Transcript The picture of good health

The picture of good health:
Bringing focus to persons with disabilities
Amber Eisfeld &
Ashley Oolman
Program Directors
Legacy Endeavors, Inc.
Nancy Flinn
Director of Outcomes and Research
Courage Center
Objectives
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Participants will learn about the Courage Center’s and Legacy
Endeavors’ wellness programs.
Participants will learn about the outcomes that demonstrate the
value of accessible wellness programs for people with
disabilities.
Participants will evaluate current life situations using the
healthy lifestyle wheel.
Who is Legacy?
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Founded in 1999
 Adult
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Foster Care
Expanded in 2010
 Individualized
Supports and Services
 In-home
 Independent
Living Services
 Personal Supports
 Supported Employment
 Housing Coordination
Healthy Lifestyles Initiative
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Ramsey County
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Oregon Health & Science University
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Staff Training
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Individual Training
Ensuring Balance!
Healthy Lifestyles Wheel
How does the wheel apply to you?
Emotional Health
• Know what stresses you
• Express your feelings
• Be good to yourself
Emotional Health
How does the wheel apply to you?
Physical Health
• Get regular exercise
• Avoid addictions
• Get regular doctor
checkups
• Eat healthy foods
• Get enough sleep
Physical Health
How does the wheel apply to you?
Social Health
• Make lasting relationships
• Have friends to go out with
• Visit with family
Social Health
How does the wheel apply to you?
Meaningful Activities
• Do work you enjoy
• Get involved with hobbies
Health Through Meaningful Activities
How does the wheel apply to you?
Spirituality/
Living Your Values
• Know your values
• Live your values
• Be who you are
Spiritual Health/Living Your Values
Healthy Lifestyles Wheel
How does the wheel apply to you?
An Individual’s Perspective
An Individual’s Perspective
Is healthy lifestyle maintenance more
challenging for our individuals?
Because of
 Lack of education
 Need for proper assistance
 Lack of transportation
 Lack of money
The people we serve are more likely to
experience:
 Poor
health due to secondary conditions
 Medication side effects
 Early death
How do we evaluate the individuals in
relation to the wheel?
How will you apply these concepts?
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Take a moment to come up with one goal that you
would like to work towards within your organization.
Healthy Lifestyle’s Legacy
Questions?

Amber Eisfeld-Program Director
 [email protected]

Ashley Oolman- Program Director
 [email protected]
Courage Center
Courage Center is a Minnesota-based non-profit
rehabilitation, advocacy and resource center that
empowers people with disabilities to realize their full
potential in every aspect of life.
Recently merged with Allina Health, now known at
Courage Kenny Rehabilitation Institute.
Populations Served in Health,
Wellness and Fitness
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Spinal Cord Injury
Brain Injury
Stroke
Cerebral Palsy
Arthritis
Parkinson’s
ALS
MS
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Spina Bifida
Fibromyalgia
Autism
Chronic Pain
Post Polio
Muscular Dystrophy
Spinal Muscular
Atrophy
Fitness Engagement
Adults with disabilities should get at least 150
minutes a week of moderate-intensity, or 75
minutes a week of vigorous-intensity aerobic
activity.
(2008 Physical Activity Guidelines for Adults with Disabilities from the U.S.
Department of Health and Human Services)
But…
 56% of people with disabilities report engaging
in no physical activity
 22% engage in regular moderate exercise
 14% engage in regular vigorous exercise
(US Dept of Health, 2000)
Physical Activity Benefits
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Physical Activity has been shown to decrease:
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Secondary conditions
Chronic disease development
Symptom days
Health care utilization
Health care costs
Functional impairment
Depression
(Boslaugh, 2006; Warburton, 2006)
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A high BMI/waist circumference can lead to reduced
recovery from a disability.
(Walter, 2009)
Physical Activity Benefits
Physical Activity has been shown to
improve:
• Overall independence
• Functional abilities (mobility, ADL,
strength)
• Independent living
• Endurance
• Mood
(Pang, 2006; Teixeira-Salmela, 1999; Rietberg, 2004)
Secondary Conditions
Defined as medical, social, emotional, family or
community problems that a person with a primary
disabling condition likely experiences
o
Includes chronic pain, pressures sores, but also social
sequelae such as isolation, depression, and
accessibility problems (Ravesloot et al., 2007)
Consequences of secondary conditions are
amplified in individuals with disabilities
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i.e. gaining 10 pounds may impact mobility and
transfers in this population, but not effect able-bodied
individuals significantly
Secondary Conditions
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Prevention of secondary conditions has become
a major component of health promotion for
people with chronic disabilities.
High rate of inactivity may partially account for
the increased rate of accumulation of secondary
conditions.
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3.6 in a population with mobility limitations versus 1.3
for the general population with no mobility limitations
(Rasch, 2008).
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87% of individuals with disabilities report at least one
secondary condition, versus 49% of individuals without
disabilities (Kinne, 2004).
Secondary Conditions
The high number and prevalence of
secondary conditions leads to:
o Increasingly complicated medical
needs
o More frequently in need of medical
attention (high utilization)
o Typically high cost users
30
Health Care Costs Across the Population
Percent of the Population
25
20
15
The 50% of the
population that costs
the least.
10
The 5% of the
population that costs
the most.
5
0
Low Cost
High Cost
Health Care Costs
Consequences of Secondary
Conditions
“Thin margin of health”
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“Accelerated aging”
There is a high rate of increase of secondary
conditions in individuals with disabilities
Much of the cost of care for persons with
disabilities is the cost of secondary conditions
Increased morbidity and mortality in this
population related to secondary conditions
Barriers to Fitness
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Poor accessibility
Lack of privacy
Fear of injury
Public exposure of their injuries
Cost
Lack of experience among staff at fitness
centers in dealing with persons with SCI (would
apply to other disabilities as well).
Only 8% of facilities provided adequate
accessibility around exercise equipment.
(Lavis, 2007; Rimmer et al., 2004)
Services Courage Center
Provides
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Therapeutic Pool at 2 sites (Golden Valley and
Courage St. Croix)
Fitness Centers at 3 sites (adults at Golden
Valley and Courage St. Croix, pediatrics at
Burnsville)
Classes (for example, water Tai Chi, yoga,
etc.)
Aquatics
92 degree therapeutic pool
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Independent exercise
Classes: arthritis, stroke, MS, fibromyalgia,
whole body conditioning, tai chi, prenatal,
water aerobics, back moves
1:1 therapeutic exercise sessions (Stay Fit)
Personal training
Adapted swim team
Aquatic Bodywork (watsu, aquatic integration)
Wellness and Fitness
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Accessible Fitness Center
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Independent Exercise (staff supervised)
Classes: Adapted Yoga, Teen Fitness,
Silver Sneakers Class, Nutrition and
Weight Loss
1:1 therapeutic exercise sessions (Stay
Fit and Stay Fit FES Bike)
Personal training
Assessment
Exercise Program is designed by fitness
staff certified to work with individuals with
disabilities and complex health conditions
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Flexibility
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Strength
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Cardiovascular fitness
Clients receive a fitness program to address
all three areas, as well as a
recommendation for level of assistance
Fitness Assistance Levels
Exercise programs are available in 3 levels of
assistance:
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Stay Fit Extra – for individuals who need
assistance with their exercise program from
75% to 100% of the time.
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Stay Fit - for individuals who need assistance
with their exercise program from 25% to 75%
of the time.
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Independent Exercise – for individuals who
need assistance less than 25% of the time.
Weight Management
Program
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Individuals who are receiving stay fit or stay fit extra can
participate in the Courage Center Weight Management
program
After 10 weeks in the program, individuals who were
trying to lose weight lost a significant amount of weight
(average of 2.7 pounds)
Combined exercise and weight management program
This is offered free for all program participants
Designed for persons with disabilities and for those on
limited incomes.
Accessible locker rooms
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Turning radius for power chair
High-low matts
Hoyer lifts available
Shower facilities
2012 Program Utilization
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3400 individuals participate in Health,
Wellness and Fitness activities.
This included aquatics program, land exercise,
or both.
2012 Program Benefits
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86% stated that exercise has improved their
ability to perform daily activities
95% can identify health benefits
76% are able to better participate in their
communities because of Health, Wellness and
Fitness programs
96% would recommend Courage Center to
others
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Secondary Conditions Reported
by Clients in Health, Wellness, &
Fitness
• Eating (55%)
Fatigue (71%)
• Depression
Arthritis (66%)
(45%)
Sleep disturbances
• Cardiology
(60%)
(30%)
Joint & muscle pain
• Isolation (28%)
(57%)
• Diabetes (21%)
Fitness Reduces the Severity of
Secondary Conditions after 1 year
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Cardiology (71%)
Heart/Circulatory System
(69%)
Contractures (65%)
Anemia (50%)
Depression (50%)
Eating (46%)
Social isolation (46%)
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Arthritis (45%)
Injuries sensation
(44%)
Joint & muscle pain
(43%)
Fatigue (39%)
Diabetes (33%)
Sleep (27%)
Conclusion
Macro Level
 Fitness and nutritional services have significant
results in improving peoples’ health and in
reducing secondary conditions.
 The health improvements and cost savings
associated with these services exhibit the
benefits to these services and the importance
of insurance coverage (public and private) for
these programs.
 Combining exercise and nutritional education is
an effective strategy to help clients lose weight
Conclusions
• Exercise is good
• Inactivity is bad
• If we want to manage long term health
care costs, we need to cover adapted and
accessible fitness services under
insurance plans, both public and private
Questions?
Nancy A. Flinn
[email protected]