Q&A with Shelly Mesure, MS, OTR/L, Owner of A Mesured Solution, Inc.
Shelly Mesure is an occupational therapist specializing in skilled nursing facilities, clinical excellence and regulatory compliance. She is the owner of A Mesured Solution, Inc. (www.amesuredsolution.com), a company servicing "hands-on" consulting work directly with facilities throughout the US. Shelly has a BS in rehabilitation services education and a minor in gerontology from Penn State University (University Park) in State College, Pennsylvania, and an MS in occupational therapy from Rush University in Chicago, Illinois. In addition to running her own company, she teaches two seminars with Cross Country Education, "Understanding and Managing PPS: A Rehab Perspective" and "Building Therapy Caseloads." Shelly thinks it's very important for OTs to remain aware of state and federal regulations, and "always continue to advocate for the field and industry."
Q: What motivated you to become an occupational therapist and work with older populations?
A: An undergrad internship inspired my focus in OT. I fell in love with occupational therapy because of the complexities of the job. Compared with other therapy types, I loved the ability to provide services that impacted a patient's life in so many ways. From basic ADL training through IADLs and home management, OT has allowed me to help my patients through the entire process and return home at a better quality of life.
I truly fell in love with LTC because of the "close-knit" community of facilities. I still remember some of my first patients and the relationships I developed with them on a personal level. I feel that the SNF/LTC setting is a very unique aspect of healthcare that allows us to truly spend the time with our patients and see them through a difficult time in their lives.
Q: You founded a consulting company, A Mesured Solution. What is the main focus of your business?
A: The primary focus of my consulting company is to provide on-site training, operational oversight and changing clinical philosophies directly to skilled nursing facilities. We provide various "lunch-and-learn workshops," plus my two seminars for in-house CEUs.
Q: When did you decide to start AMS?
A: I love the management aspect of healthcare. A few years ago, I was working as a Corporate Rehab Director, and I was the only resource for this company to "stay on top of" current regulations and management. My previous rehab management jobs were with large companies, and I always assumed everyone had the support I did. I believe strongly in education and teaching the right way to do your job, so I reached out to Cross Country Education and discussed several course ideas I had. CCE picked up two of my courses and before I knew it, I was teaching six-hour seminars and traveling all over the country.
The responses at my courses have always been so positive, and my consulting business, A Mesured Solution, was a result of networking with attendees of my courses. I continue to teach my seminars, but this past year with all of the regulation changes has allowed me to continue growing my business. I have gained recognition from HUD, McKnight's, SLACK and a few others.
Q: Typically, what are your day-to-day responsibilities at A Mesured Solution?
A: As a consultant, I primarily schedule regular meetings with rehab staff, rehab managers, NHA, DON and MDS coordinators. Specific patients are discussed, training is provided to roll-out new operational procedures (especially for MDS 3.0) and audits are conducted to ensure regulatory compliance.
Q: Can you share a funny story about your profession?
A: While discussing the implementation of group therapy as a routine treatment approach, I suggested a variety of group ideas. One idea was stated as "an activities of daily living (ADL) group"; the OT and COTA looked very puzzled and asked, "Do you mean a shower/bathing group?" After much laughter, I clarified my "ADL" to "grooming" and made sure not to repeat that mistake to my other clients.
Q: Are there other areas of interest for you as an OT that you plan to pursue?
A: I've developed several on-line CEUs ("webinars") with Care-2-Learn, but would love to pursue training through distant-learning courses.
Q: What are the greatest challenges you face working in home care?
A: As a consultant, changing clinical philosophies is always the most challenging. However, through proper training and education, therapists are usually very open to learning new perspectives. Ultimately, the patients reap the benefits.
Q: What do you like most about working in a home care setting? What do you dislike most?
A: Like-The challenges of each individual facility, staff interactions and communication issues.
Dislike—Lack of carry-over.
Q: Are you currently involved with any research projects? Are there any projects that you would like to be involved with?
A: Not at this time, although I am very interested in possible grant-funded projects focusing on effects of transition periods and carry-over from discharge of therapy to community and/or LTC status.
My consulting company was recently endorsed by the Housing and Urban Development (HUD) agency for our work with improving clinical and financial outcomes for SNFs. I am also currently working with the editors of SLACK, Inc. to create a "quick reference guide to Medicare" for therapy students and new grads.
Q: Do you feel that the role of occupational therapists has changed over recent years?
A: Our patients have changed, therefore they demand more from their therapists (of all disciplines). They are smarter and more informed (via the internet), they have more active lifestyles (at any age) and they are more demanding of excellence and functional application of their therapy treatments.
Q: What do you feel is of the greatest concern to OTs today?
A: Reimbursement (completely vulnerable to government regulations) and finding acceptable treatment approaches to meet the demands of our patients.
Q: What is the most rewarding part of your job?
A: Working with facilities from the beginning stages of "average therapy" to excellence, and strong reimbursement with strong clinical practice/documentation.
Q: What is the most important thing you've learned over the course of your career?
A: Healthcare=change. If you are not able to accommodate and change with new regulations or new challenges of residents, your clinical practice will be obsolete.
Q: What advice do you have for others thinking of entering a home care specialty?
A: Be prepared for the regulations and paperwork; however, always let your clinical decision-making lead the way.
Q: If you could sum up your job in one word, what would it be and why?
A: Complicated. "As long as the government keeps changing things and keeps it complicated, I have job security"— this is something I heard many years ago, but repeat all the time. My biggest challenges are staying up-to-date with current regulations and industry trends. However, I feel it is my responsibility to educate and advise my clients of any changes, recommend and remove any operational issues, and allow the clinicians to truly focus on patient care. I enjoy analyzing different issues that prevent good clinical services, and I work with companies to improve efficiencies and develop a customized approach that follows regulations and removes any barriers.
Q: How has working in long-term care allowed you to grow professionally?
A: There are so many facets to LTC/SNFs, I found a love for management early in my career. I found a love for education when developing my seminars. I found a love for consulting through networking from my seminars. And, I still find time to treat patients on a per diem basis when I need a "back-to-basics" kind of day.
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