Fourth Quarter 2013

FlagPOST Archives

Fall Risk Assessment and

Vestibular Testing

Falls are the number one cause of preventable death in those over the age of 65, with each fall resulting in a hospitalization expense of approximately $10,800 and burdening our fragile healthcare system with a $28 billion annual expense.  Even under nursing home supervision anywhere from 50-75% nursing home residents fall each year, culminating in 2000 deaths annually!  In 2002, the US Congress passed the Elderly Fall Prevention Act, hoping to raise awareness of this widespread problem. 


While most falls are multifactorial in nature, an often overlooked etiology of falls are inner ear disorders.  The vestibulo-ocular reflex is the crucial connection between our inner ears, the brainstem, and the output to the eyes that controls proprioception and helps maintain our balance.  Medical practitioners and therapists trained in neurological testing, can certainly identify patients afflicted with severe vestibular disorders, but the overwhelming 90 million Americans afflicted with a balance problem fly under the radar of the physical exam. 


Our team at The Springs and Arroyo Vista in San Diego have partnered with Dr. Pouya Afshar and his team at BalanceDx to pilot vestibular autorotation testing (VAT) in the skilled nursing environment.  VAT is an evidence-based, Medicare approved, and highly sensitive non-invasive diagnostic test that can help identify patients with vestibular disease. 


After the therapy staff at The Springs and Arroyo Vista received an intensive one day course in vestibular therapy, the BalanceDx team began screening patients for fall risk and used the VAT to help direct a specific therapy program aimed at improving patient's balance and ultimately minimizing their fall risk.   In just two months, over 100 patients at these two facilities were screened and had the VAT performed.  Given the resounding success of this pilot program, the team at BalanceDx will be reaching out soon to other facilities interested in adding vestibular therapy and the VAT for their patients. 

Dementia Program Update:

The Abilities Care Approach


Caring for our patients with dementia can be extremely rewarding if our therapists and caregivers have the training and skills necessary to bring joy, meaning and function to our patients regardless of the stage of disability. Gina Tucker-Roghi is our own therapy resource and a certified Dementia Care Specialist instructor, and she has developed the "Abilities Care Approach" to train our entire interdisciplinary teams on techniques, skills and approaches to care.


Throughout the past few months, Gina has worked closely with our activities departments with a focus on adapting activities to meet the cognitive level of our patients, Allen Cognitive levels in the SNF setting, and specific training to work with patients in middle-stage dementia. We have received remarkable feedback from those in attendance, and the program is gaining momentum. Simone Thomas from Bella Vita in Arizona remarked that it was one of the best and most useful trainings that she had ever been to! Gina is finding ways to reach more of our facilities, so reach out to your therapy resource to find out if the training will be coming to your facility soon.

Clinical Programming Resources Are Now Available on the Therapy Portal

By Tamala Sammons, Therapy Resource 


Did you know that the Therapy Portal has been given a facelift and now offers a variety of information, including Clinical Programming Resources? Often we may find ourselves recreating the wheel or not sure where to go to help with development of a clinical program. The Therapy Portal now serves as a central location to find information on various therapy clinical programs.


You can find this information by going to the Portal, selecting Therapy and then selecting Clinical Programming. There, you will find many resources based on subject (such as cognition/dementia, wound care, cardiac wellness, balance and vestibular, etc.). Resources include diagnostic tests, research articles, educational PowerPoints and program startup checklists. We are excited to be able to share information across the organization and help one another build strong clinical programs for successful outcomes.


Anyone who has additional therapy clinical programming information to share is encouraged to send the material to Tamala Sammons, Therapy Resource, at for Portal posting consideration.


Strategies for Treating Patients with Neurological Disorders

Neurodevelopmental treatment (NDT) and Neuro-Integrative Functional Rehabilitation and Habilitation (Neuro-IFRAH) are both hands-on treatment approaches used by physical therapists, occupational therapists and speech language pathologists for the treatment of neurological challenges such as stroke, brain injury and cerebral palsy. While NDT (also referred to as the Bobath Technique after its inventors Berta Bobath and Karel Bobath) has been used by clinicians across many countries for more than 50 years, Neuro-IFRAH is a comparatively newer treatment approach developed by a former NDT instructor and renowned therapist, clinician and educator, Waleed Al-Oboudi, MOT, OTR/L. We have therapists trained and certified in both treatment approaches throughout our organization. We are also responding to an increased interest specifically in the Neuro-IFRAH certification course and weekend introductory course. Plans are in place to bring the training to our facilities in 2014, so please ask your therapy resource for more information. 


The treatment techniques used by our therapists are highly individualized and vary greatly depending on the therapists' background and training.  Xiomara V. Arevalo, an OT from Alta Vista Rehabilitation and Healthcare in Brownsville, Texas, shares below her experience in using both treatment approaches for her patients following a stroke.



Utilizing Two Different Approaches to Treat Patients Following a Stroke

By Xiomara V. Arevalo, OTR, Alta Vista Rehabilitation & Healthcare, Brownsville, TX


I am an OTR currently working at Alta Vista Rehabilitation and Healthcare in Brownsville, Texas. I began working as a new OT at an inpatient hospital, where I was first introduced to Neuro Integrative Functional Rehabilitation and Habilitation (Neuro-IFRAH) techniques. Neuro-IFRAH courses cover the treatment and management of adults with hemiplegia from a stroke or a brain injury. I was given the opportunity to attend a certification course for Neuro-IFRAH in 2009. Since then, I've been utilizing their techniques to treat stroke patients in the inpatient and skilled nursing home setting. Neuro-IFRAH provides the therapist with numerous strategies, ideas and techniques that can be applied and utilized to treat the patient's functional limitations following a stroke.


I decided to continue to expand my knowledge within the neuro spectrum. I attended a certification course in NDT this year. The NDT clinical practice approach is the inclusion of precise therapeutic handling, which includes both facilitation and inhibition as key intervention to achieve independent function. During this course, we were introduced to the importance of utilizing meaningful and functional task goals with the precise therapeutic handling to facilitate normal movement into functional movement patterns....Read On

Something Awesome in Victoria

 By Erik Dziadul, Therapy Resource


LaVilla Rehabilitation and Healthcare in Victoria, TX had a very nice graduation ceremony for their students today. The ceremony culminated a 4-week on-the-job training program that was partnered by LaVilla, the Texas Department of Rehabilitative Services and Victoria High School. The sessions consisted of DRS requirements and incorporating LaVilla workplace training skills. The Mayor, local TV station, and newspaper attended. It was very cool to see. The students spent a day in Rehab and got t-shirts as prizes for answering questions about Rehab. These guys are really going out of their way to connect with their community and embrace what Ensign is all about...Click here to learn more about the program


Postural Restoration:  Treating the Unique Asymmetry of the Human Body


James Anderson is a physical therapist for Horizon Home Health and Hospice, and he brings to us a wealth of knowledge and experience in postural restoration. In his former practice at ProActive Physical Therapy in Burley, Idaho, one of the first clinics in the country to be designated a Postural Restoration Certified Center, James attained clinical excellence in the nonsurgical treatment of back, hip, knee, shoulder and neck pain. Through a combination of extensive continuing education and collaborative research, James has become an authority on postural restoration and now teaches national courses for the Postural Restoration Institute.


Over the years, James has provided course instruction and consultation to thousands of physicians, physical therapists, athletic trainers and strength and conditioning professionals nationwide. His expertise with biomechanics has led to invitations to serve as a sports performance consultant for a wide variety of collegiate and professional athletic organizations. Click here to learn more ...


Stillhouse Rehab Helps OTA Students
Gain Knowledge of Real-World Therapy

By Deb Lookingbill, DOR, Stillhouse Rehabilitation & Healthcare,

Paris, TX


A recent OTA job fair at Panola College in Carthage, Texas, turned into an opportunity for students to gain hands-on experience in a therapy setting. With an OTA class graduating that same day, I attended the fair along with Kevin Reese. After speaking with one of the clinical instructors, I was approached by the academic fieldwork coordinator. She felt that the culture of our facility and my outlook on what OTA grad students need to understand about the real world of therapy made Stillhouse an ideal match to partner with them as a fieldwork facility for their students. Panola College is going to pay for me to attend the fieldwork educator certification program on Feb. 1-2, 2014.


Judy "Kay" Sheffield

 By Trisha Wallace, DOR, Legacy Nursing and Rehab, Amarlllo, TX


Kay has lived at Legacy Nursing and Rehab for 10 years. She had both legs when she moved here and was able to walk without a walker. She had lived at home independently, but she started having trouble with both of her legs, which sent her to NWTH, and after a series of tests, she had to go on hospice. Kay ended up getting better; however, she was unable to return home to independent living. She moved into Legacy Rehab and has been here ever since. 


Kay started having more leg pain and found that it was her artificial knees causing the pain. Her doctor asked if they could amputate her legs; she refused. The pain in her legs started getting worse, and she was told she was going to lose her right leg whether she wanted to or not. It was at that time she thought, "I don't want to die, and if this is the only option to live, they will have to amputate." Both of her legs had MRSA and were amputated in 2008. She returned to her home here at Legacy and received therapy services. She has been able to function without legs with assistance.


Earlier this year, Kay saw an ad in the paper for a Prosthetist/Orthotist. She wanted to know if she qualified for prosthesis. She talked to our Social Worker, Carey Davis, and asked her to call and request a visit with the Prosthetist.  S.L. Jordon owns High Plains Orthotics and Prosthetics. He came to visit with Kay and thought to himself, "How I am going to talk her out of this?" But Kay convinced him otherwise, saying, "I have never set a goal for myself that I have not achieved." He talked with Trisha Davis, Director of Rehab, about this journey, and here we are today. Kay is able to walk on prosthesis.

The Willow Bend Therapy Team Is Committed To Excellence!

We Are Going Good to Great!

By Anna Boone, DOR, and Kelsey Hendrix, PTA Student



"We Are All in This Together"

Our Willow Bend Rehab team is, in my opinion, the best of the best. Currently on full-time staff, we have seven in the PT department, six in the OT department, two in the ST department, one Floor Tech/Wellness Tech, 1.5 Administrative Techs/Wellness and one Home Health and Outpatient Coordinator. We all work together for the benefit of our patients.


Current Services/Programs:

The Willow Bend Rehabilitation department provides a variety of unique services that are made available to our patients. Current services provided include outpatient, home health, skilled therapy, rapid recovery, long-term care (LTC) and wellness services. The wellness program was designed for several purposes to keep our LTC residents at their most optimal level, to reduce falls, to have declines of our LTC noted more quickly, and to provide customer service by enhancing our patients' rehabilitation experience.  

  • Phase 1: Wellness Classes, meeting twice a week to work on improving functional mobility skills such as gardening, playing cards, Wii games, etc. It is usually attended by our Rapid Recovery patients.
  • Phase 2: Contracture management. After receiving training for our therapists, the Wellness techs oversee the application of all devices by training CNA floor staff and monitoring applications daily under the supervision of our licensed therapists.
  • Phase 3: Walking program used for our LTC residents and our rapid recovery residents. After receiving training from the PT, the techs are able to walk with residents one time, five times a week.

Our outpatient services are offered to patients who may have completed their episode of care at the facility but are still in need of skilled therapy services as well as community referrals. This program works to continue the plan of care set up while the patient was at WBNR in an effort to maintain the patient's current level of function while always striving to meet the patient's highest potential for success.  Read On...


Marketing and Rehab

Teaming Up at Wellington!


The new Wellington Director of Marketing, Nina Musil and Director of Rehab, Stephanie Kozeny, have teamed up with a new community screening program being given to Assisted Living Communities in the Wellington, Texas, area. We are "Living Well at Wellington" and hitting the community with new and exciting screenings to help market our facility. We are using the Berg Balance Test to give the scores and the ratings of the seniors being screened at a low, moderate or high risk of falling. We inservice the seniors on balance and strengthening exercises and inform them of potential hazards in their living environments.

We are educating the seniors about our short-term-stay unit, and if they need rehab following a surgery or a hospitalization, we offer full rehabilitation services. We also educate them on our Outpatient Clinic if they are experiencing a decline in walking or transferring or are having difficulty with their activities of daily living.


We are trying to educate seniors about skilled nursing facilities and how they are no longer a nursing home where people go to die. We are attempting to educate the population that the skilled nursing facility is a transition from the hospital to home as the hospitals are discharging patients more quickly. We are trying to let our community know about us before there is a hospitalization so they are aware of our services before trying to make a decision right after an unfortunate event.


Issue: 6

In This Issue
Dementia Program Update: The Abilities Care Approach
Clinical Programming Resources Are Now on the Therapy Portal
Strategies for Treating Patients with Neurological Disorders
Utilizing Two Different Approaches to Treat Patients Following a Stroke
Something Awesome in Victoria
Postural Restoration: Treating the Unique Asymmetry of the Human Body
Stiullhouse Rehab Helps OTA Students Gain Knowledge of Real-World Therapy
Judy "Kay" Sheffield
Willow Bend Therapy Team Is Committed to Excellence!
Marketing and Rehab Teaming Up at Wellington

The Compliance Corner 

 By Shelley Johnson,

Compliance Partner


General Compliance

All Ensign employed therapy resources, DORs, therapists and therapy assistants are required to complete 2 hours of general compliance training "Introduction to Compliance and Code of Conduct"  (also available in Spanish) by January 10, 2014


Role-Based Training

All Ensign employed therapists (including therapy assistants) involved directly or indirectly in the delivery of rehabilitation therapy, or perform assessments of residents and/or patients that affect treatment decisions regarding rehabilitation therapy services or that affect reimbursement for rehabilitation therapy, are required to complete specific role-based training by January, 10, 2014. 


These trainings may include, but are not limited to, HIPAA (available in Spanish), RUG IV, Compliance ICD-9 coding, Medicare coverage of Extended Care (SNF) Services, RAI 3.0/Section O, Medical Necessity, ADL Training, Therapy policy & procedure, Understanding therapy policies in the SNF, Evaluation & Plan of Care, Guidance for professional responsibility, Billing guidelines, and documentation that prevents fraud & abuse.


Therapy resources and DORs have education requirements in addition to the courses listed above for therapists and must be completed by January 10, 2014.



Any contractor, student, or intern (a) directly or indirectly involved in patient care, (b) one who makes assessments of patients that affect treatment or reimbursement or (c) one who performs billing or coding functions AND will provide 80 or more hours of service between 10/1/13 and 9/30/14 is required to complete all training by January 10, 2014 or upon start of their work with us.


Requests to add a contract, student or intern to Ensign U should be emailed to


New Hires

Any therapy resource, DOR, therapist, therapist assistant, contractor, student or intern hired PRIOR to December 10, 2013 must complete the training by January 10, 2014. 


Any therapy resource, DOR, therapist, therapist assistant, contractor, student or intern hired ON OR AFTER December 10, 2013 must complete training within 30 days. 


Important Notes

  • Embrace our core value of Love One Another>>>Support and assist others in meeting their training requirements
  • Each person is required to invest the requisite time taking each course before taking the test.  Attesting completion is a matter of integrity in line with our core values, code of conduct and our commitment to invest the time we need to.
  • Education courses are automatically assigned to employees in Ensign U based on their job title.
  • Employees may complete the required training remotely; however, any hourly employee MUST be paid for the actual time spent performing the training and taking (and retaking) the exam.  Hourly employees must complete a "Time Adjustment Request Form" for time spent training at home.
  • Employees who do not complete their training by January 10, 2014 are subject to disciplinary action up to and including termination and must be placed on suspension until the training is complete.
  • Employees may retake the exam as many times as necessary, but passing the exam is a requirement in order to have the course marked as "complete."


AIS Training questions- Michael Gavin at


General questions-Brian Cummings at


Password resets and technical issues- IT Support at 949-540-1200 or by emailing


Lead Compliance Partner

Debbie Miller, Chief Compliance and Privacy Officer


Ensign U may be accessed through Google Chrome.  Google Chrome should take you to  In the left column "private links", click Ensign U and provide your username and password


Mary Spaeder, Editor 

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