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These are words that describe the momentum occurring at Wellington Place and Rehabilitation in Temple, TX. The Wellington rehab team has made tremendous strides fiscally and clinically over the last eight months under the direction of Curtis A. Merring, OTR/L, MOT. Curtis brings an evidenced-based approach to rehabilitation. As a published clinical researcher himself, he has conducted research involving people who have experienced a stroke or SCI at University Medical Center Brackenridge and the University of Texas at Austin. Two of his most recent publications include, “Recovery nine years post stroke with Standardized Electrical Stimulation” in Occupational Therapy in Health Care, and “Muscle spasticity associated with reduced whole-leg perfusion in persons with spinal cord injury” in the Journal of Spinal Cord Medicine.

Curtis has challenged his entire rehabilitation team to take an evidenced-based approach to their treatments. Currently, all disciplines use a standardized outcome measure to document progress and produce monthly reports to the local hospital and for local community events. such as the recent Bell County Senior Expo Fair where the rehab team demonstrated the effectiveness of Kinesiotape. In addition to community outreach, the entire rehab team has made a point to attend courses and conferences providing the most up-to-date treatment strategies that are shared during their monthly rehab in-services.

Several of the unique cutting-edge treatment strategies being implemented and utilized at Wellington have created a buzz in the community that has helped boost referrals to not only the SNF but to the facility’s recently revitalized outpatient department. One of the most talked about new treatments at Wellington is Kinesiotaping. This has been implemented and applied by Rhianna Wagers-Hughes DPT, and Josh Reis PTA, in order to facilitate muscle, inhibit muscle, reduce pain and reduce edema. This treatment approach was traditionally used with sports, but is growing in evidenced-based outcomes with the geriatric population. The occupational therapy department led by Curtis Merring, Roger Rice OTR/L, and Becky Winsor COTA, has recently begun using standardized approaches to electrotherapy including a combination of Somatosensory and high intensity neuromuscular electrical stimulation to stroke patients resulting in improved active range of motion and voluntary control. Speech therapist Stephanie Kozeny SLP/CCC, is Vital Stim-certified and has improved the swallowing qualities of many residents through vital stim, strengthening exercises, and has also began using Kinesiotape to facilitate muscle re-education.

For 2012 the Wellington team has created a vision that reaches even higher marks and includes growing the outpatient rehabilitation program through developing needed community outpatient programs. One such program the team is pioneering and refining is a Wheelchair Seating System Program that is already receiving praise from the local physicians. Through programs such as this, Wellington is truly demonstrating true Ensign Ownership, and that’s what makes this team powerful beyond measure.

Val Montoya is a PTA at Southland Care Center in Norwalk, Ca, with a B.S. in Exercise Physiology, and a dream to teach and train mobility and wellness in the elderly population. When Southland’s CEO, Jim Morrison, met with a nearby Assisted Living Facility to see how we could be a part of health and wellness in their facility, it was a perfect way for Val to pursue her dreams while educating and helping within the Norwalk community.

Val teaches an exercise class at Vintage Cerritos every Wednesday morning; the class changes monthly based on the needs and desires of the residents. Her first class started with a handful of curious folks, and within weeks they were up to over 30 residents and needed to expand the class to the library. Fall prevention and safety is a big part of her class, and the residents have given feedback that they feel more confident and stronger since taking Val’s class and implementing safety techniques back in their apartments.

This partnership is a wonderful example of how being best FOR the community can help our staff members grow while developing partnerships with those in the continuum of care for our elderly.

If ALF employees are potential Medicare / Medicaid patient referral sources, then it is not appropriate to provide a class at no cost to the ALF as that would potentially violate the Anti-Kickback Statute. Best practice is to charge the ALF a fair market fee for the classes in order to protect yourself and the ALF. Remember, Anti-Kickback violations implicate both the giver and receiver of a kickback.

Teamwork is the Key to Success in Sub Acute Care

By Elyse Matson, MA, CCC-SLP, Carmel Mountain Rehab & Healthcare Center, San Diego, CA

As we all gathered Monday morning for our weekly rounds to our patients, it occurred to me that we really are a TEAM. Although we hear that word so much in our work, this was starting to look more like the Webster’s definition: “cooperative or coordinated effort on the part of a group of persons acting together as a team or in the interests of a common cause.”

A few years back when we were first launching our Sub-Acute unit, there was some apprehension in rehab as we were unsure of our role on this new unit. How would our skills fit into this new set of patients? Even questions as simple as, “How do we move these patients?” were being asked. As training began and the unit took shape, it was clear that rehab could take its place on the team along with many other disciplines.

I remember when we received orders to see our first patient—he was on a tracheostomy tube and ventilator. The first time we placed a Passy-Muir Valve on this patient, and he spoke clearly to the staff and family, it was one of those a-ha moments. As the nursing and respiratory staff began to see how speech therapy might be utilized with these patients, we knew we could create something special. Less than a week later, physical and occupational therapy assisted that same patient out of bed and walked with him down the hall. Everyone saw we were not just going to sit idly by and care for bedbound patients. We were here to do what we always do—rehabilitate the patient to their highest potential, whatever that is.

Over the last two years of working with these incredible patients, we have worked together as a team to develop protocols, policies and procedures, and, in the process, helped many patients. We have even seen a few of our patients who were on ventilators return to visit by walking in the door unassisted.

When we review each patient with the team every week, we address issues involving their medical care, psychosocial needs, nutrition and, of course rehab. Our Director of the Sub Acute Unit and lead Pulmonologist facilitates our meeting.

Because he is there, we can make changes to the patient plan of care with ease. For example, if a patient is starting to eat, we can change the tube feeding schedule right then. If we want to evaluate a patient for tolerance of the Passy-Muir Valve, we can discuss the parameters and schedule a time to evaluate this with respiratory therapy and/or nursing. Everyone is then aware of the plan.

So… I am on the I-5 yesterday and I see what appears to be some sort of animal hanging from the back of this semi truck. Of course, I was immediately concerned that this truck driver had an animal hanging from the back of his truck and didn’t know it.

As I got closer I realized that this was nothing less than a stuffed monkey on his back. Phew, I was relieved . . . but this was a reminder to myself that I need to keep working on getting these crazy monkeys off my back. Have you been working toward this? Creating a Never again list, and moving those items that you’re most passionate about into your “To Do List”? If not, let this serve as a friendly reminder…

Submitted by Jon Anderson, Therapy Resource