GRANT APPLICATION COVER SHEET

Transcription

1 Wisconsin Rural Hospital Flexibility Program Rural Community Grant Program GRANT APPLICATION COVER SHEET Project Title: River Falls Community Falls Prevention Program Coalition Name: River Falls Community Falls Prevention Coalition Planning Grant or Implementation Grant _X (select one) Grant Amount Requested: _$14, Applicant Organization (entity with which the grant contract is to be executed) Legal Name River Falls Area Hospital Foundation Address 1629 E Division St River Falls, WI Phone (715) FAX (715) Administrator, Executive Director, or CEO 3. Contact Person for Application Name Heather Logelin Title Executive Director Phone 4. Person authorized to sign the grant contract Name Heather Logelin Title Executive Director Phone 5. Federal ID # of applicant organization: Name Heather Logelin Title Executive Director 6. List all active partners (those responsible for activities and/or contributing matching/in-kind contributions). Use an additional page if necessary this will not count against your page total: Primary Partners: River Falls Area Hospital, River Falls Medical Clinic, River Falls Area Ambulance Service Secondary Partners: Ellsworth Area Ambulance Service, Spring Valley Area Ambulance Service, St. Croix County Aging & Disability Resource Center, Pierce County Aging & Disability Resource Center Additional Partners: River Falls Housing Authority I certify that the information contained within this application is true and accurate to the best of my knowledge. I submit this application on behalf of the applicant organization. Signature Date July 22, 2010 Are you applying for the additional 5 points for an EMSrelated project? YES

2 Executive Summary In Wisconsin, falls are the leading cause of injury and deaths among older adults. Of those that fall, 20-30% suffer injuries that reduce mobility and independent living. Wisconsin ranks in the top 5 states in the United States in the number of deaths due to falls. The cost of falls that result in injuries that need hospitalization exceeds $237 million annually. The River Falls Community Falls Prevention Coalition is an affiliation of organizations committed to preventing the devastating impact of geriatric falls in our region through a comprehensive community falls prevention program. In a region like ours, where the senior population is growing at a rapid rate, the need for a community-based falls prevention program is clear. The opportunity before us is to work together as community partners to ensure that seniors in our region have the knowledge and resources to prevent falls, helping them to maintain their health and independence while decreasing health care costs. The coalition brings together community partners to expand successful hospital-based efforts to the broader community, and to do this work not only with individuals who had already been hospitalized or visited the emergency department as the result of a fall, but also with individuals who had experienced falls not requiring hospitalization or who were identified as being at a high risk for a fall. In particular, by partnering with local EMS providers, we will directly target those seniors who have already fallen, working together to prevent debilitating and costly subsequent falls. We have defined three objectives for our program: (1) to identify, evaluate and provide 1:1 preventive measures to high risk seniors; (2) to provide a classroom-style falls prevention program to the community at large; and (3) to increase community awareness of falls risks, prevention and resources. We appreciate the opportunity to apply for funding through the Rural Communities Grant Program, and sincerely thank you for your consideration of our request. Coalition Information The River Falls Community Falls Prevention Coalition is an affiliation of organizations committed to preventing geriatric falls in our region. The coalition was convened by River Falls Area Hospital (RFAH) in early 2009, as an outgrowth of a very successful hospitalbased program to prevent inpatient falls. The intention was to bring together community partners to expand these initial hospital-based efforts to help prevent falls beyond the walls of the hospital, and to do this work not only with individuals who had already been hospitalized or visited the emergency department as the result of a fall, but also with individuals who had experienced falls not requiring hospitalization or who were identified as being at a high risk for a fall. Proposal Narrative Page 1 of 8

3 The coalition established a goal to develop and implement a comprehensive community falls prevention program. After reviewing information on the multi-disciplinary geriatric falls prevention pilot program developed by Regions Hospital and the West Central Regional Trauma Advisory Council (WC-RTAC), the coalition decided to use this approach as the basis for a geriatric falls prevention program based at River Falls Area Hospital. The coalition met and continues to meet on a monthly basis, with significant work being completed between meetings by smaller groups of coalition members. Protocols and materials for the program were developed in late 2009 and early The program was rolled out to hospital inpatients in April of 2010 and expanded to include hospital outpatients (primarily emergency department patients) in July of Beginning in January of 2011, the program will be available to the community at large, including but not limited to individuals identified by EMS providers when responding to calls at community member s homes. In particular, the program will reach out to individuals who have fallen at home, receiving assistance from an EMS provider but not requiring transportation to the hospital for further medical care. While coalition members had conversations with a wide range of community groups and individuals, the primary participants in this project are RFAH, the River Falls Medical Clinic (RFMC), and the River Falls Area Ambulance Service (RFAAS). Following are the individuals from these three organizations who have regularly participated in coalition meetings: - Cyndi Bayer, RN, Nursing Supervisor, RFAH - Greg Miller, MD, RFMC - Holly Mitchell, Assistant Director, RFAAS - Karen Swenson, RN, Interim Emergency Department Manager, RFAH - Jan Hatling, RN, Care Manager, RFAH - Kent Kittleson, PT, Rehab & Wellness Manager, RFAH - Jen Loesch, RN, Quality Manager, RFAH - Kathy Hogberg, MSW, Social Worker, RFAH - Liz Black, RPh, RFAH - Shauna Knott, MA, Wellness Coordinator, RFAH - Deb Sanders, RD, RFMC As a complement to the coalition s efforts regarding the expansion of the 1:1 geriatric falls prevention program, the hospital s foundation director began to investigate the possibility of brining the state-endorsed Stepping On falls prevention program to western Wisconsin. She learned that there were no trained facilitators in the region, and worked with Anne Hvizdak, the statewide coordinator for evidence based prevention programs, and Nancy Abrahamson, the caregiver support coordinator with the St. Croix County Aging & Disability Resource Center (ADRC), to plan a train the trainer session in River Falls for early This training, supported with funding through the Greater Wisconsin Agency on Aging Resources and in-kind contributions from River Falls Area Hospital, prepared a total of six individuals four professionals, including three hospital employees, and two community members, including a hospital auxiliary member to facilitate the Stepping Proposal Narrative Page 2 of 8

4 On classes that will be offered in collaboration with the St. Croix County ADRC beginning in August of As mentioned above, active coalition members at this time include representatives of River Falls Area Hospital, the River Falls Medical Clinic, and the River Falls Area Ambulance Service. Moving forward, because of our plans to expand the program to the broader community, and to include both 1:1 and classroom style interventions, we have invited other local partners to officially sign the memorandum of understanding and join our coalition. Those who have expressed an interest in committing to the coalition are: - Ellsworth Area Ambulance Service (who have already signed on to the MOU) - Spring Valley Area Ambulance Service - Pierce County Aging & Disability Resource Center - St. Croix County Aging & Disability Resource Center We are also looking forward to working with our local housing authority, senior centers and churches, particularly on efforts to increase awareness of falls risks and prevention, and of available resources. Problem/Need Being Addressed Falls are a significant cause of injury in all ages of the U.S. population, but a particular burden in those ages 65 years and older. One third of people over the age of 65 years fall every year. Ten percent of these falls are serious enough to require hospitalization. Falls may also lead to premature death. Wisconsin has one of the highest rates of death from unintentional falls in the nation. In fact, the death rate due to unintentional falls in Wisconsin is twice the national average. In Wisconsin, falls are the leading cause of injury and deaths among older adults. Of those that fall, 20-30% suffer injuries that reduce mobility and independent living. Wisconsin ranks in the top 5 states in the United States in the number of deaths due to falls. The cost of falls that result in injuries that need hospitalization exceeds $237 million annually. The two paragraphs above succinctly summarize the need for falls prevention activities here in Wisconsin. Falls not only have a negative impact on the quality of life for older Americans, they are also extremely costly. Numerous studies have estimated the direct and indirect costs related to falls injuries for those 65 and older. A study published in Injury Prevention estimated that in 2000, direct costs alone exceeded $19 billion; this figure does not included indirect costs related to the long-term effects of these injuries. The Burden of Injury in Wisconsin (2006), which reported on the years , reflected the following statistics for Pierce and St. Croix Counties (the number in parentheses reflects adults 65 and older): Proposal Narrative Page 3 of 8

5 Pierce St. Croix Statistic Falls-related Deaths 184 (141) 429 (321) Falls-related Hospitalizations 1012 (204) 2679 (437) Falls-related ED Visits The good news is that significant falls prevention research has been done over the past decade. We now have a good understanding of falls risk factors and prevention. For instance, we know that: - the risk of falling increases with age and is greater for women than for men - two-thirds of those who experience a fall will fall again within six months - some medications increase likelihood of falling; alcohol use may also be a factor - decreased strength, flexibility and bone density contribute to falls and falls injuries - at least one-third of all geriatric falls involve environmental hazards in the home. By identifying and managing risk factors, falls prevention programs address a serious problem affecting seniors. By preventing falls, programs like this particularly multidisciplinary programs like the one we are proposing not only maintain seniors independence, they also decrease the cost of care to the broader community. In a region like ours, where the senior population is growing at a rapid rate, the need for a community-based falls prevention program is clear. While there is a general awareness and fear of falling, very little has been done to help educate the public about how to prevent falls. As one of the nurses who is leading the falls prevention coalition summarized, People are afraid of falling. They know what happens to people who fall. It s one of their biggest fears. The opportunity before us is to work together as community partners to ensure that seniors in our region have the knowledge and resources to prevent falls, connecting them with resources that will maintain their health and independence while decreasing health care costs. In particular, by partnering with local EMS providers, we will directly target those seniors who have already fallen, working together to prevent debilitating and costly subsequent falls. Work Plan The goal of this project is to reduce geriatric falls and fall-related injuries. The project will be led by the community falls prevention program coordinator in close consultation with the program s medical director, who provides medical oversight for the program. The role of the program coordinator is to convene and lead the multi-disciplinary falls prevention group, which meets monthly to provide oversight and direction for all components of the program; to coordinate care of patients enrolled in the 1:1 intervention program; to make regular follow-up calls to patients who have completed the 1:1 intervention program; and to coordinate staff and physician education regarding the falls prevention program. We have defined three objectives for our program: (1) to identify, evaluate and provide 1:1 preventive measures to high risk seniors; (2) to provide a classroom-style falls prevention program to the community at large; and (3) to increase community awareness of falls risks, prevention and resources. Proposal Narrative Page 4 of 8

6 OBJECTIVE #1: Identify, evaluate and provide 1:1 preventive measures to high risk seniors. The 1:1 intervention targets individuals 65 and older who have a history of falls and/or a score of 3 or more on the falls screening test. Eligible individuals will be identified in one of three ways, (1) during their inpatient stay at the hospital, (2) during or as a follow-up to an outpatient encounter at the hospital, most commonly a visit to the hospital s emergency department; and (3) during an EMS response to an individual s home. In the case of the latter, the EMS providers will do a brief evaluation when responding to a call and will provide information about the program; with the individual s consent, they will alert the program coordinator about the eligible participant so that she can follow up with them about the program. Once an individual is enrolled in the 1:1 intervention, the lead physician will order a comprehensive H&P and other tests and evaluations as appropriate. Most enrolled patients will receive the following clinical evaluations: - PT/OT: evaluate motor strength, coordination and stability; conduct cognitive evaluation to detect dementia; osteoporosis screening; vision screening; home safety evaluation; determination of adaptive equipment needs; recommend exercise program - Pharmacy: reviews all medications for side effects and interactions; consults with lead physician and primary care provider to determine appropriateness and necessity of prescribed drugs - Social Services: evaluates social and family situation; conducts chemical dependency evaluation; refers to other community resources as needed - Nutrition: reviews lab results, evaluates overall nutritional state, works with patient to develop a sound nutritional plan At the completion of all assessments, the program coordinator will summarize the results and recommendations for the patient s health care provider, who will ultimately manage the patient s care. The program coordinator will follow up with enrolled patients at one, three, six, nine and twelve month intervals. Through these follow-up conversations, she will (a) determine the extent to which the program participant has implemented the recommended behavioral changes; ( b) determine whether or not the program participant has experienced subsequent falls; and (c) offer continued support and recommendations. OBJECTIVE #2: Provide a classroom-style falls prevention program to the community at large. Stepping On is an evidence-based behavioral change program that helps seniors develop the knowledge and skills needed to prevent falls. Stepping On is appropriate for those who have fallen, are at risk for falling, or are merely fearful of falling. The classes are facilitated by a team of two trained leaders, one health professional and one volunteer peer leader, ideally someone with personal experience dealing with falls. Through seven weekly twohour sessions, participants learn about a wide range of topics, including (as presented in the promotional brochure): Proposal Narrative Page 5 of 8

7 - Simple and fun balance and strength training - The role vision plays in keeping your balance - How medication can contribute to falls - Ways to stay safe when out and about in your community - What to look for in safe footwear - How to check your home for safety The facilitators are supported by guest experts physical therapists, pharmacists, nutritionists, etc. most of whom are members of the falls prevention coalition. The format of the class makes it a very effective way to teach older adults. The classes are very interactive and the participants build trusting relationships with one another and with the facilitators. They finish the class confident in their ability to implement the skills learned in the class, ultimately preserving their independence and quality of life. In September of 2004, a review of the Stepping On program was published in the Journal of American Geriatrics Society, finding a 31% falls reduction among seniors who completed the program. During the first year of the program, we plan to offer Stepping On four times, twice in River Falls and twice in communities beyond River Falls, likely Ellsworth and Spring Valley. OBJECTIVE #3: Increase community awareness of falls risks, prevention and resources. Our final objective is to increase community awareness of falls risks, falls prevention and available resources. Towards that end, we will work with community partners to educate the community. The hospital s August newsletter, which will be sent to 40,000 households throughout the region, includes a cover story on falls prevention. In September, the hospital will host a falls prevention seminar, intended to introduce attendees to falls risks, prevention and resources, including the 1:1 and classroom-style interventions described in this proposal. This event will be promoted in the August newsletter, in area newspapers, through the Pierce and St. Croix County ADRCs, at local senior housing facilities, at local senior centers, and through local faith communities. Moving forward, we will be collaborating with the River Falls Housing Authority on brown bag presentations for residents of the city s senior living facilities, and plan to use a similar approach to reach out to senior living facilities, senior centers and faith communities throughout the region. In addition, we are working with the hospital s marketing manager to develop a brochure about the community falls prevention program; this brochure will be used in the hospital, by EMS providers, and throughout the community to help raise awareness about available resources. Evaluation Plan The ultimate measure of the program s efficacy will be a decrease in the number of fallsrelated deaths, injuries and emergency department visits in the two counties (Pierce and St. Croix) we serve. Because of the significant delay in the publication of those statistics, we will need to rely on other measures to assess the success of the program. The measures for our three objectives are as follows: Objective 1: Identify, evaluate and provide 1:1 falls prevention measures to high risk seniors. Proposal Narrative Page 6 of 8

8 Outcome Measures: (1) Percentage of program participants who have experienced subsequent falls; (2) Percentage of program participants who have implemented recommended behavioral changes. Objective 2: Provide a classroom-style falls prevention program to the community at large. Outcome Measure: Increased knowledge and implementation of behavioral changes to prevent falls. (Note that the delivery and evaluation of this program is strictly regulated by the Greater Wisconsin Agency on Aging Resources, which is working with local partners to roll the program out across the state. Pre- and post-tests assess improvements in both knowledge and behavioral functions.) Objective 3: Increase community awareness of falls risks, prevention and resources. Outcome Measure: Number of individuals who subsequently participate in either the 1:1 or classroom-based falls prevention interventions. In other words, we will be tracking participation in our 1:1 and classroom-style interventions, asking participants how they heard about the program. We will also be tracking telephone inquiries about the program, noting whether or not volume increases in response to promotional efforts (newspaper ads, church bulletins, etc.). Please refer to ATTACHMENT A for our detailed program and evaluation plan, which includes expected outcomes and measures for all goals, objectives and activities. Budget Narrative Please refer to ATTACHMENT B for the detailed $37,636 program budget. - Wages and benefits are the largest expense in the budget. These include expenses related to the program coordinator, who is budgeted at.2 FTE (8 hours/week); coalition members, who attend hourly coalition meetings; and the Stepping On program facilitators, including travel time to and from locations outside of River Falls. - Travel expenses will cover mileage reimbursement for facilitator traveling in their personal vehicles to locations outside of River Falls. - The budget includes $1,000 for adaptive equipment for uninsured or underinsured patients. The physical and occupational therapists involved with the coalition reported frequent incidents where seniors with insurance require new or different adaptive equipment and are denied coverage by Medicare because they have already exhausted their benefits. For instance, a senior may have already purchased a walker but may now need a different type of walker; if their coverage is limited to one walker, they are without resources to implement the strategies recommended by the therapists. With the help of this grant, we will be able to ensure that individuals in the program have access to the adaptive equipment they need to prevent falls. - The supply budget includes funding for educational materials for patients who enroll in the 1:1 intervention; for refreshments and giveaways at the falls prevention seminar; and for brochures to promote the falls prevention program. - Other costs include funds to help promote the program in area newspapers and in local newspapers. Proposal Narrative Page 7 of 8

9 Note that the program budget excludes expenses related to the clinical evaluations that those who enroll in the 1:1 intervention will receive. We decided to exclude these expenses for a few reasons: (1) the PT and OT evaluations are billable services and it is assumed that nearly all of the patients who enroll in the program will have insurance, so the hospital s expenses for those services should be offset with reimbursement; (2) while we don t currently bill for the other evaluations, the tracking and reporting of the time related to those services would be tedious, and so the hospital has opted to provide those services as an in-kind contribution to the program. We are requesting $14, 976 through the Rural Communities Grant Program; the remaining $22,660 will come from direct and in-kind contributions from the coalition partners, primarily River Falls Area Hospital, the River Falls Medical Clinic and the River Falls Area Ambulance Service. Regarding the sustainability of this program, we are confident that once we have this program up and running, the outcomes will be so positive that we will be able to secure both the continued support of our in-kind partners and annual support from other funding sources, whether through the hospital s own foundation or outside funders. In fact, assuming this program achieves the anticipated positive outcomes, we have already discussed the possibility of working with other hospitals and ambulance service providers in St. Croix County to expand this program throughout Pierce and St. Croix County; were we to go that direction, we would seek program replication funding from outside funders. At the present time, however, we are very appreciative for the opportunity to apply for implementation funding through the Rural Communities Grant Program, and sincerely thank you for your consideration of our request! Appendix 1. Letters of Support a. St. Croix County Aging & Disability Resource Center b. Pierce County Public Health Department c. River Falls Housing Authority 2. Short Bios of Key Project Staff 3. Memorandum of Understanding Proposal Narrative Page 8 of 8

10 ATTACHMENT A Program & Evaluation Plan Project Goal: Outcome measure: To reduce geriatric falls and fall-related injuries. Number of falls-related deaths, injuries and emergency department visits. Objective 1: Outcome measures: Activity 1.1 Continue to enroll eligible inpatients, providing evaluations, recommendations and follow-up as indicated. 1.2 Continue to enroll eligible Objective outpatients, 2: providing evaluations, recommendations and follow-up as Outcome measure: indicated 1.3 Provide training to hospital, clinic and ambulance personnel regarding falls prevention program and available resources. 1.4 Begin to enroll eligible individuals from the community at large, providing evaluations, recommendations and follow-up as indicated. Identify, evaluate and provide 1:1 falls prevention measures to high risk seniors. (1) Percentage of program participants who have experienced subsequent falls. (2) Percentage of program participants who have implemented recommended behavioral changes. Timeframe Responsible Person Measures and Anticipated Outcomes Ongoing Cyndy Bayer # of inpatients enrolled (target = 24) % of participants w/ subsequent falls (target = establish baseline) % of participants implementing behavioral changes (target = establish baseline) Ongoing Cyndy Bayer # of inpatients enrolled (target = 36) Provide a classroom-style falls prevention % of program participants to the w/ community subsequent at falls large. (target = establish baseline) Increased knowledge and implementation of behavioral changes to prevent falls. % of participants implementing behavioral changes (target = establish baseline) October 2010 Cyndy Bayer # of training sessions hosted (target = 4) # of information s distributed (target = 4) 01/01/11 Cyndy Bayer # of inpatients enrolled (target = 24) % of participants w/ subsequent falls (target = establish baseline) % of participants implementing behavioral changes (target = establish baseline) ATTACHMENT A

11 Activity Timeframe Responsible Person Measures and Anticipated Outcomes 2.1 Work with regional partners to develop plan for locations, timing, staffing and promotion of Stepping On program. August 2010 October 2010 Kent Kittleson Plan for the year, including locations, dates, times, staff and promotional plan, is developed and approved by coalition. 2.2 Promote Stepping On in local newspapers and through community partners, including senior living facilities, senior centers and area churches. August 2010 July 2011 Beth Nelson # of earned media placements (target = 16) # of print promotions supported through community partners (target = 16) 2.3 Provide four sessions of the Stepping On program, including two sessions in communities outside of River Falls. August 2010 July 2011 Kent Kittleson # of sessions offered (target = 4) # of participants (target = 40) Note that the delivery and evaluation of this program is strictly regulated by the Greater Wisconsin Agency on Aging Resources, which is working with local partners to roll the program out across the state. Pre- and post-tests assess improvements in both knowledge and behavioral functions. ATTACHMENT A

12 Objective 3: Outcome measure: Activity 2.1 Develop plan for logistics and promotion of falls prevention seminar. 2.2 Feature falls prevention program and available falls prevention resources in hospital newsletter 2.3 Host a falls prevention seminar at RFAH. 2.4 Promote falls prevention seminar in local newspapers and through community partners, including senior living facilities, senior centers and area churches. Increase community awareness of falls risks, prevention and resources. Number of individuals who subsequently participate in either the 1:1 or classroombased falls prevention interventions. Timeframe Responsible Person Measures and Anticipated Outcomes August 2010 Cyncd Bayer Plan developed and approved by coalition. August 2010 Beth Nelson # of households reached (target = 40,000) 09/20/10 Cyndy Bayer # of attendees (target = 40) August- September 2010 Beth Nelson # of ads placed (target = 3 X 2 weeks) # of print promotions supported through community partners (target = 8) ATTACHMENT A

13 ATTACHMENT B Program Budget BUDGET CATEGORY DESCRIPTION GRANT MATCHING/ TOTAL Wages REQUEST IN-KIND EXPENSE Project Coord (RN) $ 8,320 $ 8,320 $ 16,640 Rehab & Wellness Mgr $ - $ 480 $ 480 Care Mgr $ - $ 480 $ 480 ED Mgr $ - $ 480 $ 480 Quality Mgr $ - $ 480 $ 480 Social Worker $ - $ 360 $ 360 Pharmacist $ - $ 600 $ 600 Wellness Coord $ - $ 240 $ 240 Physician $ - $ 1,500 $ 1,500 Dietician $ - $ 360 $ 360 Ambulance Asst Dir $ - $ 300 $ 300 Stepping On Facilitator $ 1,470 $ 1,470 $ 2,940 Total Wages $ 9,790 $ 15,070 $ 24,860 Fringe Benefits Travel Total Fringe 28% of wages $ 2,741 $ 4,220 $ 6,961 Stepping On Facilitator 35 miles/class for 2 7-week sessions $ 245 $ - $ 245 Total Travel $ 245 $ - $ 245 Equipment Supplies Adaptive Equipment for uninsured or underinsured patients $ 1,000 $ - $ 1,000 Total Equipment $ 1,000 $ - $ 1,000 Educational Materials $ 5 cost per participant $ - $ 670 $ 670 Falls Prevention refreshments and giveaways $ 200 $ 200 Seminar $ - Promotional Materials design and printing of brochures (2000) $ - $ 1,000 $ 1,000 Total Supplies $ 200 $ 1,870 $ 1,670 Consultants/Contracts $ - $ - $ - Total Consult/Contracts $ - $ - $ - Other Costs Print Advertising Promotion in Local Newspapers $ 1,000 $ 500 $ 1,500 Print Advertising Promotion in Hospital Newsletter $ - $ 1,000 $ 1,000 Total Other Costs $ 1,000 $ 1,500 $ 2,500 TOTAL PROJECT BUDGET $ 14,976 $ 22,660 $ 37,636 ATTACHMENT B