Onboarding New Therapy Team Members

By Lisa Brook, DOR, St. Joseph Villa, Salt Lake City, Utah
Lisa Brook, DOR at St. Joseph Villa, recently shared their new therapist/new employee training and mentorship process. As COVID continues to de-escalate, their team is beginning to focus again on leadership development and believe this process starts from the very beginning of employment at St. Joe’s. They are attempting to be more intentional about onboarding and training of new therapists as their skilled census grows and they are expanding their outpatient programing as well as their LTC programing. The therapy team at St. Joe’s is being more intentional about the hiring process with improved communication with Jamie Funk, involvement of key staff in the interview process and then setting more specific plans for the onboarding and training process. In order to grow leaders we must start with growing good therapists, mindful of their treatment approaches, seeking to make the most of their time. Lisa walked us through their onboarding process:

Day 1: NetHealth email sent to the staff early in the a.m. of the first day of a new therapist’s arrival that introduces him/her so that everyone knows the person by name. On this day, the new therapist is assigned to a therapist of the same discipline just to observe. This is planned ahead of time so the therapists are aware they will have someone shadowing them that day. We encourage the new therapist to take notes as we go through the login process for NetHealth, PCC, tour the building, meet members of the leadership team, observe the pace of things, etc. The first day is usually only a half day.

Day 2-3: Again, these are usually not full days. The new employee treats two or three patients on our skilled rehab unit. Their schedule is loaded with patients who will cooperate and give them a “win” for the day. The goal is to feel comfortable with the patients and just be a therapist! At the end of those treatments, they will spend time verbally reviewing the treatment, patient response to treatment, and potential documentation with the same therapist they shadowed with on Day 1. They do their billing, write their TENs, and then the therapist reviews and they discuss necessary corrections.

Day 4 and on: As the new therapists get more comfortable, more patients are added to their caseload. They treat patients on our skilled rehab unit and start to initiate point of service documentation. Time is scheduled with their “mentoring” therapist to answer questions and review documentation and goals. This process has been helpful for new employees, and they look forward to it as it gives them an opportunity to get all their questions answered in a more in-depth manner.

Next Steps: Next steps are really driven by the new team member. We initiate writing progress notes during week 2 for a new graduate and then add other necessary documentation as they begin to have success. As the DOR, Lisa said she checks in with them each day, but this process allows the experienced staff to take ownership of our training/onboarding process, and it seems to be working! Lisa said that even if they hired an experienced therapist rather than a new grad, there is still a lot of mentoring that we need to provide. They consider the confidence level of the therapist and tweak the process as needed. As they add more patients to their caseload, we have ongoing conversations.

Variables to Consider: New grads often require more mentoring. However, experienced therapists, part-time/PRN staff should always be provided an opportunity to receive mentorship as needed. Consideration must also be given to the confidence level of the individual. It often takes as much “coaching” for a seasoned therapist to get acclimated to treatment approaches, writing appropriate goals and skilled TENS because there are some differences in documentation in each subset of our programming (skilled rehab, skilled maintenance, outpatient, sub-acute respiratory, LTC).

Lisa said we need to allow our therapists time to grow. If we are going to create leaders, we need to be intentional about onboarding and training. We want them to be confident in their skills and critical thinking and be leaders among their peers in the building. Jamie added that Lisa has done an amazing job! St. Joseph Villa has a reputation in the community of empowering their therapists in establishing plan of care and treatment approaches to fit the needs of the community. She has heard from candidates that they know how great it is to work at St. Joseph’s, and all of the tools Lisa shared with us are having an enormous impact in growing therapists to be outstanding clinicians, leaders in St. Joe’s and then leaders beyond St. Joe’s.

Train Your Replacement? Yes, Please!

By Gary McGiven, Milestone Therapy Resource, Utah
Nicole Newberry was the DOR at Draper Rehab for the last 15 months. Early on in her experience as a DOR, she saw the value of having an ADOR and growing leaders. As a result of this realization, she identified a member of her team that she wanted to help grow as a leader. Jamie Sack, SLP, was the natural choice, as Jamie has been completely bought into the growth of the therapy program at Draper.

Over the last year, Jamie has participated in the DORiTO program, learned the daily technical, weekly skilled review, triple check process, and spent about eight weeks filling in for Nicole while she was on maternity leave. While Nicole was on leave, we learned that she would be moving her family to St. Louis so her husband could complete a medical school fellowship in pediatric ENT. While we were saddened by the news that Nicole would be leaving us, we immediately were excited by the thought that Jamie would be able to seamlessly take over the role of DOR. With some further education on the DOR role provided to Jamie and Jamie explaining some of her expectations, we were able to solidify Jamie as the DOR for Draper Rehab.

Jamie was officially named the DOR a few weeks ago as sort of a Co-DOR. The week of June 21 was her first full week as the DOR of Draper Rehab. She has hit the ground running, and the transition to date has truly been seamless.

Going through this process made me realize the benefits of growing leaders and preparing/training your potential replacement. Most obviously, this makes the process seamless, as the future leader learns the systems needed to be an effective DOR and is given an opportunity to develop relationships with members of the Therapy and interdisciplinary teams.

In addition to the obvious, this allowed Jamie to see some of the challenges of the DOR role. As Jamie saw these challenges and more of the ins and outs of being a DOR, she has been able to set boundaries for herself to ensure she enjoys a greater work/life balance. We are so thankful for Nicole and Jamie and look forward to the great things Jamie will do as she continues to learn the DOR role.

Recognizing St. Joseph SLPs for their Outstanding Clinical Outcomes

Submitted by Lisa Brook, PT/DOR, St. Joseph Villa, Salt Lake City, UT
Susan Roubian, Hannah Allen, Katie Paulsen and Taylor Schweitzer comprise the St. Joseph Villa Speech Therapy team. This program has grown significantly, going from 1 1/2 SLPs to four full-time SLPs over the last two years! These SLPs have made an effort to collaborate with interdisciplinary teams in our facility to change the way we care for our residents and improve their therapy and quality of life. We have been developing programs in the areas of AmpCare, Think Thin!, Oral Care, Speak Out!, Abilities Care, and high-level cognitive groups for our residents with mild cognitive impairment.

L to R: Taylor Schweitzer, Hannah Allen, Susan Roubian, Katie Paulsen

During our COVID outbreaks, our SLPs played a crucial role in managing change in condition and aspiration risk and significantly changed our outcomes. They are now utilizing The Breather with our Respiratory Muscle Strength Training program to meet the growing needs of post-COVID respiratory insufficiency impacting communication and swallowing.

We have also been developing programs to improve outreach to our ALF, ILF and outpatients from the community! Beginning in June, we will begin FEES training in preparation for an in-house FEES program, increasing access to instrumental evaluations by the treating therapists. Our trained SLPs will be facilitating mentorship of others seeking to be FEES certified in our market.

Our SLP team is recognized by our IDT team for their outstanding clinical outcomes, their care of our residents, and their outstanding communication with providers. This team of exceptional therapists are dedicated to providing high-quality care to our residents and are excited to keep expanding and optimizing care for those we serve!

SLP Helps Resident Find Purpose and Decrease Behaviors

By Dominic DeLaquil, PT, CEEAA, Therapy Resource, ID/NV
Steve is a LTC resident at McCall Rehab being treated by Speech Therapy for cognitive/communication deficits. He has a history of alcohol abuse and dementia. With winter in the mountains and COVID restrictions, his behaviors had become a real problem. He was initially refusing to get OOB and staying in a dark room, but as the weather began to turn to spring, he began excessive wandering, wanting to get out of the facility. He was agitated and confused and began urinating in sinks and trash cans.

Using the ACA approach, SLP Cassie Johnson took him outside and listened. He was remarking on all of the things around that building that might need repair or upkeep after the long winter. She asked him what he would do, and one thing led to another, and she got some sandpaper and he started working on refinishing a wooden patio table at the facility. Another resident became interested, and they worked on the table together. They have since formed a friendship and seek each other out. All of Steve’s behaviors have ceased and he is more motivated to improve his abilities and hopes to discharge to an ALF. As an additional benefit, other residents became interested and the furniture sanding became a group activity!

In addition, his SLUMS score in February, when he was depressed and his confusion was worse, was a 13/30. Tested recently, after finding some purpose and satisfaction, his cognition actually shows improvement and he scored a 22/30!

Millennium Post Acute Rehab’s SLP Superstar Team

By Heather Bjernudd, Therapy Resource, South Carolina
Our speech therapists at Millennium Post Acute Rehab in West Columbia, South Carolina, are incredible! When this facility started taking ventilator-dependent patients this year, these ladies jumped in and have had incredible results.

Here is a highlight on a current patient: 32-year-old male admitted with severe trauma, left hemi craniotomy that affected all function and ventilator-dependent. Swallow response was absent; silently aspirating, NPO, PEG; mild/moderate aphasia with decreased ability to communicate via trach. Cognition impaired, BIMS score of 7. Forty days since admission. Patient able to tolerate Passy Muir Valve up to five hours at a time. Swallow trials with ice chips showing improvement, improved swallow initiation and laryngeal function. Patient is able to follow multi-step directions for swallowing maneuvers and functional tasks. Able to complete diaphragmatic breathing exercises with min assists. Patient has been weaned off of the ventilator and has a real possibility of being weaned off of the trach.

Growing SLP Programs

By Jeremy Osmond, DOR, Provo Rehabilitation and Nursing, Provo, UT
Dot Stuart, SLP at Provo Rehabilitation and Nursing, decided to focus on education related to growing SLP programs for her Director of Rehab in Training Ops (DORiTO) capstone project. The information was so impressive that I asked her to present at a Sunstone DOR meeting to help other therapy leaders really understand all the things SLPs can do in our setting.

She highlighted that the SLP needs to be committed beyond the patients that they receive orders for on admits and really focus on all residents in their facility to make sure their highest level of function is being attained. Her training focused on SLP support for PDPM, including completing the BIMs; identifying NTAs such as malnutrition and SLPs’ role in intervention; and ensuring SLP swallow assessments are reviewed for accurate Section K reporting.

She focused on the importance of really knowing each payer plan and what that means for intervention. SLPs need to manage their program efficiently based on payers and authorizations along with clinical presentations. They need to be a partner to the DOR to ensure clinical outcomes even with reimbursement challenges.

She addressed how SLPs can help so many LTC patients, including what tools we have in place to help quickly identify any changes of condition; long-term modified diets; etc. Many SLPs and DORs are not as familiar with the available reports in PCC to help with patient identification. She also trained on the importance of being present in the facility and making sure the IDT members, clinical team and other therapy disciplines really understand how they can help with patient care. Click below for a summary of helpful reports in PCC for SLPs.

Dot also emphasized the importance of strong student programs to help future SLPs really understand their value and how they can make a difference in a patient’s life in the Post-Acute and LTC setting.

Provo has trended increased treatment hours and need for more SLP staff with the help of Dot’s focus and drive to ensure every patient’s needs are met.

Lymphedema Success Story

Danielle Kistler, OTR/L, is a new CLT at Holladay Healthcare. We are so excited to have a CLT at our facility, and we are already seeing some great successes with her interventions. We have an LTC resident that had LE skin tears that developed into stasis ulcers. The nurses were providing wound care for about six months with the patient being on and off antibiotics due to infections, with the ulcers being unable to heal.

At the same time Danielle became certified in lymphedema management, the patient was referred to a wound clinic for further wound treatment. With Danielle being able to provide appropriate compression wraps at the same time the patient was attending the wound clinic, his stasis ulcers are now healed. The nurse manager received multiple calls from the wound clinic on how well his legs were being wrapped and how impressed they were with the healing of his wounds. This patient also has aphasia and has difficulty communicating with his caregivers. We have seen a change in this patient, with signs of reduced pain, increased participation in ADLs, decreased outbursts, and improved quality of life.

Submitted by Jeremy McCorristin, DOR, Holladay Healthcare, Salt Lake City, UT

LTC Programming: Rise and Dine

Our long-term care population is now fully vaccinated, and it seems as if we are entering, dare I say it, a post-pandemic environment. We made it, but now what?

During the pandemic, we have seen our residents’ version of normalcy altered. Those who used to spend most of their day in the dining room, in activities or the therapy gym, and visiting with their friends and family now are found sleeping in more, not eating as much or as healthy as before, and no longer have the desire to engage in social activities. When they do feel like getting out of their room, seeing them use a wheelchair is more common. Some of them are COVID-recovered and have never fully bounced back after fighting the virus.

Our therapists opened their minds to different therapy approaches and gained the skills that it takes to truly dignify the lives of long-term care residents. We knew these effects of illness and quarantine isolation would take a toll on our vulnerable population, and we did everything we could to combat them in real time with preventative therapeutic approaches. In a pre-COVID world, our building was predominantly a rehab-to-home facility, and it was uncomfortable at times for our therapists to develop long-term care treatment plans. The pandemic highlighted the necessity for our services, and now it is hard to imagine not being this involved with them.

Our Speech Therapists, with multidisciplinary collaboration, hosted a new program this month called “Rise and Dine.” This program began as a nutrition and hydration-based club that requires participants to get out of bed and engage cognitive and communication skills in choosing meal preferences for the event. “We are all very passionate about our residents’ quality of lives and saw this as an opportunity to meet our residents’ nutritional and social needs. The excitement and feedback of our residents really fueled the idea and brought our entire dietary and therapy staff together to make this such a successful event!” — Breean Ludwig, HCRO Speech Therapist

As excitement grew, we realized this program could address almost all the abilities we have seen deteriorate. We ordered T-shirts to encourage dressing and hygiene before the event, and all our therapists came in to facilitate transfers, self-care routines, and mobility to and from the dining room. We also were able to treat goals related to self-feeding, dynamic standing, and sitting tolerance and positioning.

“We saw such a negative impact after so many in-room isolations during the COVID pandemic. Our Residents were discouraged, losing weight, not socializing, showed physical and cognitive changes, and did not want to come out of their rooms. We wanted to do something to bring excitement back into their lives while still being able to target our goals in therapy. This program offers an opportunity for all disciplines (PT/OT/ST) to participate.” — Ke’ren Grimaldo, HCRO Speech Therapist.

Although we are striving to return our residents back to “normal,” I am proud to say our Therapy team has established a new norm as well, and we are not looking back. Just as preventative interventions were important during the pandemic, how we move forward now is just as crucial. 85% of our long-term care residents got out of their rooms to participate in this program. We owe a big thank-you to our dietary manager and her team for being as excited for this program as we were. Our team has a seasonal themed event planned for the rest of the year, and we can hardly wait!
Remember, every county and state Department of Health has specific guidelines for re-opening, so always consult with your DNS with your “back to normal” plan.

Submitted by Elizabeth Munford, PTA/TPM, The Healthcare Resort of Olathe, KS

Motivating Employees—Meet the M.E. Committee at Copperfield

The strength of a team can truly be powerful when everyone sees and feels the vision. Employee culture and retention has been at the top of the initiative list. How can we improve this area and create an environment that truly embodies Customer Second? Well let me introduce you to the M.E. committee. I spent time with one of the M.E. committee members, Loretta Johnson, PTA, to get a better understanding of what this committee has to offer.

As explained by Loretta, the Copperfield Healthcare and Rehab facility created the M.E. Committee (Motivating Employees), with a purpose to engage, support and reward their fellow coworkers. They have designed and cultivated strategies to build interpersonal skills, through exciting team-building exercises. This level of cultural promotion encourages open communication, challenges employees with friendly competition, and assists with facilitating a healthy work-life balance.

The M.E. committee has put together a calendar of events that caters to employee engagement. As Loretta put it, “An employee who enjoys coming to work is a worthy investment, and a good day at work fuels the desire to be better the next day. This feeling of happiness at work will spill over into the love and care that we provide to our patients.”

Most recently, the M.E. committee hosted a Coloring Contest. All employees were asked to color a picture of a butterfly. Each butterfly was judged by the panel of patients, employees and visitors. The grand prize winner received a beautiful, laundry-themed gift basket. Other events included: Chili Cook-Off, World Water Day, and National Laugh Day. The time spent together is intentional, and it has allowed new-hires to comfortably blend in with the team.

The Copperfield Healthcare and Rehabilitation facility leadership team includes:
Noni Gill, ED; Unnati Patel, DON; Shayla Goode, M.Ed CCC-SLP

Submitted by Kai Williams, Therapy Resource, Keystone-East

Outpatient/Inpatient Synergy at McCall Rehab and Care Center

The Rehab team at McCall Rehab and Care Center in McCall, Idaho, has had a vision of providing community-based outpatient therapy in people’s homes since the facility became part of the Pennant-ID/NV market in 2018.

McCall’s DOR, Jenny Sowers, DPT, couldn’t ever seem to find the consistent time to grow an outpatient program, so she decided she should find a therapist willing to take on that challenge. In September of 2020, Jenny hired Ellie Toscan, DPT, with the goal of Ellie building their Community-Based Outpatient program.

Ellie has shown tremendous ownership of the program, from marketing to clinical to financial. She independently tracks the financials weekly and monthly to ensure the program is financially viable. Executive Director Kurt Holm’s main goal for the program is to build relationships and reputation in the community. A recent admission gives clear indication that Kurt’s goal is being realized. Ellie was working with a patient in her home. She had a change of condition, went to the hospital, and was referred to McCall Rehab. Because of the relationship that Ellie built with this patient, she readily agreed to the discharge plan. The patient is now receiving skilled therapy and nursing services in our facility. Thanks Ellie for this great example of the power of our core value of ownership!

If you are looking to grow your community based outpatient program, please consult your therapy resource or Deb Bielek for regulatory help specific to your state.

Submitted by Dominic DeLaquil, Therapy Resource, Idaho/Nevada