Crucial Accountability
A thriving therapy team that sustains clinical, cultural and financial results is undoubtedly one where the therapists hold themselves and others accountable for the role each person plays in achieving amazing outcomes. Accountability is one of our Core Values, and it is the subject matter of the book we are reading together as an organization this year, Crucial Accountability.
Holding each other accountable from every seat, regardless of title or position, is a critical concept that plays out among our most successful teams. The shorter the lag time between identifying a concern and addressing the concern, the healthier and, most likely, happier the team will be overall. A longer lag time, where individuals feel afraid to speak up or don't feel like it is their place, usually leads to gossip, colluding and mistrust. The more we avoid giving the feedback, the pricklier the thought of having the conversation can become, and before we know it, dysfunction has set in.
How we hold each other accountable in a "rigorous not ruthless" way is modeled by our best Level 5 leaders. The approach we take in giving the feedback and the way we choose to give it are just as important as the decision to have the conversation. By taking time to frame the feedback in a constructive way (versus being reactive and lashing out), we can demonstrate that we truly want to help one another grow, and in turn, the strength of the team can grow.
Giving open, thoughtful, direct feedback is arguably one of the most compassionate things we can do for one another. Crucial Accountability offers many practical ways to learn how to get better and better at living this Core Value. The DORs should have a copy of Crucial Accountability. If your team is in need of a copy, please let your ED/CEO or therapy resource know.
by Mary Spaeder

The team at Park View Post Acute Care in Santa Rosa, CA, had an awesome clebration for their first Abilities Care Experts (ACE) graduating class.  Contact Gina Tucker Roghi ( for more information on how your facility can get involved! 
Sharing Special Therapy Strategies
Simplified Rehab Approach for Clinically Complex Patients
By John Patrick Diaz, PT, DPT, CEEAA, RAC-CT
Director of Rehab, Parkside Rehabilitation Center,
El Cajon, CA
The health industry has grown through the years, with advances in technology to assist in diagnostic testing, less invasive surgical procedures that cut down hospital or nursing home stays for a patient's recovery, and evidenced-based practice that assists medical professionals and clinicians in meeting the needs of patients. The promotion of health and wellness within companies and even with public exposure and social media has been a positive tool in improving health.
On the other side of the coin, we also have seen or been exposed to patients who, aside from a broken hip or a replaced joint, present to us with other co-morbidities that make it more challenging to establish a therapeutic recovery program for them to transition to a lower level of care. For clinically complex patients, we as clinicians are faced with a daunting task to assist these patients with our skills and translate it into our documentation to limit the risk of reviews and audits.
Poetry in Motion: A Tribute to the Eden Alternative  
Sonny Gonzalez, DOR, and Jennifer Daniels, SLP of Oceanview Healthcare and Rehabilitation in Texas City, Texas, have been participating in a national grant project of the Eden Alternative called Creating a Culture of Person-Directed Dementia Care. Both Sonny and Jennifer have each shared poems they've penned in response to what they've learned. Sonny's poem, Alone,echoes the message behind Eden Alternative Principle Three, which acknowledges that companionship is the antidote to the plague of loneliness. Click here to read Alone. 
Reducing Restlessness With Baby Dolls 
By Aimee and Sacchin Bhatia, Glenwood Care, Oxnard, CA
About six months ago, in an effort to decrease falls among residents with dementia, our falls committee came up with an idea to give residents baby dolls in order to reduce their restlessness and give them a sense of purpose. The effort has been extremely successful, and people who used to try to climb out of bed at night or out of their wheelchairs now snuggle with their babies instead. Their families are even bringing in baby clothes for them to change their babies. Overall, we have seen decreased restlessness and reduced efforts to get out of their wheelchairs as residents tend to their babies. 

Going forward, we are discussing how the effort could be potentially looked at as a dignity issue despite it being a part of their care plan and families agreeing with our intervention. Are there any cognitive assessments or tools that could be used to prove that it is an appropriate intervention for a documentation trail in the residents' charts? We welcome input from the Ensign community as we continue to assess the program.
Contracture Management Course at St. Joseph Villa
By Kelly Alvord, Therapy Resource - Utah
We had a course at SLCC addressing contracture management for our therapists. We had close to 40 therapists attend from 10 facilities within Milestone. I appreciate everyone taking the time on a Saturday to gain additional tools to help our residents dealing with contractures. I've received positive feedback from many who attended, and I look forward hearing about the outcomes from the interventions that have been enhanced and learned. 

A big thank-you to Lisa Brook (DOR at St. Joseph Villa, Salt Lake City, UT) for bringing this course to Utah for us! She saw the need to enhance our care and made this happen. Thank you, Lisa!
Ask the therapists who attended to share what they learned from the course and how therapy can continue to improve the lives of our residents.
Neuro Gym Sit to Stand Trainer
By Jeremy Nelson, PT, DPT
Director of Rehab, Carmel Mountain Healthcare & Rehabilitation
One of the best pieces of equipment that has changed our facility is the Neurogym Sit to Stand Trainer. We purchased this piece of equipment last December from a Canadian vendor that
presented at last year's DOR meeting, and I highly recommend this trainer to all of our facilities. (

We have had multiple residents who were total assist with bed mobility, transfers and just standing due to prolonged immobilization in the ICU. The first few treatments, the residents would be Max A x 2 for sitting balance, having had other complications that go along with immobility (hypotension, desaturation and poor O2 perfusion, diaphoresis, and muscle atrophy) from being supine in the ICU for weeks. The following example is one of many success stories we have had from the Neurogym Sit to Stand Trainer.  
Yellow Flag
Compliance Corner
Are We on the Same Frequency?
By Lisa Harvey, Lead Compliance Partner - Pennant
Hello Ensign Therapy teams,
We are well into year three of our Corporate Integrity Agreement (CIA)! Many of you have already had an onsite Medicare Systems Compliance Audit (MSCA) conducted by one of our compliance partners for Medicare Part A services provided to residents in our facilities. We have seen many examples of excellent therapy documentation supporting the vital therapy services that help our patients improve their quality of life and in many cases return home or to a lesser level of care.
One trend that has been observed while completing the MSCAs is either over-delivery or under-delivery of therapy visits according to the Plan of Care or Updated Plan of Care and subsequently, physician's orders.
Celebrating Occupational and SpeechTherapists
April Is Occupational Therapy Month

During the month of April, the American Occupational Therapy Association celebrated
Occupational Therapy Month to honor the more than 213,000 occupational therapists, assistants and students nationwide who work to create fuller lives for patients and their families. Evidence-based and deeply rooted in science, the nearly 100-year-old occupational therapy profession takes a holistic approach with patients, centered on adapting environments to suit the person.
As the saying goes, a doctor may save your life, but an occupational therapist helps you live it. Please join us in thanking our occupational therapists for working tirelessly to improve the lives of residents at Ensign facilities. To learn more about Occupational Therapy Month and the role of OTs in skilled nursing facilities, visit

May Is Better Hearing & Speech Month 
May is an opportunity for SLPs to raise awareness about communication disorders and the role of ASHA members in providing life-altering treatment. We celebrate the 182,000 audiologists; speech-language pathologists; speech, language and hearing scientists; audiology and speech-language pathology support personnel; and undergraduate, graduate and doctoral students in communication sciences and disorders.
Speech-language pathologists (SLPs) provide a wide range of services, mainly on an individual basis, but also by providing support and information for families, support groups and the general public. SLPs work to prevent, assess, diagnose and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults. 
The Pomp and Circumstances of Hiring a CFY
By Elyse Matson, M.A., CCC-SLP, Carmel Mountain Rehabilitation & Healthcare, San Diego, CA

Spring is in the air, and many SLP graduate students are breathing a sigh of relief as they finish their theses, pass their oral exams and start to look for their CFY positions.
What is a CFY? Clinical fellowship year is the full meaning. It is a residency of sorts. The CFY/SLP is hired and employed but still requires supervision by a more experienced (and licensed) SLP. There are important rules regarding the hiring of CFYs that come from the American Speech-Language-Hearing Association (ASHA). In addition, there is often a separate set of rules for your own state licensure. In California, for example, a newly hired CFY might have to wait up to two months to process paperwork and be able to start treating patients. As a Director of Rehab, if hiring an SLP is on your to-do list this summer, here is some basic information to help you decide if a CFY is right for you and your department. 
Meet Our New SPARC Award Winners! 

Catherine Whitlock, DPT student at the University of Washington, graduating in June 2016

Chelsea Shearman, 

August 2015 SLP graduate of Northern Arizona University and  student intern for Sabino Canyon in Tucson, AZ.

Congratulations to our most recent SPARC award winners!  

Learn more about our Scholarship Program And Recognition Campaign (SPARC) at

ICD-10 Coding Corner

By Casey Bastemeyer RHIT, CCA, CHPS, RAC-CT, AHIMA-Approved ICD-10-CM Trainer 

The good news is that our operations did not grind to a halt on Oct. 1, 2015, as others in the industry; we made it. Many are reporting that the transition from ICD-9 to ICD-10 went smoothly. Overall, everything we did to get ready for ICD-10 paid off. However, with everything new, ICD-10 didn't come without its challenges. Hot topics were reported to be coding with Excludes 1 notes, the seventh characters for fractures and injuries. Coding accuracy is very important. With all the potential changes to the billing system, we need to have a strong understanding of coding and the coding guidelines. There is still some work ahead of us.
With that said, we need to focus on getting accurate coding not only for billing, but also for reporting and trending. Our BPCI facilities know this more than most. We need to make sure we are all painting that picture the same. For example, when we code for a hip replacement, we need to make sure we are using the most accurate code.
Coding CPT 97532 (Cognitive Skills Development) 
By Tamala Sammons, 
Therapy Resource

It is important to understand the various CPT codes we utilize when reporting the services provided to our patients. One particular code, 97532, has specific parameters to consider before logging this code.

The Definition: This activity focuses on cognitive skills development to improve attention, memory and problem-solving, with direct one-on-one patient contact by the qualified professional, each 15 minutes.  

Ensign Therapy | 27101 Puerta Real, Suite 450 | Mission Viejo | CA | 92691