2. Annual Neurosymposium DeSales University, 2016 Dr. Julia Corsi, OTD, OTR/L, C-GCM Where do we go from here?

3. Objectives  Gain a background understanding of the aging population and current healthcare challenges.  Identify community facilities that support and enable neurodegenerative disorders.  Define occupational therapy’s role in neurodegenerative disorders.  Distinguish the future of healthcare and its impact on individuals with neurodegenerative disorders

4. Occupation: The art of humanism meets the science of function

5. Challenges of Healthcare in the 21 st Century  Baby Boomers are aging and approaching retirement.  The Well Elderly Movement  Those aged 65 years and older will increase from 35 million in 2000, to nearly 71 million in 2030  Those aged 80 years and older will increase from 9.3 million in 2000, to 19.5 million in 2030 1 in 8 Americans in 2000 1 in 5 Americans in 2030

8. Challenges of Healthcare in the 21 st Century  Healthcare Reform is moving towards community sustained independence in the well elderly – aging in place.  Previous goal of health care – survival – is being replaced with the concern for how individuals will be able to live effectively and holistically.  The social cost of incapacitation is skyrocketing and the aging population will increase these costs exponentially.  It is imperative that society find new ways to enable its disabled members to live more competent and satisfying lives.

9. Challenges of Healthcare in the 21 st Century  In spite of expanding technology, the medical model is failing to impact functional capacity and quality of life.  The societal cost of incapacitation is skyrocketing and the aging population will increase these costs exponentially.  34 million Americans are providing care to older family members (15% or 5.1 million of these caregivers live one or more hours away)

10. The Acute Care Setting  Assess, diagnose and treat individuals with acute and chronic medical conditions  United States 2012 Statistics  36.5 million hospital stays  Average LOS: 4.5 days  Average Cost per stay: $10,400

11. Occupational Therapy Services in the Acute Care Setting  Perform Evaluations Assessing:  Previous Environment  Prior Level of Function  Use of adaptive equipment or durable medical equipment  Current Level of Function Self-Care (ADLS), IADLS, Functional Balance/Mobility, Upper Extremity ROM/Strength, Vision, Cognition Occupations

12.  Collaborate with the interdisciplinary team to coordinate a plan of care and formulate appropriate discharge plans.  Push for well elderly, aging in place, and dementia friendly environments for community based independent and safe living for geriatrics Healthcare and Acute Care: Past and Future

13. What else can be done? It’s not always that easy…

14. The Next Step: Discharge  What are the options?  Home with daily checks, weekly checks, 24 hr S  Home health care aides, family, private duty caregivers  Increasing supervised environment  Assisted living, personal care facility, Senior high rise, I living apartments with HHC services, MOW, companion agencies  Inpatient Rehab  Acute Rehab  Skilled Nursing Facility  Short term rehab  Long term care placement CAN ALONE  You CAN skill for cognitive impairments with OT ALONE in order to obtain inpt rehab approval that can evolve into LTCP

15. Objectives  Gain a background understanding of the aging population and current healthcare challenges.  Identify community facilities that support and enable neurodegenerative disorders.  Define occupational therapy’s role in neurodegenerative disorders.  Distinguish the future of healthcare and its impact on individuals with neurodegenerative disorders

16. Area Agency on Aging  Provides assistance to people age 60+  Services can include:  Information and referral  Benefits counseling  Senior centers  Home delivered meals  Level of care assessment  Protective services  Ombudsman advocacy for residents of long term living facilities  Family Caregiver Support Program (offers reimbursement for supplies needed to care for a person as well as one-time home modification)  Adult day care funding (supplemental funding)  Pennsylvania Department of Aging Waiver Program –for those people who are nursing facility eligible but wish to remain in their homes  OPTIONS Program- care management and personal care services

17. Area Agency on Aging (Cont’d)  Strict eligibility (need based and financial) requirements/cost-sharing can be associated with these programs  A representative from the Area Agency on Aging would need to determine a patient’s eligibility for each service:  Lehigh County610-782-3200  Northampton County610-559-3270  Carbon County800-441-1315  Berks County610-478-6500  Monroe County570-420-3735  Bucks County215-348-0510

18. Home Health Care  Services include: skilled nursing, home health aides, physical/occupational/speech therapy, and medical social work services  Require a physician order  Patient must be homebound in order to receive these services  Services are typically covered by insurance for at least a short duration  Extensions can be granted if patient’s condition warrants

19. Non-Medical Care/Private Duty Care  Services may include personal care, companionship, light housekeeping, meal preparation, transportation, medication reminders, laundry, etc.  Do not require a physician order  Not covered by health insurance  May be private pay  May be covered, at least in part, if patient has a long term care insurance plan  These are government funded program (Waiver Program/OPTION Program) that may be able to help  Strict need-based and financial criteria need to be met

20. Senior Centers  Non-residential facilities that offer a hot lunch (nominal donation requested), socialization, and activities to people age 60 and older  Centers are typically open Monday-Friday 10am-2pm  Patients need to be able to handle their own personal ADL care (toileting, feeing, grooming, dressing, bathing, ambulation, etc.)

21. Adult Day Programs  Non-residential facilities that specialize in providing activities for older adults with cognitive/physical disabilities in a safe, supervised setting  Typically open Monday-Friday 7am-5pm  Provide snacks, lunch, medication administration, socialization, therapeutic activities, respite services  Payment can be through private pay/long term care insurance policies  Area Agency on Aging may be able to provide supplemental funding if financial criteria are met

22. Adult Day Programs (Cont’d)  Day programs  Provide transportation to and from the day program  Evaluated quarterly by the director of nursing for a change in daily functioning  Restorative nursing program available  Some must arrange their own transportation, others offer arrangements and/or information on public transportation  Crafts  Pet therapy  Music therapy

23. Seniors Helping Seniors  A unique program where seniors provide services to other seniors in their community  2 – 3 hour weekly check-in  Services: companionship, light housekeeping, cooking, gardening, grooming/dressing, transportation, medication set up, Alzheimer’s and Dementia care, shopping, and overnight stays  Locations  Seniors Helping Seniors Lehigh Valley Phone: 610-253-3232  Seniors Helping Seniors Luzerne County Phone: 570-472-0200  Seniors Helping Seniors Western Montgomery and Upper Bucks County Phone: 610-334-4276

24. Outpatient Testing  St. Luke’s Center for Positive Aging:  Team of Geriatricians, Physicians, NP, SW  Physical exam  Psychological Testing  Diagnostic Testing  Care Coordination  Family Conference  Bethlehem  St. Luke's North 153 Brodhead Road Bethlehem, PA 18017 484-526-7035  Phillipsburg, NJ  Hillcrest Professional Plaza Building 302 755 Memorial Parkway Phillipsburg, NJ 08865 908-859-6722

25. Personal Care Facility  Residencies that provide shelter, meals, supervision and assistance with personal care tasks.  Typically for older adults or people with physical, behavioral, or cognitive disabilities who are unable to care for themselves but do not need nursing home or medical care  When a residents needs become too great, resident will be transitioned to a higher level of care (CANNOT provide medical care)  Communal spaces (i.e. bedroom, living room)  Some may accept SSI/Personal Care Home Boarding Supplement

26. Assisted Living Facility  Residencies that provide shelter, meals, supervision and assistance with personal care tasks  Created to bridge a gap between personal care homes and skill nursing facilities –offers various levels of care  Cost is between ½ and 2/3 cost of daily skilled nursing care  Residents are able to “age in place”- idea is not to have residents to be relocated to a higher level of care when their needs increase  Offers more independence with private bedrooms/bathrooms/kitchenettes  Out of pocket costs (long term care insurance may supplement cost, though not everyone has this type of insurance)

27. Specialized Memory Units  Designated facilities that have designated staff and personnel that are specialty trained in caring for individuals who are typically fairly mobile though require continuous 24 hour supervision and at times physical assistance for mostly cognitive decline  Typically are required to be at least an assist of one trained professional with or without an assistive device  Locked Dementia units  Geriatric Behavioral Health units  Memory care units  Assisted living facilities  Personal Care Facilities

28. Skilling Nursing Facility  The highest level of care outside of a hospital setting  Residents can receive the following care:  Skilled care- medical care or related services AND/OR rehabilitation- PT/OT/SLP needed post injury/illness/disability  Typically covered by an insurance for a short period of time following a 3 day qualifying stay in an acute care setting  Custodial- health related care and services (above the level of room and board) that are not available in the community regularly due to mental/physical condition  Typically paid via private pay or else patient would need to apply for Medicaid

29. Respite Care  “Short-term inpatient care provided to the individual only when necessary to relieve the family members or the person caring for the individual at home.”-Medicare  Situations that are considered necessary include:  Caregivers who may be suffering from physical or emotional exhaustion from taking care of a patient around the clock  Caregivers who would like to attend a family event such as a graduation, wedding, funeral, etc.  Caregivers who become ill and cannot take care of the patient.  Physicians can place an order for a patient to be placed into a Medicare-approved facility, such as a hospice inpatient unit, a bed in a hospital contracted by the hospice, or a nursing home.

30. Palliative Care  Palliative care is specialized medical care for people with serious illnesses  It focuses on providing patients with relief from the symptoms and stress of a serious illness  The goal is to improve quality of life for both the patient and the family  Provided by a specially trained team of physicians, nurses, and extenders who work together to provide additional comfort and support- often times pain management  Appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment

31. Hospice Care  Designed to provide supportive care to a person at the end of his/her life  Focus is on comfort and quality of life rather than curing the ailment  Services may include: skilled nursing, home health aide, medical social work, bereavement, counseling, spiritual coordinator, and music therapy  Services can be offered in a home, skilled nursing, or inpatient hospice facility  Services are typically covered by insurance

32. Objectives  Gain a background understanding of the aging population and current healthcare challenges.  Identify community facilities that support and enable neurodegenerative disorders.  Define occupational therapy’s role in neurodegenerative disorders.  Distinguish the future of healthcare and its impact on individuals with neurodegenerative disorders

33. We play a large role…

34. Lifeline Medical Alert  “One out of three older adults (those aged 65 or older) falls each year” (cdc.gov)  Lifeline offers a way for older individuals to SAFELY age in place  Website provides Ebooks, Ebrochures

35. Lifeline Medical Alert Home Safe Standard Home Safe AlertGo SafeResponse App Features and Benefits Help at the press of a button in and around your home Maximum protection in and around your home Maximum protection at home and on the go Convenience for smartphone users Where it Works In and around your homeIn and around homeAnywhere with AT&T service Anywhere with smartphone What is Included  Pendant  24/7 Access response center  Communicator Unit  Pendant  24/7 Access response center  Communicator Unit Mobile Button Pendant  24/7 Access response center  Communicator Unit  Application  24/7 Access response center Automatic detection of falls NoYes No Location Capabilities Home Location on file 6 locationsPhone’s GPS Pricing$29.95/month$44.95/month One time button purchase of $149.00 $54.95/month $13.95/month

36. Transportation Services  LantaVan  Shared ride transportation program that services Lehigh and Northampton counties  Door-to-door service  65+ pay 15% of fare  If have Medical Access card eligible for MA reimbursable services  Mon-Sat 5:30am-7pm and Sun 7am-7pm  For more information call: 610- 253-8333  Lanta Bus  Fixed route bus system throughout Lehigh/Northampton Counties  Angel Flight  Free air transportation for children and adults with medical conditions who need to get to treatment far from home  Must be medically stable and able to board an aircraft  For more information visit: http://www.angelflighteast.org or call 610-940-1717

37. Driving Evaluations  Certified Driver Rehabilitation Specialist and Assistive Technology Professionals will determine your ability to drive safely  Participants must be medically stable (having reached optimal physical and cognitive potential), be seizure-free for the past 6 months, and have state-required vision quality, MD order is required.  Services may include:  Clinical evaluation- evaluate physical functioning, ROM strength, coordination, sensation, reaction time, etc.  Behind the wheel- take you on the road with a training vehicle to evaluate your driving skills (must have a driver’s license/permit)  Van evaluation- assess for various types of adaptive devices and conversions that can help you drive with or without a wheelchair  Transportation evaluation- assess what is the proper type of vehicle to improve your independence  Training- work with you to practice your driving skills with or without adaptive devices  Education- provide information on procedures, licensing, and driving equipment

38. Driving Evaluations (Cont’d)  Reports of driving evaluations will be sent to you and your doctor/alternate referral source  You may also receive a written prescription of adaptive driving aides and a list of vendors/recommendations  Payment sources may include:  Your auto insurance company (if your disability was a result of an MVA)  Office of vocational rehabilitation  Worker’s compensation  Most commonly, self pay  Locations:  Good Shepherd, Allentown 1888-44-REHAB ($386)  Moss Rehab ($320, for senior 65+ $280)  Jenkintown/Doylestown PA 215-886-7706  Woodbury/Marlton in NJ  Rehoboth Beach/Wilmington in DE

39. Driving Assessments  AAA Senior Driving  Self Rating Tool: 15 questions self evaluation driving assessment to examine driving performance  Interactive Driving Evaluation: Online access, to Roadwise Review exercises in the privacy of your home to see if visual, mental and physical conditions affect your driving skills and driving abilities.  * FREE, CONFIDENTIAL self-evaluation based on both accuracy and speed of responses  Website: http://www.roadwiseonline.org/#GSMMSplash3  Professional Assessment: is organized into two categories:  1) Driving Skills Evaluation: in-car evaluation of your driving abilities  and a recommendation regarding any further specialized drivers' training  2) Clinical Driving Assessment: identify underlying medical causes of any  driving performance deficits and offer ways to address them  *Cost is approximately $100 to $200. Additional training sessions $75-150/hr  *Contact your local AAA office for more information

40. Medication Management  Approximately 30 percent of hospital admissions of older adults are drug related, with more than 11 percent attributed to medication noncompliance and 10–17% related to adverse drug reactions (ADRs) (Marek & Antle).  Pill Organizer Boxes- Weekly set up of medications  Several types of organizers (AM/PM, morning, noon, night, bedtime)  Talking Pill Boxes: visually impaired  Large print prescription bottles- visually impaired  Simply label pill boxes  Set alarms as reminder to take medications  Automatic Refill of Medications  In a study of elderly patients at 15 days post hospitalization, 27 percent had not filled their new prescriptions. Patients who participated in programs that provided pharmacy delivery and refill reminders had fewer adverse drug events and higher compliance than those who did not. (Marek & Antle). CVS Ready Fill - Create an account online or in store - Automatic Refill of medications - When medication runs out, CVS calls the doctor for a refill prescription **Offer medication delivery Walgreens Pharmacy - Automatic Refills - Free Shipping or Pick Up in the store

41. PACE/PACENET  Offers low-cost prescriptions to qualified residents  Must be 65+  Must be PA residents for at least 90 days prior to applying  Cannot be enrolled in the Medicaid prescription benefit  PACE  Income qualifications limited to $14,500 per year for individuals; $17,700 per year for couples (assets/resources not counted as income)  Costs of medications - $6 for generics; $9 for brand  PACENET  Income qualifications limited to $23,500 for individuals; $31,500 per year for couples (assets/resources not counted as income)  Costs of medications - $8 for generics; $15 for brand  Not all medications are covered. There is a formulary.  Can be enrolled in PACE/PACENET together with Medicare Part D.  Contact number: 1-800-225-7223  Website address: https://pacecares.magellanhealth.comhttps://pacecares.magellanhealth.com

42. Extra Help/ Low Income Subsidy  Medicare beneficiaries may be able to qualify for extra help with their Medicare prescription drug plan costs  Estimated to be worth $4000 per year  To qualify:  Must receive Medicare  Be a US resident  Have limited resources/income  Resources limited to those under $13,640 for individuals; $27,500 for couples. Includes bank accounts, stocks, bonds. Does not include house, car, life insurance.  Incomes limited to those under $17,655 per year for individuals; $23,895 per year for couples  Contact number: 1-800-772-1213  Website address: www.socialsecurity.gov/extrahelpwww.socialsecurity.gov/extrahelp

43. Prescription Assistance Programs  Some pharmaceutical companies offer assistance programs for the drugs they manufacture  Each company’s eligibility criteria varies  Typically must be a US resident  Typically have income guidelines  Some require proof of out-of-pocket cost  Some allow applicants to have Medicare Part D, while others do not allow applicants to have any prescription coverage  Not all medications have a patient assistance program, especially medications that are available as generics

44. Patient Access Network  Independent non-profit organization that provides assistance to under-insured patients for their out-of-pocket expenses for life saving medications.  Maximum award level is $16,500 per year  Eligibility criteria:  Patient must have Medicare insurance.  Medicare must cover the medication for which patient seeks assistance.  The medication must treat the disease directly.  Patient must reside and receive treatment in the United States.  Patient’s income must fall below 500% of the Federal Poverty Level  Subject to availability of funding  Currently only accepting renewals only  Contact number: 1-866-316-PANF  Website: https://www.panfoundation.org/index.phphttps://www.panfoundation.org/index.php

45. Mobility and Transfers  Beasy Board Transfer Board Transfer Disc Lift Chair Hoyer Lift Sit to Stand Stair Glide

46. Lifts and Ramps  Portable Car Ramp  Ceiling lifts  Vertical Wheelchair Lift  Ceiling lifts

47. Ramp Companies  Amramp  - Specializes in modular steel wheelchair ramps, stair lifts, vertical platform lifts, free-standing lifts, pool lifts, and portable showers  - Option to rent ramps  - Free on site consultation  - 48 hour set up  Contact: 1-888-715-7598  http://www.amramp.com  Northeast Accessibility  - Specializes in entrance ramps, stair lift and wheelchair lift installations, bathroom modifications, ceiling lifts, and electric scooters  -Portable ramps are ideal for thresholds or as vehicle ramps  - Also offer home safety evaluations  Contact: 570-253-7700  http://www.northeastaccessibility.com

48. Bathing and Toileting  Bath Lifts Shower Chair Grab Bars Shower Mat Drop arm Commode Toilet Tongs Raised Toilet Seat Toilet Aid

49. Dressing and Grooming  TED donner Sock Aid Dressing Stick Button Hook Toothpaste Holder Long handled Comb Reacher Elastic Shoelaces

50. Meals on Wheels  Sliding Scale payment based on income Meals Monday-Friday Weekend package available Grocery shopping service available Frozen Meals option No Age Limit! Do not have to be home bound! Varying diets available- including dysphagia levels  Contact: Lehigh County 610-398-2563 or 215-679-6949 Northampton County 610-691-103 Schuylkill County 570-668-6954 or 570-621-7201

51. Online Grocery Shopping  Weis Markets: Place order online at www.weismarkets.com Select from one of two store locations: Cedar Crest Blvd Allentown, PA Crawford Drive, Bethlehem, PA ○ Associates load groceries for carside pickup  Giant: Peapod- in store pickup or delivery  ShopRite: in store pickup or delivery  Walmart Grocery: Delivery to your door, Choice of delivery times

52. Silver Sneakers  1 out of 5 people 65 or older is eligible for a SilverSneakers membership as part of a Medicare Advantage or Medicare Supplement Health plan  Over 12,000 gyms nationwide  Membership Includes:  - Access to fitness equipment, pools and saunas  - Access to HealthwaysFIT.com to help you track your health progress  - Health education seminars and other events  45-60 minute classes focusing on ROM, flexibility, strengthening, coordination, agility and endurance  Home Exercise Programs available  FLEX program  Classes offered in community parks, recreation centers, and older adult living centers  line dance and Latin dance, indoor and outdoor boot camp, walking groups  Steel Fitness in Bethlehem, Bethlehem YMCA, Planet Fitness in Allentown, Hanover Township Community Center  BOOM program: advanced fitness program for the active adult  Fast pace, intense exercise programs  ** Currently NOT offered in Pennsylvania https://www.silversneakers.com/

53. Pet Care  Critter Care Plus  In Home Pet Sitting  Services offered include: Dog Walking Plant care Newspaper/Mail pick up  Contact: Fountain Hill: 610-867-8780 Allentown: 610-797-5150 Easton: 610-253-9778  No Worries Pet Sitting  In Home Pet Sitting  Services offered include: Dog Walking Litter Box Care Bathing Nail Trimming Overnight Sitting Medication Administering Injections Pet Transportation  Contact: NJ 908-319-3324 PA 484-725-4650

54. National Organizations (Dementia)  Alzheimer’s Association (www.alz.org)www.alz.org  Discusses all types of dementias including AD, vascular, LBD, mixed dementia, PD, frontotemporal dementia, Creutzfeldt-Jakob disease, NPH, Huntington’s, & Wernicke-Korsakoff Syndrome  Lewy Body Dementia [LBDA]. (2013). Lewy Body Dementia Association, Inc.: Learn About LBD. Retrieved September 5th, 2013, from http://www.lbda.org. http://www.lbda.org  Dementia Society of America (http://www.dementiasociety.org/)http://www.dementiasociety.org/  Dementia Caregiver Resources (http://www.dcrinc.org/)http://www.dcrinc.org/

55. National Organizations (PD)  National Parkinson Foundation (www.parkinson.org)www.parkinson.org  Find a cure and improve QOL  Parkinson’s Disease Foundation (www.pdf.org)www.pdf.org  Research based  American Parkinson’s Disease Association (www.apdaparkinson.org)www.apdaparkinson.org  Public awareness, patient resources, and research  Davis Phinney Foundation (www.davisphinneyfoundation.org)www.davisphinneyfoundation.org  Enable those with PD live well today  Michael J. Fox Foundation for Parkinson’s Research (www.michaeljfox.org)www.michaeljfox.org  Blog, understanding PD re: dx and s/s, social support  Northwest Parkinson’s Foundation (www.nwpf.org)www.nwpf.org  Improve community health and QOL, bridge gap between dx and cure through EBP at low cost

56.  St. Luke’s University Health Network is not representing any of the foundations/companies listed, nor is taking an responsibility for information that is provides on the websites or by the organization/individual.

57. Objectives  Gain a background understanding of the aging population and current healthcare challenges.  Identify community facilities that support and enable neurodegenerative disorders.  Define occupational therapy’s role in neurodegenerative disorders.  Distinguish the future of healthcare and its impact on individuals with neurodegenerative disorders

58.  The movement of healthcare is moving towards deinstitutionalization- aging in place and well elderly  Education and advocacy are key towards holistic, client centered, and safe comprehensive care for the overall safety and well-being for the patient  Identify and utilize community resources  Assess and address complex biopsychosocial issues in a wide variety of patient populations and settings.

59. Conclusion  Occupational therapists & healthcare clinicians can play a huge role in impacting safe and effective discharge planning recommendations in the geriatric population  Healthcare professionals are striving to embrace the well elderly movements and dementia friendly environments  Majority of deficits in the elderly are comprehensive and can include physical, cognitive, behavioral, psychosocial, and functional impairments  Occupational therapists are pivotal healthcare professionals for the provision of holistic and comprehensive resources as well as geriatric services for both patients and caregivers  Treatment methods include primary and secondary prevention strategies in addition to supplemental medicinal management  Geriatric management and promotion of the well elderly and aging in place come through proactive, preventative, and comprehensive means through medicinal, therapeutic, and educational management ***ALL PRESENTATION REFERENCES/RESOURCES AVAILABLE UPON REQUEST

61. 60 Kris Levine Special Thanks To… Meghan Foley Stef Becker