Synopsis of project

Occupational Therapists (OTs), whose services are reimbursable under Medicare Part B, will be trained to assess the needs and concerns of family caregivers, in addition to the cognitive and functional capabilities of the person with dementia. Occupational Therapists will develop strategies to improve the quality of life for both patient and caregiver. The program is based on the Environmental Skill Building Program developed by Dr. Laura Gitlin, Director of the Center for Applied Research on Aging and Health (CARAH) at Thomas Jefferson University (TJU). Dr. Gitlin will assist with implementation of the program.

Occupational Therapists with enhanced training in dementia care

Individuals with dementia receiving skilled OT services in their home

Diverse family caregivers of dementia patients who are living at home

Academic/technical assistance provided

Thomas Jefferson University’s CARAH staff will provide training to the Fox Rehabilitation OT staff on the Environmental Skill Building program, and will provide on-going consultation throughout the project.

Principal Investigator: Dr. Laura Gitlin

Investigator's Web Site

Site Director: Mimi Jacobs

Community Based Organization’s Website

Project Update - July 3, 2008

Fox Rehabilitation uses an "out-of-the-box" approach to delivering caregiver support services. Listen to an except from a presentation made by Fox Rehab CEO Tim Fox. This and other podcasts are available on the www.qualitycareconnections.org website, and are also available on iTunes.

Project Update - June 16, 2008

The J&J/RCI team met at Fox Rehabilitation in early June. Tim Fox and his staff gave a detailed introduction to Fox Rehabilitation’s Geriatric Therapy at Home program as well as an explanation of Occupational Therapy and introduction to Medicare. Tim explained how services provided by Fox are not bound by the same eligibility criteria that home health agencies and outpatient rehabilitation clinics are, and made the case that the services provided by Fox are more cost-effective. He explained that services provided to the caregiver under the grant are billed to an existing Medicare Part B code for the care recipient, so results have to be linked to an improvement in functioning/quality of life for the care recipient.

Tim explained that the translation from Dr. Gitlin's Environmental Skills Building Program (ESP) went smoothly at Fox because the organizational culture of Fox Rehab emphasizes an evidence-based approach. He added that there needs to be an infrastructure in place at an agency for effective translation to occur. At Fox, the OTs delivering the intervention believe strongly in the program and the evidence-based approach, therefore the training being offered to them “sticks”.

After giving us an introduction to CARAH (Center for Applied Research on Aging & Health) at Thomas Jefferson University, Dr. Laura Gitlin gave us a detailed description of the ESP intervention, explaining aspects of the translational process in detail.

We received a status report of the project from Tracey Vause-Earland. She and Laura developed the OT training specific to this project. The training includes recommended and required readings prior to training, on-site training presentations, participant role play of intervention components, and detailed post-training follow-up. As of this date, 15 OT’s have completed 16 hours of training and are providing in-home caregiver support services to 10 families. Laura and Tracey are currently working on identifying which aspects of the training can be conducted online. A Manual of Operations has been developed exclusively for this program, which includes all forms and materials necessary for implementation. In addition, OT’s are given program folders for each family participating in the program. These folders help track what services are offered and delivered for each caregiver.

Mimi Jacobs discussed plans for expansion in year 2 of the project, which include training 20 additional Fox therapists in 5 states to deliver the ESP program to 40-50 additional caregivers. Fox is in the process of developing an electronic system for input of treatment documentation. They will continue to collect information on Medicare Part B reimbursement for caregiver participation in the program. The ultimate goal of the program is to expand CMS’s (Centers for Medicare & Medicaid Services) reimbursement policies to include a billing CPT code that is specific for caregivers.

Meredith Hicks, one of the ESP interventionists, shared her personal reflections on the benefits of the program. She credited her confidence level in delivering the program to the outstanding training she received. She firmly believes that ESP is an advanced practice that should stand alone as a caregiver treatment.

Project Update - May 6, 2008

Occupational Therapists at Fox Rehabilitation recently underwent training at the Fox corporate office on the evidence-based Environmental Skill Building Program for caregivers of people with dementia. Dr. Laura Gitlin conducted the training along with Tracey Vause Earland, MS, OTR/L. Ms. Vause Earland is the Clinical Coordinator for CARAH at Thomas Jefferson University and has worked directly with Dr. Gitlin on the ESP intervention for over 10 years. See photos from the training session.

Project Update - April 1, 2008

Over the last several months of the grant period, The Fox Rehabilitation ESP (Environmental Skills Building Program) has focused on nine steps and activities:

1. We refined intervention protocols and practice guidelines, specifically protocols and documentation required for reimbursement. We also refined our treatment manual and fidelity measures.

2. We established a training certification criteria and training for our PT/OT staff, refining our existing internal educational program and OT staff level of knowledge to advance their understanding of dementia, identification of depression and suicide protocols.

3. We established internal and external referral and intake processes, and developed a marketing strategy.

4. We developed and pilot tested ESP forms, a caregiver satisfaction questionnaire, and developed and implemented tracking policies and procedures.

5. We completed development of a fidelity approach and monitoring is ongoing.

6. We conducted a pilot test of all mechanisms; training a core group of OTs/PTs, evaluating adequacy of treatment documentation for reimbursement, and evaluating acceptability of service to therapists and family caregivers.

7. We implemented the program in the South New Jersey region with 15 therapists and 30 families. Ongoing caregiver progress is being measured by level of goal attainment, satisfaction questionnaire and a “success stories” program.

8. We are monitoring treatment fidelity on an ongoing basis.

9. We are refining the program for sustainability based on lessons learned in year one.

In addition to these accomplishments, implementation of the program has resulted in important benefits for Fox, improving practice throughout the agency. These benefits include:

1. Enhanced understanding among Fox therapists of the importance of evidence-based programs.

2. Introduction of a systematic approach to identifying depression in clients

3. Establishment of agency-wide suicide and elder abuse protocols

4. Refinement of Fox’s existing training program in dementia

We’re looking forward to extending the reach and adoption of ESP to a wider Fox Rehabilitation territory.