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ACCELERATE HEALTH CARE

ACCELERATE HEALTH CARE. Platform Presentations – Session B March 12, 2018. www.dhsa.org. www.de-ctr.org/community. Delaware’s Road Map for Engaging Adults with Intellectual and /or Developmental Disabilities (IDD) in Health Promotion. JoAnn Abbott, DNP

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ACCELERATE HEALTH CARE

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  1. ACCELERATE HEALTH CARE Platform Presentations – Session B March 12, 2018 www.dhsa.org www.de-ctr.org/community

  2. Delaware’s Road Map for Engaging Adults with Intellectual and /or Developmental Disabilities (IDD) in Health Promotion JoAnn Abbott, DNP Delaware Division of Developmental Disabilities Pilot Study Supported by U of Delaware, CDS, ARC and DDDS. No Disclosures. Exempt Study NO DISCLOSURES: Human Subjects EXEMPT * Source Abbott, J, 2016

  3. WHERE is DE on THE ROAD to HEALTH PROMOTION ? • Delawareans with IDD have higher rates of obesity, diabetes and heart disease. • Physical activity has many health benefits however, Delawareans with IDD report lower levels of exercise/ physical activity. • Delawareans with IDD face many barriers to being active including lack of supportive environments and appropriate learning tools that would encourage self-determination.

  4. Engagement with HealthMatters™ Staff Trainer-led Pilot CURRICULUM** STAFF TRAINING * Train-the-Trainer 12 weeks • Three webinar sessions on HealthMatters Curriculum • Two collaborative implementation planning meetings 1.5-3 hrs. 3 times per week over 12 wks. Pilot Community Supported by U of Delaware, CDS, ARC and DDDS

  5. Engaging with HealthMatters™ CURRICULUM HealthMatters is a Research-based, field tested Curriculum that engages people with IDD showing them how to: • develop clear exercise and nutrition goals • develop an exercise routine • improve health knowledge • promotes self-determination

  6. PROCESS EVALUATION: Engagement and Outcomes IMPLEMENTATION of HealthMatters™ (HM) Pilot “SETTING” or environment Staff surveys Assessment of organization “REACH” PARTICIPANTS, STAFF and PCP ENGAGEMENT “FIDELITY” Comparison of Pilot with HM Program “COSTS” SWOT (Strengths Weaknesses Opportunities Threats)

  7. REACH: PARTICIPATION & ENGAGEMENT High participation of the 10 adults with IDD • 8 of 10 completed all 12 weeks • participated in the exercise and nutrition curriculum High Primary Care Providers’ (PCPs) Participation 100% of PCPs provided written responses allowing for the participation in the exercise and nutrition curriculum Comments “ …it was fun…helped my pain” “ … made friends…feel better…”

  8. Assessing the“SETTING” of Pilot’s Implementation usingValidated survey tools of “CAPACITY” and “NEEDS” “CAPACITY”: agree/improve with 30 statements on Pro-Health Promotion Policies “NEEDS”: agree/improve with 7 statements on Pro-Health Promotion Needs

  9. Developing Support with Community Collaboration to Sustain Health Promotion Goals: An Opportunity

  10. COSTS of PILOT IMPLEMENTATION ~ $300/participant Cost estimate of providing the curriculum by previously trained staff in existing facilities would be ~$230/participant

  11. DIASTOLIC BP Diastolic Blood Pressure Mean (mmHg): 81 ----------------------------------------------- 77 80 mmHG PRE- and POST- PARTICIPATION

  12. DE is NOW ON THE HEALTH PROMOTION ROAD Strengths: Delaware's PILOT demonstrated that HealthMatters™ is an effective learning tool for People with Disabilities to self-determine exercise participation and healthy meal choices.

  13. DE is NOW ON THE HEALTH PROMOTION ROAD Strengths: High levels of engagement by participants, DDDS Staff Trainers and PCPs creates necessary supportive environments

  14. DE is NOW ON THE HEALTH PROMOTION ROAD Opportunity: Lowering BP and low costs/participant predicts that statewide adoption of HealthMatters would likely reduce yearly health care costs well more than the Program’s costs.

  15. We Thank you

  16. Questions Comments please

  17. The Looking Glass: Insight into Homeless Elders’ Barriers to Care Jim Ellison MD Diane Bohner MD Loretta Consiglio-Ward MSN Susan Howard-Smola JD MBA Elizabeth Brown MD MSPH Linda Brittingham, LCSW Carmela Longobardi, MSW Joel Harris, Director

  18. Presented by: None of the study investigators or personnel have conflicts of interest to disclose.

  19. Why Focus on homeless elders? http://c.ymcdn.com/sites/www.delawaregrantmakers.org/ resource/resmgr/Docs/Overview_of_Poverty_in_Delaw.pdf

  20. https://www.bing.com/images/search?view=detailV2&ccid=xY6pVPCh&id=ECF4D43728211CB2EA4700AF316BD4DF7E0E2120&thid=OIP.xY6pVPChml8j69OHwhwsbQHaFk&mediaurl=http%3a%2f%2fwww.senior-care-resources.com%2fwp-content%2fuploads%2f2013%2f03%2fHomeless-senior-e1364157621719.jpg&exph=338&expw=450&q=homeless+elderly+in+america&simid=608024009546075889&selectedIndex=0&ajaxhist=0https://www.bing.com/images/search?view=detailV2&ccid=xY6pVPCh&id=ECF4D43728211CB2EA4700AF316BD4DF7E0E2120&thid=OIP.xY6pVPChml8j69OHwhwsbQHaFk&mediaurl=http%3a%2f%2fwww.senior-care-resources.com%2fwp-content%2fuploads%2f2013%2f03%2fHomeless-senior-e1364157621719.jpg&exph=338&expw=450&q=homeless+elderly+in+america&simid=608024009546075889&selectedIndex=0&ajaxhist=0

  21. Increase in older population • Aging of chronically homeless individuals • Newly homeless elders – a common route • Becoming homeless: • Financial (limited safety net/income options, job loss) • Mental or cognitive health crises, including Substance Use • Relationship breakdown (e.g. widowhood) • Health problems and medical bankruptcy • Staying homeless: • High “housing cost burden” for fixed-income elders • Social Security benefits often fail to cover the cost of housing. • Nation-wide, at least nine seniors wait for every unit of affordable elderly housing. The waiting list is often 3 to 5 years. Pathways to Elder Homelessness http://c.ymcdn.com/sites/www.delawaregrantmakers.org/ resource/resmgr/Docs/Overview_of_Poverty_in_Delaw.pdf

  22. Aging Baby-Boomers: Driving the increase in homeless elders

  23. from the 2017 Annual Homeless assessment report to congress https://www.hudexchange.info/resources/documents/2017-AHAR-Part-1.pdf

  24. Poverty In US and Delaware: On the Rise http://c.ymcdn.com/sites/www.delawaregrantmakers.org/ resource/resmgr/Docs/Overview_of_Poverty_in_Delaw.pdf

  25. 85% have chronic medical condition (3.6x more than homeless<50) • Most common: Hypertension, Arthritis, Other musculoskeletal • 73% have mental health/cognitive disorders • 75% have Substance Use Disorders • Other Geriatric Syndromes (a San Francisco study) • Urinary incontinence 48% • Difficulty with ≥1 ADL 38.9% • Falls 33.7% • Cognitive impairment 25.8% • Vision impairment 45.1% • Hearing impairment also common Medical Problems in Homeless Elders Joyce & Limbos. Can Fam Phys 2009;55(11):110-1111 Gonyea et al. J Geront SW 2010;53:575-90; Brown et al. Gerontologist 2016;00;1-20.doi:10.1093/3gergnw011.

  26. Grim Prognosis for Homeless Elders: Follow Up Study 1. Data from O’Connell et al. Care Manag J. 2004;5(2):101-6.

  27. Medical: Emergency/Immediate assistance: 911 or ER of WH, St Francis Hospital, Christiana Care Need medical appointment without insurance: St. Clare Mobile Health Clinic Emergency Dental: Wilmington Hospital/Pierre Toussant Dental Clinic Prescriptions (non-narcotic): Friendship House Day Centers (once per year) Mental Health: Hotline 302-428-2118 Suicidal: Hotline 800-273-8255 Mental Health: Drop-in Center Delaware Psychiatric Center Wilmington Hospital Center for Comprehensive Behavioral Health Meadowwood Behavioral Health Center / Rockford Center LIMITED Local Health Care Resources for Homeless Elders:

  28. What is St. PatRICK’s Center?

  29. Sanctuary for people in need on Wilmington’s east side since 1971 Provide services in a welcoming, dignified, respectful, and caring environment St. Patrick’s Center107 East 14th Street, Wilmington, DE, 19801

  30. Food Programs • Transportation • Homeless Respite Services • Clothing Bank • Recreational and Educational Activities  • Individualized Services Services Offered

  31. A Health Needs Assessment for the homeless elders of st. Patrick’s Center: Study objectives Funded by a grant from the CCHS Physicians Professionalism Council

  32. Study design

  33. Preliminary Results

  34. Preliminary Results

  35. 1. Complete the planned 100 health assessments and evaluate findings. • 2. Disseminate results • Guide allocation of resources • Focus guest education efforts • Justify appeal for further support Future Directions

  36. Thank you! Questions?

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