Encore Keynote - December 2021

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- Encore Rehabilitation’s monthly publication, designed to give you updates on trends we are seeing in the Post-Acute Care industry. 


When Holiday Foods Bring Challenges Versus Cheer

While the holidays are filled with fun and cheer for many around the world, the emphasis on sampling delicious food during this time of year can bring about frustration, sadness, and depression for others.  Many of our residents have diet modifications, whether they are due to following a cardiac (low salt) diet or because of the inability to safely swallow regular food textures and/or drink thin liquids.  When this is the case, knowing resident rights in relation to diet modifications can help SNF communities navigate the season safely while following food preferences and choices made by our residents.

When concerns related to diet are identified, diets are often modified.  Although modifications to a resident’s diet are done with the resident’s best interests in mind due to medical or other reasons, we sometimes forget to consider the downside of diet modifications.  Some of the risks that can be attributed to diet modifications include the following: 

  • Weight loss
  • Depression
  • Isolation
  • Malnutrition
  • Dehydration
  • Skin breakdown
  • PEG site infection
  • Loss of function 
The American Speech-Language-Hearing Association (ASHA) along with the Pioneer Network/Rothschild Foundation, have established a Food and Dining Clinical Standards Task Force to address the rights of residents in regard to diet modification.  That task force has created a care planning tool to use when working toward reaching a mutual decision as to how the IDT will accommodate dietary choices to maximize residents’ well-being.  

An example of the tool used in the care planning process is titled the Documentation Form for Honoring Resident Choice and Mitigating Risk, and can be seen in the link below.



Skilled nursing communities should adopt a policy regarding utilization of the care planning tool prior to putting the tool into practice. Including the tool in SNF policies will provide the components needed to outline each discipline’s piece of the process and serve as a written policy & procedure for state surveyors to reference at survey time.

The intention behind the tool is for SNFs to honor resident choices while at the same time incorporateing clinical judgment and uphold resident rights. 

Below outlines the CMS Critical Element Pathways, which support philosophies surrounding diet and nutrition.

  • CMS 20053 - Dining
  • CMS 20075 - Nutrition
  • CMS 20080 - Rehab and Restorative
  • CMS 20092 - Hydration
  • CMS 20093 - Tube Feeding
With proper utilization of the Rothchild Person-Centered Care Planning Tool, Speech and Language Pathologists (Speech Therapists) can help residents, families and SNF communities navigate the process of understanding how to meet both clinical best practices and regulations associated with safety, food preference and choices.
Let’s do all we can to make this holiday season as joyful and full of holiday cheer as we can by ensuring our patients’ wellbeing is considered on all spheres—physical, mental, emotional and social -- and ensure that we are always mindful of the risks associated with food restrictions or diet modifications.


It’s hard not to enjoy the sparkling lights, holiday decorations, festive music, and all that the holiday season has to offer.  Although good times, laughter, and cheer are the plan, seniors are at a greater risk for falls during the holidays due to a variety of factors.
Holiday season fall risk:
  • Daylight savings time: change in the number of daylight hours; poorly lit areas movement pathway•
  • Furniture set up, or placement is changed to accommodate decorating. Change in customary ambulation, 
  • Decorative items can become a trip hazard due to size and shape
  • Electrical cords used to light decorations can be a trip hazard
In addition to seniors being at a greater risk for falls, the holiday season also brings a condition called Holiday Heart Syndrome.  Holiday heart syndrome is most likely to occur in individuals with known risk factors such as high blood pressure, high cholesterol, irregular heartbeat, diabetes, and obesity.  Changes in diet and lifestyle can be extreme over the holiday season, and overindulgence can strain the heart and lead to a heart attack.

Weight gain due to consumption of holiday foods can build up fatty plaques in the blood vessels, and stress brought on by the holidays can put a strain on the heart. Be sure not to ignore the warning signs as chest pain can be passed off as indigestion, and dizziness can be mistaken for fatigue and potentially lead to loss of balance and falls.


  • One out of four older adults will fall each year
  • One out of every five falls causes injury such as fractures or head injuries
  • More than 95% of hip fractures are caused by falling sideways
  • Women fall more often than men and account for three-quarters of all hip fractures
Safety tips:
  • Declutter pathways to ensure safe pathways for mobility
  • Enjoy the signs and sounds of the holiday season with lights on.  Maintain well-lit areas and clear of decorative items that create hazards
  • Strive to maintain healthy eating habits
  • Listen to your body and don’t ignore warning signs
  • Maintain regular medication and sleep schedules.  Altering medications and/or sleep schedules can cause dizziness that can lead to stability problems during mobility
  • Holiday decorations that require electricity should be placed near outlets, minimizing the potential for trip hazards 
  • Enjoy the beautiful holiday decorations but be mindful of decorations that can potentially lead to falls in seniors

Let’s do our part and give our seniors the opportunity for a wonderful holiday season by staying mindful of potential fall risks and other related holiday health concerns.   


NASL Emerging Leader - Kimberlee Hooker

ASHA Presenter - Masha Cherpakov

AHCA Presenters - Drita Vulaj, Kathleen Simenton 

NASL Vice Chair for Medical Services Committee - Shawn Halcsik

NASL Board - Shawn Halcsik

Illinois Nursing Home Administrators Association Board Member - Jill Wunderlich

Illinois Nursing Home Administrators Association Presenter - Kathy Claypool 

Florida Healthcare Public Relations - Kimberlee Hooker

ASHA SLP Mentor - Jan Ward 

Healthcare Association of Michigan Presenter - Drita Vulaj

ASHA Special Interest Group 15 - “Through the Eyes of SLP” - Rose Vargo



  • ACHCA Convocation
  • LeadingAge Kansas
  • Nebraska Healthcare Association - Spring
  • LeadingAge California
  • LeadingAge Colorado
  • LeadingAge New York
  • Georgia Healthcare Association - Summer
  • LeadingAge NJ, PA, DE
  • LeadingAge Washington
  • CA Association of Healthcare Facilities -  Summer
  • Florida Healthcare Association
  • LeadingAge Ohio
  • Indiana Healthcare Association
  • Zimmet Reimbursement-CON
  • Tennessee Healthcare Association
  • Kansas Adult Care Executives
  • Missouri Healthcare Association
  • Nebraska Healthcare Association - Summer
  • Ohio Healthcare Association
  • LeadingAge Florida
  • Illinois Healthcare Association
  • Healthcare Association of  Michigan
  • LeadingAge Georgia & South Carolina
  • LeadingAge Michigan
  • Iowa Healthcare Association
  • Texas Healthcare Association
  • Kansas Healthcare Association
  • Pennsylvania Healthcare Association
  • North Carolina Assisted Living Association
  • American Health Care Association
  • Virginia Assisted Living Association
  • LeadingAge Annual Meeting
  • Healthcare Association of New Jersey 
  • Virginia Healthcare Association
  • Kentucky Association of Healthcare Facilities
  • American Healthcare Association - Fall CEO
  • CA Association of Healthcare Facilities - Annual
  • Louisiana Nursing Home Association


s. 2562/H.R. 5514

The Choose Home Care Act of 2021, S. 2562/H.R. 1544 was introduced into Congress on July 29, 2021.
Encore Rehabilitation is following the legislative process closely. This legislation, as currently written, would establish a home-based extended care benefit which would allow certain Medicare beneficiaries to receive extended Medicare services such as skilled nursing or rehabilitation services in their homes for up to 30 days following hospitalizations or surgeries, in addition to their usual home health allowance.
Currently, Medicare recipients cannot receive home-based nursing services on anything other than intermittent/part-time basis. To qualify for the extended benefit, a patient must meet Medicare’s skilled nursing benefit eligibility including a three-day preceding hospital inpatient stay and reside at home. A comparison of the current home health benefit and proposed expanded benefit under the Choose Home Care Act of 2021 is below.
















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