snf-therapy-during-covid

Let’s use the state of SNF therapy today as a springboard for more positive outcomes

There’s no question that therapy today in skilled nursing facilities looks vastly different than it did several months ago (and for many years before that). What is yet to be determined is whether or not these changes can result in positive outcomes for all parties involved--patients, of course, therapists and skilled nursing facilities.

Just recently, the federal government released a much-needed $5 billion aid package to SNFs--one that came on the heels of the industry's first-ever decline in margins reported since 1999. That funding, combined with the collective will to improve therapy challenges that existed in the industry even prior to COVID-19, is a rare opportunity. Of course, COVID-19 exacerbated challenges SNFs were already facing, it is also an opportunity for a total redesign of how SNFs provide therapy. I would like to propose that the vastly different climate in SNFs this summer 2020 should be a springboard for a more positive future for therapy in skilled nursing facilities. 

Moving from RUG-IV reimbursement to PDPM for therapy

Last October 2019 when the federal government entered a new fiscal year, the new Patient-Driven Payment Model (PDPM) replaced the long-held Prospective Payment System, RUG-IV approach to billing for therapy based on time spent per patient. The immediate effect of that change was that 43 percent of operators reported laying off therapists to a Skilled Nursing News SNF poll, as well as a reduction in hours. Facilities started providing more group therapy and concurrent therapy sessions, offering patients a chance to be motivated by one another as they each worked toward personal goals.

That was until COVID-19 hit in March 2020.  

We in the industry would still be sorting out the ripple effect of the move to PDPM this year, except that a bigger tsunami hit the skilled nursing facility industry in the form of a global pandemic. 

COVID-19 results in bigger changes for therapy

Five months into the COVID-19 pandemic, and most long term care patients are still spending the majority of time in their rooms, with little to no outside visitors. Therapy gyms are closed or only available to a limited number of patients at a time--at a social distance. And skilled nursing facilities are no longer getting reimbursed by therapy minute thresholds.

Therapists are now providing therapy within patient rooms, but this can be limited to the creativity, experience level and motivation of each individual therapist.

You could look at this as a disaster for the state of therapy in skilled nursing facilities, but I see it as an opportunity. As an experienced occupational therapist, I long ago recognized the need for a new approach to SNF therapy. The tired therapy exercises of batting at balloons and using cones or a pegboard are not enough to motivate patients to reach new goals. I despised going through the motions of cookie-cutter therapy. I knew I wasn’t providing the best opportunity for healing to my patients.

The SNF therapy industry needed a shakeup, and now we have it. 

The change to PDPM means the number one focus is on patient outcomes. This should always be our goal as therapists and SNFs, and COVID-19 doesn’t change this goal either.

COVID-19

Here are 4 ways we can take 2020’s changes to SNF therapy and use it as a springboard for better therapy and more positive outcomes in the future

Focus on our ability to accelerate outcomes

Patients, therapists and SNFs are all now aligned around one goal every time: achieving the best outcome in the shortest, most responsible period of time. This has always been what the patient wants and what is best for the facility, but now the PDPM reimbursement aligns with that goal. 

How do we achieve this? By focusing on the patient experience. We make therapy fun, engaging and rewarding. Patients who are motivated in therapy will achieve a more positive outcome in a shorter span of time. Of course, every therapist appreciates the rare patient who is motivated and agreeable, but this isn’t always the case when patients can have a whole host of complicated reasons that leave them less motivated in therapy. Therapists need tools they can use that make therapy effective and engaging. The technology exists to do this. I work for a cutting edge company that is leading the way in this area with therapy gaming technology, and the early adopters of this kind of therapy will be among those who are best poised to achieve accelerated outcomes for their patients. 

Focus on connectivity and transparency

Prior to COVID-19, SNF facilities could rely on family visits to keep families connected to their loved ones. Families could easily pop in and ask a question to a nurse or social worker during these visits and, of course, schedule a care consultation.

Now with limited visitation for the foreseeable future due to COVID-19, facilities must proactively keep families in touch with their loved ones and informed about their care. Connectivity and transparency needed to always be a priority, but now all SNFs are forced to make this happen.

Most facilities have succeeded in scheduling Zoom and Facetime calls with families. Some facilities are mandated to do so by their state. But imagine if instead of talking from a chair or bed, families joined parts of a therapy session? Technology offers an incredible level of transparency, as families can motivate patients and celebrate their achievements as they watch. Families will recognize the value of long term care rehab and rest assured their loved one is getting excellent treatment. Gone are the concerns about what is happening behind the walls of a SNF when the relatives aren’t there. 

We at RESTORE have incorporated video conferencing into our platform, and no doubt, this will be an initiative with staying power.

Improve continuity of care

SNFs have always had high turnover and a constant need to aggressively hire new staff. And in therapy, the use of PRNs can mean that new therapists frequently join the care team. COVID-19 escalated this issue as SNF employees were suddenly called upon to soldier through a battle they hadn’t realized they signed up for, and facilities faced more shortages than ever.

The need to standardize care for every person providing treatment has always been a priority, but now it’s an absolute necessity. This is where technology comes in. With therapy technology, every therapist on the team can facilitate a similar session experience, regardless of how well they know the patient. Obviously, rapport in therapy is key to overall success, but when that’s not a possibility, it’s still essential that the patient continues to reach individual goals. Technology that tracks this progress and helps therapists facilitate the actual exercises is key.

Skilled nursing facilities that do this well will have an evidence-based practice to identify patients’ needs and show progress.

This is what we developed with RESTORE Skills, and this is where the future of SNF therapy lies.

Differentiate the care approach and share success stories

Competition is fierce for the same type of patient now with PDPM. It’s not enough to just have an aesthetically beautiful facility. SNFs have to offer a higher quality of care than their competition and then share those stories through marketing. 

Those skilled nursing facilities that differentiate themselves from their competitors by offering better therapy outcomes will be positioned to succeed in the future.

Ultimately, to achieve all of these improvements, SNF employees need to work as a team. When it comes to creating positive outcomes for patients, none of the goals of SNF employees can be individual or exist in a silo. For example, I can’t manage to succeed with a patient in OT if he didn’t get the nutrition he needs or a good night sleep because his roommate kept him up. SNFs need more collective leadership to actually achieve the integrative care approach. This is more than just a morning meeting. It’s one where every team member realizes that they are one piece of a puzzle, working together for a greater goal that can only be achieved with all of them together. 

I left my position after 25 years as a therapy provider, clinical specialist and multiple senior care operator because I saw in my position as CCO at RESTORE Skills an opportunity to impact the whole industry. I recognize how new ways of thinking about therapy in SNFs can have a greater impact on patients and on the facilities and their employees as well. As we continue to deal with the ripple effect of these past few months, I have no doubt that more innovation and new ways of thinking about SNF therapy will develop. Those skilled nursing facilities that embrace this technology and look for ways to achieve more accelerated positive outcomes will come out on top.

Click here to learn more about how RESTORE Skills is helping skilled nursing facilities meet therapy needs, improve patient outcomes, and keep patients engaged and connected, especially during COVID-19. 

About the author:

Ian Oppel is a healthcare executive with over 25 years of post-acute healthcare leadership experience providing expertise in rehabilitation, fiscal and clinical operations, memory care, senior living, reimbursement, and regulatory compliance. Ian is currently the co-founder and chief clinical officer for RestoreSkills, a leading edge therapeutic gamification and telehealth company.

Challenges and wins for skilled nursing therapy during COVID-19

Four leaders in the skilled nursing therapy space gathered last week to discuss the state of therapy during COVID-19. They shared challenges and even some wins that have occurred over the past three months in this new normal for long-term care facilities.

Featured panelists were Andrea Gale, VP of case management, Marquis Health Services; Michael Sciacca, CEO, Zimmet Healthcare; and Ian Oppel, OTR, CCO, RESTORE Skills; and Aaryn Crosby, CEO, Adaptive Rehab. Monitoring the discussion was RESTORE Skills CEO Eran Arden.

Highlights of the discussion included the following. Click here to watch the full webinar video. Click here to find out about our COVID-19 special for a better therapy solution during COVID-19.

The challenges for therapy in skilled nursing facilities are many. 

Among those challenges the panelists defined are the following: 

 

Andrea: Helping residents stay connected to loved ones

Mike: The skilled nursing facility industry is lean in a normal time. There's not a lot of redundancy, and the resilience of these organizations has been challenged now that a pandemic has been brought upon them.

Aaryn: Finding ways to address staffing issues and adjust workflow to accommodate for social distancing is a challenge. We’re having to find ways to figure out how to provide quality functional treatment in people's rooms in a way that's portable.

Ian: There are 2.4 million people in long-term care facilities. We have been entrusted with a great responsibility and an escalated need for transparency and accountability beyond what we have previously known.

Andrea: We're seeing an increase in depression and other comorbidities among long-term care patients. Short-term patients are worried about being in the nursing home and not having a family member to sit by their side and advocate for them.

 

What therapy looks like in skilled nursing facilities during COVID-19 

While challenges may seem insurmountable, skilled nursing facilities across the country continue to provide excellent care, and even in some cases, are improving aspects of that care in creative, new ways. Our panelists discuss what they're seeing on the ground in facilities and with patients.

 

Aaryn: In some ways, we are providing a higher quality of treatment during this pandemic. We’re using RESTORE Skills to provide therapy because it's portable and we can roll it down the hallway to bring it into patient rooms. We get them out of bed to do therapeutic activities right there in their rooms. We can connect them with loved ones and everyone feels better knowing their loved ones are okay.

 

Ian: There is truly no team better suited to mitigate the physical, cognitive, and psychosocial risks of isolation than the rehabilitation team. Therapists can add immense value in this new normal, but it is essential they are afforded the time, tools, training, and support. In return, therapists have to be open to changes in the current care delivery model. Staggering schedules to have an extended presence beyond typical 7am-5pm windows with the majority of service between 9-3, lessening resistance to change and ensuring that therapy sessions demonstrate resourcefulness, meaning, engagement, and as much as possible, fun. As therapists, we have a responsibility to connect families and friends of loved ones with video chat to build trust through transparency, allow for encouragement, and provide an opportunity for patient/family education/training. 

 

Andrea: During COVID we’re using laptops in the rooms as well as and using RESTORE Skills in a streaming mode so we can do group exercise and residents feel like they’re with a team. We even have a leader board.

Covid-19’s lasting impact on the future of SNF therapy 

Panelists also discussed how meeting therapy needs during COVID-19 may change the industry permanently. And many of these outcomes look to be positive.

 

Mike: Our goal is to get patients active. Before COVID and PDPM, we were tied to therapy minutes and a whole generation of therapists are used to working like that. PDPM gives us all the flexibility to be creative. The pandemic exacerbates this need so that by necessity we have to be creative.

 

Ian: It's becoming more about the goal and less about the role. There is a clear shift taking place from a focus on individual competence and isolated outcomes in therapy to collective competence and optimizing patient-centered outcomes. Therapists are finding new ways to add value by integrating their care approach with activities, nursing, dietary, social services, and others as their presence has increased away from the therapy gym.        

 

Andrea: It’s even more important now to share positive patient outcomes. We need to produce data on what we’re doing to make people feel at ease as possible. We’re now offering live virtual tours and having to be able to explain how skilled nursing therapy, activities, and a monitored diet can support recovery and help patients avoid readmission.

 

Mike: One of the lasting impacts of this will be telehealth therapy and that this has allowed us all to be more creative in how we provide care. There’s been rapid growth in technology to make our work lives more efficient, as well as increase the connection between family and institutions. 

 

Andrea: As tech-savvy as we were, we still saw ways we can improve our use of technology for efficiency and communication. We have more Zoom and Facetime meetings for communication and care conferences with teams. Providers are moving to telemedicine and still continuing with rounds, but they are able to see more patients now that it’s virtual. And we haven’t seen a difference in outcomes, so we’ll continue to see this grow. Rounds with specialists over telemedicine have opened up avenues for multiple parties on team meetings so there’s more collaboration. 

 

How RESTORE helps therapists meet goals

While skilled nursing facilities across the country are focused on protecting residents from Coronavirus, therapists face the added challenge to keep patients progressing in physical, occupational, speech, and cognitive therapy. Nearly 200 rehabilitation companies and skilled nursing facilities across the U.S. are turning to virtual therapy solution RESTORE Skills to keep patients active and engaged in their rooms – all while having fun and staying in touch with loved ones.

RESTORE Skills is an interactive software product for adult rehabilitation patients that uses any webcam-equipped, Wi-Fi-enabled device as a therapy tool in the gym, at the bedside, or at home post-discharge. The virtual gamification tool that ensures skill-building can happen anywhere is a game-changer during this COVID-19 outbreak.

Improving therapy outcomes especially during COVID-19

I want to share with you positive news. On the frontlines in the battle against COVID-19 and under more public scrutiny than ever, I’m seeing nursing home professionals creatively provide therapy and engagement to patients. Patients are reaching therapy goals even in this new season of social distancing and closed therapy gyms.

How?

Our clients are using gaming software in skilled nursing facilities so that all they need is a laptop to get patients engaged in therapy. They’re reaching higher for a slot machine level or standing up and moving side to side by playing games like Jackpot and Skiing.

  • Patients are so busy playing, they forget they’re in therapy
  • Patients are connecting with loved ones back at home, who join the therapy session right there on the app
  • Facility team members on all levels are stepping in to support therapy goals

Imagine Zoom with a Wii. That’s how I’m seeing seniors reach new goals in therapy and even get discharged home where they continue using the software – even during COVID-19. Especially during COVID-19.

RESTORE Skills is the only therapy software available with no device required outside of a laptop. We are the only player in the market that allows users to take a laptop in a room and reach therapy goals. At a time when nursing homes are even more severely understaffed and patients are isolated in their rooms, RESTORE skills turns every team member into a skill-building superstar – from activities directors, to CNAs and nurses. 

It is our goal to give as many seniors access to this transformative tool as possible.

Because across the country, many nursing home patients are missing this opportunity and most likely missing out on crucial therapy sessions while isolated in their rooms. We are offering our software at an unprecedented low price during COVID-19 so that we can help many skilled nursing facilities continue to provide cutting edge therapy even amidst a pandemic.

Let’s change the trajectory of the story of skilled nursing care in the news right now and fill it with stories of positive outcomes. Because anyone familiar with this industry knows the positive outcomes are typical, even if they’re not the story in the news. 

RESTORE Remote: Invite Family to Join LIVE Therapy Sessions

Introducing RESTORE Remote: A better way to virtually connect to patients

Introducing RESTORE Remote: A better way to virtually connect to patients

When we launched RESTORE Skills, never did we imagine that therapy gyms would close for months at a time and skilled nursing facility patients would be isolated in their rooms. Now that COVID-19 has made this a reality, with no foreseeable end in sight, we at RESTORE Skills are seeing just how transformative our tool is for providing therapy to seniors now more than ever. 

  • Clients are using our gamified software to turn every patient room into a therapy gym
  • RESTORE Remote offers the ability to invite family members to virtually join therapy sessions with the click of a button

New communication tool in our technology

When we saw our clients setting up Zoom calls for residents and families, we quickly developed a new communication tool for our software. RESTORE Remote allows patients and therapists to invite family members to join therapy sessions right there within the games. 

RESTORE Remote is helping skilled nursing patients connect with loved ones in a powerful new way. Videoconferences with seniors can be challenging for those who struggle with new technology, but RESTORE Remote is a therapy tool seniors and therapists already know how to use. The communication tool also allows families to connect with loved ones in cognitive and speech therapy in a meaningful way.

We developed RESTORE Skills as a skill-building tool for therapy gyms, where patients can show off their new skills, compete in therapy games against one another and cheer each other on. Each player can work on their own set of skills, within their personal range of motion, but the games themselves offer a sense of competition where patients celebrate and strive to outperform one another. Users only need our software and a webcam to use RESTORE Skills anywhere, so it has always been a significant bonus that patients can continue building therapy skills on their own at home.

Now with RESTORE Remote, the audience patients enjoyed in the therapy gyms is back. Only this time, the audience is made up of loved ones.

Turns out we started getting RESTORE Skills into long term care facilities just in time. 

Our tool supports challenges facilities are facing right now. 

  • Skilled nursing facilities are struggling with staff shortages
  • Patients no longer have visitors 
  • Activity directors have limited options for keeping seniors social and engaged
  • Therapists are having to provide therapy within patient rooms
  • Skilled nursing staff are now also the IT experts, connecting residents with families over video conferences.

We at RESTORE Skills are helping SNFs meet all of these challenges. We’re working harder than ever to get RESTORE Skills into as many skilled nursing facilities as possible. Therapy and positive outcomes for our seniors in these facilities depend on it.

 

Click here to schedule a demo and find out how RESTORE-Skills can help your facility meet therapy needs during COVID-19.

 

National Nurses Day

Celebrating Nurses by Improving Patient Outcomes

On this day and every day, all of us at RESTORE-Skills honor nurses as the healthcare heroes that they are. I see firsthand in our work with senior care facilities the demands placed on nurses. They are always on the frontlines of every patients’ battle for the best outcome possible. Perhaps during no time since World War II has this been more apparent than in the middle of our current global pandemic of COVID-19. 

This National Nurses Day my team and I are celebrating long term care nurses by improving therapy outcomes for their patients.

I’ve seen firsthand that nurses in skilled nursing facilities are among the most dedicated in the field. They get to know patients in senior care facilities over a length of time and many consider the residents like family. It takes a special soul to nurse a patient back to health at a time when there are so many compounding issues that come with aging. Sometimes the job of the nurse is to simply hold a patients’ hands and provide comfort.

 

Other times, it’s the job of long term care nurses to motivate their patients to get up and get moving for therapy. While they are not the therapy providers, nurses and their assistants are key players in ensuring that patients are ready and in the best mindset possible for therapy sessions.

What if we made that part of nurses’ jobs a lot easier? And in the process, we improved the outcomes for patients these nurses have come to love?

My team and I are doing just that with RESTORE-Skills. Here’s how I am seeing our skilled nursing facility clients benefit from our therapy software tool:

  • Our award-winning gamification technology makes therapy fun and engaging so that patients actually ask to play. 
  • Skilled nursing patients are actually playing therapy games right in their rooms during COVID-19 while therapy gyms are closed.
  • Every team member of skilled nursing facilities becomes a therapy skill building superstar with just a laptop and webcam.
  • Patients are staying busy, active and engaged while reaching therapy goals, breaking up these long days isolated in their rooms while eating meals by the door.

 

This National Nurses Day, we’re honoring these healthcare heroes by working to advance their quiet daily goal of improving each patient’s outcome. I believe in the power of this software to create positive therapy outcomes on a massive scale because we see it happen in our clients’ facilities every day. The time is now to give nurses and all dedicated employees in skilled nursing facilities a game-changing tool in their arsenal.

 

We want to get RESTORE Skills in the hands of every long term care facility possible. Click here to learn about our COVID-19 special offer.

 

Skilled Nursing News

An Interview with Skilled Nursing News

We're thrilled to be featured on Skilled Nursing News today. Aaryn Crosby of Adaptive Rehab Services and our CEO, Eran Arden sat down with Skilled Nursing News to discuss the impact of RESTORE-Skills on therapy services and the unforeseen benefits in the wake of the COVID-19 pandemic. Below, is an excerpt from the article:

By “gamifying” therapy via a hardware-agnostic platform, some providers are finding not only much greater engagement among patients and residents receiving therapy, but also the unforeseen benefit of engaging non-therapy residents and their family members under social distancing protocols set under the COVID-19 pandemic. 

Driving therapy engagement 

As a third-party therapy provider in multiple settings including post-acute and long-term care facilities, Adaptive Rehabilitation Services set out in 2019 to find a platform that would improve patient participation and garner more engagement in therapy as well as to measure functional skills and progress. Further, Adaptive wanted a solution that did not require a hardware purchase to host the platform. 

“There are a lot of products that require the user to have [a specific] device,” says Aaryn Crosby, Chief Operating Officer at Middleburg Heights, Ohio-based Adaptive Rehabilitation Services. “We were looking for something that can work on multiple systems and computers… something that could deliver functional room treatments. Many patients may not be able to come down or are nervous to come down to the gym.”

The company implemented RESTORE Skills in early 2020 and saw measured success in engagement. The platform, which can run on any web-enabled laptop with a display and a camera, provides a series of goal-oriented games that merge therapy with fun tasks that can be played with a single player or multiple players engaged on a single screen. 

With games to present to residents and patients, therapy teams soon reported that those not previously participating were increasingly using the platform and we're seeing increased functional outcomes. They were practicing more and were resisting less, which led to improved progress overall. 

“Having a truly fun and interactive therapy session versus a standard therapeutic exercise has increased engagement and mental well being by allowing patients to perform together and compete,” Crosby says. 

An unforeseen benefit: the platform serves as an activity for non-therapy residents as well. 

“We have had activity aides asking for us to train them on the program; residents’ roommates are telling them they want to try it out too,” he says.

Click here to read the full article. Interested in seeing gamification in action? Contact our team to schedule a demo and to learn how gamification can drive engagement and outcomes during the COVID-19 pandemic.

Meet Your Group & Concurrent Therapy Goals

We want to help you reach your group and concurrent therapy goals in an exciting and engaging way. Add fun to your center, encourage residents to move more, and build community with our new group play feature. In this post, we'll discuss group play and learn how centers are incorporating games into their group practice. Then, we'll review tips to help you and your team get started!

The RESTORE Difference

The Group Play feature helps with the PDPM requirements for group and concurrent therapy. The portability of the platform eliminates environmental limitations to promote enjoyable and engaging group therapy opportunities. For instance, you can create practice opportunities by setting up several stations or engaging multiple players on different devices simultaneously.

Our users love to engage with the group play setting. In fact, at a team training in a Massachusetts center we saw the power of gamification during simultaneous group sessions. To start, the therapists split people into two groups and set up each station was to play Ski Saga. Then, players worked on weight shifting, trunk rotation, squatting, strengthening, and standing tolerance. It was great to see the variety of exercises and controllers used to enhance the session! The whole room was full of excitement as players took turns "skiing" to reach their therapy goals.

Together is Fun

Our fun, innovative, and engaging therapeutic activities bring a vibrant boost to your therapy gym. Playing games in a group session can facilitate conversation among players as they discuss their hobbies, memories, or traditions. Players enjoy playing together as a team, in large groups by taking turns, or even tournament style to create some excitement and light-hearted competition.

Centers can also enjoy Group Play when playing as part of a community event in the activity department or elsewhere. For instance, the team can create a "pet therapy" day at the center and incorporate RESTORE animal-themed games as one station, along with stations for making dog biscuits, playing fetch with a therapy retriever, and setting up a pet show.

We hope these tips spark your imagination and encourage you to step out of the box for your next therapy session or group activity. Do you have any fun stories from a RESTORE group play session? Tell me about it by sending your account and a few of your favorite pictures to amanda@restoreskills.com.

Follow  RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

 

Data-driven activities & daily progress tracking

How Do You Measure Daily Progress?

Hi, I am excited to share that RESTORE's Daily Progress dashboard is now live.

We understand how important it is for you to track your patients’ progress. You want to know if today was better than yesterday and plan for tomorrow's activity accordingly. For example, you want to see if your patient can reach higher, react faster, and respond with greater accuracy. Now, with RESTORE’s *NEW* Daily Progress dashboard, you can monitor your patients' functional progress over time.

What Progress Can Be Measured?

Game Positions Skill Data Point Displayed
Car Cross Standing & Sitting L&R Hand, Two Hands, Two Hands Together Range of Motion Max Height Reached
Falling Fruit Standing & Sitting L&R Hand Crossing Midline Midline_crosses_right
Bulls Eye Sitting & Standing L&R Hand Range of Motion Correct hits
Order Up Sitting & Standing L&R Hand Range of Motion items_caught_in_correct_order
Memory Game Sitting & Standing L&R Hand Range of Motion Wrong_couples/matches
Falling Fruit Standing L&R Hand,  Two Hands Balance correct_moves
Bounce It R&L Leg w/ & w/o support Up / Down Movements L/R Calibration Percentage

 

*Results will appear in the Daily Progress dashboard found in the Player Profile*

 

Why come back daily?

Progress data is collected when patients play different skill-building activities on our platform. To see consistent data and track progress over time, make sure your patients are practicing every day.

PDPM - What can we do for you?

Under PDPM, presenting objective data when reporting patient progress will be more important than ever. We will continue to develop and provide our users with the best measurement and therapy tools possible. If you have an idea for an activity or measurement that can empower you and your patients, let us know. We are happy to develop and add therapist ideas for the benefit of all of our users!

We look forward to hearing from you and supporting your goals!

Eran Arden
CEO & Founder