Do you often wake up feeling stiff and sore in the morning? Do you have trouble getting out of bed or walking into the kitchen to get your breakfast? This is commonly known as morning stiffness that is caused by worn joints, muscle tightness, or arthritis. We feel this tightness in our bodies more frequently in the morning due to the hours of inactivity while sleeping. The area of stiffness varies by person, but most say in the morning is when it feels the worst. Research shows pain will subside about an hour after waking or soon after moving.

To help ease morning stiffness, keep these tips in mind…

  • Medication: Keep pain-relieving or anti-inflammatory medications by your bedside and take them 30 minutes prior to getting up.
  • Arm & Leg Circles: Moving arms and legs gently in a circular motion while lying in bed can help relax muscles and get the blood circulating.
  • Stretching: While still lying in bed, incorporate stretches that target the stiffest areas of your body including the back, hips, knees, and shoulders.
  • Heat: Before or after stretching apply a heating pad or take a hot bath to help loosen tight muscles and make it easier to get moving.
  • Joint Cream: Putting joint cream on specific areas of tightness can provide short-term relief and make it easier to move and stretch.
  • Herbs and Supplements: Herbal treatments like fish oil, evening primrose, borage, or black currant oils may ease joint stiffness and inflammation from arthritis.

If morning stiffness affects your ability to safely get out of bed or is keeping you from enjoying activities, talk with your doctor about the benefits of physical and occupational therapy.

How Can Physical & Occupational Therapy Help?

After a thorough evaluation, therapy may recommend different sleep positions and exercises to improve flexibility, strength, and range of motion. Additional specialized treatments may include hot and cold therapy, therapeutic massage, and the use of pain-reducing technology such as electrical stimulation and ultrasound therapy.

Why is hand and grip strength so important? Having a strong grip makes it easier to perform normal daily tasks like holding a coffee cup, carrying grocery bags, or brushing your teeth. Research has shown that a person’s grip strength can be an indicator for overall muscle strength, upper limb function, bone mineral density, increased fractures and falls, and overall quality of life.

It’s common as we age to see a decrease in grip strength due to natural age-related loss of strength and muscle mass. Additionally, other causes may include scar tissue, carpal tunnel, arthritis, and nerve or tendon damage. As a result, a person may experience trouble holding and opening items and other activities they enjoy.

Now that we recognize why grip strength is so important, below are exercises that can help to improve your overall hand and grip strength.

  • Improve Crush Grip (ability to squeeze something between your fingers and palms) with hand strengthening equipment like stress balls, therapy putty, and hand exercisers.
  • Improve Finger Strength & Dexterity with a finger-walking exercise. Put your hand on a table, palm facing down. Slowly lift each finger moving toward the thumb.
  • Improve Support Grip (ability to hold on to an object) with farmer carries. Hold a weight or bag and walk with it across the length of the room, then turn around and walk back.
  • Improve Pinch Grip (the grip strength between the tips of your four fingers and thumb) by pinching clothespins or using tweezers to manipulate small objects.
  • Improve Hand Range of Motion with finger stretches. Put your palm down on the table, straighten your fingers, hold the stretch for 30-60 seconds, and release.

Physical & Occupational Therapy Can Help! If you are having difficulty with hand strength or pain due to weakness, injury, or illness, you may find that performing a simple task is troublesome. Physical therapists recommend exercises to improve range of motion, build strength, and regain function. Occupational therapists offer strategies to overcome challenges so you can fully participate in daily and leisurely activities.

Talk with your doctor about a prescription for outpatient therapy.

The COVID-19 virus has impacted the health of millions of people. Research studies have shown that COVID-19 affects your body in several different capacities. As pulmonary issues are the most widely known complication from COVID-19, the virus can also affect your heart muscles, brain function, muscle strength, activity tolerance, and overall functional mobility. If you had COVID-19, you may need therapy to get you back to good health.


Our Post COVID-19 Recovery Program helps individuals who continue to have lingering effects from a battle with COVID-19. Our program utilizes physical, occupational, and speech therapists to provide strength training that aims to restore lost muscle and exercises focused on improving lung function and activities of daily living. Our goal is to ensure you get back to an independent and active lifestyle.

Treatment can help improve:

  • Strength
  • Endurance
  • Balance
  • Mobility
  • Swallowing
  • Communication
  • Memory
  • Daily Living Skills (bathing, dressing, cooking, and cleaning)

In order to participate in this program, you must have a doctor’s order for therapy. For more information about this program, please contact your on-site Therapy Department to discuss your concerns and treatment options.

On December 2nd, the release of the CY 2021 Medicare Physician Fee Schedule Final Rule confirmed that we would face a huge overall 9% cut in our Med B Therapy CPT code reimbursement beginning January 1, 2021. I talked to many of you as we shook our heads and shared our mutual concern about such a large cut. The impact on our senior care providers and specifically, our rural locations would be devastating.  It was clear that the outpouring of advocacy efforts in response to the fee schedule proposed rule were being ignored. During a pandemic, that has overwhelmingly impacted our geriatric population, our critical rehabilitation services were gravely at risk of not being accessible due to such significant reimbursement cuts.

Thankfully, our industry has once again proved to be irrepressible! Our associations, industry leaders, and stakeholders nationwide persevered by rallying together to fight for our rehab services to be regarded as essential and to reduce the financial impact that was imminent in the final rule. We at HTS, as an active member of NASL (National Association for Support of Long-Term Care), urged all of our therapy team members to fervently become part of the advocacy for our patients and our profession. Proudly, countless HTS employees reached out to our federal legislators to provide the necessary details of how this cut in reimbursement would affect our most vulnerable population during the PHE.

The outcry from stakeholders commanding legislative action to protect rehabilitative services paid off.  In late December, Congress passed the Consolidated Appropriations Act of 2021 (H.R. 133).  This provided a partial fix for the looming therapy cuts.
The overall impact to the Medicare B Therapy CPT codes was significantly diminished as a result of the provisions of this Act. Now, instead of an estimated overall 9% cut, therapy codes’ reimbursement will be reduced by approximately 3.5% (depending on the code). While this is still a financial hit in the midst of a pandemic, the ability for operators to compensate and adapt to lower reimbursement is more fathomable than the original 9% reduction. This partial fix is made possible by the following measures:

  • The bill delays the implementation of the new add-on fee schedule complexity code (G2211) for three years.
  • The bill infuses $3 billion into the 2021 fee schedule for one year only which adds 3.75% of payment for all codes.
  • The bill delays the 2% Medicare sequester cuts for three months.
  • The bill continues the current Alternative Payment Model thresholds for two additional years
  • The bill extends the work 1.0 geographic index floor which increases payments for the work component of the physician fee schedule payments through December 31, 2023 for geographical areas that labor cost is lower than the national average.

Here is an example of commonly used therapy CPT codes illustrating the impact of the Consolidated Appropriations Act of 2021 (H.R. 133) for both the 9% and 3.5% reductions.

As shown in this example, providers and therapy companies alike will be challenged to offset the reduction in reimbursement. This offset may additionally be exaggerated by the overall increased costs associated with the pandemic. The need for PPE, COVID testing for employees, as well as reduced efficiencies due to isolation and other restrictions, will continue through the coming months as we continue to power through the most difficult challenge in our industry.

HTS will continue to stay steadfast during this time and true to our mission of providing “a hope and a future” (Jeremiah 29:11) to maintain the best quality of life for those we serve. Please contact me with questions, and we will continue to keep you updated on any changes on this topic and many others in the future.


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




Did you know that physical activity is one of the best ways to lower your risk of heart disease? Regular exercise helps to strengthen the heart muscle, reduce blood pressure, lower cholesterol, and also is linked to better sleep and brain function. The CDC recommends that adults 65 and older should aim for at least 30 minutes of moderate-intensity exercise five days a week. Use the tips below to help you stay motivated and make exercise an enjoyable part of your everyday routine.

Find a Workout Partner – a workout buddy can help keep you encouraged and accountable so you’re less likely to skip out on a trip to the gym or exercise class.

Create a Schedule – Working out at the same time each day/week can help you keep a routine and also plan other activities so you don’t have to miss anything.

Start Small – Start with low-intensity activities such as walking for 10 minutes. Gradually increase the amount of time and intensity of your workouts.

Exercise for Free – Walking inside and outside are both free and easy ways to incorporate physical activity. Look within your community to find free exercise classes.

Talk with Your Doctor – If you are uncertain what exercises would be best for you, discuss your exercise plan with your doctor.

As you get older, you may find it difficult to exercise due to pain or have challenges with your balance and mobility. Physical therapists can teach you how to exercise appropriately for joint mobility, muscle strength, and fitness so you can regain a more active lifestyle. Talk with your doctor to see if physical therapy could benefit you.

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.