Author: Reliant Communications

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CMS Updates Nursing Home Requirements of Participation Guidance

On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued updates to guidance on minimum health and safety standards that Long-Term Care (LTC) facilities must meet to participate in Medicare and Medicaid. CMS also updated and developed new guidance in the State Operations Manual (SOM) to address issues that significantly affect residents of LTC facilities.

Surveyors will begin using this guidance to identify noncompliance on October 24, 2022.

Key areas of guidance include

  • Requirements for surveyors to incorporate the use of Payroll Based Journal (PBJ) staffing data for their inspections.
    • CMS indicates the believe this will help identify potential noncompliance with CMS’ nursing staff requirements, uncover instance of insufficient staffing, and yield higher quality care. In addition, they state this allows facilities to begin addressing the staffing issues while the new rule making for minimum staffing levels is underway.
  • Requirements for an onsite at least part-time Infection Preventionist (IP) who has specialized training to effectively oversee the facilities infection prevention and control program.
    • CMS believes that the role of the Infection Preventionist (IP) is critical in the facility’s efforts to mitigate the onset and spread of infections. CMS cites the IP role as critical to mitigating infectious diseases through an effective infection prevention and control program.
  • For additional guidance and details, refer to the State Operations Manual and QSO-22-19-NH.

CMS included in memorandum QSO-22-19-NH recommendations related to resident room capacity.  There are no new regulations related to resident room capacity. However, CMS wanted to highlight the benefits of reducing the number of residents in each room given the lessons learned during the COVID-19 pandemic for preventing infections and the importance of residents’ rights to privacy and homelike environment. CMS urges providers to consider making changes to their settings to allow for a maximum of double occupancy in each room and encouraging facilities to explore ways to allow for more single occupancy rooms for nursing home residents.

Additional details can be found in the following CMS documents: QSO-22-19-NH, Press Release, Fact Sheet

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Clinicians Who Inspire – June 2022 Alaynna Hebert Savoy

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Alaynna Hebert Savoy, Director of Rehabilitation/PTA/Champion Level II therapist at New Iberia Manor South. Alaynna loves to incorporate music into therapy interventions. She explained interventions aren’t always going to be textbook. “You have to throw in fun stuff to keep your patient’s interest. Be flexible and creative.” Alaynna loves to work on dynamic reaching through dancing whether seated in a chair or in standing. She reports dancing to music always puts a smile on her patients’ faces. Alaynna also incorporates music in group interventions using a therapy ball to play “hot potato”. When the music stops, the person holding the ball has to do individualized exercises such as leg kicks or sit to stands. Her patients like group because it’s something different from individual therapy sessions. Alaynna also talked about the importance of positivity. She said “I try to make sure I’m happy. They don’t need to see someone with a sad face, they need to see me with a smiling face.” Thank you, Alaynna, for being creative, putting smiles on your patients’ faces, and inspiring your therapy peers.

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A Reflection on Connection

May plays host to both National Skilled Nursing Care Week (NSNCW) and Better Hearing and Speech Month (BHSM). Although this planning may not be intentional, the themes of each celebrate their profession’s role in human connection. NSNCW’s theme of “Creating and Nurturing Connections” and BHSM’s theme of “Connecting People” could not be better timed to raise awareness and celebrate these distinct, yet entwined, professions.

Every member of the skilled nursing care team is a vital part of building connections within that facility. Oftentimes for residents, these settings are new and unfamiliar, leading to isolation and the potential for depression. Front-line healthcare workers have been instrumental in helping residents cultivate meaningful relationships, leading to improved comfort and quality of life. Opportunities for authentic, mutual connections present in different ways and allow for meaningful relationships between residents and staff to occur organically and naturally strengthen.  It is through these daily interactions with residents, families, and each other, that positive connections have been established and fostered. These connections are needed to create moments of joy and purpose for both staff and residents.

For the staff who provide encouraging smiles when the resident first arrives at the facility, the CNA who always remembers a resident’s favorite sweater, the social worker who holds a resident’s hand reassuringly and listens, the dietary aide who never forgets that a particular resident only likes Cornflakes for breakfast, the housekeeping staff member who pauses to discuss a resident’s predictions for this baseball season, the nurse who takes the extra time to help a resident Skype with her daughter, and the speech-language pathologist who ensures a resident is able to confidently voice their wishes during a care plan meeting – a week, or even a month of celebration simply does not feel adequate. These are the moments of creating and nurturing connections that should be celebrated daily. This month and every month, we applaud our teams for their role in connecting and linking the human spirit in facilities across the nation.

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Clinicians Who Inspire – May 2022 Halen Coker

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Halen Coker, DOR/SLP/Champion Level I Therapist at Pierremont Healthcare Center in Louisiana. Halen loves the added opportunities to communicate with family and caregivers in her role as DOR. As an SLP, she continues to expand her clinical skills by completing CEUs offered in Reliant University. She especially appreciates those courses targeting dysphagia and dementia. To target communication skills, Halen often plays various resident-preferred board and card games in a group setting. Recently, her focus has been on residents experiencing weight loss. She is working with the interdisciplinary team to brainstorm and utilize strategies to enhance the dining experience and improve mealtime intake. Halen attributes the positive vibes in the gym to the amazing team of clinicians she works with and their close collaboration. Not only do they continue to make the gym a fun and active place to be, but they also work to spread that positivity throughout the facility. She states, “this is their home, we have to make it happy.” Thank you, Halen and team, for being clinicians who inspire each other, your patients, and all your therapy peers!

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Clinicians Who Inspire – April 2022 Alyssa Stead

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month, we spoke with Alyssa Stead, COTA/DOR and Champion Level II therapist from Avalon Care Center Sonora. Alyssa shared that though there have been challenges over the past two years, a shifted mindset has allowed the therapy team and residents something to look forward to.

As residents within the dementia unit were isolated from typical routines and interactions during the pandemic per federal guidance, Alyssa and her team took the initiative to create opportunities for meaningful participation. They obtained information about their residents’ interests and created kits that included materials for activities according to those interests. Through participation in these activity kits, Alyssa saw not only satisfaction from the residents, but also a decrease in some of the potential challenging behaviors that presented on their dementia unit. This successful intervention was something that both the residents and therapists could be excited about.

Even as the residents begin to regain a sense of normalcy, these activity kits remain relevant and beneficial. Alyssa Stead, COTA/DOR shared a quote that has always stuck with her, “People don’t care how much you know, until they know how much you care.” Taking the time to learn what is meaningful and motivating to a resident can go a long way in showing that you care.

Thank you, Alyssa and team at Avalon Care Center Sonora, for shifting your mindset and exemplifying Care Matters!

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Quality of Life is Medically Necessary

Since the Omnibus Budget Reconciliation Act (OBRA), or the Nursing Home Reform Act of 1987, federal standards have been in place to regulate efforts to address a resident’s quality of life (QOL). These federal standards identify six principles of QOL, including: sense of well-being, satisfaction with life/oneself, self-worth/self-esteem, satisfaction with environment and care, goals, and control. New data gathered during the COVID-19 era highlights the necessity to prioritize QOL, revealing that adverse effects of isolation have resulted in cognitive, psychosocial, and physical decline for many in post-acute care settings.

Because QOL is a multi-dimensional concept, this essential component of health and wellbeing should be addressed through the comprehensive efforts of an IDT. Each member of the IDT plays a distinct role to promote a resident’s QOL. Consider implementation of some of the following interventions for improved QOL within your facility:

  • Identify resident-specific interests and provide opportunities for participation in these activities on a regular basis. Consider virtual leisure opportunities, as well.
  • Improve the resident’s health literacy to promote wellness and prevent future injury/illness.
  • Execute environmental modifications that promote greater participation for all residents in activity groups.
  • Implement a facility-wide screening process for identification of depressive symptoms in residents.
  • Offer scheduled check-ins to allow residents the opportunity to present questions/concerns.
  • Consult with key players to identify activity groups, community outings, events, speakers, and responsibilities that could serve as opportunities for resident participation.
  • Provide stress management and relaxation strategies for residents and healthcare workers in the facility.

As experts in analysis of performance and participation, PT, OT and SLP can assist in assessing the resident’s functional abilities and tailoring interventions, like those listed above, to achieve person-centered goals. With the unique lens and contribution of each additional member of the IDT, these interventions can become reality; ultimately maximizing QOL, functional outcomes, and patient satisfaction.

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Care Matters Spotlight – Forest Haven Nursing and Rehabilitation

Mr. Freberthauser, a long-term care resident living with dementia at Forest Haven Nursing and Rehab, had been experiencing frequent falls within the facility for a while. With some guidance from Reliant’s Clinical Team, the amazing therapists at Forest Haven worked together to investigate and understand what would work best to engage Mr. Freberthauser and ultimately prevent or reduce falls from occurring. For Mr. Freberthauser, music was the key to improving participation in therapy. The team did some research and found the biggest hits of his generation. When the SLP tried the timeline with country music hits, they really scored. He was beaming with a face full of expression and articulated, “I like to hear Hank Williams music.” The team also found that he performed better with regularly scheduled visits and interactions. Colby Millen, DOR, reports that Mr. Freberthauser “went from stumbling around aimlessly with no affect to smiling when he would see us (the therapy team) and had nicknames for each member of the team.”

With Mr. Freterthauser’s improved attention skills, the therapy team was able to work on the goals they had established. After weeks of therapy, he is now ambulating throughout the facility independently with an improved stable gait and improved safety. He can get out and safely enjoy the activities he loves with as much independence possible. Although there will always be some risk, he has now been fall free for the last month!

In order to set him up for a successful discharge, the therapy team requested that the activities department see Mr. Freberthauser daily to continue to have one-on-one time engaging him in meaningful conversations and allow him a chance to enjoy his favorite music that has improved his quality of life so much.

Thank you to Colby and the Forest Haven therapy team for taking the extra steps necessary to facilitate Mr. Freberthauser’s success!

Discipline Snapshot:

PT: The PT team incorporated music to engage Mr. Freberthauser in meaningful interactions while also working on goals for improved strength, balance, transfer, and ambulation safety.

OT: The OT team also incorporated music and engaging conversation to encourage him in activities to improve his abilities to feed and dress himself.

ST: For ST, facilitating improved engagement has been paramount to the success he has seen. Goals included following directions, comprehension of simple messages, and expression of wants and needs.

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Spring into Action Against Weight Loss

Spring is in the air! With the arrival of a new season comes new junctures to enhance the intricate care provided to seniors. Many challenges emerged during this pandemic, but along with these challenges comes opportunity for new ideas and programming to help improve patient care and quality of life. One major area of concern that continues to “spring up” is unintentional weight loss.

Medication use, disease processes, cognitive impairments, social isolation, and depression are a few reasons why weight loss problems are often common in skilled nursing facilities. Left untreated, weight loss can lead to skin breakdown, confusion, and overall decline in function and quality of life. The risk and harm of weight loss has also been identified by the Centers for Medicare and Medicaid Services (CMS) as a trigger for focused infection control surveys.

Here are some ideas to SPRING into action against weight loss:

Shaped plates and colored dinnerware increase the vibrancy of meal presentation and help residents with cognitive impairment retain focus on meals, reduce frustration, and increase intake. Contrasting dinnerware is beneficial for those with visual impairments.

Promote healthy oral care. Oral care may be overlooked when discussing weight loss. Research shows that dental issues, ill-fitting dentures, chewing problems, and mouth pain can contribute to weight loss.

Refer residents with weight loss to rehab for screenings related to positioning needs, adaptive utensils, cognitive and communication strategy training, or any chewing or swallowing impairments.

Interview the resident and caregivers regarding all mealtime preferences, including food likes/dislikes, preferred dining location, ambiance options, and snacking habits. Residents’ meal preferences are distinct and different.

Nutrients! For residents experiencing weight loss, discuss fortification of meals with the resident’s physician and dietician. Recommendations may include fortified foods, additional supplements, frequent snacks, or increased portion sizes to maximize nutritional intake.

Grant flexibilities with mealtimes. Enable residents to have choices with how, when, and what they eat to promote patient-centered dining programs. Unfamiliar dining schedules, food choices, and mealtime settings cause disruptions in intake.

Spring brings with it new beginnings and a reminder of how rejuvenating change can be! Seasons change and so do the needs of the residents. Adjusting and changing dining culture based on the needs of the individual provides comfort, safety, and independence during meals. Patient-centered dining experiences are critical to fighting weight loss and improving patient satisfaction and quality of life.

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Clinicians Who Inspire – March 2022 Yvette Aquino-Luna

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month, we spoke with Yvette Aquino-Luna, Champion Level II therapist, OTA/DOR at Murrieta Health and Rehab.  Yvette shared that there have been a lot of changes for her team over the past few years. Through the many changes, she has seen the team grow, becoming like a cohesive family.  While continuing to provide excellent patient care, they have learned more about each other, and have even volunteered to learn aspects of the DOR role.  She said, “I honestly couldn’t do this job without the team we have here!”  

Last year, they won several awards, receiving Visa gift cards as prizes. Yvette used them to purchase an escape room, team building activity.  She said the team enjoyed the activity so much that they are planning to do something else in the spring, perhaps an obstacle ropes course.  She noted, learning to communicate “makes a big difference when time gets tough.”

Yvette expressed that “teams need to feel appreciated.”  She has accomplished this by obtaining lunch donations from local restaurants during spirit weeks. Yvette says, “they take care of the patients, so I try to take care of them.”  Her advice for any team is to get to know your co-workers as we often “spend more time here at work than we do with our own families.”  Thank you, Yvette and team at Murrieta Health and Rehab, for remaining positive and adapting to help each other flourish.

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Clinicians Who Inspire – February 2022 Kale Hintz

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month, we spoke with Kale Hintz, Mentor Therapist and PTA/DOR at Premier Estates of Kenesaw.  Kale says that the biggest tip he can share with fellow clinicians working during the COVID-19 pandemic is flexibility. From staffing challenges, patients and colleagues testing positive for COVID, to evolving procedural changes, being flexible and having a good team with you are key components to success. Kale reports that having a positive attitude has given his team the ability to make everything run smoothly for their patients and other staff members despite a high number of variables and obstacles. Thank you, Kale and team at Premier Estates of Kenesaw, for remaining upbeat and adapting as needed in order to help your patients and each other flourish.

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Rediscovering Delight in Their Days

According to recent studies, older adults have experienced increased depression, loneliness, anxiety, and suicidal thoughts, as well as decreased physical health and overall quality of life as a result of COVID-19 and social isolation. As providers who relate so intimately with this population, we ask ourselves, what can we do now?

Participation in leisure, or the use of free time for enjoyment, has a large impact on the health and well-being of older adults. Research suggests that active engagement in healthy leisure can help to maintain preserved cognition, overall physical functioning, mental health, and quality of life. Now, more than ever, residents need opportunities to engage in meaningful activities that bring purpose and joy to their days. Through active collaboration and creativity from the interdisciplinary team, we can facilitate improved morale, satisfaction, and health for those in our care.  Review the following opportunities to explore ways to keep the resident’s mind, body, and spirit engaged:

  • Identify hobbies that are meaningful to the resident or activities they are willing to explore. Talk to your therapy team about the Resident’s InterestChecklist for collaborative discussion.
  • Request family and friends bring in items, games, or activities that are meaningful to the resident.
  • Use creativity to incorporate resident’s interests into the care plan. Are there activity groups, events, or outings in which the resident could participate? Are there specific roles or responsibilities the resident could “own” (i.e. delivering mail, providing daily announcements, assisting with facility decorations, leading a weekly book club discussion)?
  • Encourage participation in activities of interest during the resident’s downtime. Discuss safety precautions and resident capabilities with your therapy team.
  • Provide opportunities for virtual leisure. Online card games, weekly FaceTime calls with loved ones, online learning platforms, and digital tours through museums and galleries around the world allow for engagement despite physical barriers.
  • Communicate with your resident. Ensure that each resident feels known, heard, and cared for on both the physical and emotional level.

Although we can’t change what COVID -19 has brought to so many of our residents over the past two years, we are able to move forward with a fresh focus on their overall well-being. Through participation in healthy leisure, we can help our residents rediscover delight in their days.

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Grow Through What You Go Through

At Reliant, we are excited for another year of partnering with our customers to ensure that no matter the environment or the obstacles we encounter, the needs of our residents remain the number one priority. We have a great opportunity to unite forces, growing together, to improve the lives of our residents and empower our team members in the process.

What better way to ensure resident needs are being met than collaborating the development of quality assurance performance improvement (QAPI) activities with the staff that are in direct contact with the residents? QAPI is how we respond to areas identified as needing attention or that are found to be high priority based on needs of the resident and/or facility assessment. By proactively identifying areas of opportunity, our teams can unite and affect meaningful and lasting change.

Let’s take time to QAPI our QAPI programs! Are the current processes effective? It is important to continuously review and update our QAPI programs to reflect our goal to not only meet the standards laid out in the Requirements of Participation (RoP), but to exceed these guidelines and aim for higher quality care for our residents. By including all team members as active participants in quality improvement, we create an environment that prioritizes involvement and value ensuring that we GROW through what we go through TOGETHER.

TIPS TO ENSURE YOUR QAPI PROGRAMMING IS EFFECTIVE:

  • Develop a method to track, investigate, and prevent recurring adverse events.
  • Learn from your peers’ successes and obstacles.
  • Create quality targets.
  • Ensure a process is in place to receive, investigate, and process improvement for complaints/concerns.
  • Consider feedback from direct care staff, residents, and resident representatives.
  • Engage staff in your facility’s QAPI mission by offering training of strategies and tools.
  • Receive feedback from residents to improve the safety of the environment.
  • Consider the residents’ personal goals for health, quality of life, and daily activities.
  • Utilize data to identify quality problems and opportunities for improvement, and then set priorities for action.
  • Develop Performance Improvement Project (PIP) teams with specific tasks.
  • Perform Root Cause Analysis (RCA) to get to the REAL reason for the problem.
  • Develop a system of promoting and asking for continuous feedback.
  • Have a written/documented plan that includes steps necessary to identify, implement, and sustain improvements in all departments.
  • Monitor systems and processes to sustain and promote a ‘culture of quality’ for continuous improvement.

WAYS THERAPY CAN ASSIST WITH QAPI PROGRAMMING:

  • Routinely screen through direct observation and conversations with the resident/resident representative or caregiver.
  • Request facility reports such as MDS 3.0 Resident Level Quality Measure Reports, CMS 802 Form, ADL flow charts, etc.
  • Track residents utilizing splints to ensure consistent application and intact skin integrity.
  • Track residents with contractures or those at risk to ensure range of motion is being addressed as frequently as possible using natural opportunities.
  • Track residents with modified diets or liquids to ensure diet recommendations continue to be appropriate, allowing for patient to maintain nutrition, hydration, and quality of life.
  • Communicate timely and effectively including the presence of subtle signs and symptoms or care planning updates.
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Clinicians Who Inspire – January 2022 Cindy Akins

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. We spoke with Cindy Akins, Champion Level II Therapist and COTA/DOR. Cindy shared that effective time management, collaboration, and creativity have helped to maintain positive morale and success in her facilities.

Cindy spoke about some of the processes she uses to organize her time between the facilities where she provides care, highlighting the benefits of good organization in managing time while maintaining a positive attitude. She spoke to the importance of recognizing the impact of what we do as therapists: serve the needs of others, as a catalyst to motivate her to always keep keeping on.

Cindy also shared some innovative ideas for group therapy that have allowed residents to participate in functional, everyday activities that they enjoy. With facility and community collaboration, her facility was able to set up a fishing tournament for their residents using stocked water tanks, fishing poles, and therapeutic interventions. “We’re always trying to find activities that are functional, that will keep residents doing the things that they like.” This activity was such a hit that it is going to become an annual, community event. Cindy emphasized that therapeutic events like these become possible with the teamwork of all players on the interdisciplinary team.

Thank you, Cindy Akins, Champion Level II Therapist and COTA/DOR, for sharing your positivity and inspiration with those in your sphere of influence. You are making a difference!

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A Moving Experience

October is a month of moving experiences- temporal, seasonal, and physical! It’s the beginning of the last quarter of the calendar year and the beginning of the Medicare fiscal year. It ushers in the holiday excitement with weather changes and spooky decor. Amid all of this, it is Physical Therapy Month, and an excellent opportunity to emphasize encouraging mobility for our residents at every possible opportunity. Almost daily, articles are released citing the benefits of mobility from improving appetite to improving skin integrity to preventing contractures.  With that in mind, there is a steadfast need to maintain and improve mobility with our residents.

Incorporating “moving experiences” into the daily facility routine is multifaceted and can bring holiday cheer while also embedding a culture of mobility and independence. There is no amount of too little movement- if residents are moving, benefits are happening. This may look like a high five in the hallway, door decorating contests, a shoulder shrug or leg kick “dance break” with music over the loudspeaker and referrals to therapy for concerns for safety with mobility.

It’s impossible not to think of the effect COVID-19 has had on industry as we round the second year under a healthcare emergency cloud, but we adapt. Skilled nursing residents and staff are resilient and keep looking forward. With an arsenal of wellness and mobility strategies provided to residents, we shape a holistic, healthy environment in which to thrive.  Remember, Reliant therapists are champions at mobility and are equipped to combat barriers to a quality “moving experience”. Thank you for partnering with Reliant!

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Care Matters Spotlight – Riverside Health & Rehabilitation

Ms. Turner arrived at Riverside Health and Rehab after suffering a devastating brain bleed that resulted in her depending on both breathing and feeding tubes. Upon arrival, Ms. Turner’s initial prognosis was that she likely would need to reside in the long-term care facility with assistance. 

While at Riverside, Ms. Turner received physical, occupational and speech therapy services alongside a restorative nursing program. The Riverside team worked closely with the facility team to ensure she received the best possible care. In time, she began to flourish, and her abilities with therapy improved, as well as her independence with the Riverside nursing team. 

During her stay, Ms. Turner enjoyed reminiscing about cooking for her “babies” and was able to improve her functional communication skills by talking about the recipes she cooked for her family.

After three months, Ms. Turner was able to get in and out of bed independently, walk household distances and climb stairs with supervision, complete all her self-care tasks with set-up, and enjoy meals again!  With the improvements Ms. Turner made over the three-month stay at Riverside Health and Rehab she was able to regain her functional independence to return home with her family. Way to go Ms. Turner and team!

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Success Beyond Discharge

As skilled nursing facility providers and caregivers, we are privileged to experience many of the fruits of our patient’s progress during their stay, directly related to the services and care that we provide. We are able to share in the excitement and pride that accompanies progress towards a safe discharge to the next level of care after sustaining an often times life-altering injury or health-related episode. But what about life after discharge from our care? Are we confident that our patients and their caregivers are equipped to maintain their progress and successful outcomes, on their own?

The healthcare community, including the Centers for Medicare and Medicaid Services (CMS), emphasizes the importance of interdisciplinary, comprehensive discharge planning from the time of the patient’s admission. Recent literature suggests that the interdisciplinary team (IDT) is able to reduce hospital readmissions and facilitate successful outcomes beyond discharge through provision of high-quality discharge information, participation of the patient and caregiver in the discharge process and focus on increasing the patient and caregiver’s understanding of the discharge information (Hesselink et. al, 2014).  All skilled nursing providers play an important role in the interdisciplinary approach to discharge planning, and a collaborative partnership between therapy, facility staff, case managers, family, and the patient is paramount to success. The weight of the interdisciplinary team’s commitment to patient and caregiver preparation for the next level of care cannot be overlooked. Consider these key components of discharge planning throughout the patient’s stay:

  •  Upon admission:
    • From the time of admit, discharge plans should be considered. Goals should be developed and updated to ensure preparedness for the setting, level of assistance, and needs anticipated at discharge.
  • Throughout the episode of care:
    • Consider a system to ensure all staff are aware of the patient’s personal goals. Implement ongoing patient/caregiver education for health literacy, functional targets, and training to allow ample time for questions, problem solving, and repetition prior to time of discharge.
  • At time of discharge:
    • Provide clear, comprehensive, and accurate information regarding the patient’s discharge level of function, recommendations for equipment or follow-up care, and level of assistance or supervision for daily tasks. Enable the patient and caregiver’s understanding of skilled staff recommendations.

Reliant has created proprietary resources to guide clinicians through comprehensive, effective discharge planning. These resources can also facilitate education, trainings, and increased opportunity for IDT discussion.  Check out Reliant’s Discharge from Therapy to Community Packet and Discharge from Therapy to Nursing Packet to ensure that your patients and caregivers are properly prepared for the next level of care.

With effective discharge planning that occurs throughout the patient’s episode of care, we can facilitate carryover of learned strategies, patient and caregiver confidence, reduced risk of rehospitalization and successful outcomes beyond discharge from therapy.  Reliant is proud to partner with you to confidently guide our patients, caregivers, and staff through discharge planning that will lead to patient success beyond discharge!

References

Hesselink, G., Zegers, M., Vernooij-Dassen, M., Barach, P., Kalkman, C., Flink, M., Öhlen, G., Olsson, M., Bergenbrant, S., Orrego, C., Suñol, R., Toccafondi, G., Venneri, F., Dudzik-Urbaniak, E., Kutryba, B., Schoonhoven, L., Wollersheim, H., & European HANDOVER Research Collaborative (2014). Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC health services research, 14, 389. https://doi.org/10.1186/1472-6963-14-389

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Clinicians Who Inspire: September 2021 Melissa Huggins

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Melissa Huggins, Champion Level II Therapist, PTA, and Director of Rehabilitation at Panora Specialty Care in Iowa.  Melissa states that dealing with the effects of COVID-19 really forced her to think outside the box.  She mentioned the need for creativity in therapy interventions to help encourage participation in sessions.  Melissa and her team like to use Reliant resources like A Year of Wellness to help generate creative ideas.  One of Melissa’s favorite activities has been card making with patients during therapy.  The patients worked on their individualized therapy goals in conjunction with making cards for other residents who weren’t getting as much interaction.  A lot of the residents knew of others who might benefit from a little “pick-me-up” card, but if not, the therapy staff assisted in making those connections.  As part of their therapy intervention, the patients were often able to deliver the cards to their resident friends in person.  Melissa reports that these cards made everyone, from the therapy staff to the residents, very happy!  These interactions helped residents who were spending more time in their rooms to socialize and, in some cases, even leave their rooms to connect with other residents.  Melissa also reports that pictures of residents in therapy sessions being featured on social media is seen as a privilege.  One resident even told her, “You’re going to make me a star!”  Not only are your residents STARS to us, Melissa, but you are also as is the entire team at Panora Specialty Care!

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A Refresher on Fall Prevention Strategies

As the Delta variant of COVID surges through the country, long-term care facilities are forced to revisit the effects of closure, social distancing, and isolation on residents.  This variant has caused healthcare professionals to reframe thinking from potentially leaving a pandemic behind, to best practice strategies to mitigate an ongoing response pattern. Facility staff should revisit the impact moving in and out of isolation has on residents. Consequently, a refresher on fall prevention strategies is appropriate.

Isolation has detrimental effects including reduced mobility, decreased cognition, increased depression, weight loss, and increased risk for falls. While the list of obstacles at times seems insurmountable, keen interdisciplinary teams can be a shining light to our residents by constantly adapting, advocating, evolving, and simply showing up. Though increased isolation may lead to residents spending more time alone, unsupervised in their rooms, putting them at an increased risk for falls, there are ways to reduce this risk through a proactive, interdisciplinary team approach.

Consider implementation of these simple tips to help mitigate the risk of falls:

  1. Keep frequently used items within reach, especially the call button.
  2. Educate new staff on residents’ preferences and nighttime routines: lights on/off, TV on/off, toileting schedule, bed positioning, etc.  
  3. Make time to reassure residents who are feeling isolated and lonely.  Even 2-3 minutes of non-task-oriented company is beneficial. Set up virtual visits with family and friends. Decreased anxiety and agitation lead to calmer residents, and hopefully, fewer falls.
  4. Place any mobility devices in the best position for self-transfer; remove if unable to self-transfer to avoid fall risks.
  5. Take extra care to reduce clutter and ensure clear pathways in the residents’ rooms. Remove any throw rugs or items that may be blocking pathways.
  6. Ensure exercise programs, including therapy, stretching, and balance activities are available to all residents as appropriate. Improved strength and balance can assist with fall prevention and help lessen injuries should a fall occur.
  7. Identify residents’ interests and collaborate with the interdisciplinary team to facilitate creative ways for them to participate in preferred leisure activities.  
  8. Refer to physical therapy for balance strategies, assistive device assessment and training, strengthening, transfer training, gait assessment and training, bed mobility training, education on fall prevention, and floor transfers.
  9. Refer to occupational therapy for strength training, balance training, transfers and bed mobility training, facilitation of self-care independence, adaptive equipment training, education on safety awareness, room modifications, and/or cognitive training.
  10. Refer to speech therapy for expressive and receptive communication skills training and strategies, memory, attention to task, sequencing, and safety awareness training techniques.

Educate staff to watch for signs and/or changes which may reflect an increased risk for falls and proactively adapt environments at every level. With a team approach of collaboration and communication, facilities are well equipped to not only reduce the risk of falls for this vulnerable population, but also to ensure that No Patient is Left Behind.  

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Clinicians Who Inspire: August 2021 Shannon Rasmussen

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Shannon Rasmussen, Champion Level II Therapist, and SLP at Pecan Tree Rehabilitation & Healthcare in Texas. Shannon states that working through the pandemic was the most trying time of her SLP career.  What kept her encouraged during those times is the advice she now gives other clinicians, “remember why you became a therapist.” Shannon stresses the importance of staying focused on remembering that we are in our field of work to help others. This focus is what motivated her to use her vocation to provide a positive, meaningful impact during the pandemic. When social isolation became a reality in her facility, Shannon decided to tackle a very real consequence of isolation- weight loss. She met with the dietary manager, and together they initiated a snack cart, filled with a variety of the residents’ favorite snacks. This cart would make its rounds at the facility and provide a real pick-me-up (and additional calories) to the residents spending increased time in their rooms. As in many facilities, another area of concern was the loss of communal meals. Shannon recognized that residents spending increased time in bed could negatively impact their cognitive and communication skills. She worked with the IDT to ensure residents were up and enjoying mealtimes. She even facilitated roommates enjoying socially distanced meals together while seated and facing each other to promote mealtime conversations and socialization. These seemingly straightforward strategies are just a couple of examples of Shannon and her IDT communicating, brainstorming, and working together to bring back some sense of normalcy during demanding times and a reminder to us to focus on our calling to provide patient-centered care. Thank you, Shannon, and team, for being clinicians who inspire each other, your patients, and all of your therapy peers! Keep up the amazing work you do each and every day!

Condensed Version:

Through the Clinicians Who Inspire series, we continue to share motivation, creativity, and inspiration from clinicians in the field. This month we spoke with Shannon Rasmussen, Champion Level II Therapist, and SLP at Pecan Tree Rehabilitation & Healthcare in Texas.  What kept her encouraged during trying times is the advice she now gives other clinicians, “remember why you became a therapist.”  When social isolation became a reality in her facility, Shannon decided to tackle a very real consequence of isolation- weight loss. Together with the dietary manager, they initiated a snack cart, filled with a variety of the residents’ favorite snacks. Another area of concern was the loss of communal meals. She facilitated roommates enjoying socially distanced meals together while seated and facing each other to promote mealtime conversations. These are just some examples of Shannon and her IDT working together to bring back some sense of normalcy during demanding times and a reminder to us to focus on our calling to provide patient-centered care. Thank you, Shannon, and team, for being clinicians who inspire each other, your patients, and all of your therapy peers! Keep up the amazing work you do each and every day! #CareMatters

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A Motivating Movement: Promoting Restorative Care Through Everyday Activities

As the occupancy of residents in our facilities begins to rebound, labor challenges appear to be one of the biggest dilemmas nursing home operators are facing. With staffing shortages, it may be difficult to implement optimal programming; however, as healthcare professionals in skilled nursing we are governed by the overarching concepts of quality of life, quality of care, and patient-centered care that are present in the 2016 Medicare and Medicaid Program Reform of Requirements for Long Term Care Facilities (81 FR 68688). These requirements provide the minimum framework of effective care regardless of resource availability or staffing.

Facility staff members should feel empowered to live a culture that improves resident’s quality of life and promotes healthy aging.  Providing extra “care on the move” throughout the day while performing usual daily tasks makes a tremendous difference and allows facilities to meet federal requirements.  Providing “care on the move” allows facilities who are facing staffing challenges or inconsistent program execution to meet residents’ needs and potentially document their “moves” on the MDS.

A key element at the center of this quality-of-life promotion is emphasizing resident’s ability versus disability and capitalizing on what the resident can do over what they cannot.  Some examples of “care on the move” that take advantage of improving or maintaining abilities include:

  • Allow any resident who is able to ambulate short distances or propel themself in their wheelchair, to mobilize to and from daily weight checks.
  • Use daily assist with dressing and grooming as a time to incorporate effective communication by allowing time for conversation and encouraging the resident to express wants/needs, and complete tasks as independently as possible.
  • When a resident is toileting, provide encouraging verbal cues versus automatic physical assist, as much as safely possible, to allow for maximal independence.
  • Utilize bed mobility and transfers with a resident as an opportunity to encourage the use of bed rails; and to provide training for rolling, supine to sit, and positioning themself in bed.
  • Use the facility PA system to elicit facility-wide range of motion activities. For example, when music is played, all restorative trained staff take time to assist with range of motion goals or perform sit to stand activities with the residents.

The moments spent reinforcing residents’ abilities builds both resident and staff confidence and satisfaction, and ultimately improves quality of life. For those facilities that have restorative nursing programs in place, “care on the move” is an additional avenue to promote the health and wellness of residents. In the face of challenges, we must do our part to ensure that our residents’ care needs come first. Lead the way with your interprofessional team by providing your residents those extra moves that make a difference!