Outpatient On Demand

By Kathey Perez, Therapy Resource – Keystone South Central, TX

Outpatient On Demand is a great way to look at ways to expand our delivery of outpatient services. Many of our patients are afraid to leave their home due to the pandemic, or can’t leave due to transportation issues, or maybe they are fearful to leave our facilities worried about failure when they go home. Outpatient on Demand helps us overcome some of these concerns while meeting the needs of our community. We can help those that may not be homebound by home health standards but have a need for services, and help the successful transition of patients back into their home by being able to provide education and training in the area they need to thrive. Once the patient is able to come to our facility, we can transition them to Outpatient at the facility as well. Patient identification should start with care planning upon admission to our facility. We can also identify them by doing home evaluations prior to discharge.

Home eval prior to discharge:
What allows us to provide therapy in the home?
o Medicare specifies four locations from which a provider can provide outpatient physical therapy. Medicare Part B pays for outpatient physical therapy services when furnished by: a provider to its outpatients in the patient’s home; in the facility’s outpatient department; to inpatients of other institutions

What is it and Why Now?
o Therapy services (PT, OT, ST) offered that meet the patients where they’re at, focusing on what matters most, being able to function in their actual home/community environment.
o COVID related shutdown, limitations, and resident declines created a shortage of therapy and a need more than ever

What differentiates this from Home Health Services?
o Residents are not required to be certified as home-bound to participate in our services. On average, we are able to provide MORE therapy than is typically seen in HH settings. Maintenance programs are a big part of our outpatient programs

Code Sepsis: Pilot Program

Submitted by Esther Allmond, DOR, The Cove at La Jolla, CA

The Cove volunteered to be a pilot site and is now entering their 3rd month for the EPIC program: CODE SEPSIS. Dr. Pouya Afshar handpicked our facility to trial this pilot program to help prevent sepsis in-house by carefully monitoring vitals throughout the day. Throughout this time, we have gained a new appreciation and respect for taking vitals before, during and after therapy treatment sessions. Rehab has taken a more active role in vital signs at The Cove, and I just wanted to share with all of you a little bit more about EPIC, CODE SEPSIS, and our current protocol at our facility.

EPIC (Excellence in Programming and IDT Care): Programs dedicated to taking IDT action with a QAPI approach in order to provide the most excellent care possible for our patients.

CODE SEPSIS MISSION: Early identification of sepsis to improve patient outcomes.

WHY: Sepsis is the leading cause of readmissions to the hospital in 2019 (20% of Medicare readmission!). With every hour that treatment is delayed for sepsis, the mortality rate increases by 8%.

CODE SEPSIS PROTOCOL: Taking vital signs early and often for each of Dr. Afshar’s patients. Nurses take vital signs Q shift (or more often). and therapists take vital signs before each treatment session and enter it into PCC. Notify charge nurse immediately with any one of the following triggers:
1. Temp > 99.5F
2. SBP < 100
3. HR > 90

CODE ACTIVATION/METRICS:
• Clinician identifies patient meeting criteria (initiation, time stamp)
• Notify charge nurse (5 minutes)
• Verify/repeat vitals (5 minutes)
• Nurse activates code (5 minutes)
• Code team clinician contacts on call MD/NP (5 minutes)
• Response back from on call MD/NP (10 minutes)
• Total time spent: 30 minutes
• Reassess at the end of each 30-day cycle
• Duration of phase 1: 90 days

CODE SEPSIS was triggered several times in the past two months, allowing us to implement interventions in a timely manner and preventing re-hospitalization for our patients! As we close the last 30 days of Phase 1, we hope to remain consistent and vigilant in monitoring vital signs for our patients, providing the most EXCELLENT care possible for patients and improving outcomes. Please feel free to reach out to me at any time if you have any questions, comments, feedback, or interest in implementing CODE SEPSIS at your own facilities!

Congratulations Carl Meyer, PT SPARC Winner!

Carl Meyer, PT
Marquette University, Milwaukee, WI — Grad Date: 05/08/2021
In the midst of the current health crisis and social justice demonstrations, I see a world needing communities to be filled with sparks, small bright lights that the darkness cannot overcome. Indeed, as I examine my own education, talents, and abilities, I know that it is not just an opportunity, but my responsibility to step into my community as this light, and I write this encouraged, knowing that I have been equipped by those who have come before me to be that exact spark in the community I call home.

As a physical therapy student at Marquette University, my work at the local Milwaukee Rescue Mission as the Sports and Recreation Coordinator has been a foundational piece of my education. My time at the Mission has opened my eyes to the health disparities in the inner city of Milwaukee; particularly among young African-American men and in the communities they call home. The first time I drove one of my high school students to his home in north Milwaukee, I encouraged him to get his ankle examined, as he had badly sprained it that day at our Youth Center. Laughing, and shaking his head, he told me that he’d never been to the doctor before, and he wouldn’t even know where to find one. As I watched him limp to his door, the reality of Milwaukee’s environment settled in and my passion was sparked, leading me to choose a career in the medical sciences to reduce health disparities in the impoverished communities of Milwaukee.

My passion for impoverished communities and my calling to these areas of need started long before Milwaukee. Growing up in Albuquerque, New Mexico, I was a minority in the diverse and ethnic landscape of New Mexico, often witnessing the hardships of my classmates, and the health disparities experienced by Native American and underserved classmates from the reservations and poor communities of the southwest. These childhood experiences became the foundation of my mission to serve the poor by reducing health disparities, and led me to Colorado State University.

In my time at Colorado State, I was able to experience leadership as an Intern for the Office of Admissions, as an Academic Success Coordinator for the Department of Health and Exercise Science, and as a Resident Assistant. Most importantly, however, was my undergraduate thesis, which was titled “Project Play: A Mission to Study and Improve Areas of Need for Health and Wellness in Homeless and Underserved Youth Populations.” My work was written after spending a semester working with youth at the Matthew’s House, an organization that provided programming for homeless and immigrant families in northern Colorado. If my foundation was forged in New Mexico, my vision was truly carved during my time in Colorado. After graduating as a cum laude Honors student with Dean’s List distinction, and
with the Myron Ludlow Brown and Eddie Hanna Awards, my experience at the Matthew’s House led me directly to Milwaukee, and into the ZIP code with the highest rate of incarceration for men in the nation.

At the Milwaukee Rescue Mission, I provide exercise and leadership programming for homeless youth at the Mission, as well as for local students. I have frequently witnessed the impact of health education on the outcomes of the inner city youth that I work with, and this service has given me the vision of how to use my education to be a part of the outreach in Milwaukee, with an emphasis on communities with health disparities due to socio-economic divisions. I was able to start a local mentorship program for area youth at the Mission, and as my education has progressed, my vision of how to make this goal a reality beyond graduation has coalesced. I see an incredible opportunity for physical therapy to provide low-income healthcare, at clinics with high accessibility, leading to the training that can make
community mentorship a reality.

My first year at Marquette only enhanced my awareness of these disparities through my work as a Student Physical Therapist at Marquette’s Pro Bono Clinic for the uninsured. Like the Mission, I have seen the hard realities of limited access to healthcare, including one gentleman who visited our clinic after suffering from crippling pain for years and came to our clinic as a last resort. Bringing access and resources to communities that lack both has the power to drastically improve quality of life, making the reduction of health disparities not simply an opportunity, but a matter of justice. As a service-oriented University, I found further opportunity at Marquette to practice leadership by being elected Vice President of my class, and as a WPTA Emerging Leader Nominee.

Given my experiences, without the traditional corporate limitations of healthcare, I truly believe that physical therapy can reduce health disparities in a unique and practical way. My vision is to supplement my clinical practice with an initiative called The Friday Project, a project crafted during my time at the Rescue Mission. Supplementing normal clinical income with grants, those physical therapists partnered with the initiative would be able to offer community health screens every Friday, along with youth mentorship activities, including job shadowing for local students and scholarship assistance. As experts in musculoskeletal conditions among a population in which millions suffer from chronic pain, I believe we carry the education to refer high need patients, and to economically help and treat all others, bringing equity to the communities that need it most. As doctors face increased demands on their time, in which patients get less and less time, physical therapy offers the opportunity to partner healthcare with the mentorship needed to truly treat the disparities we see in the clinic.

My connections to Marquette and the communities of Milwaukee have given me the passion and platform to increase healthcare access for those who are underserved, and this is why I am applying for the SPARC scholarship from Ensign Therapy. From my experiences, my hope is that you can see my desire to use any financial assistance with the gratitude and humility worthy of such generosity. While such generosity is not intended for repayment, if I am selected, you can be sure I would pay it forward. For this reason, I believe I would make an excellent candidate for your scholarship program, as my vision and action to reduce health disparities in the Milwaukee community are already being enacted in my education as a physical therapy student at Marquette University, and as I actively live out service
in the Pro Bono Clinic and at the Milwaukee Rescue Mission.

In this way, I do not have the opportunity, but rather the responsibility to use my education to be a spark for the communities of Milwaukee. This is why I chose my profession. It gives me the chance to be a light in the community I call my own. My passion for leadership and service centers on my belief in the power of education to help those who need it most, and my learning has been supported and guided by the power of a calling found and a goal pursued. This is the legacy and strength of the many leaders who have come before me, and they continue to teach me how to translate potential into selflessness Indeed, it is the first spark that brings the light.

“If I have been able to see further, it is because I have stood on the shoulders of giants.” ~ Isaac Newton

 

Congratulations April Westbrook, OT SPARC Winner!

April Westbrook, OT
Keiser University, Ft. Lauderdale, FL — Grad Date: 12/31/20
Fidelity is a core value of Occupational Therapy. Through trust and loyalty, this value can “spark” others toward healing. In order for patients to open up and allow a therapist to truly impact their lives, they must gather a sense of loyalty and empathy first. This value is paramount in OT and is one that I had to refine within myself prior to jumping into the field. I had to truly trust my passion, dedication, and commitment to learning before making such an immense life change.

I fell in love with Occupational Therapy when a friend of mine introduced me to the field. As I read through the qualities and qualifications of an occupational therapist, I knew that OT would provide me with a unique opportunity to make a difference in the lives of others. It was a pivotal time in my life when I made this career change; I was a mother with three young children who had just undergone a divorce from a ten-year marriage, and I was working as a small business owner where I was unable to make an impact on the lives of others the way I knew that I could. Although it was certainly not an easy time to follow this “spark,” it is one of the most rewarding decisions that I have ever made. Through this decision, I have modeled for my children that you can follow your dreams and make the necessary changes in your life at any point. Through fidelity and dedication, anything is possible.

Upon beginning my career as a COTA, schooling became my full-time job. I would care for my three children in the mornings and evenings, study until midnight, and work my part-time job on the weekends. This dedication afforded me the opportunity to serve the most endearing of people and made me stronger than I ever thought possible. I have practiced the perseverance that I encourage in others and have gained a true insight for empathy.

After working as a COTA for six years, I began to consider making another life change to provide the best possible opportunities for myself, my children, and my future patients. I began to consider becoming an OTR through a bridge over program through Keiser University. I understood that gaining more knowledge in this field would provide opportunities to make a greater impact in my community, one individual at a time. Becoming an OTR meant that I would be able to create goals for my patients that would allow them to become their most successful and independent selves. I sought the opportunity to dedicate myself to my patients through the entire OT process, from evaluation, to creating goals, bonding through treatment sessions, all the way through discharge. This wasn’t within my scope as a
COTA, and I knew that it is what I needed to do to feel fully fulfilled in my career.

The most rewarding opportunity in the field of OT is to become the agent of change in one’s life. It is incredibly humbling to connect with those who are sick or disabled and provide a means to aid in their healing and create change. When an individual looks you in the eyes and says, “thank you for understanding, encouraging me to heal, and getting me to where I am today,” it makes every sacrifice worthwhile.

I have endured many obstacles, and at times, thought the tribulations were too great to persevere through. However, those obstacles became the pivotal points to leading me into this field. I look back at these obstacles and use them as a springboard to provide the most meaningful conversations with my patients. Conversations are driven by empathy, compassion, encouragement, and a “spark” for change in the lives of others. When we fight to endure challenges, dedicate every ounce of ourselves, and then overcome these adversities, it provides a platform to help others through truly understanding by way of empathy and perseverance. Occupational Therapy provides a perfect balance between technical knowledge and compassion through our code of ethics, core values, and standards of practice, all of which come together to empower others.

I am currently working towards completing my degree as a master’s student to become an OTR. It has been a long road, especially while completing my internships in the midst of a global pandemic, but fidelity and perseverance continue to lead the way. Becoming an agent of change for individuals whose voices are not always heard and to physically improve that person’s health, is what makes Occupational Therapy the most rewarding of fields. I plan to address those needs through compassionate service, a holistic approach, creative interventions, local advocacy, and evidence-based practice. I look forward to making a lasting impact in the lives of others by creating a “spark” for healing, hope, and endless opportunities.

I appreciate any support received and am committed to paying it forward through my dedication to serving others through Occupational Therapy

Washington Receives Eldergrow Grant

By Mira Waszak, Therapy Resource, Washington

Another gift of a grant in Washington. Pictured is Lynnwood Post Acute getting their setup and initial training.

The Eldergrow G.A.R.D.E.N Project would enable each of the nine participating Washington communities to help residents cope with this difficult time of isolation and loneliness, while also providing an interactive and meaningful activity to improve their quality of life now and long into the future.

Numerous health care studies show a positive link between gardening and healing. Contact with gardens and nature can augment a resident’s medical treatment, including mental, physical and emotional needs. Therapeutic horticulture has been proven to deliver tangible wellness benefits, including improved self-esteem, improved memory, reduced depression, improved motor skills, and increased socialization. The project goals include, but are not limited to: 1) Increasing the quality of life by improving the residents’ emotional states and 2) improving the quality of care by focusing on the six therapeutic horticulture wellness goals set forth from the American Horticultural Therapy Society. Eldergrow strives to reach an 80% resident attainment rate on both goals.

The plan to accomplish this for the nine communities will be to launch the Eldergrow G.A.R.D.E.N program as soon as possible, even if on a limited basis initially. The Eldergrow program is a well-managed, supported and respected therapeutic program offered through horticultural gardening which many residents enjoyed previously. It has been successfully used to engage residents in long-term care facilities with the best outcome of enhancing their quality of life. Eldergrow Educators use engagement and a hands-on approach, and they enable everyone in the care center — residents, staff and family, regardless of experience, physical or intellectual abilities — to participate in this program. Eldergrow enhances residents’ quality of life through therapeutic gardens physically, socially, cognitively and creatively.

Making PDPM Training Fun!

Submitted by Mira Waszak, Therapy Resource, Pennant – WA

Connecting and training with our teams has been challenging in our new normal. So how do we make training effective and fun on a Zoom call?  Introducing PDPM Brain Benders by Jessika Booth, MDS Resource/Pennant WA. She created a simple but effective exercise bringing the 9 Washington IDTs together on a 30-minute Zoom call.

 

 

Jessika forwarded Reference tools the day before the Zoom meeting, which included:
PDPM quick reference guide
PDPM ST comorbidity CMI guide
NTA workbook
PDPM ICD10 Mapping
PDPM Nursing quick reference guide
And a sample diagnosis list

Zoom call format
Brain Bender Rules:
• Mute your lines unless called on or when conversation is opened to the group
• First facility to type facility name in chat answers the question
• If wrong, the second facility with name in chat will get opportunity for half of the points with correct answer
• Next question picked by facility with correct answer

Teams were only given the diagnosis sheet to answer some of the sample questions below:

Question: What PT/OT Clinical Category does the current primary diagnosis of OSTEOMYELITIS Unspecified – M86.9 map to?
Answer: Other Orthopedic

Question: Based on the diagnosis list provided, are there currently any SLP CO-MORBIDITIES available?
Answer: No, none of the diagnoses listed will map to an SLP Co-morbidity 410.

Question: Based on Diagnosis review, what would the IDT need to clarify in order to get the resident into a Special Care High Category?

Answers:
● The type of Quadriplegia — as you can only code I5100 Quadriplegia if it is a result of spinal cord injury.
● Sepsis — related to osteomyelitis and or UTI
● Respiratory Therapy — Hypoventilation Syndrome
● COPD and other restrictive lung disease — Hypoventilation Syndrome

Special thanks to Jessika Booth and our MDS partners! Congratulations to team Park Manor for winning this round of PDPM Brain Benders.

Our Virtual Student Program Is Up and Running

Submitted by Kai Williams, Therapy Resource, Keystone East, TX
By late March, therapy students across the United States were dismissed from their onsite clinical affiliations. The wave of COVID-19 created an unprecedented level of displacement for so many therapy students, especially those in the SNF setting. One can only imagine the feeling of despair felt by those who needed just two more weeks to fulfil their affiliation requirements to graduate.

Intelligent risk taking remains one of my favorite core values because it is through that core value that progressive ideas are imagined and crafted into programs that transcend into the next level of care. It was through unified brainstorming that the Virtual Student Program was imagined. After several weeks of discussion with our University partner, we drafted a proposal to the Commission on Accreditation in Physical Therapy Education (CAPTE). We successfully received approval to provide a two‐week/80‐hour virtual clinical learning program to 10 students who were dismissed from their clinical site secondary to the COVID‐19 pandemic. We have officially become the first SNF organization to offer this level of experience to therapy students. These 10 students who participated joined us virtually from a variety of states across the U.S. Many of them had no experience within a SNF setting and during their exit interviews stated how overwhelmingly surprised they were about the depth of exposure they received. We will never aim to dismiss the benefits of onsite instruction, but with the supplement of a virtual clinical experience, you can alleviate some of the onboarding constraints many clinical instructors and students face. This also allows the student to build on their level of confidence and readiness in our care setting. Their level of preparation is enhanced, thus giving them a stronger shot to hit the ground running upon their arrival.

So what does the virtual student experience look like? The virtual program is structured with an interdisciplinary education format designed for student occupational therapists, student physical therapists, and student speech and language pathologists. The virtual program included 55 live instruction hours (labor) provided by over 20 clinicians (PT, OT, ST,). Our objectives spanned the topics of memory care, cardiac care, documentation training, and leadership skills in management, Parkinson ’s disease, and live interactive telehealth sessions with a patient, just to name a few. Additionally, the students gained access to our learning management system (LMS), “Ensign University,” where the students were assigned 17 additional courses to support/facilitate their learning. The interactive courses included learning checkpoints and a final test at the end of each module. The students also had a dedicated PT Clinical Instructor to connect with to offer guidance/feedback.

What’s next? Our hope is to host our second cohort of students, which will include both PT and OT. With the support of our University partners along with our affiliated facilities, we would love to create an “enhanced” student standard that would improve the value of our overall student program. Each student would complete a two-week virtual experience prior to beginning onsite at a facility, in accordance with the National Nursing Home Reopening plan.

Congratulations to Our Newest SPARC Winner!

Ashley Sells, an OT student at the University of Texas at Tyler, is our SPARC winner this quarter. She plans to graduate in December 2020 and already practices our Ensign culture.

Read her awesome essay below:

I have always known I wanted to pursue a healthcare career since high school. When I was a junior in high school, I was selected to join an elective group called Health Science Technology, which allowed us to shadow different departments in the medical field to better understand what we are interested in. From the beginning, I was always drawn to therapy, and once I learned what distinguished occupational therapy and physical therapy, I fell in love with occupational therapy.

I have been a full time COTA in home health for 4 years and I can honestly say I’m happy with my job and couldn’t imagine anything better. The deciding factor for me to return to school for my master’s degree and become an OTR was job security. The medical field is ever changing, and I want to secure my place in the field of occupational therapy as a supervising therapist because I have such a passion for this career field. This career and setting allows for flexibility of treatments and building rapport with my clients in their natural environments in addition to balancing my personal life as a special needs mother. Raising a special needs child makes it very easy for me to have empathy for all my clients and their families, regardless of age. I am the kind of therapist who has a passion for my patients. I am dedicated just as much to building rapport and relationships with my patients as I am to provide skilled intervention for them. I look at my patients from a holistic view and consider many additional aspects besides reason for therapy referral. I strive to build lasting relationships with my clients and their families and make a lifelong impression.

I understand that, many times, I am coming into my patient’s lives during one of the lowest valleys they may ever encounter, and I see that as an opportunity to provide perspective and motivate them to keep trying. As a therapist, we live for success stories; you know, the ones that remind you why you fell in love with this profession. One of my favorite memories included a patient who had spina bifida and was transferred to my caseload from another therapist who “couldn’t handle her”. I was expecting a rude, non-compliant patient, but I received a humble, respectful 36-year-old woman who had been through 27 surgeries and just wanted to take a shower and learn to put her clothes on by herself again. Before she became my patient, she hadn’t had a shower in 3 months. In fact, she cried the first time I helped her in the shower and stated, “You have no idea how much this means to me.” And, after 4 months of hard work, dedication, and creative thinking, she was able to shower with supervision and dress herself independently. She will never have to go 3 months without a shower again.

Often, my most difficult patients are the most rewarding. In fact, I recently had a gentleman on caseload who has been depressed since he had his stroke several months ago and didn’t ever want to participate in therapy because he just didn’t see the point in it; he didn’t think he would ever come back from this diagnosis. When encouraged to participate, he would often lash out, asking “Have you ever had a stroke? Then you don’t understand what it feels like.” After just 2 weeks of seeing him, he smiled at me and cracked a joke. In addition, he walked twice as far as he did the week prior. And when I mentioned possible discharge the following week at his reassessment, he even asked if I could keep coming a few more weeks and made phenomenal progress those last few weeks. As a therapist, physical improvements are often what we work towards and they are great, but words cannot describe what kind of victory it feels like for me to connect with a patient who continuously shuts everyone out.

Although I have been a practicing COTA for 4 years, I continue to learn and grow as a practitioner every week. My passion for learning contributes to my patients’ well-being daily due to various reasons. When I have a patient who has multiple comorbidities that prevent him/her from completing a functional task with a common or simple adaptation, I am able to research through online databases for alternative ways to achieve the same task. When I have a family who has a less than optimal bathroom layout that increases fall risk and compromises the patient’s safety, I am able to research and brainstorm different pieces of adaptive equipment and placement options that best fit the client’s needs. When I had a 300 pound client who had to painfully crawl on his hands and knees up/down 3 wooden steps outside his home in order to leave his home for doctors’ appointments, I attempted to call the home health agency to request a social work visit in order to get a ramp installed for the client. When my attempts remained unresolved after a week, I took it upon myself to research nonprofit organizations in his county that provided ramps for no cost to low income families. I contacted the organization, filled out the application, and had a ramp installed for him in less than 2 weeks, all while having no idea if I was going through the correct avenue or not. Since the first ramp application I filled out, I have filled out numerous more and had the opportunity to share my knowledge with other therapists in surrounding counties to better serve their clients.

In the home health setting, there are some instances when therapists and clients are unfortunately left with little to no assistance or guidance for problems that arise outside their believed “scope of practice.” With 4-5 professionals (including nurses, physical therapists, and even a home health doctor) entering the previously mentioned clients home before I did, it is a shame to me that no one had started the process to help the client obtain a ramp. This particular situation allowed me to realize that I cannot ever assume anyone else will help a client handle their challenges that arise on a daily basis; I am the type of therapist who remembers that anything pertaining to my client’s wellbeing falls within my scope of practice and it is my mission to help my clients be safe, independent, and have good quality of life.

These are a few of the reasons I fell in love with this profession and these are the reasons I will continue to be successful in my profession and spark joy in my clients’ lives. I know you have many deserving applicants that apply for this scholarship; I do not think I am any more deserving than the next applicant, but I would be very honored and appreciative to accept any type of assistance you may be able to offer. In May, I will have to stop working in order to complete my 6-month fieldwork and this will put a huge financial burden on my family. I am a single mother to a 6-year-old boy with autism who attends full time, intensive ABA therapy because he is not yet functional enough to attend public school. The insurance and therapy expenses alone are enough to cause financial struggles for any single income family, but when factoring in normal bills and not having a steady income for 6 months, it makes me very anxious to see if I will be able to finish school this year and not fall behind on my monthly bills. I take out school loans each semester to help me get through and I save as much as I can, but I am not sure I will have enough to cover all my expenses. I know this is a temporary financial struggle I have to push through in order to graduate, but I would greatly appreciate any amount of financial assistance your organization might be able to offer. Thank you for your time.

Program for Spanish-Speaking Residents 

By Sarah Scott, SLP, Pointe Meadows, Lehi, Utah

About six weeks ago, my DOR asked me if I had any suggestions for therapy interventions for one of our Spanish-speaking residents who was having significant behaviors, including medication refusal, exit seeking, aggression, falls and throwing himself onto the ground. His diagnoses included Parkinson’s disease, severe anxiety, and repeated falls. We truly wanted to identify a plan that would address his needs and reduce the behaviors and anxiety.

We created, among other things, new simple Spanish communication boards, visual aids to support medication administration, functional problem solving, and protocol to prevent escalation of behaviors. With our therapeutic interventions, the patient started to demonstrate a dramatic increase in cognitive linguistic potential and decrease in adverse behaviors. His test scores increased, and he and his family also reported feeling happier. The nursing notes reported pleasant and compliant behaviors.

Our therapists are passionate about program implementation for diverse cultures, and understanding the backgrounds and stories behind the countries and cultures that our patients come from. The more we learn about and engage with our residents, the more we understand their lives that were rich with love, laughter, service, work, pleasure, pain, and purpose. Our therapists are becoming specialist in evaluating patients from culturally diverse backgrounds to help preserve abilities, maintain cognitive linguistic function, and facilitate opportunities for each unique need.

The interventions included extensive communication with and support from family to identify cultural, social, recreational, professional, familial, religious, educational, historical and experiential factors that could be utilized within a plan of including group and individual interventions. We continue to build our resources to understand and address different cultures.

For our Spanish speaking residents, we encouraged the patient’s participation in creating PowerPoint presentations on their home countries of Chile, Bolivia, Peru, El Salvador and Mexico. We created presentations of musicians, including Julio Iglesias, Jose Jose, and Armando Manzanero. Families emailed me links to YouTube videos of favorite songs with the lyrics that patients who otherwise never speak have sung out loud. We have created material on Mariachi bands, flute music from Peru, Tangos, etc. We used smells, tastes, colors, sounds, routines, pictures, objects, scarves, maracas, a guitar, etc. to facilitate engagement and participation. We have also created materials that we are using to support verbal expression and comprehension, memory, attention, reminiscing, sequencing, following directions, turn taking, following a schedule, orientation to place, TOD, and activities of choice. We have residents who previously have never left their rooms who are now tooling around looking for opportunities to interact and be involved.

The quarterly SLUMS in Spanish test scores that we administered increased between 2 and 12 points for EVERY one of these residents. We have continued progress with residents and are programming more complex goals and tasks with reading and other more complex activities because we have not yet reached the patients’ potential. COVID has slowed the generalization of our social/group programming, but we look forward to resuming the resident-created Club Espanol, which operates three times a week for half an hour. Restorative and Recreational Therapy have been highly involved and supportive of these residents and efforts maintaining the program once established.

During COVID, we have created social scripts and we’ve enabled patients to be engaged in therapy with family members via Facebook video messenger all over the state and as far as Bolivia and France, which has been fun and rewarding for all. A bright moment in a difficult time.

Here are a few pictures from these sessions.


A favorite song with Spanish subtitles


Reading large print script on Manzaneras aloud


Following social script on call to son in Bolivia.


Life Story Board for one of our residents allowing others to know him better and him to share information about himself.

A Journey for a Passion for Learning

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.