We know the why, here’s the how.

At the Villas at Sunny Acres, we wanted to create guidelines and instructions on ways to identify long-term care residents who could benefit from therapy. If we could improve their quality of life, decrease falls, improve strength, and improve or maintain function as well as ADL participation, it would not only help residents, but also improve facility quality measures and outcomes.

Through the ADL Significant Change Analysis Report, you can pick up for declines and improvements.  A few caveats:

  • Some United plans require authorization.
  • Hospice typically defaults to Part B. It’s a misconception that if a patient has hospice, you cannot do Part B. You can! Just make sure Therapy and hospice are billing different codes. In addition, ensure there are no patient copays, and if there are, let the POA know upfront.


  • Clinicians will perform routine and requested screens/consultations received verbally, in writing or based on an assessment schedule (MDS, care plan, etc.). The clinician will document the results of the screen/consultation and provide feedback to referral sources (Screens Postette).
  • Consultations should have documentation in the clinical record to support the need for a Therapy consultation (i.e., change in condition).

Therapists can screen for all three disciplines (PT/OT/ST). They get input from nurses/CNAs but also lay eyes on the resident themselves to look for self-isolation, decreased participation in meals/activities, and ROM. Screens should only take five minutes to determine a yes/no for therapy, so there should not be an impact on productivity.

Where else to look:

  • Referrals from Nursing staff
  • Risk Management
  • Skins and weight: weight loss, positioning
  • QAPI meetings: B&B, falls, weight loss
  • Restorative nurses
  • Change of condition note/e-interact
  • Social workers: Sometimes families will request therapy in care conferences
  • Other disciplines in therapy: Encourage open communication between therapists to refer to each other

Pitfalls and How to Avoid Them
A few common pitfalls include:

  • “They were just on therapy” or “Therapy can’t do anything”
  • “They have dementia”
  • “We did that; they never got better”
  • “That’s just how they are”

Navigating these roadblocks requires regular communication between management and floor staff — and among the floor staff themselves. Have a clear vision about what’s possible for long-term care residents, with the idea that it’s not about getting them to their prime; it’s about aging with dignity.

From there, ensure your staff has the tools to do their jobs effectively. Get buy-in from the whole facility, and regularly assess the impact on QMs and financials. If one strategy doesn’t work, try something else. Above all, try, try and try again until you’ve found the proper course of action and motivating factors for residents and caregivers alike.

View poster: How We B (PDF format)

Jennifer Kuehn, PT, DPT, WCC & Dee Nissle-Rolstad, RN