The Pulse

Patient Information: Female, Age 82

Diagnosis: Right Hip Open Reduction Internal Fixation (ORIF) / Right Hip Pain / Falls

History: This woman was referred to a skilled nursing facility for rehabilitation services after hospitalization due to a fall which resulted in a hip fracture requiring surgery. Prior to her fall she lived independently at home.

Stroke is a common diagnosis in rehabilitation and resultant visual field disorders can be a significant barrier to a successful rehabilitation program.

Patient Information: Male, Age 62

Diagnosis: Muscle Weakness / Falls / Dementia

History: This gentleman, a long-term skilled nursing facility resident, experienced several falls from his wheelchair and was referred to therapy by nursing to maximize his overall functional mobility in an effort to reduce his fall risk.

What do you do in your free time?
In my free time, I enjoy gardening, cooking, spending time with my three dogs and helping my stepdaughter with her extracurricular activities: raising a goat for FFA and racing her junior dragster.  

How long have you been with ACP?  I am celebrating one year with ACP this week!  

What is your career background? 
Before ACP, I was an art director working in ad agencies for high tech and healthcare clients. This is my first time to work in-house for a corporate marketing department.

My current role as a Dysphagia Clinical Program Consultant (CPC) for Accelerated Care Plus is one that is energizing, enjoyable, and also challenging at times. It is a role I feel incredibly grateful to have at this point in my career. I often have the opportunity to sit down with Speech Language Pathologists who are the only SLP working in the facility, which can feel like being on an island without a colleague with whom to brainstorm on a case. I can’t claim I have all of the answers to dysphagia questions, but I am happy to combine knowledge from articles I have read, experience I have, and evidenced based assessment and treatment techniques I been trained to utilize to help problem solve with treating clinicians to provide the best clinical care for the patients they serve. I am also fortunate to have a team of SLP CPC colleagues to consult with for perspective and insights on effective dysphagia rehabilitation for tough cases.

Patient Information: Female, Age 74

Diagnosis: Urinary Incontinence / Hip Fracture

History: This woman was admitted to a skilled nursing facility with significant decline in mobility
and function after an extended hospitalization due to a fall and subsequent fractured hip. Prior to her fall she lived at home with her family. Due to the severe decline in her function, she received rehabilitation services for one month prior to the continence program being added to her plan of care. Urinary incontinence had been an issue for years, but got significantly worse over the course of her hospitalization.

Swallow efficacy and safety are influenced by more than oropharyngeal muscle strength and performance. Head and neck positioning and posture can have a significant impact on an individual’s ability to effectively and safely swallow. Poor positioning can develop as a result of advanced age, neurologic impairment, and musculoskeletal involvement. The incidence of postural malalignment of the head, neck, and shoulders is increasing as a result of repetitive poor positioning with the use of computers and hand-held devices.

Patient Information: Female, Age 72

Diagnosis: Urge and Stress Incontinence

History: This woman, an independent living resident, referred herself to therapy for incontinence rehabilitation after attending a facility open house where she learned of the program. She reported gradual decreased control of urine with both stress incontinence (inability to hold back urine leakage with increases in abdominal pressure caused by laughing and sneezing) and urge incontinence (inability to stop unexpected and urgent urine flow) over the past year.

From 2012 through 2017, SNF occupancies fell from nearly 86% to less than 82%.  This drop is associated with a number of factors, including the influence of Medicare Managed Care contracts navigating shorter length of stay in SNF, the impact of bundled payment models trying to constrain spend by reducing the time spent in inpatient PAC settings, and the growth in beneficiaries electing to bypass SNF to receive PAC services through home health.  Overcoming these challenges to build census is comprised of two main components; attracting and providing superior quality outcomes to short-stay rehabilitation clients, and providing quality care and delivering an exceptional customer experience to maintain residential patients.

What do you do in your free time?
I love to go hiking with my pack of three German shepherds (and a Chihuahua), biking, kayaking, gardening. Most important is spending time with my 18 month old daughter, watching her learn and grow. I’ve even taken her on a few short hikes already! 

How long have you been with ACP?  3.5 years