Fox Rehabilitation: Geriatrics Therapy at Home
7 Carnegie Plaza, Suite 101
Cherry Hill, NJ 08003
Contact: Mimi Jacobs, PT, GCS, OCS
Executive Director, Fox GERI
E-mail: mimijacobs@foxgeri.org
Fox Rehabilitation Website
Intervention Implemented: Environmental Skill-Building Program (ESP)
Project Description: The primary goal of this collaborative pilot project was to successfully translate the Environmental Skill-Building Program (ESP) from a research environment to a reimbursable community practice setting. As translation of the intervention into practice was the end goal, small numbers of caregivers were served during the implementation process. Another goal was to ensure that a proven caregiver intervention accurately reached the intended population. Fox Rehabilitation felt a call to provide an evidence-based intervention in the home because of several factors:
• A large proportion of the elderly population live at home and need therapeutic services to improve function, safety, and quality of life
• The home is the primary care setting for over 5 million Americans diagnosed with Alzheimer’s disease and related dementias
• As more seniors try to stay in their own home, home health care remains a growing industry
• Occupational therapists, physical therapists, nurses and social workers routinely see individuals with dementia in their home but are not trained to provide evidence-based programs
• Most therapists are not equipped to enhance caregiver skills in managing dementia
• Supporting families must occur in every setting and service delivery system, including in-home services
ESP includes the following components:
• Assessment of need
o Functional decline (bathing, dressing)
o Behavioral challenges
o Home Safety
o Caregiver depression and emotional responses
o Activity engagement
• For each caregiver-identified targeted area:
o Education about dementia, environment, specific issues/conditions contributing to behaviors (e.g. UTI, dehydration)
o Problem solving to identify specific contributors
o Customized strategies:
- Communication
- Task and environmental simplification
- Activity engagement
• Taking care of self (finding time for self, healthy behaviors, stress reduction)
Dr. Laura Gitlin, Principal Investigator for the ESP and Director of the Jefferson Center for Applied Research on Aging & Health (CARAH), provided training and supervision to the project. Dr. Gitlin was also one of the original REACH investigators.
Target Population: The project was implemented to serve Alzheimer’s disease caregivers whose loved one was receiving OT/PT services in the home.
Setting: Fox therapists delivered the intervention in the homes of the caregivers.
Challenges:
• Medicare Part B limitations to ESP delivery
o Treatment prescription resides with “patient”, not caregiver
o Patient can only receive skilled OT services if deemed “medically necessary”
o Treatment delivery (duration of visit) must comply with Medicare Part B parameters
• Collaborative process was labor intensive
• Site readiness
• Requires a high level of clinical reasoning
CRITICAL FINDING
Fox Rehabilitation has been reimbursed for all submitted caregiver training sessions through Medicare Part B.
Translational Process:
Year 1 focused on refinement of the intervention for use in a community setting. Based on a collaborative team approach involving researchers and practitioners, 14 steps were identified for moving ESP from the randomized trial environment to its implementation in the practice setting. Critical to translation was the development of training, monitoring, coaching and documentation processes that balanced company structure and reimbursement requirements with fidelity to ESP.
In Year 2, all project-related materials were refined based on year 1 experience and feedback from the interventionists using them. Program reach was expanded and Fox Rehabilitation is currently in the process of training additional therapists in ESP and providing the intervention in multiple states. Program staff continue to collect information on Medicare Part B reimbursement for caregiver participation in ESP.
Project Outcomes:
Caregiver Outcomes:
• 41 caregivers received ESP services
• All caregivers surveyed believed they gained knowledge & skill from ESP sessions
o 31% somewhat beneficial
o 68% a great deal
• 90% did not believe the OT visits required too much work or effort
• 100% of caregivers would recommend ESP to other families in similar situations
Therapist Outcomes:
• 23 agency based occupational therapists received ESP training
• 16 of these continued using ESP in practice
• Therapists perceived ESP as effective and useful
• Fidelity was maintained and adoption by Fox therapists was successful
Community Based Organization: The mission of Fox Rehabilitation is to provide the highest quality rehabilitation to the geriatric community with compassion and respect, while promoting optimal function and meaningful lives. A for-profit company providing house calls, services provided are in-home occupational and physical therapy, as well as speech pathology services to older adults. As a Medicare Part B provider, a physician script for therapy is required and safety, functional decline, and functional training is required to be performed for the identified client. Fox Rehabilitation practices a new and unique method of delivery that allows the elderly to access medically necessary therapies on a consistent basis that produces functional results. It has a well-defined infrastructure to assure quality control, provide on-going continuing education to its therapists, and implement evidence-based programs.
Presentations:
Translating the ESP Program into a Home Care Practice: Outcomes and Lessons Learned
Real World Implementation I: Best Practices in Staffing, Training and Certification
Real World Implementation II: Best Practices in Establishing Organizational Supports
Journal Article:
Translation of a Dementia Caregiver Intervention for Delivery in Homecare as a Reimburseable Medicare Service: Outcomes and Lessons Learned
