Case Study: The Encore At Boca Raton Rehabilitation & Nursing Center (January 2019)

Patients Age: 71-years-old
Admission Date: 11/16/2018
Admitted From: Westside Regional
Discharge Date: TBD
Discharged To: TBD
Length of Stay: TBD
Reason for Stay: Intracerebral Hemorrhage
How did this patient hear about The Encore: A friend who knew about The Encore told patients sister.

Details of experience:
When Mrs. Irene Fiorella entered our community from Nursing Center from the Westside Regional Medical Center with a PEG (Percutaneous Endoscopic Gastrostomy), she was unable to eat anything, and speech she was barely responsive, completely non-vocal, unable to follow

simple directions such as being asked to blink and was only able to answer yes and no questions with a very minimal nod and headshake.

Her speech therapist decided to try a different method. She brought in a cold moist spoon and did cold oral sensory stimulation (placed the spoon on Irene’s tongue). This initiated Irene’s first real response. Her swallow was delayed and weak, but this became the primary focus as it was something to expand on due to it being her strongest response. When asked if she wanted to do it again, Irene suddenly had a much stronger nod.

As time moved along, the swallowing stayed more consistent although Irene had some difficulties staying awake and had trouble with single unit questions.

About a week later, she began talking. She was answering two-unit questions which shortly progressed to multiple unit questions! Everything began progressing for the better very quickly which led to Irene and her family telling people how grateful they are for her therapists and her.

Only a few days later, Irene was able to name objects in the environment, answer W.H. questions (who what when where), and count the days of the week and the months of the year. Her cold oral sensory stimulation also escalated to 100% on swallowing. This began a new journey… foods and liquids! At the end of the week, Irene was tolerating drops of water!

The next week Irene’s therapist started testing minimal amounts of thin water and was successful! This led to trials of mechanical soft food which was a success, leading her to regular food and that was successful as well! Her swallowing was strong! Irene can eat regular foods again, completely opposite of the conditions she was in upon arriving at The Encore!

Irene shared her whole story with the concierge director while enjoying a tuna fish sandwich that The Encore had served for lunch that day! We wish Irene many more years of health and hope she enjoys all the delicious foods out there that she now can continue to experience.

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Professional Of The Quarter, Dave Smith

Congratulations to our Professional of the Quarter, Dave Smith, Director of Environmental Services at The Encore at Boca Raton Rehabilitation and Nursing Center!

Dave Smith has been working in healthcare for 46 years, 36 of those years at The Encore; Smith was brought on as the community was being built.

“We have a good team here, I have a good crew; it’s the best part of the day. All of the people here are nice, it’s a good structure. The job itself is challenging, but we want to make sure that everyone gets done what they [our patients] need.”

Nominated by Smith’s colleagues, he has a strong presence in The Encore community. When he learned that he had won Professional of the Quarter, he began, “I was kind of shocked! It felt good!” He continued, “We work hard here; I was thankful. I was very surprised, and I’m humbled.”

Dave Smith is a finalist for the Professional of the Year contest; the winner will be announced during Nursing Home Week 2019!

Congratulations Dave Smith! You are #TheCareRiteDifference!

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Case Study: The Encore At Boca Raton Rehabilitation & Nursing Center (December 2018)

Patients Age: 91-years-old
Admission Date: 09/04/2018
Admitted From: West Boca Medical Center
Discharge Date: 12/04/2018
Discharged To: Daughter’s House
Length of Stay: 3 Months
Reason for Stay: Kidney Infection
How did this patient hear about The Encore: Case Manager at West Boca Medical Center

Details of experience:

Mr. Paul Kachmarik arrived to The Encore at Boca Raton from West Boca Medical Center for a weak lower body and severity levels of unstable medical conditions. He was highly discouraged and was not sure if he was going to succeed.

As Paul stated to our director of concierge services, “I didn’t feel well, I didn’t want to eat. I was scared I would never recover. I had no strength, could not walk or get out of bed.”

Paul was unable to get out of bed, was on max assist of two, and was unable to propel a wheelchair on his own. After being evaluated by his therapist, he immediately got to work.

For the first few weeks, the therapists worked hard with him, but Paul was unable to do too much exercise due to a weak heart. Nonetheless, Paul remained motivated. He reached a level of moderate assist and walked 30 feet altogether!

Despite Paul’s frustration about his inability to exercise, he was pleased at the other things that The Encore had to offer. He shared with the director of concierge services, “I was amazed how nice it was. I had my thoughts on nursing homes… I was amazed by the [service of the] aides and nurses, [the housekeepers] always kept my room neat, and the food was always on time. It was different than a regular nursing home.”

A few weeks later something clicked. Suddenly, Paul had a burst of inspiration and hope based on his results in therapy, along with his appetite coming back! Paul stated, “after I started eating, I started having hope, my appetite was coming back. Progressively every day, I started looking forward to my meal. The tilapia was very good.”

Paul had also remained determined based on all the encouragement that his therapists gave him, as he shared with his therapist, Debra, “Debra, if not for your encouragement, I would not have this confidence in me do to it.”

Paul’s progression really took off throughout the weeks. He progressed to contact guard assist, walked 100 feet, wheeled himself to therapy, was able to get out of bed, and dress his upper body all on his own! Within a week, he progressed to 200 feet standby assist, was able to walk to therapy, able to car transfer with a rolling walker, which very soon led to supervision!

Paul was discharged on December 4th to his daughter’s home. He left walking 250 feet modified independent with a walker. He went from 25 feet max mobility to 250 feet modified! Paul was very grateful upon discharging as he shared, “I was on a low number when I came. I had no appetite and I was just weak. Now I can get out of bed and walk with a walker! I just walked on my own yesterday! I’m able to go to the bathroom without assistance and OH, DO I HAVE AN APPETITE!”

We are always proud of our residents, patients, and staff, but hearing the kind words from Paul was a pleasant reminder that we always strive for the best for everyone that walks through the doors at The Encore. We wish Paul the best of luck!

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Case Study: The Encore At Boca Raton Rehabilitation & Nursing Center (October 2018)

Patients Age: 85-years-old
Admission Date: 09/17/2018
Admitted From: Delray Medical Center
Discharge Date: 10/15/2018
Discharged To: Home
Length Of Stay: 29 Days
Reason For Stay: UTI, Muscle Illness, Enlarged Aortic
How did this patient hear about The Encore: A former patient of the resident shared about The Encore with the residents’ son (as the resident was a chiropractor).

Details of experience

Dr. Marshall Kaufer was admitted to The Encore at Boca Raton from Delray Medical Center for an urinary tract infection, muscle illness, and an enlarged aortic. He came on max assist, could not bathe, could not lower body dress, and could not get out of bed. Upon arrival, he was greeted by the concierge director as well as the admissions director to ensure his comfort while staying at The Encore.

Dr. Kaufer was very discouraged when he arrived and was not at all motivated; he just wanted to go home. He shared with our of concierge, “I thought I was going to die. I was a mess, I couldn’t walk.” His therapists, Debra De Silva and Grace Montague arrived to evaluate him. During his first session, he walked 50 feet with a rolling walker and contact guard assist.

A few weeks later, one of the nurses helped out with Dr. Kaufers’ cellulitis, which was one of Dr. Kaufers’ biggest reasons for discouragement. This helped Dr. Kaufer regain his confidence and helped create a new motivation. He began participating with his therapy as well as attending activities and socializing. Dr. Kaufer shared, “I can’t speak highly enough about your physical therapy, I couldn’t stand before. My sons would have to hold me to transfer.” When asked what else he enjoyed about The Encore, Dr. Kaufer stated “The food was great!”

Dr. Kaufer continued to work hard with his therapists. He began making much better and quicker progress. With only a few more weeks, Dr. Kaufers progress escalated to incredible levels . He had gotten to a point of getting out of bed, dressing, and going to the bathroom all on his own!

Dr. Kaufer was discharged to his home on October 15th, 2018, walking 150 feet. He had came from max assist to independence with a walker! We wish Dr. Kaufer only health and happiness going forward!

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Case Study: The Encore At Boca Raton Rehabilitation & Nursing Center (November 2018)

Patients Age: 58-years-old
Admission Date: 09/20/2018
Admitted From: Delray Medical Center
Discharge Date: 10/17/2018
Discharged To: Home
Length Of Stay: 28 Days
Reason For Stay: Quadriparesis
How did this patient hear about The Encore: Patient’s sister, internet search.

Details of experience:

Mr. John Giragos was admitted to The Encore from Delray Medical Center with a diagnosis of Quadriparesis (weakness in arms and legs). Upon arrival, he was greeted by the Assistant Administrator, the Director of Admissions, and the Director of Concierge Services to assure Mr. Giragos excellent customer service and comfort. Mr. Giragos was quite concerned as he had never needed skilled care and rehabilitation before. He shared, “I was afraid and uncertain,” with the team at The Encore.

The next day, Mr. Giragos was evaluated by his therapists. He was extremely frustrated to be in this situation. He was determined to get back to running his restaurant (John G’s) in Manalapan. He was extremely motivated and determined to do what he had to do to get his health back!
Mr. Giragos required minimal assistance for bed mobility and transfers, and he was only able to ambulate 60 feet with a walker. He also required max assist for dressing and showering. Despite having great determination and motivation, Mr. Giragos did experience periods of self-doubt and uneasiness during the early stages of his healing journey. Who wouldn’t in his situation? The team here at The Encore provided consistent support and guidance, reassuring him that the small victories would eventually make it all worthwhile!

The therapists decided to work with Mr. Giragos in the ADL suite (an area simulated as a home with a kitchen, a bedroom, and a bathroom) to familiarize him with the environment of being back home. As a restaurant owner, the kitchen would be a sanctuary for him and an area that he would be spending a great deal of his time. His goal was to work on his fine motor skills and crafting through use of his hands.

Within just a short time, Mr. Giragos was able to chop vegetables as he had prior to his hospitalization. His successes were a breakthrough as Mr. Giragos began to have greater amounts of hope and inspiration; he even made a signature turkey sandwich of his! With the support of the litegait, he began to increase his walking distances and his mobility subsequently improved.

Mr. Giragos was discharged from The Encore on October 17th. He was very grateful when he left as he was able to work, walk, and live again. He shared with the Director of Concierge Services, “I was happy here, it’s a good place. I would recommend you guys in a heartbeat. The nurses were helpful, the therapy was the best! Everything went perfectly. My prayers were answered – I am walking!”

We wish John the very best with only happiness and health! He shared with the Director of Concierge Services that he plans on stopping by soon to see everyone. We look forward to seeing him!

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Case Study: The Encore At Boca Raton Rehabilitation & Nursing Center (September 2018)

Patients Age: 65-years-old
Admission Date: 06/23/2018
Admitted From: University of Miami Hospital
Discharge Date: TBD
Discharged To: TBD
Length Of Stay: TBD
Reason For Stay: Melanoma and Tear Duct
How did this patient hear about The Encore: VA Hospital Suggested

Details of experience:

Mr. Richard Melito was admitted to The Encore from the University of Miami Hospital for melanoma and a tear duct (skin cancer). He was barely able to function when arriving at the hospital. He was unable to roll over in bed and if he would sit up, he would get dizzy and have to lay down quickly to avoid passing out.

In Mr. Melito’s first week at The Encore, he would only have treatment in his room because he simply was not well enough to leave. His therapists, Eric and Michael, would conduct exercises while Mr. Melito was in his bed. Mr. Melito shared, “My legs were so weak I couldn’t stand. I couldn’t even say the alphabet.”

After a few weeks of slow but steady progress, Mr. Melito was able to join the therapy team in the gym for a short time due to his ability to sit up longer. Mr. Melito would use the seated stepping machine and the standing frame but would have to end his sessions very early due to dizziness from his low blood pressure.

A little time after, Mr. Melito received a cerebral shunt, which helped drain liquid that was causing swelling and had affected other areas of the body, which was causing his slow progress. His blood pressure stabilized. Only a few days later, Mr. Melito began using the parallel bars and was walking 30 feet. Mr. Melito shared, “When I was walking everyone was shocked and they were all cheering and clapping.”
Two weeks after that, Mr. Melito was walking 100 feet with a walker and minimal assist. His progress began improving vastly at this point and with a short time, this expanded to 150 feet with contact guard assist! Just two weeks after that, Mr. Melito was walking 200 feet with only standby assist!

Today, Mr. Melito is able to get out of bed, go to the bathroom, dress, put himself in a wheelchair, and go to therapy all on his own! He is completely independent with a walker! Mr. Melito has taken back his life. He had shared with the Director of Concierge Services, “The therapy has been very good, it pushed me to where I am right now, I couldn’t do anything!”

His therapist, Michael, said, “In all my years I’ve never seen anything like it, his cancer is actively progressing, but every day he’s functioning better and better!”

Mr. Melito is very grateful to The Encore for all his incredible progress and is also very grateful to his amazing wife, Debbie, who has been with him through it all. As Mr. Melito shared with the Director of Concierge Services about his wife, “I hit the jackpot!”
We wish Richard and Debbie only the best going forward and can’t wait to see him keep on progressing!

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Case Study: The Encore At Boca Raton Rehabilitation & Nursing Center (August 2018)

Patients Age: 74-years-old
Admission Date: 05/28/2018
Admitted From: Bethesda Hospital
Discharge Date: 07/31/2018
Discharged To: Brookdale Assisted Living
Length Of Stay: 62 Days
Reason For Stay: Atrial Flutter
How did this patient hear about The Encore: Daughter shared about it

Details of experience:

Mr. Stephen Frazier arrived at The Encore after discharging from Bethesda Hospital where he had moderate to maximal assist for all of his activities of daily living (ADL’s). He was extremely weak, was in a lot of pain, and was NPO (unable to consume food or drink by mouth). It appeared from previous test results that Mr. Frazier would be unable to ever eat by mouth again. Mr. Frazier was extremely depressed about his condition. Aside from being extremely frustrated and anxious about his poor swallowing, he was also the caregiver for his wife prior to his hospitalization. Despite being on edge, he was very determined to get better and return home.

Due to Mr. Frazier’s motivation and the help from his physical, occupational and speech therapists, within just a few weeks he had increased bed mobility and was starting to be able to stand for slightly longer periods of time. His speech therapist, Julie Levy, was working with him on an oral motor and hyolaryngeal elevation exercises, and he had progressed from NPO to puree and honey thick liquid within a very short time.

Around a week later, Mr. Frazier’s mood had begun to change. Although he wasn’t thrilled, he had started to have more hope and was getting less depressed due to his progress. He was unable to walk a long distance with his walker but was still very determined.

With a little more time, Mr. Frazier was walking longer distances while at the same time was trialing one mechanical soft meal a day! At this point, Mr. Frazier’s mood had improved tremendously. Mr. Frazier would often say how appreciative he was of his therapists’ help and how they would go above and beyond to make him comfortable along with his aide, Stacy Anna, whom he loved very much.

Only a few weeks later, Mr. Frazier was walking over 300 feet and was wearing a green band which meant he’d be able to eat small amounts of regular foods!
On July 31st, 2018, when Mr. Frazier was discharged, he was performing ADL’s regularly with modified independence. Mr. Frazier had left The Encore to return back to Brookdale Assisted Living to be with his wife. We wish him and his wife only the best from The Encore.

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Case Study: The Encore At Boca Raton Rehabilitation & Nursing Center (July 2018)

Patients Age: 85
Admission Date: 6/3/2018
Admitted From: Boca Regional Hospital
Discharge Date: 7/16/2018
Discharged To: Home
Length of Stay: 44 Days
Reason of Stay: Fractured Hip, Right Left Open Reduction Internal Fixation
How did this patient hear about The Encore: Boca Regional Hospital

Mr. Gordon Dern was admitted to The Encore from Boca Regional Hospital where he had been in a state of complete living dependence and came to The Encore to learn how to live independently again. When Mr. Dern arrived, he was completely dependent and was in a lot of pain. On Mr. Dern’s first day, his therapists, Grace Montague and Edline Morin, treated him immediately for pain.

Mr. Dern was unable to do anything on his own. He was on oxygen and required assistance with lifting his foot. He was able to stand but could not take any steps. He was only able to tolerate approximately 20 minutes of therapy at a time and he would often complain that he was in pain. At this point, Mr. Dern was concerned that he may never be able to walk again or go home. Mr. Dern, however, was committed to doing everything he could to get better.
With time, Mr. Dern was able to tolerate extended therapy sessions. He would go to therapy every day and personally challenge himself alongside his therapists. Mr. Dern shared, “The therapists were excellent. I have no complaints about the treatment. They went beyond the call of duty.” Through his progression, his mood subsequently improved, becoming increasingly more hopeful in the rehabilitation process.

A week later, Mr. Dern’s pain began to decrease, and he was able to tolerate standing while taking a few steps with a walker. His activity tolerance and endurance began to increase, allowing him to participate in self-care tasks, including self-dressing without pain. With a little more time, Mr. Dern started ambulating with contact guard assist with a walker and was walking approximately 50 feet. In the same week, Mr. Dern progressed to standby assist, ambulating approximately 75 feet and very shortly after he was under basic supervision with a walker.

By the time Mr. Dern was ready for discharge, he was ambulating with a rolling walker with supervision from his aide and was up to 150 feet. Mr. Dern was discharged on August 17th, 2018, to his home in Delray Beach and was thrilled with his progress. He had reached out to Michael Rubin, director of concierge services and shared, “Only after a month later I’m in excellent shape. A physical therapist came to my house and was amazed by my condition. Everything about my hip is basically perfect. I’m in good shape. In fact, I went to a surgeon a few weeks ago and he as in awe about the condition I was in after such a short time of rehab.”

We wish the best to Mr. Dern as he is working towards a point with the least restrictive device.

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Case Study: The Encore At Boca Raton Rehabilitation & Nursing Center (June 2018)

Patients Age: 70
Admission Date: 3/24/2018
Admitted From: Northwest Medical Center
Discharge Date: 6/12/2018
Discharged To: Home
Length of Stay: 73 Days
Reason of Stay: Overall Weakness
How did this patient hear about The Encore: Friends that were at The Encore before (and mother is a resident)

Dr. Sandra Porterfield was admitted to The Encore from Northwest Medical Center for sepsis, which required roughly three months of physical, occupational, and speech therapy. When Dr. Porterfield arrived, she was 100% dependent. She was fragile, as she couldn’t even lift her cell phone. Dr. Porterfield was unable to eat without a peg-tube and needed a Hoyer-lift to be transferred. She felt paralyzed from the waist down. She was suffering from clinically induced depression, which resulted in her often being upset when considering her current state of health. Dr. Porterfield was placed on isolation for her first week. She was very non-cooperative in result of her depression. Her physical therapist, Mical Orrell, and her occupational therapist, Eric Kalina, originally were only able to position her in bed and perform select in-bed exercises and active assistive techniques to begin. In a short amount of time, her therapist asked her sit on a chair after Dr. Porterfield finally agreed to transfer from bed. Eventually, she agreed to come to the gym for therapy. She would only stay for a short time and would go back to her room. With more time, Dr. Porterfield’s therapists had her standing in the standing frame!

Dr. Porterfield shared with our Director of Concierge Services, Michael Rubin, “when noticing myself getting stronger I stopped resisting, I was less depressed and began to have hope. I realized my therapists were right.” A few days after speaking with Michael she took four steps in light-gate, which had officially begun the walking process. The next attempt she took ten steps, then the next time she had walked the full length of the bar in the light gate and back (20 feet)! She was finally strong enough to use a walker for approximately 20 feet of walking while being supported through contact guard assist.

During the rehabilitation process, Dr. Porterfield enjoyed some of the amenities of The Encore such as the musical entertainment, as well as the nursing staff. She stated “I was treated like a princess. Belmante (her nurse aid) acted as my fairy godmother and took care of me like I was her child.”
Her distance progressed over time. She was able to tolerate light standing balance activity, and within a few weeks, she was able to progress to very high-level of balance activities. She was able to perform toilet transfers with a walker alongside a trained aid, which soon progressed to just needing her husband, which eventually progressed further to her complete independence. Dr. Porterfield said, “The effort they had made, made me feel that it was so sincere and personable; I formed a strong bond.”

Eventually, the rehabilitation team recommended upgraded Dr. Porterfield to walking with a cane, but the team did not feel it was entirely safe just yet, so they supported her more through training with the walker for additional balance. Before Dr. Porterfield was discharged, she had progressed to walking stairs as well as car transfers, and was able to go to doctor appointments with her husband. Dr. Porterfield shared one final time as she was beginning to return home:
“It is because of these therapists, how they put up with me and dealt with me. It’s just a wonderful situation how I was able to come back to life. Ever since being able to transfer to the car, my husband and I have been celebrating by getting dinner together. They didn’t give up on me, they always challenged me to progress.”

Dr. Porterfield left The Encore to her home and was very happy. Her goal was to be more independent with a cane alongside home health support. She has since reached out to Michael Rubin stating that she is walking regularly with a cane! We wish her only health and happiness going forward. Dr. Porterfield still comes to visit The Encore as her mother is a resident at The Encore as well.

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