First Quarter 2014

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 Post-Acute Cardiac Wellness Programs


Developing a specialty in caring for patients recovering from various heart conditions can be a great way to hone in on a need in your community while also expanding on your therapists' skills and knowledge with taking care of the heart. Many of our facilities are recognizing the need for this specialty program and are compiling a comprehensive list of services to address their special needs. Congestive Heart Failure (CHF) and Myocardial Infarction (MI) have been identified by the Center for Medicare and Medicaid Services (CMS) as high-risk diagnoses, and the goal of our programs is to partner with local hospitals to reduce re-hospitalizations related to these diagnoses. Our programs are designed to integrate physician protocols, invite hospital and physician participation, and monitor and report dates to reduce these readmissions. Our approach integrates the physician involvement with nursing, therapy, dietary needs and social services to provide a comprehensive and individualized plan for each patient. Our therapy and clinical teams have resources available on the portal for you to get started, and we are currently working on expanding our educational toolbox related to cardiac aftercare to offer you additional educational resources. If you are interested in learning what it takes to get a program started in your facility, please click here for the Cardiovascular Programming Implementation and Strategies checklist. (Note that the link for this article is only available from the Ensign Portal.)

The Future Is Here With Bionic Legs!


Those of you who grew up in the 1970s probably remember Steve Austin in The Six Million Dollar Man and marveled at the idea of robotic limbs powering our bodies. While not designed to help our patients run 60 mph like the fictional Austin, the AlterG Bionic Leg is working wonders to help our patients recover quickly and get back on their feet with a normalized gait pattern in record time. The AlterG Bionic Leg is activated by the patient's intent to move, combining the principles of neuroplasticity and active motor learning with robotic technology to improve strength, balance and function. We currently have the AlterG Bionic Leg at three of our facilities: Wisteria Place in Abilene, Texas; Glenwood Care Center in Oxnard, California; and Rosewood Rehabilitation Center in Reno, Nevada. Click below to see the benefits of the bionic leg:

AlterG CES
AlterG CES


Therapy and the Barihab Table

Changing Lives


Monte Vista Hills Healthcare Center in Pocatello, Idaho, recently purchased a Barihab rehabilitation table, and they are seeing incredible results with patients who had all but lost hope for recovery. The multipurpose treatment mat was designed by an occupational therapy assistant, Edward Estrada, in order to eliminate the physical strain and multiple therapists needed to rehabilitate severely debilitated or heavier patients. The mat can be converted into a standing apparatus with the assistance of only one therapist, and it leaves the trunk and upper extremities free to develop core strength with UE movement.


Angela Hall, DOR at Monte Vista, has seen encouraging results with the use of the mat, and one case stands out in particular. A 57-year-old female patient with multiple diagnoses including RA, a lumbar laminectomy and obesity had become dependent for her self-care and required Hoyer-lift transfers. Angela and her team saw the potential in their patient, and through the use of the Barihab table, they were able to rehabilitate her to requiring only minimal assistance for all of her transfers and ADLs. Therapy programs across our organization are seeing similar results with this innovative piece of equipment, and demonstrating exciting patient outcomes in return for the investment.


Wound Care Treatment Approach for Physical Therapists


The PulseCare Medical Closed Pulse Irrigation™ system was founded by Dr. Patrick Marasco, an American Board Certified physician specializing in wound cleaning and care and reconstructive plastic surgery. The result is a unique Closed Pulse Lavage/Closed Pulse Irrigation™ system that allows patients to receive wound care by physical therapists at bedside. The system includes products that enable wounds to be safely sealed and isolated while they are irrigated by trained clinicians. PulseCare has been proven to reduce bacteria (biofilm) from the surface of wounds by 86.9 percent. PulseCare products eliminate the possibility of contamination through aerosolization and splash back, and they enable all byproducts of wound irrigation to be safely collected and disposed. Read on...


Tools for Tracking and Reporting Therapy Outcomes

 By Tamala Sammons, Therapy Resource


As more and more emphasis is placed on therapy outcomes, two programs have made it to the top of the list for implementation at Ensign.  

  1. National Outcomes Measurement System (NOMS) for Speech-Language Pathologists

  2. Continuity Assessment Record and Evaluation Item Set (CARE) for Physical and Occupational Therapists.

Rehab Optima is already approved as a data collector for CARE, so our clinicians will be able to simply enter data directly into the electronic record. Rehab Optima is also working on a partnership with ASHA to be able to do the same for NOMS in the future. Read on for more valuable information...

OT Awareness in Colorado

 By Brandy Morgan, Therapy Resource


Hannah and one of her OT patients

April is Occupational Therapy Month, providing a perfect opportunity to address the question on the mind of anyone who is unfamiliar with the profession: What does an occupational therapist do? AOTA provides consumers and healthcare professionals with this explanation: "OT is a profession that helps people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities. OT's holistic and customized approach to evaluations, interventions, and outcomes help a child with disabilities participate in school and in social situations, assist a person recovering from injuries to regain skills, aid an older adult to stay as independent as possible, and offer the specialized support and services to people of all ages and in all circumstances that only occupational therapy can provide" (AOTA, April).


One OT in Colorado decided that OT month was a great time to help her coworkers, patients and family understand just what an OT does and how she can help them. Hannah Stillings, OTR, has been an OT for a little over a year and with Ensign at Littleton Care and Rehab for about six months. Hannah put together a plan throughout the month to spread awareness of OT.  Read On...;
How STRONG is Your Exercise Prescription for an Older Adult?


Ellen Strunk, PT, MS, GCS, CEFAA, has completed training of our therapy staff to strengthen our ability to write evidenced-based exercise programs specifically designed for older adults. The course helped us all to delve into whether we are truly tapping into our patients' fitness capacity, and ways that we can better measure and document our programs. Ellen traveled across the organization to train our therapists on improving our evidence-based practices in working with the elderly. 


Our elderly population is faced with a combination of low functional status and a high incidence of chronic disease, and even though fewer than 50 percent of older adults report having received a suggestion to exercise from their physicians, there is no segment of the population that can benefit more from exercise than the elderly (American College of Sports Medicine, Exercise Training Guidelines for the Elderly). The course gave us tests and tools to challenge and increase muscle and cardiovascular performance.


We know as therapists that we can have a positive impact on reducing or helping to manage many of the health conditions that our elderly patients face. We also know that Medicare reimbursement is changing, and measuring outcomes and implementing evidence-based treatment plans will be instrumental in retaining payment for our services provided. We are grateful to partner with Ellen in improving our therapy practices, and we look forward to working with her on more educational opportunities for our therapists. We have developed some shortcuts from her training so you can easily refer to many of her training tools and tests, and these tools are now available on the Ensign Portal for you to print and use. Check out the Quick Reference Cards for Cardiovascular / Respiratory and Exercise Prescription. (Links for this article are only available from the Ensign Portal). 

Communication and Follow-up

Key to Physician Relationships at Lemon Grove Care and Rehabilitation


Sometimes, it is the simple things that we implement in our therapy departments that make a big difference in how we improve the communication with our physicians. Ann Marie Hulse, DOR at Lemon Grove in Lemon Grove, California, has designed a simple ortho follow-up tool that is getting rave reviews from the orthopedic physicians in the area. This a great tool to use, especially when the therapist is unable to personally attend the follow-up appointment with the patient. The team has also designed "What to expect in post-acute therapy" forms that are included in the ortho kits that are provided to the patients who will be coming to Lemon Grove following surgery. 

The Northern Oaks Team is Feeling

Good Vibrations with the New

VibeTech One


The Northern Oaks therapy team has recently purchased a cutting-edge, astronaut-inspired piece of equipment called the VibeTech One. The technology for the VibeTech was originally developed in 2002 by VibeTech founder Dr. Jeff Leismer to counter disuse atrophy in astronauts when in space. The VibeTech One uses neuromuscular stimulation to help patients recover strength and balance, and because it is a passive vibrational system, it can be tolerated by patients who are not yet ready for weight-bearing activities. The equipment is backed by the National Institute of Aging and supported by international scientists and researchers.


Billye Alford-Lee, DOR at Northern Oaks, and her team will be partnering with Hardin Simmons University to collaborate on a study utilizing the VibeTech One. Baseline measurements will look at the Short Physical Performance Battery (SPPB), sit to stand and Timed Up and Go (TUG), among other measurements, in order to measure the effectiveness of the equipment. We look forward to following Billye and her team on their progress! 


For more information about VibeTech One, visit their website at


 Moving BIG and Speaking LOUD at Holladay and Copper Ridge in Utah


The Lee Silverman Voice Treatment (LSVT) Big and Loud exercise program is designed to improve the vocal quality and movement ability of people affected by Parkinson's Disease (PD). The typical progression of the disease results in movements and vocal quality becoming smaller and slower. The Big and Loud program teaches patients to think and move BIG and think and speak LOUD. The research is exciting and promising for patients with PD, including faster and bigger stride length, improved balance, improved trunk rotation, improved vocalization, and even two brain imaging studies documenting evidence of positive changes in the brain following the administration of therapy.  


Jeremy McCorristin is a physical therapist At Holladay Healthcare Center in Holladay, Utah, and is certified in LSVT Big program. In the 10 months that he has been doing the BIG program with PD patients, he has seen some compelling changes in physical function. Lindsay Gonzalez, SLP, and Diane Hagen, PT, at Copper Ridge in West Jordan, Utah, are also implementing the program and are certified in LOUD and BIG respectively. Lindsay and Diane are also starting a support group for PD with emphasis on caregivers that they will be holding at the facility once a month.


Parkinson's is a disease that cannot be cured. Many people afflicted with PD do not know where to turn or are unaware that there may be ways to stabilize their condition and even slow its progression. It is amazing to see the passion in these therapists and their total commitment to helping with their Big and Loud healing hands and hearts.   


Parking stalls are narrow making it difficult for patients with walkers to ambulate through. Side stepping is required.
Lemon Grove Care and Rehabilitation Community Reintegration Program


The therapists at Lemon Grove are leading the charge in their community with helping patients return to their prior level of function through the newly integrated community reintegration program. Carry-over of function from the rehab gym to the community has been an eye-opener to the Lemon Grove therapy team, and patients often realize that they have a few more barriers to overcome before they are safe in the community.


The team has integrated shopping, crossing busy streets, tackling curbs and uneven sidewalks, and getting in and out of local restaurants. Some of the surprise obstacles encountered by the team included overcoming tight parking spaces, heavy items on low grocery store shelves, walk signs that don't allow for enough time to cross and heavy retail doors.

Shopping while sitting, and only standing as needed conserves BLE strength.

Our patients don't always consider these barriers before heading out on their own.


Keep in mind that when using community reintegration in your treatment approach, be sure to document the Prior Level of Function (PLOF) and goals for the re-entry program, and include it in your written plan of care.





Loren Sok was hired as a rehab tech for Northern Oaks Living and Rehabilitation Center in Abilene, Texas, in 2007, then left to attend PTA school In Salt Lake City, Utah. Loren immediately came back to join his team at Northern Oaks as a PTA because he felt that the facility was the perfect place to grow in his career, but especially because of the outstanding teamwork and leadership under their DOR, Billye Alford-Lee: "She is an awesome teacher, and I know I will have an opportunity to learn a lot from her," said Loren. Residents and employees comment on Loren's kind and patient demeanor, and he truly lives the Ensign culture every day. We are so glad he is back! 

Laughter, Encouragement Are the Best Medicine at Stillhouse

By Michael Reese, Operations Manager, Stillhouse Rehabilitation & Healthcare, Paris, Texas


Paris News does a special seven-week miniseries covering lifestyle topics. This year, healthcare was the chosen topic, and Stillhouse was the only SNF to be featured in this section. They also included many photos of our team and therapists working with residents. This is the third time in the last three months that the Paris News has been in our facility to write positive articles about our building, and we are thrilled that our community gets a chance to read about all the wonderful care being provided by our team. Thank you, Deb Lookingbill, DOR at Stillhouse, for your incredible leadership of the therapy team. You tirelessly put your heart into all that you do to build a special team of therapists who, in turn, deliver amazing patient care. Click here for the complete story published in the Paris News

Members of the Stillhouse Nursing and Rehabilitation staff are, front row, from left, Lisa Sillivan, Deb Spencer, Jennifer Thornton, Deb Lookingbill, Glenda Neisler, Connie Musick and Selina Lewis; back row, Rhonda Sisson, Danica Simmons, John Brazile, Michael Reese, Cari Fortenberry, Rocky Watley and Cari Johnson. Not pictured are LeAlandra Chandler and Charlotte Winton.

Issue: 7

In This Issue
The Future Is Here With Bionic Legs!
Therapy and the Barihab Table - Changing Lives
Wound Care Treatment Approach for Physical Therapists
Tools for Tracking and Reporting Therapy Outcomes
OT Awareness in Colorado
Communication and Follow-up - Key to Physician Relationships at Lemon Grove
Northern Oaks Team is Feeling Good Vibrations with the New Vibe Tech One
Lemon Grove Community Reintegration Program
Congratulations Loren Sok!
Laughter, Encouragement Are the Best Medicine at Stillhouse
Ensign Therapy Introduces SPARC (Scholarship Program And Recognition Campaign)

The Compliance Corner 


By Brian Cummings,

Education Compliance Partner


Required CIA Education

Training makes up a large portion of our Corporate Integrity Agreement ("CIA"), and as an organization, we have an awesome resource to help train our employees quickly and efficiently: Ensign U. Ensign U is an online training tool that uses the convenience of the Internet to allow our employees to train when it works best for them, 24 hours a day, 7 days a week. Here are some tips to have a great training experience:

  1. Use an Ensign computer with Microsoft Windows Vista or newer operating system.

  2. Use Google Chrome as your Web browser. Ensign computers should have an ENSIGN U icon on the desktop.

  3. Access Ensign U by opening Google Chrome and going to and click on Ensign U, if you don't have the Ensign U icon on your desktop.

  4. Be on the lookout for the gray shield in the upper right-hand area of your address bar. If you happen to see it, just click on it and click "load unsafe script." The student will be signed out and will need to log back in to Ensign U. The gray shield will disappear, and the student may access the course.

Q: How much time does a brand-new hire or employee of an acquisition get to complete his/her required initial CIA training?


A: Brand-new hires and those who are considered new hires as a result of an acquisition (date of close of the acquisition) used to get 30 days from the date of hire to complete the training entered into our human resources information system, ADP. In the near future, to better ensure compliance with the CIA training requirements, the period for completion will be adjusted from 30 days to 21 days to provide a "cushion" and to ensure timely compliance with the terms of our CIA. In addition, improved methods of notification to the operation regarding an employee's status with the required training will be provided.


After that 21-day period, your operation will start the suspension process for the employee, not Human Resources at the Service Center. When the employee is placed on suspension for failing to complete the CIA training, he or she is only allowed to "be on the clock" to complete the required compliance training.


Employees who fail to finish their training must be terminated on day 31. This is a change from the previous deadline of day 37. Allowing employees to exceed the "30 Day" due date placed your operation and the organization at great financial risk. Fines for violating the terms of the Ensign CIA can reach more than $2,500 per day, per employee, per required course. Employees terminated for non-compliance are ineligible for rehire at any Ensign-affiliated entity.


Q: What is the best practice to get our new employees through the required CIA training?

A: We recommend that all new employees complete the required compliance training within the first two days of starting work, before they even begin performing their job duties. This approach eliminates the need to have a dedicated person in your operation to manage training completion. This will save your business valuable time and money.


Q: Can students get extensions on the due dates for the required CIA training?

A: No, the terms of Ensign's CIA define when all new-hire and employee training must be completed, and extensions cannot be granted.


Q: When do PRN (As Needed Employees) need to start the required CIA training?

A: Non-full-time employees are given access to Ensign U to start the training when they start. The due date becomes 21 days from when the PRN reaches 80 hours total combined for all facilities or entities (i.e., the employee works at more than one facility or entity) from October 1, 2013.


Q: How much time will an employee have to complete the CIA Compliance Training after returning to work from a Leave of Absence or if the employee's job changes?

A: In each of these cases, the employees will have the same 21 days as described above and will follow the same suspension and termination guidelines as stated above for new hires.


Q: Who do I call if I have questions regarding CIA Compliance Training?

A: You can always reach out to Brian Cummings, Education Compliance Partner, at (949) 540-2035 or by email at If you have an Ensign U question, contact Michael Gavin at (949) 540-1928 or by email at If you need a contractor or vendor account login set-up in Ensign U, send those requests to


Training helps us to provide better patient and resident care, one course at a time, and it gives us the opportunity to develop our skills and ensure compliance with our CIA training requirements. The "P" in CAPLICO stands for our core value of "Passion For Learning," and Ensign U helps us to follow this core value. 






Ensign Therapy Introduces SPARC (Scholarship Program And Recognition Campaign)


Ensign Therapy SPARC (Scholarship Program And Recognition Campaign) is inspired by its namesake and the sense of liveliness and excitement that therapy students and new graduates bring to our facilities and in-house therapy programs. With this scholarship program, we are deliberately seeking out those individuals who ignite a desire for excellence in themselves, their patients, their colleagues and their co-workers.


Each quarter, $2,000 will be awarded to one student.


The criteria will include demonstrated academic performance, volunteer and other extra-curricular activities pertaining to healthcare, academic and character references, and how well the essay portion of the application demonstrates individual excellence.


Each scholarship will be awarded to a PT, OT, SLP, PTA or OTA student currently enrolled in an accredited therapy program and within 12 months of graduation. The scholarship funds will be disbursed to the selected student within one month of the application deadline.


The application must be completed prior to each quarterly deadline:


Q1 - March 20
Q2 - June 20
Q3 - September 20
Q4 - December 20


Click here for more details and to complete the application: 


Mary Spaeder, Editor 

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