Marcia Kosstrin, OTR/L Occupational Therapist 43 Aquila Road Stamford, CT 06902

July 30, 2011 To whom it may concern, I, Marcia Kosstrin, OTR/L, am a licensed and registered Occupational Therapist with thirty years experience. I have had the pleasure to know Ms. Marjorie Partch for the past four years and her mother, Mrs. Dorothy Partch for the past fourteen months. During the time that I have known Mrs. Partch, she has been confined to Wilton Meadows Skilled Nursing and Rehabilitation Center. Recently, I have accompanied Marjorie to visit her mother on five visits during the month of July. At several visits, Marjorie raised concerns about her mother's care and politely requested that Wilton Meadows staff address these health issues. Each concern that Marjorie expressed demonstrated a very specific understanding of the health care needs associated with her mother's physical condition. For example, she noticed that her mother's skin was not adequately moisturized and Mrs. Partch has developed sores on her skin. She also noticed that the socks Mrs. Partch was dressed in were extremely tight and were causing swelling. Marjorie demonstrates a detailed understanding of many of the rehabilitation needs of her mother's medical condition as a stroke patient. For example, Mrs. Partch wears a splint (orthosis) on her left hand and forearm. The staff at Wilton Meadows had placed the splint incorrectly and Marjorie was able to correct the placement, thereby avoiding damage to Mrs. Partch's wrist. Marjorie was also able to work with her mother to help her improve her posture in the chair, thus improving her mother's ability to breathe. Each time I described a rehabilitation technique to Marjorie (such as a method to relax the hand before repositioning the orthosis) she was able to understand its significance and implement it in a competent way, thereby improving her mother's physical response to her environment. Marjorie consistently behaves in a loving way with Mrs. Partch, gently encouraging her to interact and perform simple functional tasks. This is not surprising, as Marjorie was Mrs. Partch's caregiver for seven years prior to her admission to Wilton Meadows. Throughout each visit, Marjorie remained very attentive to her mother's physical and emotional needs. Mrs. Partch has not received rehabilitation services during the past year, as her Medicare rehabilitation benefits ended in June 2010. Yet, there is consistent scientific literature which demonstrates that stroke patients can continue to improve their functional abilities with continued rehabilitation. It is clear to me that Marjorie Partch, as a loving daughter and family caregiver, would continue to provide her mother with multiple opportunities for improved health and well being, including more opportunities for supervised rehabilitative

practices such as gentle stretching/range of motion, weight bearing, correct use of adaptive devices such as a hand/wrist orthosis and functional activities such as assisted self care (feeding, grooming, dressing) and social interaction. The quality and quantity of the care that Marjorie can provide Mrs. Partch far exceeds the limited care that Mrs. Partch presently receives in the custodial care setting at Wilton Meadows.

Sincerely,

Marcia Kosstrin
Marcia Kosstrin, OTR/L Occupational Therapist