Therapist Spotlight: Avenlea Gamble

Submitted by Julia Schmutz, PT, Therapy Resource, Northern California

There is something magical about Northern California, the landscape, the misty mornings and warm afternoons, the ageless redwoods, spectacular rugged coastline, the orderly rows of lush grapes and, of course, the people. This is a place that embodies hardiness and resilience. For the best wines, grapevines need a challenge. They love slate and sand and clay and rocky, precipitous hillsides to produce wines of character. In poor soil, the roots have to work harder, “ramifying” or branching out to gather nutrients. This increases to surface area of root to soil and regulates water absorption, and produces better grapes. The redwoods, too, show an amazing picture of resilience, burned out but still standing, majestic and wise. And so, the people who live here reflect the lessons of their environment. Avenlea Gamble is one of those people.

Avenlea is the DOR at Northbrook, a small facility in the northern town of Willits in Northern California. She grew up in this facility, where her mother is the administrator. She has worked there since she was 17 years old and specifically went to school and studied to be an SLP to fill the need in their community. She is one of the most resilient people I have ever had the joy to know. With each challenge she rises up to meet it with a smile and determination. She is unassuming and sees herself as just doing what anyone else would. But ask yourself: Would you be willing to run the kitchen if you didn’t have staffing? Would you step up and cook dinner for your residents twice a week if the need arose? Would you cover for admissions if someone quit?

Besides the challenges of the COVID pandemic, Avenlea has been faced with a multitude of ongoing trials, all of which she has met with grace. She puts it down to her team and facility community who she sees as family. These are deep roots, spread out and well-grounded like the grapes that surround them. Her commitment to serve this small community is unwavering and remarkable. Her foundation is strong and immovable as the redwoods and is built on relationships.

Avenlea is the personification of Herzberg’s theory that for a job to be meaningful, there has to be passion, challenging work, responsivity, personal growth, recognition and meaningful contribution. Hers is a life well-spent from which I am learning much and hope to learn more as I get the privilege of continuing to journey by her side.

#PIVOT for Nursing

By Dominic DeLaquil, PT, Therapy Resource, Pennant Idaho/Nevada

#PIVOT is the rally cry for Summit, which comprises the markets in Utah, Idaho, Nevada and Washington. It stands for Proactively Identifying Vital Opportunities in Therapy, and in September, the DORs in Idaho/Nevada decided to apply #PIVOT to support their Nursing partners. Here are some of the ways Therapy has been helping Nursing:

Monte Vista — Therapy is “donating” one hour per day to Nursing to answer call lights, pass trays, train on hoyer lifts, decorate the halls, etc. and it rotates among the Therapy staff, which helps the nurses and aides get to know the Therapy team better.

Owyhee — Therapy is doing the showers for skilled patients and they are also doing the assisted feeding in the RNA dining section at breakfast and lunch two days each week. They are also helping by doing larger groups, even with many non-skilled patients, so that the aides have that me to actually take their full breaks.

Meadowview — Therapy is lending their Rehab Tech to nursing to work on the floor and the Therapy team is giving more attention to call lights.

Rosewood — They are helping nursing to pass trays at mealtimes.

Creekside — Therapy has a PT assisting with ADLs on the COVID unit, and Therapy is doing resident showers on the skilled side of the building.

Bennett Hills — Daily Post-Stand Up Huddle with floor staff, led by Therapy to discuss admissions, discharges, appointments, room changes, and family visitation schedules. Monthly CNA meeting led by Therapy Program Manager to discuss opportunities for collaboration, education, ways to better support one another, and develop trust. Monthly recognition of specific CNAs that embody the CAPLICO culture, awarded with plaque and T-shirt.

The response has been extraordinary so far, and these are just the starting points! The DOR clusters are having an ongoing dialogue to share ideas and inspire each other to continue to find more ways to support their Nursing partners. Great job, Idaho/Nevada DORs. #PIVOT for Nursing!

Clinical Spotlight: Love My Clinical Partners

By Brooke Stanley OTR/L, DOR, The Terrace at Mt. Ogden/Mt. Ogden Health and Rehab

A partnership is a valuable tool that leads to great success but must be planted, nurtured and maintained to grow. It is vital to any successful organization, building or department. It is giving selflessly. It is serving your partner. It is respecting one another.

I have the great blessing to work with two incredible women, moms, wives, who happen to be the best DONs and clinical partners, Channdra Dabling, the DON at Mt. Ogden Health and Rehab, and Jessica Hawkins, the DON at The Terrace at Mt. Ogden. They are the most selfless, loving women who lead by example. They both care about our staff and residents, as it shows in their quiet actions, not just words. They are humble. They both are not afraid to accept help when asked and ask for help when they need it. They truly lead out of love!

“Great leaders may be found at the top of a mountain looking back upon their challenges, but the greatest leaders are often found at the foot of that mountain still helping others reach that summit.” —Robert Clancy

Jessica is one of those leaders. She steps up, helps quietly, and leads by working side by side. She asks for opportunities to problem-solve difficult patients or situations and values the input from other partners in the building. Most importantly, she leads out with love. If you haven’t had a Jessica hug, you’re missing out!

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” — Maya Angelou

Channdra is a master of making you feel loved. She is often found in patient rooms, talking with them, getting to know what is important to them. She takes time to truly know her staff. She is patient and kind to all those she comes in contact with. Channdra speaks kindly of difficult patients and families and strives to understand and not make judgements. She makes you feel valued because your concerns are heard. You feel that love anytime you speak with her.

I value the partnership I have with both of these amazing women. I could not lead effectively without them. I value their knowledge, leadership and friendship! They inspire me daily to LOVE and serve.

Moment of Truth: Truly Demonstrating Our Amazing People


Submitted by Devin Bodily, PT, Cedar Health & Rehabilitation, Cedar City, Utah

During the month of August, Cedar City received a large amount of rain within a very short span of time, including over 6 inches during a 24-hour period in the mountains above town. A frightening amount of muddy water, logs and boulders came crashing down Coal Creek, out of the canyon, and right through town. This eventually clogged a main floodwater-diverting channel, which caused the water to rush into, and overflow, the canal in the western part of town. Many homes were flooded and surrounded by several inches of water and mud without warning.

Our Director of Nursing, Trent Nielsen, has a home in this area and had been keeping tabs on how the flooding was going throughout the morning. To complicate matters, Cedar Health and Rehabilitation was undergoing state survey, which made it difficult for Trent to adequately prepare for any flooding at his home.

Just before noon, Trent was made aware that the water had crossed the road and was quickly traveling across the field toward his house. Without knowing how much time there was to spare, Devin Bodily, PT; Jake Holm, OT; and Braden Wiscombe, AIT, quickly rearranged their schedules and left to help Trent and his family. They were able to quickly obtain sandbags and shovels to create a wall to divert the floodwaters from reaching Trent’s home. If they had arrived minutes later, Trent’s home would have been flooded and permanently damaged.

They stayed for several hours into the evening to help maintain the wall. Community members eventually came along with skid steer loaders and mini excavators to build a dam and divert the water around the neighborhood. Ty Liston, COTA, and Eric Brown, Director of Maintenance, joined later in the evening and late into the night to help with the efforts of having an adequate water pumping system in his backyard. Having these pumps in place was instrumental to saving his home as heavy rains returned that night and broke the dam, pushing floodwaters within inches of Trent’s home before they finally subsided.

The effort to save Trent’s home was bolstered by the many facility staff members, regional nursing resources, and Executive Director, Spencer Eaton, who helped fill in for Trent’s duties during the state survey process so he could focus on saving his home through the night and into the next day.

The response to help Trent and his family was automatic as several employees demonstrated the core values of “Love One Another” and “Customer Second.”

Golden Acres Outpatient at ABBA Healthcare

By Cara Koepsel, M.S. CCC-SLP, DOR/CTO, Golden Acres Living and Rehabilitation, Dallas, TX
Golden Acres began a partnership with this ALF at the beginning of March 2021. It all started with a cold call from the DOR to the facility, in which the administrator agreed to a Webex with her team and me. I was able to really sell the services of what my team has to offer and show why a partnership would benefit their facility.

We started day one with two screens that turned into PT/OT/ST evaluations. Pictured is my team that accompanied me on day one! We came prepared to be flexible and assess as many patients as they wanted. I sat on the couch in their dining room and communicated with my BOM to run payer sources, check for home health, find primary MD to obtain orders, etc. These items were certainly a barrier, but all things that, with patience and persistence, we were able to work through.

Since day one, we have established six to seven patients on caseload for all three disciplines, and we visit the facility with a team that is there all day to treat these patients three days a week. We are a part of their daily routine, and they absolutely love our presence there. Also pictured is our group therapy we have initiated with the patients as well, which they love! Currently, we are working on partnering with this ALF to host an event at their facility to assist them in building their census after COVID. They are pleased to be able to tell prospective families and patients that Golden Acres’ rehab team will be a part of their loved one’s stay at their facility and their potential new home.

There may be hiccups and barriers as you start these partnerships, but once you get in the door and show these facilities what your team is capable of, I guarantee you they will want to partner with you for life! Keep pushing that flywheel even when it seems tough, because an ALF partnership is so worth it.

Abilities Care Approach for a Win-Win

By Tiffany Bishop, Therapy Resource, Keystone North, TX
For those of us in the therapy world, we all know the value that the Abilities Care Approach can bring to our residents in the form of increased independence, decreased behaviors, and increased ability to function in the environment. Just this past week, our most recent Therapy Experts in the Abilities Care Holistic Approach (TEACHA) team had a brief check-in call. One of the items we identified as a potential for growth is partnering better with our clinical partners to integrate our ACA programming throughout residents’ whole intervention plan.

In a time when our partners are already stretched thin, we identified the need for making any recommendations for our clinical teams more manageable to follow. There were several suggestions that were shared, and Elyse Matson is leading the charge to collect any more that have been effective and putting those ideas in an easy-t- distribute format. Below are some of the tips and tricks that were identified during our call.

● Make sure that we are working around their schedules when training
● Include these caregivers in the process of developing and implementing any adaptive strategies/tools so they can provide input along the way and have ownership in the intervention
● Empower our frontline partners as caregivers to be able to follow through with the day-to-day implementation of any interventions
● Be specific
● Be frugal in our expectations
● Be strategic in when/how we train; consider utilizing Skills Fairs to train common interventions
● Identify and stress how any intervention can be a win for them; how will it decrease their daily burden?

Stay tuned for more details to come from the Long Term Care Think Tank, and if you have any ideas that have worked well in your facility, please reach out to Elyse Matson.

Student Interns Share Transfer Reference Guide

Submitted by Gary Pearson, OT/DOR, Pointe Meadows, Lehi, UT
Here at Pointe Meadows, we had some wonderful students this past summer, including three physical therapy students from the University of St. Augustine. The students are Zachary Dreyer, Austin Jenson and Antonino Russo. In collaboration with these three students we made a Transfer Reference Guide, which is an easy-to-follow pamphlet with hints and tips on multiple techniques for transfers and other precautions related to weight-bearing and gait belt use. Also included are QR codes with links to videos on specific transfer techniques and bed mobility.

As DOR, I have incorporated this pamphlet into my portion of new-hire orientation utilizing the information to guide my transfer training for all new employees with the onboarding process. It has also been presented at two all-staff meetings and a nursing/CNA specific training.

As we are working hard on retention and showing our wonderful staff support in these hard times, our therapy department is attempting to provide expertise in training to all staff in our building. We are trying to support our clinical partners in any way possible and have had good feedback from staff on improved confidence and understanding with the process of transfers throughout our building.

Please let me know if you have any questions or would like more information. I feel this is a way our therapy teams can support our nursing and CNA partners in our buildings.

Teaming Up in Supporting Our Nurses

By Hannah Allen, SLP, St. Joseph’s Villa, Salt Lake City, UT
The Milestone Market SLPs get together for an SLP call once a month to share clinical ideas. During our last call, I was able to lead a discussion about considerations to include in our clinical thinking process when we recommend alternative forms of medication administration due to dysphagia. My husband is a clinical pharmacist who works in the ICU setting and is often involved in determining appropriate adjustments made to medications when patients are not able to take them orally, or not able to take them whole with liquid. He was able to share some great information that can be very helpful in our SLPs teaming up with and supporting Nursing with medication administration.

For example, we discussed how recommendations for crushed medications, or medications taken in any alternative forms, may be affecting the efficacy of the patient’s medication management if appropriate adjustments are not made by a pharmacist. Many medications are OK to be crushed, but some are not. If we crush them, this may make the Therapy of the medications ineffective or less effective. In some cases (such as in the case of seizure medications), we may also have the potential to cause harm. In other cases (such as Parkinson’s medications), we may be making their medications ineffective or less effective, which may decrease the actual therapeutic benefit they get from any of their PT/OT/SLP interventions.

The best option is to make sure we (or someone) is consulting the pharmacist to ensure medications are compatible with crushing. If they are not, a pharmacist may have suggestions on adjustments or changes to medications that will facilitate the safest form of delivery while maintaining medication efficacy. Some of us may have something like this in place in our facilities already, but some of us may not. This may be a process to build into our practice and the procedures of our facilities as we recommend alternative medication administration methods for our patients with dysphagia.

Below are some of the resources that were shared:
Podcast Episode: Swallow Your Pride Episode 173 — Crushing Meds: What’s an SLP to Do?
http://file.lacounty.gov/SDSInter/dmh/1042766_MedicationsDoNotCrushList.pdf
ISMP Do Not Crush List:
http://file.lacounty.gov/SDSInter/dmh/1042766_MedicationsDoNotCrushList.pdf
Blog Post by Karen Sheffler all about Pill Dysphagia
https://swallowstudy.com/trouble-swallowing-pills-what-to-do-for-pill-dysphagia/
Attached items:
-Article on effects of thickened liquids and puree on medication absorption


-PILL-5 Questionnaire, a patient-reported outcome measure; may be a good measure to utilize when we get consulted specifically for patients struggling with medications.


-Show Notes for the Podcast episode with many of the same resources and a quick rundown of the episode in written form

Community Outreach Efforts at Eastview

Submitted by Sunny Chahal, PT/DOR, Eastview Healthcare and Rehabilitation, Houston, TX
Sanikqu Maire became our Interim DON in March 2021. She had gained experience in our sister facility at Legend Oaks Northwest as an ADON prior to stepping into a DOR role at Eastview. Late in May, she transitioned from an LVN to an RN and stepped into the DON position on a full-time basis. With little experience at the building or as a DON, she helped lead the building through our annual state survey in April2021 with only two minor deficiencies. With the state survey and MSCA completed, the big 5 at our building decided on some initiatives and goals for the building for the rest of the year. One thing that Sanikqa really pushed was to get our facility name and face more visible in our community.

Since March 2020, due to the COVID pandemic, our building had been largely in lockdown and restricted for visitation from resident families and the surrounding community. In 2021, we wanted to get out and reestablish and develop our ties into the surrounding East Houston area. In addition, one of our goals for 2021 was to develop an outpatient program where we could follow our discharged skilled residents and also look to develop relationships with assisted living facilities (ALFs) and independent living facilities (ILFs) where we could partner up and offer our services to the residents.

We have targeted three large ILFs within a 5-mile radius of the building, and have already set up and completed health fairs at two of those three facilities. At the career fair, we have representatives from the Admission/Marketing, Dietary/Nutritionist, Nursing, and Therapy present at separate booths. For two hours, residents from the facilities go booth to booth to perform screens and receive education.

At the dietary and nutritionist booth, the residents were educated on proper foods to eat and other preventative health tips. Next they would go to the Nursing section and get their blood pressure and O2 saturation readings. After that, they would go to the Therapy booth, where they would get their height/weight and BMI calculated. They would also do a single limb stance test and test their grip strength. They would be educated about our new mobile outpatient program and screens performed.

It was a success, as we obtained four to five therapy referrals from each career fair we completed. We have since gone on to exponentially grow our outpatient program over the past three months. Sanikqa’s energy and vision for community outreach and willingness to partner with Therapy and other departments in the building has been very instrumental to the success of our mobile outpatient program.

Therapy and Nursing Work Together to Prepare for COVID Outbreaks

By Dominic DeLaquil, PT, Therapy Resource Pennant – Idaho/Nevada
Just a couple of months ago, you could almost hear the collective sigh of relief as we were looking forward to a return to a more normal routine in our facilities. 2020 was a difficult year, as we were constantly pivoting to adapt to changing protocols in each building as outbreaks occurred, settled down, then surged again. The beginning of summer 2021 was bright with promise, most of our residents had been vaccinated, COVID case rates were dropping, and hope was in the air. Then the Delta variant showed up.

As one DOR in Idaho said, “As much as I’d like to bury my head in the sand about it, it does make sense to start preparing now.” So the Infinity and Lady Luck clusters in Idaho/Nevada asked the market Infection Prevention nurse, Clinical Resource Kristin Mumford, to join their next DOR call. The DORs and Kristin had a robust conversation, discussing topics such as how to manage therapist movements in a building, the importance of therapy to the psychosocial and physical well-being of residents when they have to stay in their rooms, the value of Therapy helping out our Nursing partners throughout the building in various “non-therapy” ways when extra help is needed on the floor, and other topics.

The conversation was an important early step to prepare for the worst, while we hope for the best. The conversation was productive for nursing and therapy, and the DORs left the call with agreements to their cluster partner DORs to each set up meetings with their DONs and EDs to discuss the plans in their buildings and how Therapy can help Nursing, serve the residents, and partner to ensure the best infection prevention protocols.