with a focus on current functional barriers
  • Education in home safety, home modifications, DME needed for safety in the home
  • Education in community resources for home safety
  • Education in self-awareness and techniques to facilitate relaxation and awareness of your body at rest
  • Education in the purpose of home health services and benefits of continuing therapy at home and as an outpatient

So many of our patients have expressed gratitude and appreciation as they learn from one of our OTs or COTAs AND from one another about adaptive equipment, techniques and strategies to improve their lives. One patient commented after attending the group, “I was so worried about falling in my bathroom. What you’ve taught me will make things much safer and easier — it will change my life!” We have allowed family members to attend our group, which has helped them learn how to better care for and support their loved ones. Overall, this education group has been a valuable addition and rewarding experience for both our patients and therapists!

Drum Circle Group Activity

Submitted by Loupel Antiquiera, DOR, and Laura Kramer, COTA/L, Pacific Care Center, Hoquiam, WA

Laura Kramer, OT, provided the following exercise to promote OT month.

Residents are provided with a yoga ball placed on a base (like a round laundry basket) and a pair of drumsticks with instructions to follow the leader in a set of coordinated movements with lively music that has a strong musical beat. The variations of instructions may be tailored to the residents’ limitations and therapeutic goals. It can be upgraded or downgraded to tolerance throughout the task, with the therapist monitoring signs of fatigue or pain, cueing residents to rest if needed.

As the therapist, I may begin by explaining the benefits of the activity, which can include increased circulation, cardio exercise, targeted joint range of motion, music appreciation and most of all fun, but I always preface with “If it hurts, don’t do it.” Coordinated movements may include:

  • Elbow flexion only while drumming on the ball; downgrade to just wrist flexion if necessary to tap out the rhythm of the music
  • Knee up both right, then left
  • Reaching far right/far left, targeting shoulder abduction and trunk stability
  • Hands up with crossing drumsticks
  • Drumming to the beat, either slow or medium or double speed
  • One-handed (one-sided)

Overall, the benefits I’ve observed are promising, with most patients demonstrating very good attention and following directions, and some will even become happy to lead a set of instructions and take turns to try out their own combination. Some find the activity too simple and ask to leave, and one resident commented she thought it “felt like kindergarten, but it was still fun I guess.” However, this same resident actively participated again and was observed having fun. One resident required closer observation d/t asthma; her O2 sats dropped too low, and she was returned to her room with nursing notified for breathing tx’s. One pt reported BUE shoulder pain d/t OA.