Sharing the SLP Love

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Submitted by Jennifer Raymond, Therapy Resource — Northern CA

In January, Elyse Matson, MA CCC-SLP, Speech Language Pathology Resource/Ensign Services, provided an onsite half-day training course for the Flagstone NorCal Market Speech Language Pathologists and DORs.

The training content focused on how PDPM has changed SLP practice, including review of PDPM and SLP case mix, use of group and concurrent therapy, clinical documentation for both skilled and LTC patients, coding/goal writing, standardized testing, Medicare Part B utilization, dementia treatment utilizing Abilities Care, and the latest evidence-based practice and treatment techniques.

Since all of the SLPs in the NorCal market work independently in their facilities and many of them are geographically far apart, these therapists rarely are able to collaborate with each other in person. The course was an opportunity for them to meet face-to-face (some for the first time), share a meal, ask questions and discuss best practices with their colleagues, and update their learning together.

The course was enthusiastically received by our SLPs, as demonstrated in their comments below:

  • “I feel more confident in documenting skilled services, great use of resources”
  • “I have more tools now for providing abilities-based care”
  • “I have learned new coding and documentation skills”
  • “I feel more comfortable treating patients with dementia”
  • “Now I really understand the increased role of SLP with PDPM”
  • “Going forward, I know how to make my goals more specific on my POC”
  • “Wonderful learning and networking afternoon; can we please do this at least every six months?”

In addition, by inviting the non-SLP DORs, it provided an opportunity for our OT and PT leaders to have a better understanding of the broad range of available ST clinical services, documentation requirements and processes specific to PDPM and LTC interventions for their SLP programs.

JB Chua, PT/DOR for Summerfield, shared:

“Attending the SLP training course gave me tools on how to support my SLP in growing our program. It gave me insight on what to look for during our Daily Technical Meeting. Triggers that will make me ask my SLP to screen a particular patient to help us capture an accurate clinical picture of our patients. Lastly, it also helped me understand words/phrases that SLPs use that a PT seldom or never uses in their documentation. Overall, this training course is highly recommended not only for our awesome SLPs, but most especially for DORs without an SLP background.”

Thank you, Elyse, for this opportunity to exercise our Passion for Learning in NorCal!

A Journey for a Passion for Learning

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By John Patrick Diaz, DOR/DPT, CEEAA, RAC-CT, Magnolia Post Acute Care, El Cajon, CA

My journey with Ensign started five years ago when my current ED, Matt Oldroyd (shoutout for recently achieving the title of CEO) gave me the opportunity to be part of his team. Parkside was part of the huge acquisition that occurred in 2014 here in San Diego, where part of the transition was to hire new staff to complement previous staff who stayed on. He gave me a start date, which I begged to delay for a week as I was planning to attend the American Physical Therapy Association’s (APTA) Combined Sections Meeting (CSM) that was to be held in Indianapolis. This has been an annual commitment that I have made since being a member of the association and the Academy of Geriatrics. When he allowed me to start after my trip, this gave me the reassurance that I did make the right decision, considering that I would be working with an ED who supports my passion for being a lifelong learner in pursuit of clinical excellence.

Every year since then, I have consistently stayed true to my commitment, but this year almost didn’t happen as the annual surveys for the facilities that I have been supporting were delayed. We only had a week left before the 2020 CSM, and I was torn if I would still attend the event or just cancel my trip altogether. We do have very strong and supportive partners, with one of our therapists being experienced who could step up on short notice. I told Stew, ED at Magnolia, on a Monday that I wished for them to come this week so we could get it done and start working on the goals that we were planning for this year. Lo and behold, Tuesday morning comes and I get nonstop text messages indicating that the surveyors have arrived at not one but two of the facilities that I have been supporting. The next message I got was from Stew who said, “Well, you got your wish. LOL.” I replied to him, “I know!!! We got this. This is the start of our journey for the FLAG.” It was such a relief, but a rewarding experience to have simultaneous surveys and to get triple check done in a week.

I got the chance to attend the event the following week, and being at such a gathering never gets old. Networking and meeting old peers, students, presenters/speakers, authors, vendors, etc. with a common goal of learning just makes it so rewarding. This year’s event was more meaningful to me, as the Academy of Geriatrics rebranded and created a video depicting the importance of the population we serve. With the changes that have occurred since October 2019, we all have tried to embrace and change our mindset on how we can meet the needs of our long-term population. I firmly believe that we all have the foundation to make a difference and be influential in making aging an intentional and meaningful experience for our patients. Gone are the days where aging was considered as something passive with the stigma of, “Once I enter the nursing home, that’s it for me.”

With our mission of transforming and dignifying post-acute care in the eyes of the world, gray does matter and we have to help our residents age on. I encourage everyone that if you have that opportunity to be active with your own organizations, please take it. Whether you are a regular member, part of a committee or even a special interest group (SIG), you will still learn a lot and it will show in your practice. The benefits of having the passion for learning are endless. Having different titles at the end of your name is not what’s important, but what matters most is the information you get (and how you use and share the information in your practice) in earning such credentials and certifications. Be open to change. Don’t limit yourself to what you learn in books, because we have to realize that it takes three to five years to even publish a book, and once we get ahold of it, the information may no longer be up to date. Who would have thought that teaching an 80-year-old to plank is now being practiced, or using a pillow under the knee of a patient with a TKR is now recommended in the acute phase of a patient’s recovery?

As movement specialists, make a difference in helping the community and change our mindset to realize that gray does matter. Let’s all come together to develop a passion for learning.

Cluster Meetings - DOR Involvement

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By Rachel (Ray) Yarman, DPT/DOR, City Creek Post Acute, Salt Lake City, UT

Roughly 1.5 years ago, the Seal Team Cluster from Utah started to include the DORs in cluster meetings. As the most novice DOR in our market, I was honored to be invited and to learn in a real cluster approach. I am lucky to have two other very strong and knowledgeable DORs in my cluster. Prior to our cluster meetings, I had a very difficult time coordinating learning from other DORs, or physical therapists in our market or cluster.

Our cluster meetings started out with mostly timidness from our DORs: learning, listening and digesting information. We all review therapy outcomes with our resource and have discussions about our building with the influence of DONs/EDs. We additionally review facility outcomes across the milestone market as a means of accountability. Learning about the financials of the building and seeing how therapy plays a role in the success of the buildings allowed us to have some crucial conversations. Our meetings have fostered a large amount of trust with one another. The trust that we now have is the building block of being able to have discussions at the table to celebrate, challenge and think big together to work to dignify long-term care.

I personally feel so grateful for the added support and learning from our clusters EDs and DONs. The cluster really feels like such a support team. We continue to push forward with thinking big for our staff members, which ultimately results in better care for our residents. Learning from numerous sources is always better than learning from just one source. As we share our successes and opportunities for improvement, I feel a greater sense of ownership for not only my building, but also our cluster as a whole. I relish the times that our buildings get to come together, and I get to learn from other sources and return to City Creek with that knowledge.

I can honestly say that my ownership and accountability have grown exponentially from having the cluster support. I cannot recommend enough having DORs sit at the table to discuss progress and growth of our buildings, to ensure that we are all on the same page in achieving our mission to dignify long-term care.

5 Strengths of a DON/DOR Team

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By JB Chua, DOR, PT, CEEAA, Summerfield Healthcare, Santa Rosa, CA

“If you play for the name in front of the jersey, then everybody will remember the name on the back.” — Sherwood Bassin

I did a book review with one of my employees this month, and we read The 5 Dysfunctions of a Team by Patrick Lencioni. After I finished the book, I reflected on these dysfunctions and how my relationship with my coworkers is, specifically with my Director of Nursing, Enedina De La Cruz. I am so proud to realize that we have overcome all these dysfunctions, and I would like to share the strengths (antonym of dysfunction) that we possess. Hopefully, it will serve as an inspiration to some of our partners.

  1. Presence of trust: Dina and I are not afraid to be vulnerable with each other. We are open to admitting our weaknesses as well as acknowledging our strong instincts in our unique characteristics as people as well as leaders.
  2. Acceptance of conflict: Conflicts are bound to happen between Nursing and Therapy teams. But instead of creating an artificial harmony by not addressing the problem and being satisfied with inferior decisions, Dina and I engage in a healthy debate where we listen to each other’s opinions to come up with the best possible solution to our facility’s problem.
  3. Unwavering commitment: When a decision is made after our debate, we know that we are both in, even when it may not have been the idea we had in mind. For us, it is not about who is right; it is about our opinion being heard and how we can do things right.
  4. Extreme accountability: From making sure that UDAs are being done, to what time the fall committee should happen, Dina and I make sure that we are holding ourselves accountable. We call each other out when we notice that something is getting dropped.
  5. Paramount attention to results: Whether we get good or bad results, we make it a point to make sure that we understand how we get there, how we can make it again or how we can be better. Dina and I understand that we are not just aiming for the success of the Nursing or Therapy department; we are aiming at a much bigger picture: the success of Summerfield Healthcare Center.

PDPM Lessons Learned - Section GG

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Submitted by Jennifer Raymond, Therapy Resource – Northern CA

During a recent NorCal Weekly DOR call, a question came up that prompted discussion regarding how Section GG scores are being determined when there is a discrepancy between Nursing and Therapy.

When we have differences between Nursing and Therapy scoring for GG, this must be reconciled per the RAI MDS manual criteria by answering the following question:

“What is the usual/baseline performance (days 1, 2, 3) BEFORE therapeutic interventions occurred?”

We cannot average or modify the assist levels that have been documented but instead through discussion and chart review need to determine which of those scores best represents the “usual/baseline performance” for this patient before the onset of any therapeutic intervention.

Therapy/MDS folks are clearly collaborating well to compare Nursing/Therapy documentation as part of the daily technical GG process. The next step is to ensure that when these values differ we are determining which documented assist level best describes the patients’ usual/baseline performance at the time of admission and discharge and are recording that score on the MDS.

Thank you NorCal DORs for bringing up this important topic.

Please reach out to your MDS/Therapy resources if you have additional questions and share this info with your Daily Technical Team!

Why I Love Running

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By Julie Uychiat, Clinical Market Lead – Arizona

Discovering running at a much later stage in life has been the greatest gift life has given me. It came at a perfect time when I needed a lift, to be reminded of my life’s purpose and overcome my self-imposed limitations. Running has given me everything … my renewed self-love, my self-confidence, my fearlessness, my grateful attitude and my purpose. It has inspired my new direction and outlook. It has taught me to push forward when things get difficult. In return, I am giving it my heart.

I come from zero running background. I hated running. In late 2015, my sister started running with my best friend. I remember asking her how she is able to run when I can’t even run from my house to the next stop sign without getting short of breath. She told me to just slow down my pace and keep going … further saying, “You won’t die.” Her words stuck with me as I attempted to give running one more shot that afternoon. I ran my very first 2.5 miles that day and remembered how incredible that feeling was. It gave me the confidence to join our Bandera Ragnar team in 2016, but I still wasn’t serious about running at that point.

In March 2017, I ran my first individual race, which was a half marathon with my sister. We decided to follow the 2:30 pacer. I wasn’t serious about it at first, conversing with her while running, answering texts during the race until around mile 8-9 when I saw how serious and competitive other runners were and thought to myself that maybe I should take it more seriously, too. I started giving it my best and got ahead of the 2:15 pacer to the finish. This race gave me a glimpse of the possibilities, although a full marathon was still out of the picture at that time.

In May 2017, two months after that race, I was at the Service Center for a meeting. There were about seven or eight of us in the conference room. Jess Dalton had his laptop open and told me that he wouldn’t be starting the meeting until I signed up for the St. George Marathon with him that October. I quickly refused and told him to give me at least a year, but he insisted. I made a deal and told him that if there was another person in the room who would sign up with us, then I would commit to doing it. The first person I asked was Rebecca Higbee, whom to my surprise said yes without hesitation. I didn’t know then that she was a runner, so I was committed.

Marathon training presented opportunities to discover the deepest parts of me at age 44. I didn’t know I had the discipline, passion and commitment to endure the hard work in spite of my very hectic work schedule and weekly travel commitments.

I Boston-qualified my first race that year, and that opened things up to a whole new exciting world for me. I am currently chasing the 6 Major Marathons in the world and since 2018 have completed four of six (Berlin, Chicago, Boston and New York). From these races, I have earned a respectable world ranking and received an invite to run the Wanda Age Group World Championships inaugural race in London this April. This is where I will be competing against 84 other top world runners in my age group.

I recently surprised myself when I ran my best race at the Phoenix Marathon on Feb. 8. I got very emotional when I crossed the finish and saw my time, 3:19:30. It exceeded our expectations (coach and I), and my heart was full once again.

I believe in Hal Elrod’s Miracle Equation:

Unwavering Faith + Extraordinary Effort = Miracles.

My marathon journey is a true testament to this. In fact, this equation applies to every other area in our lives. We just need to first believe that WE.ARE.LIMITLESS and put forth the effort to see the miracles happen.

From Ultra “High” to Ultramarathon

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By Dennis Baloy, OTR/L, OTD/DOR, St. Elizabeth Rehabilitation, Fullerton, CA

It’s 5:05 a.m.

You’ve already hit the snooze button twice. You get up, fix your coffee and open your laptop. You check the assignment board and check patient projection and staff scheduling. You take a sip of your coffee. You open your email, read your email and reply accordingly. You take another sip of your coffee. You are now more awake and you’ve started planning your day.

You take a shower, brush your teeth, and wake up your kids and get them ready for school. You finish dressing up and you drop off your kids, and now you are on your way to work. By this time, you have already replied to five people (both coworkers and family members). You might have taken or made a phone call or two. By this time, you’ve probably browsed some daily news, greeted some friends on social media and read some inspiring quotes to start your long day. You are ready. Well, sort of. Still, you feel like there’s a lot of things not accomplished, but you come to work as prepared as you can be.

Then your eight-hour workday commences.

You are done with the day. You’ve tied up loose ends. Made a lot of people smile. You feel productive, though there’s a couple more pending items that you are left to do. You did your best, and there’s another day waiting to finish it all up. You get the job done and another one awaits. “I can do this,” you say to yourself.

On your way home, you pick up your kids, run errands, fix dinner and help them with their homework. You take them to shower, read them a book and you finally have a few more minutes (sometimes when you are lucky, an hour or so) for you and your spouse to spend.

Then 5:05 a.m. strikes, and it’s back to the daily grind.

If this routine sounds familiar, then we are all in the same boat. Truly, we are creatures of habit, bound to do things over and over again. And it’s all good! After all, we try to manage our time in the best possible way, expecting the best possible productive result.

So where did my running affair start?

I am an average joe. I hated running and could barely run a mile. My knees would start hurting, and it just didn’t feel right. I know as a therapist, there are countless full-body workouts I can do to achieve the physical fitness that I want. But one thing I know about myself is I am always up for the challenge — physically and mentally. There is an inner adventurer in me wanting to experience life to its fullest. I love sunshine, the oceans and the outdoors. I can be a very laid-back person, yet I can switch it on to be a very competitive one.

So why do I run, and why run an ultramarathon?

  1. The ultra “high”: Studies have shown that running and other physical activities release endorphins and decrease cortisol levels. Running definitely has a positive effect not only on your body, but also in your mind. A good run will leave me a clear mind and calmer self. Every time after I run, I come home a completely different person — more positive, understanding and caring. It’s definitely a mood changer. The lasting effects are definitely noticeable by your family, friends, coworkers and loved ones.
  2. Empowering, develops resilience (and humility!): The feeling of accomplishing a goal, whether it’s buying a new pair of shoes, having your kid graduate from school, cooking a new dish, learning a new language or perhaps running your first 5K, will leave you feeling like a champion. There is no better satisfaction knowing you are able to accomplish the personal goals you’ve set. Conquering distances, facing hardships and dealing with pain during runs translate to life in general. Knowing you can push through these obstacles allows you to do the same in life. Not all runs you will finish, and not all life’s struggles you can face, thus running is also a very humbling experience.
  3. Happily disconnected: It’s rare that we get disconnected in this technological world that we live in. We are always on our laptops, phones and TVs— so much so that being “disconnected” is a blessing. It is also by all means a choice. Being outdoors, may it be with or without music, and running give you this wonderful experience of being one with the world. It’s a religious experience that connects you and everything else that you see, feel and hear (the sights of nature, the sounds of wildlife and the drizzle of rain). It’s equally soothing, stress-relieving and euphoric.
  4. You vs. you: As competitive as I can be (most of my close family and friends can attest to this <insert emoji of choice here>), I always believe in the Ironman mantra, “You vs. You.” Oftentimes you want to go faster, you want to go longer and you want to be the athlete you idolize. In the end, you are always reminded that the best part about this journey is just to be a better version of yourself. You want to be stronger, wiser and better than you were yesterday. This is more than enough.
  5. Community: Lastly, running brings people together. Runners are such happy people in general. You all undergo the same painful yet satisfying experience. The community of runners helps each other finish their goals. There were numerous times when a running buddy helped and carried me ‘til I finished, and I’ve done the same — motivating and physically assisting them to the end. No wonder there are tons of running charities out there that aim to bring awareness of all different sorts (health, socio-civic, for-a-cause, running-tributes, etc). You get the above benefits, but more importantly, you are helping make this world a better place to live in. How cool is that?

My Journey kicked off way in 2017. I started with the Angels Stadium 5K, then completed all the Spartan Races, the 70.3 Ironman in Arizona last year and recently the 50K ultramarathon. I hope this story resonates with all runners or non-runners. We can all break our routine and try out this spiritual experience that not only yields physical gains, but also emotional, mental and psychosocial benefits.

….and before you know it, it’s 5:05 a.m.

Are you ready to lace up?

Leaders Made Here - TJ Petty

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Submitted by Chad Long, Therapy Resource

For those of you who have never had a chance to meet Tyler “TJ” Petty, DOR at Montecito Post-Acute and Rehabilitation in Mesa, AZ…you should. TJ is a leader full of charisma, compassion and focused on moving his team and facility forward in a CAPLICO manner. He started his journey with Montecito in 2008 as a PRN Physical Therapist, then a full-time staff member in 2009 and has been the DOR since 2010.

Over the last 10 years, TJ has developed a dynamic therapy department in a very successful facility. Montecito has grown to an average census of 190 with 100 skilled patients. It is also a large Ventilator and Trach-dependent facility caring for acutely ill patients and fragile LTC residents, boasting 156 admissions and discharges per month!

I was able to ask TJ a few specific questions about his views on Leadership in order to gain a little insight into the success of Montecito:

How do you on-board and orient new therapy team members to a CAPLICO culture?

During interviews, TJ performs the first meeting on his own. Then the entire therapy team must interview the candidate and come to a unanimous decision to recommend the hire; “That new person will only be successful if we are all on board.” This process encourages healthy and vigorous debate among the team.

Next, the new team member’s first day on the job must be “memorable, in a good way.” Having the name badge and orientation paperwork ready, along with ensuring the mentor/trainer is prepared, is key to showing that Montecito therapy is proactive, professional and FUN. TJ loves to quote his former ED, Forrest Peterson, during orientation, “Our building will go as far as our therapy team takes us.” This sets the tone for the new member that therapy is looked to as leaders, ensuring the vision for the facility, so they should conduct themselves accordingly. “Once you get the ball rolling, the team will take over.”

Finally, TJ sits down with each new staff and discusses their personal/professional goals so he can facilitate the growth of that therapy leader.

What specifically do you do to grow leaders in your therapy department?

With such a large team and busy case load, TJ noticed the weekly therapy meeting was not focused and inefficient. Thus, he created his “rope teams.” Using the analogy from mountain climbing and how 3-4 members of a team are roped together and have different responsibilities, TJ linked teams of one licensed therapist to 2-3 assistants. The “Lead” therapists meet weekly with the assistants to discuss the patients, etc., AND THEN they also discuss anything else to build relationship and camaraderie. This is the rope team’s opportunity to build each other up, have fun and develop leadership skills.

Also, TJ meets one-on-one with his team, teaching them to bring problems with solutions and coaching them in their professional goals. From this process, TJ has helped grow two DORs and said, “Any therapist could take my job.”

How do you/your therapy team cross over and support other departments in your facility?

Each month the therapy department formally recognizes a CNA letting the individual and facility know how much therapy appreciates all the hard work and collaboration. Another example is having therapy take a teaching role with their nursing partners. Currently, therapy and nursing are learning the Ranchos Los Amigos Scale for their brain inured patients to coordinate therapy-nursing care effectively. The therapy staff also take IDT roles throughout the facility: Speech Therapy works closely with Respiratory to ween patients off the ventilator and progress them along in the trach process; Physical Therapy supports the Falls Committee, and each lead therapist is responsible for patient care conference; and TJ meets with nursing to identify LTC residents with mobility issues for the purpose of discharging them to a more independent level of care. “Who can we help get out of here.”

Also, every therapy staff member is ready to help support Marketing/Admissions with tours or supporting the facility in the community.

Who is a mentor to you and what specifically did/does that individual do that impacts your leadership today?

Three individual were immediately identified:

Forrest Peterson, former ED at Montecito and current Bandera Market Leader. TJ described, “seeing the way he would develop people and his thought process,” as very formative. Forrest would (still does) spend time with others, hold them accountable in a consistent process that TJ likened to the Mr. Myiagi approach of the 1980’s iconic movie, The Karate Kid.

His Father. “My Dad told me, once you get that job, make yourself as valuable as possible.” Thus, TJ makes sure he gets involved in every department, “whenever I can to figure out where I can help.”

Pat Tillman, football player with TJ’s beloved Arizona State University Sun Devils and professionally with the Arizona Cardinals, who enlisted with the U.S. Army after the attacks of September 11th. Pat Tillman was killed in April of 2004 in Afghanistan. “What a cool leader; he knew what was right for him and he did it, not for the recognition, but because he knew it was right.”