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.

Optima Update - Why Clinisign?

By Aimee Bhatia, OT, DOR, Glenwood Care Center, Oxnard, CA

When we were given the challenge to get our physicians signed up for Clinisign, it seemed daunting. We had tried several years ago with no success and a lot of push-back. After our quarterly meeting in Las Vegas, I came back determined to make a change. I presented in QA that we would be switching to Clinisign and highlighted how much it would cut down on being hunted down for signatures, how much less work it would be for the facility to coordinate signatures and clarification orders to remain in compliance, and how easy it would be to do at their convenience.

I gave the physicians a deadline, and with Mahta Mirhosseini’s help, I got three of our main physicians signed up within a week. Two of our doctors preferred to have their nurse practitioners sign, and that was perfectly acceptable. Setting up the doctors also allowed sister facilities in the area to more smoothly transition to Clinisign because the doctors were already in the system.

Since we started, it is remarkable how much less time myself and the rehab aides spend chasing down doctors for signatures. There is less filing and fewer errors in typing clarification orders into PCC, and overall efficiencies have improved, eliminating the need to print and write clarification orders upon evaluation and re-certifications. Our physicians occasionally need a reminder to log in and sign documents that are waiting for them, but even with that, it is an efficient process.

If you have not mandated that your physicians jump on board, please do. Enlist your administrators if needed. Remember, once your physicians are using Clinisign to sign evaluation and re-certification documents, you will no longer have to write clarification orders, you will no longer have to type signed clarification orders into PCC, and you will not have to print because everything is signed in Rehab Optima. Our facility chooses to print the signed documents so they are accessible when needed in the medical chart, but that is just a preference of our facility. Happy Clinisigning!

WELL - Skip the Fast Weight Loss Diets and Go for Long-Term Health

By Angela Ambrose, contributing writer

With a wide array of diets on the market, it can be tough to weed out all the fad diets and find a nutritionally well-balanced diet that is rooted in sound science and also simple to follow over the long haul.

“It’s easy to be overwhelmed, but don’t get sucked in by all the fad diets,” says Katherine Beals, associate clinical professor of nutrition and integrative physiology at the University of Utah. “Sticking to the tried and true research-based recommendations is the best way to go. It’s pretty basic – fruits, vegetables, whole grains, lean sources of protein and low-fat or non-fat dairy.” These nutrition recommendations stand the test of time and are summed up in the U.S. government’s “Dietary Guidelines for Americans” that have been around for decades.

Not surprisingly, the Mediterranean Diet, which closely mirrors these guidelines, has been rated the No. 1 best diet overall for three straight years by U.S. News and World Report. Tied for second place is the Flexitarian diet and DASH diet, which stands for dietary approaches to stop hypertension.

Rather than strict diets, all three are more accurately defined as healthy eating patterns with no foods off-limits. Each emphasizes whole, plant-based foods with a few minor differences. The Mediterranean diet adds more healthy fats, such as olive oil and nuts, as well as red wine, if desired. The DASH diet is designed to lower blood pressure and focuses on cutting sodium and saturated fat. The Flexitarian diet is primarily a vegetarian diet with the “flexibility” of adding in an occasional serving of meat or fish, when you get a hankering for it.

The Downside to Fast Weight Loss

Choosing the best diet depends on your ultimate goal. For example, if you want to lose weight very quickly so you can look slim and trim in your wedding dress or tux in five weeks, then a weight loss diet like HMR, Optavia, Atkins or Ketogenic may be a good short-term option. Despite their popularity, these same low-carb, high-fat diets fall to the bottom of the list for diabetes, heart disease and overall health.

“You will lose weight fast, but it’s not sustainable,” says Beals. “You can only do it for so long and then you start adding foods back in that you’re missing. And before you know it, you gain weight back.” Plus, they are nutritionally unbalanced and often require vitamin and mineral supplements.

If you’re looking to cut weight and keep it off, Beals suggests skipping these trendy fast weight loss diets and following the universal rule for shedding pounds.

“I don’t care who you are or what you do – the only way you’re going to lose weight is if you’re eating fewer calories than you’re expending. How you do that is highly individualized.”

The best diet for losing weight is the one that matches your lifestyle, personality and food preferences. For example, if ongoing support and guidance is important to you, consider Weight Watchers (rebranded as WW), which received the U.S. News’ top rating for weight loss and best commercial diet. The Vegan and Volumetrics diets tied for second place in the weight loss category.

Carbs, Protein and Fat – Your Body Needs Them All

Instead of restrictive diets that eliminate entire food groups, look for healthy eating patterns that include all three macronutrients – carbohydrates, protein and fat – and adjust the amounts of each to match your health goals.

While many of today’s fad diets drastically cut or eliminate carbs, Beals says they are a critical part of a healthy diet. “Carbohydrate-rich foods like fruits, vegetables and whole grains are the foods that provide the bulk of our vitamins, minerals and fiber, so if you don’t eat carbohydrates, you’re missing out on all those nutrients,” says Beals. The key is to select nutrient-dense carbs and go easy on the empty calorie carbs like soda, sweets and refined grains that are easy to overeat.

Higher Protein Aids Weight Loss

One proven way to lose weight is to bump up the protein in your calorie-reduced diet. “There’s ample evidence to suggest if you increase your protein intake, while consuming moderate amounts of nutrient-dense carbohydrates and healthy fats, you not only will lose weight, but also the composition of that weight loss will be more favorable,” says Beals. “You’ll lose more fat while maintaining lean tissue.”

Whether it’s a pork chop, chicken breast, salmon fillet or beans, tempeh and quinoa, eating more protein can make you feel full longer, so you’ll be less likely to snack in between meals or fill up on empty calories.

Which diet is right for you?

For those concerned with lowering their risk of chronic diseases such as diabetes, hypertension or heart disease, any of the eating plans that emphasize whole, plant-based foods and low saturated fats are sensible choices – from the Ornish, Mayo Clinic or Nordic diets to the MIND diet, which combines the Mediterranean and DASH principles with a focus on brain-healthy foods such as berries and leafy greens.

No single diet is right for everyone. Select one that is nutritionally balanced, allows you to maintain a healthy weight and matches your palate and lifestyle.

Don’t forget the other key ingredient for overall good health – regular exercise. All eating plans are more effective when combined with daily physical activity. Not only will you burn more calories and be more likely to keep the pounds off, but you will also build stronger muscles, bones and immune system, which may add years to your life.

Optima Update: What’s So Great About Clinisign?

By Mahta Mirhosseini, Therapy Resource

I recently had a chance to interview Lana Mathis about her experience with Clinisign. Lana is an OTA who has been with Ensign since 2012 as a DOR at Granite Mesa and now at Legend Oaks Kyle in Texas. When she is not “DORing,” she loves archery, and likes to travel, fish, take long motorcycle trips, and read. Her favorite ice cream flavor is Haagen-Dazs® Caramel Cone.

How long have you been using Clinisign?

LM: I have been using CliniSign since 2017

Did you have any challenges in getting started and how did you overcome them?

LM: The main challenge that I had was getting the Physicians to sign.   Once I explained how it works and gave them a copy of the CliniSign for Physicians they were more open to it.   I think the key words here are “time saving” and “it’s as easy as punching a button.”    It is a lot easier to get Nurse Practitioners to sign up.    I signed on a Nurse Practitioner here at Legend Oaks Kyle.    She stated, “Oh that was really easy and very convenient.”

How does Clinisign impact your therapy program?

LM: CliniSign has a tremendous impact on the therapy program.   It affects productivity/time.   It saves so much time and chance for errors.   It helps with compliance and especially with MSCA audits.    The amount of time saved is enormous. I changed buildings recently and I had forgotten how cumbersome and outdated it was to have to chase signed papers.

How does Clinisign impact your therapists?

LM: The therapists love Clinisign because it saves them time from having to complete clarification orders.   It also saves time from having to rewrite clarification orders because the through dates were different from the evaluation dates. They also don’t have to print their evals and recerts anymore.

Did your IDT have to do anything different to adapt to Clinisign?

LM: All of the IDT related information is on the portal and very user friendly. I recently had a Nurse Practitioner out on vacation for a week, and the covering Nurse Practitioner was not in Clinisign. It felt like going back in time to life before electronic health records.   The amount of time chasing pieces of paper and making sure they were scanned into PCC was ridiculous.

Any advice for therapy programs who are thinking of getting started with Clinisign?  

LM: To all programs that are thinking about getting started with Clinisign, I say…

Just Do It!

What are you waiting for?

It’s a life changer for the therapy department!

You will be amazed at how much time you save!

It’s much easier than you think!

Give yourself an early Holiday present and do it now!

You deserve it!

Remember, if you have any questions about getting started with Clinisign, please reach out to Mahta Mirhosseini (mmirhosseini@ensignservices.net) or your local therapy resource.

WELL - A Few Minutes of Meditation Can Transform Your Day

By Angela Ambrose, contributing writer

The hectic holiday season is in full swing and chances are your to-do list has more than doubled in length. When you’re feeling harried and overwhelmed, this is the best time to hit the pause button and find a few minutes to just sit and breathe.

Meditation involves bringing your full attention to a single point, such as following your breath as it flows in and out, repeating a soothing word or phrase to yourself, gazing at an object such as a candle flame or listening to an inspirational song.

“We live in the 21st century where the fast-paced world we’ve built is inundating us with floods of energy constantly, if we allow it. A 10-minute break from that can be very beneficial,” says Benjamin Decker, meditation teacher and author of Practical Meditation: a Holistic Three-fold Approach to Meditation.

Hundreds of research studies show that meditating regularly can help reduce stress, sharpen your focus and memory, manage depression, lower your blood pressure and improve the quality of your sleep. Studies also prove that regular meditation can create positive changes in the physical structure of your brain that may lead to better decision-making, increased empathy and better emotional control.

“The biggest challenge that I find with clients who have resistance to learning meditation is their lack of understanding of what it really is and what the benefits actually are,” says Decker. “The only way to really understand the benefits of meditation is to ‘take the leap,’ so to speak, and begin the experiment of engaging in the practice.”

6 Simple Steps to Meditating

Take a moment now to try this simple meditation technique of counting your breaths:

  1. Find a quiet place free of distractions.
  2. Sit comfortably in a chair with your feet flat on the floor and a straight spine. Avoid leaning against the back of the chair. You can also sit on the floor with your hips elevated on a cushion. If sitting upright is painful, lie on your back with a rolled up blanket or pillow under your head and neck.
  3. Close your eyes, take three big, deep breaths and exhale out your mouth with a “ha” sound.
  4. Bring your lips together and breathe naturally through your nose. Nostril breathing is more calming to the nervous system, but if this isn’t possible, breathe in whatever way is comfortable.
  5. Start to count your breaths backwards from 10 to 1. As you inhale, say to yourself “10” and as you exhale, repeat “10” silently. Continue like this with the numbers 9, 8, 7, and so on, until you reach zero. Then return to 10 and begin again. If you lose the count, simply start over from 10. Aim to complete at least 3 cycles of counting.
  6. When you’re done, slowly open your eyes and take a few moments to notice any thoughts and sensations in your body before moving back into your daily routine.

How to Stay Committed to Your Practice

Set a goal of meditating daily for five minutes, slowly increasing the duration each week. On days when you feel too busy to meditate, just take 10 slow, deep breaths anywhere you can find a few moments to yourself — in your car before you pull out of the driveway, at your desk or even in a bathroom stall.

Be patient with yourself and let go of any judgment about how your practice is going. It’s normal for thoughts to come up while you’re meditating. When they do, just observe them like clouds floating by in the sky. The true benefits of meditation come, not while you’re sitting there in stillness, but rather during times of high stress — when someone cuts you off in traffic, your toddler throws a tantrum in the middle of the grocery store or when you’re dealing with a serious health issue. With regular practice, the heightened sense of awareness and inner calm that you cultivate while meditating will start to spill over into other parts of your life.

“Every moment of our lives can become a meditation. How are you driving? How are you speaking to loved ones and strangers? What kinds of thoughts, feelings and emotions come up for you when you’re moving through life? Begin to bring your awareness into life as you are already living it,” says Decker. “Turn off the radio, turn off the TV, be with yourself and be more present with others.”

Meditation can transform your life by making you more patient, grounded and less reactive in all your relationships and with the unexpected challenges that inevitably come your way— at home, work and on the road.

Try a Free Meditation App on Your Mobile Phone

If you find it difficult to meditate on your own, download a meditation mobile app such as Insight Timer, Calm, Sattva, 10% Happier or Stop, Breathe & Think. These mobile apps track your progress and offer a myriad of meditation styles – from guided meditations and chanting to sounds of nature and relaxing music. The mobile apps are free, but premium content costs extra.

WELL (We Embrace Living|Loving Life!) — We Can Make a Difference!

Incorporating a WELL Lifestyle can help to prevent or halt Diabetes! November is National Diabetes Month, a time when communities across the country team up to bring attention to diabetes.

By Angela Ambrose, contributing writer

Healthy Eating and Exercise to Slow or Reverse Diabetes?

Many diabetics view their diagnosis as a lifelong sentence of taking daily medications and dealing with the complications of chronically elevated blood sugar levels. However, numerous studies indicate that small lifestyle changes have the potential to prevent or halt the progression of this disease.

Over 30 million Americans have diabetes, and nearly one-quarter of these cases are undiagnosed, according to the 2017 National Diabetes Statistics Report from the Centers for Disease Control and Prevention (CDC).

Diabetes Cases Are Soaring

Diabetes is expected to dramatically increase from one in 10 Americans to one in three by the year 2050. Type 2 is the most common form of diabetes, in which the body’s cells develop insulin resistance.

The alarming rate of type 2 diabetes is fueled by unhealthy lifestyle trends such as obesity, physical inactivity and poor eating habits. A growing aging population may push this rate even higher in the coming years. Other risk factors include smoking, high blood pressure, high cholesterol and high blood glucose.

More than one-third of Americans have prediabetes, which puts them at high risk of developing full-blown type 2 diabetes, stroke and heart disease.

Adopt a Healthy Whole Food Diet

Many people rely heavily on medications to manage their diabetes and overlook the single most important factor in controlling diabetes — eating healthy foods and limiting portion sizes.

“In many cases, diabetes can be completely reversed, particularly in the early stages, if we start with the dietary treatment of diabetes early enough after the diagnosis,” says Dr. Hana Kahleova, director of clinical research for Physicians Committee for Responsible Medicine and author of Vegetarian Diet in the Treatment of Diabetes. “Oftentimes, after switching to a predominantly plant-based diet, people start losing weight, their blood sugar normalizes, and they may even be able to reduce or completely drop off their medications.”

Kahleova recommends a diet that emphasizes plant-based whole foods such as vegetables, fruits, legumes and whole grains. While no single eating pattern is right for everyone, the American Diabetes Association suggests the Mediterranean, DASH and vegetarian diets as healthy options to consider.

Exercise Regularly in Short Spurts

Exercise not only strengthens the body and burns calories, but also helps release tension and reduce cortisol stress hormones, which may have a positive impact on glucose levels. When you exercise, your cells become more responsive to insulin, which allows more glucose from your blood into your cells to use as fuel when you work out.

All physical activity offers benefits, but for most people brisk walking is the simplest way to get started. Aim for 30 minutes daily with short bursts of exercise spread out throughout the day.

“For people with diabetes, it’s better to go on a brisk walk after each meal for 10 minutes,” says Kahleova. “That helps with glycemic control better than just one workout session for 30 minutes.”

Get More Sleep, Sunshine and Vitamin D

Getting enough sleep and going to bed early can increase the secretion of the hormone melatonin, which in turn, promotes insulin sensitivity. Kahleova recommends going to bed no later than 10 p.m. and getting seven to eight hours of sleep each night. Reducing your exposure to blue light from digital devices two hours before bed can also improve sleep.

To up your production of melatonin at night, spend time outdoors in the sunlight. This also helps your body produce more vitamin D.

“Many people with diabetes are vitamin D deficient,” says Kahleova. “Vitamin D is important, not only for bone density and calcium, but also for our immune system and increasing insulin sensitivity.

Shedding a Few Pounds Can Make a Big Difference

About 88 percent of adults with diagnosed diabetes are either overweight or obese. Losing as little as 5 to 10 percent of your body weight and exercising for 20 to 30 minutes daily may help prevent or slow the progression of type 2 diabetes, according to the CDC’s latest Consensus Report.

For a person weighing 200 pounds, that means losing 10 to 20 pounds.

Be Open to Change

We can’t change our genetics, but we do have the ability to change our eating, exercise and sleep habits.

“If we all made these small changes, the rate of diabetes would go down dramatically,” says Kahleova. “These are things that are doable. We just need to do them consistently.”

WELL Challenge! Share your own stories about nutrition, exercise and sleep habits that work for you! Here are two simple ways to share. Choose the one that works best for you:

  1. From your smartphone, visit EnsignTherapy.com, click “WELL” at the top of the page, then click “Share your Story” from the top of the WELL Site. There you’ll find room to share a short story and upload a picture from your phone.
  2. From your Instagram account, share a picture and caption and remember to hashtag both #CAPLICOwell and #CAPLICOnation.

We look forward to seeing your inspiring stories as a collaborator to our WELL Project. 

Creating a Movement!

By Cheri Prince, Therapy Resource

Have you heard about it? There’s a spark, and it’s starting to catch fire! Last week’s workshops had over 30 participants in total — and this is just the beginning!

PDWELL came from a desire to do more to meet the needs of the Parkinson’s community in the Omaha metro area. As a Physical Therapist and Rehabilitation Director at a skilled nursing facility, I had the opportunity to develop a Parkinson’s program over the last six years. Through this experience, we identified a need for a place for Persons with Parkinson’s Disease (PwPD) to go for Parkinson’s-specific therapy, exercise classes, education and resources.

While there are Parkinson’s offerings in town, the services are fragmented, with most people attending classes at many different locations in the area in order to meet their needs and/or interests. The same issue exists for support groups. Many PwPD attend multiple groups in order to obtain all of the education and support they and their care partners are looking for.

In addition, many people don’t know where to go to obtain Parkinson’s-specific therapy services. They get an MD order for therapy but are frustrated by the non-specific services they may receive at a typical outpatient clinic. Based on the feedback from physicians and the PwPD in the community, the concept of PDWELL was born.

The three pillars of PDWELL include Exercise (skilled therapy and exercise classes), Education (patient, caregiver and professional) and Community (fostering a sense of community among the members). We are establishing PDWELL initially with a focus on the pillars of education and community.


PDWELL is offering an educational workshop based on the book Every Victory Counts, developed by the Davis Phinney Foundation. This is a nine-week workshop that focuses on living well with Parkinson’s. It’s being offered two times per week and is open to anyone with Parkinson’s, their caregivers or any other person who provides care to persons with PD.

We are getting the word out about PDWELL and the workshop through support groups, visiting PD-specific exercise classes in Omaha, as well as informing health care providers in the Parkinson’s community. Participants will be going through the interactive lessons on topics such as Parkinson’s symptoms, exercise and nutrition, assembling a wellness team, and navigating your Parkinson’s with your care partner.

Other educational workshops are being developed and will be both ongoing, like Every Victory Counts, as well as specific “boot camp” sessions for the newly diagnosed. We are planning other special events such as physician presentations and special topics of interest, such as Nutrition, Current Research in PD and pharmacology considerations.

Another component of education that PDWELL will provide is professional-level education. Currently, we have two CEU courses that have been developed and will be held in October and November in Omaha, Nebraska: Gait impairments and Parkinson’s Disease for PTs and PTAs, and Dual Tasking and Parkinson’s Disease for PTs, OTs and SLPs. In November, Practical Approaches to the Assessment and Treatment of Parkinson’s Disease will be offered in San Antonio, Texas, for PTs, PTAs, OTs and COTAs.


PDWELL is developing community in multiple ways. First of all, our educational offerings will bring a sense of community through learning and sharing experiences. The Omaha-area Parkinson’s community will be invited to “Give a Gift to Themselves” in December as we gather together to prepare Aware in Care kits from the Parkinson’s Foundation. These kits are designed to help ensure preparation in the event of a medical need. We are currently planning social outings and non-educational gatherings such as a ping-pong tournament as well as intergenerational offerings based around exercise and healthy living, such as cooking foods that are “brain rich” for Parkinson’s. We are reaching out into the community to bring in resources that will enrich their lives while they share the knowledge and passion they have for their hobbies/recreational activities.

PDWELL is sponsoring local Parkinson’s events. On Sept. 29, we sponsored Walk the Park for Parkinson’s, which is a 5K and fun run/walk for Parkinson’s Nebraska. We also provided educational support during the recent Nebraska Medicine 2019 Patient and Caregiver Symposium held on Oct. 14.

Cheri and her daughters at our PDWELL Booth at the Parkinson’s Walk in NE

PDWELL is also participating nationally with Parkinson’s Foundation through hosting viewing parties for their 2019-2020 Expert Briefing series on topics such as “Coping with Dementia for Care Partners” as well as “Optimal Exercise Strategies for Stability, Stamina and Strength.” As an “Aware in Care Kit Ambassador,” I will be educating the Parkinson’s community in Nebraska on the benefit of utilizing an Aware in Care Kit for every inpatient stay. We are on the planning committee both for Moving Day Omaha — a walk for Parkinson’s through the Parkinson’s Foundation — and the 2020 Victory Summit from the Davis Phinney Foundation.

In addition to these PD-focused events, I have had the opportunity to work closely with some of our local post-acute care facilities to further develop Parkinson’s programs and provide input and support with patients.

One of our PDWELL Workshops in Omaha being led by Cheri

I could not be more excited to be a part of an organization that supports building programs like PDWELL, which can lead to life-changing impact! I am so blessed to have the opportunity to serve the Parkinson’s community here in the Omaha metro and beyond!

Note: If you would like more information on interrupting the course of Parkinson’s disease in your community, please reach out to Cheri Prince, Therapy Resource, at ChePrince@ensignservices.net. Cheri is also offering upcoming courses through www.EnsignTherapy.com.