29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
February 2021

Round 2 of the vaccinations is now underway, and good news! Our overall resident COVID cases have declined 3 weeks in a row as an organization! This includes a dramatic decline in both staff and resident cases! ! This is exciting progress to share with your teams! There certainly is a light at the end of the tunnel. Thank you for all you are doing day in and day out to protect our residents and staff. Our hearts are full of gratitude and love for all of you!
Love red hearts floating on white banner design
Osborn Health & Rehabilitation in Scottsdale, Arizona, is giving out shirts and goodies to those who get vaccinated.
Why Take the Vaccine?
By Patrick Amar, DOR/PT, Mountain View Rehabilitation & Care, Marysville, WA
Here at Mountain View, we’ve experienced close to 100% facility staff vaccinations, and attribute our success to a couple of key reasons: the scars left on our minds and hearts as we reflect back over the past 13 months that we never want to repeat again, and communication, communication, communication. Looking back, we never thought the virus would hit so close to home. We heard about it in the news from China, but that’s a world away. We were taken by surprise when the first case of COVID-19 in the United States happened here in our backyard in January 2020. . Shortly after, the first outbreak also happened in our area; it was just across the county line. Suddenly we were thrust into the epicenter of the virus, and it seemed the whole world was watching how we managed. 

We quickly saw the virus spread in a nearby facility, then in another facility, and then in our community, like an uncontrollable wildfire. In June of that year, it finally came on our doorstep. We knew it was just a matter of time. I think the only positive thing about this pandemic is that it brought our team together even closer. We’ve seen the impact that the virus has had on our patients — their health, their emotions, their psyche and not just them, the family members, too, and the staff. This was the main reason why our staff was so determined to do something about this pandemic by way of getting vaccinated. Read On...
Village Healthcare Pushes for 100% Vaccinations
Village Healthcare and Rehabilitation Center in McAllen, Texas, is pushing for 100% of their staff to be vaccinated against the virus. Recently, ED Alexandra Yzaguirre was featured in an article on KRGV.com. "We're fully vaccinated — the ones that were able to get it. We're about 90% vaccinated for the staff; we had our second dose on Friday." Read the full story here
Cheers to Spring and Summer
Full of Blooms and Possibilities 
By Jon Anderson, DPT, Therapy Resource
Looking at these flowers today in my backyard surprised me because these particular plants usually die in December here in San Antonio. But this year, they have been incredibly resilient, surviving two separate near freezes a few weeks back. The fact that they survived then bloomed makes me think of many things related to COVID. We may have some bumps and bruises (represented by the wearing and tearing of these leaves) from this year, but we trail-blazed forward, and here we are nearing the end and will soon begin to see the fruits (flowers) of all this hard work. 
Keller Oaks: The Culture is in the Details (#startamovement)
Love red hearts floating on white banner design
“KO Let’s Go, Let’s Go KO!” This is the rally cry at Keller Oaks in Keller, Texas, and it is a commonly heard anthem when you visit the facility. In a year that has been difficult at best in healthcare, the culture has done nothing but improve at Keller Oaks. When you look deeper to see what is in the air at Keller Oaks, it goes far beyond COVID.

Kristin Ryther, the therapy program manager at Keller, has been a breath of fresh air in a very trying year at a facility that has been hit hard by COVID on multiple occasions. We asked her to share a bit of her best practices and were blown away by what is developing there.

Starting with onboarding, Keller embraces culture by conducting group interviews and hiring only those people who the team agrees can be grown into great leaders. They agree on all hires and then make sure that the process does not stop there. According to Kristin, “Love is in the details.” She ensures that the new employee is greeted with everything that they need to be successful. She has their log-ins ready, an itinerary for their first day, and a team member assigned to them as a mentor. Kristin provides them with a bit of “swag” and has a ready-made reference form entitled “KO NEED TO KNOW” that includes everything from door codes to restroom locations to documentation tips and PCC locations of interest. Read On...
Therapist Profiles
Jessica Ballera, COTA, St. Elizabeth Healthcare and Rehabilitation, Fullerton, CA 
Submitted by Dennis Baloy, OTD, OTR/L, Therapy Resource, CA
All in the Family 
Jessica’s career as a therapist in an Ensign-affiliated facility was inspired from way back. When she was a little girl, she distinctly remembered how her grandmother was being taken care of by therapists of an Ensign affiliated facility. To this date, she vividly remembers her grandma’s smile after every therapy session. She reminisces about this image of her grandmother all throughout her life. 

Her family is also not new to the therapy world. Her mom, Jasmine, is also an Occupational Therapist Assistant working with our company. Together with her Mom's guidance and Jessica’s love of therapy, Jessica eventually obtained her degree as a Certified Occupational Therapist Assistant from Stanbridge University in 2018. She worked as a part time employee to explore her options and eventually was hired full time at St. Elizabeth Healthcare and Rehabilitation in Fullerton, CA. Read On...
Jihan Antipolo-Baldonado
Rehab Aide: The Secret Sauce  
Submitted by Carlos Pineda, CTO/DOR, Southland Care Center, Norwalk, CA
“Teamwork is the ability to work together toward common vision. The ability to direct individual accomplishment toward organizational objectives. It is the fuel that allows common people to attain uncommon results” – Andrew Carnegie. It is fascinating to watch an organization continue climbing up and inspiring the members to be the best they can be despite unpreventable hiccups. As you dissect this great phenomenon, you will always find those who are the concrete and steel of the institution. They are usually the quiet, humble but full-of-smiles individual or group that is sitting behind. You can feel their presence in any space and even more when they are not around. They are culture lovers. They are the catalyst for innovation. They spark love among individuals.

When the Momentum market gave me an opportunity to manage two great buildings, Southland Care Center and Downey Post-Acute, there was one person who stepped behind me and whispered, “This opportunity is best for our patients and therapists.” She did not see the struggle that I was heading into, but the opportunity of spreading our core values. I always feel proud, with teary eyes, every time I brag about this person to my colleagues when they ask about our best practices. My answer is that our secret sauce is Jihan Antipolo. Read On...
Caitlin Colteryahn, OT, TEACHA
Submitted by Danielle Banman, DOR, The Healthcare Resort of Leawood, KS
Caitlin Colteryahn is our lead occupational therapist here at The Healthcare Resort of Leawood and has been with us for four years. Caitlin graduated from Rockhurst University in 2014. She has been married for 10 years and has two boys. She loves spending time outdoors and traveling, especially with friends and family. 

Caitlin is an outstanding occupational therapist and is passionate about developing programs for maximizing independence for our residents with dementia. She received advanced training in dementia care in March 2020 to earn the title of Therapy Expert for Abilities Care Holistic Approach (TEACHA). Caitlin has developed an amazing program here at our facility and enjoys teaching other occupational therapists in our market about this program to improve the quality of life for all individuals with dementia that we have the privilege to serve. 
Passion for Learning
So You Want to Hire a CFY?
Submitted by Elyse Matson, MA CCC-SLP, SLP Resource
One of our initiatives for 2021 is to increase our SLP programming, thus providing a more cohesive and multi-disciplinary approach to care. Hiring SLPs can be challenging depending on the market. One way to increase the number of candidates for SLP positions is to consider hiring a newly graduated SLP, also referred to as a CFY. 

What is a CFY? CFY stands for Clinical Fellowship Year. Think of it like a residency. It is a mentored experience to better transition SLPs from student to licensed and certified clinician. In order to hire a CFY, a licensed and certified SLP needs to agree to mentor for approximately nine months if it is a full-time position. This involves some supervision and guidance of the CFY, depending on the state regulations. In addition, the licensed SLP needs some training in supervision. These regulations vary by state. 
There are numerous benefits to hiring a CFY. The new grad is likely to be motivated to learn, eager to build a caseload and willing to accept guidance. A CFY is not a student. If you hire a new grad SLP, they are a regular employee. The only difference is they require some supervision from another SLP. During the COVID-19 pandemic, ASHA is allowing tele-supervision. The mentor needs to be licensed in the state where the CFY will be working. See the changes for 2020 here: 2020 requirements ASHA SLP Crosswalk. Read On...
Exercising Your Passion for Learning
Submitted by Kai Williams, Therapy Resource, Keystone East, TX
There are many times that we run across clinicians that have such a passion for integrating new and innovative clinical ideas. Some move with hesitancy, unsure if their idea will really gain traction. We say to those that are hesitant, please Exercise your Passion for Learning! Malathy Venkatesh, PhD, CCC-SLP, originally joined our Mason Creek facility in Katy, Texas, in 2019. She recently relocated to our Tempe post-acute facility located in Arizona in late 2020. From the very first time I met Malathy, our conversations revolved around the underutilization of speech therapy services with a goal on how to increase awareness around clinical programming. Malathy has spent the last six months introducing LTC patients to the Montessori Method. Below you will find details about the Montessori approach to dementia from an SLP perspective, along with some ideas on how SLPs can use this approach in the LTC setting with examples of materials and goals.  Read On...
Managing Lymphedema
By Calli Carlson, OT/DOR, North Mountain Medical & Rehabilitation, Phoenix, AZ
In the fall of 2020, two of North Mountain Medical Center's therapists, Tyler Lieberman, COTA/L, and Calli Carlson, OTR/L DOR, spent 145 hours over the course of three weekends to become certified lymphedema therapists. Calli received a brief introduction to lymphedema management in her occupational therapy graduate program but knew there was still a great deal to learn in order to provide the best possible care to residents. Tyler also expressed interest in becoming certified, particularly after observing many residents with edema/lymphedema and the subsequent joint stiffness and skin changes that resulted. North Mountain's CEO, Jason Postl, and Director of Nursing, Jacque Green, were extremely supportive in providing the means for training and were equally as committed to providing the highest quality, holistic care for residents.

Lymphedema itself is historically ill-understood in clinical practice despite affecting 90 to 250 million people worldwide. Lymph node removals, trauma, surgeries, medications, genetics and obesity are just a few of the contributing factors to disruption of the lymphatic system, which can result in protein-rich fluid in the interstitium and cause a cascade of adverse reactions.   Read On...
The Power of Asking
By Jon Anderson, DPT, Therapy Resource
Recently, I was reminded of the power of asking for something. Contrary to belief, curiosity didn’t kill the cat. Turns out, being curious and asking questions is a really good thing. Think of it like this: Have you ever had a conversation with someone who only responded in two- or three-word sentences, and you walked away feeling like you learned very little? The person might not have been intentionally giving you short answers; perhaps you could have phrased your questions better. A lot of people fail to understand the power of asking quality questions. One effective tip for asking stronger questions is to frame questions in a positive tone. For example, ask, “How can I help with that?” instead of, “What do I have to do?” Framing things positively assures the direction of the conversation and leaves others with a pleasant memory of the exchange.

This is what I did as I recently partnered with Medtronic and wrote a letter as a Physical Therapist to various Medicare Intermediaries (MACS) to ask for the ability for PTs to bill Medicare Part B for PTNM (Percutaneous Tibial Neuromodulation) in all of the settings where we provide services. I’ll be the first to admit, I have never been a big fan of letter-writing campaigns to ask for things because I felt like I’m just one little voice, and will they actually even read my letter? My negative bias led to me censoring my own voice, creating a lesser impact as a patient advocate. To my surprise, all four letters to the MACs received responses, and three of the four were positive, meaning PTs can now bill across all settings for PTNM treatment in most of the country. As for the last hold-out MAC — well, I’m working on a follow-up letter to be even more curious and ask more questions. 

As I sit and reflect on this, I think how my one voice helped make this difference. That thought inspired me to share this with you, and remind you to be curious and ask well-thought-out questions. Each of you has such powerful voices as patient advocates and healthcare professionals, so use it. 
Temple View Transitional Care Improves their Self-Care GG Scores
By Cory Robertson, Therapy Resource - Idaho
Temple View Transitional Care Center in Rexburg, Idaho, Therapy led by Susie Swetter, DPT, DOR, joined the organization in the fall of 2019 during the transition from PPS to PDPM. One area in particular they have been focused on is improving their Self-Care GG scores. The challenge to improve was brought to the team, and their new OT, Neil Marion, stepped up to own it. 

The team met to review their GG scores and their coding process. Neil looked at the metrics and said, “I want Temple View to lead the market in the self-care increase score.” At the time, Temple View was behind several other buildings in the Market in self-care. However, within several weeks of continued improvement in self-care scores, Temple View grabbed the top spot in percentage improvement in self-care scores for the ID/NV market. When asked how Neil did it, his response to getting the top spot was amazing: Read On...
A Trio of Wellness: Oral Health, Overall Health and Quality of Life
By Razan Malkawi, M.S., CF-SLP, Rose Villa Healthcare Center, Bellflower, CA
Research indicates a clear link between oral hygiene and the overall health of patients. Poor oral hygiene can contribute to new arising medical conditions, and it may worsen the existing disease and interfere with the outcomes of treatment. Continuous education and awareness in oral hygiene are essential in our facility. We hold weekly, if not daily, in-services to discuss preventative measures collaboratively. Members of the interdisciplinary team, including but not limited to the speech therapist, occupational and physical therapists, CNAs, nurses, and the administrators, are all involved in providing evidence-based resources to assure a high quality of life for our patients here at Rose Villa Healthcare Center.

Causes of poor oral hygiene may be related to genetic, developmental and environmental factors. Most of our patients receive medications that may have side effects. For example, Xerostomia (i.e., extremely dry mouth) is a common problem that contributes to poor oral hygiene; causes include drugs, smoking, radiation therapy, diabetes Mellitus, etc. (Kapoor et al., 2014). Our role is to assist with and provide instructions and education regarding the different mouth care approaches for our patients Read On...
Importance of Therapy Intervention for Patients Post-COVID 
By Tamala Sammons, MA, CCC/SLP, Therapy Resource
COVID-19 is a respiratory viral disease with multi-organ involvement resulting in potentially temporary and episodic health challenges such as impaired lung function, physical deconditioning, cognitive impairments, impaired swallow and communication, and mental health disorders. The effect of the virus on the respiratory system appears to range from a simple respiratory tract infection to acute respiratory distress syndrome (ARDS) with multi-organ failure. People with COVID-19 may also develop coagulopathy that can lead to venous thromboembolism (VTE) and microvascular thrombosis throughout the body, increasing the risk of negative mental health outcomes. (https://academic.oup.com/ptj/article/100/12/2127/5903663)

Older adults respond to their own stress and that experienced by staff, which can increase the risk of behavioral problems. Isolation and lack of stimulation may also lead to loneliness and depression. Each of these negative psychological outcomes has a significant impact on an individual’s immune system and the ability to fight infection. An increasing number of patients recovering from COVID-19 are having lingering cognitive symptoms, including confusion and impaired executive functions, short-term memory issues, and learning difficulties. For those who had compromised cognitive-communication status before COVID-19, we need to be ready for ongoing exacerbation of symptoms. Read On...
Thinking Outside the Box: Modified Diets That Are Tasty and Appealing! 
Submitted by Shelby Donahoo, Therapy Resource - Tucson, AZ
When Sara Mohr, CFY at Sabino Canyon in Tucson, Arizona, was a SLP graduate student at the University of Arizona, the reality for those on modified diets became clear. Often a diagnosis of dysphagia brings confusion and worry. Getting modified diets right seems obvious, but actually can be quite hard. Options seemed few: mashed potatoes, blended meat and yogurt. She found few resources out there for patients in terms of appealing and tasty recipes with easy instructions for cooking and modifying.

She and her colleague, Louisa Williams, had an idea. What if they created a food blog to improve accessibility to quality information on modified diets? So they established realmealsmodified.com and began creating recipes and posting foods that meet texture requirements of the International Dysphagia Diet Standardization Initiative (IDDSI) while looking appetizing and tasting flavorful! Read On...
Think Thin
The Path to Thin Liquids
Carly Peevers — Passionate About Think Thin
By Dominic DeLaquil, Therapy Resource - Idaho
Carly Peevers is an SLP out of Rosewood Rehabilitation in Reno, Nevada. Carly is passionate about giving great clinical care and has recently taken on an educational role within the Pennant, Idaho/Nevada, market.

Carly has been an employee at Rosewood since 2015. In her first year at Rosewood, she worked collaboratively with the kitchen team to revamp the menus so that the diet recommendations match with the diets provided by the food services company. Since then, she has worked hard to train new and existing kitchen staff on diet restrictions and make sure they are comfortable with the administration of current diet orders. She has also worked with CNA and nursing staff to communicate actively when diets change to ensure the entire team is collaborating with regard to patient care. Read On...
Think Thin In Our Pennant Locations!
By Elyse Matson, MA CCC-SLP, SLP Resource
Our Pennant Washington facilities have embraced our Think Thin initiative to better give our residents a reason to live. Valerie Gaskill, M.S. CCC-SLP, our SLP at Pacific Care in Hoquiam, Washington, has taken a step-wise approach to the program. She is reassessing residents who have been on thickened liquids, providing skilled therapy and conducting instrumental swallow studies to determine the patients’ ability to advance to thin liquids. Valerie sees the value in providing the least restrictive diet and giving her residents a better quality of life. Great work, Valerie! 

Morgan Vaughn, our SLP at Beacon Hill in Longview, Washington, has had the Free Water Protocol in his SLP toolbox for some time. Now he is working to add the oral care piece to the program in order to provide the highest level of safety for residents receiving free water. He is looking to add Occupational Therapy to the plan to help implement the oral care program needed for the residents at Beacon Hill. We are so excited to see the implementation of Think Thin! 
Valerie Gaskill, M.S. CCC-SLP, Pacific Care and Rehabilitation, Hoquiam, Washington
Morgan Vaughn, SLP, (L), and Lori Gobel, OT, (R), Beacon Hill Rehabilitation, Longview, Washington
CPT Coding Tips
By Tamala Sammons, MA, CCC/SLP, Therapy Resource
CPT Code 96125 (Standardized Cognitive Performance Testing, Per Hour) 
Log this when:
  1. The combined time it takes to conduct the evaluation, interpret the results, and write the evaluation report* is at least 31 minutes to report the first hour, 91 minutes to report the second hour, and so on.
  2. The test is completed using a standardized assessment, independently or in conjunction with subjective observations and findings.
*Note: Clinicians may count interpretation and documentation time toward the minimum minutes only when billing for 96125, and only for Medicare Part B patients. Medicare Part A minutes still follow RAI manual guidelines of direct face-to-face time, which is followed regardless of code definition. Additionally, when administered as the initial evaluation, this code is non-MDS for Part A payers. Read On...
Wound Care CPT Codes 97597 and 97598
Wound debridement codes are intended for acute wounds that are debrided of devitalized tissue. Debridement is measured in total depth and surface area, going from skin level down to the bone.

  • 97597 Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less.

  • 97598 Debridement each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure). Use 97598 in conjunction with 97597. Note: Log 97598 for each occasion of 20 sq cm after the initial 20 sq cm.
The Importance of SLP Intervention for Respiratory Function 
By Tamala Sammons, MA, CCC/SLP, Therapy Resource
Why is respiratory function so important for SLP involvement?
  • Successful phonation is dependent upon effective respiration. 
  • Uncoordinated breathing patterns or open vocal folds increase risk for aspiration. Compromised breath support limits cough strength and effectiveness to remove any substances that pass the vocal folds. 
Low oxygen levels can affect:
  • The heart due to the need for it to pump harder 
  • The brain, resulting in mood changes, reasoning and memory deficits (i.e. decreased cognitive function; increased safety risk)
  • Physical abilities due to decreased sensory or motor planning (i.e., increased risk for falls)
The focus of SLP respiratory intervention is to improve the patient’s quality of breathing patterns for improved communication, swallow, and patient performance during ADLs or other physical activities. Read On...
Congratulations !
Gina Tucker-Roghi, OTD, OTR/L, one of our resources behind the development of the Abilities Care Approach and many of our dementia-related tools, is now a full-time professor at Dominican University in the Occupational Therapy Program and has been pursuing grants and using these grants to research and further develop tools for the older adult population. We continue to have part-time access to her for support, partnership and expertise on specific projects, while also having the privilege of working closely with Gina and her grad students on a variety of projects.  

Gina just got published, and it’s a very relevant and interesting article on applying an age-friendly health systems framework to long-term care. Please take a moment to read the article and share with your teams! How can we use this information to create an even stronger environment for our LTC residents? It provokes thought around the 4 M’s and some very important considerations for us to incorporate for training in our healthcare communities, as well. Click this link to download the full article

Congratulations, Gina. Thank you for sharing this with us. We are so proud of you. Keep going! 
Ray Yarman, DOR/CTO, City Creek Post Acute Care, Salt Lake City, Utah 
By Gary McGiven, Therapy Resource, Milestone, Utah
(Pictured Left with Gary McGiven)
Please join with me in congratulating Ray Yarman as Chief Therapy Officer at City Creek Post Acute. Ray truly embodies our CAPLICO core values as she has fully embraced our culture. Ray has thrived in our model of leadership at the facility level. She has been an integral part of the interdisciplinary team at City Creek as the longest tenured department head. She has helped to establish a culture of accountability within the department head team, and continues to be a strength. Ray has also done a phenomenal job building a therapy team that has bought into her vision of providing great care to all who come through the doors of City Creek. You can expect to see “outside the box” therapy interventions as you observe treatment sessions at City Creek. As Ensign affiliates, utilization of the cluster model is a key component to a facility’s success. Ray realized this early in her role as DOR and has been a great cluster partner. She holds herself to a very high standard as well as her peers. She has helped to elevate her cluster partners and each of them are achieving great things.

I’ve heard it said that the core value of intelligent risk taking is one we as an organization struggle with the most. The team at City Creek took the risk to partner with the state of Utah to become a COVID-only facility. Ray and her team have been a significant strength to the facility during this very challenging time. This is an intelligent risk that will be remembered throughout history, and Ray’s leadership has been a major key to the success City Creek has had. Thank you for your leadership, Ray, and congratulations on earning the CTO award.
Cathy Champlin, DOR/CTO Cedar Health & Rehabilitation, Cedar City, Utah  Submitted by Tyler Hoopes, Market Leader, Sunstone, Utah
We are super excited to announce that Cathy Champlin is our newest CTO in Sunstone. Cathy has been with our company since we acquired Coral Desert in April 2015. She was a strong staff member there as well as ADOR. Two years ago, Cathy started at Cedar Rehab as our DOR and has quickly become a top DOR in our organization. Below is a summary of her recommendation from Spencer (administrator) and the Cedar leadership team:
“I couldn’t be happier to nominate Cathy Champlin for CTO. My heart is so full with appreciation to her for the heavy load that she has helped to lift and for her leadership. Cathy is a determined member of our team that will never say “that’s not my job” or pass the buck. Cathy is always quick to volunteer and step in and help where needed without being asked. The reality is that Cedar Health and Rehabilitation would not have been able to reach these significant achievements without the contributions Cathy has made. If I were to define one of Cathy’s greatest qualities and characteristics, it would be that she is a Level 5 Leader. Her humility and drive to succeed are second to none; no matter the obstacle, she will just push and fight to make it happen. Cathy strives to make our leadership team and her department better, indeed the therapy department has turned 180 degrees under her leadership as expectations are set and followed up with for her team to ensure that changes are lasting and impactful. To tell the truth, I am not sure if Cathy has any allergies, but I do believe she has one to accepting credit; she simply cannot do it. The window and the mirror is a guiding principle that Cathy simply cannot get away from. Cathy is a true partner and I am thrilled to share in the continued partnership and ownership with her.”  
Thank you, Cathy, for acting like an owner in Cedar Rehab and Sunstone. Your influence is felt in many of our facilities.