Providers are now tasked with the responsibility of mitigating the risk of virus exposure in their facilities which, unfortunately, sometimes requires preventing some staff from entering the building. At times the staff being turned away has included therapists. Lack of detailed guidance early on during the PHE created an environment in which key long term care decision-makers such as administrators were left to interpret regulations as best as possible until further clarification was received. However, thanks to the numerous studies recently published in 2020 and clarification from the CDC, it has become clear that providing early and consistent rehabilitation care throughout the SNF stay is important for successful outcomes.

Long-term negative physical, cognitive, and psychosocial effects for those not receiving the caliber of care required to meet their individualized needs are now evident. Furthermore, on March 19, 2020, a Memorandum from the Department of Homeland Security stated that therapy practitioners are critical health care workers and need to be a part of the treating team.  Simply put, if a patient requires skilled level of care, that service must be provided. If services required to rehabilitate the patient back to a prior level of function are not being delivered, this puts the facility at risk for substandard quality of care.

The CDC has also now provided guidance. When asked “should any diagnostic or therapeutic intervention be withheld due to concern about transmission of COVID-19?” The CDC answered by stating patients should continue to have the opportunity to get any interventions they would normally receive as a standard of care. The Journal of Physical Therapy Science recently published research study findings to further support this claim. The purpose of the study was to recommend methods of respiratory rehabilitation and psychotherapy for patients in different stages of the coronavirus.

“Physical therapy of COVID-19 patients will not only reduce the mortality rate of patients, hospital admission time, and medical expenses, but also save medical resources, reduce personal and national economic losses, and the probability of adverse social stability events such as medical collapse. Therefore, physical therapy should be introduced into the mainstream treatment of COVID-19 patients as early as possible.”

Although this example depicts the critical nature of service delivery from a physical therapist…occupational therapists and speech-language pathologists also play a pivotal role in patient rehabilitation. With respiratory distress comes a myriad of potential complications including insufficient breath support for communication and/or swallowing as well as the inability to complete one’s daily tasks due to insufficient pulmonary capacity required to complete the activity. The bottom line remains that therapists are highly skilled healthcare professionals that play a significant role in the rehabilitation of patients.

In order to further support HTS therapists, resources, and tools were created to not only educate on infection control but also to facilitate best practices in these unprecedented times. Check out the list below for just a few examples of recently created materials:

  • Breathe: A Pulmonary Intervention Program
  • Therapist Treatment Hierarchy Delivery Chart
  • Dining Assistant Emergency Program Toolkit
  • HTS Annual Training: COVID-19 Supplement
  • Teletechnology Quick Reference Tools
  • Virtual Home Assessment Tool
  • Waiver Related Claim Guidance

Written by: Sheena Mattingly, M.S., CCC-SLP, RAC-CT, HTS Director of Clinical Outcomes



Older adults are faced with many stressful situations. Stress can be the result of coping with the loss a loved one, managing a chronic illness, being a caregiver, and challenges with loss of balance and mobility. If we don’t overcome these stressors right away and let it impact our daily lives, this is known as chronic stress.

Stress can significantly impact your overall health. The effect of chronic stress on the body can lead to heart disease, a weakened immune system, diabetes, high blood pressure, digestion issues, short-term memory loss, difficulty sleeping, depression, and anxiety. That is why managing stress should be a top priority for seniors. Here are a few ways to limit the health risks associated with stress and help clear your mind…


Physical and occupational therapists offer interventions to help people cope with stress. Physical therapists can customize an exercise plan, teach breathing techniques, and help manage your pain. Occupational therapists help you develop coping skills, offer support to manage daily activities, and intervene with mindfulness-based techniques.


Blog by Cassie Murray, OTR, MBA, QCP, Chief Operating & Clinical Officer

As you may already be aware, CMS has finalized cuts in reimbursement for our Med B therapy codes (physician fee schedule codes). These reduced payments are set to begin ‪on‬ ‪1/1/2021‬. We have a short time to appeal to our lawmakers to ask them to support a delay in these cuts while we are in the midst of the PHE. The population that our team serves is the most vulnerable to decline and the impacts of COVID-19. Please consider the implications of how reduced reimbursement for important therapy services may reduce access to care for many Medicare beneficiaries. The cuts are expected to result in 9% reduction in PT/OT reimbursement and 6% reduction in ST reimbursement. These cuts are significant and will create a hardship nationwide for providing therapy services, especially in rural areas that already experience therapist shortages and difficulties with access to care. Reducing the reimbursement of critical therapy services only increases the challenges of providing quality services to our most vulnerable patients.

ACT NOW! Please reach out to your representative to request support for therapy services. We, at HTS, are an active member of the National Association for Support of Long-Term Care (NASL). NASL has prepared a letter for you to email your lawmakers to fix this policy through legislative action. We only have a few days to act! This is very time-sensitive and requires all of us to act as advocates for our patients, as well as our professions!

Please follow this link to reach out to your representatives:

Thank you in advance for your advocacy! This is a critical situation that requires all rehab professionals’ attention.
Please share this information with colleagues and family/friends. Now is the time that we need to come together to ask our representatives to support our services!

Cassie Murray, OTR, MBA, QCP
Chief Operating Officer, Chief Clinical Officer
Healthcare Therapy Services, Inc.

Giving Thanks

As I reflect back on this year, I am overwhelmed with profound gratitude for our partners and healthcare heroes that have shown devotion, bravery, and solidarity during the most challenging times in our industry. There is no doubt that this crisis has brought us all together.

HTS has remained strong as we continue to adapt and deliver the services and quality of care that our patients deserve. From utilizing telehealth technology services to providing new clinical programs focused on COVID and respiratory interventions, we are committed to providing the best patient-centered care. Together, this compliments our combined mission as we improve the lives of those entrusted to our care.

On behalf of the entire HTS Family, we express our most heartfelt thank you for choosing HTS as your partner in therapy. It is an honor to serve your organization and we are blessed to continue to provide a “hope and future” (Jeremiah 29:11) for those in our care.



Cassie Murray, OTR, MBA, QCP

Chief Operating Officer | Chief Clinical Officer

Healthcare Therapy Services, Inc.

Presenting:  Staying Healthy During COVID

During this presentation, we discuss the impact COVID has had on our daily lives and overall wellness. A closer look at our emotional, social and physical wellness is discussed with strategies and tips to stay in good physical and mental shape.

Toolkit Includes:

  • VIDEO – Staying Healthy During COVID Presentation Recording
  • MARKETING FLYER – Use this flyer to advertise the presentation video airing on your community TV channel or a specialviewing in the lounge area.
  • HANDOUT – Tips to Stay in Good Physical & Mental Shape

HTS Partners can conveniently access this toolkit along with many other wellness resources under the Wellness Dashboard on HTS PartnerHQ web portal.

Meet Denise Johnson, PT

Denise brings with her several years of field experience and a somewhat new accolade: Teletechnology Delivery Service Mode Expert. It all started back in September with a SNF COVID-19 outbreak. Implementation of telehealth as a service delivery mode became imperative after the outbreak and Denise led the charge! Denise, like many other HTS therapists, provides therapy at a few buildings. As we know all too well, due to the PHE, many facilities have implemented policies prohibiting therapists to work at mulsites in order to mitigate exposure of contagion. These types of (necessary) policies and the need for therapeutic services in a building with a COVID-19 outbreak furthermore illustrated the need for Telehealth.

So, how did Telehealth implementation begin? After the administrator of the building was made aware and approved Telehealth as a service delivery mode, the therapy team went to work on logistics. Per Denise, this is the biggest challenge with Telehealth Services. Consent forms must be received prior to treatment. Brian Kemp, PTA at Southfield Village suggests use of a binder so that all of the consent forms can be tracked and kept in one place. Once the consent form is signed and received, the person at the other end of the camera with the patient must then play their part in order to effectively provide a Telehealth session. Most often this person is a PTA/COTA. However, depending on your facility’s staffing and policy, other facility staff members are also able to fill-in. “Things like getting the camera angle right and assuring the patient is able to hear you is imperative and contributes to the effectiveness of your skilled therapeutic session” says Denise. As a seasoned PT working with Telehealth, Denise’s main concern with the newly available platform being used (Zoom) is those patients suffering from dementia. Patients with poor or limited participation poses its own set of challenges. However, for the most part, telehealth has worked and bottom line, although most therapists prefer visits to be face-to-face and hand- on, Telehealth provides an acceptable alternative to provide coverage to a population who needs it.

When specifically asked about the benefit of Telehealth as a service delivery mode, Denise emphasized and thanked the PTAs and COTAs she has worked with. For example, a therapist providing Telehealth is unable to look to quantify edema in the legs, accurately observe when a patient goes sit-to-stand, or if there is a retro bias when the patient is standing. The therapist on the other side of the Zoom video call may be missing firsthand on these clinical components and are heavily reliant on the person on the other camera who is with the patient to pick-up on these types of observations. What’s the silver lining? Well, according to Denise, the nice thing is that the therapy assistants she has worked with are even more in-tune with the global picture of what is trying to be achieved during evaluations and supervisory visits. This results in more accurate documentation and effective treatment sessions.


Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at for your chance to be featured in a “Story from the Field!”

Along with colder temperatures, winter brings us fresh crisp air, crackling fires, and glistening snow. Winter temperatures also pose many health risks, especially for older adults. While falls can happen year-round, winter can be increasingly hazardous for seniors with icy sidewalks and snow-covered roads. Falls can lead to hip fractures and other serious injuries. In fact, each year falls account for more than 2.8 million emergency room visits and 800,000 hospitalizations due to a fall injury.

Here are a few safety tips that everyone, especially older adults, should take this winter…

Outdoor Fall Prevention Tips:
• Wear rubber-soled shoes that provide traction on snow or ice
• Avoid walking on snow and ice by staying on designated walkways
• Try attaching an ice gripper to your cane tip
• Test potentially icy areas by tapping your foot on them
• Carry a small bag of rock salt to sprinkle on slick surfaces

Tips to Fall Safely & Prevent Injury:
Avoiding a fall all together is the best method of prevention. However, learning how to fall safely can help reduce your risk of getting injured when a fall does occur.
• Keep your body relaxed and loose
• Protect your head
• Don’t use your arms to catch yourself
• Keep your legs and arms bent to protect yourself
• Let your bottom take the hit

If you have fallen recently or are having trouble with your balance, talk with your doctor about Physical and Occupational Therapy. Our goal is to identify and address any factors that lead to falls to keep you moving safely and help prevent future falls.

On October 21, 2020, Governor Holcomb and the Indiana Department of Health (IDH) announced the Indiana National Guard would be utilized for administrative and other similar tasks at nursing facilities in Indiana, in order for nursing facility staff to be able to focus their time on providing resident care.

The Indiana National Guard will be sent to nursing facilities in three phases—on November 2, November 9, and November 16—based on the need / outbreak status of the facility. Those nursing facilities in Phase 1 and Phase 2 will be assigned three guard members each, and those nursing facilities in Phase 3 will be assigned two guard members each.

Click here for all the details.
Click here to download a list of phases and locate your facility in the applicable phase.

Meet HTS SHEro Jessica Duffy

You may be asking yourself, what exactly is a SHEro? A SHEro is a woman admired for her courage, outstanding achievements or noble qualities; a heroine. The pandemic has made it clear that HTS has been blessed with many heros and sheros but for this story from the field’s purposes we will focus on Jessica.

“Great leaders don’t set out to be a leader, they set out to make a difference. It’s never about the role…always about the goal.” Author Unknown

Jessica is an OTR and Regional Director who has been with HTS for 13 years. Like many HTS facilities, staffing became cumbersome due to a COVID-19 outbreak resulting in therapists being unable to provide therapy at multiple buildings. This has become common practice and is done in order to mitigate risk of exposure. Jessica knew there was a need and immediately jumped in to help navigate this all too familiar situation. Census soon began increasing a couple months after the pandemic began. Jessica took swift action to assist with the staffing issue which ensued. She began by facilitating and setting-up PT with telehealth treatment sessions. Jessica herself also served as the primary therapist and OTR for the facility. As she juggled her primary responsibilities to provide support and management for her region, she also provided patient care to ensure each patient received the vital therapy services needed.

“Ultimately, it is our responsibility to the patients we serve to figure out a way to make it work” said Jessica. And make it work she did! According to Jessica and the therapy team, the most challenging aspect of an outbreak within a SNF is logistics. Scheduling of patients becomes tricky at times as does assuring all precautions are appropriately taken to keep the staff and the families they return home to safe. Jessica does have a tip for other facilities going through a similar situation… over-communicate. Educating nursing staff on patient needs observed during therapy (which are constantly changing and evolving) is of utmost importance. Communication of isolation, environmental stimulation techniques, and activity engagement to combat contagion and depression risks are some examples of the training Jessica has provided facility staff members.

Jessica is encouraging fellow therapists to assure they are taking time for themselves and engaging in activities that are fulfilling. Jessica herself likes to spend time with her family outdoors which has helped her refocus during stressful, overwhelming times. Just as many of our star therapists in the field, Jessica has gone above and beyond and for that we thank her (and you)!


Past Stories From the Field can be found on the HTS Portal. Have a great “Hoping & Coping Story from the Field ” you would like to share with fellow HTS therapists?

Email Sheena Mattingly, Director of Clinical Outcomes at for your chance to be featured in a “Story from the Field!”

Although research is still developing, there is strong evidence that people leading a healthy lifestyle can lower their risk of developing Alzheimer’s disease and other types of dementia. By following these tips, you can take the steps to reduce your risk of cognitive decline.

1. Cardiovascular Exercise
Incorporate physical activity that raises your heart rate and increases blood flow to your brain and body such as walking, swimming, and aerobics.

2. Brain Challenge
Stimulate your brain by playing bridge, chess, and crossword puzzles. Challenge your brain by trying something new like learning a new language or playing an instrument.

3. Healthy Diet
The Alzheimer’s Association suggests a diet that is rich in vegetables and fruits and low in fat may help to protect brain cells.

4. Laughter
Most people agree that laughing can cheer you up, but did you know laughing can lower stress hormones, stimulate your brain, and reduce stress. Tell a funny story to a friend or watch a comedy movie.

5. Sleep
During sleep, the brain is able to repair and regenerate. Quality sleep is essential for healthy brain function.

If you or someone you know is having problems with completing daily tasks, comprehension and/or expressing thoughts, please talk with a doctor. Ask your doctor if you could benefit from physical, occupational, or speech therapy.