This article is sponsored by Evolutionary Healthcare. In this Voices interview, Skilled Nursing News sits down with Dr. Tamelia Lakraj-Edwards, Associate Medical Director at Evolutionary Healthcare, to discuss the growing role of Osteopathic Manipulative Treatment (OMT) in skilled nursing facilities (SNFs). As CMS places greater emphasis on non-pharmacologic pain management, many SNFs still rely on opioids due to limited physician availability. Dr. Lakraj-Edwards explains how OMT provides a hands-on, sustainable alternative that improves resident care, supports regulatory compliance, and aligns with the industry’s shift toward holistic, value-based treatment models.
Skilled Nursing News: What is your background, and how did it lead to your role today?
Dr. Tamelia Lakraj-Edwards: I’m an osteopathic neuromusculoskeletal medicine (ONMM) physician. I’ve always wanted to be a doctor. Growing up, I spent a lot of time in primary care practices with family members—especially my uncle in Michigan. I remember working with him, seeing patients and watching how he took his time with them. That really stuck with me, and I knew early on that I wanted to follow the same path.
I went through the steps to become a physician—school, training, everything that came with it. I earned my MD from Spartan Health Sciences in Saint Lucia and initially went into family medicine. But I quickly realized it wasn’t the right fit. Modern medicine has turned into this 15-minute-per-patient system, where doctors barely get to connect with their patients. That wasn’t what I had envisioned. My grandmother always told me I talked too much, so she thought geriatric medicine would be a good fit. She also used to say I had “healing hands” and would bless them, which always stuck with me. But in traditional family medicine, I wasn’t able to practice the kind of hands-on care I wanted.
I started working toward my Master of Public Health, thinking I could explore alternative approaches—especially with the opioid crisis in mind. That led me to a research project with Dr. Joel Stein in South Miami at a community hospital, where I was introduced to Osteopathic Medicine. We used a lot of hands-on techniques like osteopathic manipulative treatment (OMT) and injections—real alternatives beyond just prescribing pain medication. Dr. Stein, who was both family board-certified and pain-certified, showed me how to integrate these approaches. When he offered me a spot in his program, I knew it was exactly what I had been looking for.
While going through the program, I connected with Dr. Ballout, the owner of Evolutionary Healthcare. He gave me the opportunity to perform OMT in nursing homes, which turned out to be the perfect fit. I get to talk with my patients—just like my grandmother always said I would—and, more importantly, I get to take my time with them. I can use my hands, my medical knowledge, and therapeutic injections to truly treat patients. It’s been a great experience, and that’s my background.
What is osteopathic manipulative treatment or OMT, and how does it benefit residents in a skilled nursing setting, particularly those undergoing physical and occupational therapy?
OMT is a hands-on approach used by osteopathic physicians. In my case, I’m an MD with osteopathic training. We use our hands to diagnose, treat and prevent various conditions by manipulating the musculoskeletal system. A lot of people relate it to massage, but it’s more than that—it’s targeted manipulation. Unlike chiropractors, who focus primarily on spinal alignment, we address the entire body.
We use techniques like myofascial release, soft tissue mobilization, joint articulation, and craniosacral therapy. The goal is to relieve pain, improve mobility and enhance overall function. In skilled nursing and assisted living facilities, we see incredible benefits when working alongside physical therapy, occupational therapy, and restorative programs for long-term residents. OMT helps restore joint and soft tissue mobility, allowing residents to perform daily activities and participate in facility programs more easily.
Pain relief is one of the biggest advantages. We can also address restrictions, contractures, imbalances and lower extremity swelling, making movement more functional and comfortable. One area I’ve seen make a huge difference is lymphatic drainage. Many PT and OT teams don’t have the tools or time to focus on it, but we can facilitate that process. By improving circulation and lymphatic flow, we’ve seen shorter antibiotic treatment durations, faster wound healing and reduced post-surgical swelling.
Most importantly, by integrating OMT with PT, OT and restorative programs, we’re reducing dependence on medications. It’s an incredible non-pharmacologic approach to pain management and chronic conditions. And when you tie it into a value-based care model in SNFs, it fully supports rehab goals, promotes faster recovery and enhances overall quality of life. It’s just so cool—I could talk about it for hours.
CMS has placed a strong emphasis on non-pharmacologic pain management, yet so many SNFs rely on narcotics due to limited physician availability and MP-driven care models. How can OMT help facilities transition to a more sustainable hands-on approach to pain management?
Ultimately, with the non-pharmacologic pain management approach we’ve implemented through OMT, we can focus on spending time with patients. It takes me back to my early days in family medicine—sitting in the clinic with my uncle, shadowing him. You had the time to really sit and talk with families, get to know the patients and their loved ones, and you didn’t have to think twice every time they came into the office. OMT brings that back. I think CMS is trying to bring that back too with their new regulations.
When it comes to pain management compliance, OMT offers an effective, evidence-based, non-drug option that directly supports opioid reduction. It helps prevent hospital readmissions by addressing musculoskeletal dysfunction, and it’s fully aligned with value-based care models. We integrate with physical and occupational therapy to optimize function and outcomes.
So when CMS comes into the building and asks, “Are you spending time with your patients? Are you addressing their pain?”—and they ask the patients—those patients can confidently say yes. That benefits the facility in a big way.
It’s also incredibly cost-effective and shows true innovation in pain management. Facilities that have adopted our OMT program are really positioning themselves as leaders in holistic, CMS-aligned care. It boosts patient and family satisfaction too. I can’t tell you how many times I’ve walked into a facility and heard patients or family members say, “I don’t want narcotics,” or, “They cause constipation,” or, “When my mom takes pain meds, she gets really loopy,” or, “The last time they gave her something, it caused a fall.”
It’s clear that this approach not only aligns with CMS priorities—it’s what patients and families want.
Beyond pain management, OMT has been shown to help with conditions like lymphedema and constipation. Can you discuss how these treatments work and their benefits for SNF residents?
Through OMT, we work on the somatic viscera—specifically the abdominal fascia. The best way I can explain fascia is this: if you’ve ever peeled chicken and seen that white film between the skin and the muscle—that’s fascia. And it plays a huge role in what’s going on inside our bodies.
What we do is come in and work on that fascia to loosen it up, then go a bit deeper to help stimulate bowel movement. We also use different techniques to address the sympathetic and parasympathetic systems—the body’s fight-or-flight response—to help reset things and get everything working the way it should.
For respiratory issues, we focus on opening up lung space. Take someone who’s leaning forward on their walker—if a nurse says, “This patient has low oxygen,” my first question is, “Have you looked at their posture?”
We also think about how much time residents spend in wheelchairs, or lying down. Their bodies just aren’t in positions that promote optimal function. So whether it’s lymphatic drainage, improving circulation or relieving swelling, OMT can help restore balance. I’ve seen patients come off Foley catheters because we improved kidney blood flow by reducing swelling through lymphatic work.
Even things like vertigo can be addressed. Honestly, once you hit 30, arthritis starts creeping in, and if you’re older and sedentary most of the day, that stiffness only gets worse. With OMT, we can come in, get the body moving, and work alongside PT, OT, and restorative care to promote better daily function.
How receptive have SNFs been to adopting OMT, and what factors contribute to successful implementation? Can you share any success stories?
The first question any facility asks is, “What is OMT?”
ONMM was founded in 1874 by Dr. Still—but it’s still not as widely recognized as something like prescribing medications. You’ll see pain management doctors come in, write a script, and leave. It’s often not physician-led in a hands-on, ongoing way. That’s where OMT is different, and I think that’s part of why facilities are more receptive to it from the start. It’s physician-led.
We do work with nurse practitioners—not for the OMT itself, but to help manage pain alongside what we do. We also incorporate therapeutic-guided injections and collaborate with PT and OT. Can we prescribe pain meds? Yes. Do we? Sometimes. But we always try to start with a more conservative, non-pharmacologic approach. And once we explain that to facilities, they’re usually very open to it.
Then, once we start and they see the results, it really makes an impression. In one building I’ve been working in for about a year, we were able to reduce narcotic use by 86%, falls by almost 36%, and hospital readmissions by around 12%. Of course, the numbers can vary depending on things like skilled rehab admissions, holidays, and so on.
But over time, we saw hospital readmissions drop by as much as 40% with our OMT program. In another facility where we ran a six-month pilot, we saw fall reduction and lower readmission rates by 30% to 40%.
Of course, population plays a role—every facility is different depending on demographics, chronic conditions, and the type of patients they serve. But the numbers speak for themselves.
As the health care industry shifts toward holistic value-based care, how do you see OMT becoming a more standard part of SNF treatment plans?
I’m hoping that from both a primary care and pain management perspective, we can start to see OMT used as a standard part of care. Just like we have gold standards for screenings—mammograms, colonoscopies, and so on—I truly believe that if OMT were integrated in that same way, we could not only support a stronger value-based care model, but also reduce costs and help maintain overall patient health.
I really believe it helps reduce polypharmacy, and that creates a ripple effect across all the key performance indicators facilities track—from fall rates to hospital readmissions to opioid use.
Finish this sentence: “In 2025, the skilled nursing industry will be shaped by…”
…ONMM.
Editor’s note: This interview has been edited for length and clarity.
Evolutionary Healthcare is dedicated to transforming pain management in skilled nursing facilities through innovative, non-pharmacologic approaches like Osteopathic Manipulative Treatment (OMT). Our experienced osteopathic physicians partner with SNFs to enhance resident outcomes, reduce opioid reliance, and improve CMS compliance. To learn more, visit Evolutionaryhc.org or contact us today.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].
