Host an Entry-Level OTD Capstone Student

A Great Way to Extend the Reach of Your Department! By Ciara Cox, Therapy Resource

As many of you know, entry-level occupational therapy degrees are available at the master’s and doctoral level. Excitingly, part of the requirements for an entry-level OTD included is a 14-week Capstone experience.

The students will have finished their internships and will be looking for 14 weeks’ in-depth exposure to one or more of the following areas:

  • Clinical practice skills
  • Research skills
  • Administration
  • Leadership
  • Program and policy development
  • Advocacy
  • Education
  • Theory development

The students can work fairly independently; their onsite mentor does not have to be an OT, and the onsite role is mentoring rather than supervising. (If the student is treating as part of their Capstone, then student-supervision rules apply.)

Some examples of planned Entry-Level OTD Capstones at SNFs include:

  • Environmental Modifications to Increase Participation and Quality of Life for Individuals with Dementia
  • The Abilities Care Approach: Life Story Boards for Individuals with Dementia
  • Cultural Competency in Dementia Care
  • Mindfulness Education for Stress Reduction

You can find a university offering an entry-level OTD by clicking on this link: https://www.aota.org/Education-Careers/Find-School/AccreditEntryLevel/DoctoralEntryLevel.aspx

Please email ccox@ensignservices.net if you would like more information.

Using HeartMath Spontaneously!

Heart Math Variability, By Casey Murphy, Therapy Resource

I was at our Legend Greenville facility to assist with Mock survey, and I ended up (organically and unplanned) doing an impromptu in-service with the therapy team on HeartMath. I demoed the Bluetooth device on one of the therapists who told me she was “stressed,” and we saw amazing results just with a three- to five-minute session (in front of a bunch of therapists!). She felt more relaxed afterward and was smiling a lot more for the duration of the day.

The team was so impressed, they wanted to try it on one of their patients. I sat with a speech therapy student with a patient who had dementia (and a pacemaker). I was able to sit and talk to her, taking her through the breathing exercises and talking about her family for a total of 6.5 minutes. She was only in high coherence for 12% of the time, but was in medium coherence for a whopping 41% of the time. We ended things with her smiling and thanking me for taking the time to talk to her about her family. The supervising SLP told me that she normally is not able to hold her attention; in fact, they had a goal for holding attention span for five minutes. She also told me she is usually very anxious.

Later that afternoon, I walked back into the gym and noticed the patient on the bike working with a PT, smiling and waving at me as I walked by. The PTA (who I demoed the unit on) pulled me into the charting office elated! She informed me that the patient hasn’t been able to ride the bike previously because she would scream out in pain. The staff couldn’t believe she was participating and enjoying working with everyone! The team was convinced it was the HRV session. Who knows, maybe we got lucky, but it was really cool to see that therapist and patient benefit from just one short session each!

So, needless to say, the Greenville therapy team is very interested in learning more. I loaned them my device so they can practice on their patients and themselves.

Group & Concurrent – The Data and the Delivery

By Chad Long, Therapy Resource

As we close out June, we find ourselves only three months away from PDPM! So how are we doing?

Overall in May we are providing 5% clinically appropriate Group & Concurrent to all Payers and 17% to our Non-PPS Payers.

 

How does each affiliated company stack up? Here are a few stats through May:

Highest percentage for All Payers in May goes to … Monument! Great job last month with 9%!

 

 

 

 

Best performance Year-to-Date for Non-PPS payers goes to … Bandera! They’re consistently delivering over 20% in functional multi-participant therapy programming!

 

 

 

Who has had the greatest increase from January to May? Midwest increased 13% in May compared to the beginning of 2019!

 

 

 

 

Each company has made significant gains in statistical improvement; however, what does that say about quality? Every week, we see emails about highly skilled functional groups from several facilities. Here are a few great examples to follow:

THE SOUTHLAND OCTAGON

The “Southland Octagon” was their creation in order to have functional, skilled and evidence-based group programming. For example, each bar was carefully measured to also allow for functional assessments such as the seated step test.

Additionally, they developed clinical group treatment protocols such as:

Functional Transfer Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale, standard height chair and patient’s own W/C

Purpose:

  • To strengthen LE Hip & knee extensor and Hip Abductor/Adductor group of muscles to improve functional transfer
  • To promote safe functional transfer technique
  • To promote motor learning through repetition
  • For the individual to learn, encourage and motivate one another

Procedure:

  • Therapists and pts may introduce themselves to each other. Briefly discuss the goal.
  • Check and record vital signs, RPE and pulse oximetry.
  • Demonstrate the task.
  • Patient is instructed to stand up (may utilize arm rest) and hold on to the Southland Octagon bar.
  • Make two to three side steps to the next practice chair (return to/from)
  • Let the patient repeat as many as possible until they feel fatigue.
  • Observe and record the form, smoothness of movement, movement compensation, etc.
  • At the end of the last attempt, have the individual sit, take and record BP, HR, RR, PRE and oxygen saturation.

Seated Step Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale,

metronome (set at 60 bpm)

Purpose:

  • To strengthen LE Hip flexor and knee extensor group of muscles to improve mobility
  • To improve aerobic capacity and endurance
  • Suitable for those unable to stand up safely with less assistance
  • For the individual to learn, encourage and motivate one another

Procedure:

  • Therapists and patients may introduce themselves to each other. Briefly discuss the goal.
  • Check and record vital signs, RPE and pulse oximetry.
  • If one of your goals is to improve aerobic capacity, determine target heart rate (Karvonen’s formula). Monitor heart rate during the procedure.
  • Demonstrate the task.
  • Patient is instructed to alternately touch each foot to the edge of the step at the rate of set bpm (metronome) to touch the edge of the step; next beat brings the foot to the floor, and next beat the opposite foot touches the edge of the step.
  • Let the patient repeat as many as possible until they feel fatigue.
  • Observe and record the form, smoothness of movement, movement compensation, etc.
  • At the end of the last attempt, take and record BP, HR,RR, PRE and oxygen saturation.

Progression:

  • May progress to 12”, to 18” with UE movement. Right shoulder flexion to 90 degrees when raising right Leg. Repeat with the opposite side.

Sit to Stand Group

Equipment:

Southland Octagon, blood pressure, stethoscope, pulse oximetry, RPE scale/Borg Scale

Purpose:

  • To strengthen LE extensor group of muscles and improve functional transfer
  • To promote motor learning by repetition
  • For the individual to learn, encourage and motivate one another.

Procedure:

  • Therapists and patients may introduce themselves to each other. Briefly discuss the goal.
  • Check vital signs, RPE and pulse oximetry.
  • Demonstrate the proper form of doing sit <> stand.
  • Patient is instructed to stand up (patient may utilize the arm rest), hold on to the Southland Octagon bar then sit down, doing as many as possible until they feel fatigue.
  • Observe and record the form, smoothness of movement, movement compensation, etc.
  • At the end of the last attempt, have the individual sit, take and record BP, HR, RR, PRE and oxygen saturation.

Optima Update - POS Part 2 of 2

Point of Service Documentation: Part 2 in a 2-Part Series, by Mahta Mirhosseini, Therapy Resource

In Part 1 of our Point of Service Documentation (POS) series, we discussed how POS style documentation can have great therapeutic benefits over traditional treating first and documentation at the end of the day. If you missed the first part of this series, click here.

Today’s post on POS documentation will highlight our therapy EMR’s POS platform: Optima’s Point of Care or POC (pronounced “pok”). Let’s see how POC helps with efficient POS documentation.

POC is designed with the treating and documenting therapist in mind. That is why it does not have administrative and reporting features to slow down the system.

POC is many (and I mean many) times faster than traditional Optima, saving our evaluating and treating therapists time, not having to wait for documents and screens to open up.

POC is designed to work on any tablet (iPad, Chromebook and laptops) because it is device-agnostic.

POC can work offline, so once therapists download their caseload onto the device, they are able to complete billing and documentation even in areas of poor connectivity in the facility.

POC has the names of the other disciplines’ therapists that are scheduled with each patient, so no need to constantly refer to the assignment board to find that info.

POC’s documents have an “H” button that offers all historical info that has been added in that field since the day of the eval.

Last but not least, POC has a feature called the “side by side viewer.” Anytime a therapist is working on a document, this feature offers a split screen and instantly loads all prior documents (including TENs) that can be referred to as the therapist completes the current document.

Please reach out to me or your local therapy resource if you would like more information about getting started with POC. Remember that POC can be used on any device, including your existing laptops.

LTC Think Tanks – A Vision to Reality


We are only just beginning. We started with a vision about wanting to share the best practices that we are seeing in our facilities throughout the organization. With a centered focus on long-term care, we turned our vision into reality with the creation of the LTC Think Tanks. Below you will read a brief recap about a few of our LTC Think Tanks, and we hope to continue to bring you innovative, inspiring, passion-driven ideas to help keep your long-term care residents performing at their highest level of potential with the ultimate goal to decrease their risk of further decline.

If you or members of your team would like support in program development, patient care identification strategies, and/or feedback on questions regarding long-term care, please reach out to LTC_TaskForce@ensignservices.net. Our mission is to provide a centralized hub to facilitate the dissemination of ideas.

 


Renew Purpose and Restore Peace

The rehab team at the Garrison facility, led by Christa Keesee, is inspiring us all. By identifying the needs of their patients, they created a specialized program to “Renew Purpose and Restore Peace” for their ever-deserving long-term care residents. Molly Setliff, occupational therapist from Garrison, provided a thorough presentation to help walk you through the mission and implementation process of the program. Molly also takes you through challenges you may experience and helpful alternatives.

Reach out to Christa Keesee to learn more.

 


Benefits of Using Therapy Animals in LTC

We had great contributors such as Michelle Wang, Jon Anderson, Barbara Mohrle and Ciara Cox who centered on the benefits of using therapy animals in LTC. Each has had great experience with using therapy animals in their facilities, and it provided great joy to many of the patients during their treatment sessions. We have a detailed presentation that bullets the ADL and musculoskeletal benefits of using therapy animals during patient care.

If considering a pet therapy program, consult with your state to ensure you have all requisite elements in place and also that the facility has a policy in place, as the state will look for this on survey.

Below are some helpful sites to visit if you are interested in learning more about therapy animals or getting your animal trained:

  • Take a look at the Good Dog Citizen program at https://www.akc.org/ to learn more about the specialized training program.
  • Contact your local zoo. Many are available to come on site and visit your facilities with a variety of animals.
  • Search Google under Therapy Animals along with the name of your city. This search will populate contacts for therapy animals in your area.

 

…But How Should I Document

We usually receive tons of questions regarding how to best document our skilled maintenance services that are provided to our LTC patients. A special thank-you to Lori O’Hara for debunking some documentation myths surrounding Skilled Maintenance Therapy and for also giving us clear breakdowns of what this type of service should look like. We offer a skilled Maintenance POSTette, located on the portal, which includes documentation examples.

During the Think Tank, we also shared a really cool therapy tracking tool. The creator, Shaun Baldwin, was unable to join us, so I hope I did it justice with my explanation. We viewed the spreadsheet, which has a ton of information; he uses it during his Medicaid meetings to keep track of patients during the week. To make sure that he does not overlook any of his LTC residents, he built a section that lets him know how long it has been since a discipline last treated a patient. If the patient has not been on a discipline for longer than 75 days, the cell will turn yellow, and if it has been greater than 150 days, the cell will turn red. He uses the spreadsheet as a visual reminder of who may need to receive a follow-up by therapy. Shaun is very open and available to answer any of your questions regarding the tracking tool. Shaun Baldwin is the DOR at our San Marcos facility in Texas.

Functional Jobs Program

Program development is not always about structured exercise programs and textbook balance training. There are a variety of programs that may not sound like therapy in the traditional sense, but they are oftentimes the most beneficial to our patients’ physical and psychological well-being. Do your residents need a “job”? Barbara Mohrle, DOR/Therapy Resource, and Marisa Parker, DOR/Therapy Resource, reminded us all about living a purposeful life and why that is so important to our residents.

What is the Functional Jobs Program? It is a LTC program designed to allow residents an opportunity to serve and take part in daily activities that keep them fulfilled.

  • The therapy team realized that many of their residents had a passion to serve, and they wanted to take part in daily activities that allow them to improve/maintain their level of functional mobility and decrease the risk of injury.
  • As therapists/assistants, we have an opportunity to provide skilled care to our patients and help prepare/engage them in their “job.”

Reach out to Barbara Mohrle and Marisa Parker for more information on implementing the Functional Job Program in your facility.

PTNM and NMES

Marci Williams, PT, DPT, and Katie Kellagher, CCC-SLP, discussed two types of modalities that can significantly impact a patient’s quality of life.

Here are some key takeaways:

Percutaneous Tibial Neuromodulation (PTNM)

  • Geared toward patients suffering from urinary incontinence
  • Huge opportunity for the therapy and nursing partnership
  • Email LTC_Taskforce for assistance with implementation
  • This is a service-based billing code with opportunity to provide care to more than one patient at a time

Neuromuscular Electrical Stimulation (NMES)

  • Certification in Vital Stim or NMES is a great adjunct to traditional interventions
  • Referral sources are always excited to hear about therapists who are certified in NMES
  • Please reach out to Elyse Matson, SLP Educational Resource, for additional support in modality implementation and/or documentation

Figuring Out LTC

Jennifer Kuehn, DOR from the Endura Market, led an excellent presentation on how to effectively navigate the area of LTC. Jenny dove into the clinical decision-making and patient identification process with great strategy and clinical reasoning. Reach out to Jenny to get your hands on her PowerPoint presentation. We received tons of great questions on the call; one question in particular stood out regarding patient weight loss. Elsye Matson, MA CCC-SLP, serves as our SLP educational resource. Elyse, with great detail, answered the posed question below. Please feel free to follow up with Elsye directly for further clarification.

What is the desired weight loss that a patient must have to warrant speech to evaluate?

SLPs should either be a part of the weight-loss committee or get updates from the RD in their facility on a weekly basis. The MDS triggers issues with weight loss at 5.0, 7.5, or 10.0% weight loss over a period such as a week or a month. There are a multitude of reasons one loses weight, including issues with self-feeding (refer to OT), medical complications affecting appetite and desired weight loss. A small amount of weight loss may indicate a serious issue if the patient was admitted weighing 80 pounds. Alternatively, a large weight loss from a 300-pound patient may be desired.

Finally, it is important to know information about meds, labs and conditions to differentiate a patient losing weight from diuresis/CHF issues versus true weight loss. So the circuitous answer re: weight loss and dysphagia is that it depends on each individual situation. We must always look at the whole patient and assess what is needed. There really is no correct answer, as weight loss is one symptom of many problems. We need to know our residents, stay in contact with our IDT and re-assess tube feedings and modified diets on a regular basis.

How Culture and Clinical Meet Financial

We had a great speaker by the name of Karlena (Valerie) Brooks, COTA. Karlena joined the Legend North Austin team as the Therapy Program Manager almost a year ago. Through her focus on revamping the culture and implementation of clinical programs, Karlena has tremendously grown her financial results in the area of LTC. It was wonderful to have her ED, Jocelyn, contribute to the discussion by sharing the effectiveness of what the development of a true partnership with the IDT can lead to. Reach out to Karlena to learn more; it will be well worth your time.

By Kai Williams, Therapy Resource

Getting Credit for Joint Replacement

Say your patient had a hip replacement after a fall with a fracture. Coding rules say you code the fracture first, not the aftercare code. But that’s fine — as long as you check the box that says “Hip Replacement” in section J of the MDS, then the fracture code will automatically “bump” up into the Major Joint Replacement, right?

Wrong! The bump is not automatic. The fracture code that’s selected has to be eligible for re-categorization.

But how do I know? you are asking yourself.

Easy! Look at the map!

CMS has mapped every ICD-10 diagnosis to a category (or an RTP!), and the map will tell you if the code you’ve selected is eligible for re-categorization if it gets partnered with a surgery in the MDS. This is true for the bump into the Major Joint or Spinal Surgery as well as the Other Orthopedic Surgery category.

So where’s the map? The PDPM ICD-10 Map is available in the “Resource” tab in the “PDPM Ready 106 — Field Practice, Identifying the Primary Medical Condition” LMS training, or on the CMS.gov website (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html).

How do I read the map? When you find your diagnosis, look to see what the map says in the “Resident Had a Major Procedure during the Prior Inpatient Stay that Impacts the SNF Care Plan?” column. If it says “NA,” then checking the “hip replacement” box in the MDS won’t do a thing. But if it says, “May be Eligible for One of the Two Orthopedic Surgery Categories,” then checking the box will “bump” the code.

Let’s look at some examples from the map. Here are three femur fracture codes:


Look at the first code: S722.5XD describes a closed left femur fracture with routine healing. By itself, it would qualify only for the Non-Surgical Ortho category. But the box on the right says, “May be Eligible for One of the Two Orthopedic Surgery Categories.” So checking the “hip replacement” box in the MDS will bump this code into the category we should have — Major Joint Replacement.

The middle code (S722.6XD) describes a fracture of an unspecified femur. This is a Return to Provider (RTP) code. And with good reason — we can tell which femur was broken!

The bottom code (S723.01D) describes a closed fracture of the shaft of the right femur. This qualifies for an orthopedic surgery category, but look at the box on the far right — the one that tells you if the code is eligible for the bump. The box says, “NA.” This means if you used this code, even if you check the “Hip Replacement” box, the category wouldn’t change. This makes good clinical sense, since a fractured femur shaft isn’t when a hip replacement would be done. But what if that code got in there by accident and no one noticed? This is why close attention to codes is so important! The input of a therapist whose expertise includes the nature of fractures and joint replacements is a critical support to the team who is selecting the diagnoses.

So, the takeaway is that while CMS is happy to provide us with reimbursement commensurate with taking care of a major joint replacement or spinal surgery, we need to watch how we’re coding carefully so that we build the case in such a way that CMS can know that that’s what we’re doing.

By Lori O’Hara, MA, CCC-SLP, Therapy Resource – ADR/Appeals/Clinical Review

Therapy/Nursing Partnership

At Glenwood Care Center in Oxnard, CA, Cherryll Santos (L) and Aimee Bhatia (R) have a unique close relationship. Cherryll’s 18 years of leadership are evident in the culture of the nursing department, as this is a happy, cohesive team with strong clinical systems in place. Aimee, DOR, has been at Glenwood as a treating OT for five years, and a DOR for almost three. The relationship between these two leaders has a big impact on how nursing and therapy work closely together.

Cherryll and Aimee collaborate on clinical decision making and utilize each other’s strengths to collaborate with physicians, build programs, nurture relationships with families, and ensure excellence in patient care. The therapy team has a Culture Committee to partner with nursing in spreading love, celebration and appreciation to the CNAs and nursing staff. It’s amazing what a little bit of recognition and gratefulness does to boost morale!

The department head team also initiated a “random acts of appreciation” task force where the department heads pass out small gift cards when someone on the floor is noted to go above and beyond with their job assignments or to assist co-workers — once again, a simple gesture that goes a long way. For nurses week this year, a few department heads teamed up to plan daily dress-ups and games/events to appreciate staff and make them feel loved.

On a daily basis, therapy assists with CNA training and in-services to ensure quality of care and reduce workplace injury. We work closely with nursing to establish appropriate fall precautions for high-risk residents. We advocate for needed services for our long-term residents while working hand in hand on identifying appropriate residents, and we work closely with RNA to ensure a continuum of care and no loss of function that is preventable. Our Glenwood Care Center nursing and therapy partnership is a powerful team of dedicated clinicians with the common goal of providing quality care, a safe environment and opportunities for residents and staff to flourish.

Joy in Leadership: The Unexpected Power of Leading with Love!

Over 250 therapy leaders gathered in Newport Beach to create a Therapy Leadership Experience powered by love! The theme of this year’s experience resonated throughout our amazing two days together spent in learning, loving and leading. Beginning with an optional yoga session in the outdoor amphitheater each morning and continuing with healthy meal and snack options combined with fresh flowers and an indoor/outdoor ambiance, the tone of the event centered on wellness.

The WELL Project Team provided context to the idea of creating a wellness movement with the goal of not only helping ourselves, but also leading by example to positively impact all with whom we come in contact. Leaders provided written notes of gratitude, WELL Commitments and ideas for inspiring wellness among one another. Our Therapy Director, Mary Spaeder, provided a beautiful reminder about our ability to choose our response to all that we face in life and leadership, while reinforcing the use of tools and techniques such as heart rate variability training to help us build our resilience.

We experienced an awesome opportunity of interacting with some of our great organizational leaders. Barry Port, Bev Wittekind, Soon Burnam, Clay Christensen, Debbie Miller, Tyler Douglas and Spencer Burton all spent valuable time sharing thought-provoking lessons on leadership and learning. Following the recommendation of our 2018 Summit Leaders, Mike Dalton joined us to stimulate our thinking about life and leadership.

The learning and sharing of best practices for enhancing outcomes-based care of our LTC residents, outpatient program development, therapy utilization techniques and tools, business development, clinical program development and the inner workings and considerations for functioning in a Patient-Driven Payment Model environment were central to our 19 different Think Tank Sessions and over 40 Poster Sessions presented at the event. We invited CMS Leader, John Kane, who shared brilliant insight and led a dynamic Q and A session allowing our leaders to get a close-up view of the rationale behind a PDPM and the CMS perspective on hopeful outcomes from the reimbursement system.

Ultimately, we left the experience more enlightened and overflowing with joy and love for an organization that values our growth and supports our passion for learning.

As Mary so beautifully shared during her opening remarks through the words of Rabindranath Tagore:

I slept and dreamt that life was joy
I awoke and saw that joy was service
I acted and behold, service was joy

The 2019 Experience calls us to continue our quest toward Joy in Leadership and the unexpected power of leading with love!

Thanks to Alan Gibby for lots of great photos! Click here for Part 1 and Part 2

Got Joy? The therapists, nurses, residents and IDT members at Mt. Ogden Nursing and Rehab do, and they are sharing these joyful moments through messages and photos. How will you inspire a WELL movement like DOR Brooke Stanley and her team did?

Therapist Profile: Roger Pavon

Roger Pavon has been part of the California Southland family for over 20 years and was one of our original pioneers who traveled via the “Southland bus” and “Southland jet” to help our affiliate operations in San Diego and Northern California. Roger was instrumental in helping implement in-house therapy with the then-named Northern Pioneers operations.

“Roger and his wife, Grace, have three beautiful kids who grew up with us at Southland. He is a humble, loving, passionate therapist who knows how to bring out the best in every patient. My mom could not smile anymore by the time her Parkinson’s had advanced, but the moment we brought her in for outpatient services at Southland in 2017 and she saw Roger, she smiled for the first time in months with tears of joy in her eyes,” said Mary Spaeder of her appreciation of Roger.

Roger became interested in physical therapy after his grandmother had a stroke. He witnessed and took part in her rehabilitation and was inspired to help other people make positive changes in their lives. His favorite part of being a therapist today is helping people regain their mobility and improve the quality of their lives physically, mentally and emotionally. Even after over 20 years of being a therapist, Roger finds his work extremely rewarding.

When asked who on his team he admires the most, Roger said, “I admire each and every team member I work with because each person contributes something special that makes our team what it is.” Roger doesn’t have a specific professional mentor at this stage in his therapy career, but he is a life-long learner and likes to listen to podcasts and read books by motivational leaders like Louise Hay, Dandapani and Wayne Dyer.

Roger’s favorite Disney character is Peter Pan, “because he is carefree and adventurous, and doesn’t grow up. We don’t stop playing because we grow old; we grow old because we stop playing,” Roger says. Roger does plenty of playing himself — his favorite outdoor activities are snowboarding, stand-up paddle-board, and spending time at the beach and in nature. His favorite core value is Love One Another. As he explains, “Love is God and God is love!”

Roger believes that the biggest thing that leaders and resources in our organization can do to support our therapists is to appreciate them. “It is said that a person who feels appreciated will always do more than expected,” he explains. Roger Pavon, you are appreciated!