First Quarter 2012

The FlagPOST
Welcome to the First Online Edition of
The FlagPOST


This edition of the FlagPOST is dedicated to one of our favorite Core Values: Our Passion to Learn! Whether it be attending our sponsored continuing education courses, taking on a student, or participating in research and education, it is clear that our therapists live and breathe this core value.


We are gradually moving to a paperless FlagPOST, so please set as your home page on your facility computers, and watch for updated articles. Deb Bielek has introduced Oppties (learning opportunities) this month, so be sure to go online to check it out. If you answer a question correctly, you are entered to win some cool prizes! 


Thanks for all that you are doing to contribute to the lives of so many. Our regulatory environment is ever-changing, and somehow our therapists continue to keep excellence in patient care at the heart of what we do every day. Our ongoing passion for never-ending learning continues to better our patients, our staff, our local communities, and our academic communities. We are so grateful for all that you do.     

Ensign Facility Services Hosts
First Clinical Instructor Course  


CI Course
Our first Ensign-hosted APTA Clinical Instructor Course was held in Southern California at Southland Care Center in November. We had a great turn-out of PTs, OTs, and SLPs from across the country. Debra Bierwas PT, DPT from Midwestern University was the course instructor. Debra is the Director of Clinical Education at the Doctor of Physical Therapy Program for Midwestern University. There was a wealth of information for both the experienced and novice clinical instructor, with a lot of real-life examples with challenging situations discussed in detail. Debra Bierwas told us afterward that it was the best and most interactive CI course that she has ever taught. Not a surprise to me with our outstanding Ensign therapists! Thanks to Deb Bielek for making this happen, and thank you to all the therapists who attended. We will be looking to host another CI course soon, so let your therapy resource know if you are interested!   
PlaybookFootball Has a Playbook...
And We Have the RAI

Football has a play book, but sometimes, the plays get changed. Troy Palamalu picks up on the quarterback's audible at the line of scrimmage and calls for a blitz and "BAM," down goes the quarterback. Troy got it right and made the play. Rehabilitation in the Skilled Nursing Facility has regulations. The therapist is comfortable with his understanding of a rule and "BAM," the rule changes. But, unlike the quarterback in this story, the therapist doesn't go down.


Let's face it. We work in the most highly regulated, analyzed and scrutinized setting in America. Why do we hang in there? We hang in there for the love of it. That's right, we LOVE what we do. We LOVE the people we serve. We LOVE our co-workers. We LOVE the difference we make every single day. We don't go down.

As the regulations continue to change, we are finding ways to continue to deliver beautiful care and achieve tremendous outcomes with our patients and residents. We must celebrate those successes. Share those stories of progress and recovery. Show the outside world that we are capable and we will continue to evolve through changes thrust upon us.


With the ever-changing environment, taking care of the basics becomes paramount. For example, we must know and follow our state practice acts. Ask yourself - What is the responsibility I have as a supervising therapist? What obligations do I have as a therapist assistant? What is on the agenda with my licensing board? Will a new rule impact my practice?... Read on...

Case Management and Therapy Team: Working Together To Maximize the Overall Experience for the Managed Care Patient

As we all know, our facilities have experienced substantial growth in their managed care business in the past 10 years. As with all changes, we will continue to experience certain growing pains. These growing pains are a natural part of the process to become a stronger and more effective team managing the care of our patients while ensuring we are being paid in accordance with the care we deliver.

One of the most important relationships often overlooked in a facility is between the Case Management Team and the Therapy Team... Read on...

Think back to when you were a therapy student. What did you love about your clinical experience? Most likely your favorite internships were with energetic and excited therapists in a lively learning environment, and I bet you can still remember that special clinical instructor that mentored you on the way to becoming a professional. Wouldn't you love to give back to your profession in a meaningful way? There is no better way to learn that than to teach, and I know that our therapists have so much to give - not only intellectually, but teaching our amazing culture can leave such a lasting impression on our students. And guess what? Those students who have a wonderful experience with us will also want to be part of our staff after graduation. Taking students is an incredible win-win for the student, the therapist, and our facilities.


Ciara Cox is our therapy resource and a professor in the School of Occupational Therapy at Samuel Merritt University, so teaching and students are near and dear to her heart. She shares below some nuts and bolts strategies on making the student experience successful for both mentor and student with consideration to today's complex healthcare reimbursement environment.   



Why Take a Student?  

  • To give back to the profession
  • To provide intellectual stimulation for the supervising therapist
  • To provide a continuing supply of therapists
  • To expose students to the wonderful rehabilitation environment of SNFs
  • For the recruiting opportunity

There were a couple of changes in Medicare regulations in Fall 2011 that improve the experience of students treating Medicare Part A residents (Part B rules have not changed)... Read on...

A Thriving Student Partnership at

Atlantic Memorial 

Alex Nguyen started at Atlantic Memorial a little over two years ago with a vision to develop a thriving student program. Only a year out of school himself, he knew the impact of what a phenomenal clinical experience could make. His experience during his internship with Jenny Farley, the DOR at Atlantic Memorial, influenced him to take a position with her despite multiple job offers in a variety of settings. His vision with his student programs was to weave it into part of the vision of the facility: building extraordinary relationships with the surrounding community. Alex set out to build these same extraordinary relationships with the academic community. The first student contracts were signed in December of 2010.  Since January 2011 Alex and the Atlantic team have accepted 11 students: 5 OT interns, 2 PT interns and 4 SLP students.


Over half of the staff has taken a lead clinical instructor role. One of the important clinical benefits of staff assuming a leadership role is raising the daily standard of patient care. Therapists that may have been practicing for awhile are infused with renewed passion for learning and teaching. One of the externs became an Ensign employee! Atlantic Memorial currently receives many inquiries from previous and future students to set up internships, and there is even a waiting list now because of the excitement in the academic community.


Alex's passion for teaching is infectious! You only need to spend a few minutes with him to catch the excitement and energy that he has. The community visibility has greatly increased with students attending ortho appointments, patient home visits, and interfacing at community events. In addition, Alex has been invited for guest lecture opportunities at Loma Linda University and USC. Alex and the staff at Atlantic Memorial are helping to define the "new face" of skilled nursing settings! 


If you are interested in taking a student or are unsure where to start, please let your DOR and your therapy resource know. We have lots of week-by-week tools for you to use to guide you through the process, and signed contracts ready to go with many schools throughout the country. We can be an integral part in shaping our new generation of therapists. We have heard first-hand from several academic coordinators that the buzz about our therapy programs is out there, and they are eager to send their students to our facilities for an outstanding clinical experience. 

Powerful Beyond Measure

The Wellington Rehab team (L to R): Curtis Merring, Rhianna Hughes, Josh Reis, Becky Winsor, Roger Rice, Stephany Kozney

These are words that describe the momentum occurring at Wellington Place and Rehabilitation in Temple, TX. The Wellington rehab team has made tremendous strides fiscally and clinically over the last eight months under the direction of Curtis A. Merring, OTR/L, MOT. Curtis brings an evidenced-based approach to rehabilitation.  As a published clinical researcher himself, he has conducted research involving people who have experienced a stroke or SCI at University Medical Center Brackenridge and the University of Texas at Austin.  Two of his most recent publications include, "Recovery nine years post stroke with Standardized Electrical Stimulation" in Occupational Therapy in Health Care, and "Muscle spasticity associated with reduced whole-leg perfusion in persons with spinal cord injury" in the Journal of Spinal Cord Medicine


Curtis has challenged his entire rehabilitation team to take an evidenced-based approach to their treatments.  Currently, all disciplines use a standardized outcome measure to document progress and produce monthly reports...Read on... 

Kinesio Taping Seminar - Applying the "Magic" of Tape Across Rehab Centers

Kinesio seminar

When Texas hosts a CEU course, they think BIG. Jon Anderson, Texas Therapy Resource, identified a growing interest and need for Kinesio Taping, and soon after he posted the course details, interested therapists from across South Texas clamored to register. Jamie Funk quickly worked with our Service Center to set up a PayPal account for outside therapists to register and pay through Deb Bielek, Jon, and Jamie met and talked with therapists throughout the 2-day course to share information about our facilities and our unique culture. 38 therapists attended in all, with 20 outside therapists from around the community.  Jon used the money earned to pay for the course and the venue at South Texas College, and the residual earnings will go toward a scholarship fund for the college's PTA/COTA program.


"Something better than any laser, wrap, or electric massager...The Tape.  It is a special hot-pink athletic tape that came from Japan and seemed to have special powers. Every morning before the stage, they would tape us all up, different parts of our bodies . . . George's back, Chechu's knees. Sometimes we'd be so wrapped up in hot-pink tape that we'd look like dolls, a bunch of broken dolls. But the next day the pain disappeared-it was gone."

     ----Excerpt from Lance Armstrong' s book,

                                                                  "Every Second Counts"


The description above of this magical tape is catching on and spreading like wildfire, and has now made its way from the athlete to the geriatric setting. Therapistsworking in skilled nursing facilities supported by Ensign Facility Services, Inc. (EFSI) have taken notice and recently participated in a three-part certification course to become certified Kinesiotape therapists. The first and second phases of the course (K1 and K2) were held on Jan 21 and 22 for nearly 40 therapists in South Texas (19 Ensign Therapists, and 21 outside therapists). The 16 CEU credit hour course received an overwhelming response and filled up in record time with nearly 30 outside therapists on the waiting list...Read on...

Building a Therapy Niche for LVAD
LVAD team
(L to R): Kathy Falcon PTA, Karen Wetzel PT

Therapists and staff at Heritage Gardens in Carrollton, Texas, have undergone training to care for patients with a left ventricular assist device (LVAD). LVAD is an implantable mechanical pump that helps pump blood from the lower left chamber of your heart (the left ventricle) to the rest of your body. LVADs are used for patients with complete heart failure who are waiting for a heart transplant or medically unstable to undergo a transplant. Part of the device is implanted in your heart and abdomen, and part remains outside your body. You carry the external part of the device on a belt around your waist or on a shoulder strap. Most LVADs have an electric pump, an electronic controller, an energy supply (usually a battery weighing about 8 pounds) and 2 tubes. One tube carries blood from your left ventricle into the device. The other tube takes blood pumped from the device into your aorta (artery) to be circulated throughout your body.


After special training, the therapists have been able to treat these patients. They work on strengthening, balance activities, functional mobility...the goal is to get their patients to the highest functional level so they may return home. Gait training, ADL retraining, self-care management retraining, transfers and wheelchair mobility are all part of the treatment plans along with family education. Speech therapy is also involved, not just PT and OT. The therapists plan to take a course online with a test to become certified. Currently, Heritage Gardens is the only facility in the area that gets LVAD referrals.

Happy Valentine's Day!


From Village Care Center, McAllen, TX (L to R): Katie Mania, PT; Martine Valdez, PTA; Monica Fuentes, OT; Lupe Rivera, PTA; Amy Gutierrez, SLP; Becky Guerra, OT; Jeff Hicks, DOR; Denise Gonzalez, SLP Intern; Sarah Acevedo, Tech; Joanna Smith, OTA

Issue: 1

In This Issue
Ensign Hosts Clinical Instructor Course
Football Has a Playbook--And We Have the RAI
Case Management and Therapy Team: Working Together
Why Take a Student?
A Thriving Student Partnership at Atlantic Memorial
Powerful Beyond Measure
Kinesio Taping Seminar
Building a Therapy Niche for LVAD
Happy Valentine's Day!
The Yellow Flag - Being Accountable
Learning Oppties 


And, to CELEBRATE our PASSION FOR LEARNING, therapists, assistants and therapy techs working in facilities supported by Ensign Facility Services, Inc., will have the opportunity to LEARN AND WIN. In the July 2010 issue of Spirit Magazine (Southwest Airlines), Jay Heinrichs authored an article about a concept of giving back to employees by rewarding them with something that can help make them a little better.  Heinrichs termed these rewards, "oppties." We loved the idea and


So, for each day during the month of love (yes, February), a new learning opportunity related to various topics will be posted to the "LEARNING OPPTIES" page on  Read the message, review the question and blog your response by hitting the "Discuss" link.  

You can also fill out the "reply" section located just below the question.  Timely and correct responses will be entered to win "Oppties." 

In addition to individual winners, there will also be other "Oppties" awarded, such as highest number of participants from a facility therapy department over a period of time and teams with the most consistent participation throughout a period of time.   Winners will be posted.   Don't forget to check us out at
 each day, beginning February 1, 2012, for your opportunity to LEARN AND WIN! 


 The Yellow Flag

Yellow Flag

 Being Accountable

by Carissa Podesta,

Compliance Officer


A couple of recent therapy compliance incidents caused some Ensign facilities to part ways with good therapists who made poor decisions.
     I want everyone to know that these situations could have been avoided had those therapists sought help and support instead of acting in a way that placed their license and position in jeopardy.  I personally feel bad that these individuals did not recognize that help and support existed and want to make sure that each of you understands what to do if you are ever in such a situation.


Holding Ourselves Accountable

Our Compliance Manual and Code of Conduct:

  1. Prohibits conduct that violates our policies or the law.
  2. Requires that we report any violations or suspected compliance violations.
  3. Prohibits retaliation against anyone who reports a compliance violation.

   These standards are absolute and without exception. So, for example, we cannot violate policies or the law and then claim someone else made us do it. We also cannot fail to report a violation for fear of retaliation.

   One of our organization's Core Values is "Accountability." We are asked to hold ourselves to the highest standards of care and professionalism. That means something more than just following policies or the law; it means acting ethically and with integrity in all of our actions as employees.  Let this guide everything you do.

   Our culture is one in which asking questions and challenging one another is encouraged. We will only become better if we make ourselves better. This means questioning the status quo and questioning anything or anyone that impacts our ability to act legally, ethically, with integrity or be accountable. This aligns wonderfully with our compliance responsibilities.

   The take away-- always report anything suspicious; always act legally, ethically and with integrity; never hesitate to question things and understand that there is never a valid excuse for doing otherwise.


Holding Others



   At the conclusion of the two recent therapy compliance incidents, the therapists involved said they engaged in misconduct because (1) their supervisor told them to do it; or (2) their supervisor made an unintelligent comment that was interpreted as a directive to act unethically.

If you believe anyone, even your supervisor, is instructing you to do something wrong, you must hold them accountable. Let's apply the standards discussed above. 

  1. Refuse to act on the request to engage in illegal or unethical conduct.
  2. If you feel comfortable, question or challenge the request. Tell the person why the request is inappropriate and use it as a teaching moment.
  3. If you feel uncomfortable, go to your operation leader, contact your local Therapy Resource or call the Compliance Hotline at 1-866-256-0955 (you may remain anonymous if you prefer).
  4. Be confident in the knowledge that you are doing exactly the right thing and that you are protected from retaliation.

   The therapists involved in the recent therapy compliance investigations did none of the above. I truly wish they had understood that they were not alone, had another choice and had the complete support of this organization.


Questions and comments concerning these and other compliance issues are welcomed. Contact



Visit our Therapy Website at:

Mary Spaeder, Editor