CTO Recognition: Todd Burgener, PT, DPT, CBIS, CTO/DOR Paramount Health & Rehabilitation, Salt Lake City, UT

Submitted by Gary McGiven, Therapy Resource, Milestone, Utah

Todd (pictured left with Gary McGiven) has done amazing things as the Therapy leader at Paramount in Salt Lake City. He has grown a team from all PRN employees to a full PT, OT, and SLP staff with an ADC ranging from 45-60. Todd and his team have set the bar in our market for what is possible with long-term care. They have gone from a sub-$5 PNSD to $40+ PNSD. They have some of the happiest residents you will ever see and have some amazing rehab stories. They have also partnered with Nursing and Rec Therapy, providing amazing groups in a time where the socialization that groups bring has been vital to quality of life.

CTO Recognition: Michael Ong, PT, DOR, Legacy Rehabilitation and Living, Keystone West

Submitted by Jon Anderson, DPT, Senior Therapy Resource, Keystone, Texas

When Michael Ong began his studies in the Philippines, he set out on a course to be a surgeon. As he continued his studies and began his internship, he realized that he wanted to provide more hands-on care. He discovered a passion for exercise and patient progression, which he sees as the backbone of physical therapy. Michael started his career in the United States in Florida as a physical therapist. He established core skills and a love for his profession and his patients.

After 11 years in Florida, his job as a travel therapist took him to a position in Amarillo, Texas. Even though he was originally scheduled to be there for only three months, he decided to become a permanent member of the team and took a full-time position under then DOR, Marisa Parker. When Marisa became the executive director of the facility, Michael stepped into the DOR role in September 2019. Hesitant at first, he grew into a true leader. The facility program had already been successful and expectations were high. Michael stepped up to the challenge, seeking out ways to learn everything he could about leading his team. He has been a trailblazer in long-term care programming and frequently leads Keystone West and the top one-third in all Keystone therapy metrics, all while finding new and creative ways to improve patient outcomes.

Michael has worked tirelessly to improve relationships in the Amarillo community and continues to lead the West market in outpatient development. He displays true ownership, leading in the important metric of DOR productivity while continuously providing teachings and trainings to members of his department and their clinical partners. Michael is certified as a wound care specialist, LSVT BIG, Clinical Instructor, and is credentialed in the cutting-edge incontinence program of PTNM. He utilizes all these skills to improve outcomes and develop future leaders on his team. He has embodied CAPLICO in his own facility as well as with our newest West market acquisition, The Medical Lodge of Amarillo, assisting with training and development with the Therapy team. Michael continues to grow and evolve, joining IDT committees to better Keystone, and we are so proud to honor Michael, recognizing him as Chief Therapy Officer! Congratulations, Michael!

CTO Recognition: Katie Kellagher, SLP, DOR, Legend NW Houston, Keystone East

Submitted by Jon Anderson, DPT, Senior Therapy Resource, Keystone, Texas

Soon after graduating from Texas Tech University, Katie started working at one of our Legend Healthcare locations, and shortly after that, Katie stepped into the role of ADOR. Although she was initially hesitant to take the next step into a leadership role, in 2019 the nudging paid off and Katie transitioned into the role as DOR at Legend Oaks Northwest Houston.

Katie is incredibly humble and displays Level 5 leadership qualities; for example, if you give her praise, she will shyly say thank you and credit the success to her team. The demographic of her facility is primarily made up of long-term care residents. Katie quickly realized and embraced the need for creating a therapeutic environment for those residents, building solid relationships with orthotic and wheelchair vendors, and increased her proficiency in understanding PASRR and how valuable access to therapy services can be for that resident population.

Katie has introduced clinical specialty programs in each therapy discipline and has supported the advanced clinical training for members of her Therapy team. Her OT is LSVT Big certified, her PT is trained to perform Percutaneous Tibial Neuromodulation (for urinary incontinence management), and her SLP is trained in the McNeil Dysphagia therapy program (individualized treatment program for patients with dementia). This is only a small share of the clinical program offerings in her facility.

Another area worth mentioning is Katie’s urgency to not allow her team or facility to fall behind the curve. Katie offers outpatient therapy services in-house or at the patient’s home to those in need. She also extends her support to her cluster partners and beyond, playing a vital role in the therapy market initiative about the Power of the Cluster and how to carry out the model. Katie believes and understands the need to grow others around her; this is evident by her invested development of her current ADOR. Katie is also a PDPM champion and serves on the Keystone PDPM committee. Katie’s joy of serving and her passion for leading makes it truly apparent as to why the honor of Chief Therapy Officer is deserved! Congratulations, Katie, and welcome to the club!

CTO Recognition: April Trammell, SLP, DOR, Beacon Harbor, Keystone North

Submitted by Jon Anderson, DPT, Senior Therapy Resource, Keystone, Texas

April Trammell, SLP, DOR, Beacon Harbor, Keystone North
April Trammell transitioned into the Beacon Harbor family with the acquisition in December 2019, leaving her with only three months of “normalcy” to learn our culture and core values before the pandemic started and our health care world completely changed. April took advantage of every moment of those three months, and she was a sponge, soaking up everything she could learn and asking for more. She showed true ownership from day one, asking questions, starting programs, and striving to make the Beacon Harbor Therapy team the best it could be. She embraced their CAPLICO culture and began doing things with and for her staff to illustrate Customer Second and Celebration.

April has been instrumental in Beacon Harbor’s growth to a preferred facility in the area, through programming and putting the facility’s needs before her own. She and her daughter donated their personal bunnies to the facility to help spread some joy during isolation; she has put on other disciplines’ hats when needed to, never saying “That’s not my job,” but instead jumping in ready and willing to help. Any LTC, skilled or outpatient program that has been introduced, April is always one of the first in the North market to try it and share her wins with everyone! One of the amazing things about April is she does not stay in her silo in the facility. She loves to share her ideas with others, to help them experience the same success. During OT week, she shared the positivity flower garden they made, she has consistently shared her group ideas with all of Keystone, and she has presented at DOR meetings on drumming groups and success with interdepartmental communication and culture in the facility. April has assisted with training the staff and DOR at a new acquisition; she identified a need in her cluster and offered a Speech boot camp for anyone who was interested.

In addition to being a culture warrior, April has been instrumental in the financial success at the facility as well. Their long-term care programming is in the top 5 of the market. April manages her costs by maintaining a high therapy productivity, taking advantage of the appropriate use of efficiencies such as group and concurrent, and managing overtime and any other expenses. She is always in the top third of every single therapy metric we measure and continues to ask if there’s anything she can do better, and our clinical outcomes and success stories reflect all of this. April is a true owner and has shown her facility and market what that looks like on a daily basis! Congratulations, April, on joining the elite CTO club!

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.

Falls Management: Collaboration is KEY

By Tamala Sammons, M.A., CCC-SLP, Senior Therapy Resource

Part 1: Fall Reduction: Focus on Strategies for Prevention
How do we identify who is at risk for a fall? Generally, we assess a resident’s physical and cognitive performance to determine who is a fall risk. However, many residents score as a fall risk, so how do we really sort it out? Do we really know who is most likely to attempt to move and why? That is a key difference.

The Challenge: Identify fall risk residents by finding out who is motivated to move and then find out what that motivating factor is. Give the residents a voice … give the CNAs a voice. Ask the resident and CNA about any changes, challenges and unmet needs.

Complete fall rounds on the floor, not in a meeting room! Assess the environment. How is the resident room set up? How is the bathroom set up? Where is the bed in relation to heating/cooling systems? How is the closet designed? What is lighting like at night? Ask the resident about their environment: how it is set up, temperature preferences, access, lighting, etc.

Provide the nurses with a tool kit based on activity prescriptions: Complete a thorough evaluation, determine who is motivated to move, determine what activities they enjoy being engaged in, determine what they can do alone and with caregivers, create activity-based prescriptions based on eval and treatment findings. Have this information and the supplies in the tool kit for nurses to easily access.

Create a Falls IDT with Nursing, Activities/Rec Therapy, RNA, and Therapy. Re-think how to really identify who’s at risk (motivated to move). Do rounds together. Have daily huddles to review the 24-hour report. Share interventions. Keep building the tool kits.

Part 2: Fall Reduction: Focus on Strategies Post-Fall
Partner with clinical to determine the cause of the fall. Ask the resident what they were doing/wanting. See if they can re-enact what they were doing prior to the fall. When reviewing a fall, ask: Is it cursory, perfunctory with the same approaches/interventions? Or are we creative, thorough and using great detective work to truly develop individualized interventions?

Complete a comprehensive evaluation. If currently on caseload, consider a re-evaluation … head to toe! Engage all therapy disciplines. Leave nothing out of the investigation to the root cause. It may take a few days to figure it all out.

  • Vital signs: Review blood sugars and check orthostatic BPs
  • Standardized tests: Assess strength and muscle performance; aerobic capacity; gait and locomotion; range of motion; ADLs; cognition; pain scales; vital signs!; sensory impairments; footwear; seating and positioning/support surfaces; modify their environment — remove hazards, modify the bathroom, modify closets; review medications
  • Toileting/Incontinence: Was the resident attempting to toilet? Were they incontinent at the time of the fall? How is the bathroom set up? What adaptive equipment is in place/needed?
  • Positioning: Does the resident have difficulty maintaining good positioning and is it different in bed versus in a wheelchair? Were all positioning devices in place at the time of the fall? What is needed now?
  • Pain: Were they motivated to move due to pain? Was there a pain treatment in place prior to the fall? Does there need to be one now?
  • Cognition/Communication: Is there any difficulty using the call light? Any difficulty expressing needs? Can they understand and follow requests? Can they explain what happened and why they fell?
  • Strength/Balance mobility: What are the safety concerns with physical movement or use of current devices? Was there sudden weakness or dizziness reported? Can they demonstrate what they were doing when they fell? Complete muscle and sensory testing.
  • Low vision assessment: Can they see the things they need? How is the lighting? Does there need to be color contrast in the room or bathroom?

Provide skilled interventions to address:

  • Difficulty with transfers in/out wheelchair/standard chair/bed
  • Inability to accurately position wheelchair when transferring
  • Inability to safely reach objects in near/far proximity
  • Difficulty crossing midline
  • Losing balance when challenged outside base of support
  • Inability to lift/carry objects
  • Difficulty with ambulation while multitasking (e.g., walking and talking)
  • Losing balance with overhead activities
  • Poor body alignment or losing balance when bending
  • Gait deviations when ambulating
  • Loss of balance with direction change or varying surfaces when ambulating
  • Shortness of breath with increased mobility distance/ambulation distance
  • Confusion or misuse of assistive device(s)
  • Difficulty climbing stairs/curbs
  • Poor recognition of safety hazards with mobility tasks
  • Impaired mobility
  • Impaired vision/hearing/sensation
  • Impaired cognition
  • Modify the environment: lighting, grab bars, raised toilet seats, bedside commodes, add color for low vision or other visual impairments; what about the closet?

Additional Resources

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!

Putting Theory into Practice with Activity Cards

By Carly Peevers, SLP and Andrew Folmar, OT Rosewood Rehabilitation, Reno, NV

You’ve done the assessments, sensory profiles, interventions, accumulated all this information about your residents to create a specific maintenance program within their Allen Cognitive Level, but what now? How do we effectively share and educate the caregivers to create a successful functional maintenance program and have a place where they can reference this information as needed? This was a question we had early on in the Abilities Care Approach, and that’s when our facility implemented activity cards.

Activity Cards are a summary of the information collected throughout the intervention which may include:
• Stage specific recommendations within different environmental and activity demands, personally relevant activities with modifications and strategies for this patient,
• Pertinent life history and
• Sensory information that may assist in engagement and/or management of behaviors
in order to increase meaningful engagement, quality of life, and maintenance of cognitive and/or communicative function.

What does the Activity Card look like on paper? We use a tri-fold pamphlet to present our information. The front has a color outline corresponding to their ACL level (red, orange, yellow, blue). On the inside there are three columns.
• The first provides a list of activities/interests and modification recommendations.
• The second column is a summary and description of current abilities in cognition (attention, problem solving, sequencing etc.), communication, physical strengths and limitations during ADLs, and possible barriers in their cognitive function.
• The third column is a running shopping list that incorporates this patient’s personal interests and functional needs (grooming/hygiene supplies, sensory stimulation tools, clothes, etc.). We attach this pamphlet to the patient’s life history board with Velcro so it is easily accessible to all caregivers and support staff for a quick reference.

We hope this information helps others with their caregiver engagement for dementia residents.

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!