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HomeMy WebLinkAboutAgenda - 01-24-2006-5lORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: January 24, 2006 Action Agenda Item No. 5- 1 SUBJECT: Preventive Home Visit Research Project for the Elderly with UNC Occupational Science Division DEPARTMENT: Aging PUBLIC HEARING: (Y/N) No ATTACHMENT(S): INFORMATION CONTACT: (1)Preventive Home Visit Project Jerry Passmore, ext. 2009 Description Summary Kate Barrett, 968-2085 (2) Letter of Participation TELEPHONE NUMBERS: Hillsborough 732-8181 PURPOSE: To seek approval for the DOA's Eldercare Services to participate in a preventive home visit research project to be submitted for NIH funding by UNC Occupational Science Division. BACKGROUND: For five years, the Department on Aging's Eldercare Services Division has employed a full time occupational therapist, Vibeke Talley, OTR/L, who is part of the division's inter-disciplinary team that works with older adults and their families in providing home and community services. The Department on Aging is the only county aging program in the state that employs an occupational therapist who focuses on home safety, fall prevention, and home modifications to help older adults age in place. For several years, the UNC Occupational Science Division has place students with Vibeke Talley as part of their required field placement to graduate. In 2005 Vibeke Talley responded to 48 older citizen requests and referrals for home assessments. Vibeke Talley is recognized nationally and by the UNC Occupational Science Division as a leader in the emerging field of community occupational therapy, She has been selected to serve on the National Occupational Therapy Association's Commission on Practice for a three year term. The North Carolina Occupational Therapy Association gave her the "Award of Outstanding Practice in Gerontology" in 2001. Carol Woods Retirement Community, interested in this preventive approach, paid Vibeke Talley's expenses in November, 2004 to fly to Denmark (her native country) with UNC faculty for a 7-day fact finding trip. The purpose of the trip was to collaborate with the faculty at the Danish Occupational Therapy Program and to experience first-hand the Danish social model that focuses on prevention. In return, DOA and UNC Occupational Science Division carried out a summer pilot program in 2005 at Carol Woods with occupational therapy students conducting home visits. 2 UNC Occupational Science Division is now applying for an NIH two year grant to investigative further if preventive home visits help seniors (age 75+) age in place safely, maintain function, maintain health (physical and mental), and improve their quality of life and reported life satisfaction. If funded, the Preventive Home Visit Project would begin in January 1, 2007 and end December 31, 2008. UNC Department of Occupational Science is requesting that the Department on Aging collaborate in the study by having Vibeke Talley, the Department's Occupational Therapist, carry out all the home visits for the project with students and be a part of the research team. The UNC Occupational Science Division would be responsible for the grant and would reimburse the Department on Aging for all expenses associated with her time (part time-average 15 hours per week over a two year period) and pay the county's indirect costs calculated by County Finance. The estimated cost to reimburse Orange County is $56,194 over a two year period. Part of Vibeke Talleys current duties, those of CAP care manager, would be assumed by and limited to a part time temporary employee. Based on positive research findings at the end of the study, the preventive home visit project could possibly be offered as a fundable service under the Older Americans Act, Medicaid or Medicare. The current number of Department on Aging's home assessments will not be reduced as a result of participation in this research project. FINANCIAL IMPACT: The estimated cost for the Department on Aging's participation under contract with the UNC Occupational Science Division would be $56,194 over a two year period which includes the county's indirect costs. No County funds would be required for this project. RECOMMENDATION(S): The Manager recommends that the Board approve the Department on Aging's Eldercare Services Division participation in the Preventive Home Visit Research Project if funded and authorize the Manager to sign a subcontract commitment letter of participation. Feasibility and Effects of Preventive Home Visits Project Summary A. SPECIFIC AIMS Aging in place is now recognized as a policy goal as well as an objective of most older adults. While medically driven interventions such as home health care assist older adults to age in place, these occur not as true preventive measures but as reactions to losses in function or health. The search for preventive methods to mitigate decline and an unwanted move from home and community is important. One such method, Preventive Home Visits (PHVs), has been utilized in parts of Europe for approximately two decades. The PHV model is based on infrequent but regular visits to an older adult's home by a trained practitioner (typically occupational therapist or nurse). The visit is designed to assess the older person's situation and provide information and advice to optimize function and well-being. Evidence about PHV efficacy is mixed but generally supportive, and there is a distinct need to create and examine a preventive non-medical intervention in the USA. A successfully developed and implemented approach could enhance quality of life for older adults and their families as well as save health care costs. Based on a well-grounded, theoretical framework, we aim to implement and evaluate such a PHV intervention model in Orange County, North Carolina to assess the feasibility and effects of home visits with older adults, We will use an experimental, repeated measures design in which approximately 120 older (75+ years) community-dwelling adults are randomly assigned to experimental and comparison groups. The experimental group will receive the PHV intervention four times across a 12 month period. The comparison group will receive a minimal intervention of two informational phone calls and printed materials about local services during the same period, An occupational therapist with the requisite training and experience in home-based evaluation and intervention will conduct the experimental intervention. We will administer a set of standardized scales to both groups immediately pre-intervention, and again at regular intervals that fall two months after each intervention. These outcome measures will cover the primary dimensions that we hypothesize PHVs will have a positive influence on: functional ability, participation in occupations (meaningful activities), self-efficacy, life satisfaction, self-reported health/well-being. Secondary outcomes include hospitalization and institutionalization.. We plan to augment the quantitative data with qualitative data collection and analysis to develop a better understanding about how the intervention worked and how it can be improved for a subsequent study. The specific aims of the proposed project include the following: 1. Determine if the PHV intervention used in the proposed project is feasible in an American context. By tracking time, effort, costs, adherence to recommendations, participant recruitment and retention rates, and participant feedback, we expect to be able to provide data that both supports the feasibility of the intervention and helps us improve it for a subsequent study. 2- Establish if the PHV intervention creates improved outcomes in functional ability (the level activity performance as measured by the Late Life Function and Disability Instrument). The following directional hypotheses are based on this aim: Hl: The intervention group will exhibit a significantly better (more positive or less negative) slope for functional ability scores across the study period than the comparison group. 3. Ascertain if the PHV intervention causes improved psychosocial outcomes that relate to well- being. The following directional hypotheses follow from this aim: HZ: The intervention group will show a significantly better slope for general self-efficacy scores across the study period than the comparison group. H3: The intervention group will show a significantly better slope for life satisfaction scores across the study period than the comparison group, H4: The intervention group will show a significantly better slope for participation scores (as measured by the Late Life Function and Disability Instrument) across the study period than the comparison group, 4. Estimate the effect of the intervention on health outcomes. The following directional hypotheses are to be addressed: H5: The intervention group will show a significantly better slope for self-reported health scores (total health score, physical component score, and mental component score as measured by the SF-12) across the study period than the comparison group. H5: The intervention group will have significantly fewer hospitalizations by the end of the study period than the comparison group, 1-17: The intervention group will have significantly fewer instances of referral to skilled nursing or assisted living facilities than the comparison group. B. Project Staffing Malcolm Cutchin, Ph, D„ Sue Coppola, MS, OTR/L, BCG and Carol Siebert MS, OTR/L) at the UNC Occupational Science Division and Vibeke Talley, OTR/L with the Orange County Department on Aging are proposing a pilot project in Orange County to assess the benefits of preventive home visits to the well elderly in the greater community. Dr. Cutchin will be the principal investigator, If funded the money will go to UNC-CH, They will pay the Department on Aging for the DoA expenses associated with participating in this project. C. Project Timeline - January 1, 2007 - December 31, 2008 A grant proposal to NIH will be prepared outlining the following. • Project will run over two years, • Preparation for the project will take 6 months. • Four home visits are planned for a 12-month period, • 60 people will be in the experimental group. • There will be two additional groups; one receiving telephone calls, and one with no service. • Analyzing the data will take 6 months, FEASIBILITY AND EFFECTS OF PREVENTIVE HOME VISITS PREVENTIVE HOME VISIT COMMITMENT RESPONSIBILITIES The Orange County Department on Aging is committed to participate in this research in the following ways: ¦ Supply the database of seniors for the recruitment process. Adults over the age of 70 will be recruited through our multiple senior centers and community programs. ¦ Conduct all the intervention home visits. 60 participants will be visited 4 times. Additional visits may be granted if the participant needs help following-through on recommendations. ¦ Complete the Preventive Horne Visit Instrument at each of the 4 intervention visits. ¦ Complete documentation of other related information. ¦ Collaborate in reviewing the data, preparing reports and papers, as well as making recommendations, ¦ Collaborate in refining the design and protocol for subsequent studies. ¦ Collaborate in designing community programs using information gained from this study. BUDGET DETAIL Year I Year 2 Total for both years Personnel $24,461 $20,988 $45,449 Mileage 2,025 750 2,775 Telephone 120 120 240 Laptop 1,800 0 1,800 Indirect Cost 2,965 2,965 5,930 Total $31,371 $24,823 $56,194 BARRYJACORE. CHAIR ORANGE COUNTY BOARD OF COMMISSIONERS MOSES SrEPHENH -TROPE, VICECHAIR POST OFFICE Box 8 181 MOEEE CAREY,Y, JR VALHRIEP. FOUEHEE 200 SOUTH CAMERON STREET ALICEM GORDON HILLSBOROUGH, NORTH CAROLINA 27278 January 24, 2006 Dr. Malcolm Cutchin Associate Professor Division of Occupational Science Department of Allied Health Sciences University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7120 77 5? larth cave ?`cQ Subject: Orange County, NC Commitment to Feasibility and Effects of Preventive Home Visits Project Reference: 1) Preventive Home Visit Commitment Responsibilities 2) Budget Detail Dear Dr. Cutchin: This letter provides the commitment of Orange County to enter into a subcontract providing support on the Feasibility and Effects of Preventive Home Visits Project. The commitment responsibilities and budget detail are provided as an enclosure to this letter. The estimated cost of this subcontract will not exceed $56,194. The appropriate programmatic and administrative personnel of each institution involved is this grant application will establish written inter-institutional agreements that will ensure compliance with all pertinent Federal regulations and policies in accordance with the: PHS Grant Policy Statement for Establishing and Operating Consortium Grants. If you have any questions, please contact Department on Aging Director Jerry Passmore at 919-245-2009.. Sincerely, Barry .Jacobs, Chair Board of County Commissioners Enclosure WWW.CO.ORANGE NC. US PROTECTING AND PRESERVING-PEOPLE, RESOURCES, QUALITY OF LIFE ORANGE COUNTY, NORTH CAROLINA - YOU COUNT! (919) 2452130 • FAX (919)644-0246 '