Healthy Moves for Aging Well Enhancing Physical Activity for Frail Elders Changing Care Management P

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Healthy Moves for Aging WellEnhancing Physical
Activity for Frail EldersChanging Care
Management Practice
Jennifer Wieckowski, MSG Christy Nishita,
PhD June Simmons, LCSW, CEO Kate Wilber,
PhD Mira Trufasiu, MSG USC Andrus
Gerontology Partners in Care Foundation
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Funders Sponsors

• Originally funded by the John A. Hartford
  Foundation
• Currently funded by
• Archstone Foundation
• The California Endowment
• UniHealth Foundation
• Sponsored by the AoA Evidence-based Prevention
  Initiative
• Guided by the National Council on the Aging
• Evaluated by the USC Andrus Gerontology School

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Benefits of Physical Activity

• Reduces the Risk of Developing Chronic Diseases
• Aids in the management of active problems such as
  high blood pressure, diabetes, obesity and high
  cholesterol
• Improves the ability to function and stay
  independent in the face of active problems like
  lung disease or arthritis
• Reduces symptoms of depression and pain
• Improves balance and prevents falls

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Evidence-Based Study (Rikli Jones, 1999)SENIOR
FITNESS TEST

• Nationwide study conducted to establish normative
  physical performance scores for
  community-residing older adults
• Ages 60 to 94
• 7,183 participants
• 5,048 women 2,135 men
• 267 sites
• 21 states

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Implementation in Care Management Practice

• Care Managers as Change Agents
• Regular Interaction with Frail, Nursing Home
  Certifiable Older Adults
• Most effective vehicle for addressing physical
  activity issues, but lack training in setting
  client goals, fostering behavior change, and
  improving physical activity

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Pilot ResultsModel Programs Project76 Client
Retention Rate

• 4 Care Management Sites
• Senior Care Network at Huntington Hospital
• Jewish Family Service
• AltaMed Health Services Corporation
• Partners in Care North
• Number of Clients 49
• Average Age 78 years
• Living Status
• 65.3 Living Alone
• 30.6 Living with Family
• 4.1 Living with Family Caregiver

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Healthy Moves PilotWHAT WE LEARNED

• The majority of clients were too frail to perform
  tests according to protocol.
• Care management staff was overwhelmed
• Gathering valuable input from care managers, site
  leaders, seniors, evaluation team and advisory
  team the program evolved intoHEALTHY MOVES FOR
  AGING WELL

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HOW DO THE MOVEMENTS APPLY TO MY LIFE?
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Client Goal Setting
Pouring a Drink From a Carton
Getting the Mail
Holding Grandchild
Your Goal
Doing Your Own Grocery Shopping
Lifting Toes to Avoid Tripping
Rising From a Chair or Toilet
Walking in the Home
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Behavior Change Education

• Brief Negotiation Curriculum
• Teaches skills needed to incorporate physical
  activity into clients daily routines
• Trusts the natural change potential in every
  client
• Client self-assessment of readiness for change

• How ready are you to consider increasing your
  physical activity?

0 1 2 3 4 5 6 7 8
9 10
Not Ready Thinking About It
Ready
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Exercise Coaches Monitor Progress

• Community volunteers student interns

Are you doing your new movements? Which ones? How
many times a week? For how long each time? Which
movement is easiest/hardest? Are you experiencing
any discomfort? Have you had any falls? Rate the
enthusiasm of client from 0-10
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Protocol

• Care managers teach intervention
• Volunteer Coaches monitor progress and reinforce
  the change by phone
• Care managers follow-up with client at monthly
  phone calls and at a 3 month visit

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2nd Generation of Healthy Moves

• 4 MSSP Sites
• Jewish Family Service of Los Angeles- 700 clients
• Partners in Care South Central Site- 400 clients
• AltaMed Health Services Corporation- 603 clients
• Senior Care Network at Huntington Hospital- 440
  clients

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Three Research Questions

• Does intervention change care manager behavior?
• Focus Groups and Questionnaires
• Acceptance, Adoption, Satisfaction, Behavior and
  System Change
• Does intervention change client behavior?
• Readiness to exercise
• Client goal achievement
• Maintenance of exercises without a coach
• Does intervention improve clients health
  outcomes?
• Pre and post-test design
• Evaluating Pain, Depression, Falls, Fear of
  Falling, and Physical Functioning

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Preliminary FindingsClient Behavior Outcomes
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Preliminary Findings

• 264 participating clients (enrollment began
  6/2005)
• Average age 80 years old
• Languages English, Spanish, Russian, Chinese,
  Korean, Farsi
• Examples of Client Goals
• Rise from chair/toilet Walk outside to get ride
• Ambulate transfer better Improve general health
• Goal Achievement Score- 6.23 out of 10
• 75 Very Likely to Continue Exercises

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Number of Falls
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Pain Scale
0 1 2 3 4 5 6 7 8
9 10

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Depression / Anxiety
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Client Example96 year old

• "I know that I am stronger. I count myself as
  doing wonderful. I give myself praise because I'm
  doing a lot better. I'm not afraid of falling
  anymore because I am a lot stronger. -96 year
  old.
• Pain decreased from 9 to 1
• Fear of falling decreased
• Endurance to perform step-in-place improved
• 40 Seconds To 2 Minutes
• Achieved goal to walk outside
• How likely will you continue without a coach?
• Client said, "I won't be able to stop."

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Preliminary Findings The Care Manager Perspective
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Initial Concerns With Participation

• Additional Workload
• Extra Time Needed
• Staffs Level of Support for Program
• Client Safety

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Important Motivators

• Guest Speaker That Discussed Importance of
  Physical Activity
• Recognition of Potential Benefits to Clients
• Improving their Professional Capacity

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Satisfaction With Program

• Staff Very Satisfied With the Programs Benefits
  to the Client and Agency Itself
• Majority Believed that the Volunteer Coaches Were
  Very Important In Keeping Clients Motivated
• 60 Stated that the Addition of the Program to
  Their Current Caseload Was Manageable, the
  Remainder Believed It Was Difficult

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Sustainability of the Program

• Continued Concerns Because of Heavy Caseload and
  the Extra Time Needed to Introduce Program
• 80 of Care Managers Agreed With the Following
  Statements
• Providing safe exercises to frail elders should
  be a part of a MSSP care managers' scope of
  practice
• The use of MSSP care managers is an effective
  approach to encouraging physical activity among
  MSSP clients.

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Care Manager Recommendations

• I feel the Healthy Moves program is very
  effective how it is set up. Clients have said
  nothing but positive things about the program.
• They seem to want more sophisticated exercises.
• A greater variety of exercises should be
  provided to accommodate clients with different
  levels of physical fitness.

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Challenges in Delivery System Change

• Liability Concerns
• Workload
• Reinforcement of staff training
• Social Worker Bias
• CM scope of practice
• CM resistance to change

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Lessons Learned Changing Care Management Practice

• Changing practice standards shifting staff
  responsibilities almost always elicits a learning
  curve.
• Intervention must fit practice environment-
  simple succinct
• Changing behavior requires supervisory buy-in
• Agencies must be ready to adopt a new
  innovationstaff shortages complicate demands on
  staff

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Lessons Learned Contd

• Joint planning with staff supervisors
  identifies valuable methods to create change
  (i.e. focus groups, questionnaires)
• Intervention must be marketed in terms of value
  to staff
• Client testimonials generate enthusiasm for
  adoption
• Volunteer recruitment requires new partners
  innovations

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Contact Information

• Jennifer Wieckowski, MSG
• Project Manager
• Partners in Care Foundation
• 732 Mott Street, Suite 150
• San Fernando, CA 91340
• 818-837-3775, ext. 115
• jwieckowski_at_picf.org
• www.picf.org

• Christy Nishita, PhD
• Post-Doctoral Research Associate
• University of Southern California
• Andrus Gerontology Center
• Los Angeles, CA 90089-0191
• cnishita_at_usc.edu