Transcript Community Resources for Neurodegenerative Disorders

Where do we go from here?
Annual Neurosymposium
DeSales University, 2016
Dr. Julia Corsi, OTD, OTR/L, C-GCM
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
Occupation: The art of humanism meets the
science of function
Challenges of Healthcare in the
21st 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
Challenges of Healthcare in the
21st 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.

Challenges of Healthcare in the
21st Century

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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)
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
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
Healthcare and Acute Care:
Past and Future
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

It’s not always that easy…
What else can be done?
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

You CAN skill for cognitive impairments with OT
ALONE in order to obtain inpt rehab approval that
can evolve into LTCP
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
Area Agency on Aging
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Provides assistance to people age 60+
Services can include:
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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
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 County
 Northampton County
 Carbon County
 Berks County
 Monroe County
 Bucks County
610-782-3200
610-559-3270
800-441-1315
610-478-6500
570-420-3735
215-348-0510
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
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
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.)
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Adult Day Programs
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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
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
Seniors Helping Seniors
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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
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
Phillipsburg, NJ
St. Luke's North
Hillcrest
153 Brodhead
Professional Plaza
Road
Building 302
Bethlehem, PA
755 Memorial
18017
Parkway
484-526-7035
Phillipsburg, NJ
08865
908-859-6722
Personal Care Facility
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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
Assisted Living Facility
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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)
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
Skilling Nursing Facility
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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
Respite Care

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“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.
Palliative Care
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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
Hospice Care
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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
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
We play a large role…
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
Lifeline Medical Alert
Home Safe
Standard
Home Safe Alert
Go Safe
Response App
Maximum protection at
home and on the go
Convenience for
smartphone users
Anywhere with AT&T service
Anywhere with
smartphone
Help at the press of a
Features and
Maximum protection in
button in and around your
Benefits
and around your home
home
Where it
Works
In and around your home
What is
Included
 Pendant
 Pendant
 24/7 Access response  24/7 Access response
center
center
 Communicator Unit
 Communicator Unit
In and around home
•
Mobile Button Pendant
 24/7 Access response
center
 Communicator Unit
 Application
 24/7 Access
response
center
Automatic
detection of
falls
No
Yes
Yes
No
Location
Capabilities
Home Location on file
Home Location on file
6 locations
Phone’s GPS
$44.95/month
One time button purchase of
$149.00
$54.95/month
$13.95/month
Pricing
$29.95/month
Transportation Services
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LantaVan
 Shared ride transportation
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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: 610253-8333
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
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,
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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
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
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
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
PACE/PACENET
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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.com
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Extra Help/
Low Income Subsidy
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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

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Contact number: 1-800-772-1213
Website address: www.socialsecurity.gov/extrahelp
Prescription Assistance
Programs
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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
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.php
Mobility and Transfers

Beasy Board
Lift Chair
Transfer Board
Hoyer Lift
Transfer Disc
Sit to Stand
Stair Glide
Lifts and Ramps
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Ceiling lifts
Ceiling lifts
Vertical
Wheelchair Lift

Portable Car
Ramp
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
Bathing and Toileting
 Bath Lifts
Shower Chair
Drop arm Commode Toilet Tongs
Grab Bars
Raised Toilet Seat
Shower Mat
Toilet Aid

Dressing and Grooming
TED donner
Sock Aid
Dressing Stick
Button Hook
Toothpaste Holder Long handled Comb Reacher Elastic Shoelaces
Meals on Wheels

Sliding Scale payment based on income
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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
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

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:
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- 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/
Pet Care
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Critter Care Plus
In Home Pet Sitting
Services offered include:
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 Dog Walking
 Plant care
 Newspaper/Mail pick up

No Worries Pet Sitting
In Home Pet Sitting
Services offered include:
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Contact:
 Fountain Hill: 610-867-8780
 Allentown: 610-797-5150
 Easton: 610-253-9778

Dog Walking
Litter Box Care
Bathing
Nail Trimming
Overnight Sitting
Medication Administering
Injections
Pet Transportation
Contact:
 NJ 908-319-3324
 PA 484-725-4650
National Organizations
(Dementia)

Alzheimer’s Association (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.
Dementia Society of America
(http://www.dementiasociety.org/)
Dementia Caregiver Resources
(http://www.dcrinc.org/)
National Organizations (PD)

National Parkinson Foundation (www.parkinson.org)
 Find a cure and improve QOL

Parkinson’s Disease Foundation (www.pdf.org)
 Research based

American Parkinson’s Disease Association
(www.apdaparkinson.org)
 Public awareness, patient resources, and research

Davis Phinney Foundation (www.davisphinneyfoundation.org)
 Enable those with PD live well today

Michael J. Fox Foundation for Parkinson’s Research
(www.michaeljfox.org)
 Blog, understanding PD re: dx and s/s, social support

Northwest Parkinson’s Foundation (www.nwpf.org)
 Improve community health and QOL, bridge gap between dx and cure
through EBP at low cost

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.
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

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.
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
Special Thanks To…
Kris Levine
Stef Becker
Meghan Foley
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