Finding Tools for Success at Northeast Nursing & Rehabilitation

Group of Hands Holding TherapyWhen one 70-year-old retired man came to Northeast Nursing & Rehabilitation, he had a range of health concerns, including a recent hospitalization as a result of a colostomy secondary to colon cancer. Furthermore, this patient had an exacerbation of his COPD, along with chronic respiratory failure, diastolic CHF, aortic valve insufficiency, morbid obesity and HTN.

Previously, the patient was living in the community in a first-floor apartment with no steps, was I with managing household responsibilities, I with IADLs, I with transfers and MI with gait, utilizing a cane for household/community ambulation. In addition, this patient had good static/dynamic standing balance and did not use supplemental oxygen.

In the community, this patient made short drives to visit family, go to the grocery store and attend doctor’s appointments. His family members lived close by and were available to provide assistance if needed.

We determined that a combination of physical, occupational and speech therapy would best allow us to help the patient meet various goals:

Physical therapy — PT assisted the patient with progressive therapeutic exercises to increase gross B LE ms strength, thus improving his ability to transfer and ambulate with less dependence upon caregivers and adaptive equipment. The patient’s six-minute walk test improved to 627m, above normal for his age range. PT educated him to use a pedometer so he had visual cues to work on endurance, conditioning and gait distance. Upon discharge, the patient could do greater than 6,000 steps per day.

Occupational therapy — OT assisted the patient with progressive therapeutic exercises to increase gross B UE ms strength (arm curl test improved to 18, rated as average for this patient’s age group), thus improving the patient’s ability to perform UE/LE dressing and general household management. Furthermore, the patient was able to step over a tub and bathe himself independently, along with managing his colostomy bag.

Speech therapy — In coordination with PT and OT, ST worked on training the patient to self-monitor O2 stats through maintaining an 02 level log every hour, when he was without supplemental O2. Eventually, the patient was able to wean off O2, and he had improved volume control and intelligibility of articulation of speech through diaphoretic exercises and in spirometer to facilitate improved respiratory support.

This collaborative approach served the patient well. Through the combined efforts of PT, OT and ST, we were able to equip him with tools to improve his quality of life and more fully enjoy his retirement years.

By Rochelle Lefton, MA, OTR, DOR; Michelle Scribner, MSLP, Heather Cox, DPT,

Susan Garcia, COTA, Jesusa Herrera, PTA

Legacy-Building at Sea Cliff Health Care

Arrangement of color-coordinated scrapbooking itemsPrior research has indicated that older adults treated with four weeks of reminiscence-structured activities to target specific personal memories showed fewer depressive symptoms, less hopelessness, improved life satisfaction and retrieval of more specific life events (Allen, 2009). Toward that end, we wanted to provide rehab patients and/or their caregivers with a value-added service — one that emphasizes a celebration of life and identifies the patient’s volition, rituals and habits through the use of a client-centered legacy-building intervention.

Through legacy-building activities, such as engaging with family members, creating slideshows, creating scrapbooks and creating videos, the patient and family improve existential awareness of their past, present and future. The goal is to improve activity tolerance, facilitate out-of-bed activities and address underlying deficits that influence ADL performance skills.

Partnerships and Collaborations

Our partnership with the Loma Linda University Occupational Therapy department, as well as other higher education institutions, allows us to recruit graduate-level fieldwork students to participate in our legacy-building project. By the end of week 12 (the end of fieldwork rotation), the FW II student presents a facility in-service regarding implementation and outcomes of the legacy-building program.

A Case Study in Legacy-Building

One patient, an 87-year-old woman, was admitted to Sea Cliff Health Care after a hospitalization secondary to generalized weakness, decreased functionality and decreased oral intake that revealed UTI, dementia, dehydration, coronary artery disease, anemia and urosepsis. The patient was evaluated by physical and occupational therapists for intervention once a day, five days per week, from March 24 to May 18, 2015.

Plan-of-care goals had to be modified throughout the process to address the patient’s increased aversive behaviors, outbursts and anxiety with therapy requests. We introduced behavioral modification techniques and legacy-building interventions, such as scrapbook making, a quote book and an interview for personal needs.

Thereafter, the patient met several functional goals and showed increases in other areas of ADL function, including BUE strength, seated balance, UB/LB dressing tasks and hygiene/grooming tasks. With the help of behavioral modification techniques and legacy-building interventions, the patient was able to demonstrate decreased aversive behaviors, confabulations, outbursts and anxiety and increased socialization (she sang more) without the use of psychotropic drugs.

Conclusion: a FW II Student’s View

Is the legacy-building project a valuable interpersonal teaching exercise? Why?

The experience during my level 2 fieldwork with the legacy-building project has allowed me to be a part of making a difference in the life of a patient that otherwise may have not had the means to advocate for their own care or means of participating in meaningful occupations at a vulnerable time in life.

What characteristics should future FW II students possess to be successful in this program?

It was important to be able to use therapeutic use-of-self in order to shape therapy sessions based on the patient’s needs and desires. Patience and empathy were also important characteristics for building rapport necessary to facilitate patient honesty, thoroughness and willingness to reveal personal anecdotes and experiences.

Did the program meet its objectives? The program reached its objectives to create mementos and informative aids for facilitating increased communication between patient and family/caregivers, while creating a product that is meaningful and can be used to maintain the patient’s legacy.

By Kristine Lewis MOT, OTR/L, Sea Cliff Health Care, Hungtington Beach, CA, In partnership with Loma Linda University OT Department

 

Connecting Our Youth With Residents at Park View

Parkview event2I have to share about the beautiful morning I was privileged to be part of at Park View Post Acute Care in Santa Rosa, CA. The Abilities Care team at Park View hosted an event that was a gift to all those who participated, and even to those who observed from the sidelines. A local school has decided to partner with PVPA and will be a part of their Abilities Care team. The students will be part of the iPod music program for the residents, and I am sure the partnership will be rich and rewarding for the students and our residents. This morning was the kickoff event (despite being annual survey). The seventh grade class loaded onto their school bus and came to PVPA to perform a concert for about 25 of our residents in the park at the facility.

Jennifer Raymond, DOR, spoke to the children at their school yesterday, teaching them about the elderly and dementia. She also shared some tips about how to communicate with our residents.

Parkview event1

After the students performed for the residents, the Abilities Care team led the residents in their drum circle. The finale was the students playing “Circle of Life” with the residents playing along on their drums. Following the drumming, the students and residents mingled together.

The residents absolutely came to life, and the intergenerational exchange and engagement between the residents and the students was powerful to experience. The residents didn’t want to go back inside until they had said good-bye and seen the students load onto their bus and drive away.

The surveyors who watched the event told me this was something they would love to see at all facilities. It was clear how moving it was to the staff to see our residents regarded as elders by the students. There wasn’t a dry eye to be found.

Thanks so much to the team at Park View for making this happen despite the business of survey and daily life. It was so very special, and I was blessed to be a part of it.

By Gina Tucker Roghi, Therapy Resource

Fall Prevention at Timberwood Nursing & Rehabilitation

Senior PainEach year, more than one-third of individuals age 65 or older take a fall — that is, an unexpected event in which the faller comes to rest on the ground, on the floor or on a lower-level surface. Some 30 percent of people who fall suffer moderate to severe injuries.

As the leading cause of death from injury and the most common cause of nonfatal injuries and hospital admission, falls are a serious matter. Falling can have a significant impact on a person’s ability to live independently.

Many people who fall, even those who are not injured, develop a fear of falling. Identification of risk factors and prevention of falls is important to decrease medical and financial complications. The following are considered risk factors among high-risk populations:

  • Medications — Taking four or more medications, including over-the-counter meds, increases the risk of falls. It is necessary to take all meds prescribed by your doctors. However, make sure your physician and pharmacist are aware of all your medications.
  • Strength, bones and joint motion — As we age, it simply becomes more difficult to move because of changes in our strength, bones and joints.
  • Vision — We rely strongly on vision to maintain our balance. Unfortunately, as we age, our ability to see clearly and accurately decreases.
  • Cardiovascular deficits — Changes in the heart and blood vessels, decreased physical activity, decreased endurance and other factors are all factors to consider.
  • Prior falls and a fear of falling
  • Environmental risk factors — Most people fall within their own There are a variety of trip hazards present at home, such as throw rugs, long phone cords, pets, narrow stairs, no handrails, poor lighting, slippery or wet floors, and unclear pathways.

Prevention

Environmental modifications such as good lighting, clear pathways, call lights and chair/bed alarms within reach, and easily accessible bathrooms all can help with fall prevention. Additional measures can include high-quality footwear, proper use of assistive devices such as canes and walkers, and use of a call light or chair/bed alarms if a patient wants to get up. These preventative steps, combined with tests to determine a person’s risk of falling, enable us to prevent falls and keep patients out of harm’s way.

By Jamie Krefting, SPT, University of St Augustine, Student Intern at Timberwood Nursing & Rehabilitation, Livingston, TX

Therapeutic Use of Self at Southland Rehabilitation & Healthcare

help word on product box

At Southland Rehabilitation & Healthcare Center in Lufkin, TX, we have found success in using a “Therapeutic Use of Self” method of treatment. Defined as “the use of oneself in such a way that one becomes an effective tool in the evaluation and intervention process” (Mosey, 1986), Therapeutic Use of Self consists of a planned interaction between a patient and another person in order to:

  • Alleviate fear
  • Provide reassurance
  • Obtain and provide information
  • Give advice
  • Assist the other individual to gain more functional use of inner resources

We implemented the Therapeutic Use of Self method with Mr. K, using various techniques to engage the patient, including patience, rapport, trust, humor and honesty.

Since the use of Therapeutic Use of Self, Mr. K. is a changed man! Today he actively participates in occupational and speech therapy, inquires about other ideas to improve his health, smiles more often and enjoys his therapy. We look forward to using Therapeutic Use of Self with many more patients in the future and seeing the benefits firsthand.

Caring for Lives One Step at a Time at Somerset Subacute & Rehab Center

Somerset

At Somerset Subacute & Rehab Center, our goal is to keep patients involved with their care by providing various activities that encourage participation for active mobility. By providing complex medical, therapeutic and rehabilitative care for those recovering after a hospital stay or an acute setting, we provide comprehensive clinical care for individuals suffering from chronic conditions and/or those who need assistance with activities of daily living.

Our rehabilitation team of physical, occupational and speech therapists is what allows us to provide the best possible care to our patients. We collaborate with our nursing staff and respiratory therapists to assist patients to transition to a lower level of care — from a sub-acute vent/trach. setting to skilled setting and eventually discharge to home.

Evidence-Based Fall Prevention Program at Willow Bend Nursing & Rehabilitation

Fall prevention is a primary concern at Willow Bend Nursing & Rehabilitation, and we Willow Bend FallPrevention1work diligently to evaluate patients for fall risks as well as implement preventative measures. With Therapy working closely with our Activities Department, we have helped many patients to avoid falls as well as gain greater independence.

Our Balance Program consists of a screening, an evaluation with a standardized test upon admission, therapeutic intervention, quarterly balance assessments and various balance-related activities. The goal is to progress patients from a medium fall risk to a low fall risk, with modified independence in activities such as ambulating, standing balance in grooming tasks and toileting.

Willow Bend FallPrevention3In our program, we had a patient move from a Berg score of 27 and a medium fall risk at evaluation to a score of 47 and a low fall risk at discharge. The patient was able to return to assisted living at PLOF and continue being independent with all basic ADLs, simple meal prep, light housekeeping, leisure activities, walking to the dining room and community outings.

Through a close collaboration between Therapy and Activities, we are able to develop and implement balance-related activities for our patients, such as tai chi, core stability and our walking program. The combination of therapy and balance-focused activities enables us to progress patients safely through the program and reduce their fall risk significantly.

An Abilities Care Approach at Oceanview Healthcare and Rehab

Tree with hands and hearts figures logo vectorAt Oceanview Healthcare and Rehab, our mission is simple: to improve the quality of life for residents with dementia, while secondarily improving employee satisfaction. Through the development of patient-specific programs that target each resident’s best ability to function, we are able to accomplish that goal. Below, we’ve outlined just a few of the many success stories we’ve seen at our facility.

Goal: Fall Prevention

  • Nursing concern: A resident was having multiple falls, sometimes more than one per day.
  • Solution: Therapy identified that the resident was a wanderer and was not safe to walk. We provided a cushion and WC with the height adjusted to allow the patient to wander. We also instructed caregivers to have shoes on the patient at all times and to avoid locking the WC brakes.
  • Results: The resident has had a significant decrease in falls.

Goal: Behavior Modification

  • Nursing concern: A resident was non-compliant, often displaying physical aggression during care.
  • Solution: Therapy provided caregiver education to identify high-risk situations and prevention strategies.
  • Results: Caregivers are now better able to prevent situations where the resident becomes aggressive.

By collaborating across disciplines, we are able to maintain patient independence, integrity and safety. We are committed to facility-wide education to improve awareness of the dementia disease process, so that we can speak a common “language” when communicating about patient care. By staying true to our mission, we set up our patients for success, as well as our entire team.

By Jennifer Yocum M.S. CCC/SLP and Sonny Gonzalez DOR, Oceanview Healthcare and Rehab, Texas City, TX

Restarting the Restorative Nursing Program at Wellington Rehabilitation and Healthcare

In our facility, we wanted to restart the Restorative Nursing Program to keep our patients at their highest practical level, to be proactive with declines and to capture appropriate resources being provided to patients. Due to high turnover on the nursing team, as well as nursing leadership, it became a challenge to keep the program alive at our facility. With a new Director of Nurses hired, it created an opportunity for us to cultivate a partnership with the nursing team and revamp the program to the benefit of our residents.

We identified the following problem areas:

  • The therapy department did not have a specific system to identify appropriate residents to refer to this program.
  • The RNP was not properly trained in how to carry out the program.
  • The therapists were uneducated on how to create recommendations for clinically appropriate patients to the nursing team.
  • There was a lack of communication between nursing and therapy about who was on the program and who might need a referral.

We then implemented several solutions:

  • Identify significant changes in function through reports in PCC and review weekly.
  • Meet with the MDS Coordinator weekly to determine referrals through MDS reports.
  • Meet with facility staff weekly to discuss any changes, including declines or improvements.
  • Implement therapy discipline-specific quarterly screens and ROM screens.
  • Train each patient we refer to this program through one-on-one restorative training and additional trainings throughout the year.
  • Train therapy team in how to appropriately screen patients and make referrals to the Restorative Nursing Program.
  • Create a culture of therapy, Functional Maintenance Program, Restorative Nursing Program or activities, involving all patients at our facility in at least one of these programs.
  • Get behind the program and drive the bus, not allowing others to get complacent and quickly fixing issues that arise. Instill confidence in those who provide the program and those who refer to it.

Outcomes

Once our facility put systems in place to identify appropriate patients to refer to this program, we added two full-time restorative aides to provide restorative nursing six days per week. Since then, our residents have increased socialization through this program and have experienced shorter length of stays on therapy services. Due to continual staff education, nursing is more aware of how therapy can help. When there is a decline or an improvement, the therapy department receives more timely notifications.

Additionally, we have an increased Medicaid rate due to the facility being able to capture the additional resources being provided to the patients through the robust utilization of this program. This has allowed the facility to pay for the additional full-time restorative nurse aides and helped shift burden off the primary caregivers (certified nurse aides).

By Stephany Kozeny M.A. CCC/SLP and Mandi Kelly LVN RAC, Wellington Rehabilitation and Healthcare, Temple, TX

The Road to Success at Lake Village Nursing & Rehabilitation

Lake Village Nursing & Rehabilitation is known for its high quality of care and success rate. Many patients continue to return to this innovative facility for all of their rehab needs. What is it about Lake Village that allows us to generate consistently high success rates as well as quantifiable profit margins?

We believe it comes down to a multifaceted approach to patient care involving teamwork, staffing and equipment, and patient-directed treatment. Combined, these components result in a thriving platform year after year.

Teamwork, Staffing and Equipment

At Lake Village, we have found that a collaboration of disciplines may enhance patients’ compliance, satisfaction and overall generalization/carryover of skills. For example, physical and occupational therapy work together to develop strength, balance and teaching skills needed for ADLs. While PT works on W/C transfers, OT might incorporate these instructions while practicing toilet transfers, as well as self-care and dressing.

Meanwhile, the speech therapist may communicate with the team regarding patients’ communication needs, including levels of cuing when learning an activity, appropriate complexity of language and the maximum number of directions patients can follow, in order to increase overall retention of coaching and treatment.

In order to maximize teamwork and communication between disciplines for overall quality of care, it is important to recognize the role of team-building, led by the DOR, using techniques such as lunch and learns for therapy staff, off-site departmental lunches, group mentoring, one-on-one feedback and a generalized focus on employee satisfaction.

An Employee Satisfaction Survey was administered to all full-time therapists in order to measure overall happiness at work and its effects on patient care:

Patient-Directed Care

Disability may relate to several body systems and affect many aspects of life. Therefore, rehabilitation should address all needs of the individual patient. The delivery of care should be tailored to the patient’s needs.

At Lake Village, team members are problem-oriented rather than status-minded. The therapists treat the patients, instead of treating the diagnosis. Upon leaving the facility and/or upon discharge, patients feel a sense of completion and success, as well as a full understanding of techniques to assist in maintaining their achieved level of function.

Catering to the specific needs of each patient, along with creating an individualized plan of care, leads to a higher rate of goal-met status as well as positive results/reviews for the therapy team and the facility as a whole. Below is a testimonial from a satisfied patient:

“When I first arrived, I was helpless. I could barely roll over or move around in my bed, let alone sit up in a chair without having severe anxiety and tremors. After months of therapy, with therapists I trusted, I gained confidence enough to make progress. I can now transfer much easier; I walk 190 feet at a time with a walker, with just one standing rest break! I really appreciate the therapists, who in the end, turned out more like friends, because of how much they care.”

Conclusion

Lake Village provides skilled therapeutic intervention aimed at increasing overall quality of care. We focus on teamwork, staffing and equipment, and patient-directed treatment in order to provide a thriving environment for all. This year, we have improved in many areas, including employee satisfaction and decreased use of contract labor. In the future, we aim to create an outpatient setting, in order to transition our patients in the continuum of care with personalized and trustworthy care.