First Quarter 2015

FlagPOST Archives

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A blogging site for our Therapy Teams! Simply go to our website, Click on Ensign Exchange and follow the instructions to register for our private forum.  ENJOY the opportunity to sure to pass this along to your fellow therapy teammates.

Program with Drum Maker Remo Offers New Outlet for Park View Post Acute

The therapy music programs at Park View Post Acute were recently highlighted by columnist Martin Espinoza in The Press Democrat.  

Click here to read the full story! 

Sonya Sweeney, OT, helps residents roll around a bead filled drum to create the sound of the ocean at Park View Post Acute skilled nursing home in Santa Rosa. (JOHN BURGESS / The Press Democrat)

Lighting Up Lives With Music!

The Evening Club of the Rotary in Santa Rosa, California, has partnered with Park View Post Acute (PVPA) to bring individualized, meaningful music to residents at Park View. The Rotary and PVPA have just completed a pilot program whereby 10 residents received iPods that were loaded with individualized playlists, with meaningful music that was selected based on Rotarian volunteers' interviews with families and residents. The Rotarians enlisted the assistance of local high school students to load the music onto the iPods.


Residents access their playlists and iPods during scheduled listening groups. However, the nursing staff and the Activity Director, Celeste, quickly saw the benefit of the individualized and meaningful music in the lives of their residents and are beginning to offer the music on an as-needed basis to help residents maintain a positive mood state. One resident, "June," has a history of wandering in the halls restlessly in her wheelchair, grabbing at people and calling out. When she would get into this state, she did not want to join activities, was disruptive if she did go into group settings and would resist care. She loves her iPod, and now when she starts to get restless, the staff puts on her music. She smiles and wheels around greeting people, "Well hello, your hair looks lovely today," and she invites them to join her in singing show tunes - her favorite of which is "New York, New York."


The program has been a success for the Rotary members, who were grateful for the opportunity to connect with our residents. They will continue the partnership with PVPA and have requested that we identify the next candidates for the program 

Cloverdale Healthcare Center

Abilities Care Approach to Dementia

By Teresa Martin, DOR, Cloverdale Healthcare Center, Cloverdale, CA

One long-term resident (J.K.), living in the facility for more than a year, had been originally admitted following a knee replacement surgery. Prior to this time, she was living alone independently in the community. The patient suffered from depression and refused rehabilitation services.


After two to three weeks, the patient was transitioned to an FMP and continued to refuse care. She chose to remain bed-bound essentially for the next 12 months, refusing all out-of-bed activity and frequently stating she wanted to just die. After multiple attempts at resuming rehab services over the year and the patient continuing to refuse, she was reviewed at one of the Abilities Care Workgroup meetings. The staff and Abilities Care Workgroup were able to see the benefits of this program for their residents. She was referred in the hopes that the program could make a difference and that our Abilities Care therapist, Amanda Grace, could work her magic and re-awaken J.K.'s spark for life.


Amanda evaluated the patient and completed an ACL test, with the patient scoring in the low 4s. This information told us that from a cognitive perspective, J.K. should be able to complete basic self-care tasks and meaningful activities that were simple and familiar to her. The Life History Profile was also completed, and it was identified that the patient loved flower arranging and was a florist in her career. Amanda brought in fresh flowers and requested that J.K. create a corsage and boutonniere for Amanda's son's senior prom. J.K. became immediately brightened, animated, engaged and talkative and was proud of her ability to teach the skill of making a corsage to Amanda. It was a true transformation for this patient!This moment of trust was the beginning, and Amanda later enticed her out of the bed to "inspect" the facility garden.


Once out of bed and moving about in the facility in her wheelchair, J.K. began to respond happily to the greetings and positive comments from facility staffand residents.She is now getting out of bed every day and has verbalized a strong desire to resume ambulation.She is now on an active PT program and thriving! .  

Understanding Patients as Persons Using the Abilities Care Approach

By JB Chua, DOR, Northbrook Healthcare Center, Willits, CA


Helen is a long-term care resident at Northbrook Healthcare Center. Initially when she was admitted, staff was having difficulty caring for Helen because of her cognition, and she was sometimes combative and anxious. When we started implementing the Abilities Care Approach to Dementia, she was one of the initial six residents enrolled in the program. Occupational Therapy identified her Allen Cognitive Level, and with the support of Social Services, we obtained her Life History Profile during an interview with Helen's daughter, enabling us to better understand her habits, preferences and long-term memories.


By integrating what we knew from her Allen Cognitive Level and the individualized information we obtained from her life profile, we were able to train staff on how to communicate and support Helen to avoid her becoming agitated during care. Puzzles and flower arrangements were identified during the family interview as areas of past interest and skill. The therapist also identified that due to her cognitive challenges and her personality profile, large group settings were difficult for Helen, and that she had a higher quality of engagement in activities if she was by herself. 

Read On

Use of Meaningful Activities to Redirect Negative Behaviors

By Jeanelle Kintner, OT/R, San Marcos Rehabilitation and Healthcare, San Marcos, TX


What if there were something besides a medication that could assist with redirecting negative behaviors? What else can we offer, after looking at basic needs - cold, hungry, in pain, needing to use the bathroom - when behaviors persist? What if we could tap into a resident's past and provide meaningful activities to engage the resident and redirect their behaviors?


For Ron, that is exactly what he needed. At first glance, many said Ron was not able to attend to any task. He wandered around throughout the day, pacing the halls and knocking on the tables - a behavior the other residents and staff found annoying as he invaded personal space, knocking on the tables regardless of what was going on. Staff might be able to redirect him momentarily, but within seconds, he was back knocking away Read On... 

Student Intern Experiences with

Abilities Care Approach

By Janet Weinberger, DOR, Summerfield Healthcare Center,

Santa Rosa, CA


At Summerfield Healthcare Center, the recent growth and development of our abilities care program is largely due to the efforts by Jennifer Brayton, one of our occupational therapists. Abilities Care is our dementia program based on the Allen Cognitive Model. The occupational and speech therapists provide cognitive assessments and then develop tailored activities, ADL and communication programs to promote maximal engagement with both our long-term residents and the appropriate short-term population in our facility.


Jennifer has recently completed supervision of two level II OT interns who were at Summerfield for their psychosocial clinical rotation. Involved in the abilities care program, they were able to develop their skills administering Allen cognitive testing, interpreting the results, and designing tailored ADLP and activity programs to assist our residents with improved engagement with their environment and with easing the transition to living in a long-term care setting.


The OT interns were also actively involved in staff education in one-on-one situations during staff meetings and during CNA inservices. Our abilities care program allows us to enhance our ability to provide OT students with a quality psychosocial internship experience. In turn, the students are able to help us develop systems and materials to assist us further in developing our program. 

Steps to Assessing Pain in Patients

With Dementia

By Jennifer Raymond, DOR, Park View Post Acute Care,

Santa Rosa, CA


As part of the Abilities Care Approach to Dementia, the SLPs in Northern Pioneers are working to create a specialty program to better assess pain in people with dementia. The Northern Pioneers' facilities are triggering high in the Quality Measures of pain management for long- and short-stay residents. Recently, the cluster SLPs held a skills workshop on the use of a standardized test to support this work: the FLCI, or Functional Linguistic Communication Inventory. Park View Post Acute's Director of Rehabilitation, Jennifer Raymond, is leading this pilot program.


Overview of the Communication of Pain (COP) Assessment

The SLP program is designed as an adjunct to Abilities Care for residents with cognitive and/or communication deficits who cannot utilize the "Tell me your level of pain on a 1-10 scale" system. Referrals occur through pain committee, behavior and psychotropic committee, Abilities Care programming and Quality Measures...Read On


How a Little Vision Can Go a Long Way
By Jeanelle Kintner, OT/R, San Marcos Rehabilitation and Healthcare, 
San Marcos, TX



When looking at our residents, how often are we assessing their vision? Could putting on a pair of glasses, changing the lighting or adding some contrast give them more independence?  Our residents have lost so much Independence and control of their environment that giving them the ability to see as optimally as they are able can be the little difference that gives them back some independence and control.


For Mr. Arroyo, a gentleman who is legally blind, adding a motion detector lamp and light in his bathroom gave him back the ability to use the bathroom at night independently without mistaking the sink or his roommate's bed for the bathroom. Placing his food on a divided plate and telling him where all of his items are located with the clock method gave him back the independence to feed himself.


For Mr. Claybourne, making sure his glasses are on and adding a contrasting placemat under his plate gave him the ability to feed himself again as well. What a delight to hear him say, "Wow, look at that!" when he was able to see his plate.


For Ms. Swart, in good lighting and with her glasses on, she is able to see her memory book and reminisce while looking at her pictures, putting a smile on her face.


So, the next time you walk into your resident's room, look for those glasses, turn on the lights to provide adequate lighting, and add contrast when needed.

Working With Cognitively Impaired Patients

By Tamala Sammons, Therapy Resource




Cognitively impaired patients are described as those whose skills and abilities they had before their accident or medical problem are now either absent or have some defect that compromises their ability to function.   Cognitive impairments can be caused by head trauma, neurological conditions, Dementia, anoxia, encephalopathy, etc....The need for skilled intervention must make sense; support medical necessity and tie back to the goals. It is important to ask what could happen if skilled rehabilitation services were not initiated, such as safety risks and possible further decline.  Read On

Congratulations to Our Newest SPARC Award Winner!


Shannon Cook is the most recent winner of Ensign's SPARC award of $2,000. Shannon is currently completing her last year of the Occupational Therapy Assistant Program at Central Community College in Grand Island, Nebraska. She has demonstrated a love of serving those in need through her many volunteer experiences, including Project Homeless Connect, Opportunity House, and the Veteran's Home of Grand Island Meals on Wheels programs. Shannon is highly regarded by her professors and her fieldwork supervisors and promises to be a wonderful asset to the occupational therapy profession.


As Shannon expressed in her SPARC application essay: "Each patient and the journey they are on is incredibly unique, and each will have their own set of qualities that that will impact their journey to recovery. I am so excited to enter the work force as an OTA practitioner with the role of providing the best care possible for my patients. It will be my mission to make sure I am walking side by side with each patient and helping them accomplish their goals, doing whatever I can to advocate for them and sparking new possibilities for every patient I meet." Ensign Therapy congratulates Shannon and wishes her the best as she begins her therapy career.


Ensign Field Recruiter Program

By Jamie Funk, Therapy Recruiting Resource


We are excited to announce The Field Recruiter Program that will pay Ensign therapists a $1,000 bonus for finding full time staff and $500 for part time hires. This program is intended to generate more candidate flow in our geographic regions that are difficult to staff. Places where we have a larger population of therapists like the Plano area, San Diego, Denver, etc., would normally not be included unless there were extenuating circumstances that made the position in those areas harder to fill. If you are an Ensign therapist interested in helping us, please Click Here  for full details and requirements.  

Celebrate Better Hearing and

Speech Month!!

By Tamala Sammons, Therapy Resource



For over 75 years, May has been designated as Better Hearing and Speech Month -- a time to raise public awareness, knowledge, and understanding of the various forms of communication impairments to include those of hearing, speech, language, and voice. Communication impairments often affect the most vulnerable in our society -- the young, the aged, and the disabled.


Helen Keller once noted that of all her impairments, she was perhaps troubled most by her lack of speech and hearing.  She elaborated that while blindness separated her from things, her lack of speech and hearing separated her from people -- the human connection of communication.


For a fun way to share some common speech disorders - click here for a video with our favorite Looney Tunes characters!


For more information on Better Hearing and Speech Month: 


A big thanks to all of our SLPs for all they do!!  

Littleton Celebrates OT Month!
By Brandy Morgan, Therapy Resource

Littleton Rehab's OT team once again promoted OT Month in their facility in April to educate residents, staff and families. They not only hung a large informational and colorful board in the hallway, but each of the Littleton staff was given a small gift with a message about occupational therapy. The message was written by AOTA president Ginny Stoffel: "Occupational therapy addresses real, down to earth, everyday life issues. We are true to our profession when our practice results in helping people reengage in everyday life activities that hold meaning, purpose and value for them." 
What is Occupational Therapy? Spread the word!
Occupational therapy is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent-or live better with-injury, illness, or disability..Read On

DORs: You're Not Alone 

By Donna Black, DOR, The Courtyard Rehabilitation & Healthcare,

Victoria, TX


I want to give a big shout-out to all the DORs to remind you that you are not alone out there. Every DOR in every Ensign facility shares your struggles and wants to celebrate your successes. We do our best to be strong leaders for our teams, but we also need to remember to lean on each other when times are tough.  Read On

Healthcare Reimbursement Updates - 

The Part B Cap Exception is Extended

Transition to Value-Based Service Model Continues 


Some of our rehabilitation therapy revenue is paid by the Medicare Part B program under a fee schedule. Congress has established annual caps that limit the amounts that can be paid (including deductible and coinsurance amounts) for rehabilitation therapy services rendered to any Medicare beneficiary under Medicare Part B.  The Deficit Reduction Act of 2005 (DRA) added Sec. 1833(g)(5) of the Social Security Act and directed the Centers for Medicare and Medicaid Services to develop a process that allows exceptions for Medicare beneficiaries to therapy caps when continued therapy is deemed medically necessary.

Annual limitations on per beneficiary incurred expenses for outpatient therapy services under Medicare Part B are commonly referred to as "therapy caps." All beneficiaries began a new cap year on January 1, 2015, since the therapy caps are determined on a calendar year basis. For physical therapy (PT) and speech-language pathology services (SLP) combined, the limit on incurred expenses is $1,940 in 2015. For occupational therapy (OT) services, the limit is $1,940 in 2015. Deductible and coinsurance amounts paid by the beneficiary for therapy services count toward the amount applied to the limit....Read On

Willow Bend Wins the Flag!

By Anna Boone, DOR, Willow Bend Nursing & Rehabilitation,
Mesquite, TX


For the first time ever, Willow Bend Nursing and Rehabilitation Center has won the most elite 2014 Ensign flag award! We are so honored and blessed to work here.


Willow Bend Nursing and Rehabilitation is a 162-bed skilled nursing facility in the heart of Mesquite, Texas. Willow Bend has been voted the best rehab in Mesquite for two years in a row. We pride ourselves on improving year after year in almost every significant measurement.


We have overcome many major hurdles, such as: 1) A brand-new skilled nursing facility opened up in between our number one referring hospital and us, and 2) We have taken on rising costs, such as hiring an additional case manager, increasing our MDS nurses from two to three and strengthening the number of employees involved in the admissions process. Despite these challenges, we have been able to increase our EBITDAR Margin. We have implemented many new programs this year to increase our employee and resident satisfaction, and we truly continue to grow as a staff. We are always striving to meet the needs of our community to remain the best SNF in our community..Read On...


Congratulations to All of Our Ensign Flag Winners!:




Park Avenue





Arbor Glen

St. Joe's


North Mountain



Modified Cooking Group

By Ann Marie Hulse, DOR, Lemon Grove Care and Rehabilitation Center,
Lemon Grove, CA

The purpose of a modified cooking group is to facilitate participation in a meaningful occupation for individuals with disabilities.


Population: Individuals with cognitive or physical disabilities and diagnoses such as fractures, ORIF, TKR, THR, laminectomy, CVA, Parkinson's disease, Alzheimer's disease and dementia. A modified cooking group is more appropriate for individuals who want to return to living independently...Read;On

Promoting Culture at Willow Bend

By Anna Boone, DOR, Willow Bend Nursing & Rehabilitation,

Mesquite, TX


CAPLICO is our motto. In the therapy department, we promote our culture daily. I believe that educating the staff on our core values and living it daily has transformed the Willow Bend therapy department from being good to being awesome.


C: Customer second. It's a tough concept for many therapists to grasp due to the fact that no other company has this philosophy. Having a team that puts your needs first keeps our staff happy and focused on the great job they are doing. We demonstrate this by covering for each other in times of emergency. I personally have had family emergencies and have benefited from the employee emergency fund


A: Accountability. Each member of the team holds themselves accountable to exceptional standards. At Willow Bend, we use peer reviews and annual reviews


P: Passion for Learning. We are all striving to better ourselves through continuing education and learning about the newest and greatest technologies. In Texas, we have developed a CEU committee to help ensure we are delivering quality CEUs to our therapists. Willow Bend's therapists have completed training on all Postettes and annual orientation, and we have initiated Ensign U training.


L: Love One Another. This comes easy for us at Willow Bend


I: Intelligent Risk-Taking. It is so great to be part of a team that promotes change. Ensign as a whole, but more specifically Willow Bend, has the right type of leadership. We are always looking for ways to set us apart from everyone else. By updating programs, purchasing new equipment or signing agreements with home health companies, we are ensuring a successful bottom line.


C: Celebration. Willow Bend Therapy department has a lot to celebrate. As we celebrate, it promotes team spirit and strengthens our team. We have a monthly schedule of in-house and sometimes off-site events.

O: Ownership. We take pride in what we do. We promote and believe that being the best you can be is what it's all about. We strive for excellence in knowledge, treatment, documentation and accuracy with billing and documentation. Our officer program is one-of-a-kind and has been a contributing factor in the success of the Willow Bend therapy department. 

RO5 Rollout  

By Franco Estacio, DOR, Victoria Healthcare, Costa Mesa, CA
  • Date of rollout - March 21, 2015

  • Number of iPad units: Seven iPad Mini 2 (one each for full-time staff), one full-size iPad 2 (previously owned by facility)

  • Accessories: Five Lifeproof Frč (shock-proof, waterproof, dust-proof) with strap, two Zagg Backlit Bluetooth keyboards

  • Storage/Charging station: Locked heavy-duty steel cabinet with 10 slots for charging, bolted on desk for added security 


 Feedback from the staff:

Reduced time to finish evals and weeklies.

Cool option to dictate documentation.

Can dictate notes instead of typing while patient is doing treatment.

Can be carried around the building in your pocket or wrapped around the shoulder/neck with strap.

No need to worry about accidentally dropping the unit due to very reliable cover/protector.

Therapists are able to wear the iPad unit around the neck with the cover's carry-on strap for easy hands-free transport 

Saves a lot of time!


Issue: 9

In This Issue

The Compliance Corner 


By Priscilla Diaz de Leon

Compliance Partner


Compliance Matters!


Hello, Ensign Therapy teams! After researching many ethics and compliance articles, I found one that I wanted to share because of its simple but valuable message. It is an article by Andrew Foose, called "Unexpected Scientific Evidence on the Value of Ethics and Compliance Training and Awareness." He and his team discovered a real-life situation that provided powerful evidence of the value and effectiveness of ethics and compliance training when paired with open, honest communication.

"When scientists want to prove the effect of something such as, for example, a new drug, they often conduct a study comparing two groups. Ideally, the two groups are as similar as possible to each other, with the only meaningful difference being the factor being studied (e.g., only one group would get the new drug). 
Such a scientific approach is very difficult to implement, however, with ethics and compliance programs. And yet my team recently came across a situation that came surprisingly close.
The Subjects of Our Comparison: "Site A" and "Site B"

We were recently engaged to assess the ethics and compliance culture of a global company. In the course of our company-wide culture assessment, we visited a number of offices around the country. Of the sites we visited, there were two (let's call them "Site A" and "Site B") that were similar in many ways, and both Site A and Site B were also subject to the same policies, Code of Conduct, etc., and had the same company structure.


So, all else being equal, we might expect similar results of the cultural assessment for the two sites, right?

The Surprising - and Significant - Differences Between the Two Similar Sites

On a number of the measures in our culture assessment, however, the two sites differed significantly.

For example, the employees at Site A:

  • Knew more about the company's ethics and compliance helpline than the other

  • Had greater confidence that they would not experience retaliation if they raised a concern (through the helpline or through another channel); and 

  • Felt more strongly that their managers and senior leaders lived up to the company's values.

In some cases the differences were very large. For example, the percentage of employees at Site A who reported that they would not fear retaliation if they raised an issue was more than 50 percent greater than the percentage of employees at Site B who felt that way.

Why the Differences?

At first we were stumped by how there could be such significant differences in ethics and compliance program awareness between the two sites. However, in discussing the results with the client, we learned that, for a handful of business reasons, Site A had received significantly more training and communication about the organization's ethics program, helpline, and other ethics and compliance program components than Site B.

This, of course, explains why Site A knew more about the helpline than Site B. But it also shows the effectiveness of the training and communications - with less of it, the employees at Site B were less aware of the helpline and how it worked. 

Perhaps much more interesting, however, is the fact that Site A's results on a number of other measures were also significantly more positive, including confidence that management would do the right thing if alerted to an ethics or compliance violation. This, it would seem, is a collateral effect of the training and communications."


So, what is the takeaway?

Talk about Culture, Compliance and Ethics in your therapy departments. It can be a team-building activity to discuss scenarios or problem-solve dealing with a difficult situation or family member. Take time to complete the Ensign U courses in an environment conducive to learning. Talk about our Ensign Core Values, and build an environment that promotes open and honest communication and actions that are in line with our core values. Talking, communicating and living our core values on a frequent basis demonstrates that culture, ethics and compliance matter. This research, while not a controlled, scientific study, supports strong evidence that taking the time to do quality training/education, paired with avenues that promote open communication, can make a real difference and can lead to a stronger culture of compliance. 



Patient Spotlight  

By Lucy Gayton, DOR,San Marcos Rehabilitation & Healthcare,

San Marcos, TX

The San Marcos Rehab therapy team would like to spotlight Mr.Jim Sims. He has been in moderate to severe pain for years, and with the help of our sklled team, he has received specialized bracing along with pain management and functional strengthening techniques. He is now walking freely and participating in activities within our community with only mild pain, and he is expected to continue to improve over the next few weeks!

We're very PROUD of our talented therapists, and very happy for Mr. Sims!



New Amputee Program Guide and Patient Handouts now available!


We are excited to provide a new Amputee Program guide and other supportive material now available on the Portal under Clinical Programming - Amputee.  Kameshe Jackson, DOR and the team at Cambridge Health & Rehab, have established an amputee program and worked hard to develop the supporting materials.  Kameshe and her team will provide more insight to their program in the next FlagPOST, so stay tuned for more exciting amputee program ideas!!


Mary Spaeder, Editor 

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