Monday, December 26, 2011

The Importance of Sleep!

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I went back to work today utterly exhausted. I had great rest all weekend, and last night, it all fell to pieces.

I went into work with a sore neck and a bad attitude.

I have to be honest! It happens once in a blue moon.



In fact, by early afternoon, I felt so sleep deprived that I headed 4 blocks west to my little studio, and I fell deeply asleep the moment my head hit the pillow. I woke up snoring 45 minutes later, (which I only do if I am exhausted!) and on the hour mark, I had clocked back in to work.

I've never done this in 16 years of being a therapist!

You now what?  I finished the day with more energy, a brighter affect and better attitude than ever!


According to soundsleep.org, the body needs sleep:

  • for healthy cell growth and for cell and tissue repair.
  • to enable the immune system to function effectively.
  • to enable the brain to encode and store recently received information. REM sleep activates the parts of the brain that deal with learning, and
  • to allow neurons to regenerate and repair during sleep so that our bodies can continue to function as effectively as possible both physically and mentally.
According to wikipedia, sleep deprivation can cause a laundry list of general problems:
That's not even going over the effects of brain and cognitive function, the effects on the healing process, and impairment of ability and other processes!
Crazy, huh?

I knew I was not being patient, encouraging and positive today. I had to stop it in midstream. The only way I knew was to get some rest.

I'm glad I did!

It also made me think about what my patients tell me when they say,

"I had a terrible night sleep!
I don't think I can work right now."

After last night, I'm much more likely to give them the benefit of the doubt!!

Friday, December 23, 2011

Yogi Tea's Advice of the Day

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I had intended to work today; my body instead imposed a sick day.

Really! I did a lot of one particular ADL (activity of daily living) this week with my patients....ask any OT, and they will tell you that "toileting" is the least favorite part of their job!

So, guess what problem I may be having? Suffice to say, during this first week of winter season, that I am having symptoms of the flu...

To aid in the calming of my nausea and other less than delightful symptom, I reach for my Yogi Tea.

Thought it very fitting today to see this on the tab:


I assume that Yogi Tea may have been referring to the practice of meditation here, but I was thinking about something else...

Last night, I had read a post on a website for travel healthcare professionals that a particular traveler was having a difficult assignment. She was working in a facility with a lot of dementia patients. Like me. She felt as if she could not make it through the 13 weeks there.

When I read the tab, I thought about her, "Yes, you can  -  you can do it! Just follow these directions...."

Actually, I think if we follow these directions for everything in life, we'll be quite okay.

Don't you?




Wednesday, December 21, 2011

Christmas Stocking Project

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Wanted to share a project I did this weekend that I think would be great in the future for your patients to assist with (next year....this is a little last minute!)....

I needed 2 stockings for friends' gifts, and I decided to test how crafty I could get.

I went to the local hospice thrift store that has nice clothing, and I found a great quality red wool vest for $3.


I figured out a pattern that would fit both sides and made the initial cuts.


I kept the buttons and the collar. One of my friends is a rightie and her roommate is a leftie. I thought the direction of the stockings fit them perfectly! Check out how the direction of the decorative seams in the vest fit the stocking perfectly...

Next, I picked out an antique shade of green, and I started a quilting stitch around the stocking. The great thing about this is that it doesn't have to be precise!

Next, I reinforced it with a running horizontal stitch.


Afterwards, I split the collar of the vest and created a cuff on the top of the stocking (it's a bit difficult to see what it really looks like). I forgot to take a photo at that point.

Lastly, I sewed the rest of the buttons on the pocket flap.

Voila!


Two Christmas stockings for under $4.

This will be on my list to try with patients next year! They may or may not be able to do the stitching, but think of all the things you can assess while doing a project like this:
  • sequencing
  • problem solving
  • organizational planning
  • sitting balance
  • UE strength
  • fine motor coordination
  • activity tolerance
  • reminiscing/remote memory
Don't hesitate to share your projects!

It's Not Always What We Say

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I go in to wake Ann from her afternoon nap. She will sleep from lunch to dinner every day. Because we are trying to get her stronger and functionally mobile to return to home, though, we have to make sure she doesn't stay in bed for dinner, too!

I gently put my hand on her arm. After a few seconds, I rub just a little. I know she is a person who does not mind being touched. If she was, I would have to use a different method!

She stirs. I tell her in a voice just loud enough for her to hear, "Ann, it's time to wake up. Almost dinner time."

She pulls back the covers and puts her warm hand on my forearm. She feels warm and wonderful! We start a daily conversation that I enjoy so much.

She speaks to me in Finnish, and I have no idea what she is saying. I speak back in English, which at times she understands, and at others, well, I'm really not sure.

She begins to rub my forearm while we talk, the way a grandmother would give comfort to a child.

Some people get frustrated with Ann because she won't speak English. I see that in her cognitive decline, she is losing her second language. She is reverting to the language she spoke as a child.

I allow her to slowly get up and assist her to the wheelchair. This is when the elderly are most at risk for falls, right after sleeping when they start to stand up.

She is awake now, still speaking Finnish. She signals the time, then says, "Morning?!"

"No, Annie," it's late afternoon. Time for dinner. It's Tuesday still."

She holds my hand for a moment and looks in my eyes.

We both smile.

I am keenly aware that it doesn't matter what language we speak to each other. The most important language is that of love and respect for each other that flows between us. Together we share a short moment in time that fills both our hearts and enables us to move on to the end of the day.

It's not always what we say....

Monday, December 19, 2011

Lesson of the Day: Never Underestimate the Power of Enthusiasm!

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Ginny is really been a show stopper at the facility! She is like the welcoming committee, party planner and "go-to person' who can be counted on for giving encouragement to those who are struggling. Thing is, she is quite confused, and half of what she says makes no sense at all.

It really doesn't make a difference, though, because her enthusiasm is contagious!!

One thing does make sense today....Ginny goes first thing this morning to the Administrator with a story and a plan...

"I wheeled past this amazing room yesterday!" she tells our leader. "I didn't know it existed! It was full of sun and there were some books in there!"

Ginny goes on to describe the sun room, which contains two bookshelves, about 2/3 of which are stacked with donated books, a sofa, a table and dining chair, an easy chair, and a large bird cage. It houses LeeRoy, the African Gray Parrot, who 


can whistle like a sailor, growl like a dog, say "fresh air!" and "whatever!"  Only on his terms, of course!

She tells the Administrator that she wants to "develop the library!"

Wonderful!

Ginny was the school librarian in the middle school of this town for most of her life. I ask around, and no one remembers her in this role because she's been retired more than 25 years! Goodness sakes, she's 90!



I get wind of the request when Ginny rolls into the gym for therapeutic exercise about 10:30am this morning. She's ready tell the world that she plans to be the librarian here.

"I don't want to be paid! I want to volunteer." She makes me smile!

My mind goes into "how to make it happen" mode. Due to her cognitive deficits, we will have to modify a few things. I stroll alongside her as she wheels down to "show me" the library.

"Let's do a needs analysis, Ginny! We'll figure out what you need in order to get this rolling," I tell her.

"Well (pause), we need a card envelope in each book, a check out card, and I need to catalog the books."

In my mind, I am thinking, "No, no, no....Modification #1...." I will keep it positive but work to sway her line of thinking. Remember, she is old school.  Literally.

"Ginny, it's a great idea to catalog the books we have. What would you think about streamlining the borrowing process to a checkout log so you don't have to handle all those cards?"

"Well..." I can see she can't make the jump without my assistance.

I describe how it will look. "We'll have a binder in which each resident will sign out their book on a special sheet. There will be a column for who is checking out the book, their room #, title of the book, date they check it out, and the date it needs to be returned."

I ask her expertise about how long it should be checked out. "Two weeks," is her confident answer. I have her buy-in on the checkout log.

OK. One thing accomplished. We develop a checkout log on the computer in no time and print it out. While I am at it, I print out the list of Dewey Decimal classes from Wikipedia just to make her day.

You should see Ginny smile.  I have her punch holes and put it in a binder I have picked up just for her.

Enthusiasm is contagious. I begin to get excited for her, too!

A few times I have to redirect her. She goes into,  "Now, we really need to order some books for the middle school age, and I'd like to get some for the early elementary."

I remind her, "Ginny, this library is for older kids, ages 75 to 100!"

"Oh, like me!" she says.

"Yes."

And I count the number of times I remind her in an hour....five.

We brainstorm and make some great plans. Ginny wants to have a "book drive" to collect donations from employees and current residents. Great idea!

We will create cool bookmarks, and we'll ask the receptionist to laminate them. I'll bring in my hundred colors of embroidery floss and she can work on fine motor coordination by punching a hole and making a tassle for each one. Great idea!

We will start a book cart, and she will be the welcoming committee, deliverer of news and books in the building, and overall person of encouragement for those around her. Great idea!

Hopefully by then, we will have her fully ambulatory again.

The process has begun. We are assisting Ginny with integrating her life into long term care. We are giving her a reason to get up in the morning, an avenue to share her passion, and the ability for her to touch the lives of everyone else with her enthusiasm.

Ginny will not shrivel up and die. She will live gracefully, joyfully and just plain "fully" until she graduates from this life.

Never underestimate
the power of enthusiasm!

Saturday, December 17, 2011

Short Video from Tre/Thoughts for Today

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Recorded this short video with my droid on my morning walk...

Click here
for Tre's Message Today!

Thursday, December 15, 2011

The Gift of Your Presence

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I had the pleasure of returning to wine country last weekend to visit several sets of friends that I made during my last assignment. Some of the visits were planned, and others spontaneous.

It really spoke to my spirit as I drove past my old place, along my daily walk to work, and then, to the facility in which I greatly enjoyed working!

I planned to catch Monty and Joan just before dinner. When I walked in and greeted my old rehab director, he told me that "Mont" was out of town. My disappointment could not be masked!

BJ walked throughout the facility with me, pointing out changes in the three months since I have been gone. We walked down one hall, and I knew there was a room in which I would need to poke my head.

"Brendon!" I called out.

"Tre?...Tre!!"  The only part of him that could turn was his head. He is quadriplegic, shot in the spine half his life ago as he walked home from middle school on the streets of a large city in northern California.

Brendon and I spent a lot of time together. We identified his desire to get his GED. We figured out that he could use Dragon software to run a computer with his voice. I nominated him for a special trip to visit with his mom through Granted Wish Foundation (though they did not grant the wish, it gave us hope for a while!)
We practiced driving his sip and puff wheelchair, a motor wheelchair that is run by using breathwork. Sipping and puffing command the chair to drive forward, backward, turn, tilt and recline. You do it all with the straw, see?


We only spent a few minutes together, but I had to let him know that I think of him often, and I wish the best for him.

I turned to go, and I glanced over at his closet door. Taped on the door was an 8 x 10 photo of the two of us that we had taken when I nominated him for Granted Wish. (He hadn't known at the time we took the photo!) Under the photo, I had written,


You are never given a wish
without also being given the power
to make it come true.
Richard Bach, Illusions

"Brendan, you still have our photo!" I was so surprised!

"Of course, Tre, I will never forget you."

I turned to him.  "And I, you, my friend."

With that, we parted. I left his room feeling that I had just received a beautiful gift. What I hadn't realized until I saw our photo is that I had been a gift to him as well.

It brought tears to my eyes.

My message today is this: 

we never know how we impact people
with whom we may spend
a minute,
an hour,
a day,
a month,
a year.
The challenge
is to leave each and every person
feeling as if they have received a gift.

Wednesday, December 14, 2011

My Advice for Today

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My advice for today
is simple;
I read it
on my coffee cup
every morning:

Monday, December 12, 2011

3 Tips for Dementia Management

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Every building in which I've had the pleasure - and challenge - to work has provided a blank canvas from which to jump start my
"therapeutic art." I sum up the personalities, diagnoses, and behavior problems from the start.

 
I've learned that the majority of behavior problems in long term care (and at home) are caused by folks with cognitive decline. Because the diagnosis of "dementia" in patient charts is rarely defined to the actual diagnosis, I decided several years ago to research dementia management in order to provide better care to my patients with cognitive decline. Since then, I have learned a lot!

Here, my friends, are three great tips for managing someone with dementia:

Three Tips for Managing Someone with Dementia:
  • Identify the type of dementia
  • Learn about the individual
  • Modify former leisure interests/avocations to help the individual engage in functional activities with less acting out!

 Identify the Type of Dementia:
When I was a student years ago, I had no idea how many forms of dementia there were. Take a look! I've added links to all the reference sources I used, yet there are many more resources on the internet....the main thing to remember is that each disease has slightly different symptoms, so if you have a family member or patient who is demonstrating behaviors, check out this graph for quick reference:

Types of Dementia:
Broad Category
Type of Dementia
Average Age of Onset
Symptoms
Degenerative Neurological Diseases
Alzheimer's
50-80% of all dementia
Check out ALZ.ORG

 
Lewy Body Dementia
Same underlying changes in brain as Parkinson’s

 
Parkinson’s Disease

 
Huntington’s Disease

 
Fronto-Temporo Lobe Dementia
(aka Pick’s Disease)
Vascular Disorders
Multi-infarct dementia
Infections in the Nervous System
HIV dementia
Varies
*       Symptoms

 
Creutzfeldt-Jakob disease
Pseudo-dementias
Cognitive Decline caused by:
·         Malnutrition
·         Dehydration
·         Medication-Related
·         Substance Abuse
·         Depression

 

 

 
What to do next?

Learn about the person:


  • Interview the person. If they are able to converse, you may have an interesting conversation that sheds a bit of light! If they are unable to have an intelligible conversation,  don't stop...

  • Call their contact on the face sheet, usually the DPOA. It's usually a spouse or family member. Tell them you are seeking info about "who this person was" earlier in life so you can create some meaningful activities for them! Usually, if it is a spouse or child of the person, they will share willingly and lovingly about who this person was. I've learned so much through these conversations!!

  • If they have done public work, google them! I've learned much about my patients through the internet, usually really good stuff!

Next, modify the activity:


You've learned about the person through conversation. You had an idea of what they loved to do when they were younger and cognitively intact. Now it's time to provide this person with the familiar activity modified for the current cognitive level.

Some examples:

I worked with a man who hadn't said more than a few words for a year. After talking to his daughter, I found out that he and his wife had taken 4-5 trips a year to Las Vegas from the midwest to visit the casinos. He loved to gamble!! I sat down with him and simply handed him a deck of cards. I wanted to see what he would do.



He picked up the cards, rubbed his fingers over the edges, began to turn them over one by one.

"There are 52 cards in a deck...four suits...    diamonds...spades...hearts...clubs..."

I was shocked! Wow. He went on to turn over every card and named the number and suit of each one. He may not have been able to play poker, but he could certainly enjoy his cards.

It's about finding what they love!!

Another lady sundowned every day about 4, just before dinner. Sundowner's syndrome is when someone demonstrates increased confusion, agitation, anxiety or behaviors around sundown. It's a fact of life on a dementia unit.

I interviewed her daughter, and I found out she had enjoyed quilting all her adult life. I knew she couldn't quilt, but how could I modify that task so that she could enjoy it?

I went to the fabric store and bought a bunch of remnants in beautiful colors. I had another patient with whom I was working help me neasure and cut out the fabric into 4" squares. We put them in her "activity box" (more on activity boxes at another post.) 

The next afternoon shortly before dinner, she was teary eyed, running her feet along the floor, leaning foward in her wheelchair and pulling herself along the handrails in the hall.

"Bette, come with me! I have something special for you," I told her.

She rolled up to the table. I took out the fabric and started to lay down one piece at a time, as if I was piecing a quilt. She reached for the fabric and that was it.  She was engaged. Her anxiety and tears melted away as her concentration and focus moved straight into "piecing her quilt."



There was no need to sew or quilt. It was enough to present something familiar that she loved. The staff was then trained to present the fabric squares to her prior to dinner so that she could "work on her quilt." This diminished her sundowning behavior dramatically.

This is not rocket science. It is best done thinking outside the box. You will run into dead ends. Don't give up! Keep looking for the connection. Find the connection with that individual.

What can you do
for your loved ones
or patients with cognitive decline?
Think outside the box!

 Photo credits:

Sunday, December 11, 2011

5 Exercises To Improve Your Posture

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Every patient comes into skilled nursing for a different reason. No case is identical; however, there is one aspect that all patients share. 100% of my patients have deficits in their posture.

The importance of posture increases as we age...




WHY??

In the population with whom I work, posture affects:
  • the visual field
  • the ability to swallow
  • the respiratory capacity
  • the ability to digest food
  • balance and stability when sitting without back support and standing, and
  • joint stiffness, causing back and neck pain.

What contributes to a person's posture?

  • genetics
  • your muscle strength that holds your bones together
  • your bone density
  • your awareness of your posture throughout the day
  • your activity level
  • your nutritional intake
  • the physical requirements of your job, or
  • injury or illness that changes a person's muscle tone.
For example, here's what you might look like if you have a desk job
and you're not aware of how you sit (two of the factors above):
 
This is what I would record in my occupational therapy documentation as acquired thoracic kyphosis with forward neck flexion, which I observe in a majority of older patients...
 When I evaluate a new patient, I am keenly aware of the person's posture.

It affects everything!
Luckily,
subtle changes in our lifestyle
can reverse poor posture
and increase our vitality!
Let's start with exercise!

Posture Exercise Regimen
I immediately begin an exercise regimen with my patients. It's a modified regimen that I have used to keep my trunk and neck strengthened and in the proper position since a back injury last year.

Here's what you need:
  • A therapy ball (recommend 65cm for people under 5'9")
  • A yoga mat
  • A door or wall that is clear for you to stand against.
  • 20 minutes of your time devoted to optimal health....
    By the way, 
    your body always tells you what it needs.

    (Always consult your physician before starting an exercise regimen!)

    These exercises are not necessarily recommended in this order. You can do one or all. I've found each of them to be helpful in promoting better posture.

    Posture Exercise #1
    Start off on the yoga mat on your back. Reach up and stretch your arms above your head. Lengthen your spine. Roll over onto your stomach. Get up on your elbows. Lift your head. Breathe deeply. For some, this can feel tight. If it's not difficult for you, go a step further to straighten your arms and arch your back into a great stretch. Like this:


    Stretching Exercise(s) #2
    Now, roll over and and progress to stretching your quadratus lumborum through a series of moves outlined by Athletes Treating Athletes. (click!) The last one in this sequence is best done on the edge of a bed or therapy mat.

    Posture Exercise #3
    Next, stand up against the wall. Put your feet, buttocks, and upper back against the wall. Tuck your chin and push your head back against the wall. Drop your shoulders.  Relax. Do this 10 times.   (9 out of 10 of my patients have difficulty reaching the wall with their head...) 
    Next....
    Therapy Ball
    Posture Exercise #4
    Sit down on the therapy ball, then roll down until you arch your back and almost touch your hands to the floor above your head. From this position, you can strengthen your abs by doing modified sit ups. I like to stretch my arms straight out to the side and stretch my pectoralis muscles (chest muscles) - this helps open the chest area and decrease rounded shoulders.

    Posture Exercise(s) #5
    Turn over on the therapy ball and do the following:
    a) Superman stretch: feet on the floor, balance your stomach on the ball and hold your arms straight out like Superman. Work up until you can hold the position for 60 seconds.
    b) Roll forward, stomach on the ball, until your feet are straight out off the floor, your arms are straight, elbows locked and your hands are on the floor.  Head lifted and looking straight ahead. Hold for up to 60 seconds.
    c) Stomach stays on the ball, alternate lifting left arm and right leg together while balancing, then lift right arm and left leg together. This one is a little more challenging, but you'll find you can hold it longer as time goes on. You'll be very aware of any weaknesses on this one!

    OK, go to it!
    • Look in the mirror.
    • Be aware of your shoulders and your head position.
    • Modify your work station.
    • Switch our your office chair for a therapy ball!


    I'd love you hear about your exercises and advice on posture....

    Sunday, December 4, 2011

    Skilled Nursing Facility Comparison Checklist

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    Three weeks ago, I wrote a blog on what to look for if you are interviewing and comparing skilled nursing facilities for a loved one who needs care.

    Feel free to use and reproduce this basic checklist; however, please credit the source if you share it.


    Skilled Nursing Facility Comparison Checklist
    Copyright © 2011. Thresa M. Kussman, MOT, OTR
    http://travelingotr.blogspot.com




    Criteria
    Name of Facility
    Name of Facility
    Name of Facility
    Five Star Rating
    1 (poor) –
    5 (excellent)

    1 (poor) –
    5 (excellent)
    1 (poor) –
    5 (excellent)
    Deficiencies
    Staffing
    Hydration
    Weight Loss
    Skin Integrity
    Range of Motion
    Privacy
    Infection Control
    Dietary
    Falls with Injury
    Other
    Staffing
    Hydration
    Weight Loss
    Skin Integrity
    Range of Motion
    Privacy
    Infection Control
    Dietary
    Falls with Injury
    Other
    Staffing
    Hydration
    Weight Loss
    Skin Integrity
    Range of Motion
    Privacy
    Infection Control
    Dietary
    Falls with Injury
    Other

    First Impressions
    Initial call
    Professional
    Friendly
    Rude
    Other
    Professional
    Friendly
    Rude
    Other
    Professional
    Friendly
    Rude
    Other

    Was I put on hold?
    Yes
    No
    Yes
    No
    Yes
    No

    How long?
    Under 1 min
    2-4 minutes
    5 minutes+

    Under 1 min
    2-4 minutes
    5 minutes+
    Under 1 min
    2-4 minutes
    5 minutes+
    Outside of building
    Clean
    Welcoming
    Contemporary
    Aged
    Dirty
    Unkempt
    Clean
    Welcoming
    Contemporary
    Aged
    Dirty
    Unkempt
    Clean
    Welcoming
    Contemporary
    Aged
    Dirty
    Unkempt

    Inside of building

    Calm
    Friendly
    Chaotic
    Stressful
    Odor
    Other

    Calm
    Friendly
    Chaotic
    Stressful
    Odor
    Other

    Calm
    Friendly
    Chaotic
    Stressful
    Odor
    Other

    Lobby
    Clean
    Welcoming
    Contemporary
    Aged
    Dirty
    Unkempt

    Clean
    Welcoming
    Contemporary
    Aged
    Dirty
    Unkempt

    Clean
    Welcoming
    Contemporary
    Aged
    Dirty
    Unkempt

    What did I hear?

    Music
    Laughter
    Silence
    Buzzers
    Alarms
    Residents
    Overhead pages
    Other

    Music
    Laughter
    Silence
    Buzzers
    Alarms
    Residents
    Overhead pages
    Other

    Music
    Laughter
    Silence
    Buzzers
    Alarms
    Residents
    Overhead pages
    Other

    Nurses’ Station
    Buzzers going off?

    Yes
    No
    Yes
    No
    Yes
    No
    Do staff acknowledge me?

    Yes
    No
    Yes
    No
    Yes
    No
    Are charts protected from view?

    Yes
    No
    Yes
    No
    Yes
    No
    Is it a quiet environment for my loved one?
    Yes
    No
    Yes
    No
    Yes
    No
    Residents
    Hair combed?
    Yes
    No
    Yes
    No
    Yes
    No
    Faces clean?
    Teeth brushed?

    Yes
    No
    Yes
    No
    Yes
    No
    Fingernails trimmed & clean?

    Yes
    No
    Yes
    No
    Yes
    No
    Clothing free of food stains?

    Yes
    No
    Yes
    No
    Yes
    No
    Wheelchairs clean?

    Yes
    No
    Yes
    No
    Yes
    No
    Rooms
    Bedroom




    Private
    One roommate
    Two roommates

    Private
    One roommate
    Two roommates
    Private
    One roommate
    Two roommates
    Dining Room
    Attentive nurse aides?
    Yes
    No
    Yes
    No
    Yes
    No
    Age appropriate music?

    Yes
    No
    Yes
    No
    Yes
    No
    Showers / Bathrooms
    Showers clean?

    Yes
    No
    Yes
    No
    Yes
    No
    Bathrooms clean?

    Yes
    No
    Yes
    No
    Yes
    No
    Enough turning radius for a wheelchair in bathroom?

    Yes
    No
    Yes
    No
    Yes
    No
    Visitor bathroom clean?
    Yes
    No
    Yes
    No
    Yes
    No
    Therapy
    Rehab
    Physical
    Occupational
    Speech
    Restorative Nursing Exercise
    Physical
    Occupational
    Speech
    Restorative Nursing Exercise
    Physical
    Occupational
    Speech
    Restorative Nursing Exercise
    If my loved one is on Medicaid, does facility offer therapy?

    Yes
    No
    Yes
    No
    Yes
    No