How do you spell Rehab- SUCCESS!

One of the greatest gifts a therapist can give to a resident is the ability to function as normal after under-going short-term rehab treatments. Recently, one of our therapy teams received high remarks from an Orthopedic Surgeon about the progress that his patient was making while receiving therapy through one of our facilities.

A patient came to our Blue Sky Therapists after tearing his quadriceps tendon for the third time. The goal was to put him through regimented therapy treatments and get him back to where he was before his last injury. In as little as three weeks, he was able to bend his knee to 110 degrees and could walk independently, transfer, and care for himself with some adaptive equipment. When this patient's orthopedic surgeon saw him for his follow-up appointment, he was amazed at his progress and personally congratulated the Blue Sky Therapy staff on a job well done!

There is no better feeling than to hear a success story such as this!

For the full story, visit

Therapy Cap- Exceptions Process Due to Expire

Congress has introduced a proposal to reform the sustainable growth rate (SGR) formula, which does not include repealing the Medicare therapy cap. If Congress passes legislation addressing the SGR formula, but does not include a repeal of the Medicare therapy cap, it is likely that patients will face a hard cap on outpatient therapy services in 2014. Everyone needs to get involved and contact Congress to prevent the therapy cap from going into effect!

You can find action alerts from AOTA, APTA and ASHA below.  You can also call the Capitol Switchboard at (202) 224-3121 to speak to the offices of your members of Congress and request that they repeal the Medicare therapy cap before December 31, 2013. Don’t let Congress deny beneficiaries vital coverage for much needed therapy services!


 *Information brought to you by #StopTheTherapyCap:

We appreciate our Physical Therapists and Assistants!

National Physical Therapy Month is a month to THANK and APPRECIATE all of our physical therapists and physical therapy assistants. We send a BIG thank you for making a difference, improving lives every day and helping people to remain active throughout their lives.

Therapists aid people to walk for the first time or regain the ability to move. Their healing hands, compassion and drive mold people to be the best that they can physically be. From the athlete who is treated in an outpatient clinic to a resident who receives treatment at a skilled nursing facility, mobility is very important as we strive to stay active and independent through our lives; without a therapist, this would not be possible. Our Blue Sky Therapists strive for the personal satisfaction of changing lives every day. Thank you to the Blue Sky Therapists, we honor your hard work and the inspiration you bring to many lives; and most importantly, WE HONOR YOU!

Happy National Rehab Week!

National Rehabilitation Awareness Celebration Week is indeed a “CELEBRATION”. We celebrate the patients and their courage, the therapists and their gift, the stories and memories, but most of all we celebrate the journey to recovery!

It is so easy to take what you do for granted if you do it on a daily basis. Everyday our therapists assist multiple patients and those multiple patients a day turns into thousands of patients a year. Blue Sky Therapy understands that these patients are mothers, fathers, brothers, sisters, grandparents, loved ones etc. Although rehabilitation can somewhat become a routine we understand that every interaction matters, and every interaction changes a life! Every day is a chance to be our best and bring out the best in our patients. To Blue Sky therapy, everyday week is chance to celebrate rehabilitation awareness.  We THANK all of our therapists for what they do and the lives that they change every day!  Our slogan at Blue Sky Therapy is Changing Lives isn't just something we say; it's what we do!

Blue Sky is TEAM VINCE!

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There is no better feeling than to hear the stories and watch the journeys of the patients we have in therapy each and every day.  The relationship that a therapist has with a patient is indescribable.  When a team of therapists are all a part of one patient's journey, the feeling is magical!

This is a story of Vince, a young CVA patient at Nugent Convalescent Home where Blue Sky Therapists are involved in his everyday treatment.  Vince arrived at the facility with little function and has made leaps in bounds in therapy over the span of a few months.  After much hard work and a new wheel chair he is now able to self-propel to get himself around the facility! 

The Blue Sky team had high hopes for Vince when he arrived at the facility.  His determination, ambition and amazing attitude have made our hopes a reality!  The Blue Sky Team is so very proud of Vince and will be by his side every step of the way through his journey!

Blue Sky Therapy is TEAM VINCE! 

PT Post-Surgery

Swelling, pain, bruising, and even loss of motion are all things that affect people after they undergo surgery, especially those elderly patients.  Getting up and moving post surgery is vital for recovery and pain management. Blue Sky Therapy will customize treatment to a clients specific conditions, all leading towards one goal, to strengthen them!

Physical Therapy right after surgery can help with an array of different things.

  • Improves blood circulation; Decreases swelling by removing the fluid that builds up in your body. You will heal faster if you get the blood flowing!
  • Increases your strength faster; Re-injury is common after surgery. Strength is so important because weakness leads to re-injury.
  • Helps range of motion; Exercise helps you move your injured limb as far as possible and you will heal a lot faster!

Strengthening your body by undergoing physical therapy can reduce the stress of recovery. You will begin to feel better at a quicker pace than if you did not undergo therapy. Physical Therapy at Blue Sky will help restore your body and benefit you immensely in the future.

"Importance of early physical therapy after surgery." CDApress. CDApress, 20 Jun 2012. Web. 3 Sep 2013.


The importance of exercise over 50

Fitness overall is something important that should be a part of every individual’s life, but committing to a workout plan over the age of 50 is one of the most important decisions seniors can make!  Physical activity is something most dread to do but need to find time for. The benefits to staying active as seniors are unlimited, so why not make it a part of your lifestyle instead of just sweeping it under the rug. There are plenty of things that seniors can do to make exercising more enjoyable as a part of an everyday lifestyle-here are just a few!

  • Listen to music while lifting weights or stretching
  • Window shop while walking laps at the mall
  • Get competitive and start playing tennis
  • Take photographs on a nature hike
  • Meet new people at a yoga class
  • Watch a new movie while on the treadmill
  • Take a friend with you to walk, stretch, or strength train

There are many ways to incorporate enjoyable things into a workout plan. First find which activities and exercises you enjoy and how you can incorporate them into your individual plan and life!

Sarah Kovatch, M.F.A., Melinda Smith, M.A., and Jeanne Segal, Ph.D. "Exercise and Fitness Over 50." Help Guide. Web. 27 Aug 2013.


Justifying Therapy Services for LTC Residents

Written By: Kathy Boyarko, PT, CDP, Program Development Manager

One of the best ways to justify therapy services with long term care residents who have demonstrated a functional decline is to have nursing documentation supporting the patient’s decline or issues.  Often time’s nurses may verbally tell you of a concern or decline when you screen the patient, but they have not documented it in their notes.  For an auditor, when this happens, it can appear as though the therapist is picking the patient up for therapy services unnecessarily. 

The solution to this problem is NOT to fail to pick the patient up for therapy, it is to assist and encourage the nurses to document the decline in their notes. 

If you do not already have a process for this in your facility, here are some guidelines to get you started.

First, make sure to have the rehab manager discuss the topic in morning meeting.  Be sure to explain that in order to avoid denial of payment for therapy services, nurses supporting documentation is needed.  Show them the nurses documentation request form and explain that you will be giving it to them when you wish to pick up a resident for therapy.  If you fail to introduce this and explain it, and then go and ask a nurse to give you supporting documentation, they will not likely understand what you need and why. 

Medicare strongly recommends at least 3 days worth of supporting documentation in the nurse’s notes to justify therapy.  However there are a few exceptions to this, particularly when safety is involved.  For example-- if a patient has a fall or is noted by nursing to be choking on their food.  In these instances, the resident should be evaluated right away for their safety.  

In other cases where there is no immediate safety demand, the procedure is:

  1. Nursing identifies a need for therapy or the therapist identifies a need through their screening.
  2. Begin whatever process you normally use to obtain a physicians order, unless you have standing orders.
  3. Complete a nurse’s documentation request form.  Blue Sky Therapy provides our therapists with a quick and easy form to complete and give to the nursing staff to remind them to make sure that the reported decline in functional status is documented in the nurses notes.
  4. In 3 days, verify that the nurses have documented something regarding the decline and that you have an order and if so, go ahead and evaluate the patient.

Sometimes a nurse does not feel comfortable documenting a decline that an aide verbally told you about and the aides may not perform any documentation in the chart.  If this is the case, explain to the nurse that you are not asking them to document that they saw a decline if they didn’t, you are simply asking them to document that the aide stated that they noticed a decline.  This should reassure them and make them more comfortable.

Exercise, the Best RX for Dementia Patients!

Dementia is one of the biggest fears among the aging population and for some, it is a harsh reality. As we grow old, we slowly lose our memory capability, but to those suffering from dementia, they lose their memory capability at a much faster pace.

As many of us know, exercise can do a lot of great things for the body, but what we often forget about it is how exercise improves our minds. We feel more energetic and have a clear, positive mindset after a great work out. What if exercise could actually improve the memory function of those suffering from Dementia? Recent studies tell us that it can!

Dr. J Carson Smith, assistant professor in the Department of Kinesiology, believes he’s getting pretty close to a cure for dementia. His secret to providing hope to those suffering...moderate exercise!

Dr. Smith’s study included two groups of physically inactive older adults ranging from 60-88 years old, one group suffered with Mild Cognitive Impairment, the second group were adults with healthy active brains. They were put on a 12 week exercise program that focused on regular treadmill walking and were guided by a personal trainer. Both improved cardiovascular fitness by 10 percent and best of all, both improved their memory performance and showed enhanced neural efficiency while engaged in memory retrieval tasks. Exercise may in fact reduce the need for over-activation of the brain to correctly remember something. This is also encouraging news for those trying to preserve brain function.

Smith states that “People with Moderate Cognitive Impairment are on a very sharp decline with their memory function, so being able to improve their recall is a very big step in the right direction”.

For more information on how Blue Sky Therapy can improve the lives of those suffering from Dementia at your facility, visit

"Exercise may be best medicine for Alzheimer's disease." ScienceDaily, your source for the latest research news. Science Daily, 13 Jul 2013. Web. 13 Aug 2013.

Baby Boomers, Social Media and Census...How are they related?

When we think of who is using social media, we tend to think of younger individuals.  But did you know that 43% of Americans over 65 use at least one social networking site! According to a Mashable article, "Seniors are fastest social media adopters in the U.S."

Has your long-term care facility thought about incorporating social media into your marketing strategy to attract more residents?  Now that the baby boomers are using social media, there is a greater chance they will find your facility via a social networking site. Once they find you on social media, they have the opportunity to view information about your facility, pictures of your residents, as well as see all the events that are happening.  Don't you think seeing pictures of your residents having fun will make them smile? IT WILL! Social media will increase brand awareness and make your facility more attractive to prospects.

Now that we know boomers outside of the long-term care facilities are using social media, have you thought about how many of your residents would "like" to be engaged with social networking?  The smiles on their faces will be priceless when they Skype with their grandchildren who are away at college or when they follow their families on Facebook and come across pictures from the family picnic. Incorporating social media into the list of many activities you have for residents to do at your facility can make a significant difference.

Looking for more ways to increase census at your facility, Contact Blue Sky Therapy to find out more about our Census Development Program!  Click here for more information.

Source: Mashable. "Seniors Are Fastest Social Media Adopters in U.S." 

MMR Process and Part B Therapy

Written By: Kathy Boyarko, PT, CDP, Program Development Manager

As you may have noted, the Manual Medical Review process for Medicare Part B therapy patients  receiving outpatient therapy in 2013 is a little different than it was for 2012.  The pre-approval process for Medicare Part B patients who are over their threshold of $3700.00 is no longer required; however, an ADR or additional development request will be generated and sent to the facility once the claim is billed for each of these patients that exceed their threshold.  This new process is more streamlined and provides an opportunity to better prepare and meet the ADR requirements.

Last fall Medicare was overwhelmed with all of the MMR reviews and the process was not successful.  Therefore this year the reviews are going to be performed by RACs or Recovery Audit Contractors, which are specialists that contract their services to Medicare to perform the auditing for them.   When Part B patients reach the $3700.00 threshold, the regional MAC (Medicare Administrative Contractor) will send the provider (the facility) an ADR letter.  Remember, this letter is not a denial as it is just a request for more information.  The facility will have 30 calendar days from the date on the letter to respond to the ADR.  Some RAC ADRs have been asking for more information than the MACs have asked for in the past. 


  • A copy of the billing submitted (CPT codes).  If they ask for this you will need to do a review to ensure that what was billed matches the documentation for what was billed.   Occasionally a therapist may mistakenly document their daily note in the incorrect CPT code box.  This would cause a problem and be a red flag for denial.  Any errors found should be corrected and then the billing report re-printed before being sent in.

  • A copy of the professional license of the provider.  It is recommended that all therapists make several copies of their licenses for the RMs to keep in a folder to have on hand when needed. This can be completed now before you get an ADR and then only have a limited time to respond.

  • An abbreviation list.  Medicare does not have an official abbreviation lists and recommends that each facility has their own.  Find out if your facility does and make several copies of it to have on hand. 

  • Justification when the certification of the POC is delayed more than 30 days.  If your physician fails to sign the POC within 30 days there needs to be a written explanation of why it was delayed. 

 The RAC auditors have 10 days to review the information and make a determination.  If they are unable to review within the allotted time frame, the claim will be paid.

If you receive a denial after submitting the requested ADR information, you will need to follow the normal steps for a redetermination.  If this is denied you can follow the normal steps for a reconsideration.  If the reconsideration is denied, you can request an ALJ, or Administrative Law Judge hearing.  Blue Sky recommends completing all the steps of the auditing process and has an excellent rate of recovery for our claims.


Active Aging and Your Body...

Did you know that every hour of every day, 330 Americans turn 60? At this age, people lose muscle mass and strength, flexibility and bone.  Jane E. Brody, in her article, ""Fit not Frail: Exercise as a Tonic for Aging" tells us that, "the resulting frailty leads to a loss of mobility and independence."

A routine exercise plan is crucial now so that your body is prepared for what the future holds.  Take 30 minutes a day to exercise and you will begin to notice a huge difference in improving how your joints and bones function.  Just ask any Physical Therapist.  They are keen on educating about the importance of a routine exercise plan to increase mobility and independence in elderly adults.

The article, "Fit not Frail: Exercise as a Tonic for Aging", written by Jane Brody, gives us a series of physical activity recommendations for older Adults:

 •    Outdoor exercise; brisk walking, cycling, lap swimming, or jogging.
Focuses on: Aerobic training for heart, lungs, and circulation.
•    Indoor exercise; treadmill, cross-trainer, step machine, or exercise bike.
Focuses on: Reducing stress on joints, bones, and soft tissue, enhance stability and reduce risk of falls.
•    Strength training; series of machines, light weights, and resistant bands.
Focuses on: Reducing risk of muscle fatigue, and improving balance.

Brody, Jane. "Fit not Frail: Exercise as a Tonic for Aging." New York Times, 24 Jun 2008. Web. 31 Jul 2013.

A smile can go a LONG way!

Are you the type of person that loves to smile or you would like to smile more?  Do you know how much a smile can change your life? A smile, says Crystal Lee, an eHow Contributor, can help you start living a healthy, active life. “Age is nothing but a number. Your health and energy level truly determine your age, contrary to the chronological number.”  A healthy lifestyle can be a smile away and in the long term, can help decrease your chances of developing diseases like obesity, diabetes, and some cancers. Here are your simple instructions!

·        Watch what you eat and eat in moderation. Your body needs everything!

·        Stay active to keep your heart muscles pounding.

·        Drop the soda and indulge in the H2O.

·        Make sure to sleep 6-8 hours.

·        Don’t forget to smile, stay positive.

Remember that your age is only a number.  The tranquility of your mind and how physically fit you are determines your real age. Continue to make healthy lifestyle changes and remember to keep a smile on your face.

Lee, Crystal. "How to Live a Healthy & Active Life." eHow. n. page. Web. 30 Jul. 2013.

Staying Active to Stay Young!

Time is flying by but one thing remains the same for people between the ages of 1946 and 1964, to stay forever young. Many baby boomers are busy on their path to healthiness and immortality. According to the National Institute on Aging, next to improving diet and shunning tobacco, nothing a person does increases life expectancy more than exercising. It is said that exercise it great for many things including your body and mind.

However, it does not come without risks. A local news station in El paso, Texas posted five ways, plus a bonus, on how boomers can stay safe and have fun while exercising.

•   Know your limitations

•   Try something new

•   Take control

•   Spice rack resources

•   Boost your metabolism

•   Recharge at night.

“Avoid medications that mask pain coming from strained or damaged tissues,” says Jyl Steinback, author of “Superfoods:  Cook Your Way to Health,” and executive director of “Instead, consider a homeopathic medicine, such as Arnicare Gel, that works naturally with the body to help it heal and won’t interfere with other medications you’re taking. I bring it with me whenever I exercise.”

They recommend working with a skilled, licensed trainer at first, until you can create your own custom workout. Do not let pains and aches stop you from having a regular exercise routine. With these six tricks, you can exercise pain free and safer than ever.

Local News from El paso, Texas (2013). Five Ways Baby Boomers Can Stay Active. Retrieved on July 29, 2013 from

The Importance of Part B Therapy

Written By: Kathy Boyarko, PT, CDP, Program Development Manager

With all of the changes in the long term care rehab industry, such as the MMR process and auditing, it may be tempting to think that we should not be picking up Part B residents for fear of denial.  However it is important that we understand that although Medicare is trying to cut expenses, they are obligated to pay for therapy services to those who need and deserve them.  So when recommendations are made regarding denial prevention, the point is not to stop seeing Part B residents; it is to simply make sure to that the care provided is skilled and the documentation demonstrates that skill.

Simply reducing the number of Part B resident seen would prevent denials, but it would also be unfair to our residents and devastating to our bottom line and the future of our industry.  As therapists, now is not the time to back away and underrate the importance of therapy, it is the time to fight to show what a difference we do make with our patients and that our skilled care is needed. 

At Blue Sky Therapy we assist our therapists in helping to build a Part B caseload and justify the services that we give through good documentation to prevent denial of our services.  We do this through several programs including a helping hands program, weekly documentation tips, annual documentation webinars, online training videos providing many documentation samples of various scenarios for specific patient types as well as sample ADR cover letters, and of course auditing to ensure good follow and an employee recognition program to reward excellence in documentation from our staff.  

Functional Outcome Reporting Deadline Approaching

Written By: Kathy Boyarko, PT, CDP, Program Development Manager

We are down to the wire now with only 1 month left of the trial period for functional outcome reporting of Medicare Part B Therapy services.  If you are a therapist who treats Part B patients and you have not yet begun your reporting, you only have 1 month to practice and work out all of the bugs. 

  • For example, what do you do when you see a patient for an evaluation only? 
  • What happens if you are seeing a patient for maintenance therapy only and your end status is not likely to be different from you onset status? 
  • What about situations when a patient is low level and there are not any common Functional Assessment Tools that would be appropriate for them? 
  • What do you report for an end status if your patient is admitted to the hospital and a non-billable discharge summary is done?

At Blue Sky, our therapists were initially trained in February and we have had continuous online and webinar training for new employees or employee who need a review.  We also provide continuous training based on the various situations that our therapists find challenging as in the above scenarios.  We have provided sample patients/reporting situations for these scenarios, including an evaluation only, low level patients, maintenance therapy and general patients for each discipline.   These samples help our therapists to view an example and give them ideas for how to code appropriately and objectively. 

The importance of proper outcome reporting cannot be emphasized enough as the future of our industry may very well depend on the results of this data collection.  So if you have not yet begun your reporting, make sure to get started and do the best job that you can to demonstrate the good outcomes that we bring to our patients every day!

Blue Sky Therapy Receives 2013 Best of Warren Award

Blue Sky US Commerce Award.jpg

U.S. Commerce Association’s Award Plaque Honors the Achievement

NEW YORK, NY, May 7, 2013 -- For the fifth consecutive year, Blue Sky Therapy has been selected for the 2013 Best of Warren Award in the Physical Therapists category by the U.S. Commerce Association (USCA).

The USCA "Best of Local Business" Award Program recognizes outstanding local businesses throughout the country. Each year, the USCA identifies companies that they believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and community.

Nationwide, only 1 in 1000 (less than one-tenth of 1%) 2013 Award recipients qualified as Five-Time Award Winners. Various sources of information were gathered and analyzed to choose the winners in each category. The 2013 USCA Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the USCA and data provided by third parties.

About U.S. Commerce Association (USCA)

U.S. Commerce Association (USCA) is a New York City based organization funded by local businesses operating in towns, large and small, across America. The purpose of USCA is to promote local business through public relations, marketing and advertising.

The USCA was established to recognize the best of local businesses in their community. Our organization works exclusively with local business owners, trade groups, professional associations, chambers of commerce and other business advertising and marketing groups. Our mission is to be an advocate for small and medium size businesses and business entrepreneurs across America.

Documentation At Its Finest!

Written By: Kathy Boyarko, PT, CDP, Program Development Manager

Most physical, occupational and speech therapists went to school to treat patients, not to become expert documenters.  However, Medicare is now performing an increasingly large number of audits or all types which have caused therapists to have to expand their documentation skills.   Meeting all Medicare documentation requirements can be a daunting task and most therapists would rather spend their time treating patients instead of learning the art of good documentation.

That is why we developed the Blue Sky Institute at Blue Sky Therapy.  The Institute not only provides continuing education at no charge to our employees and our facilities, but we also provide an extensive Documentation Program. 

The 4 main components of our Documentation Program are:

1.       Auditing

2.      Education

3.      Recognition

4.      Re-audits

Auditing:  We begin our process with the simple act of auditing charts.  Our  therapists perform peer audits on each others’ charts every month.  This process not only helps identify any issues of concern, but also serves as a learning tool for the therapist.  The act of auditing a chart serves as a monthly reminder of how documentation should look, and what the important aspect of documenting are.  In addition we have a quality assurance auditing team consisting of several experienced therapists who perform a more thorough auditing procedure.  Each of our facilities has a QA audit at least once a quarter. 

Education:  Once we perform the audits we can get a feel for any issues of concern.  We then need to communicate these areas and what changes need to be made to the therapists.  This is where the Blue Sky Institute comes into play.  In 2011 Blue Sky introduced “Blue Dog Documentation” which is our initiative to improve the documentation skills of our therapists.  Extensive education on good documentation began including providing tips and samples of good documentation.  We also provide annual webinars on documentation for CEU credit for our therapists.  The webinars are based on an overview of current trends and industry demands as well as issues found in the audits.  In addition, Blue Dog throws our therapists a weekly “biscuit” which is an email tip sent out regarding proper documentation.  We have an online training website where new employees can log onto if they missed the annual webinar and view it there.  The website also offers videos of therapists performing functional assessments tests on actual patients demonstrating how to perform the tests in a timely and efficient manner.  Each facility is also provided with a documentation manual which contains samples of all types of documentation (evaluations, progress reports, re-certifications, daily notes and discharge summaries) for all 3 disciplines and for several patient types including cardiac, CHF, incontinence, dementia ACL level 1-2, dementia SCL level 3 and dementia ACL level 4.  This allows the therapists to see an sample of good documentation for each of these areas to use as a reference or to stimulate ideas for good documentation.

When issues of concern are identified and unable to be resolved through the above education, then one on-one-training is provided by our Quality Assurance/Program Development Team.

Recognition:  Each month 2 employees are nominated for our Blue Sky Employee Documentation Recognition Program.  There is a drawing at the end of the month and the winner gets a Blue Sky Strength for Life t-shirt.   The program demonstrates to all of our therapists how our excellent documenters can manage the task of treating and documenting with excellence. 

When issues occur that are beyond the scope of the above procedures, action plans are developed and if necessary, disciplinary action taken.   We have found taking this step to be uncommon due to the above proactive process which typically stops the problems before they get to this point.

Blue Sky is pleased to say that with the above process in place, our overall quality of documentation has improved significantly over the last few years.  And just in time too with the manual medical review and increase in auditing done this year!   With the proper education and support, quality therapists can quickly become quality documenters as well.

Taking on the MMR Pre-payment Review Process

Written By: Kathy Boyarko, PT, CDP, Program Development Manager

With continuing reimbursement challenges in the forms of audits, Blue Sky Therapy has implemented a process to address the MMR threshold of $3,700 and the new prepayment review process implemented on April 1, 2013.  With our advanced software, we are able to identify those patients approaching their threshold and complete an comprehensive documentation audit prior to receiving the Additional Development Request from Medicare.

Our dedicated QA team and ongoing staff education through webinars, on-line training videos, customized individual and team education, and documentation tips and examples that are sent out each week provide  numerous educational opportunities to ensure our staff is documenting to support the services being billed and  that the services are medically necessary.

Blue Sky is committed to being proactive with all documentation reviews and working through the process as outlined by Medicare to appeal all denials and achieve a positive outcome in the form of payment received for all services provided to our residents.