29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
March 2022
Click Here for a printable copy of The FlagPOST
The Valentine’s Day Tree in my neighborhood gave me the opportunity to scribble down a love note for our nurses and therapists. A tiny gesture dangling from a tree branch, but lately it seems every little bit we do to spread love to each other matters. Many business articles that you read today talk about how love is the new driver of business. Thanks to the wisdom of our founder Roy Christensen, we were in the business of love long before it was even heard of to include love as a core value for a business. Whether love is revealed in a tender moment with a patient, or in the fierce passion and dedication of our teams, it is the lifeblood of our organization and fundamental to our future growth. #LoveOneAnother! 
Roy's Corner Legacy of Leadership
Announcing Bandera’s Newest CTO Recipient: Dora Alvarez, TPM at Sabino Canyon, Tucson, AZ 
Submitted by Shelby Donahoo, Therapy Resource, Arizona

Here's an example of leadership development at its best!

Dora started at Sabino Canyon in 2012 as a therapy tech and transitioned to COTA once she completed school and received her license. She was promoted to TPM in 2015 and has now received CTO in 2022, 10 years after she began with Sabino Canyon.

In fact, when you ask Dora what she values most about her job, she says it's "the ability to allow people to grow in the organization" like herself. “There’s an investment in people to learn — to allow them to develop and get it right.” She also values the ability to be flexible to meet others’ needs: the patients, the team and her co-workers.

Dora is part of an interdisciplinary team that shows the importance of thinking out of the box and of teamwork, especially between nursing and rehab. She and her DNS partner, Quinny Mazzola, work together hand in hand to achieve excellence. They know, understand and respect each other’s goals, and they equate their success in therapy metrics, outcome scores, quality measures, turnover and facility ranking (2nd in Arizona) to this collaboration.

Dora is from Tucson and is married with three kids. Her oldest is currently in COTA school! It’s family first for Dora. In addition to multiple dogs, she recently added chickens, and her husband built the coop! Dora loves music, art and tranquility, all contributing to her work/life balance. Congratulations, Dora!
Congratulations to Our DORiTOs
Since establishing the Director of Rehab in Training (DORiTO) Program in 2018, more than 100 therapists have completed the program. Shared below are a few of their Capstone Projects. We will continue to share more in future issues of the FlagPOST.
ACA Overview at Holladay Healthcare
By Danielle Kistler, OTR/L, CLT, Holladay Healthcare, Salt Lake City, UT
The goal of the DORiTO Capstone Project is to find a need in our facility and implement a program that will benefit the residents, interdisciplinary team (IDT), or facility as a whole. I chose to implement the Abilities Care Program at Holladay Healthcare with the goal of improving the quality of life of the residents living with dementia at our facility. Little did I know, the effects of this program not only helped the residents, but their families and our entire interdisciplinary team.

The Abilities Care Approach is a specialized dementia program that results in a comprehensive understanding of a resident’s remaining abilities and life story in order to provide skilled interventions and caregiving approaches to match the individual’s preferences, abilities, and established patterns. This program is unique because the goal is not to restore an individual’s abilities or change anything about them, but to adapt the environment and how we provide care to support each resident’s highest level of function. Once I established the Abilities Care Program as my capstone project, our OT department took the Ensign-U LMS trainings, utilized resources from the Ensign Portal, and visited another facility supported by Ensign to observe a successfully implemented program. Since beginning the program, every Monday we have been participating in The ADR and Appeal’s team “Buddy Program” to facilitate our ability to provide the highest quality of Medicare Part B documentation specifically for the Abilities Care Program.
Nursing and Staff Retention
Submitted by Roe Hughes, DOR, Rock Hill Post Acute, Rock Hill, SC 
Kyle Hayes, a Physical Therapy Assistant, has successfully completed his DORiTO training targeting Nursing and Staff Retention as his Capstone Project. He is originally from central Illinois. He initially worked for an Ensign affiliate on the West Coast in San Diego and now serves on the East Coast at Rock Hill Post Acute Rehabilitation Center here in Rock Hill, SC. He loves the core values of our company and uses creativity to help his patients successfully return to their home environment. Kyle is a vital member of our rehab team. We are so excited for what the future will bring his way.
Blood Flow Restriction Training (BFR) at Irondale 
By David Schlachtenhaufen, PTA, Irondale Post Acute, Commerce City, CO
David just finished the DORiTO training, and this is his Capstone Project as well as a programming initiative at Irondale. – MaryAnn Bowles, Therapy Resource, Endura, CO

The Therapy team at Irondale Post Acute is changing the way we think about exercise in the geriatric population. Using B Strong’s Blood Flow Restriction bands, they are improving outcomes for patients with a variety of functional limitations. 

BFR is achieved through the application of specific external pressure, proximally, over the extremities using pressure-controlled bands. Light exercise then results in significant metabolic stress, which stimulates adaptation both locally, in the muscles, and throughout the body via a neurohumoral anabolic cascade. 

Some of the benefits of BFR include: increased strength and hypertrophy with loads as low as 20% of 1RM, the release of 70% more growth hormone when compared to traditional heavy resistance exercise, increased bone mineral density, angiogenesis, and collagen synthesis. Irondale’s therapists are incorporating BFR into gait training, therapeutic exercise, and therapeutic activities with outstanding results.
Therapist Profiles
Kristine Schafer, PTA, Sonterra Health Center, San Antonio, TX  
Submitted by Lindsay Fry, Therapy Resource, Keystone, South Central TX
We are very excited to announce that Kristine Schafer is the newest Therapy Program Manager at Sonterra Health Center in San Antonio, Texas. Kris has been a staff PTA at this location for over 12 years, was the ADOR, and has now stepped into this role. She has proved her dedication to Sonterra, both the building and its residents. Kris was the therapist who could always get her patients to participate, even when they wanted to refuse. Most recently, she worked with the skilled population exclusively, where she had amazing outcomes. Recently, multiple management changes have occurred at Sonterra to include the MDS nurse, social worker, administrator, DOR, and case manager, and Kris has proved that she can withstand the storm. Welcome, Kris! Here are a few other fun facts about Kris:
  • Kris has a 6-year-old daughter, Daniela, who is the light of her life.
  • Kris is an amazing baker — her carrot cake is especially delicious. 😊
  • Kris was in the Army.
  • Kris enjoys spending her summer days at SeaWorld with Daniela. 
  • Kris loves spending time with her family, going to church, and doing yard work.
Celebrating Dawn Schill, OTA, TPM Rock Creek of Ottawa, KS
Submitted by Danielle Banman, Therapy Resource, Kansas
Dawn transitioned to the role of TPM as the inpatient therapy leader as the current DOR transitions to the outpatient therapy leader to further develop the program here in Ottawa. Dawn graduated from the local college in 2015 and has worked at Rock Creek for almost two years. Dawn is a CLT and especially enjoys challenging patients and improving their quality of life through building rapport and the Abilities Care Approach. 

Dawn is married and has seven “kids”: four dogs and three horses. She and her husband live in the country and enjoy being outdoors, and she has plans to start barrel racing next year! We are excited to see all she will accomplish in her new role! 
A Labor of Love at City Creek
Submitted by Ray Yarman, DOR, City Creek Post Acute, Salt Lake City, UT
Jennifer Farnsworth, OTR/L, has been a pillar of City Creek Post Acute’s rehab team for over five years. Jen has truly embraced the understanding and carrying out of “dignifying long-term care.” She was the first one to start to plan for an integrative celebration for our residents. Jen has done this for numerous years at City Creek, and 2022 is no exception. 

This year, Jen planned and carried out our “Valentine’s Day Dance,” including a choreographed dance. She helped our residents get in dresses/pants suits with their hair done and the best jewelry selected. Jen reached out to our local community thrift co-op, The Other Place, which donated dresses to our residents. Jen therapeutically taught the residents in a collaborative approach with our recreational therapist, with choreography to “Can’t Stop the Feeling” by Justin Timberlake. 

Our residents were floored by our Valentine’s Day Dance celebration and truly felt so special dressing in nice attire to celebrate Valentine’s Day. Jen is so much of our heart and soul here at City Creek, and we are so lucky to have her as part of our team. 
Congratulations, Iris Rubalcava
Submitted by Aimee Bhatia, Therapy Resource, Flagstone NCI - CA
Please join me in congratulating Iris Rubalcava, PTA at Channel Islands Post Acute in Santa Barbara, California, for becoming a citizen of the United States of America! She worked hard, studied proudly, and achieved what she has been working toward. 

Iris has been working at CIPA since the time of their acquisition in 2019 and also had a history at that building prior to that. She is a highly valued, compassionate, dedicated and hardworking employee we are honored to have caring for our residents. This is such a special time for Iris and her family, both her family at home and her work family. Thank you, Iris! We are proud of your accomplishment. 
ILF "Outside These Four Walls" Partnership
Submitted by Jacqueline Eaton, TPM, The Healthcare Resort of Topeka, KS
HCR of Topeka partnered with the preferred Home Health Agency (HHA) in our community to create better clinical collaboration when patients are finishing their home health services, but continue to have outpatient therapy needs.  
Many of the patients seen by the local home health agency reside in an Independent Living Facility (ILF) in our area. In an effort to ensure a smooth transition, the HHA requests outpatient therapy orders once the home health service is ending. Upon receipt of these orders, we schedule the patients for an evaluation at our therapy gym. Some patients will benefit from therapy services provided in their home and community, and we schedule the patient for the service location that will optimize their individualized treatment plan.

We also provide support to the local ILF by providing general education and training to the administration and the Thrive-at-Home representative to ensure optimal wellness programming for ILF residents and to offer our services for PT, OT, and SLP consultation when it is clinically indicated. We collaborate with the HHA, Thrive-at-Home, and the local ILF to offer Health Fairs and balance clinics on a regular basis. Read On...
These are just a few of our AMAZing therapists here at the Healthcare Resort of Topeka
Therapy / Nursing Partnership
Discovering the Joy in Collaboration
Submitted by Dominic DeLaquil, Therapy Resource, ID/NV
Like all of the Summit Markets, Meadowview Nursing and Rehabilitation in Nampa, Idaho, is intently focused on building its Therapy-Nursing collaboration into something truly transformative. 

Director of Rehab and CTO Kristen Bailey acknowledges that while they have only begun to scratch the surface of the various ways Therapy and Nursing can collaborate to improve quality metrics, increase staff retention throughout the facility, and improve the lives of the residents, she has already seen a significant change in the atmosphere at Meadowview.  

“If you’re not in the building every day, you probably won’t see it. Our Nursing and Therapy have always gotten along, but it’s different now. I see the therapists and nurses having a different energy to their conversations in the hallways." Read On...
Pivoting with Nursing 
Submitted by Scott Langdale, Therapy Resource, Washington
We love our nursing partners! Over the last few months, we have seen stronger and deeper relationships grow between Nursing and Therapy in every one of our programs in Washington. I wanted to highlight a great example of that at The Oaks at Lakewood.

In Washington, our facilities are eligible for a Quality Enhancement add-on to our Medicaid rate based on clinical categories of pressure ulcers, UTIs, falls with major injury, and staffing turnover. The higher the facility scores, the higher Tier they are eligible for. When Glenn Aricaya, PT, and Erlinda (Erlin) Calsado, DON, joined the team at The Oaks at Lakewood, the facility was a Tier 1. Glenn and Erlin developed great systems together for reducing falls, eliminating and preventing wounds, and addressing weight loss. All of this hard work and collaboration has brought them up to Tier 4. Great job, Team Lakewood!
Group and Concurrent
How the Organizational LEADER
Gets It Done!
(Hint: It’s About Teamwork 😉)
By Shelby Donahoo, Therapy Resource, Arizona
Month in, month out, COVID or no COVID, Sabino Canyon in Tucson, AZ, leads our organization in group and concurrent metrics. Averaging around 30% in both skilled and long-term care provision, it’s just become part of the facility culture. Executive Director Jaron Watson, DNS Quinny Mazzola, and TPM Dora Alvarez spoke to the Tucson market at an ED/DNS/DOR meeting last month to discuss.

“It’s about partnership,” they all said. “There aren’t ‘department goals’ but all-inclusive “facility goals.” Nursing is just as invested in rehab metrics as their own, and vice versa. There is an understanding of the benefit of group and concurrent for the residents and the facility from an IDT perspective, so it’s considered a group effort to achieve this metric.

Sabino Canyon runs an extremely busy skilled and long-term care program and services, so services need to be focused on function from day one. With a combination of group and one-on-one services, we get to spend more time with our patients overall, and our patients receive longer rehab services during a given day,” said Dora. This is a philosophy adapted with PT, OT and SLP.  Read On...
Sharing a Fun Way to Love One Another Submitted by Sharon Merritt, TPM, Opus Post Acute Care, West Columbia, SC 
Porky is a cute stuffed pig that sings. Porky helps spread the love by getting passed around within our department head team when someone “saves your bacon.” Receiving Porky means you helped someone out who was having a hard time or needed a hand. Porky hangs out with you for the month, and then the receiver of Porky gets to pass the love along at the beginning of the next month! 
Fun Times at Pinnacle 
Submitted by Seth Anderson, Executive Director, Pinnacle Nursing & Rehabilitation, Price, UT
We celebrated 80’s day recently at Pinnacle, when we dressed up and did a patient and staff aerobic session with over 20 residents. 

Then we had a memorial service with a balloon release for one of our residents who recently passed. 
Lots of tears were shed, and it was therapeutic for residents and staff.

Tag Busters:
FALL PREVENTION FOCUS 
Partnering with Nursing: F-Tag 689 
Submitted by Tamala Sammons, M.A. CCC-SLP, Sr. Therapy Resource
Federal Tags (F Tags) are the minimal Federal and State Standards of Care that are used to survey Skilled Nursing Facilities as a measure of performance. Rehab Services provides an important role in order to ensure compliance with these standards by having strong systems for IDT collaboration, patient identification, and providing skilled intervention programming.

“Assistance Device or Assistive Device” refers to any item (e.g., fixtures such as handrails, grab bars, and mechanical devices/equipment such as stand-alone or overhead transfer lifts, canes, wheelchairs, and walkers, etc.) that is used by, or in the care of a resident to promote, supplement, or enhance the resident’s function and/or safety.

  • Are Safety Assessments part of therapy evaluations? Are they completed during different times of the day with various scenarios? 
  • How often does therapy engage in assessing assistance devices and providing staff education on proper use? How often does therapy assess to see if those devices are still the best option for each resident?
  • Does therapy use a gait belt on patients anytime they require more than a supervision level of assistance?
  • Is Therapy familiar with what’s on the care plan and helping to ensure it’s accurate for device usage?
  • Is Therapy familiar with the CCA audit specific to this tag? Read On...
Falls Team at Rosewood
By Whitney Wilding, DOR Rosewood Rehabilitation, Reno, NV
We have started a Falls Team at Rosewood that includes two of my PTs and I meeting monthly to discuss issues and trends. We do our meeting following the monthly QA meeting and look at trend data as well as personal experience from those on the floor regarding issues, patterns, etc. I feel it has been very successful at this point! Here are a few of the things we have put together:
  • We started a screen form specific to falls as we felt the UDA in PCC did not gather the information we really needed to intervene properly after a fall. This screener is filled out by a therapist and includes time-of-day information, fall predictor information such as patient’s history of falls, and qualitative information such as fear of falling to complete our analysis. This also includes what Nursing interventions are currently in place and any referrals to Therapy following the incident. I have attached a copy of that for your perusal. 
  • After implementing this form, we began to take note of some patterns that were happening with falls that we could address. After implementing some additional safety measures to address the patterns we noted, our falls declined 18% month over month. Read On...
APTA Geriatrics Certification: Balance and Fall Prevention 
By John Diaz, DOR, Magnolia and Parkside, El Cajon, CA
Lorna Garcia, PT, and I are in the final process of completing the APTA Geriatrics Certification: Balance and Fall Prevention in Community Dwelling Older Adults. We took the course in preparation for the outpatient program at Magnolia, where we want to serve the community outpatient needs. These are screening tools (three tests and a questionnaire) that the CDC has been utilizing for their STEADI (Stop Elderly Accidents, Deaths & Injuries). Their algorithm is to screen, assess, and intervene. 

We can use these tools to assist us in doing a quick screen to support why we need to conduct a more thorough evaluation for our patients. We can use them in all settings, and it would be beneficial to have as baseline information to look into when we do a quarterly or annual screen at the skilled nursing level.
Fall Prevention at North Mountain 
Submitted by Calli Carlson, DOR, North Mountain Medical, Phoenix, AZ
Missy Lee, Physical Therapy Assistant at North Mountain Medical, spent many afternoons after work studying to be a fall prevention specialist. An experienced therapist herself, Missy became interested in this topic in order to help patients and their families maximize safety and independence within the home as well as to diversify and challenge the therapeutic interventions she offered. 

Missy has learned to examine all factors that could contribute to falls, including, but not limited to, the following: patients' medications, lifestyle choices, types of shoes, environments, sleep quality and duration, and vestibular system. With our patients, she can administer five or six different types of balance tests that better determine a patient's fall risk and outcomes in order to provide appropriate education to patients and family members. Missy exhibits a continuous passion for learning, which provides patients with the highest quality, evidence-based practice interventions. She even provided an in-service to staff members and has already helped reduce the number of falls within the facility!
Moments of Truth
Submitted by Ryan Hough, Therapy Resource, Nebraska

Shannon Severs is a Clinical Resource in Nebraska and lives in the Omaha metro area. They have had challenges finding the right fit for DON at Falls City. Shannon has stepped up to not only be the interim DON but also lead the way in making significant changes and improvements within Falls City Nursing and Rehab. The facility is located about two hours away from her home. 

Here is the moment of truth written up by the facility. 
“Shannon Severs is the clinical resource at Falls City Nursing and Rehabilitation. She has made a great impact on our facility. She stepped up and became our interim DON when one could not be found. She has invested a lot of her time into our facility, leaving her family and friends to help us. Shannon always has good input on our culture piece from each of our IDT team. She always wants to celebrate, even the small stuff, from marketing to retention. Since Shannon has been at our facility, we are seeing a good culture change amongst the staff and the residents, as well as in our community. Given the true meaning of being selfless and showing the passion for the skilled nursing area, Shannon does not believe in an 8-to-5 job. She continues to work tirelessly, helping our facility to be successful. She is a very caring, compassionate person with all the residents and staff. Shannon has shown us the true meaning of CAPLICO.”
Getting More From Our Residents Than They Get from Us
By Kari Rhodes, MS, CCC-SLP, Therapy Resource, Keystone West TX
Recently, I had the privilege of accompanying Jon Anderson to the Texas Panhandle to spread a little love and cheer with Jon’s “Happy Cart.” We have passed coffee, tea, lemonade, candy, and “Happy Bar Prescriptions” to five of the 10 facilities in the West market. Jon and I have made a point of including the residents when we pass the refreshments. We have been so blessed with the smiles and cheer we have received on these trips! Undoubtedly, we have been more blessed by those we encounter than any blessing or joy we have delivered. From meeting perseverant staff who have cared unwaveringly for our ladies and gentlemen to encountering hundreds of smiles and thanks from those they care for daily, we have certainly had our cup filled!

One recent trip to The Garrison in Lubbock was especially remarkable to us. It was there that we had the privilege of meeting Dorothy. “Dot” is 101. Sharp as a tack, she still paints phenomenal works of art daily. She agreed to let us take her photograph (but had to see it to approve!) and tell her story. Dot taught Sunday school in her community, and she was the teacher to none other than the Garrison’s administrator, Kara Copeland! She is a remarkable lady with a beautiful smile and a talented hand. 
The Garrison is currently home to 104 residents who are able to observe and care for the chickens in their courtyard or work on the tool bench in one of their memory care halls. Life storyboards are everywhere, and so are smiles. What a privilege it was to spend some time there! 

It is easy to get caught up in conference calls, meetings, reports and metrics, but it is equally important to remember that without our people, there are no metrics. Thank you for the opportunity we have to care for them! 
Celebration!
Congratulations, Gina Tucker-Roghi! 
Submitted by Deb Bielek, Therapy Resource
I am so excited for our Gina. She has been tapped to move into a new role at Dominican University and will start a three-year term of service as Director and Chair of Occupational Therapy. Please join me in congratulating her on this awesome recognition of her leadership and accomplishments in the field of academia in such a short time.  

Gina, ENJOY YOUR NEW ADVENTURE. We are so grateful we have the opportunity to continue our work beside you! 
Welcome!
Welcome, Waterton, to the
Keystone Family  
On March 1, we welcomed Waterton Healthcare and Rehabilitation to the Keystone family. Waterton is located in the great city of Tyler, Texas. It is a 92-bed skilled nursing facility built in 2008. We are so excited to add this wonderful facility along with its awesome team to the Keystone Northeast Market. Pictured is our new Therapy team from the Waterton in Tyler, Texas.