Tag: SNF

Breathing New Life into Respiratory Care: NHC's Success with ACPlus® Respiratory Assessment

Breathing New Life into Respiratory Care: NHC’s Success with ACPlus® Respiratory Assessment 

Key highlights:  

  • NHC’s pilot of ACPlus® Respiratory Assessment (ARA) in 3 centers since June 2023 has significantly improved respiratory care. 
  • ARA has helped reduce rehospitalization rates by 36% and has ensured that Medicare and Medicaid submissions reflect the medical complexity of the patient population, enhancing patient care and financial performance. 
  • NHC plans to expand ARA to all 11 facilities, emphasizing staff buy-in, systematic implementation, and patient-focused benefits for success. 

Respiratory care is a critical, often challenging, aspect of patient health in skilled nursing facilities. The ACPlus Respiratory Assessment (ARA) is changing this landscape, offering an innovative approach to identifying and managing respiratory issues. National Healthcare Corporation (NHC) recently piloted ARA in three of its facilities, with results that are transforming patient care and operational efficiency. 

Sarah Ison, Regional Therapy Director for NHC's central region
Sarah Ison, Regional Therapy Director, NHC

We spoke with Sarah Ison, Regional Therapy Director for NHC’s central region, to learn more about their experience with ARA, how they have been using it across their pilot facilities, and the results they have seen since implementing it in June 2023.

Implementing ARA

Various staff members, from nurses to therapists, can perform an assessment with ARA, allowing for flexibility in implementation. “Most of the buildings have three or four people doing the assessment,” Ison notes. “We have therapists doing it, nurses, and some nurse practitioners and respiratory therapists.” 

After some trial and error, they found a sustainable workflow to ensure each new admission was assessed in a timely manner. “We test every new admission within the first three days,” said Ison. “For our long-term care population, we test quarterly and as needed if someone notices a change.”

Uncovering Hidden Health Issues 

Ison reveals one of the biggest surprises they have encountered since adopting ARA is the volume of patients experiencing respiratory deficits who show no obvious symptoms. She estimates that of the patients they have assessed, 95% return results indicating a respiratory deficit. “It has really helped us to identify patients who would benefit from respiratory therapy, whom we might not have typically provided that service to,” said Ison.

Strengthening Documentation 

In an era of frequent healthcare audits, ARA provides robust documentation and objective data that has been invaluable for NHC’s staff. “Our documentation is constantly being reviewed, so we have found it was extremely beneficial having those ARA results and the documentation of those deficits to support what we were capturing on the MDS,” said Ison.

ARA’s Impact by the Numbers 

One of NHC’s inpatient facilities saw significant year-over-year improvement, which Ison attributes in part to their use of ARA starting in June 2023: 

  • Rehospitalization rates dropped 36% from May 2023 vs May 2024
  • Average daily Medicare Part A reimbursement increased by 4%  
  • Medicaid reimbursement rose 7.4% 

These numbers reflect not just financial value but also improved patient care and better outcomes. 

Finding Success with ARA

For those interested in implementing ARA in their facility, Ison offers the following framework to extract the most value from the tool: 

  1. Secure buy-in from leadership and key staff members 
  2. Develop a systematic approach to conducting assessments 
  3. Remain flexible and willing to adjust processes 
  4. Focus on the patient benefits to motivate staff

Looking Ahead

As a testament to ARA’s success, NHC plans to roll out ARA across all 11 facilities in Ison’s region. NHC’s experience with ARA emphasizes how early detection of respiratory deficits can transform patient care. By providing precise data and robust documentation, ARA is helping facilities like NHC deliver more comprehensive, targeted care for better patient outcomes. 

National Healthcare Corporation’s (NHC) experience does not represent a claim made by Accelerated Care plus. Your results with ACPlus® Respiratory Assessment may vary. 

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Respiratory care is a critical, often challenging, aspect of patient health in skilled nursing facilities. The ACPlus Respiratory Assessment (ARA) is changing this landscape, offering an innovative approach to identifying and managing respiratory issues. National Healthcare Corporation (NHC) recently piloted ARA in three of its facilities, with results that are transforming patient care and operational efficiency.

Enhancing Group Therapy with Virtual Reality in SNF Rehab 

Enhancing Group Therapy with Virtual Reality in SNF Rehab 

The highlights:

  • Integrating virtual reality (VR) into group therapy enhances patient engagement and functional outcomes, transforming the rehabilitation experience
  • Effective implementation involves selecting collaborative VR activities, fostering healthy competition, and adapting experiences to group dynamics for maximum benefit
  • ACP will soon launch a new technology that helps clinicians seamlessly incorporate VR into group therapy

As skilled nursing facilities (SNFs) navigate an increasingly competitive landscape, they constantly seek innovative ways to improve patient outcomes, drive operational efficiencies, and differentiate their rehabilitation programs. We recently covered how VR could transform skilled rehab. By thoughtfully integrating VR into group therapy sessions, clinicians can tap into synergies that address the key goals of modern SNFs: boosting patient engagement, enhancing functional outcomes, and optimizing the efficiency of care delivery.

The Synergies of VR and Group Therapy 

The Synergies of VR and Group Therapy

We have explored the individual benefits of VR and group therapy in SNF rehab. VR has proven to be an innovative solution that can increase patient engagement, encourage longer and more intense therapy sessions, and positively impact patient mood.1, 2 Meanwhile, group therapy settings have been shown to foster a supportive environment that enhances socialization, promotes healthy competition, and allows for more cost-effective care delivery. 

Together, group therapy and VR unlock a world of possibilities. The immersive, interactive nature of VR can take the group therapy experience to new heights, motivating patients to push the boundaries of their abilities while enjoying the camaraderie and encouragement of their peers. The social dynamics of group therapy can further amplify the engagement and therapeutic value of the VR experience. 

Practical Strategies for Incorporating VR into Group Therapy 

So, how can SNF clinicians harness the power of this dynamic duo? Here are some practical strategies for incorporating VR into group therapy sessions: 

Choose VR Experiences that Promote Collaboration 

Select VR applications that encourage teamwork and group interaction. For example, choose multiplayer activities where patients work together to achieve a shared goal or VR environments that simulate real-world tasks requiring coordination. 

Foster Friendly Competition  

Competition knows no age! Incorporate VR activities that allow patients to compete against their peers in a fun, supportive environment. Healthy rivalry can boost engagement and motivation, pushing participants to go beyond their perceived limits. 

Leverage Dual-Task Training 

Use VR to introduce cognitive challenges alongside physical exercise. As patients navigate the virtual world, have them perform tasks that engage both the body and the mind, such as remembering sequences, solving puzzles, or making decisions. This dual-task training can enhance overall functional abilities. 

Adapt VR Experiences to Group Dynamics  

When choosing VR applications, be mindful of group size, patient abilities, and therapy goals. Customize the virtual environments and tasks to ensure all participants are appropriately challenged and can actively engage with each other. 

Complement VR with Traditional Group Activities 

While VR can be an excellent supplement to group therapy, it should never wholly replace more conventional group activities. Combine VR experiences with traditional group activities to create a well-rounded rehab program. 

Elevating Rehabilitation Outcomes with VR-Enhanced Group Therapy

By combining evidence-based group therapy and VR, clinicians can foster better engagement, improved functional outcomes, and a heightened sense of community that supports the whole patient. 

This powerful combination can change how patients experience rehabilitation, which is why we are excited to share that we will soon launch a new, immersive VR technology that integrates seamlessly into group therapy – keep an eye out for more on that soon. In the meantime, as you continue to explore ways to optimize your skilled nursing rehabilitation program, consider the transformative potential of VR-enhanced group therapy. This dynamic combination can help you deliver exceptional care and position your facility for long-term success. 

  1. Kizmaz, E., Telli Atalay, O., Çetin, N., & Uğurlu, E. (2024). Virtual reality for COPD exacerbation: A randomized controlled trial. Respiratory Medicine, 230, 107696. https://doi.org/10.1016/j.rmed.2024.107696 ↩︎
  2. D’Cunha, N. M., Nguyen, D., Naumovski, N., McKune, A. J., Kellett, J., Georgousopoulou, E. N., Frost, J., & Isbel, S. (2019). A mini-review of virtual reality-based interventions to promote well-being for people living with dementia and mild cognitive impairment. Gerontology, 65(4), 430-440. https://doi.org/10.1159/000500040  ↩︎

As skilled nursing facilities (SNFs) navigate an increasingly competitive landscape, they constantly seek innovative ways to improve patient outcomes, drive operational efficiencies, and differentiate their rehabilitation programs. We recently covered how VR could transform skilled rehab. Learn how you can combine VR with group therapy to boost patient engagement, enhance functional outcomes, and optimize care delivery.

Reimagining Rehabilitation with Virtual Reality in Skilled Nursing Facilities

Reimagining Rehabilitation with Virtual Reality in Skilled Nursing Facilities 

The highlights: 

  • Virtual reality (VR) has been shown to boost patient motivation and engagement with their treatment. 
  • VR can push patients to train longer, harder, and with greater intensity, leading to better rehabilitation outcomes.  
  • By allowing clinicians to maximize their skilled time and incorporate dual-task training, VR can optimize treatment efficiency and effectiveness. 

Virtual reality (VR) is revolutionizing rehabilitation in skilled nursing facilities (SNFs), offering innovative solutions to common clinical challenges. As the evidence supporting VR in skilled rehab grows, it’s clear that this technology can reshape patient care and outcomes. Let’s dive into how incorporating VR into therapy has the potential to transform rehab in the SNF space.  

The Growing Evidence for VR in Skilled Nursing 

VR has been studied for a variety of diagnoses, including stroke1, Parkinson’s disease2, multiple sclerosis3, dementia4, and pain5. Over the years, research has consistently shown VR’s potential to enhance patient engagement and motivation while increasing the repetitions and duration of exercise—critical factors in successful rehabilitative outcomes. 

Key Benefits of VR in SNF Settings

Enhancing Patient Engagement 

One of the more challenging aspects of skilled nursing rehab is keeping patients engaged and motivated6 to participate in treatment. The immersive nature of VR creates a welcome distraction for many patients, allowing them to push their limits while experiencing something new, exciting, and even fun.  

Motivating Longer, More Effective Sessions 

In addition to boosting patient engagement, incorporating VR into therapy sessions has also shown a remarkable ability to motivate patients to train longer, harder, and at a greater intensity. This is a recipe for maximizing therapeutic benefits and accelerating recovery.

Improving Mood  

Beyond the physical benefits, VR can positively impact patients’ overall well-being. There is evidence that patients who use VR experience mood improvements and reductions in apathy7. Improved mood resulting from VR experiences can significantly influence engagement and recovery, addressing both physical and emotional aspects of healing. 

Optimizing Therapy Efficiency and Effectiveness 

Key Benefits of VR in SNF Settings

Dual-Task Training 

VR offers an excellent opportunity to introduce dual-task training, where patients work on one activity while simultaneously engaging in other tasks (cognitive or motor). This approach has been shown to be beneficial for postural control, mobility, and cognitive functions88

Maximizing Skilled Time 

For clinicians, VR offers a clinically effective means to maximize patients’ therapy sessions. Therapists can focus on modifying patient parameters to optimize each individual’s exercises, ensuring every minute of therapy is as productive as possible. 

Embracing the Future of Skilled Rehabilitation 

There is no question that, when used thoughtfully, virtual reality is making a positive impact on patient outcomes. By embracing the potential of VR, skilled nursing facilities can offer more engaging, effective, and efficient therapy programs that reimagine the entire rehabilitation experience.  

  1. Karamians, R., Proffitt, R., Kline, D., Gauthier, L.V. (2019, Dec 7). Effectiveness of virtual reality – and gaming-based interventions for upper extremity rehabilitation post-stroke: A meta-analysis. Archives of Physical Medicine and Rehabilitation, (Epub ahead of print), DOI: 10.1016/j.apmr.2019.10.195 ↩︎
  2. Triegaardt, J., Han, T. S., Sada, C., Sharma, S., Sharma, P. (2019). The role of virtual reality on outcomes in rehabilitation of Parkinson’s disease: Meta-Analysis and systematic review in 1031 Participants. Neurological Sciences, (Epub ahead of print). DOI: 10.10007/s10072-019-04144-3 ↩︎
  3. Porras, D. C., Siemonsma, P., Inzelberg, R., Zeilig, G., Plotnik, M. (2019). Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review. Neurology, 90(22), 1017-1025. DOI: 10.1212 WNL.0000000000005603 ↩︎
  4. Coyle, H., Traynor, V., Solowij, N. (2015). Computerized and virtual reality cognitive training for individuals at high risk of cognitive decline: Systematic review of the literature. American Journal of Geriatric Psychiatry, 23(4), 335-359. DOI: 10.1016/j.jagp.2014.04.009 ↩︎
  5. Mallari, B., Spaeth, E. K., Goh, H., Boyd, B. S. (2019). Virtual reality as an analgesic for acute and chronic pain in adults: A systematic review and meta-analysis. Journal of Pain Research, 12, 2053-2085. DOI 10.2147/JPR.S200498 ↩︎
  6. Kizmaz, E., Telli Atalay, O., Çetin, N., & Uğurlu, E. (2024). Virtual reality for COPD exacerbation: A randomized controlled trial. Respiratory Medicine, 230, 107696. https://doi.org/10.1016/j.rmed.2024.107696 ↩︎
  7. D’Cunha, N. M., Nguyen, D., Naumovski, N., McKune, A. J., Kellett, J., Georgousopoulou, E. N., Frost, J., & Isbel, S. (2019). A mini-review of virtual reality-based interventions to promote well-being for people living with dementia and mild cognitive impairment. Gerontology, 65(4), 430-440. DOI: 10.1159/000500040 ↩︎
  8. Scarmagnan, G. S., Lino, T. B., Pimentel, D.E., Silva, A. V. B., da Silva Ramos, I. M., Christofoletti, G. (2024). Benefits of a dual-task training on motor and cognitive functions in community-dwelling older adults. American Journal of Physical Medicine & Rehabilitation, 103(5), 377-383. DOI: 10.1097/PHM.0000000000002352 ↩︎

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Virtual reality (VR) is revolutionizing rehabilitation in skilled nursing facilities (SNFs), offering innovative solutions to common clinical challenges. As the evidence supporting VR in skilled rehab grows, it’s clear that this technology can reshape patient care and outcomes. Check out our latest blog to find out how incorporating VR into therapy has the potential to transform rehab in the SNF space.

Boosting Patient Outcomes & Engagement with Group Therapy

Boosting Patient Engagement & Outcomes with Group Therapy

The highlights:

  • Recent research shows that incorporating group therapy alongside individual treatment can significantly improve patient self-care performance in skilled nursing facilities (SNFs). 
  • Group therapy in SNFs creates a supportive network that promotes growth, learning, and improved socialization skills while reducing feelings of isolation among patients. 
  • Implementing group therapy can be cost-effective, allowing therapists to provide impactful care to more patients while maintaining high-quality outcomes.   

For skilled nursing facilities seeking to deliver optimal patient care, group therapy is a powerful tool that can increase patient engagement and enhance therapy outcomes while optimizing resources. Let’s explore how this treatment modality can benefit both patients and facilities seeking to elevate their standard of care. 

Key Benefits of Group Therapy in SNFs

Better Patient Engagement and Outcomes

Recent research published in the American Journal of Occupational Therapy demonstrates that incorporating group therapy sessions alongside individual treatment can lead to significant improvements in patient self-care performance. The study found that patients participating in both group and individual occupational therapy sessions showed statistically- significant improvements in selfcare compared to those receiving only individual sessions.1

Increased Patient Satisfaction

The same study revealed that 76% of participants were satisfied with group therapy sessions, compared to 60% satisfaction with individual treatment. This suggests that patients not only benefit from group therapy but also enjoy the experience.

Improved Socialization and Connection

Regular participation in group therapy sessions provides patients with a chance to socialize and give and receive support throughout a shared experience. This approach can foster valuable social connections among patients, reducing feelings of loneliness and isolation. 

Motivation Through Healthy Competition

Group settings also provide an opportunity for patients to engage in healthy competition, which can boost engagement and motivate patients to exercise longer and at a greater intensity throughout their session.

Cost-Effective Care

Group therapy enables facilities to efficiently provide care to more patients simultaneously, making it a cost-effective supplement to individual therapy. This can help SNFs manage resources while maintaining high-quality care. 

Real-World Skill Application

Group sessions enable therapists to perform interventions in more complex or distractible environments that mimic real-world experiences. This helps patients practice day-to-day life tasks they typically do with others, enhancing the transfer of skills to daily life upon discharge. 

Considerations for Effective Group Therapy Implementation

To maximize the benefits of group therapy, therapists should consider the following when designing and delivering treatment:

  • Focus Areas: Determine whether the group will target specific impairments, mobility, self-care, or education.
  • Group Size: Ensure that the group size allows for safety, active engagement, and appropriate challenges for all members. Medicare Part A guidelines suggest groups of two to six residents.
  • Balance with Individual Treatment: While group therapy offers numerous benefits, it should complement, not replace, individualized care. The study mentioned above found optimal results when group sessions were combined with individual therapy.

Regulatory Considerations

When implementing group therapy, it’s crucial to adhere to payer guidelines: 

Medicare Part AMedicare Part BOther Payers
Defines group therapy as the treatment of two to six residents performing the same or similar activities, supervised by a therapist or assistant not overseeing other individuals.Considers group therapy as the treatment of two or more patients simultaneously, who may or may not be performing the same activity. For other payers, follow Medicare Part A guidelines unless otherwise specified.

Maximizing Quality Care

Group therapy in skilled nursing facilities offers a win-win solution, benefiting both patients and providers. As you consider incorporating or expanding group therapy in your facility, remember that the key to success lies in thoughtful implementation. By carefully designing groups, balancing them with individual care, and adhering to regulatory guidelines, you can harness the full potential of this powerful treatment modality to provide impactful patient care. 

  1. Luchynsky, M. K., Ashbaugh, K., Bowser, A., Campisi, E., Gleixner, M., Heinbach, B., & Snak, A. (2023). Efficacy of utilizing the group mode of treatment delivery in OT for skilled nursing facility settings. The American Journal of Occupational Therapy, 77(Supplement_2), 7711510267p1. https://doi.org/10.5014/ajot.2023.77S2-PO267 ↩︎

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For skilled nursing facilities seeking to deliver optimal patient care, group therapy is a powerful tool that can increase patient engagement and enhance therapy outcomes while optimizing resources. Let’s explore how this treatment modality can benefit both patients and facilities seeking to elevate their standard of care.

Patient Outcome Testimonial - Mr. Maya

Patient Testimonial – Mr. Maya

Mr. Maya had a stage 4 (full thickness tissue loss) pressure injury on his sacrum (base of spine) affecting his ability to sit and lie in bed comfortably. He received treatment with OmniSWD® for wound healing as part of therapy, and in only six weeks the injury was completely healed!

I’m happiest to now be able to sit in my wheelchair and visit with family on the front porch. I am also more comfortable in bed.

Mr. Maya

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Transform Respiratory Outcomes with ACPlus Respiratory Assessment

Transform Respiratory Outcomes with ACPlus Respiratory Assessment (ARA)

We are thrilled to announce the launch of our newest product, ACPlus® Respiratory Assessment, or ARA. ARA is an innovative software enabling skilled nursing operators to proactively identify patients with pulmonary dysfunction and provide them with the care they need. ARA’s objective data helps clinicians build an effective treatment plan while providing robust documentation needed to justify respiratory care and support reimbursement. 

ARA Features & Results

ARA makes respiratory assessment easier than ever. Here are just a few of the key features that make it a powerful tool to enhance your respiratory care: 

  • Data-Driven Care: ARA identifies patients with pulmonary dysfunction and automatically suggests possible lung disease patterns and severity levels to deliver the precise data needed to build an individualized treatment plan.  
  • Early Patient Identification: ARA helps capture potential respiratory concerns during the initial assessment, which is more critical than ever with higher acuity patient populations and today’s PDPM requirements. 
  • Robust Documentation: ARA’s objective data provides documentation required to justify respiratory care, helping you get reimbursed for the true complexity of your patient population. 

Don’t just take our word for it – we implemented ARA in skilled nursing facilities and found that ARA helped operators:1 

  • Conduct efficient, standardized respiratory assessment 
  • Identify undiagnosed respiratory deficits 
  • Establish baseline respiratory deficits upon admission 
  • Eliminate external spirometry Pulmonary Function Test wait time 
  • Justify respiratory services  
  • Enhance treatment planning  

Explore our study to learn how inpatient, outpatient, and contract rehab providers within skilled nursing have used ARA and see their results.

How ARA Works

ARA is designed to be simple and easy to use, seamlessly integrating respiratory assessment into clinical workflows. 

  1. Using an iPad and Bluetooth spirometer, a clinician can select a patient in the app, enter their demographics, and conduct breathing tests that capture baseline metrics.  
  1. ARA interprets the data to suggest possible lung disease patterns and severity levels the clinical team can use to tailor the best treatment plan for that patient.  
  1. If a re-assessment is needed, the clinician can access the patient’s record and easily conduct a follow-up. 

Unlock Efficiencies with EHR Integration

You can get even more out of ARA through EHR integration with PointClickCare. By enabling EHR integration, ACPlus can instantly sync ARA results, reports, and notes with your EHR at the point of service, proactively identifying patients who may benefit from respiratory therapy upon admission.  

  1. Based on ACPlus Respiratory Assessment Pilot Study data.  ↩︎

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Restoring Strength and Self-Care with Dynamic Balance and Virtual Rehab Technologies

Restoring Strength and Self-Care with Dynamic Balance and Virtual Rehab Technologies

A 75-year-old woman was admitted to a skilled nursing facility with weakness and inability to perform self-care following hospitalization for spinal abscess and resulting C7-L2 laminectomy (spinal surgery). Prior to hospitalization, she lived in a one-story home, used a rollator walker, and performed self-care tasks independently.


Therapy Protocol

Occupational Therapy

  • 5x/week x 9 weeks

OmniVR® Virtual Rehabilitation System

  • OmniVR® virtual reality exercise performed using Bingo, Carnival, and Picnic activities to increase strength and endurance.

OmniStand® Dynamic Balance System

  • Static and dynamic balance training with OmniStand® for improved control during self-care activities.

Additional Interventions

  • Training for strength, balance, and transfers; self-care management.

OmniVR®

Virtual Rehabilitation

OmniStand®

Dynamic Balance System

The therapist reports that this woman performed OmniVR® activities with a high level of engagement and enjoyment:

During the picnic activity, she kept requesting to repeat the exercise in order to achieve zero errors. She met all her goals, allowing her to return home!

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A 75-year-old woman was admitted to a skilled nursing facility with weakness and inability to perform self-care following hospitalization for spinal abscess and resulting C7-L2 laminectomy (spinal surgery). Prior to hospitalization, she lived in a one-story home, used a rollator walker, and performed self-care tasks independently. Discover how her care team used OmniVR and OmniStand to help her regain her strength and return home.

Decreasing Knee Pain and Improving Functional Mobility with Electrical Stimulation and Exercise

A patient was admitted to a skilled nursing facility for rehabilitation services due to increased knee pain, decreased strength, and a significant decline in functional mobility. Before his decline, he lived at home with his wife and could travel household distances using a rolling walker.

this is a test


Therapy Protocol

Physical Therapy

  • 5x/week x 15 weeks

OmniVersa® Ultrasound/Electrotherapy System

  • Interferential current (IFC) motor sensory electrical stimulation with OmniVersa to both knees to decrease pain.

OmniCycle® Elite Motorized Therapeutic Exercise System

  • OmniCycle neuro mode with patterned electrical neuromuscular stimulation (PENS) cycle protocol to the quadriceps to increase leg strength, coordination, and endurance.

Additional Interventions

  • Gait training, transfer training, bed mobility, balance exercises, postural control, and energy conservation.

OmniCycle®

Motorized Therapeutic Exercise System

OmniVersa®

Electrotherapy & Ultrasound System

This patient and his wife are so happy with the results of his therapy, which allowed him to return home. The use of electrical stimulation for relieving knee pain facilitated weight bearing on his legs and helped him walk again. His wife is incredibly thankful he has returned home instead of remaining as a long-term care resident.