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Coming Home From The Hospital Is Actually More Dangerous Than You Might Expect


After a stressful stay in the hospital, your doctors have finally given you the green light to return home.  A sigh of relief passes over you with the realization that the worst is behind you.


Not so fast …


Coming home from the hospital is actually more dangerous than you might expect, and there is a high likelihood of readmission if proper precautions aren’t taken.  Let’s look at some of the facts from AARP’s Public Policy Institute:


  • One in five Medicare beneficiaries is re-hospitalized within 30 days of discharge; one in three is readmitted within 90 days.
  • More than 20% of older Americans suffer from five or more chronic conditions that account for 75% of total Medicare spending—mainly due to high rates of hospital admission and readmission.
  • It is estimated Medicare spends approximately $17.4 billion in annual readmission costs.


Because of this, it’s important to find ways to improve transitional care in order to decrease the likelihood of an adverse event or readmission.


First, we need to understand some of the terms.  “Care transitions” describe the movement patients make between healthcare practitioners and environments as their condition and care requirements change.  For example, a patient might receive care from a specialist in an outpatient setting, then transition to a hospital physician and nursing team during an inpatient admission before moving on to yet another care team at a skilled nursing facility.  Finally, the patient might return home, where he or she might receive care from a visiting nurse.  Each of these shifts from care providers and settings is defined as a care transition.  “Transitional care” is the set of actions designed to ensure the coordination and continuity of healthcare, as patients transfer between different locations or different levels of care within the same location.


One group looking closely at the problem of care transitions is the Betty Irene Moore Nursing Initiative (BIMNI), funded by the Gordon and Betty Moore Foundation.  Marybeth Sharpe, BIMNI Program Director, explained, “The initiative was established to improve the experience and outcomes of patients in Northern California.  Improving the care patients receive as they transition from the hospital to their home or other care settings is one of four strategies of the initiative.”  She added that, during the past 10 years, the initiative has:


  • Improved patient care in more than 80% of adult acute care hospitals in the San Francisco Bay Area and the Greater Sacramento area.
  • Supported 75% of San Francisco Bay Area hospitals to implement strategies to improve transitional care and reduce readmission rates.
  • Achieved a 30% reduction in 30-day readmission rates and/or a 15% reduction in 90-day readmission rates in 30% of San Francisco Bay Area hospitals.


 hospital image


If you’re not careful, coming home from the hospital may be more dangerous than you might expect. (Image source: sturti via istockphoto)


There are a number of ways that patients can be more proactive with their healthcare and improve the likelihood of successful care transitions.  Kate Weiland, Program Officer for BIMNI and an expert on transitional care, offered the following six strategies for improving the likelihood of safe, effective transitions.


1.  Understand your medications and ensure you talk to your doctor or pharmacist about how to take them.


  • 26% of hospitalized patients report that medications were not explained to them, making it more challenging to adhere to the regimens when patients return home.
  • According to the Centers for Disease Control and Prevention, 82% of all American adults take at least one prescription medication, and 29% take five or more.
  • The average Medicare Part D patient filled 49 standardized 30-day prescriptions in 2010.


2.  Make sure to schedule and go to follow-up appointments with your doctor.


  • There are various reasons why patients do not schedule or attend follow-up appointments, with statistics in the range of 5 to 55% on no-shows.
  • Scheduling a follow-up doctor’s appointment before leaving the hospital can reduce a patient’s risk of being readmitted to the hospital unnecessarily.


3.  Find out if your hospital offers home visits or makes follow-up calls.


  • Follow-up phone calls or home visits from a health care professional can help reduce the risk of being readmitted to the hospital.
  • Patients who received a follow-up discharge call were 23% less likely to be readmitted within 30 days of leaving the hospital.


4.  Inquire about referrals to community services, such as free transportation to follow up appointments and Meals on Wheels, and take advantage of them.


  • Individuals who live alone, who are unemployed, or who have challenges affording healthcare are more likely to be readmitted.
  • Compared to patients with extensive social networks, hospital readmission was more frequent among those who had moderate to negligible social networks.


5.  Ensure anyone taking care of you is engaged in all conversations throughout your healthcare experience.


  • 40 to 80% of medical information provided by health care practitioners is forgotten by patients immediately.
  • Nearly 20% of patients said their health had suffered due to poor communication for varying reasons.
  • 52 million informal caregivers provide care to adults (aged 18+) with a disability or illness.


6.  Clearly know your instructions when leaving the hospital, and if you are unsure, ask, ask, ask – and ask again.


  • Roughly 23% of hospitalized patients report they were not given information about what to do when recovering at home.
  • Only 12% of adults have proficient health literacy, which means that nearly nine out of ten adults may lack the skills needed to manage their health and to prevent disease.


It’s still okay to look forward to the day you are well enough to leave the hospital.  But paying attention to the details of your transition can help make sure you don’t end up right back in that same hospital bed.


Follow Rob Szczerba on ForbesTwitter (@RJSzczerba),Facebook, and LinkedIn.






1,700 Hospitals Win Quality Bonuses From Medicare, But Most Will Never Collect


By Jordan Rau January 22, 2015


 Medicare is giving bonuses to a majority of hospitals that it graded on quality, but many of those rewards will be wiped out by penalties the government has issued for other shortcomings, federal data show.


As required by the 2010 health law, the government is taking performance into account when paying hospitals, one of the biggest changes in Medicare’s 50-year-history. This year 1,700 hospitals – 55 percent of those graded – earned higher payments for providing comparatively good care in the federal government’s most comprehensive review of quality. The government measured criteria such as patient satisfaction, lower death rates and how much patients cost Medicare. This incentive program, known as value-based purchasing, led to penalties for 1,360 hospitals.


However, fewer than 800 of the 1,700 hospitals that earned bonuses from this one program will actually receive extra money, according to a Kaiser Health News analysis. That’s because the others are being penalized through two other Medicare quality programs: one punishes hospitals for having too many patients readmitted for follow-up care and the other lowers payments to hospitals where too many patients developed infections during their stays or got hurt in other ways.


When all these incentive programs are combined, the average bonus for large hospitals — those with more than 400 beds — will be nearly $213,000, while the average penalty will be about $1.2 million, according to estimates by Eric Fontana, an analyst at The Advisory Board Company, a consulting company based in Washington. For hospitals with 200 or fewer beds, the average bonus will be about $32,000 and the average penalty will be about $131,000, Fontana estimated. Twenty-eight percent of hospitals will break even or get extra money.


This KHN story can be republished for free (details).


On top of that, Medicare this year also began docking about 200 hospitals for not making enough progress in switching over to electronic medical records. Together, more than 6 percent of Medicare payments are contingent on performance.


Download the data




Medicare is rewarding hospitals that are giving quality care and penalizing those with high rates of infections and readmissions. View by hospital, state and other data:



“You’re starting to talk about real money,” said Josh Seidman, a hospital adviser at Avalere Health, another consulting firm in Washington. “That becomes a really big driver; it really gets the attention of the chief financial officer as well as everybody else in the executive suite of the hospital.”


Among these programs, the Hospital Value-Based Purchasing initiative, now in its third year, is the only one that offers bonuses as well as penalties. It is also the only one that recognizes hospital improvement even if a hospital’s quality metrics are still subpar. The value-based purchasing bonuses and penalties were based on 26 different measures, including how consistently hospitals followed a dozen recommended medical guidelines, such as giving patients antibiotics within an hour of surgery, and how patients rated their experiences while in the hospital. Medicare also examined death rates for congestive heart failure, heart attack and pneumonia patients, as well as bloodstream infections from catheters and serious complications from surgery such as blood clots.


Adding An Efficiency Measure


Medicare this year added a measure intended to encourage hospitals to deliver care in the most efficient manner possible. Federal officials calculated what it cost to care for each hospital’s average patient, not only during the patient’s stay but also in the three days before and a month after. Often the biggest differences in medical costs between hospitals are due to what happens to patients after they leave. For instance, Medicare pays more to inpatient rehabilitation facilities than it does to skilled nursing homes, even though both treat similar kinds of patients.


“It’s your one opportunity either to make money on pay-for-performance or at least recoup some of the potential losses you have from the other programs,” said Paul Matsui, who directs data research at The Advisory Board Company.


This year, Medicare judged hospitals based on how they performed in comparison to others in the second half of 2012 and all of 2013, and how much they had improvedfrom two years before. Medicare adds a hospital’s bonus or penalty to every Medicare reimbursement for a patient stay from last October through the end of September.


Nearly 500 more hospitals earned bonuses in the value-based purchasing program compared to last year. The biggest is going to Black River Community Medical Center in Poplar Bluff, Mo., which is getting a 2.09 percent increase, the analysis found. The largest penalty this year is assigned to the Massachusetts Eye and Ear Infirmary, a teaching hospital of Harvard Medical School, in Boston. It is losing 1.24 percent of its Medicare payments.


The Massachusetts infirmary said in a statement that it was losing only about $60,000 because most of its patients do not remain overnight in the hospital, and the penalties only apply to inpatient stays. The infirmary had so few of those cases that Medicare could not assess its performance on more than half the measures the government uses. Medicare’s program “is a poor match for what” the infirmary does, it said.


Nationally, the average bonus for hospitals under value-based purchasing was a 0.44 percent increase, while the average penalty — not including the other penalty programs — was a 0.30 percent reduction, the KHN analysis found. The actual dollar amount will depend on the mix of Medicare patients that hospitals treat through September and how much they bill Medicare. Medicare set aside 1.5 percent of its payments for the incentives, totaling about $1.4 billion.


States Most Impacted


Medicare awarded bonuses to at least three-fourths of the hospitals it evaluated in Alaska, Hawaii, Maine, Minnesota, Montana, Oregon, South Dakota and Wisconsin, the KHN analysis found. Medicare penalized more than half the hospitals it evaluated in Arizona, Arkansas, California, Connecticut, Delaware, the District of Columbia, Florida, Nevada, New Jersey, New York, North Dakota, Pennsylvania, Washington and Wyoming.


More than 1,600 hospitals were exempted from the incentives, either because they specialize in narrow types of patients, such as children or veterans, or because they are paid differently by Medicare, such as all hospitals in Maryland and “critical access hospitals” that are mostly in rural areas.


Hospitals awarded bonuses in one year of the value-based purchasing program do not necessarily do as well the next year. Out of 2,672 hospitals that have been evaluated in all three years of the program, roughly a quarter got bonuses all three years and a quarter lost money in all three years. The rest had a mix of bonuses and penalties, the KHN analysis found.


Matsui said swings were not surprising given that hospitals are getting acclimated to the programs and Medicare has added new measurements each year. “In the grand scheme of things,” he said, “we’re still in the embryonic stage of the pay for performance programs.”


This article was produced by Kaiser Health News with support from The SCAN Foundation.



Please join me in congratulating Marci Rudick (SBCC SLP) for winning December 2014 Clinical/Customer Excellence Award.  Marci won a $50 Gift Card and Certificate Award.  Hats off to Marci for a job well done!

Marci was nominated by Brian M (SBCC RTM) and Jess R (KWT RTM).  Here's what both Jess and Brian had to say:

Marcie is a new grad SLP who has gone above and beyond to assist with a building that has not had a permanent SLP in a long time. Marcie has completed multiple in services with nursing staff and kitchen staff to improve carryover of thickened liquids. She has adjusted the time she arrives to accommodate the nurses' schedules to educate night and day shift.  She has completed individual education when the moment arises. She has been in communication with the DON, the RTM and me as her CFY supervisor to identify areas that need improvement as well as make suggestions on solutions. 
Marcie has spent extensive time communicating with families for improved carryover of strategies, creating memory books, and improving quality of life with the long term patients regarding diet recommendations.
Not only have I noted she has excellent documentation, Stephanie B, the Clinical Compliance Coordinator reached out to me to say her documentation is excellent as a new employee and new grad. 
Marcie keeps a positive attitude and seems to be a great fit with the team at Southbrook. She is organized, cheerful, professional, and always willing to adjust her schedule. 
I am sure Brian believes she is an excellent addition to his team!
Jess Rolfes
I would like to second this nomination. Marcie has been a fantastic addition to our team and has fit in extremely well. The administration at SBCC has commented on how it is a great addition for us to have a full time SLP and that she has done a good job with educating staff on altered diet issues that have been an issue but had not been resolved until Marcie's education. 
As Jess said Marcie has been very flexible with her schedule to accomodate getting as many people educated as possible on the altered diets/thickened liquids. She truly shows an interest in the well being of our patients, those on caseload and those who are not. It has been a huge relief to myself, as the RTM, to have a full time SLP to really take ownership of the ST dept in SBCC. Patient's and families have had nothing but compliments for Marcie. 
Marcie is the ideal UR employee and would be a great choice for the Clinical/Customer Excellence award. 


Skilled Nursing Care, "The Basics"!~posted 1/20/15

How often is it covered?

Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.

Medicare-covered services include, but aren't limited to:

*Medicare covers these services if they're needed to meet your health goal.


Medicare covers swing bed services in certain hospitals and when the hospital or critical access hospital (CAH) has entered into a "swing-bed" agreement with theDepartment of Health and Human Services (HHS), under which the facility can "swing" its beds and provide either acute hospital or SNF-level care, as needed. When swing beds are used to furnish SNF-level care, the same coverage and cost-sharing rules apply as though the services were furnished in a SNF.

If you're in a SNF but must be readmitted to the hospital, there's no guarantee that a bed will be available for you at the same SNF if you need more skilled care after your hospital stay. Ask the SNF if it will hold a bed for you if you must go back to the hospital. Also, ask if there's a cost to hold the bed for you.

Who's eligible?

People with Medicare are covered if they meet all of these conditions:

Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you're getting observation services in the hospital, you're considered an outpatient—you can't count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay.Find out if you're an inpatient or an outpatient.

Here are some common hospital situations that may affect your SNF coverage:


Is my SNF stay covered?

You came to the Emergency Department (ED) and were formally admitted to the hospital with a doctor’s order as an inpatient for 3 days. You were discharged on the 4th day. Yes. You met the 3-day inpatient hospital stay requirement for a covered SNF stay.
You came to the ED and spent one day getting observation services. Then, you were formally admitted to the hospital as an inpatient for 2 more days. No. Even though you spent 3 days in the hospital, you were considered an outpatient while getting ED and observation services. These days don’t count toward the 3-day inpatient hospital stay requirement.

Remember, any days you spend in a hospital as an outpatient (before you’re formally admitted as an inpatient based on the doctor’s order) aren’t counted as inpatient days. An inpatient stay begins on the day you’re formally admitted to a hospital with a doctor’s order. That’s your first inpatient day. The day of discharge doesn’t count as an inpatient day.


If you refuse your daily skilled care or therapy, you may lose your Medicare SNF coverage. If your condition won't allow you to get skilled care (like if you get the flu), you may be able to continue to get Medicare coverage temporarily.

Your costs in Original Medicare

You pay:

  • Days 1–20: $0 for each benefit period.
  • Days 21–100: $157.50 coinsurance per day of each benefit period.
  • Days 101 and beyond: all costs.

If you stop getting skilled care in the SNF, or leave the SNF altogether, your SNF coverage may be affected depending on how long your break in SNF care lasts.

  • If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.
  • If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your SNF benefits. This means that the maximum coverage available would be up to 100 days of SNF benefits.

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

Related resources


Please join Ultimate Rehab's Executive Team  in congratulating Joy Medley, RTM (Hyde Park) for winning the 4th Quarter "Manager of the Quarter "award.   Ultimate Rehab appreciates Joy's dedication and hard work.

The criteria that Joy met is as follows:

  • Employee Retention and assist with recruiting
  • Above average staff productivity
  • LOS increased in 2014
  • Facility revenue increased in 2014
  • Chart Audits in place, documentation up to date
  • Below average emplpuyee/team and self call offs
  • Good client relations - transforming relationships
  • Manager's productivity met Company standards

Hats off to Joy!

Here is what Camille had to say about Anya:

"Anya has recently presented to me so much in the way of compassion for the patients' that she treats.  Recently Anya managed the physical therapy care and rehabilitation of Mrs. R.  Mrs. R lived in the campus “Independent Living” housing.   During Mrs R's rehabilitation, her  daughters attended the treatment sessions.  Anya addressed multiple concerns that Mrs. R’s daughters had in regards to her mobility.  Anya educated Mrs. R daughters on her condition.  She adjusted her treatment style so that Mrs. R’s daughters were able to be involved in the rehabilitation program.   Anya provided guidance and support to Mrs. R’s daughter as they realized that their mother was struggling with some memory deficits.  Mrs. R became a welcoming site to me as I came in to work every morning.  She was often seen ambulating to and from the dining room, or the lounge under the staff and family supervision. Mrs. R felt safe. Anya provided a great service in that Mrs. R and her family transitioned to the assisted living campus with ease.  Anya took the lead in this case.  She represented Ultimate Rehab as a company who knows that every patient is important.

Why Patient Engagement is Key to Improving Health, Reducing Costs

The Engelberg Center for Health Care Reform recently hosted “The State of Accountable Care: Evidence to Date and Next Steps” to discuss the development, challenges, and potential future for accountable care efforts across the country.  Sean Cavanaugh, Deputy Administrator & Director of the Center for Medicare at CMS, kicked off the event, and highlighted progress and challenges of the Medicare ACO program and potential regulatory changes that could be included in the soon to be released Medicare Shared Savings Program (MSSP) proposed rule.

A Key Takeaway: Patient Engagement is Critical to the Success of ACOs
The need for greater patient engagement was a prevailing theme of the day for ACOs at Brookings.  Patient engagement is viewed as a key to improved health outcomes and lower costswell-designed patient engagement strategies can also improve patient experience by allowing individuals to become more active participants in their care. For example, shared decision making and patient activation are proven strategies for engaging patients at the direct care level. These approaches help providers and patients to recognize that a clinical decision is necessary, understand the evidence on best available interventions, and ensure patient preferences are built into treatment decisions and plans. A recent study by Jennifer Sweeney and colleagues highlights some successful examples.

Several examples of effective strategies for engaging patients with chronic disease were highlighted at the Brookings event.  Kelly Taylor, Director of Quality Improvement at Mercy Clinics, highlighted Mercy’s chronic disease outreach program, which employs health coaches to motivate patient behavior change. The program creates actionable lists for patients due for hospital visits, helps with coordinating care transitions, and conducts pre-visit and post-visit assessments. Patients that receive these services typically score in the 90thpercentile for HEDIS measures, such as control of blood pressure and blood sugar levels. A financial analysis demonstrated that for every dollar spent on the health coaching program, four dollars in revenue is received.

Morey Menacker, President and CEO of Hackensack Alliance Accountable Care Organization discussed Hackensack’s remote monitoring and care management tool that allow patients to monitor their diseases in their own homes. This program has contributed to a reduction in unnecessary hospital visits and improvement in patient self-management.

A number of organizations have also used web-based tools such as online or smartphone applications for patient engagement purposes.  For example, Beth Israel Deaconess Medical Center developed patientsite.org, an interactive web-based portal decision aid giving patients access to their clinical records and the ability to check accuracy of allergy and medication lists. A recent study of 30,000 patients found that even after adjusting for health status and other factors, patients with the lowest activation scores incurred costs of 8 percent to 21 percent higher than those with the highest activation scores. Despite these encouraging innovations, more work is needed to empower patients in health systems across the country.

ACO Attribution: A Challenge for Engaging Patients
Over the next twenty years, we will see the baby boomer population inflate the number of Medicare beneficiaries by 60 percent; increasing from 50 million to 80 million. This statistic, emphasized by Cavanaugh, underscores the need to engage these patients in their care through more innovative approaches. If not, “slipping through the ACO cracks” will become all too real for too many patients.

While ACOs acknowledge they have work to do to more fully engage patients in their care, they also point out that program design issues need to address patient engagement. For example, a major fault in the MSSP patient attribution process is that some patient may not be aware they have been assigned to an ACO. In this case, they may seek care outside the ACO network of providers and in fact be assigned to a different ACO from year to year. Most importantly, there are no incentives for patients to remain loyal to an ACO when the attribution process does not reflect patient preferences.

Recent research highlights concerns with current approaches to patient attribution in ACOs.  A recent study by Harvard Medical School researchers analyzed whether, over a two year period, Medicare beneficiaries would continue their care within their attributed ACO, or seek medical attention outside the network. Approximately 80 percent of beneficiaries would have chosen to remain with doctors inside their ACO. Not surprisingly, the research indicates that primary care doctors have more “sticking power” than specialists, who would have lost 66 percent of their beneficiaries to competitors outside the ACO. More worrisome, however, was the finding that most of the beneficiaries that strayed from the ACO were those with chronic conditions. ACOs need to address the fragmented system and consider why they are unable to retain so many high-risk patients.

The potential turnover of ACO-attributed patients from year to year (or patient churn) warrants attention, but little evidence exists to suggest that patient dissatisfaction is the cause. In fact, Medicare ACOs are achieving overall high performance on patient satisfaction measures to date. So far, there is no clear relationship between patient satisfaction measures (CAHPS) and turnover. However, it is not unreasonable to assume that more direct patient engagement in selecting an ACO might reduce patient turnover.

Policy and Regulatory Solutions
There are a number of structural adjustments that CMS could make to the MSSP program to more effectively engage patients through financial and other incentives.

  • Provide financial incentives for beneficiaries: These incentives may include reduced co-pays or deductibles for choosing providers within the ACO network or other high-performing or high-value providers. ACOs could also provide rebates or extra benefits to patients who successfully adhere to medications or provide additional discounts to patients who meet specific outcomes, such as reduced BMI or blood pressure control. Finally, beneficiaries could potentially share in some of the savings generated by the ACO, assuming that they meet a set of patient requirements or compliance metrics. While allowing patients to share in savings would be a more complex and controversial proposition, it could transform how patients think about ACOs and their own personal behavior to improve their health.
  • Implement “Welcome to ACO visits” (similar to a “Welcome to Medicare visit”):These visits could provide an opportunity for ACOs to educate patients about the benefits of being in an ACO. Patients could learn how an ACO model will affect the care they receive, and how patients can become more activated and engaged.
  • Transition away from the current attribution model to allow beneficiaries to actively and directly enroll in an ACO:  Active enrollment could enhance patient commitment to organization, and help them better understand the implications for their care. Potential challenges to this approach include increased opportunity for adverse selection (unhealthy patient disproportionately enrolling in the ACO, thereby disrupting the overall risk pool) and not enough beneficiaries agreeing to join the ACO. While adverse selection could be addressed through additional technical changes to the program (e.g., more frequent updates to benchmarks, etc.), without a sufficient patient population, the ACO would likely not succeed. Furthermore, it is not clear how such a model would differ significantly from current Medicare Advantage and why patients would choose to join an ACO over an MA plan. We may soon have a better idea of whether an enrollment model will work; the CMMI has launched a demonstration program with a selected number of Pioneer ACO participants to test whether and to what extent beneficiaries will elect to enroll in an ACO, and what the consequences may be on the ACOs population and performance.

Patient engagement interventions and programs highlighted during the recent Brookings event are encouraging, but much more work needs to be done. Effectively engaging patients will require ACOs to think differently about what patient engagement really means; it will also require a willingness and desire on the part of patients to become more engaged as active participants in their care.  A regulatory environment that encourages provider organizations to pilot new approaches to patient engagement, including innovative financial and other incentives, could be a starting point for innovation in patient engagement.  The health care system will not be transformed without the patient; moreover, the real promise of ACOs—continuous improvements in quality and reduced costs—cannot be realized over the longer term without more active involvement of patients in their care.


Please join Ultimate Rehab's Executive Team in congratulating Amy Ballman Huffman, RTM at Forest Hills, for winning the "Manager of the Quarter" for 3rd quarter. Amy won a $250 Gift Card and Award Certificate.

The criteria that Amy met is as follows:

Employee Retention and assist with recruiting
Above average staff productivity
LOS increased in 2014
Facility revenue increased in 2014
Chart Audits in place, documentation up to date
Below average emplpuyee/team and self call offs
Good client relations - transforming relationships
Manager's productivity met Company standards

Great job Amy! Thank you for your amazing dedication and hard work to Ultimate Rehab, the facility, your patients and your team.


Please join me in congratulating Stephanie Brenner as UR's Clinical Complaince Coordinator.   Stephanie is very knowledgeable and will be a great resource to each facility as well as to UR's Corporate Office.  

Welcome Stephanie to your new role - CCC!  Congratulations!


Please join me in congratulating Clarisse Tuazon (OT) from The Palms of Sebring as the winner of the September 2014 Clinical/Customer Excellence Award.  Clarisse has won a $50 Visa Gift Card as well as an Award Certificate. 

Here is what Mindy (Rehab Team Manager) and Mike (COTA) have to say about Clarisse:

Mindy's comments:   "Clarisse over the last 7 months, has grown in her position here at Ultimate Rehab.  Whenever I ask Clarisse to help out with anything, whether it act as supervisor/facility go to person or attend a careplan for a pt no longer on caseload to explain pts LOF to a family she steps up without hesitation.  Clarisse worked closely with Mr. Ward and helped him return to the community where he is an active member.  While Clarisse receives compliments and thank you notes from family members and pts continuously, this pt sent Clarisse flowers with a lovely note that thanked her for her dedication to his wellness."

Mike's comments:  "Clarisse is a great asset to our rehab team. She is always willing to go the extra step to help patients achieve the maximum level of care and comfort they deserve. She always finds time to answer questions or concerns a family member or patient might have. As an OTA myself, Clarisse is always willing to help me figure things out whether it be a difficult patient or just improving my documentation.  She is definitely a pleasure to work with and deserves the nomination for September's 2014 Clinical/Customer Excellence Award."

Thank you Clarisse for your dedication and hard work towards  your patients, The Palms of Sebring therapy team, the facility and Ultimate Rehab.  Congrats on a job well done!

Also, congratulations to the other nominees who were also very deserving.  Anya Cooper (PTA) was nominated by Friendship Village RTM, Camille and Pam Grooms (OT) was nominted by Helen Prater at McKendree Village.


Please join me in congratulating Dee Southwood and Christy Fuller for winning the August 2014 Clinical/Customer Excellence Award.   Dee and Christy receive a $50 Visa Gift Card as well an Award Certificate.  Here is what Amy Huffman (RTM at Forest Hills) had to say:

"Dee and Christy both worked very diligently to provide the most outstanding therapy to a very special patient here at FHCC.  This patient has locked-in syndrome and although most cases make no significant improvements, Dee and Christy worked daily to allow this patient to gain the most movement and function over this past month with hard work, dedication, and true compassion.  This patient, whom was stated as paralyzed, can now sit up on the edge of the mat for up to 5 minutes unsupported,  has movement of hands, feet, gluts, quads, and beginning movements in his shoulders.  He can now verbalize commands and also has begun to swallow.  Dee and Christy worked hard to get him the most optimal w/c  to increase his independence.  He made such great progress that he is being transferred to a special unit in Chicago, to continue his therapy and success.  This case is a true miracle and Dee and Christy's care has been above and beyond the call of duty.  On a daily basis, it is bought to my attention how happy the family is regarding Dee and Christy's care and support during his stay at FHCC."
Thank you Dee and Christy for your hard work and committment to your patients, the FHCC therapy team, the facility and Ultimate Rehab.  Great job!


Once again Ultimate Rehab has expanded our services in Greater Cincinnati by providing contract therapy services to our newest location Mountain Crest Nursing & Rehabilitation Center

Located in metropolitan Cincinnati, Mountain Crest is situated in a city that hasn't lost its small town charm. Nestled in the middle of museums, lively downtown areas and beautiful parks Mountain Crest provides the best nursing and rehabilitative services that Cincinnati has to offer. Our staff works to provide personalized and quality care across our four separate buildings. Mountain Crest is home to a dedicated sub-acute unit, a mental health unit, a long term care unit, and a memory enhancement unit that each exceed personalized patient expectations.

Services & Amenities

  • Dedicated Rehabilitation & Complex Care Unit
  • Psychological services
  • Hospice care
  • Activities 7-days a week
  • Respite care
  • Registered dietitian services
  • Physical, occupational and speech therapy
  • Outpatient rehabilitation
  • RN/LPN coverage 24 hours a day, 365 days a year
  • Wound care nurse 7-days a week

~ Aug. 1, 2014




Choose the Right Long-Term-Care Facility for Your Parents

About ten years ago, when Donna Braley was 79, her family started to notice that she was having trouble doing the things that she had always loved to do -- crocheting, cooking, doing crossword puzzles. Because her children lived in different states, it took a while for them to piece together their stories and discover that their mother needed help. The family hired a geriatric care manager, and “her assessment made it obvious to us that Mom would soon no longer be able to live at home without full-time caregiving,” says her daughter Kathi Dunn. 

The family moved Braley to a semi-independent apartment in a locked Alzheimer’s facility in Roseville, Cal., near her son Scott and his wife, Amy. But after she was there for a few months, she became combative and difficult to manage. So they found another Alzheimer’s facility that “looked like a model home with a gourmet chef,” says Amy. “But it was too large.” Braley would roam the huge hallways and go in and out of people’s rooms, disturbing their belongings.

When money started to run short, the family searched for another option. They heard about a 15-person facility that focused on dementia, which seemed like a better fit and was less expensive. The third time was the charm: For the past two years, Braley has required total care and uses a wheelchair full-time, but the staff at her new home have found ways for her to be as active as she can. When her grandchildren visit, they play in the backyard as if it were Grandma’s house, and the residents’ families watch out for one another.


Start the search

When it’s time to get extra care for your parents, you may be forced to decide quickly, especially if your parent has been in the hospital and needs extra help as soon as he or she is released. “You’re making a traumatic and important decision under pressure,” says Byron Cordes, a geriatric care manager with Sage Care Management, in San Antonio. “The hospital may say you need to move your dad by the end of business today, then just hand you a magazine about senior-living options and say, ‘Good luck finding a nursing home,’ ” he says.

Cordes recommends that you take the time to find out exactly what your parent needs. That often means talking to the doctor, social worker, nursing staff, case manager and discharge manager. Or it may mean hiring a geriatric care manager to help coordinate the various care providers.

It can be challenging to balance quality and cost. The median price of a private room in a nursing home tops $6,900 per month, and assisted-living facilities cost more than $3,400 per month, according to the Genworth 2013 Cost of Care Survey. So unless your parents have long-term-care insurance, they -- or you, if you’re helping to pay the bills -- may not be able to afford the ideal setting for very long. Medicare covers very little long-term care, and most people aren’t eligible for Medicaid until they’ve spent most of their money (see Where to Find the Money).

But new resources can help you make the decision. “The landscape has changed for senior housing,” says Andy Cohen, CEO of Caring.com, where people share reviews of nursing homes and assisted-living facilities. “Some are more like college dorms for seniors, with good food, transportation and activities. A lot of children feel guilty, but after they visit these places, they say that Mom’s healthier and happier.”

Assisted living in many cases can take the place of nursing-home care, at least in the early stages of care, says Sandra Timmermann, a gerontologist in Fairfield, Conn. Some facilities have continuing care, and residents can move to another wing in the same facility if they need more supervision. Or you can hire a caregiver to provide extra assistance in an assisted-living facility so that you don’t have to move your parent to a nursing home. And people with dementia and Alzheimer’s have many options for memory care.

Medicaid generally covers nursing homes but not assisted-living facilities, so your parents can usually choose assisted living only if they have enough savings or long-term-care insurance. (A few states have Medicaid voucher programs, which allow a limited number of people to use Medicaid money for assisted living; see Medicaid.gov for each state’s rules.)

The Medicare Nursing Home Compare tool assesses more than 15,000 nursing homes throughout the U.S. based on inspections, complaints and staffing ratings. But it doesn’t include most assisted-living facilities, which have different licensing requirements in each state. You can go to the Eldercare Locator or a local Area Agency on Aging for help finding assisted-living facilities, but these resources don’t assess the services. Review sites, such as Caring.com, let you see others’ experience with the facilities.

Several services can help you with your search. CareScout includes ratings and profiles for more than 90,000 assisted-living facilities, nursing homes and home-care providers. For $495, you can work with a care advocate, who helps assess your needs and narrow the list to three or more facilities to visit; the advocate can also negotiate discounts at the facilities. Many Genworth policyholders get free access to CareScout for themselves or their parents, and some employee-assistance programs include access to similar services.

Hire a pro?

A geriatric care manager can help you explore your options. Care managers are also familiar with local facilities and benefits programs, so hiring one can be a good idea if your family has multiple siblings or if you are researching care options from a distance (see How to Manage From Afar). Go to www.caremanager.org to search for care managers throughout the U.S. They generally charge $100 to $180 per hour and are not allowed to accept finder’s fees from facilities.

Geriatric care managers have made a big difference for Jennifer Russell of Tampa. Her mother, Margie Yeagley, who lived in San Antonio, seemed to be doing fine living alone after her husband died. But four years ago, Russell realized that she needed more help.

Russell asked Byron Cordes, the geriatric care manager, to have Yeagley evaluated and discovered that she had significantly progressed dementia. Cordes found an assisted-living facility in San Antonio with a memory-care unit, and they moved her mother right away. After two years of traveling back and forth between California, where Russell lived then, and Texas, Russell decided it would be easier to move her mother out to California.

Her first step was to find a care manager in California, who helped identify the best facilities and doctors. When Russell’s husband got a new job in Tampa, they repeated the process again. Russell’s mother is now in a memory-care wing of a large assisted-living facility nearby.

What to look for

After you narrow the list to two to five places, visit and ask a lot of questions. And don’t just talk with the marketing people; talk with the people who are providing the care. “Go completely unannounced and walk in at whatever time of day you can,” says Cordes. “I’ve been in nursing homes when they’ve announced that a tour is coming in. You see the housekeeping staff spraying the halls with Febreze and closing the doors to patients’ rooms.” See how people are treated at mealtime and how they’re treated at 8 p.m.

Next, schedule a meeting with the marketing director to get more details about how the facility cares for residents. Every nursing home is required to have a care plan. What would be in the care plan for your parent? What activities would the facility offer to your parent? How are the residents’ physical needs monitored? Ask about the patient-to-staff ratio (Cordes usually recommends 18 to 20 patients per caregiving staffer). What type of specialized training do the staff have in dealing with your parent’s medical condition? Ask if your parent will get any time outside the facility, especially if he or she is in a locked memory-care wing of a long-term-care facility (some have courtyards).

Ask for a list of the costs, especially for assisted living. In some facilities, you may get a set number of hours of personal care, and you may be charged extra if your parent needs more. After your visit, ask yourself: Is this a place where you would want to spend time? Is it clean? How does it smell? Are the residents showered, with clean clothes? Is the food healthy and tasty? How would your parent fit in with the other residents? “Does the staff treat the residents with respect or, better yet, like beloved grandparents?” adds Amy Braley, Donna Braley’s daughter-in-law.

Things change: Your parent may start out in assisted living but eventually need care in a nursing home. No matter what, monitor your parent’s care with the same critical eye you brought to the selection process. If the place isn’t a good match, don’t be afraid to move your parent to one that feels like home.

Read more at http://www.kiplinger.com/article/insurance/T013-C000-S002-choose-the-right-long-term-care-facility.html#jTbpM05BMqKcXQd2.99


Please join me in congratulating Claire Miller, SLP at Hyde Park, for winning May 2014 Clincial/Customer Excellence Award.    Joy and Brian, RTM's at Hyde Park nominated Claire.  This is what Joy/Brian had to say:

Claire consistently receives positive feedback from patients and families and is always willing to spend extra time with education of speech therapy. Claire manages the speech department with little help from the manager. 

Through chart audits we have noticed that Claires documentation is very clear and thorough in explaining patients status and progress. While managing the whole speech caseload and schedule Claire doesn't ever get behind on discharges or paperwork. 
Claire was a huge help during a SLP maternity leave and took extra hours every day to assist with coverage needs. Even during this time of doing sometimes 10 hours of care Claire was still willing to assist the department with miscellaneous tasks when needed.   Claire is very deserving of this award and a great example for future employees of Ultimate Rehab.  

 Thank you Claire for your hard work and dedication to your patients, Ultimate Rehab, your team at Hyde park and the facility.  

"Excellence is not a skill.  It is an attitude."  Ralph Marston




Please join me in congratulating Carol Mong,  April 2014 Clinical/Customer Award winner.  Carol wins a $50 Gift Card as well as a Award Certificate.  Jess Kotsko, Lincoln Crawford Rehab Team Manager nominated Carol and this is what Jess had to say:


 "I would like to nominate Carol Mong (PTA) for April Clinical/Customer Excellence Award.  Carol has done an excellent job helping Ultimate Rehab get our new facility, Lincoln Crawford, off the ground.  Carol has worked for Ultimate Rehab for the last 6 years and throughout the 6 years has shown patience, loyalty and flexibility.   Carol opened the Hyde Park facility and did an impressive job.  Ultimate Rehab knew Carol’s excellent skills in assisting in grand openings so Lorie, Tom, Sheryl and Kelley requested Carol to help with Lincoln Crawford’s opening.  Carol has contributed so much to the success of Lincoln Crawford the last 3 months and I am very thankful and appreciative. 


 Also, Carol has such a great rapport with the residents here and has one patient that would only work with her.  I would like to take this opportunity to thank Carol for everything she does and let her know that she is a very valued member not only to our team here but also our Ultimate Rehab team.  



2014 Convention & Exhibition -- Simply Quality!

Convention Provides Education, Business, Networking, Community, Social Programs
More than 3000 long-term care professionals, consultants and vendors participated in a four-day whirlwind of seminars, social activities and camaraderie April 28 - May 1 for the 68th OHCA Annual Convention and Exhibition at the Columbus Convention Center, held in conjunction with the Ohio Centers for Assisted Living (OCAL) and the Ohio Centers for Intellectual Disabilities (OCID). The Midwest’s largest gathering of long-term care personnel, this week’s Convention featured more than 100 educational programs during its four-day run. An exhibition of over 400 booths featuring providers of goods and services to the long-term care community – one of the largest long-term care exhibitions in the country – provided registrants access to the newest innovations, including transportation services, furniture, high-tech medical devices, computer systems and software, food and dietary supplements, kitchen and laundry appliances, therapy aids, and pharmacy services, among others. Many Association members took advantage of the free registration coupon offered by the Board of Directors as a member benefit.

Educational programs were presented for licensed administrators, nurses, therapists, dietary personnel, social workers, activity professionals, housekeeping staff and other long-term care personnel. Topics include clinical, operational, administrative and technical aspects of providing care services, as well as personal improvement and motivational sessions. During the Awards Luncheon on Tuesday, the new lineup of OHCA, OCAL and OCID Professional Excellence Awards were presented.. Wednesday's program included the presentation of 46 scholarships from the Educational Foundation of OHCA, and a special presentation with motivator and humorist Dr. Brad Neider.

Social programming included the PAC Night at the Races; the Awards Luncheon; EFOHCA Celebration Event; hospitality hops; and the special Club RLH Party, sponsored by OHCA Past President Robin Hillier, which was open to all registrants on Wednesday night. Networking opportunities were available to participants throughout the week. The OHCA Community Center served as a gathering place and an area to relax, as well as online education services in the Learning Lab, and guest services at the registration counters.