Author: Marguerite Mullaney



We woke up again, Hurray! We have unlimited power to make the world a better place. Free of charge. Doesn’t cost you anything. In fact, it might gain you something more important than money.

Be nice to somebody who needs somebody to be nice to them. Smile. Wish them a good day. Be polite even if they are rude to you. Stay positive against the negative. Be a light in the darkness.

I started yesterday intent on staying positive but sagged in the middle of the day. It seemed I ran out of smiles by lunch time. Today, I’ll try to make to 2 pm. I’m thinking of this as training for the #HappyOlympics.…

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Dysphagia Topics: A Caretaker’s Handout

Dysphagia Topics: A Caretaker’s Handout

image Courtney Perrone, a Northeastern graduate student, has asked for our help with a current project. She’s looking for feedback on a Caretaker Handout she is developing. Please review and provide constructive comments in the section following this post. For best viewing, use a PC or laptop as iPad/iPhone does not capture the full scope of the visuals in this piece. Thanks in advance.


Caretaker Handout

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Sky’s the Limit

Sky’s the Limit

The weather here in the Commonweath is never predictable. There was snow in November for what was, I think, the first time since 1989. So far, December has been dreary gray and rainy. Lots of rain. Lots and lots. It rained so much here that there were mudslides in California. That was a little joke.

Friday and Saturday were gloomy and rain soaked. Made it very difficult to engage in more than the basics. Weather like that always makes me think of sleeping for a week or so.

But today! A Sunday that is sunny. Bright blue skies and a chill wind that takes the air right out of your tires. I was rushing this morning and paying little attention to the change of weather fortune. Had to hurry off to watch a lunch and then there was grocery shopping to do on the way home. It made for a hectic couple of hours.

Driving home my brain was listing off all the things which still needed doing. The laundry, cat box, paperwork list we all store up to do at 9pm on Sunday night. It was a weighty list and I rolled my eyes as I pulled into the final stretch home.

Blue. Beautiful blue.

I notice just how blue the sky was at that moment. How spectacular the clouds were. How frantic the seagulls were as they raced for the beach. Following them seemed like the only reasonable thing to do. I took the road toward the beach and not my driveway.

The sky, without interruption of roof tops, was picture perfect blue withimage obligatory puffy white clouds. The seagulls were endulging on a buffet table of seafood washed up on the sand from last night’s storm. Such was the abundance that they lingered on air currents instead of fighting over scraps. Even the youngest bird knew there was plenty.

Like them, I lingered on the sea wall. Snapping a picture or two but mostly just to view the abundant beauty I’ve been missing for so long now. In ten years, I won’t remember what paperwork was needed or which pants I washed but I will be happier for taking a moment longer to enjoy the bright blue day. …

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Not At ASHA2014

Not At ASHA2014

Good Morning!

For all of you hoping to see us at #ASHA2014, sorry. Lisa and I decided to skip this year. We do hope you folks will email and Tweet us about the events. We are disappointed to miss the annual gathering but not so disappointed we will miss the plunging tempt in FLA. We deal with enough New England cold.

We are continuing to update this site. It is less regular than we hoped but life gets busy. If you have a story to tell or a ramble you’d like to post, please email us with your ideas. We’d love to hear from you …

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Spring 2014

Spring 2014

This has become the spring of my discontent in a thoroughly terrible year. A year which still has seven and a half months to play out. Any number of things could be causing my distress.

It was a miserable weather winter
The spring has been an epic weather failure
Politicians and talking heads argue about endlessly
Nothing gets solved with arguments
We are either having global warming or not
Honeybees are dying off and nobody cares
A whole plane went missing and then CNN lost interest
The economy is making a come back or not
Healthcare is failing or not
Obamacare is succeeding or not
Sugar is subsidized but the federal government
Sugar is addictive or not
Trouble in the Ukraine until CNN lost interest
A glacier broke last week and can’t be fixed
The melting glacier will flood the planet drowning us
Apparently 100% of California is burning or not
Soldiers are dying in a country that is hard to spell
10 million Americans were expected to protest in DC 5/16
10 million Americans were unable to find Washington DC
The Bruins lost the playoffs

That last one really hurt.

So, what are we to do? The world is spinning widely out of control and will surely snap right off its axis. All is lost. And, it’s all our own fault

or not

I’m tired of the blame for not saving the world. Because I do save the world. Everyday I go to work, I save a little bit of somebody’s world. I give them the tools they need to speak their mind or save their minds. I help them get back to regular diets or closer to regular diets.

I’m an SLP and I walk the walk but, more important is I talk the talk so they can too. …

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Matthew J. Mullaney
1918 - 1997

What my Dad knew

Matthew J. Mullaney 1918 - 1997
Matthew J. Mullaney
1918 – 1997

My Dad worked for 37 years at a job he loved. He worked at Boston City Hospital in the TB Control Department. His job was to do the intake and keep the records of all the outpatients being treated for active TB. If somebody failed to come in for scheduled treatment, he would alert the public health nurse who would go track the person down and bring them in for care. His department approached the public health crisis, which was swamping the nation, one patient at a time to save a city from an epidemic. Dad was proud of his work and the lives saved and the city that invested manpower and resources in the “general welfare” for the public health of the City of Boston.

It was toward the end of his career, his faith in healthcare was shattered. He watched helplessly as politicians declared the TB epidemic over, closed TB hospitals and merged departments under a larger Infectious Disease umbrella.

“We almost wiped it out. They stopped before it was completely gone. TB will be back. It’s too opportunistic to give it a chance to get away from us again,” Dad said to me after reading another chronic care hospital was closing.

Dad died shortly before it became evident TB was on the rise once again in the US and stronger than ever. Which means, Dad missed the total politicalization of healthcare. I’m glad he didn’t live to see the disgrace we have made of a once noble profession. Work where we worried about saving the world one life at a time.

Healthcare has become a system where decisions are made based on insurance type dictating care dispensed, the duty to die versus being a long term financial drain on a buckling system, and state legislatures and congress deciding what women and their doctors must discuss regarding their most personal care. Do no harm is very low on the decision tree for most providers these days.

The constant strain of doing more with less, generating revenue and cutting costs has shifted our collective focus from the person needing care and the professionals providing care to a bottom line mentality. Politicians and insurance companies are now standing between the ill and their caregivers. They have become the self appointed gatekeepers holding the purse strings.

Politicians and TV’s talking heads have stated as a matter of fact that fixing healthcare means cutting costs. For some reason, most of the public choose to believe this. The truth is closer to these being two separate problems which may be mutually exclusive. Fixing healthcare means getting people the care they need before they are in need of emergency treatment and educating/retaining enough professionals to fill the huge gaps we have in caregiver coverage. Cutting the cost of healthcare means getting serious about fraud, kickback schemes, rethinking for profit healthcare, and equitable prescription drug costs.

Each day the system seems to collapse another millimeter. We professionals grow more callous every time we see the darkness shrouding health squeeze the hope out of the next desperately ill patient on our ever growing list of treats to be seen in 8 hours. People have become IDC9’s and are dealt with in billable units greater than 8 minutes per HCPCS code.

It all sounds so terribly hopeless, doesn’t it? Most days, it feels that way too. But, the solution is really very simple. It is the approach my father and his colleagues used to wrestle the TB epidemic in the 1950’s. You treat one patient at a time, regardless of ability to pay, to arrest the spread of the disease and save your patient. This ensures the general welfare of the public and you save your city one life at a time.…

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And we will know them by their scarves…, and their swagger

And we will know them by their scarves…, and their swagger

I saw the moment approach from across a crowded convention center. The look of concern furrowing a brow, the quickened pace to avoid missing even one moment more before resolving the ‘issue’ at hand, and the mandatory accessories required by a true professional; overly large purse, scarf, a rainbow of achievement ribbons flapping from the registration badge.

“What is your competency?”

Asked not in interest but in challenge. A demand to justify my qualifications. A self appointed societal gatekeeper arrived to confront me about me. The intent of the question was quite clear.

“Just who do you think you are?”

Hmm, who do I think I am?

I’m a daughter to no living person and a sister to a lost brother.

I’m an inner city kid who got really lucky to be surround by adults who understood education was a way out of poverty.

I’m the product of Boston Public Schools, the Massachusetts State College System, and Northeastern University.

I was an L Street Brownie for a day.

I’ve worked in companies in the top 100 and the bottom hundred.

I participated in the pilot study for FIM – sorry about that.

I’ve been radiated for the good of my clients’ swallowing.

I was thanked for that effort with a punch in the nose once.

I’ve never bounced a check.

My clothes have been soaked with every kind of bodily fluid most of which was not my own.

I’ve been published over 100 times in magazines and novels and not one word was about speech language pathology.

I presented BDAE results to Harold Goodglass.

My joke made Edith Kaplan laugh.

I’ve been hit by lightning…, twice.

Northeastern University put a plaque up with my name for the 2005 Preceptor of the year but I’ve never been able to find the sign.

I was always a pretty good aunt but my niece made me a great aunt in 2002.

Jeri Logemann poured me an orange juice once.

I got kicked out of the Smithsonian and I almost was asked to leave Graceland.

I shook hands with Reverend Jesse Jackson next to the ice rink in Rockefeller Center.

While I have lost track of the exact number of clients I treated in 25 years, 7 months, and 2 days of practice a conservative estimate would be just over 13,000.

Nancy Helms Estabrooks bought me coffee once.

My grad student supervisor taught me lessons in 1987 that I’m still using today. And, she’s still my best resource for navigating the wonderful world of Speech Language Pathology.

I know how to Twitter and know what a # is and I’m not afraid to use it.

I stopped watching TV in 2009 and haven’t missed a thing.

Since I turned 24 years old, I’ve been solely responsible for my ownself.

I’ve stood at the edge of the Atlantic during a hurricane taking a video with my cellphone so I could show my friend in Singapore what a hurricane really was like.

I’ve walked 4 5k’s.

I jumped into the Atlantic on February 23 2013 at Nantasket Beach in Hull MA to raise money for Special Olympics. It was more than a little chilly.

I have done everything that ASHA has asked and more to maintain my CCC for a quarter of a century.

but, in all that I’ve done and all the roads I’ve traveled and all the conversations I’ve had, I’ve never felt so self important as to assume another SLP needed my approval to carry out their practice. …

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Join the Fun – A Guest Post by Lori Yauch MA CCCSLP

Join the Fun – A Guest Post by Lori Yauch MA CCCSLP

Join the Fun!


This month the Road to Reminiscence takes another detour, this time to Illinois for The American Speech-Language Hearing Association (ASHA) Annual Convention.

We packed are our bags, boxes and Guidebooks to the Classic Movie Musical and heading to Chicago. November 13th – 16th.

Come visit us at McCormick Place for 3 days of fun and information as we share Booth #2210 with our friends from Clinical Colleagues Confidential.

The Movies and Music Guidebook will teach you how to utilize 12 classic movie musicals to promote communication and engagement in your clients.

Turn watching a movie into a great interactive event that will have your clients engaged, laughing, talking, reminiscing and dancing in their seats. Foster increased communication, conversation and long-term memory.

If you’re thinking…I haven’t the time to prep such an activity! Movies and Music has prepared all 12 activities for you! Just gather your residents in front of the DVD player, pop in the DVD, grab your guide and go! Nothing is simpler or more fun!

“This is one of the simplest and most entertaining activities I have ever done. I highly recommend it to clinicians working with adults/geriatrics, regardless of the setting. You will not be disappointed”.
Lisa C, M.S., CCC-SLP, New Bedford, MA

At MassCap in October, an activity specialist was heard to say, “I don’t show movies to my residents because they fall asleep”. After visiting Movies and Music and discovering that movies could be source of engagement and that the Guidebook could provide an entire year of programming for 3 dollars/ month she became a convert!

Become a Convert! Visit Booth 2210 and join the fun!

— Lori

PS: While you’re visiting like us on facebook ( and follow us on twitter @MoviesandMusic2. You can register for a chance to win a Movies and Music promotional prize.…

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ASHA 13 has arrived in Chicago and unpacked the booth. We are Booth 2210 in the exhibit hall at #asha13. Come by and Talk To Us. You can also enter our super awesome drawing. We will draw names on Thursday, Friday and Saturday in honor of our 1,000 member!

How cool is that? Ice Cold Cool, I’ll tell you.

Lisa and I woke before the sun in Boston – 4 am. Doing the Logan Shuffle to get to our 8:10 boarding. The flight was ok except we went back in time resetting ourselves to Chicago time. Getting to McCormack Place was the single most complicated thing we ever had to do until we had to pass through four check points to get to the loading dock. Then the hard work began – set up. We are coming up on 7pm Boston time and we are almost sort of close to done.

I’m so tired I don’t care if my hotel room is a cardboard box in Indiana. Don’t worry, I’ll get a good night’s sleep and be ready to meet and greet Thursday Morning.

Everybody, please travel safe and enjoy #asha13…

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Summer was brought to you by the letter G

Summer was brought to you by the letter G

I shall always remember the summer of 2013 as the summer of G Codes. It has a cold weather counterpart in the winter of 1999 which was, of course, the winter of our discontent, the winter of PPS. I don’t remember what season we were in when KX modifiers hit, but that was a particularly stressful time as well.

Okay, I’m an adult with decades working in the healthcare game. I get the need for periodic changes to the rules for reimbursement. It should be a minimum expectation. As a speech language pathologist, I realize it is part of the job. As a tax payer, I welcome any changes which try to control costs. As an aging American, I hope the changes mean Medicare will be there when I’m done caring for others and need some caring for myself.

And, it is there, with thoughts about the future, where I hit my boiling point. Each new rule, each federal attempt to control costs, each smarty pants MBA or JD adding to the litany of oversight for Medicare reimbursement only seems to add to the spending. How many more manpower hours do you think were needed to “roll out G Codes” to every OP, SNF, Mobile Xray, and other MedB service providers?

Let’s use me as an example. I spent 1 hour in training for G Codes. Over the course of the next week, I spent about 2 hours actually trying to apply what I learned to my real life clients and then entering the data into our documentation system. After the first month’s billing, I spent another 2 hours trying to fix errors which were discovered during transmission. Not bad, 5 hours to figure out a new system and work the bugs out of the software.

I hope everybody working in SNF’s, PT/OT/SLP, only shed 5 hours of the direct care time to this new system. Let’s make up some numbers and see how much was spent for the roll out. Come on, it’ll be fun.
There are 123,200 SLP’s in the US as of 2010 according to the Bureau of Labor and Statistics. Only a small percentage of SLP’s work under MedB. The Bureau says about 9800 work in SNF’s or Home Health. So, we’ll use that number. They also said our mean earnings are $33.50 per hour. If each of us only lost 5 hours to the G Code roll out then the cost would be

That only accounts for the hours spent learning and not the hours of lost revenue because no treatments were provided.
For the 19,560 OT’s working in SNF, their mean hourly rate is $36.73 according to Bureau of Labor and Statistics 2010 information. The cost of their education would be

The Bureau of Labor and Statistics data from 2010 also notes there are 22,000 PT’s earning $38.39 (mean) per hour. Their education using my 5 hours as a yardstick cost

So, my grand total guess-ta-ment is $9,468,319 to education PT, OT, SLP about G Codes.

We should remember that Gnomes with good intentions and pointed hats did not emerge from our med rooms with the materials to decipher and translate the Medicare rules into English. No fairies arrived on moon beams down the elevator shaft to rework the software with sprinkles of stardust to include the G Codes into the programs. And, wanders gangs of elves did not slip in through the solarium room windows and race to rehab to teach the new rules.

All that work needed to get done by people; IT, administrators, billing departments, medical coders and middle managers. I can not even guess how many manpower hours went into that level of work. But, I think we can all agree that more than 5 hours were needed by more than 1 person at every service provider billing under Med B. It is probably safe to assume the cost at that level was at least equal to the cost to educate front line staff.

For the sake of the rest of my rant, today, I’m going to make a rough round figure guess that education for G Codes cost service providers a minimum of $20 million for the roll out. This figure does not include the losses incurred when direct line staff could not treat because they were being educated.

Where are these losses going to recouped?
How will G Codes lead to national savings or even cost controls?
What has any of this got to do with clients who need care?
When was the last time anybody in the federal government asked a direct service provided what is wrong with the system and if they have any ideas on how to fix it?

I’m beginning to despair that Medicare will even exist in 20 years when I need it. Actually, the way the rules are changing, I might be delayed in retiring until well after my 70th birthday.

Why are we all just going along with foolishness that is masquerading as Medicare policy? …

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