Ensigntherapy.com
29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
January 2021

Building Vaccine Confidence!
Big celebrations across the organization as our leaders – our influencers – are showing the world that we trust the vaccine, we trust science, and we are ready for this pandemic to be behind us! 

For those of you still waiting, I know we have leaders working around the clock as they are partnering with the local communities to bring the vaccine. We hope these early pictures will inspire you to help educate your teams and facility staff ahead of time so that we have maximum participation the day that the vaccine arrives. And we look forward to seeing your celebration when it does! To our health, our patients’ health, and beyond!

Dennis Baloy put together the following video for St. Elizabeth Healthcare, Fullerton, CA: Day 1 Vaccination at St Elizabeth. It was truly a hopeful and momentous day for all!  https://vimeo.com/497350379, Password: caplico. Click here to see more of our teams celebrating and embracing the COVID-19 vaccination.
A League of Our Own
By Mark Walker, PT, CEEAA, DOR, Orem Rehab and Nursing, Orem, UT
I wanted to share an enlightenment I had this past week. My wife and I were channel surfing the other night, and we ended up watching the last little bit of the movie, “A League of Their Own,” with Tom Hanks. Toward the end of the movie, there is a scene where the girls’ baseball coach (Tom Hanks) is angered by the fact that his star player is leaving right before they start playing in the World Series. Her husband had just returned home from war, and she says, “I can’t do it anymore; it’s too hard.” Her coach then looks at her with a glare and says, “If it was easy, everyone would do it. Being hard is what makes it so great.” That really struck a chord with me and life right now.  

We do hard things every single day, and that’s what makes what we do so darn great! We touch so many lives every day, and sometimes we lose track of that. If you are like me, I sometimes walk into work thinking, “Today is going to be an easy day; my schedule isn’t too bad and I have little to no meetings today.” That attitude changes almost instantaneously once I enter the door. I have since changed my mindset going into work. I tell myself every morning, “Today is going to be a hard day, and that’s why it’s going to be so great. I get to do hard things today.” And I give myself a little fist bump.  

It is not wrong to acknowledge that the day is going to be hard; I hope we do. But we must also remind ourselves that we can do hard things and that’s what makes our jobs so great! We have survived so much as a market, cluster, building, department and personally. We are great! And we will continue to become great through hard things. We truly are in “a league of our own” and are dignifying long-term care in the eyes of the world. Wishing peace and blessings to everyone!
Activity and Therapy Department Collaborate to Implement National Days Calendar
By Paul Emerson L. Baloy, OTD, OTR/L, DOR, The Hills Post Acute,
Santa Ana, CA 
Denise Del Cano, COTA/ADOR and Martha Ramirez, Activities Director, have revisited and re-instituted the National Days Calendar to support our cluster’s rallying call to add color and meaning to the lives of our facility’s residents. Martha’s creative and innovative activity strategies will be complemented and augmented by Denise’s occupational therapy background to come up with individually modified and designed activities for fun-filled, month-long events.  The Hills Post Acute kicked off this month with a pie-eating contest for staff and residents.
Sharing the Love at Park Avenue
By Jacob Barnes, CTO/TPM, Park Avenue Health & Rehabilitation, Tucson, AZ
Joncie Patterson, PT with Park Avenue, is always looking at ways to show support and love and improve the quality of life of our staff and residents. Prior to Christmas, Joncie spent hours working on unique arrangements, which included tea cups with tea bags, wine glasses with spider plants, and potted plants. Joncie also brought homemade baked goods, and I must say they were delish! Even adding the classic holiday movie “Elf” was just another small way to help people smile in spite of the pandemic. We are blessed to have Joncie finding ways to help us lift our spirits during these unprecedented times.  
Helping Dementia Patients to Remember
Submitted by Lindsey Callahan RN, Director of Nursing, Pinnacle Nursing and Rehab, Price, UT
Recently, I walked into the Therapy Gym and Derrick Stanger, COTA, was working with a resident who has dementia and sometimes has difficulty following directions of the task that therapy is having him complete. Derrick had a box full of rocks and was having the resident brush the rocks, looking for fossils. The resident was focused and enjoying what he was doing. 

When this resident was younger, he was the lead of several archaeological digs that found dinosaur bones and fossils. He is well-known in our area. He even consulted with Steven Spielberg on Jurassic Park.

Shoutout to the therapy department for thinking outside the box and individualizing therapy to each resident. 
Think Thin
Initiative
The Path to Thin Liquids
By JB Chua, PT, CEEAA, DOR, Summerfield Healthcare, Santa Rosa, CA
I just want to share an excellent idea and great initiation that our SLP, Carina Beckman, is doing in our building. Our building only has a couple of long-term residents who are on a thickened liquid diet, and Carina has always been on top of these cases to ensure that every opportunity to upgrade them will happen. She approached me today with this great idea which also made me realize that small details can really make an impact to our residents. 

Shown is a picture of a piece of laminated paper that Carina created so we can put it into our care boards for our nursing partner to see. She realized that some of our nursing aides on the floor may not have any idea if our residents may need assistance when doing their oral care or hydrating. She coordinated with our OTs to make sure that it will be something that they can include in their assessments, especially if SLPs are not involved in the case. Our DON also loved the idea. Thank you for guiding us to better serve our patients. We’re looking forward to more creative ideas.
Frazier Free Water Protocol:
An Essential Tool for Quality of Life 
By Brandon Larson, SLP, Rock Canyon Nursing & Rehabilitation, Pueblo, CO
The Frazier Free Water Protocol has been an essential tool here at Rock Canyon, one that has provided us with confidence during our consistency trials, and one that has provided our patients with improvements to their quality of life and overall health. As an SLP in a respiratory rehab setting, it’s common to see NPO, HTL and NTL in the diet orders of our patients. It’s uncommon to hear a patient communicate a preference for thickened liquids or a desire to remain NPO. If a patient’s personal goal is consistency advancement, the FFWP provides SLPs with an opportunity to trial thin liquids and swallow strategies safely and pragmatically if the oral care tenets are followed. 

If a patient’s goals are tailored towards quality of life, then we can rest assured that we are minimizing the risk of aspiration, while improving oral health, hydration, and a patient’s overall happiness after the protocol is implemented. Lest we forget, several peer-reviewed studies show that poor oral hygiene significantly increases the risk of aspiration pneumonia in our high-risk patients, regardless of their consistency orders. Here at Rock Canyon, the FFWP is essential for both patients and staff, and it is a technique that can be used diagnostically, therapeutically, and as a means to improve quality of life. 
Think Thin: An Inter-Disciplinary Hydration and Nutrition Collaboration Project 
Submitted by Paul Emerson L. Baloy, OTR/L, DOR, The Hills Post Acute Care, Santa Ana, CA
The Hills Post-Acute is revisiting and re-implementing the “Think Thin” program. The goal of the program is to place our residents on the path of safe intake of thin liquids like water, juices, coffee and broths at the soonest time possible to improve their overall hydration and nutrition. This is an interdisciplinary approach spearheaded by our Speech Language Pathologist and Dietary Department in collaboration with our nursing partners. Members of the team will complete assessments to reduce risks and identify strengths to come up with a safe and comprehensive hydration and nutrition program improving the overall quality of life of our residents, especially the vulnerable and compromised.

Diane Bangar, MA, CCC-SLP, CBIS, (pictured) is a lifetime member of ASHA and a CSHA fellow. Her prior experience was in the Los Angeles County Medical and Acute Rehabilitation Medical Center settings. She has worked with rehabilitation teams serving stroke, adult brain injury, SCI/TBI and progressive neurological diseases. Her practice is geared toward the rehabilitation of the neuro-geriatric population.
Think Thin Collaboration in Flagstone!  
Morgan Nebo, Dietary Supervisor at Victoria Post-Acute, and Aggie Smith, Flagstone Dietitian, provided a great presentation to the Flagstone DORs and SLPs on best practices for therapy and dietary collaboration with emphasis on ThinkThin! 

Key takeaways from this presentation:
  1. CMS — Quality of Care Intent: “To the extent possible, MAINTAIN or IMPROVE before complications arise.” 
  • Resident HYDRATION is the key (and the challenge) with thickened liquids.
  • F692, Quality of Care Nutrition and Hydration, requires that a resident is offered sufficient fluid intake to maintain proper hydration and health.  
  • As a general rule, most residents will require 1500–2000 cc daily under “normal” circumstances — SLP collaboration. Read On...
Aggie Smith, Flagstone Dietician
Morgan Nebo, Dietary Supervisor
Thinking Thin at HCR Olathe 
By Elizabeth Munford, PTA, TPM, The Healthcare Resort of Olathe, Olathe, KS
Giving a shout out to our awesome SLPs here at HCR Olathe who have started education on the three pillars of pneumonia to all staff, specifically in the midst of a COVID outbreak. With their focus, we are down to one thickened liquid case in the entire building, and this specific resident has been NPO for many years, so honey thick is still a progression. We made little symbols for the patient doors to be a better signal to staff for altered diet and thickened liquids. They have also switched our building from powder thickener to a higher quality gel thickener. 
 
The other thing we are doing is putting in a “task” on the care plan for oral hygiene. We realized none of our nursing staff is prompted with a task to prep for oral hygiene. They have previously had a generic “personal hygiene” task and oral hygiene has not been a focus. We have seen better results when we are able to actually task the oral hygiene process and approach on the care plan. 
Therapist Profile
Submitted by Jamie Funk, Therapy Recruiting Resource
Dennis Baloy is one of our more recent additions to the Ensign affiliated therapy leadership team. As the Director of Rehabilitation at St. Elizabeth Healthcare & Rehabilitation Center, Dennis immediately recognized our unique culture: “I just want everyone to know how lucky I feel to be part of this wonderful organization that truly embodies the value of Customer Second, where we as therapists and employees are celebrated, valued and appreciated. I am even more humbled to be surrounded by really bright, talented and passionate leaders. Everyone is so inspiring in their unique ways. Collectively, this is what truly sets us apart!”

Dennis has been a therapist for 15 years and a Director of Rehabilitation for the past eight years. He graduated with his Bachelor of Science in Occupational Therapy in the Philippines and later completed his Clinical Doctorate in Occupational Therapy with Geriatric Certification in the United States. As a child, Dennis always wanted to become a doctor and thought therapy might be a stepping stone to that career. However, as he immersed himself in his first OT internship, Dennis realized that OT was it for him — a career that would allow him to care for others, be creative and be human. Dennis has two brothers who are his biggest inspiration and mentors: Paul and Kirby. “They are the biggest reasons why I am where I am with my career,” Dennis says. Read On.,..
Dennis and Team ("When gathering was ok and we were allowed to take off masks")
A Sense of Renewal: Golden Acres Sensory Room Grant
By Cara Koepsel, M.S., CCC-SLP, CTO, DOR, Golden Acres Rehabilitation,
Dallas, TX
We wanted to share with you all this amazing new addition to Golden Acres. Below are pictures of the sensory room we just finished building from the funds received from a CMP grant we applied for back in February. 
 
This sensory room will tap into the five senses of our residents and hopefully give them a sense of peace, allow them to reminisce on better days, and decrease behaviors associated with the progressing stages of dementia. Having this room in our therapy gym will allow us to touch so many lives and truly give our patients a reason to live! They can come to the room to smell a scent pod of fresh-baked bread in the air; play with the textures on the tactile wall panels; and, as pictured, enjoy holding one of our many vibrating bunnies! We are so excited to bring this idea to life in our building to provide the best dementia care possible to our residents. It brought tears to my eyes as my therapists and I watched our first residents experience this room today. It's what we all needed.
 
These CMP grants can do such wonderful things for our residents and our programming in our buildings. Please reach out to me or our awesome grant committee lead, Stephanie Winkler, if you'd like more information on how to apply for a grant for your building!
Happy News from EPAR
By Paula Voorhis, PTA, DOR, Englewood Post Acute & Rehabilitation,
Englewood, CO
In recent weeks, Englewood Post-Acute and Rehab has been handling the COVID outbreak with as much grace as possible. I just wanted to take a moment to share some photos of our celebrations of success. This is our first group treatment since October, which is when we went into full lock-down, outbreak mode. It was organized by two of the most compassionate therapists I know, Emily White, PTA, and Wendy Garrison, OTA. The residents had a blast! 
This is Ron; he was in a catastrophic car accident in 2019, which brought him to us. He received prosthetic training and was set to go home in early November, when he tested positive for COVID. Plans to DC home were postponed, but he made it, and has made it back home to Nebraska.

Rock Creek Christmas Spirit
By  Stephanie Anderson, ED, Rock Creek of Ottawa, KS
I have to share this amazing-ness! Our community of local businesses and families has adopted all of our residents for Christmas.

Look at all of these gifts! You can’t hardly walk in this room. The doorbell keeps ringing, and more things keep arriving. My heart is (once again) full!
Golden Acres "Be a Santa to a Senior"
By Cara Koepsel, DOR, Golden Acres Living & Rehabilitation, Dallas, TX
At Golden Acres this holiday season, the therapy team put together an "Adopt a Resident" program to ensure that all of our patients got a wrapped present to open during the holidays. This came during a much-needed time when our residents couldn’t spend their usual time with their families and needed our love and support the most.

The looks on our residents’ faces when they were receiving their gifts was priceless! What a great way to spread holiday cheer at the end of a challenging year!
Celebrating Success at Beacon Harbor By April Trammell, SLP, DOR, Beacon Harbor Health & Rehabilitation, Rowlett, TX
Jimmy arrived at Beacon Harbor on April 13, 2020. He was in a very devastated state following a spinal fusion, which was compromised, leaving him with hemiparesis from the chest down. Because he was unable to feel his legs and feet, he was having frequent falls, required a hospital bed with assist rails in order to maneuver in and out of bed, and was wheelchair-bound. “I was brought to Beacon Harbor for my last days on earth to be comfortable and to give my wife Dianne a respite.” 

Plans for Jimmy were to transition here to Beacon Harbor long-term care. But Jimmy had other plans in mind. He was successfully determined to wean off of all pain medication. “Then I started doing therapy — that wore me out — but I had it in my head that I wanted to recover.” Jimmy and his team of therapists were determined to help him gain his independence. Read On...
Transitioning Our STOP AND WATCH Program into a True Conversation
Submitted by Kari Rhodes, MS, CCC-SLP, Therapy Resource – Keystone – West, TX
At Legend Oaks of Fort Worth, there have been a fair share of ups and downs in communication. As with most skilled nursing facilities, there are some struggles to get nursing and therapy on the same page, especially regarding changes in a patient’s condition. However, a recent change in structure for daily morning meetings has made a significant impact on both communication and patient care. 

Initially, staff were encouraged to complete paper STOP AND WATCH forms that were turned in to the charge nurse. This was helpful in reporting noted changes, but it did leave room for improvement. Papers were misplaced, the change was forgotten, or multiple forms may be completed on one resident. 

Staff were then trained in entering the STOP AND WATCH forms on the clinical dashboard in PCC. This improved the chance that the alert was seen by more people and addressed by a clinician. Unfortunately, the electronic alerts also were, at times, inadvertently left unaddressed by a busy nurse or well-meaning staff member. 
Fortunately, what has been an amazing change for the team at Legend Oaks Fort Worth was a very simple addition to the morning meeting. Read On...
Recognizing The Courtyard -- Stronger Than Ever!
By Paola DeLuna, Therapy Resource - Keystone East, TX
The Courtyard is in small town Victoria, TX, where it is very difficult to find therapists due to the rural location. They have a very small, close-knit team that grew even closer and stronger recently when their building experienced a COVID outbreak. Employees immediately began signing up to work extra hours and doing all they could as some staff had to quarantine at home. Anita Stortz, TPM, and her team did not hesitate to take on different roles and whatever it took to help patients and nursing staff. They stayed late hours to move residents, helped to provide meals and feed residents, assisted with activities and took on anything nursing needed in the COVID unit. Anita knew that she had to keep her team healthy to be able continue to provide good care for her residents. She took the initiative to help her evaluating therapists and decided that they would only provide Telehealth while she would assist every treatment for them with her phone. She was a trooper every day in and out of that unit doing her very best to stay healthy and help all her disciplines get their visits, evaluations and treatments to keep our patients happy, healthy and out of the hospital. It was a very difficult time for the team as they balanced helping to progress patients while staying safe.

As they battled through together, and despite all infection control measures that followed, many of the team members tested positive and were sent home. Anita continued to rally the team to stay strong, and as they recovered and were able to once again able to return to work, they realized that they had survived and actually grew stronger than ever.

This team of warriors is small but mighty!! We love you guys! 
Congratulations Jacob Barnes, Bandera's Newest CTO!
Submitted by Shelby Donahoo, Therapy Resource, Tucson, AZ
We are proud to honor Jacob Barnes, PTA, TPM, at Park Avenue Health and Rehab in Tucson, AZ!
Jacob has been with Ensign at Park Avenue since 2013 and truly exemplifies CAPLICO culture. Jacob’s ED, Jordan Monson, says Jacob “is like salt: He’s sprinkled into every nook and cranny that is Park Avenue.” In other words, while Jacob leads a large rehab team with strong outcomes clinically and operationally, his ownership over the years is way beyond the Rehab department. 

2020 led to some exceptionally tough times for all, but Jacob’s leadership shined through in this pandemic. In between serving meals, moving beds, and working all hours to support the facility, he quadrupled long-term care revenue, increasing margin by 8%. This was accomplished by concerted and thoughtful implementation of holistic programming to meet the growing needs of Park’s residents. He developed leaders in his team, such as our Bandera Abilities TEACHA, and created a designated long-term care lead and team. He helped facilitate support and communication with market DORs as challenges arose during COVID. Read On...
Vestibular Function
Submitted by Evette Ramirez, DPT, DOR, Legend Oaks of Waxahachie, TX
All information taken from the vestibular course given by Ann H. Newstead, PT, DPT, PhD, GCS, NCS, CEEAA
As we age, there is a greater incidence of falls. Many factors play a role in these falls; some external and some internal. Some risk factors include medications and resulting side effects, cognitive impairments, lower extremity disability including loss of sensation and/or foot deformities, balance abnormalities, dizziness, orthostatic hypotension as well as increased dependence on visual cues for ability to achieve and maintain balance.

Vestibular function is an area that we as clinicians can address to help reduce potential falls. As 30% of older adults develop vestibular dysfunction, knowledge of when and how to treat as well as when to refer to a specialist is a needed skill. As we age, vestibular changes begin at age 40 with reduced number of hair cell in the inner ear as well as a decreased number of nerve fibers, which lead to decreased to increased difficulty with competing visual and somatosensory input.
Definitions to know: Read On...
Therapy / Life Enrichment Collaboration at Omaha
By Darin Foster, DOR, Omaha Nursing & Rehabilitation, Omaha, NE
Omaha Nursing and Rehabilitation Center's Therapy department and Life Enrichment Director have formed a wonderful relationship since instituting group and concurrent modes of treatment. Although the Covid-19 pandemic has impacted our ability to continue the larger group activities, the collaboration between the two departments was able to continue in order to enrich the lives of our residents. 

We are fortunate to have an Occupational Therapist, Staci Slater, who does a photography business on the side. Utilizing her skills, we were able to create a vintage photo shoot that was absolutely entertaining for both staff and residents. Not only was this activity enjoyable but Staci was able to incorporate goals of standing/sitting balance, activity tolerance, fine and gross motor tasks from holding the props as well as dressing tasks with the costumes. Additionally, goals of sequencing and following directions were addressed as well. (See photos below). To celebrate our current Veterans in the facility, our Life Enrichment Director, Brandi Fisk, once again put our camera savvy OT to work to help create a wall in the facility that would honor those who have served to protect our great country.
Outpatient On Demand
Submitted by Kathey Perez, PT, Therapy Resource - Keystone South Central, TX
Outpatient On Demand is a great way to look at ways to expand our delivery of outpatient services. Many of our patients are afraid to leave their home due to the pandemic, or can’t leave due to transportation issues, or maybe they are fearful to leave our facilities worried about failure when they go home. Outpatient on Demand helps us overcome some of these concerns while meeting the needs of our community. We can help those that may not be homebound by home health standards but have a need for services, and help the successful transition of patients back into their home by being able to provide education and training in the area they need to thrive. Once the patient is able to come to our facility, we can transition them to Outpatient at the facility as well. Patient identification should start with care planning upon admission to our facility. We can also identify them by doing home evaluations prior to discharge. Read On...
Welcome to the Family!
Golden Hills Post Acute Care, San Diego, CA By Matt Flake, Executive Director, SD United, CA
SD United is very excited to ring in the New Year by welcoming Golden Hill Post Acute to the Ensign Family. Golden Hill, located in the city of San Diego, is a 99-bed facility including 35 subacute beds. Shaun Alkema is the Administrator, Winnie Wong is the DON, and Cassandra Mateo, PT, is the DOR. A BIG thank-you goes out to everyone who has been working so hard for months to make this a smooth transition, including the Service Center team, our SD United and Flagstone resources, and the market EDs and DONs. It's been a day of responsible, mask-wearing celebration here with T-shirts and Martinelli's at the stroke of midnight last night and pizza and goodies today. We see great things in the future for this facility and its amazing team. Happy New Year!  
Golden Hill Post Acute therapy team, led by Cassandra Mateo, PT (far right)
New Momentum Facilities
By Tyler Albrechtsen, Executive Director, Momentum Market, CA
With the start of 2021, Momentum welcomed two facilities: 
  • Camino Healthcare (formerly Windsor Gardens Hawthorne), led by Mike Forsgren, ED, and Wanda Bailey, DON; and 
  • St. Catherine Healthcare (formerly Windsor Gardens Fullerton), led by Rand Looper, ED, and Rosanna Palecpec, DON, with a new DOR to start January 18, Jen Austria, PT

These facilities are great additions, and we are excited to continue to learn and grow together as we dignify and transform post-acute care. Here are some pictures from the socially distanced celebrations:
Camino Healthcare Team
St. Catherine Healthcare Team
2021 Reset Challenge!
By Maryann Bowles, WCC, PT, Therapy Resource – Endura, CO
The Endura Market has joined together for the 2021 RESET CHALLENGE. Both Clinical and Therapy are on teams challenging each other to get fit in 2021! It’s a competitive group, but lots of fun! 

CONGRATULATIONS Estrogen Express (Lyndi, Hebba, Stephanie, and Kimmie) on 1stplace 5 days into the month! Glad to see us attempting to take better care of ourselves in 2021. We are missing Die Lard, best name EVER, (Patty, Cathy, Paula V., Caitlin) and Slow Speed Chase (Betsy, Stacey, Maryann, Scarlett). Please let me know if you are struggling to register. Here are the teams:
 
1.    Estrogen Express (Lyndi, Hebba, Stephanie, Kimmie) - 56 miles!
2.    Run Now Wine Later (Alison, Alicia, Ellen, Susan) - 48 miles!
3.    Regulators (Barry, Rima, Jo, Natasha) – 33 miles!
4.    Heart & Sole (Mel, Jessica, Josie, Nicole) - 31 miles!
5.    Not Fast, Just Furious (Kim, Shannon, Emily, Belinda) - 26 miles!
6.    Run Like the Winded (Heidi, Appy, Patty N., Angel) - 23 miles!
7.    Therapeutic Interventions (Paula R., Jenny, Nicole, Kendra) - 12 miles!
8.    Die Lard (Patty, Cathy, Paula V., Caitlin)
9.    Slow Speed Chase (Betsy, Stacey, Maryann, Scarlett)