Rehabilitation Therapy

2018 AHCA/NCAL Annual Convention

RT-1 - Raising the Bar on SNF Quality Outcomes. Rethinking the Role of PT, OT, and SLP in Interdisciplinary Approaches to Re-admissions, Restraints, Medications, Falls, and Management of Cardiac Conditions

Sunday, October 7
8:00 AM - 10:30 AM
CE: NAB: 0 | Nurses 0

The American Health Care Association (AHCA) and National Association for the Support of Long Term Care (NASL) are AOTA Single Course Providers. As Single Course Providers, AHCA and NASL are authorized to offer .4 AOTA CEUs/4 Contact Hours.
There are no prerequisites to attend RT-1 or RT-2 but it should be notes that RT-1 is considered an Advanced Level Session.

Skilled nursing facilities serve a dual purpose of providing short-term nursing and rehabilitative post-acute care as well as providing long-term care to individuals unable to safely return to living in the community. Recent value-based payment initiatives, and the recently proposed SNF Patient Driven Payment Model (PDPM), are shifting the role of SNF therapists from an emphasis on service delivery to individual residents to a more interdisciplinary quality outcomes management and consulting role that benefits all residents. Rethinking the role of PT, OT, and SLP clinicians, and exploring opportunities where interdisciplinary contributions to the care team could be expanded to improve quality in key areas and to expand partnerships with physicians and hospitals, are keys to success moving forward.

The presenters of this session will share their experiences and insights into how they have been transforming the role of therapy professionals in a SNF to be successful in achieving quality outcomes in an environment of growing alternative payment models including Accountable Care Organizations (ACOs), Bundled Payments for Care Improvement Initiatives (BPCI), Comprehensive Care for Joint Replacement (CJR) bundled payments, and other innovative managed care models.

As an active participant on a SNF care team, our first presenter will share her unique OT perspective on lessons learned from participating in new payment models. She will describe concepts and experiences in implementing interdisciplinary change management processes to reduce hospitalizations and re-hospitalizations, as well as the priority of good communication and ensuring appropriate workflow within the care team and across a national SNF corporation.

Our next presenters will discuss the interrelated role of SNF quality measures and the recently updated Requirements of Participation (RoP) and the importance of interdisciplinary collaborations in addressing the unique needs of the nursing home population. Specifically, the measures related to physical restraints, antipsychotic medications, pain, and falls will be discussed. Each of these measures are inter-related and a thorough assessment of the patient is required for the therapist to advocate for optimal resident well-being. As the nursing home population increasingly has a diagnosis of dementia, understanding the relationship among falls, restraints, pain, and medication use will require therapists to simultaneously manage complex situations with a systematic and evidence-based approach that recognizes individual resident abilities and staff/facility practices.

Our final presenters will describe a program they developed that provides a comprehensive interdisciplinary approach to exercise, counseling and education designed to support patients with cardiac disease in achieving optimal physical, psychological, and functional status. The approaches are evidence-based and supported by outcomes data that demonstrates the overall effectiveness of the program, including improvement in functional outcomes, a reduction in the SNF length of stay and a reduction in return to acute, resulting in an overall reduction in cost to the system. Kaiser Permanente has recently awarded “Super-SNF” status to one of the facilities where the program was implemented. The program serves as a potential model on the road to outcomes-based care.

Learning Objectives:

Sabrena McCarley, MBA-SL, OTR/L, CLIPP, RAC-CT

Director of Clinical Operations
RehabCare/American Occupational Therapy Association

Sabrena McCarley, MBA-SL, OTR/L, CLIPP, RAC-CT is the Director of Clinical Operations with RehabCare and is also representing the American Occupational Therapy Association. McCarley earned her Bachelor of Science degree as well as her Master of Business Administration-Strategic Leadership degree from Dominican University of California. In 2015, she obtained her Certified Living in Place Certification and in 2016, she obtained her Resident Assessment Coordinator Certificaton.

Her career has been exclusively in the post-acute care setting where she has worked as a clinician, rehab director and multi-site manager both in operations and clinical services. In her experience, she has been responsible for program development and providing clinical trainings, mentorship and partnerships with clinicians as well as interdisciplinary team members. Her philosophy is that the patient is the center of any interdisciplinary team or holistic approach and that in order to get the best outcomes for our patients, we must remember that they are the reason for what we do.

McCarley has presented on a variety of clinical and regulatory topics at state, national and international conferences for the Occupational Therapy Association of California, the American Occupational Therapy Association, the Canadian Association of Occupational Therapy, the National Association of Rehabilitation Providers and Agencies, the National Kitchen and Bath Association and and the California Association of Health Facilities. She has also acted as the AOTA CE Administrator.

In May 2017, she was appointed to the Center for Medicare and Medicaid Services MACRA Episode-Based Cost Measures –Neuropsychiatric Disease Management Clinical Subcommittee. She is a member of the American Occupational Therapy Association and is also a member of the Living in Place Medical Advisory Panel. She is actively involved in leaderhsip with the Occupational Therapy Association of California as Chair for Advocacy and Government Affairs and is Chair of the Nominations and Awards Committee for the National Association of Rehabilitation Providers and Agencies.

McCarley co-authored an article that was published in the October 2016, Vol. 32, No.10, issue of Advance Magazine for Occupational Therapy Practicioners: Securing Safer Housing Standardizing environmental design for seniors and residents with a disability. In addition, she co-authored an article that was published in the Novemeber 2017, Vol. 2, Issue 4, issue of the SIS Quaterly Practice Connections/AOTA: Using Smart Technology to Promote Aging in Place for Older Adults.


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Cathy Ciolek, DPT, GCS, FAPTA

Living Well With Dementia, LLC

Cathy Ciolek DPT,GCS, FAPTA, CDP, CADDCT, is president of Living Well With Dementia, LLC, providing education and consultation to improve well-being and create positive expectations for people with dementia. She has been a physical therapists for nearly 3 decades having graduated from Ithaca College for her entry bachelor in physical therapy and AT Still University for her DPT. She is board certified in geriatrics since 1996 (GCS) and was recognized as a Catherine Worthingham Fellow of the APTA in 2018. She is a Certified Dementia Practitioner (CDP) and Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT) and Certified Exercise Expert for Aging Adults (CEEAA). Her clinical experience spans the care spectrum for older adults including acute care, home health, SNF, academia and outpatient care for older adults. Dr. Ciolek is currently the Vice-President of the Academy of Geriatric Physical Therapy, APTA.


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Ellen R. Strunk, PT, MS, GCS, CEEAA, CHC

President, Principle Consultant
Rehab Resources and Consulting, Inc.

Ellen R. Strunk has worked in multiple post-acute care settings as both a physical therapist and manager/director. Presently, Ellen is owner of Rehab Resources & Consulting, Inc. (RRC), a company providing consulting services and training to providers in post‐acute care settings. RRC specializes in helping customers understand the CMS prospective payment systems in the skilled nursing facility and home health setting, as well as outpatient therapy billing for all provider types. Ms. Strunk’s experience includes utilizing medical record reviews and data systems to help both inpatient and outpatient therapy providers meet regulatory guidelines. She has worked with clients on a variety of Medicare/Medicaid payment and certification matters, including substantial overpayment assessments and facilitation of Corporate Integrity Agreements. Services offered include: interdisciplinary medical record review, compliance risk analysis, appeals and appeals management, and developing clinical programs and operational processes to support the transition to value-based care.

Ellen is a member of the American Physical Therapy Association, where she serves on the Payment Policy Advisory Committee advising the APTA Board of Directors on payment policy in all settings. She is a member of the American Health Care Association (AHCA), the National Association for the Support of Long Term Care (NASL), and the National Association of Rehabilitation Providers and Agencies (NARA).


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Deb Bielek, MS CCC SLP

Therapy Resource Education and Programs
Ensign Services, Inc.

Deb Bielek, MS, CCC-SLP is a Speech-Language Pathologist and serves as the Therapy Education and Programs Resource with Ensign Services, Inc. She has spent most of her career in the post-acute industry, working in various roles as both a clinician and leader. Deb provides program development and education support to greater than 200 post-acute care facilities throughout her organization. In addition to leading education and development, she also serves as a regulatory liaison, representing her organization and providing expertise to various industry panels, clinical and technical work groups and councils throughout the post-acute care industry. She is currently a member of the Therapy Policy Advisory Group and the Reimbursement Committee of the American Health Care Association. She is also a member of the Clinical Focus Workgroup for Optima Healthcare Solutions. One of her areas of specialty is helping teams develop models of care that meet the needs of their individual healthcare communities through the delivery of well-coordinated, patient-centered, outcomes-based care. Deb facilitates discussion and learning with therapy, nursing and operations teams throughout her organization and other industry providers on topics of post-acute regulatory change and implementation strategy, functional outcomes with focus on the shift to value-based payment, and clinical programming to support innovative healthcare models such as managed care, BPCI, and ACO’s. Recent speaking engagements include: Co-Presenter at the Regional Multi-facility Council Meeting for American Health Care Association; Co-Presenter of the Comparison of RUGIV and RCS1 American Health Care Association; IMPACT Act Leads Change for an interdisciplinary continuing education event.


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Skelly A. Wingard, RN, MSN, PHN, CNL

Continuum Administrator
Kaiser Permanente

Skelly is the Continuum Administrator in Marin and Sonoma Counties for Kaiser Permanente, Northern California. She is a University of San Francisco MSN graduate, with a Masters degree in Clinical Nurse Leadership. As a nurse and health care professional, her career has spanned the continuum. Including strategic clinical and operational roles with managed care, accountable care, for profit, not for profit, bundled payment, hospital, continuum, and integrated delivery organizations. The work within these organizations has contributed in molding her professional resume to include strategic work in multi-organizational integrated clinical systems, local/regional/national contracting, national organizational clinical and operational standardization, patient/provider experience, data programming and analytics, operational financial budget strategy, government/CMS contracting and relations, and organization culture development.

Skelly is confronted daily with the reality of the American health care system, and the gaps in access, utilization, and affordability. She has a vision in which health and health care in America are intentionally transformed to close these gaps, and support the continuum of care quality alignment necessary to improve quality and affordability within the dynamic health care industry.


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RT-1 - Raising the Bar on SNF Quality Outcomes. Rethinking the Role of PT, OT, and SLP in Interdisciplinary Approaches to Re-admissions, Restraints, Medications, Falls, and Management of Cardiac Conditions

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