PT/YMCA PARTNERSHIPS Combined Sections Meeting PT/YMCA Partnerships WHO WE ARE OBJECTIVES DISCLOSURES HOW ARE WE DOING? HOW ARE WE DOING?

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1 2017 Combined Sections Meeting PT/YMCA PARTNERSHIPS Clinical-Community Models for Healthy Aging WHO WE ARE Lori Schrodt, PT, MS, PhD Western Carolina University Chair, Health Promotion & Wellness SIG of AGPT Maureen Pike, BSN, RN, MPH Technical Advisor, YMCA of the USA Diane Saccone, MT(ASCP) Director of Healthy Aging Initiatives, YMCA of Western North Carolina None DISCLOSURES OBJECTIVES Describe the goals, target population, content, and support for evidence-based programs for physical activity and fall prevention currently offered by the YMCA. Discuss how each evidence-based program is managed and delivered by the YMCA, including staff credentials and outcomes assessment. Apply the benefits of PT/YMCA partnerships to physical therapy practice. Develop an action plan for developing and sustaining a partnership with your regional YMCA to support incorporation of evidence-based programs into physical therapy practice. HOW ARE WE DOING? HOW ARE WE DOING? 150+ Minutes Aerobic Activity yrs 150+ Minutes Aerobic Activity 75+ yrs Aerobic & Resistance Training yrs Aerobic & Resistance Training 75+ yrs 43% 27% 16% 9% Yes No Yes No Ward et al Ward et al 2016 Yes No Yes No This information is property of the authors and should not be copied or 1

2 2017 Combined Sections Meeting Age-Adjusted Prevalence of Physical Inactivity Among Adults with and Without Arthritis, NHIS hours of progressive, challenging balance training reduces falls $31 billion Medicare 2015 costs for falls 1 in 3 older adults fall each year HEALTHY LIFESTYLE AND BEHAVIOR CHANGE HEALTHY LIFESTYLE AND BEHAVIOR CHANGE HEALTHY LIFESTYLE AND BEHAVIOR CHANGE Episodic Care PARTNERING FOR LONG-TERM MANAGEMENT Long-Term Management This information is property of the authors and should not be copied or 2

3 2017 Combined Sections Meeting WHY CONSIDER PARTNERING WITH YMCA? Motivators We want our clients to continue their progress post-pt We and they want effective programs We talk about bridging clinical-community connections but are we really doing it in an effective, costefficient way? Policy & financial drivers OPPORTUNITIES Bridge clinical-community connections Improve outcomes Better meet the needs and demands of older adults They want effective programs! Support and enhance our professional role in current and future healthcare models Alternative Care Organizations Patient-Centered Medical Homes Comprehensive Care for Joint Replacement Model COLLABORATIONS NOW Referrals to YMCA programs at discharge Physical activity Community mental health program (In Shape) Train the trainer...collaboration for individual exercises and unique client needs for equipment use Practice within the Y Outpatient Adult day program Cardiac rehab Independent classes & programs Collaborative programming (screenings, educational sessions) Most of the referrals appear to be from PT to YMCA programs Some discounted or free YMCA access for a period of time for rehab clients Or is it really episodic with a referral to a community program? Thought about follow up? EBPs with proven efficacy and cost effectiveness 1 and done EBPs need a continuum too The Y s can/do offer multiple programs and levels of programs TRULY A CONTINUUM? WHAT IS THE NEXT STEP FOR A BETTER CONTINUUM? Bidirectional referrals Best fit for selection of programs for clients Pre-hab to rehab...to community health Outreach Collaborative service of underserved areas Goal Meaning partnership to shared mission and improved outcomes! YMCA PROGRAMS This information is property of the authors and should not be copied or 3

4 2017 Combined Sections Meeting Simplified Tai Chi Program 12 weeks 2x/wk for 60 minutes Required home program (26 hrs) Total of 50 hours YMCA TAI CHI: MOVING FOR BETTER BALANCE 65 years or older with impaired balance and/or mobility 45 years or older with a chronic condition that negatively impacts balance and/or mobility Physical Activity Program CDC Recommended Program for Arthritis 3 / wk x 60 minutes; ongoing Stretching & flexibility Low impact aerobic Strength training Balance ENHANCE FITNESS Older adults of a range of physical abilities Fit-to-frail Outcomes Mood Physical mobility Strength Fear of Falling Structured Group Intervention 8 weeks 1/ wkx 2 hours Strategies to reduce fear of falling and increase activity levels MATTER OF BALANCE Older adults with concerns about falling Able to problem solve Outcomes Confidence Physical activity Plan for continued physical activity Lifestyle Modification Program 1 hr sessions meet 25 times Over 1 year Healthier eating Smaller portions, healthier options Increasing physical activity Build to 150+ min. moderate activity Losing weight YMCA DIABETES PREVENTION PROGRAM Adults with pre-diabetes Individual Outcomes Portion size Physical activity Self-esteem Energy Overall health Lifestyle Modification Program 1 hr sessions meet 25 times Over 1 year Healthier eating Smaller portions, healthier options Increasing physical activity Build to 150+ min. moderate activity Losing weight YMCA DIABETES PREVENTION PROGRAM Adults with pre-diabetes Population Outcomes New cases type 2 diabetes 58% in all participants 71% adults over 60 Individualized Exercise Program 2 / wk for 12 wks min sessions Aerobic & strength training Balance Flexibility Fitness & Quality of Life Pre-Post rg/# LIVESTRONG AT THE YMCA Cancer survivors Outcomes Improved fitness Improved quality of life Reduced fatigue g-at-the-ymca/ This information is property of the authors and should not be copied or 4

5 THE Y: SHARED MISSION, LOCAL AUTONOMY ADDING COMMUNITY TO THE CONTINUUM YMCA AND PHYSICAL THERAPY CONNECTIONS MAUREEN PIKE, RN MPH YMCA OF THE USA The nation s 2687 Ys serve more than 20 million people each year in 10,000 communities. Fifty-seven percent of U.S. households live within three miles of a Y YMCA of the USA Y-USA STRATEGIC PLAN - HEALTHY LIVING COMMUNITY INTEGRATED HEALTH Critical Social Issues Affecting Our Communities: High rates of chronic disease and obesity (child and adult) Needs associated with an aging population Health inequities among people of different backgrounds Our Shared Intent: To improve lifestyle health and health outcomes in the U.S., the Y will help lead the transformation of health and health care from a system largely focused on treatment of illnesses to a collaborative community approach that elevates well-being, prevention and health maintenance. Our Desired Outcomes: People achieve their personal health and well-being goals People reduce the common risk factors associated with chronic disease The healthy choice is the easy, accessible and affordable choice, especially in communities with the greatest health disparities Ys emphasize prevention for all people, whether they are healthy, at-risk or reclaiming their health Ys partner with the key stakeholders who influence health and well-being 3 IMPROVING THE NATION S HEALTH AND WELL-BEING 4 PRESENTATION TITLE HERE 2011 YMCA of the USA THE Y S PIPELINE OF EVIDENCE-BASED (RCT-PROVEN) PROGRAMS DISCOVERY Efficacy Validation YMCA s Diabetes Prevention Program DEVELOPMENT Translation Scaling Enhance Fitness (Arthritis Self-Management) LIVESTRONG at the YMCA (Cancer Survivorship) YMCA Moving For Better Balance (Falls Prevention) DISSEMINATION Dissemination PROGRAM OUTCOMES - EXAMPLES Enhance Fitness (internal Y evaluation): 71% improved or maintained their lower body strength 74% improved or maintained their upper body strength 50% improved or maintained their agility/balance 99% of participants would recommend the program to a friend YMCA s Moving For Better Balance (Taylor-Piliae et al 2012; Stevens 2010) Tai Chi-based classes can reduce falls by up to 55% and aid in rehabilitation from heart disease Blood Pressure Self-Monitoring (HTN) Healthy Weight and Your Child (Childhood Obesity) Brain Health Parkinson s Tobacco Cessation Building the pool of the 21 st century LIVESTRONG at the YMCA (Irwin et al, 2016): Physical activity minutes increased by min/week vs. decrease of 5/8 min/week in controls 6-min Walk Test improved by 28.9 meters more than controls, p=0.004 Quality of life scores improved by 1.6 units compared to 1.0 unit decrease in controls, p= PRESENTATION TITLE HERE 2011 YMCA of the USA This information is the property of the authors and should not be copied or otherwise used without express written permission of the authors and/or YMCA. 5

6 A NEW DAY IN CLINICAL-COMMUNITY LINKAGES Y-USA will assume functions of a Management Services Organization (MSO) -- providing administrative, business, and technology services to local Ys to enable them to receive third party payment. Local Ys Program delivery Track participant outcomes in technology system Raise funds to assist with sustainability in absence of 3 rd party payors. Current State Chronic Disease Prevention Program Team Train Ys to deliver DPP and other evidencebased programs Management and administration support Coordinate with existing TPA for technology support Provide reporting technical assistance to Ys for reporting to partners, CDC, etc. MSO Team MSO Vendor(s) New Additional Structure Healthy Living Department MSO Employs staffs for: Payor Engagement Contracting Account Management Marketing Provider engagement Technology support Compliance Reporting Finance Contracts with vendors for: Technology platform Billing / revenue cycle management EXAMPLE: ENHANCE FITNESS Who? What? When? Where? How? Licensed from Sound Generations, Inc., endorsed by CDC For older adults, particularly those with arthritis Group exercise program for up to 25 participants Evidence-based curriculum featuring cardiovascular, strength training, balance, & flexibility exercises Class can be modified for standing or seated participants Strong social component leads to high retention rates Three 60-minute sessions per week 16 week sessions, or ongoing Held at YMCA Wellness Centers or community sites such as senior centers and churches. Standardized Fitness Checks completed at baseline and every 4 months Program data collected in Online Data Entry System Facilitated by certified EnhanceFitness Instructors 7 Title here 2016 YMCA of the USA Build Buy 8 PRESENTATION TITLE HERE 2011 YMCA of the USA EXAMPLE: ENHANCE FITNESS CON T Current Y-USA support: National Y program license Launch Guide Instructor trainings Dedicated Technical Advisors Implementation funding Quality improvement initiatives Data management Marketing materials Bidirectional referrals Future Y-USA support: All of the above Payor contracting etc. through Y-USA MSO Electronic medical record/claims billing system (athenahealth) THE IMPORTANCE OF PT-YMCA PARTNERSHIPS Strategically engaging target populations through direct referrals to make optimal impact on community health Adding a long-term community-based phase to the continuum of care Reinforcing therapy goals and achieving outcomes especially in value-based payment environments Supporting each other in maximizing resources, facilities & expertise PT-REFER study by University of Washington 9 PRESENTATION TITLE HERE 2011 YMCA of the USA 10 PRESENTATION TITLE HERE 2011 YMCA of the USA THE Y SCOPE OF PRACTICE THE Y SCOPE OF PRACTICE CON T The Y is a complement to health care, not a replacement for it. Continuum of care Severe arthritis limits knee mobility Knee arthroplasty Course of physical therapy D/c to evidencebased D/c to physical selfcare program activity delivered by Y Staff trained and certified in evidence-based program models like Enhance Fitness, YMCA s Moving For Better Balance, etc. and skills like Motivational Interviewing Y programs are a day-to-day, long-term source of community support for disease self-management and behavior change Y programs are an affordable way for patients to maintain their therapy achievements over time Structured physical activity Outcomes tracking Socialization Connections to other programs, activities & services in the community 11 PRESENTATION TITLE HERE 2011 YMCA of the USA 12 PRESENTATION TITLE HERE 2011 YMCA of the USA This information is the property of the authors and should not be copied or otherwise used without express written permission of the authors and/or YMCA. 6

7 THE Y SCOPE OF PRACTICE CON T GETTING IN TOUCH WITH YOUR LOCAL Y Staff trained and certified in evidence-based program models like Enhance Fitness, YMCA s Moving For Better Balance, etc. and skills like Motivational Interviewing Y programs are a day-to-day, long-term source of community support for disease self-management and behavior change Y programs are an affordable way for patients to maintain their therapy achievements over time Structured physical activity Outcomes tracking Socialization Connections to other programs, activities & services in the community About 1/3 of all YMCA associations offer one or more of these evidence-based health programs Y-USA is happy to help new Ys get engaged with this work Reach out to your local YMCA (COO, Health & Wellness Director, VP of Healthy Living, etc.) to see if they offer such programs, or could start one in partnership with you: Search by zip code for your nearest Y at 13 PRESENTATION TITLE HERE 2011 YMCA of the USA 14 PRESENTATION TITLE HERE 2011 YMCA of the USA THANK YOU Maureen Pike, RN MPH YMCA OF THE USA ext 8897 maureen.pike@ymca.net This information is the property of the authors and should not be copied or otherwise used without express written permission of the authors and/or YMCA. 7

8 PHYSICAL INACTIVITY RANKINGS HEALTHY FOR LIFE HEALTHY AGING INITIATIVES AT THE YMCA OF WESTERN NORTH CAROLINA DIANE SACCONE BS, MT(ASCP) DIRECTOR, HEALTHY AGING INITIATIVES YMCA OF WESTERN NORTH CAROLINA 2014 Ranking not ranked 32 North Carolina Ranking Source: North Carolina Department of Health and Human Services Injury and Violence report 2 THE OPPORTUNITY Embrace a more holistic view of aging Solutions must incorporate physical and social aspects of health and well-being specific to the aging population. >2 million over the age of 65 diagnosed with depression and face social isolation 54,000 adults will turn 65 each year with a 72% growth in the older adult population expected between OUR IMPACT Y s uniquely poised to help improve the health of aging adults in their communities through clinical community partnerships. Meaningful relationships formed through the social support in Y programs work to reduce social isolation. Potential reduction in health care cost and improved quality of life for millions of Americans. 3 4 OUR IMPACT CON T Ensuring that the needs of our healthy aging population are met will help address issues of health equity, bridge gaps in the delivery of health care and reduce rates of chronic disease so that community dwellers will continue to be active, contributing members of our community. OUR APPROACH: YMCA OF WESTERN NORTH CAROLINA HEALTH: NUTRITION PROGRAMS PREVENTION: EVIDENCE BASED PROGRAMS /CLINICAL PARTNERSHIPS FITNESS: EVIDENCE BASED GROUP EXERCISE CLASSES/NICHE CLASSES FUN: HEALTHY AGING FIELD TRIPS 5 6 This information is the property of the authors and should not be copied or 8

9 PRINCIPLES Include enhanced facility access, improved information and communications, the presence of dedicated and inclusive staff and established mechanisms for aging-adult engagement. Principles underpin a healthy-aging-friendly YMCA and provide the foundation for implementing the action plan. YMCA of Western North Carolina Branch safety inspection through the lens of the older adult Aging 101 training to YMCA staff Dementia stigma staff training February 2017 Healthy Aging Newsletter to all members 55+ YMCA welcome packet for all new members Healthy for Life: Healthy Aging Initiatives 8 PROGRAMS YMCA of Western North Carolina Healthy Aging trips and intergenerational activities Niche classes to fit the needs of the older adult population Healthy Aging Day/Active Aging Week Older Americans Month/Falls Awareness Month Celebration Evidence Based population health and wellness programs Y connect clubs Nutrition support 9 EVIDENCE-BASED PROGRAMMING YMCA Tai Chi: Moving for Better Balance Prevention Program EnhanceFitness YMCA s Diabetes Prevention Program Taking Control of Type 2 Diabetes LiveSTRONG at the YMCA 10 Partnerships LOCAL PARTNERSHIPS 10 Council on Aging Buncombe County ACO PT referrals Osher Lifelong Learning Institute Memory Care Dementia Friendly WNC WNC Aging Consortium Committee University of North Carolina Asheville Land of Sky Regional Council Area Agency on Aging Healthy for Life: Healthy Aging Initiatives This information is the property of the authors and should not be copied or 9

10 Policy change and implementation, program expansion, research Norm Medical Professionals, Providers, Structure Policy Interpersonal, Social Network, Peers, Family Life Choices COMMUNITY 2017 APTA Combined Sections Meeting Policy Local: Aging Consortium Committee Buncombe County McDowell and Henderson County Falls Prevention Coalition Regional: Western North Carolina Falls Prevention Coalition Region B and C Area Agency on Aging State: NC Dept. of Health & Wellness Resource Center Alliance of North Carolina YMCA s National: YMCA of USA National Council on Aging International Council on Active Aging Administration for Community Living 14 Healthy for Life: Healthy Aging Initiatives 15 Healthy for Life: Healthy Aging Initiatives YMCA TAI CHI: MOVING FOR BETTER BALANCE YMCA s Tai Chi: Moving for Better Balance Concepts of Collaboration: A Community Health Initiative Diane Saccone, MT(ASCP) Director of Healthy Aging Initiative YMCA of Western North Carolina Background of Moving For Better Balance Limited mobility often leads to decreased independence. Many chronic conditions such as heart disease or diabetes may contribute to impaired balance and decreased mobility. Among older adults, falls are the leading cause of both fatal and nonfatal injuries that may result in limited mobility. In 2013, 2.5 million adults were treated in the ER with falls-related injuries and up to 30 percent of those who fall suffer injuries severe enough to affect their ability to live independently. These incidents resulted in $30 billion in direct medical costs in Moving For Better Balance works to improve balance, muscle strength, flexibility, and mobility to enhance overall physical health, which leads to better functioning in daily activities. Participation in the program may also result in better mental health, reduced stress, improved memory and cognition, and increased self-esteem. Results Total # of Participants Served: 232 Average Age: 73 % Class Retention: 87.5% Total # of Classes Started: 28 PUBLIC POLICY Area Agencies on Aging, Aging Service Providers, Aging Resource Services, Social Networks, Social Impact, Values, Medical YMCA PARTICIPANT Knowledge, Skills, Behaviors, Comorbidities, 16 Healthy for Life: Healthy Aging Initiatives Purpose Through the US Department of Health and Human Services Administration for Community Living, this funding opportunity ws designed to increase the number of older adults and adults with disabilities at risk for falls who participate in evidence-based community programs to reduce falls and falls risk while concurrently increasing the sustainability of these programs through innovative financing arrangements and in partnership with clinical ACO s. Goals Conclusion Goal 1:Show improvements in balance and increase healthy behaviors that will Seeking additional funding to meet the growing demand for prevent falls and falls-related accidents falls prevention programming will be needed until evidence-based programs such as YMCA Tai Chi: Moving Goal 2: Build partnerships with the health care sector and identify innovative For Better Balance is covered under Medicare and Medicaid. funding arrangements that can support YMCA Tai Chi: Moving For Better Balance For now, we have adjusted the price structure to sliding programs, while embedding the program into an integrated, sustainable, evidence scale to support program sustainability based prevention program network. 17 Healthy for Life: Healthy Aging Initiatives PPHF EVIDENCE BASED FALLS PREVENTION PROGRAMS GRANT 2 YEAR OUTCOME Sec Chair Stand Pre BA A AA 18 Healthy for Life: Healthy Aging Initiatives 11.8 Post Pre Post Association Avg: Pre: 8.7 Post: % increase in lower body strength 1.1 BA A AA 66.2% Decrease 307.1% Increase 62.7% Increase Chair Stand Rating Pre Chair Stand Rating Post PPHF EVIDENCE BASED FALLS PREVENTION PROGRAMS GRANT 2 YEAR OUTCOME Pre 3.6 Pre TUG Stand 19 Healthy for Life: Healthy Aging Initiatives 7.1 Post 9.8 Post 1 Leg Stand Left T.U.G. Association Avg: Pre: 12.0 Post: % increase in agility 1 Leg Stand Right 3.6 Pre 7.0 Post Association Avg: Pre: 3.6 Post: % increase Left leg Association Avg: Pre: 3.6 Post: % increase right leg This information is the property of the authors and should not be copied or 10

11 ENHANCE FITNESS BLUE RIDGE TERRACE APARTMENTS Change in Rikli-Jones Norms Chair Stand Arm Curl Up and Go Change # % # % # % Decline or 4 40% 0 0% 8 80% Maintain at lowest level Decline to Average 0 0% 1 1% 0 0% Improve or Maintain at Ave or above 6 60% 9 90% 2 20% Can t compare 0 0% % Includes 13 participants with follow-up between 11/1/ /23/ HEALTHY AGING INITIATIVES AT THE YMCA Where Health Meets Social THANK YOU HEALTHY AGING INITIATIVES AT THE YMCA OF WESTERN NORTH CAROLINA DIANE SACCONE BS, MT(ASCP) DIRECTOR, HEALTHY AGING INITIATIVES YMCA OF WESTERN NORTH CAROLINA February 18, Healthy for Life: Healthy Aging Initiatives This information is the property of the authors and should not be copied or 11