Acts Signature Well-Being

ACTS SIGNATURE WELL-BEING PRODUCT INTEGRATING MIND | BODY | SPIRIT

Memory Support Mental Health

Prospect to 365

My Life Journey

Acts Signature Well-Being Product

Nutrition

Instructions Manual

Fitness Rehab

Engagement / Lifestyle

Spiritual Life

Primary Care

Version 2 11/4/22

Acts Signature Well-Being Philosophy Statement DRAFT Acts offers a holistic philosophy which supports residents along their life journey to well-being, consistent with the Acts Culture of Loving-Kindness, which integrates body, mind, and spirit across the continuum of living. Acts recognizes an individual’s uniqueness and affords each person the opportunity to achieve their best life through personal choice, engagement, spirituality, health, and wellness.

TABLE OF CONTENTS

SECTION 1

Introduction

pg 3

SECTION 2

Prospect to 365 (New Acts Residents)

pg 10

SECTION 3

My Life Journey

pg 12

SECTION 4

Engagement/Lifestyle

pg 24

SECTION 5

Spiritual Life

pg 30

SECTION 6

Primary Care

pg 34

SECTION 7

Rehab Services

pg 58

SECTION 8

Fitness

pg 69

SECTION 9

Nutrition

pg 78

SECTION 10

Mental Health

pg 85

SECTION 11

Memory Support

pg 98

SECTION 12

Well-Being Product Process Outline

pg 108

SECTION 13

Well-Being Protocols

pg 111

SECTION 14

Alpha Pilot, St. Andrews Estates, Getting Started

SECTION 15

Resident Well-Being Portfolio Sample

pg 112 pg 129

SECTION 16

Technology

pg 130

SECTION 17

Costs, Billing, Projected Financials

pg 141

SECTION 18

Research & Resources

pg 149

--letter of interest, selection criteria, consent form

SECTION 1 Introduction to the

ACTS SIGNATURE WELL-BEING PRODUCT

INTRODUCTION to the

ACTS SIGNATURE WELL-BEING PRODUCT INTEGRATING MIND | BODY | SPIRIT

Memory Support Mental Health

Nutrition

Prospect to 365

My Life Journey

Acts Signature Well-Being Product

Engagement/ Lifestyle

Spiritual Life

Primary Care

Fitness Rehab

Acts Signature Well-Being Product What is the Acts Signature Well-Being Product?

The Acts Signature Well-Being Product is a multidisciplinary integrated approach to develop a personcentered, holistic scope of a Well-Being Experience for the Independent Living Resident, with the goal of delivering a personalized Acts Signature Portfolio for each resident from a resident’s move in, to annual updates and ongoing touchpoints throughout the year.

How does the Acts Signature Well-Being Product work?

Much like a financial portfolio, all Acts residents have many options to building their signature portfolio based on personal preferences, wants and needs. Development of a signature portfolio will be accomplished by: • unifying concierge/navigation/coaching services that will support administrative, intake, scheduling, reminders, and routine support across all of our existing settings as a virtual, distributed location agnostic service.

• coordinating all health and wellness service touchpoints into an all-encompassed signature well-being product that optimizes revenue capture and well-being outcomes.

• incorporating risk sharing models (Medicare Advantage/other) to realize full benefits of our optimized signature well-being outcomes.

My Life Journey

Prospect to 365

Building the Acts Signature Well-Being Portfolio There are many facets to the Acts Signature Well-Being Portfolio. The beginning stages of building the portfolio occur during the new resident move in process. By gathering general information pertinent to the resident, the structure of an Acts Signature Well-Being Portfolio is initiated, including topics such as:

• • • • • • • •

Previous Living Arrangements Marital Status Family and Cultural Heritage Occupation/Previous Occupation Education Level Military Religion Milestones (Life)

A Well-Being Health Coach and Well-Being Concierge are assigned to each resident to provide continuous guidance in all facets of the Acts Signature Well-Being Portfolio. Building upon the structure of information gathered during the new resident move in process, the Well-Being Health Coach and Concierge will assist in expanding upon the resident’s portfolio with various questions based around the Seven Dimensions of Wellness (Physical, Spiritual, Vocational, Environmental, Intellectual, Social, and Emotional).

A variety of multi-media means will be used based on resident preference (videotape, audio tape, oneon-one interview, resident driven recording through the use of technology, hand-written or typed documentation). This segment of data gathering is intended to be conversational in nature with the direction of the conversation driven by resident responses. Conversation starters include topics such as:

• • • • • • •

Interesting stories or memories Love stories, vacation, family time, adventures, historical events A photo book, painting, or objects that have meaning Childhood upbringing or memories Relationships and family Historical and cultural Milestones, significant life events and accomplishments

Engagement | LifeStyle Spiritual Life Primary Care

Physical activity as we age offers a Further expansion of developing the Acts Signature Well-Being Portfolio variety of health benefits like lessening chronic is around interests and activity -pain, delaying and preventing previous, current or things a resident certain diseases, and helping recover may have an interest in pursuing, quicker from an illness or injury. everything from Art to Writing, to Staying connected with others helps give a group activities, fitness, sporting sense of purpose and belonging and events or joining a club. also has a major impact on overall well-being.

The Well-being Coach will evaluate Social activity and engaged experiences provide and connect a resident with others a variety of benefits like better cognitive that have like interests; expand function, maintaining good emotional capabilities and opportunities for health, boosted immune system, accessing interests; and provide enjoying restful sleep and avenues for new interests. increased longevity.

The spirit is an integral part of the overall well-being of an individual. In many ways, it is a significant determinant of the well-being of the other two dimensions -- body and mind. Community chaplains are a vital part of the interdisciplinary team. The community chaplain will conduct an initial spiritual assessment of new residents upon arrival to the community, followed by an annual assessment to determine each individual residents spiritual aspirations, needs and goals.

These assessments inform the spiritual services that the chaplain will provide to the individual resident. ♥♥♥ Chaplains provide high quality Sunday worship experience, Bible studies, support groups, opportunities for talent utilization, opportunities for giving back to the community, as well as mission trips.

Chaplains also provide counseling with residents especially during times of loss, stress or turmoil in one's life (such as hospital visits).

All of these services are designed to help meet the spiritual needs of each individual. The overall goal is to provide each resident with a purposeful filled life throughout their residency at an Acts community.

A significant component of the Acts Well-Being Portfolio is healthcare and aging in place is vital. All independent living residents will receive an annual health and wellness evaluation. The Annual Health and Wellness Evaluation (AHWE) is a comprehensive medical visit designed to develop or update a personalized prevention plan to help prevent disease and disability, based on the resident’s current health and risk factors.

Well-Being expands beyond primary care and includes Rehabilitation, Nutritional Services, Behavioral/Mental Health Services and Memory Support, in addition to referrals as needed to specialists.

Completion of Health History Assessment and Demographic Information Update Performance of Medical Evaluation and Various Diagnostic Testing Performance of Various Health Assessments such as Assessment of Cognitive Functions, Psychosocial and Behavioral risks, Mini Nutritional Assessment, Polypharmacy, Chronic conditions and Signs of elder mistreatment, In-Home Risks and Activities of Daily Living and Instrumental ADLs

Performance of Multiple Health Screenings including but not limited to:

Fitness

Rehab

Primary Care

• Audio screening • Injury Risk Assessment • Cognitive testing • Osteoporosis • Mental Health Evaluation • Sexually transmitted infections • Depression screening • Sleep consultation • High blood pressure • Stress management assessment • High cholesterol • Visual Screening Review of medical, legal and advance care planning Completion of a personalized resident health advice and referral(s) for healthcare services and specialty providers such as: • Audiology • Lab Services • Behavioral Health/Mental Health • Neurology Services • Optometry • Cardiology • Palliative Care • Dentistry • Podiatry • Dermatology • Psychiatry/Psychology • Dietitian • Rehabilitation • Home Health • Urology • Imaging Services Many of these services (based on location) are offered on campus by visiting medical providers, if not an Acts provided service.

Completion of a Personalized Education, Preventive Counseling and Support Services Plan -- community-based lifestyle interventions to reduce health risks and promote self-management and wellness: Exercise Is The Best Medicine: THRIVE With Acts® is based on the recommendation that all older adults should be engaged in appropriately dosed exercise prescriptions for Energy, Flexibility, Strength, Balance and Mind In addition to THRIVE, the Acts Rehab Acts therapists are medical team will complete assessments including: professionals who are trained to assess all body systems and how they relate to one another in • Physical Readiness Questionnaire order to achieve optimal physical and • Pelvic Health functional health. This includes • Pain recovery taking into account the many • Thrive Mind diseases and conditions that tend to • Balance and Gait for Fall prevention accumulate in older adults.

Acts Fitness programs are designed to offer a variety of opportunities to meet the physical activity needs and interests of our residents. Fitness programming includes a fully equipped fitness center, a variety of group exercise classes, recreational sports opportunities, and aquatic programming in communities with swimming pools.

The certified fitness instructors are available to create a personalized fitness program to assist residents with meeting their health, fitness or functional goals and living to their full potential. ♥♥♥

Nutrition

A Mini Nutritional Assessment (MNA) is completed as part of the Annal Wellness Evaluation with referrals to the community’s Registered Dietitian Nutritionist (RDN) for further evaluation as needed.

Acts residents have the opportunity to Participation in the Acts meal plan consult with the Registered Dietitian provides a variety of dining options for the Nutritionist (RDN) and receive in-depth resident to select foods that align with their nutritional assessment and counseling to personal nutrition plan. Nutritional facts set priorities, establish goals, and create panels can be accessed through the resident individualized vitality plans which portal to provide in depth information acknowledge and foster responsibility for about macro- and micro-nutrient content self-care. The RDN works with the resident and allergens. Community wellness to find appropriate programs and services programming by the RDN offers offered within the community to support opportunities for resident exploration in resident needs and promote well-being current nutrition topics and healthy Nutrition and independence. lifestyle.

Mental Health

Through the Annual Health and Wellness Evaluation (AHWE), the community’s Nurse Practitioner will complete assessments that will determine the potential need for mental health intervention or services. The Acts Mental Health Clinicians (MHC) serve as key members of the interdisciplinary care team and provide behavioral health assessments, care planning, therapy services, behavioral intervention, and case management to the ILU population. ♥♥♥ The MHCs are clinical licensed Social Workers or Psychologists that conduct diagnostic interviews to identify psychosocial strengths and weaknesses and inform care planning. They also provide individual, family and group psychotherapy services, as indicated through assessment and care planning processes; they offer caregiver support and education to family members and provides educational programs to the Acts community staff.

Memory Support

The fitness instructors work with each resident to create a program that will meet individual goals. They collaborate with the Nurse Practitioner, rehab and dietitians to assure that all programming is safe and effective. Recommendations are based on the interests of the residents and may include group exercise classes, aquatic programming, supervised individual exercise programming or exercise programs that can be done independently. The fitness/rehab partnership allows all residents to continue to exercise and continue to THRIVE following discharge from rehab.

The Acts Lifestyle Empowerment program, led by the Well-Being Coach, provides structured guidance for residents (and their spouses) when experiencing mild cognitive impairment. Through participation in a comprehensive individualized lifestyle program, members experience empowerment, purpose, well-being and joy while maintaining independence to live their best life, as well as they can, as long as they can. The WellBeing Coach will guide member engagement in the program that addresses lifestyle factors including: cognitive engagement ♥ social engagement ♥ physical activity and exercise nutrition ♥ stress management ♥ sleep ♥ environmental sensitivity

SECTION 2 Prospect to 365 New Move In Residents

Prospect to 365 The beginning stages of building the Acts Signature Well-Being Portfolio occurs during the new resident move in process. The Life Care Consultant or Move In Coordinator gathers general information pertinent to the resident, including topics such as: • • • • • • • • •

Previous Living Arrangements Marital Status Family Cultural Heritage Occupation/Previous Occupation Education Level Military Religion Milestones (Life)

The information is documented and stored in SalesForce. Technology goals are being investigated to determine how this information can be shared with other system. The information will be made available to the Well-Being Coach,Well-Being Concierge and the Life Engagement team. (additional information, forms, documents needed. Focus – new residents)

SECTION 3 My Life Journey

My Life Journey Building upon the structure of information gathered during the new resident move in process, the Well-Being Health Coach and/or Concierge will assist in expanding upon the resident’s portfolio with various questions based around the Seven dimensions of Wellness (Spiritual, Intellectual, Physical, Social, Vocational, Environmental, and Emotional).

Seven Dimensions of Wellness 1. Spiritual Well-Being Spiritual connections can provide an experience of meaning and purpose in life and are key to overall feeling of well-being.

• • •

Would you like to tell us about your faith beliefs and the role they play in your life?

What could the community offer or develop via outside partnerships to help you reach your spiritual well-being goals?

Would you like to know about the spiritual activities and services we offer?

2. Intellectual Well-Being Engaging in creative pursuits and intellectually stimulating activities is a proven approach to keeping minds alert and interested: • • • •

Tell us about the hobbies and interests that you currently enjoy.

What is a new adventure, project, or hobby that you would like to try?

Tell us something new you would like to learn.

What could we offer or develop via outside partnerships to help you reach your intellectual well-being goals?

3. Physical Well-Being The goal of living independently is one shared by many people, and physical health and wellness is necessary to achieve this goal: • • • • •

What physical activities do you currently enjoy?

What aspect of your physical health would you like to improve?

What nutritional topic would you benefit most from learning more about?

What physical activities are you doing now that you would like to still be doing in five years?

What could we offer or develop via outside partnerships to help you reach your physical well-being goals?

4. Social Well-Being Social interactions with family, friends, neighbors, and chosen peer groups can be valuable for maintaining health: • •

What do you like to do when spending time with family and/or friends?

How often do you like to get together with others?

• •

What similar interests would you like a new friend to have? How do you like to celebrate your birthday?

What could we offer or develop via outside partnerships to help you reach your social well-being goals.

5. Vocational/Professional Well-Being Work that utilizes a person’s skills while providing personal satisfaction is valuable for society as well as the individual: • • • •

If you would want to volunteer anywhere, now, where/what would you choose?

If you were writing a resume today, what skill would you list as your most valuable?

What could the community offer or develop via outside partnerships to help you reach your vocational well-being goals?

Have a list of volunteer opportunities available at the community

6. Environmental Well-Being Environmental wellness is an awareness of the unstable state of the earth and the effects of your daily habits on the physical environment. It consists of maintaining a way of life that maximizes harmony with the earth and minimizes harm to the environment. It includes being involved in socially responsible activities to protect the environment.

7. Emotional Well-Being Feelings are the lens through which people view the world, and the ability to be aware of and direct one’s feelings helps to create balance in life.

• • • • •

Please describe one of the simple pleasures in life that you truly enjoy.

How do you overcome feelings such as sadness and anxiety?

Who/what brings joy to your life?

What safety concerns do you have now?

What could we offer or develop via outside partnerships to help you reach your emotional well-being goals?

A variety of multi-media means will be used based on resident preference (videotape, audio tape, one-on-one interview, resident driven recording through the use of technology, hand-written or typed documentation). This segment of data gathering is intended to be conversational in nature with the direction of the conversation driven by resident responses.

*Technology to be used and electronic storage of the resident’s information – under investigation. For existing resident (vs new), the original My Story document (if previously completed by the resident) will be reviewed, updated and converted to the My Life Journey living document. This information will be made available to the WellBeing Coach/Concierge for insertion into the residents Signature Well-Being Portfolio.

Additional Resource (Dr. Green):

SECTION 4 Engagement / Lifestyle

Engagement/Lifestyle The concierge will review the collected information from the Life Care Consultant and the resident’s My Life Journey documentation to date, captured by the Well-Being Coach. The WellBeing Concierge meets with the resident to orient them to community life (new residents) and will describe the many opportunities available within and outside the community. This visit is conducted in the resident’s apartment. For ease into community life, a resident buddy with similar interests, experiences and life goals is connected with the new resident. Newcomer socials are routinely scheduled.

Based on resident preferences, the Concierge will seek similar groups, individuals, events and opportunities and provide assistance for participation.

The Well-Being Concierge will meet annually with the residents as well as conduct various touchpoints to review and update the residents’ interests, goals, and desires. The annual and intermittent touch points will continue to focus on the Seven Dimensions of Wellness: • •

•

•

•

• •

Spiritual o Prayer and meditation group, religious services, writing classes – memoir Intellectual o Lecture series, Lifelong learning classes, museums, brain/memory classes, book clubs, volunteer opportunities, computer classes, movies Physical o Walking paths, fitness centers, fitness classes, personal fitness training, bird watching, travel (day and overnight trips), healthy eating, dancing, recreational sports (pickleball, bocce, shuffleboard) Social o Card and board games, happy hour, concerts, theatre, book clubs, sporting events, art classes, gardening Vocational o Volunteer (committees, clubs, engagement, hospitality, marketing, grounds, buddy, culinary, fitness, call a friend) Environmental o Recycling, taking care of the environment, getting outdoors and enjoy its beauty Emotional o Stress reduction, meditation, mindfulness, connect with friends, yoga, tia chi, sleep, spa, massage therapist

St. Andrews Estates Resident Interest Survey August 2022 Prepared By Bill Tamulonis OBJECTIVES AND METHODOLOGY In conjunction with the New Wellbeing pilot project at St. Andrews Estates, we conducted an online-only survey of IL residents to measure the level of interest in various events and opportunities that might be offered at the community. Residents for whom we had email addresses on file received an email invitation with a link to the survey. All residents received a letter in their mailboxes with a link and QR code directing them to the survey. Life Engagement staff also provided personal assistance to residents as requested.

As an incentive to respond, residents were eligible to win a $150 gift card for Ruth’s Chris Steakhouse. We received 189 responses: a response rate of 43%.

The survey was executed by the Acts IT Department using the Salesforce Surveys platform.

EVENT/OPPORTUNITY RANKINGS Residents indicated their likelihood to participate in various events and opportunities on the following scale:

The tables below show the average rating scores. Scores of 3.5 and above are the highest priority events and opportunities. Scores between 3.0 and 3.4 are secondary priorities. Scores below 3 are Lower priorities. Note that the events and opportunities are categorized as “Clinical” or “Engagement.”

Highest Priority Category Clinical Clinical Clinical Clinical Engagement Engagement Engagement Engagement Engagement

Event/Opportunity Lab for bloodwork Podiatrist (feet) Fall prevention Care coordinator for health care Outdoor walking paths Attend concerts Attend theater Travel - day trips Lecture series

Average Score (6=max) 4.7 4.1 3.9 3.8 4.6 4.5 4.4 4.3 4.1

Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement

Spa for massage, facials, mani/pedi, etc.

Computer/Technology Classes Attend movies

4.1 4.1 4.1

Lifelong Learning classes Museum visits Attend comedian performances Attend dance troupe performances Brain fitness/Memory improvement Play cards

4.1 4.0 3.9 3.8 3.7 3.6

Go out to dinner at a local area restaurant

3.5

Secondary Priority Category Clinical Clinical Clinical Clinical Clinical Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement

Event/Opportunity Optometrist/Ophthalmologist (vision) Audiologist (hearing) Mental health counseling Dentist Mammograms Dietitian/Nutritionist

Average Score (6=max) 3.4 3.3 2.7 2.7 2.1 3.2

Board games Caregiver support Personal fitness trainer Travel - overnight trips Arts & Crafts Book club

3.2 3.1 3.1 2.9 2.8 2.8

Other volunteer opportunities Cruise trip Bird watching Attend sporting events Learn a new language Bible/Scriptures study

2.6 2.5 2.4 2.4 2.4 2.3

Art/Painting/Drawing Room for prayer/meditation Prayer/Meditation group Virtual reality experience Community gardening plot Line dancing

2.3 2.2 2.2 2.1 2.1 2.1

Shuffleboard Square dancing Investment club Mentoring younger people Corn hole/bag toss

2.0 2.0 2.0 2.0 2.0

Lower Priority Category Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement Engagement

Event/Opportunity Bocce ball

Average Score (6=max) 1.9

Writing - memoir Volunteer in OBT, WBC, or daytime respite program on campus Calligraphy Sewing/Knitting Photography Pottery/Sculpting

1.8 1.8 1.8 1.8 1.7 1.7

Hiking Billiards/Pool table Ballroom Dancing Sing in a group/choir Cooking class Play chess

1.7 1.6 1.6 1.6 1.5 1.5

Casino trip Biking Videography Acting Play musical instrument Writing - creative/poetry

1.5 1.4 1.4 1.4 1.3 1.3

Horseshoes Woodworking/Building Tutor school-age children Baking Camping Play in a musical group

1.3 1.2 1.2 1.1 0.9 0.9

Fishing Running/Jogging Child care volunteer (day care, pre-school) Skydiving

0.8 0.8 0.7 0.3

Additional Suggestions We gave respondents the opportunity to write in additional suggestions. Most of the suggestions were more specific explanations of the rated events and opportunities, such as lecture topics, subjects for classes, and locations for trips.

One new suggestion was offered by ten residents: an indoor swimming pool All of the written suggestions are available on PowerBI at this link: https://app.powerbi.com/links/cOO94LTpty?ctid=595c195a-52dd-4ba2-aeea1eaa7cccfe7a&pbi_source=linkShare

LOCAL PARTNERSHIPS Residents offered suggestions for local organizations that SAE can partner with to offer events and opportunities. The most frequently mentioned are: • • • •

Florida Atlantic University Lynne University YMCA Various local churches

The complete list of partnership suggestions is available on PowerBI at this link: https://app.powerbi.com/links/cOO94LTpty?ctid=595c195a-52dd-4ba2-aeea1eaa7cccfe7a&pbi_source=linkShare FUTURE RESIDENT INTEREST SURVEYS Based on these pilot survey results, it is recommend to shorten the questionnaire by eliminating events/opportunities that received an average score below 2.0. This will leave 48 events/opportunities for residents to rate.

Engagement and opportunity information based on residents goals, interests and desires will be made available to the Well-Being Coach/Concierge for implementation and ongoing additions to the resident’s Signature Well-Being Portfolio.

SECTION 5 Spiritual Life

Spiritual Life The Chaplain will meet with the resident and complete a spiritual assessment, A Purpose Filled Life. The goal for the Chaplain is to help each individual resident to find their God given purpose and meaning in life.

Spiritual Assessment Visits I.

Initial Spiritual Assessment visit Within the first two weeks of a new move in, the Chaplain will make an initial visit to meet and welcome the resident. At this visit, the Chaplain will also complete initial spiritual assessment that focuses on building the spiritual component of “My Life Journey” using the following questions: 1.

2.

3.

4.

5.

May I ask you about your religious beliefs?

What would you like us to know in relation to your faith background?

What role would you say your religious beliefs play in your life?

What spiritual activities, practices, or rituals are most significant to you?

Is there a spiritual milestone, a significant spiritual event, in your life you would like to tell us?

6. Are you experiencing spiritual struggles that you would like share with me?

7. What do you consider to be your spiritual gifts, talents, skills?

8. Would you like to know about the spiritual activities/services we offer?

9. Death is one of the realities of life and I’m curious to hear your thoughts about it.

10. How can I assist you to achieve your spiritual goals and preferences?

This information would then inform the overall ministry of the Chaplain to that individual resident, shape discussions in future visitation, inform focus areas of support group, Sunday sermons, Bible studies, payer, meditation groups, etc.

II.

Ongoing Spiritual Assessment Visits These could occur monthly, or quarterly, but at least annually per resident. At these visits the Chaplain will make a follow-up of the initial spiritual assessment visit to determine any changes or additions to the resident’s spiritual goals, needs, and aspirations. The Chaplain will use these on-going visits to keep the resident engaged and to build stronger connections & relationships with resident as a way of learning best ways to meet their spiritual needs and hence to inform the Chaplain’s ministry.

The Chaplain will discuss with the resident any observations about the resident’s spiritual aspirations, expectations, and preferences the Chaplain may have noted since the last scheduled visit.

The Chaplain will write notes of his/her observations and discussions with the resident in the appropriate shared website area for the information of other stakeholders. As is the case with the initial visit, these observation statements will help to connect, maintain relationship, and shape the overall chaplain’s ministry to the individual resident.

III.

High Quality In-House TV Worship Experience We will endeavor to offer alternative in-house TV worship service experiences of a quality that matches the in-person chapel service experience, and this way help to increase choice, which is an important value of the baby boomer generation.

• The IT will do what it takes to ensure high quality of picture and other functions of our in-house TV. • The Chaplain will utilize PowerPoint presentations with songs, scriptures, sermon title, (including sermon main points is encouraged) for Sunday services, and other main services. o This will enable the chaplain to bring the worship service experience to the resident apartment. o It will increase participation (in singing, reading, sermon etc) of residents who may choose to attend the service remotely in the comfort of their apartments. o It will enable the chaplain to engage those unable/unwilling to attend in person • Of course, the chaplain must beware of the danger of isolation/seclusion of residents who may choose to only participate remotely.

IV.

High Quality Preaching & Teaching We will present a clear and sound preaching and teaching of sermons and Bible Study lessons that bring the truth of biblical story alive and relevant to modern day seniors through the ministry of our chaplains.

• Each chaplain will be given access to Logos Bible Software—a sermon preparation & Bible Study tool operated by Faithlife Corporation since 1992.

• Resources include commentaries, books on historical background of the biblical narrative, church history, systematic theology, Bible maps, several Bible versions critical for understanding a text.

• It’s non-denominational and interdenominational, hence aligns with the Acts chaplains’ commitment to provide a non-denominational service. o This will help chaplains prepare high quality sermons & Bible Study lessons at a much shorter time.

V.

Participation Opportunities Based upon the rationale that baby boomers want more participation and less spectatorship, we will provide a variety of opportunities that foster participation such as: • Talent Utilization Opportunities o Chaplains will create opportunities in which residents can continue to utilize their talents (time, skills, treasure, experience) as a way of worship.

•

•

o Chaplains will be creative in identifying these talents (painting, coloring etc) and engaging residents in pertinent activity.

Giving Back Opportunities o Chaplains will create opportunities in which residents can get involved in the society to give back in service to the community, such as the following: ▪ Serving in a Community Soup Kitchen.

▪ Donating items to the less fortunate: local community clothing banks, food pantry, refugees, inmates.

▪ Writing encouraging letters to military or missionary people.

▪ Participating in worship service: Assigning residents to lead in singing, scripture reading, responsive reading, Bible Study, prayer meetings, playing instruments, serving communion, editing bulletins, folding bulletins, serving in the spiritual life committee, setting up chapel, alter guild.

▪ Praying for others during national-day-of prayer, prayer service for employees during employee recognition week.

Mission Trip Opportunities o Chaplains will arrange and take residents on mission trips.

Resources & Technology Needs 1.

2.

3.

4.

Need to purchase “Logos Bible Software” IT to assist with installation and Chaplain accessibility IT to assist with ensuring high quality In-House-TV Picture Quality which in some communities it may require installing new system.

Electronic storage of the Spiritual Assessment is undetermined but under investigation

*Assessment data will be made available to the Well-Being Coach/Concierge for insertion into the residents Signature Well-Being Portfolio.

SECTION 6 Primary Care Nurse Practitioner Services

SUMMARY Effective management of the unique needs of geriatric health requires routine health screenings, medical assessments and evaluation with a primary care provider. The Acts Nurse Practitioners offer primary care services in all its communities to participate in the care of our residents by providing high-quality primary, acute, and specialty senior health care services, helping our residents live longer, healthier, happier lives.

THE ANNUAL WELLNESS EVALUATION Acts residents are provided with an ANNUAL HEALTH AND WELLNESS EVALUATION (AHWE) each calendar year. The AHWE is a comprehensive medical visit designed to develop and update a personalized prevention plan to help prevent disease and disability, based on the resident’s current health and risk factors. The AHWE includes the following: ✓ ✓ ✓ ✓ ✓

Completion of a Health History Assessment and Resident Information Update Performance of a Comprehensive Medical Evaluation Performance of Various Health Screenings and Assessments A Personalized Resident Health Advice and Referral Plan Review of Medical, Legal and Advance Care Planning

WELLNESS STAFF The Acts NP Primary Care Practices are located on campus in the Wellness Suites. The Wellness Suites are staffed with Nurse Practitioners, Wellness Office Nurses, Wellness Office Coordinators and (in select communities), a Nurse Navigator. The Wellness staff play an integral role in the AWE and ongoing healthcare needs of the Acts residents.

TECHNOLOGY and EQUIPMENT • Electronic Health Record System(s) – NextGen Software Solutions (implemented in July 2022 to the pilot community, St. Andrews Estates) • Vitals Monitoring – on order • Body Composition Analyzer – equipment to be loaned by the vendor on a trial basis.

Arrangements in progress.

• Chemical Analyzer/Bloodwork – on order • Urine Analyzer – on order • EKG (electrocardiogram) Machine – standing equipment in all Wellness Suite.

Replacement EKG ordered for North campus.

• Bladder scanner -- standing equipment in all Wellness Suite • Nebulizer -- standing equipment in all Wellness Suite • Diabetes Management - PT/INR, A1C -- standing equipment in all Wellness Suite

PRIMARY CARE/NP SERVICES ANNUAL HEALTH AND WELLNESS EXAM PROCESS Annual Health and Wellness Pre-Visit 1. Resident is scheduled for their pre-annual interview by the Well-Being Coach. The resident reports to the Wellness Office at the time of the appointment.

2. Wellness Office Coordinator reviews and updates (in real time) the resident’s health history and information and documents all changes and updates in the electronic medical record. (Resident is to be provided with a copy of their demographics face sheet. This copy if kept in a plastic container in the resident’s freezer and made available to emergency services if needed).

3. The Mini Nutritional Assessment and height and weight measurements are completed by the Wellness Office Nurse and recorded in the electronic medical record.

4. Blood draw is done for routine blood testing. Processing is completed inhouse and/or sent to an outside lab for processing.

5. Performance of Testing: EKG, Urinalysis, Body Comp Analysis, Bladder Scanning (as indicated) Annual Health and Wellness Exam with the Nurse Practitioner Resident reports to the Wellness Suite for their scheduled visit with the Nurse Practitioner •

The NP will review all of the data provided by the Well-Being Coach prior to the resident’s scheduled visit. The NP will conduct a physical exam and complete the assessments listed below. The majority of the assessments are incorporate in an Annual Wellness template that is available in the electronic health record system (NextGen).

1.

2.

3.

4.

High blood pressure screening High cholesterol screening Depression screening Abnormal blood glucose/diabetes screening 5. Stress management assessment 6. Osteoporosis screening 7. Hepatitis C screening 8. Sexually transmitted infections screening 9. Audio screening 10. Visual screening •

11. In-Home Risks and Activities of Daily Living (ADLs) 12. Instrumental ADLs (IADLs) 13. Provide Sleep Assessment 14. Cognitive function test 15. Behavioral risk assessment 16. Psychosocial risk assessment 17. Incontinence assessment 18. Polypharmacy assessment 19. Chronic conditions assessment 20. Signs of elder mistreatment assessment

A review of medical, legal and advance care planning is completed

•

Following the visit, the NP will create a personalized resident health advise and referral plan and provide the completed plan to the Well-Being Coach for insertion to the resident’s Signature Well-Being Portfolio.

(Medicare) Annual Wellness Visit Providing Personalized Prevention Plan Services -- Guidelines for the Acts Signature Well-Being Annual Health and Wellness Visit are derived from CMS guidelines for Annual Wellness Visit for Medicare beneficiaries: (a) Definitions. For purposes of this section A review of any current opioid prescriptions means, with respect to the individual determined to have a current prescription for opioids, all of the following: (i) A review of the potential risk factors to the individual for opioid use disorder; (ii) An evaluation of the individual's severity of pain and current treatment plan; (iii) The provision of information on non-opioid treatment options; and (iv) A referral to a specialist, as appropriate.

Detection of any cognitive impairment means assessment of an individual's cognitive function by direct observation, with due consideration of information obtained by way of patient report, concerns raised by family members, friends, caretakers or others.

Eligible beneficiary means an individual who is no longer within 12 months after the effective date of his or her first Medicare Part B coverage period and who has not received either an initial preventive physical examination or an annual wellness visit providing a personalized prevention plan within the past 12 months.

Establishment of, or an update to the individual's medical and family history means, at minimum, the collection and documentation of the following: (i) Past medical and surgical history, including experiences with illnesses, hospital stays, operations, allergies, injuries and treatments. (ii) Use or exposure to medications and supplements, including calcium and vitamins. (iii) Medical events in the beneficiary's parents and any siblings and children, including diseases that may be hereditary or place the individual at increased risk.

First annual wellness visit providing personalized prevention plan services means the following services furnished to an eligible beneficiary by a health professional that include, and take into account the results of, a health risk assessment, as those terms are defined in this section: (i) Review (and administration if needed) of a health risk assessment (as defined in this section). (ii) Establishment of an individual's medical and family history. (iii) Establishment of a list of current providers and suppliers that are regularly involved in providing medical care to the individual. (iv) Measurement of an individual's height, weight, body-mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements as deemed appropriate, based on the beneficiary's medical and family history. (v) Detection of any cognitive impairment that the individual may have, as that term is defined in this section. (vi) Review of the individual's potential (risk factors) for depression, including current or past experiences with depression or other mood disorders, based on the use of an

(vii)

(viii)

(ix)

(x)

(xi) (xii) (xiii)

appropriate screening instrument for persons without a current diagnosis of depression, which the health professional may select from various available standardized screening tests designed for this purpose and recognized by national medical professional organizations.

Review of the individual's functional ability and level of safety, based on direct observation or the use of appropriate screening questions or a screening questionnaire, which the health professional as defined in this section may select from various available screening questions or standardized questionnaires designed for this purpose and recognized by national professional medical organizations.

Establishment of the following: (A) A written screening schedule for the individual such as a checklist for the next 5 to 10 years, as appropriate, based on recommendations of the United States Preventive Services Task Force and the Advisory Committee on Immunization Practices, and the individual's health risk assessment (as that term is defined in this section), health status, screening history, and age-appropriate preventive services covered by Medicare.

(B) A list of risk factors and conditions for which primary, secondary or tertiary interventions are recommended or are underway for the individual, including any mental health conditions or any such risk factors or conditions that have been identified through an initial preventive physical examination (as described under § 410.16 of this subpart), and a list of treatment options and their associated risks and benefits.

Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs aimed at reducing identified risk factors and improving self management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.

At the discretion of the beneficiary, furnish advance care planning services to include discussion about future care decisions that may need to be made, how the beneficiary can let others know about care preferences, and explanation of advance directives which may involve the completion of standard forms.

Furnishing of a review of any current opioid prescriptions as that term is defined in this section.

Screening for potential substance use disorders including a review of the individual's potential risk factors for substance use disorder and referral for treatment as appropriate.

Any other element determined appropriate through the national coverage determination process.

Health professional means (i) A physician who is a doctor of medicine or osteopathy (as defined in section 1861(r)(1) of the Act); or (ii) A physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5) of the Act); or (iii) A medical professional (including a health educator, a registered dietitian, or nutrition professional, or other licensed practitioner) or a team of such medical professionals, working under the direct supervision (as defined in § 410.32(b)(3)(ii)) of a physician as defined in paragraph (i) of this definition.

Health risk assessment means, for the purposes of this section, an evaluation tool that meets the following criteria: (i) Collects self-reported information about the beneficiary. (ii) Can be administered independently by the beneficiary or administered by a health professional prior to or as part of the AWV encounter. (iii) Is appropriately tailored to and takes into account the communication needs of underserved populations, persons with limited English proficiency, and persons with health literacy needs. (iv) Takes no more than 20 minutes to complete. (v) Addresses, at a minimum, the following topics: (A) Demographic data, including but not limited to age, gender, race, and ethnicity.

(B) Self assessment of health status, frailty, and physical functioning.

(C) Psychosocial risks, including but not limited to, depression/life satisfaction, stress, anger, loneliness/social isolation, pain, and fatigue.

(D) Behavioral risks, including but not limited to, tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (seat belt use), and home safety.

(E) Activities of daily living (ADLs), including but not limited to, dressing, feeding, toileting, grooming, physical ambulation (including balance/risk of falls), and bathing.

(F) Instrumental activities of daily living (IADLs), including but not limited to, shopping, food preparation, using the telephone, housekeeping, laundry, mode of transportation, responsibility for own medications, and ability to handle finances.

Review of the individual's functional ability and level of safety means, at minimum, assessment of the following topics: (i) Hearing impairment. (ii) Ability to successfully perform activities of daily living. (iii) Fall risk. (iv) Home safety.

Subsequent annual wellness visit providing personalized prevention plan services means the following services furnished to an eligible beneficiary by a health professional that include, and take into account the results of an updated health risk assessment, as those terms are defined in this section: (i) Review (and administration, if needed) of an updated health risk assessment (as defined in this section). (ii) An update of the individual's medical and family history. (iii) An update of the list of current providers and suppliers that are regularly involved in providing medical care to the individual as that list was developed for the first annual wellness visit providing personalized prevention plan services or the previous subsequent annual wellness visit providing personalized prevention plan services. (iv) Measurement of an individual's weight (or waist circumference), blood pressure and other routine measurements as deemed appropriate, based on the individual's medical and family history. (v) Detection of any cognitive impairment that the individual may have, as that term is defined in this section. (vi) An update to the following:

(A)

The written screening schedule for the individual as that schedule is defined in paragraph (a) of this section for the first annual wellness visit providing personalized prevention plan services.

(B) The list of risk factors and conditions for which primary, secondary or tertiary interventions are recommended or are underway for the individual as that list was developed at the first annual wellness visit providing personalized prevention plan services or the previous subsequent annual wellness visit providing personalized prevention plan services. (vii) Furnishing of personalized health advice to the individual and a referral, as appropriate, to health education or preventive counseling services or programs as that advice and related services are defined in paragraph (a) of this section. (viii) At the discretion of the beneficiary, furnish advance care planning services to include discussion about future care decisions that may need to be made, how the beneficiary can let others know about care preferences, and explanation of advance directives which may involve the completion of standard forms. (ix) Furnishing of a review of any current opioid prescriptions as that term is defined in this section. (x) Screening for potential substance use disorders including a review of the individual's potential risk factors for substance use disorder and referral for treatment as appropriate. (xi) Any other element determined appropriate through the national coverage determination process. (b) Conditions for coverage of annual wellness visits providing personalized prevention plan services. Medicare Part B pays for first and subsequent annual wellness visits providing personalized prevention plan services that are furnished to an eligible beneficiary, as described in this section, if they are furnished by a health professional, as defined in this section. (c) Limitations on coverage of an annual wellness visit providing personalized prevention plan services. Payment may not be made for either a first or a subsequent annual wellness visit providing personalized prevention plan services that is performed for an individual who is (1) Not an eligible beneficiary as described in this section.

(2) An eligible beneficiary as described in this section and who has had either an initial preventive physical examination as specified in § 410.16 of this subpart or either a first or a subsequent annual wellness visit providing personalized prevention plan services performed within the past 12 months. (d)

Effective date. Coverage for an annual wellness visit providing personalized prevention plan services is effective for services furnished on or after January 1, 2011.

Source: Code of Federal Regulation, Title 42, Chapter 4, Subchapter B, Part 410, Subpart B

Sample Assessments A significant number of the primary care assessments are embedded within one comprehensive Annual Wellness Assessment Template:

Cognitive Screening Assessments (SLUMS, MOcA, Mini Cog)

•

Sleep Quality Assessment (PSQI)

The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument used to measure the quality and patterns of sleep in adults. It differentiates “poor” from “good” sleep quality by measuring seven areas (components): subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month.

INSTRUCTIONS : The following questions relate to your usual sleep habits during the past month only. Your answers should indicate the most accurate reply for the majority of days and nights in the past month. Please answer all questions.

During the past month: 1.

2.

3.

4.

When have you usually gone to bed?

How long (in minutes) has it taken you to fall asleep each night?

What time have you usually gotten up in the morning?

How many hours of actual sleep did you get at night?

How many hours were you in bed?

5. During the past month, how often have you had trouble sleeping because you A.

Cannot get to sleep within 30 minutes

B.

Wake up in the middle of the night or early morning

C.

Have to get up to use the bathroom

D.

Cannot breathe comfortably

E.

Cough or snore loudly

F.

Feel too cold

G.

Feel too hot

H.

Have bad dreams

I.

Have pain

J.

Other reason (s), please describe, including how often you have had trouble sleeping because of this reason (s):

Not during the past month (0)

Less than once a week (1)

Once or twice a week (2)

Three or more times a week (3)

6. During the past month, how often have you taken medicine (prescribed or “over the 7.

During to thehelp pastyou month, counter”) sleep?how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?

8. During the past month, how much of a problem has it been for you to keep up enthusiasm to get things done?

9. During the past month, how would you rate your sleep quality Very good (0) overall?

Fairly good (1)

Fairly bad (2)

Very bad (3)

Scoring PSQI Component 1 #9 Score

C1

Component 2 #2 Score (<15min (0), 16-30min (1), 31-60 min (2), >60min (3)) + #5a Score (if sum is equal 0=0; 1-2=1; 3-4=2; 5-6=3) Component 3 #4 Score (>7(0), 6-7 (1), 5-6 (2), <5 (3)

C2 C3

Component 4 (total # of hours asleep) / (total # of hours in bed) x 100 >85%=0, 75%-84%=!, 65%-74%=2, <65%=3

C4

Component 5 # sum of scores 5b to 5j (0=0; 1-9=1; 10-18=2; 19-27=3)

C5

Component 6 #6 Score

C6

Component 7 #7 Score + #8 score (0=0; 1-2=1; 3-4=2; 5-6=3)

C7

Add the seven component scores together _______________ Global PSQI A total score of “5” or greater is indicative of poor sleep quality.

If you scored “5” or more it is suggested that you discuss your sleep habits with a healthcare provider

•

Mini Nutritional Assessment

•

In-Home Risks and Activities of Daily Living (ADLs)

Katz Index of Independence in Activities of Daily Living Activities

Independence

Dependence

Points (1 or 0)

(1 Point)

(0 Points)

NO supervision, direction or personal assistance.

WITH supervision, direction, personal assistance or total care.

(1 POINT) Bathes self completely or needs help in bathing only a single part of the body such as the back, genital area or disabled extremity.

(0 POINTS) Need help with bathing more than one part of the body, getting in or out of the tub or shower. Requires total bathing

(1 POINT) Get clothes from closets and drawers and puts on clothes and outer garments complete with fasteners. May have help tying shoes.

(0 POINTS) Needs help with dressing self or needs to be completely dressed.

(1 POINT) Goes to toilet, gets on and off, arranges clothes, cleans genital area without help.

(0 POINTS) Needs help transferring to the toilet, cleaning self or uses bedpan or commode.

BATHING

Points: DRESSING

Points: TOILETING

Points: TRANSFERRING (1 POINT) Moves in and out of bed or chair (0 POINTS) Needs help in moving unassisted. Mechanical transfer aids are from bed to chair or requires a acceptable complete transfer.

Points: CONTINENCE

(1 POINT) Exercises complete self control over urination and defecation.

(0 POINTS) Is partially or totally incontinent of bowel or bladder

Points: FEEDING

(1 POINT) Gets food from plate into mouth (0 POINTS) Needs partial or total without help. Preparation of food may be help with feeding or requires done by another person. parenteral feeding.

Points:

TOTAL POINTS:

SCORING: 6 = High (patient independent) 0 = Low (patient very dependent

Source: try this: Best Practices in Nursing Care to Older Adults, The Hartford Institute for Geriatric Nursing, New York University, College of Nursing, www.hartfordign.org.

• Vision Assessment What is visual acuity and what does 20/20 vision mean?

Visual acuity (VA) is commonly referred to as the sharpness of vision, measured by the ability to discern letters or numbers at a given distance according to a fixed standard.

20/20 vision is considered "normal" vision, meaning you can read at 20 feet a letter that most people should be able to read at 20 feet.

If a patient reads the 20/200 line that means they can read at 20 feet the letters that people with "normal" vision can read at 200 feet. So at 20/200, your visual acuity is very poor.

Steps to checking vision using Snellen eye chart 1. Have patient stand at appropriate marking on floor.

2. If patient has glasses make sure they are wearing the proper glasses for distance vision.

3. Give patient occluder and have them cover the eye not being tested.

4. Have patient read the smallest line they can see on the chart 5. If patient reads all 5 letters correctly and there are more lines below then ask them to try the next line.

6. Repeat steps for opposite eye.

How to record vision 1. If the patient reads all the letters on the 20/30 line you would record their vision as 20/30.

2. If the patient is reading the 20/30 line and reads 3 out of the 5 letters correctly you would record that vision as 20/30-2.

3. If the patient is reading the 20/30 line and reads all the letters correctly and then reads 2 letters of the next line correct their vision would be 20/30+2.

4. You can use that notation with any line of vision no matter what the number of letters are.

Using a pinhole occluder 1. If the patient can’t see any better than 20/40 try using the pinhole technique. This technique helps to focus the light and removes the effects of refractive errors such as myopia.

2. Using the occluder put the pinhole flap over the opening and have the patient wiggle the occluder back and forth until they find a hold that makes it look clearer for them.

3. Then have the patient read the next clearest line of vision that they can see.

4. Record the vision as PH: 20/___.

Patients with poor vision less than 20/400

•

Disability Assessment WHODAS 2.0 World Health Organization Disability Assessment Schedule 2.0 ( self-administered)

This questionnaire asks about difficulties due to health/mental health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs. Think back over the past 30 days and answer these questions thinking about how much difficulty you had doing the following activities. For each question, please circle only one response.

Numeric scores assigned to each of the items:

1

2

3

4

5

None

Mild

Moderate

Severe

None

Mild

Moderate

Severe

None

Mild

Moderate

Severe

Extreme or cannot do Extreme or cannot do

In the last 30 days, how much difficulty did you have in: Understanding and communicating Concentrating on doing something for ten D1.1 minutes?

D1.2 D1.3 D1.4

Remembering to do important things?

Analyzing and finding solutions to problems in day-to-day life?

Learning a new task, for example, learning how to get to a new place?

None

Mild

Moderate

Severe

D1.5

Generally understanding what people say?

None

Mild

Moderate

Severe

D1.6

Starting and maintaining a conversation?

None

Mild

Moderate

Severe

Raw Item Score Raw Domain Score Average Domain Score

Clinician Use Only

Extreme or cannot do Extreme or cannot do ____

____

30

5

____

____

25

5

____

____

20

5

____

____

25

5

Extreme or cannot do Extreme or cannot do

Getting around D2.1

Standing for long periods, such as 30 minutes?

None

Mild

Moderate

Severe

D2.2

Standing up from sitting down?

None

Mild

Moderate

Severe

D2.3

Moving around inside your home?

None

Mild

Moderate

Severe

D2.4

Getting out of your home?

None

Mild

Moderate

Severe

None

Mild

Moderate

Severe

D2.5

Walking a long distance, such as a kilometer (or equivalent)?

Extreme or cannot do Extreme or cannot do Extreme or cannot do Extreme or cannot do Extreme or cannot do

Self-care D3.1

Washing your whole body?

None

Mild

Moderate

Severe

D3.2

Getting dressed?

None

Mild

Moderate

Severe

D3.3

Eating?

None

Mild

Moderate

Severe

D3.4

Staying by yourself for a few days?

None

Mild

Moderate

Severe

None None

Mild Mild

Moderate Moderate

Severe Severe

None

Mild

Moderate

Severe

Extreme or cannot do Extreme or cannot do Extreme or cannot do Extreme or cannot do

Getting along with people D4.1 D4.2 D4.3

Dealing with people you do not know?

Maintaining a friendship?

Getting along with people who are close to you?

D4.4

Making new friends?

None

Mild

Moderate

Severe

D4.5

Sexual activities?

None

Mild

Moderate

Severe

Extreme or Extreme cannot door cannot do Extreme or cannot do Extreme or cannot do Extreme or cannot do

2

3

4

5

In the last 30 days, how much difficulty did you have in:

Life activities—Household D5.1

Taking care of your household responsibilities?

None

Mild

Moderate

Severe

D5.2

Doing most important household tasks well?

None

Mild

Moderate

Severe

Getting all of the household work done that None Mild Moderate Severe you needed to do?

Getting your household work done as quickly as D5.4 None Mild Moderate Severe needed?

Life activities—School/Work If you work (paid, non-paid, self-employed) or go to school, complete questions D5.5–D5.8, below. Otherwise, skip to D6.1.

Because of your health condition, in the past 30 days, how much difficulty did you have in: D5.3

D5.5 D5.6 D5.7 D5.8

Your day-to-day work/school?

Doing your most important work/school tasks well?

Getting all of the work done that you need to do?

Getting your work done as quickly as needed?

Participation in society In the past 30 days: How much of a problem did you have in joining in community activities (for example, festivities, D6.1 religious, or other activities) in the same way as anyone else can?

How much of a problem did you have because D6.2 of barriers or hindrances around you?

How much of a problem did you have living with dignity because of the attitudes and D6.3 actions of others?

How much time did you spend on your health D6.4 condition or its consequences?

How much have you been emotionally affected D6.5 by your health condition?

How much has your health been a drain on the D6.6 financial resources of you or your family?

How much of a problem did your family have D6.7 because of your health problems?

How much of a problem did you have in doing D6.8 things by yourself for relaxation or pleasure?

Extreme or cannot do Extreme or cannot do Extreme or cannot do

Average Domain Score

1

Raw Domain Score

Numeric scores assigned to each of the items:

Raw Item Score

Clinician Use Only

____

____

20

5

Extreme or cannot do

None

Mild

Moderate

Severe

Extreme or cannot do

None

Mild

Moderate

Severe

Extreme or cannot do

____

____

20

5

____

____

40

5

____

____

180

5

None

Mild

Moderate

Severe

Extreme or cannot do

None

Mild

Moderate

Severe

Extreme or cannot do

None

Mild

Moderate

Severe

Extreme or cannot do

None

Mild

Moderate

Severe

None

Mild

Moderate

Severe

Extreme or cannot do

Extreme or cannot do

None

Some

Moderate

A Lot

Extreme or cannot do

None

Mild

Moderate

Severe

Extreme or cannot do

None

Mild

Moderate

Severe

Extreme or cannot do

None

Mild

Moderate

Severe

Extreme or cannot do

None

Mild

Moderate

Severe

Extreme or cannot do

General Disability Score (Total):

© World Health Organization, 2012. All rights reserved. Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0), World Health Organization, 2010, Geneva. The World Health Organization has granted the Publisher permission for the reproduction of this instrument. O.

WHODAS 2.0 World Health Organization Disability Assessment Schedule 2.0 36-item version, self-administered

The adult self-administered version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a 36-item measure that assesses disability in adults age 18 years and older. It assesses disability across six domains, including understanding and communicating, getting around, self-care, getting along with people, life activities (i.e., household, work, and/or school activities), and participation in society. If the adult individual is of impaired capacity and unable to complete the form (e.g., a patient with dementia), a knowledgeable informant may complete the proxy-administered version of the measure, which is available at www.psychiatry.org/dsm5. Each item on the self-administered version of the WHODAS 2.0 asks the individual to rate how much difficulty he or she has had in specific areas of functioning during the past 30 days.

WHODAS 2.0 Scoring Instructions Provided by World Health Organization WHODAS 2.0 Summary Scores: There are two basic options for computing the summary scores for the WHODAS 2.0 36-item full version.

Simple: The scores assigned to each of the items—“none” (1), “mild” (2), “moderate” (3), “severe” (4), and “extreme” (5)—are summed. This method is referred to as simple scoring because the scores from each of the items are simply added up without recoding or collapsing of response categories; thus, there is no weighting of individual items. This approach is practical to use as a hand-scoring approach, and may be the method of choice in busy clinical settings or in paper-and-pencil interview situations. As a result, the simple sum of the scores of the items across all domains constitutes a statistic that is sufficient to describe the degree of functional limitations.

Complex: The more complex method of scoring is called “item-response-theory” (IRT)–based scoring.

It takes into account multiple levels of difficulty for each WHODAS 2.0 item. It takes the coding for each item response as “none,” “mild,” “moderate,” “severe,” and “extreme” separately, and then uses a computer to determine the summary score by differentially weighting the items and the levels of severity. The computer program is available from the WHO Web site. The scoring has three steps: • • •

Step 1—Summing of recoded item scores within each domain.

Step 2—Summing of all six domain scores.

Step 3—Converting the summary score into a metric ranging from 0 to 100 (where 0 = no disability; 100 = full disability).

WHODAS 2.0 Domain Scores: WHODAS 2.0 produces domain-specific scores for six different functioning domains: cognition, mobility, self-care, getting along, life activities (household and work/school) and participation.

WHODAS 2.0 Population Norms: For the population norms for IRT-based scoring of the WHODAS 2.0 and for the population distribution of IRT-based scores for WHODAS 2.0, please see http://www.who.int/classifications/icf/Pop_norms_distrib_IRT_scores.pdf

Additional Scoring and Interpretation Guidance for DSM-5 Users The clinician is asked to review the individual’s response on each item on the measure during the clinical interview and to indicate the self-reported score for each item in the section provided for “Clinician Use Only.” However, if the clinician determines that the score on an item should be different based on the clinical interview and other information available, he or she may indicate a corrected score in the raw item score box. Based on findings from the DSM-5 Field Trials in adult patient samples across six sites in the United States and one in Canada, DSM-5 recommends calculation and use of average scores for each domain and for general disability. The average scores are comparable to the WHODAS 5-point scale, which allows the clinician to think of the individual’s disability in terms of none (1), mild (2), moderate (3), severe (4), or extreme (5). The average domain and general disability

scores were found to be reliable, easy to use, and clinically useful to the clinicians in the DSM-5 Field Trials. The average domain score is calculated by dividing the raw domain score by the number of items in the domain (e.g., if all the items within the “understanding and communicating” domain are rated as being moderate then the average domain score would be 18/6 = 3, indicating moderate disability). The average general disability score is calculated by dividing the raw overall score by number of items in the measure (i.e., 36). The individual should be encouraged to complete all of the items on the WHODAS 2.0. If no response is given on 10 or more items of the measure (i.e., more than 25% of the 36 total items), calculation of the simple and average general disability scores may not be helpful. If 10 or more of the total items on the measure are missing but the items for some of the domains are 75%–100% complete, the simple or average domain scores may be used for those domains.

Frequency of Use To track change in the individual’s level of disability over time, the measure may be completed at regular intervals as clinically indicated, depending on the stability of the individual’s symptoms and treatment status. Consistently high scores on a particular domain may indicate significant and problematic areas for the individual that might warrant further assessment and intervention.

•

Elder Mistreatment Assessment

SECTION 7 Rehab Services THRIVE with Acts

Rehab Services -- THRIVE WITH ACTS THRIVE with Acts was created to help seniors maintain the independent lifestyle they’re currently enjoying. It’s an individualized program that helps you to live better today, and stave off problems in the future. The sooner a resident is evaluated, the easier any issues are to resolve.

Our therapists are medical professionals who are trained to assess all bodily systems and how they relate to one another to achieve optimal physical and functional health. Their specialized skills and treatments provide a jump start or provide a tune up to allow full benefits of Acts Fitness and Wellness programs. Because THRIVE with Acts dovetails with fitness programs, it’s easy to continue to maintain the gains made when transitioning from THRIVE with Acts to the Fitness Team.

A lot of older adults accept pain, shortness of breath, memory problems, and loss of balance as normal consequences of the aging process. At THRIVE with Acts, it doesn’t have to be that way.

If a resident is happily leading an independent lifestyle, we’re here to make sure that continues.

We not only maintain quality of life, often times we can improve it. THRIVE with Acts utilizes the skilled physical, occupational and speech therapists who are already on site to help residents maintain quality of life. We’re here to keep our residents thriving.

PROCESS We start with a 15-minute screening to determine if a resident is aging normally. We examine flexibility, strength, energy, balance and memory, using gender and age-specific standardized tests that give you an idea of where your individual capabilities fall. Our experts are trained to identify subtle signs of abnormal aging that could lead to more serious life-altering consequences somewhere down the road. If we think there are areas where quality of life could be improved, we make recommendations.

IMPROVE STRENGTH Why it’s important: Strength is critical for independent living. Physician and researcher Mary Tinetti says “leg strength – not age or other measurements – was the single most powerful predictor as to whether a person was going to have to enter a nursing home.”

What we can do about it: Our physical and occupational therapists determine which muscles you need to strengthen in order to develop a safe strengthening plan.

IMPROVE BALANCE Why it’s important: Two-thirds of adults over 65 report falls every year, and two-thirds of those will fall again within six months. For people over 85, one fall in ten results in a hip fracture – from which most individuals fail to fully recover.

What we can do about it: Balance improves only with regular practice that challenges your balance systems. We help to safely challenge balance and progress skills, while incorporating balance training into daily life.

IMPROVE FLEXIBILITY

Why it’s important: Flexibility exercises can reduce pain and the risk of injuries, reduce postural problems that can lead to falls, and improve blood flow to joints for pain relief.

What we can do about it: Our physical and occupational therapists know what muscles to stretch, and can provide education on how to stretch for lasting results, as well as what exercises to avoid. According to the American College of Sports Medicine, it takes as little as 150 minutes a week to...

IMPROVE THE MIND Why it’s important: THRIVE WITH ACTS MIND is designed to protect Acts residents from developing dementia and to slow the progression of dementia before it is even noticeable.

What we can do about it: We address your unique set of risk factors and provide a personally tailored program of brain exercises and challenges that help to build attentiveness and mental processing, aid decision-making and more.

IMPROVE ENERGY Why it’s important: Energy is like love. The more you give, the more you get back.

What we can do about it: Our physical and occupational therapists will help determine what exercise and duration will work best to improve vital heart and lung functions. While maintaining the residents safety, we we’re working hard enough to make a difference.

THRIVE SCREEN instructions and interpretation Initial Core Tests Self Selected Gait Speed Instructions: • • • • • •

Allow 6’ at the beginning and end of the measure to allow for acceleration and deceleration.

Instruct client to walk at their usual pace .

Do not tell the client where the timing will start and stop . One practice trial permitted. Test is not appropriate if human assistance is needed to walk.

Start the timer when the midsagittal line of the trunk crosses the start line (after the 6’ pre-walk) End the timer when the midsagittal line of the trunk crossed the end line (before the 6’ post walk) Repeat 3 times and calculate the average time

Risk markers/norms • • •

<.5 m/sec is correlated with Frailty < .57 m/sec correlated with fall risk < .6m/sec is associated with increased risk of hospitalization

2 Minute Walk Test Instructions •

Determine a 30 meter (98 feet, 5 inches) course to minimize turns. Minimal distance permitted for test is 50’

• • • • • • •

Place a cone at each end Client sits in a chair at the starting line for 10 minutes Use the script in Rehab EBTK. Let the client know you will be nearby but cannot walk with them and do not talk to anyone. May use assistive device and O2 if needed . No practice session permitted Take pre-test vitals Take RPE as soon as the client stands.

In the last 15 seconds of test, prepare a chair for the client to sit immediately. If the client needs to sit before 2 minutes, the test is completed. May take standing rests, but timer continues.

Take post vitals and compare to pre vitals

Risk markers/norms Gender/age

Mean distance in Meters-MEN

60-64 65-69 70-74 75-79 80-85

179 meters or 587 feet 184 meters or 603 feet 172 meters or 564 feet 158 meters or 518 feet 144 meters or 472 feet

Mean distance in MetersWOMEN 166 meters or 544 feet 155 meters or 508 feet 146 meters or 479 feet 141 meters or 462 feet 134 meters or 439 feet

Occiput to Wall Instructions: • • • •

Client stands against a wall with buttocks, back, and heels touching the wall Instruct the client to stand as tall as possible and attempt to push the back of the head into the wall.

Ensure the client maintains a neutral cervical spine and does not substitute with cervical spine extension.

Using a ruler from a lateral view, measure the distance between the occipital prominence and the wall.

Risk markers/norms Distance to wall 0 cm (occiput touches wall) >1.2 cm >4 cm

Implications Reduced risk of thoracic compression fracture Increased risk of compression fracture Recommend x-ray to rule out compression fracture. (consider pain, recent trauma or new change in posture when considering xray)

Timed Up and Go Instructions • • • • • •

Client wears their regular footwear and uses their customary walking aid No physical assistance permitted.

Clients starts by sitting is a seat that is 18” high, with back against the chair back, feet flat on the floor, and arms on the arm rests.

Place a line on the floor (do not use a cone) 3 meters or 9’10” from the client’s toes.

Instruct the patient as follows: “When I say GO, walk at your normal pace to the line on the floor, turn around, walk back to the chair and sit down.” The client is permitted one practice trial A gait belt may be used if safety is questionable . The timer begins when the client’s buttocks leave the chair and stops when the client’s buttocks contact the chair.

Risk markers/norms >/= 12 seconds=predicts future falls 30 second chair rise Instructions

• • • • •

Stabilize a 17” folding chair against a wall Instruct the client to cross arms across their chest and rise to stand without use of hands Allow client to practice 1-2 times . Instruct the client that upon “Go”, they are to rise to full standing and sit again as many times as possible in 30 seconds If more than half way up at 30 seconds, the rep may be counted Record the number of repetitions completed in 30 seconds

Risk markers/norms 0= health failure functional marker 1-8= Frail functional marker Grip strength Instructions •

• • •

Client is seated with arm at side, shoulder in neutral rotation, elbow at 90 degrees flexion, forearm in neutral pronation/supination, wrist at 0-30 degrees extension. (Client can rest the forearm on an armrest of a chair with wrist positioned just over the end of the armrest). Dynamometer is set on second handle position Client is instructed to squeeze as hard as possible for 3 seconds. Cue to client to “squeeze harder” Clinician should watch for the needle to stop rising .

Complete 3 trials on each hand, alternating sides. Use maximum of the 6 trials as result

Risk markers/norms Gender Normal lbs

Intermediate lbs.

Weak lbs

Male

70.55 or greater

57.32 - 70.54

<57.32

Female

44.09 or greater

35.27- 44.08

<35.27

Functional Trial Reach Test Instructions: •

• • • • •

Client stands next to but not touching a wall and raises arm to 90 degrees of flexion , forearm in neutral with the hand open (Therapist should be sure the shoulder is not protracted or retracted Feet should be facing forward and a comfortable distance apart Mark the wall with tape the end of the 3rd finger. Instruct the client to “Reach as far forward as you can without taking a step or losing your balance. You are not allowed to touch the wall as you reach” Client is free to use various reaching strategies Clients may have 2 practice trials Mark the wall at the end of the 3rd finger Measure the distance between the starting and ending position. Repeat the test 3 times and average the scores

Risk Markers/Norms <6”=4x more likely to have 2 falls in next 6 months 6-10”=2x more likely to have 2 falls in next 6 months Single Leg Stand Test Instructions • •

Client stands barefoot or in safe footwear. Feet should be apart (about the length of the client’s foot) Client places hands on hips. Guard client closely

• • •

Instruct the client to slowly shift weight to either leg and lift the other foot slightly off the floor (client chooses).

Time how long the resident can hold the one leg stand position Start the timer when the foot clears the ground. Stop the timer when any of the following occurs: o 30 seconds elapses o Suspended foot touches the ground o hands come off the hips o Client uses suspended limb to support weight bearing limb, displacement of the weight bearing limb

Risk Markers/Norms <5 seconds =Increased risk of injurious fall Trail Making Test A Instructions • • • •

Give the patient a copy of the Trail Making Test Part A worksheet and a pen or pencil Demonstrate the test to the client using the sample sheet Time the client as he or she follows the “trail” made by the numbers on the test Record the time Repeat the procedure for Trail Making Test Part B using letters and numbers

Trail Making Test A Risk Markers/norms Average MCI 29 seconds >48.1 seconds

Alzheimer’s >67.1 seconds

Trail Making Test B Instructions • • •

Give the patient a copy of the Trail Making Test Part B worksheet and a pen or pencil. Demonstrate the test to the client using the sample sheet Time the client as he or she follows the “trail” made by the numbers on the test Record the time

Trail Making Test B Risk Markers/norms Average MCI Alzheimer’s 75 seconds >136 seconds >190.8 seconds Subsequent Additional Tests 6 Minute Walk test Instructions • • • • • • • •

Determine a 30 meter (98 feet, 5 inches) course to minimize turns Minimal distance permitted for test is 50’. Place a cone at each end Client sits in a chair at the starting line for 10 minutes Use the script in Rehab EBTK Let the client know you will be nearby but cannot walk with them and do not to talk to anyone. May use assistive device and O2 if needed No practice session permitted Take pre-test vitals Take RPE as soon as the client stands

• • •

In the last 15 seconds of test, prepare a chair for the client to sit immediately. If the client needs to sit before 2 minutes, the test is completed.

May take standing rests, but timer continues.

Take post vitals and compare to pre vitals

Risk markers/norms Gender/age 60-69 70-79 80-89

Mean distance in MetersMEN 560 (1837’) 530 (1738.85’) 446 (1463’)

Mean distance in MetersWOMEN 595 (1952’) 490 (1607’) 382 (1253’)

2 minute Step Test Instructions • • • • • • • •

Take resting vital signs Have client stand next to a wall Measure the height of the iliac crest and patella and mark it on the wall. Then place a piece of tape on the wall half the distance between the two On the signal “go” the client begins stepping (not running) in place, raising each knee to the mark on the wall, for as many times as possible in the 2 minute period. Only count the number of times the right knee reaches the required height. That is the score If the proper knee height cannot be maintained, ask the participant to slow down, or to stop until they can regain the proper form, but keep the stopwatch running At the end of the test, provide a cool down by asking the client to walk slowly for a minute A client with impaired balance may use the back of a chair or wall as a touch-hold for stability Take post exercise vital signs

Risk markers Scores less than 65 were associated with lower levels of functional ability community residing older adults ages 60-94 Five Times Sit to Stand Test Instructions • • • • • •

Utilize a chair 16.93 to 17.72” high. Chair should be free standing and not against a wall Instruct the client to cross arms across their chest and rise to stand without use of hands Demonstrate the test and allow client to practice 1-2 times Instruct the client that upon “Go”, they are to rise to full standing and sit again as fast as possible 5 times Examiner should count the reps out loud. If more than half way up at 5 seconds, the rep may be counted Record the time to complete 5 reps

Risk Markers Predictive of disability within 2 years Individuals in need of further fall risk assessment Identification of balance dysfunction Future fallers verses non fallers cut off time Parkinson’s Disease fall risk cut off Arm Curl Test

>10 sec ≥12 sec ≥14.2 sec ≥15 sec >16 sec

Instructions • • • • •

•

Client sits with back against the backrest of an ARMLESS chair Client is not permitted to lean forward from the backrest Client should use dominant hand. Start position: Arm should be fully extended to the side of the chair in neutral supination/pronation Place 5 lb. dumbbell in hand for women and 8 lb. for men Client is instructed to perform a biceps curl by flexing the elbow and supinating the forearm. Client needs to complete the curl by aiming palm to shoulder and return to full starting position. Start the timer when the client assumes the start test position Count the number of curls the client completes in 30 secs (1 rep = flex and return to extended elbow). If the client has completed 50% of the up motion at the end of 30 seconds, the rep can be counted

Risk markers/norms Men AGE 70-74 75-79 80-84 85-89 90-94

Below average <14 <13 <13 <11 <10

Average 14-21 13-19 13-19 11-17 10-14

Above Average >21 >19 >19 >17 >14

Women AGE 70-74 75-79 80-84 85-89 90-94

Below average <12 <11 <10 <10 <8

Average 12-17 11-17 10-16 10-15 8-13

Above Average >17 >17 >16 >15 >13

Sit and Reach Test Instructions: Contraindications: Osteoporosis or signs of osteoporosis risk /History of spinal compression fracture/Total Hip Flexion precautions • • • • • • • • •

Client sits on the edge of a 17”chair with one knee flexed to 90 degrees and foot flat on floor The other leg is extended at the knee with the ankle in dorsiflexion and the heel on the floor Client is instructed to place one hand on top of the other so the middle fingers overlap evenly Instruct the client to inhale and then exhale while reaching toward the toes of the outstretched leg Monitor and ensure the client flexes from the hip and keeps the trunk in neutral with the head up .Note how far the client can reach (without illiciting pain ) Repeat with the other leg in order to determine the best side to measure Have the client practice 2 times on the chosen leg Measure the distance in inches from the tip of the extended middle finger and the tip of the great toe to the nearest ½ inch Perform 2 more trials and record the best of the 2.

Scoring: • • •

Great toe is reached: 0 Great toe is not reached: - (inches from great toe) Great toe is passed: + (inches past great toe

Risk Markers/Norms Age 60-64 65-69 Women (inches) -0.5±5.0 -.5±4.5 Men (inches) -2.5±4.0 -3.0±3.0

70-74 -1.0±4.0 -3.0±3.0

75-79 -1.5±3.5 -4.0±2.0

80-84 -2 ±3.0 -5.5±1.5

85-89 -2.5±2.5 -5.5±0.5

90-94 -4.5±1.0 -6.5±0.5

Back Scratch Test Instructions: *contraindicated in clients with acute shoulder impingement or recent shoulder surgery .

• • • • • • • •

Client stands and reaches one hand over the same shoulder with the palm facing toward the trunk and fingers extended Client takes other hand up from the waist with palm facing outward and fingers extended upward .

Instruct the client to reach both hands toward each other as far as possible trying to touch or overlap the middle fingers Repeat the other direction of each arm Choose the direction that appears to give the best result. Client then practices on the chosen side 2 times.

Measure the 3rd and 4th attempt and record the best score Measure the distance in inches between the 2 middle fingers .Record as “+” if the middle fingers overlap and as “ – “ if the middle fingers do not reach each other Do not allow the following: Breath holding, Rapid or ballistic movements, client grabbing of fingers or wrist in an attempt to gain additional range of motion, watch for scapular winging

Back Scratch test (inches) Age 70-74 75-79 Women -4.0 ±1.0 -5.0 ±.5 Men -8.0 ±1.0 -4.0 ±1.0

80-84 -5.5±1.0 -9.0 ±2.0

85-89 -7.0 ±1.0 -9.5 ±2.0

90-94 -8.0 ±1.0 -10.5±6.5

Timed Up and Go dual Task Manual Instructions: • • • • • • • • •

Client wears their regular footwear and uses their customary walking aid .No physical assistance is given for the test Clients starts by sitting is a seat that is 18” high, with back against the chair back, feet flat on the floor, and arms on the arm rests.

Place a line on the floor (do not use a cone) 3 meters or 9’10” from the client’s toes.

Instruct the patient as follows: “When I say GO, walk at your normal pace to the line on the floor, turn around, walk back to the chair and sit down.” The client is permitted one practice trial . A gait belt may be used if safety is questionable .

The timer begins when the client’s buttocks leave the chair and stops when the client’s buttocks contact the chair.

Record time for regular TUG, then repeat the test carrying a glass of water filled 1” from the top of the cup.

Place the cup on a table next to the client .Give the following instructions: “When I say GO, walk at your normal pace to the line on the floor, turn around, walk back to the chair and sit down. Take the glass of water with you by any means you choose” (The client may pick up the cup and proceed or may stand, then pick up the cup.

The client may set the cup on the table before sitting if they choose).

Risk Markers/Norms Score Difference of >4.5 sec between TUG and TUG manual

Findings predictive of risk of fall within the next 6 months.

Tandem Stand Test: Instructions: • • •

Client stands barefoot or in safe footwear Client places feet in tandem (heel to toe position with preferred limb in back). Guard client closely.

Time how long the client can hold the test position

• • • •

Client may use a chair back support to attain test position Start the timer when the client assumes the test position Stop the timer when any of the following occurs: 30 seconds elapses/ Client takes a step or loses balance .

Give 3 trials and average

Risk markers/norms < 10 sec=risk of falls Four Square Step Test Instructions: • • • • • • • • •

Form a square by using 4 canes or 1” dowels so there are 4 18’x 18” squares (do not use tape).

Demonstrate the test the test first Client begins in bottom left square and steps forward with each foot into square above, then to the right into square, then backward into square, then left to beginning square The client then reverses the same path stepping to the right, then forward, then to the left, then backward into the beginning square Client is permitted one practice trial, then 3 trials to obtain 2 valid timed trials Start the timer when the first foot touches square 2 and stops when both feet touch the original square 1.

No instructions should be given during the test Guard closely trying not to make contact with the client Invalid trial: feet touching the canes, any loss of balance, not getting both feet into any of the squares

Risk Markers/norms Fall risk indicators >15 seconds >12 seconds Inability to obtain 2 valid trails in 3 attempts

Risk Group community dwelling adults= risk multiple falls Vestibular clients= risk of > 1 fall Risk of fall

Results of the THRIVE assessment and recommendations are recorded in the Rehab electronic medical record and made available to Well-Being Coach for insertion into the resident’s Signature Well-Being Portfolio.

THRIVE Assessment has been created as a UDA (user defined assessment) in PCC. Results are then filtered into Power BI:

SECTION 8 Fitness

Fitness SUMMARY Physical activity and exercise play a vital role in health and wellbeing. The Acts fitness and recreational programs provide a variety of opportunities to engage in individual exercises, group exercise classes and recreational sports. The fitness staff work with each resident to design a personalized approach to physical activity or exercise to improve the ability to live longer, healthier, happier lives.

FITNESS ORIENTATION AND UPDATE Acts residents are provided with an orientation to the fitness program and regular consultations to update programs as needs, goals and interests change. The orientation and consultations may include an individualized exercise program, recommendations for participation in group fitness classes and recreational sports programs. ✓ Individualized exercise program include recommendations for the frequency, intensity, duration and mode of cardiovascular, muscular strength and endurance, flexibility, and balance training ✓ Recommendations for participation in group exercise classes may include aerobic, strength, flexibility, balance, or aquatic classes as well as specialty classes such as Tai Chi, Yoga, Zumba, Line Dancing etc. ✓ Recommendations for participation in recreational sports may include Bocce, Pickle Ball, Shuffleboard, Billiards, Bridge etc. ✓ Fitness programming recommendations will include programs offered within the community as well as with partners within the community at large.

STAFF The Acts fitness instructors are certified fitness and aquatic professionals. The fitness instructors work in collaboration with the Wellness staff, Rehab staff, Life Engagement staff and Dietitians to provide safe and effective physical activity and exercise programs that meet the needs and interests of the Acts residents.

TECHNOLOGY and EQUIPMENT • Cardiovascular and strength training equipment • Balance training devices • Aquatic exercise equipment • Electronic apps/devices to track exercise performance PROCESS Part 1:

Introduction to Fitness and Recreation Programming

An introduction to fitness and recreational programming is available to new residents, residents that are interested in beginning an exercise or physical activity program or residents that are recently completing a THRIVE program.

• • • •

Part 2:

Fitness staff schedules a time to meet with residents to introduce themselves and the fitness and recreational program.

Discuss the resident’s overall health, needs and interest, previous experiences and current participation in physical activity and recreational sports.

Review programs that are offered within the community as well as in the community at large.

Answer any questions and identify a plan for participation in physical activity and recreational programming.

Orientation to Fitness and Recreational Programming

The Well-Being Coach will schedule a Fitness Assessment with the Fitness Center following the resident’s pre-visit screening in the Wellness Suite. Fitness instructors will: • • • •

Provide training on the use of the tracking devise Review tracking device data at predetermined intervals Complete assessment and goal setting Develop and schedule an exercise plan

The personalized approach to fitness and recreational programming may include a combination of an individual exercise program, attendance in group exercise classes and/or participation in recreational sports: • •

•

•

•

Resident will schedule an orientation with the fitness director/trainer to identify programming options that will meet their needs and interests.

Prior to meeting with the resident, the fitness staff will review the results of the AWE and the THRIVE screen and discuss potential limitations to physical activity with the NP, Wellness and Rehab staff It is recommended that residents that have not had a recent medical evaluation consult the NP, Wellness staff, medical provider or Rehab staff prior to engaging in a physical activity or exercise program Residents interested in an individualized exercise program will: o Sign the Acknowledgement Form prior to beginning an exercise program o Receive an orientation to the fitness equipment and policies for using the Fitness Center, and swimming pool if appropriate o Receive a personalized exercise program, based on the resident’s specific fitness level, health and goals and interests Residents interested in participating in group exercise classes will:

•

o Sign the Acknowledgement Form prior to participation in a class o Receive an overview of the classes that will meet their specific fitness level, health and goals and interests Residents interested in participating in recreation sports will: o Sign the Acknowledgement Form prior to participation in any program o Receive information on the schedule and policies for participating in recreational programs o Receive contact information for committees or individual residents that oversee recreational programming if appropriate

Part 3: Follow Up Fitness staff will follow up with residents: • Every 6 months to provide motivation and encouragement and adjust programming based on new goals and interest • Meetings to adjust programming will also be scheduled anytime there is a change in medical status, a change in participation or the resident shares a new goal or obtainment of a previous goal Residents reporting or exhibiting changes in medical or functional status will be immediately referred to the NP, Wellness staff or Rehab staff for an evaluation.

Fitness assessments, goals and recommendations are made available to the Well-Being Coach and implemented into the resident’s Signature Well-Being Portfolio.

FORMS/ASSESSMENTS/TEMPLATES 1. Access to medical history, pre-Annual visit results, THRIVE Screen results 2. Acts Use of Equipment, Release and Liability Form 3. Exercise Tracking Log a. Paper form b. Electronic app/tracking device data (tracking device options are under investigation)

American College of Sports Medicine Exercise Recommendations (Guidelines for Exercise Testing and Prescription 11th ed 2022) Aerobic (Cardiovascular Endurance) Exercise Recommendations Recommendation Frequency > 5 days/wk of moderate intensity exercise > 3 days/wk of vigorous intensity exercise 3 – 5 days/wk of a combination of moderate and vigorous intensity exercise Intensity Moderate intensity of 40 – 59% HRR or 12 – 13 RPE Vigorous intensity of 60 – 89% HRR or 14 – 17 RPE Time 30 – 60 min/day (> 150 min /wk) of moderate intensity exercise 20 – 30 min/day (> 75 min/wk) of vigorous intensity exercise A combination of moderate and vigorous intensity exercise daily to obtain recommended volumes Exercise time may be accumulated over the course of a day Volume (the product or > 150 min/wk of moderate intensity aerobic exercise frequency, intensity and > 75 min/wk of vigorous intensity aerobic exercise time) Energy expenditure of > 500 – 1,000 met/min/wk A step count of 7,000 to 8,000 steps/day with at least 3,000 steps at a brisk pace (>100 steps/min) 100 steps/min meets the threshold for moderate intensity physical activity Type Aerobic exercise that involves the larger muscle groups of the body, performed in a continuous or intermittent pattern Activity should not impose excessive orthopedic stress Resistance Training Recommendations Recommendation Frequency Each major muscle group should be trained at least 2 days/wk Experienced exercisers may choose a weekly frequency per muscle group based on personal preference Intensity Progressive Weight Training: Light intensity (40 – 50% 1RM) for beginners Progress to moderate to vigorous intensity (60 – 80% 1RM)

Time

Volume (total sets performed per

Power Training: Light to moderate intensity (30 – 60% 1RM) Progressive Weight Training: 8-10 exercises involving each of the major muscle groups > 1 set, 10 – 15 reps Progressing to 1-3 sets, 8-12 reps of each exercise Power Training: 6-10 reps with high velocity One set per muscle group, per session or < 4 sets/muscle group/wk Sets may be of the same exercise or a combination of exercises using the same muscle group

muscle group per week) Type

Progressive Weight Training: Multi joint exercises affecting more than one muscle group, targeting agonist and antagonist muscle groups Single joint and core exercises, after performing multi joint exercises A variety of equipment and body weight exercises may be used Power Training: Single and multi-joint exercises using light to moderate loads

Flexibility Exercise Recommendations Recommendations Frequency > 2-3 days/wk, daily is most effective Intensity Stretch to the point of tightness or mild discomfort Time Static stretching, hold for 30-60 sec Volume (number A total of 90 sec per muscle group (hold a stretch for 30, repeat 3 times) of stretches and time held for each muscle group)* Type Activities that use slow movements to maintain or increase flexibility and terminate in a static stretch for each muscle group Neuromotor (Balance) Exercises Recommendations Frequency Neuromotor exercise training combining balance, agility and proprioceptive training should be performed 2-3 days/wk Intensity Appropriate to challenge balance Time* > 20 – 30 min for a total of > 60 min/wk Type Multi component activities (static and dynamic balance, muscular strengthening, flexibility, power, agility, etc.)

Multitask activities with high levels of physical, mental and social demands are more effective Progressively difficult postures that challenge base of support Dynamic movements challenging ability to maintain center of gravity over base of support Exercises to strengthen postural muscle groups Activities that reduce sensory input *ACSM Guidelines for Exercise Testing and Prescription 10 ed. (2018)

ACTS Retirement-Life Communities, Inc. Release and Liability Waiver Form PLEASE READ THIS RELEASE AND LIABILITY WAIVER FORM (“Form”) CAREFULLY. NO INIDIVIDUAL WILL BE PERMITTED TO USE ACTS RETIREMENT-LIFE COMMUNITIES, INC.’S (“ACTS”) EXERCISE SPACE, AMENITIES OR EQUIPMENT WITHOUT FIRST READING AND SIGNING THIS FORM. To the best of my knowledge, I am in good physical condition for exercise. I am fully aware of the risks and hazards connected with exercise and the use of exercise equipment, including physical injury (including but not limited to broken bones; muscle, tendon and ligament strains and tears; heart attack; stroke and the like) or even death, and hereby voluntarily elect to utilize the ACTS exercise space, amenities and equipment. I acknowledge that ACTS has recommended that I obtain a physical examination from my health care provider before utilizing the ACTS exercise space, amenities or equipment or beginning or changing any exercise program. I acknowledge that I will be using the ACTS exercise space, amenities and equipment (including, without limitation the exercise weights and machines, the pool, and my participation in any activity, class, program, or personal training) entirely at my own risk.

I agree that ACTS, its parents, members, subsidiaries, affiliates, successors and assigns and each of their respective officers, directors, volunteers, employees, agents, representatives, owners, members and operators (collectively, the “Indemnified Parties”) shall not be liable for any accident, injury, damage, or loss or for any other matter that may happen to me or my property as a result of my use of the ACTS exercise space, amenities or equipment. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISK OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH that may be sustained by me as a result of my use of the ACTS exercise space, amenities or equipment. I shall indemnify, defend and hold harmless the Indemnified Parties from any and all costs (including but not limited to attorneys’ fees), losses or damages arising from or associated with my use of the ACTS exercise space, amenities and/or equipment.

I, on behalf of myself and my heirs, executors, administrators, personal representatives, successors and assigns, hereby RELEASE, WAIVE, HOLD HARMLESS, AND FOREVER DISCHARGE the Indemnified Parties from any and all claims, actions, causes of action, suits, damages, judgments and demands whatsoever, in law or equity whatsoever that I, my heirs, executors, administrators, personal representatives, successors and/or assigns may have ever had, now have, or hereafter can, shall or may ever have against the Indemnified Parties relating in any way to my use of the ACTS exercise space, amenities or equipment. In giving the foregoing, I hereby waive any and all rights which I may have to make any demands and claims against the Indemnified Parties related to my use of the ACTS exercise space, amenities or equipment and the same are forever barred.

In signing this Form, I acknowledge and represent that I understand that I am giving up, among other things, any and all rights I may have to sue the Indemnified Parties for injuries, damages or losses that I may incur as a result of my use of the ACTS exercise space, amenities and equipment. I HAVE READ THE FORGOING FORM, UNDERSTAND IT AND SIGN IT VOLUNTARILY. No oral representations, statements or inducements, apart from this Form, have been made. I EXECUTE THIS FORM FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FOR MY RIGHT TO USE THE ACTS EXERCISE SPACE, AMENITIES AND EQUIPMENT AND FULLY INTEND TO BE BOUND BY THE SAME. By signing below I acknowledge that I have read this Form, understand that this is a legal document, and understand I have the right to consult with an attorney before signing the Form and using the ACTS exercise space, amenities and equipment. _________________________________ ______________________________ PARTICIPANT SIGNATURE DATE _________________________________ ______________________________ WITNESS SIGNATURE DATE Issued: 8/21/2020 FORM LE: F-01A

Cardio Training Workout Tracking NAME : NuStep

Date: Seat Setting Arm Setting Load # Time Distance

Cybercycle

Seat # Level Time Distance Rider ID:

Recumbent Bike

Seat # Level Time Distance

Treadmill

Speed Incline Time Distance

Notes:

Goals:

Strength Training Workout Tracking NAME : 1. Abdominal/ lower back extension

Date: Torso Setting Leg setting Weight # Reps # Sets

2. Dual row/ Rear Delt

Torso Setting Seat Setting Weight # Reps # Sets

3. Lat Pull Down

Leg Setting Weight # Reps # Sets

4. Chest Press

Arm Setting Seat Setting Weight # Reps # Sets

SECTION 9 Nutrition

Nutrition A Mini Nutritional Assessment (MNA) is completed by the Wellness Office Nurse during the preAnnual Health and Wellness Exam. Residents that score at risk for malnutrition or malnourished on the Mini Nutritional Assessment (MNA) will be referred to the registered dietitian nutritionist (RDN) for further assessment and medical nutritional therapy (MNT).

Residents that score at normal nutritional status are entitled to meet with the RDN to address any nutrition questions or receive nutrition counseling. MNT or counseling provided by the RDN focuses on an individualized plan for well-being using a food as medicine approach. Food as medicine is a philosophy where food and nutrition aids individuals through interventions that support health and wellness. This approach incorporates a variety of programs and experiential opportunities to support/improve healthful eating at home and in the dining venues. .

Acts residents have the opportunity to consult with the Registered Dietitian Nutritionist (RDN) and receive in-depth nutritional assessment and counseling to set priorities, establish goals, and create individualized vitality plans which acknowledge and foster responsibility for self-care.

The RDN works with the resident to find appropriate programs and services offered within the community to support resident needs and promote well-being Nutrition and independence.

Participation in the Acts meal plan provides a variety of dining options for the resident to select foods that align with their personal nutrition plan. Nutritional facts panels can be accessed through the resident portal to provide in depth information about macro- and micro-nutrient content and allergens. Community wellness programming by the RDN offers opportunities for resident exploration in current nutrition topics and healthy lifestyle.

PROCESS Track 1:

•

• • • • • •

Referral from Primary Care (PC)/Nurse Practitioner (NP) for At Risk of Malnutrition or Malnourished Status

The Mini Nutritional Assessment (MNA) is completed by the Wellness Office Nurse during the pre-Annual Health and Wellness Exam along with the resident’s Health History and Information Update.

The MNA score is recorded in the primary care electronic medical record (NextGen).

Residents that score at risk of malnutrition or malnourished status (11 points or less) on the MNA will be referred to the RDN for follow-up and assessment.

Wellness staff contacts RDN to schedule for an appointment and provides the Medical Nutrition Therapy Wellbeing Assessment Preparation Form to be completed by the resident prior to the appointment with the RDN. Resident reports to the RDN for their scheduled visit.

RDN provides individualized medical nutrition therapy as indicated using the nutrition care process and records the results of the visit in the electronic health record system.

• •

RDN refers the resident to adjunct services, as needed.

RDN arranges follow-up and monitoring with the Wellness Suite and resident, quarterly or as needed.

Track 2: • • •

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Resident Self-Referral

Mini Nutritional Assessment (MNA) is completed by the Wellness staff as part of the Health History and Information Update.

The MNA score is recorded in the electronic medical record.

Residents that score at normal nutritional status (12-14 points) on the MNA do not need to be referred to the RDN for follow-up and assessment, however, the resident is entitled to meet with the RDN to address any nutrition questions or concerns.

If the Resident wishes to meet with the RDN, Wellness staff contacts RDN to schedule an appointment and provides the Medical Nutrition Therapy Wellbeing Assessment Preparation Form to be completed by the resident prior to the appointment with the RDN. Resident reports to the RDN for their scheduled visit.

RDN provides individualized nutrition counseling, based on resident interest or need. The RDN and Resident set priorities, establish goals, and create individualized action plans which acknowledge and foster responsibility for selfcare.

RDN assists the resident in accessing community and local resources, as needed.

RDN records the results of the visit in the electronic health record system.

STAFF The Registered Dietitian Nutritionist is located on campus in the Wellness Suites.

TECHNOLOGY and EQUIPMENT • Electronic Health Record System(s) – it is anticipated that the primary care software, NextGen, can be utilized for the Nutrition Services documentation.

• Body composition analyzer • Nutrition information pamphlets and printouts • Food models • Standing/sitting scale • Tape measure • Hand grip dynamometer FORMS/ASSESSMENTS/TEMPLATES 1. Medical Nutrition Therapy Wellness Assessment Preparation Form 2. RDN Consult (needs to be built/determined in EHR)

Medical Nutrition Therapy Wellness Assessment Preparation Form Please complete this form and bring it with you to your meeting with the registered dietitian nutritionist.

Goals and Readiness 1. I would like to visit with the dietitian today because….

2. My food and nutrition-related goals are…

3. My overall health goals are…

4. The biggest challenge(s) to reaching my goals is(are):

5. In the past, I have tried the following techniques, diets, behaviors, etc. to reach my goals…

6. I would like to take away from this visit: or I would like to leave this visit today with: On a scale of 1 (not willing) to 5 (very willing), please indicate your readiness/willingness to do the following: To improve your health, how ready/willing are you to…

Modify your diet Take nutritional supplements each day (if appropriate) Keep a record of everything you eat each day Modify your lifestyle (example sleep, exercise, etc.)

Practice relaxation techniques Engage in regular exercise/physical activity Have periodic lab tests to assess your progress

1

2

Weight History 1. Usual weight 2. Weight changes in the past year? 1 month, 6 months, 12 months 3. Concerns with weight changes?

4. Highest adult weight, when?

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5

Usual Food Intake 1. Are there any foods that you avoid? Reason?

2. Has your food intake changed in the past month? Unchanged/more/less 3. Do you have any digestive issues related to food?

4. Have you had any of the following problems during the past month?

Poor appetite Mouth sores Dry mouth Difficulty chewing Difficulty swallowing

Pain on swallowing Pain in general Taste/smell changes Nausea Vomiting

Diarrhea Constipation Fatigue Feel full quickly

Meal Preparation 1. Do you prepare your own food?

2. How many meals per week do you eat in your home?

3. How many meals do you eat per week in the café/dining room?

4. How many meals per week do you eat at or take out from a restaurant?

5. Which restaurants do you eat at regularly?

3 Day Food Diary Please keep a diary of the food and beverages that you consume for 3 days. Choose any days that you wish. If you have a different eating pattern on any given days, such as the weekend, record one of these days. Include the amount you ate (serving size) and any preparation information, for example grilled, fried, breaded. If you drink alcoholic beverages, include type and serving size.

Day 1 Breakfast

Day 2 Breakfast

Day 3 Breakfast

Lunch

Lunch

Lunch

Dinner

Dinner

Dinner

Snack

Snack

Snack

Nutrition Services, Intermittent Touchpoints The initial/annual visit with the dietitian will adopt a food as medicine approach. Food as medicine is a philosophy where food and nutrition aids individuals through interventions that support health and wellness. This approach incorporates a variety of programs and experiential opportunities to support/improve healthful eating at home and in the dining venues.

Personalized Nutrition Education In addition to the annual visit, the resident will have ample opportunities through group classes, one-on-one education, and nutrition resources to explore, learn, and find actionable ways to consume a healthful diet.

Each community has the ability to create opportunities to support residents in meeting their nutrition wellness goals. Here are some ideas to consider when planning nutrition focused events and programming: •

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In-house Resident Channel or Touchtown – “Nutrition Nuggets” video played at targeted times (released quarterly) and general reminders on working on wellness portfolio, video also available on the resident portal. Can also play on TV in Wellness Suite.

Virtual Wellness Group – private group on the resident portal or scheduled Zoom meeting moderated by the community RD Newsletter article – quarterly Featured plate - Display plate of dietitian’s choice entrée and sides positioned near the entrance of the dining room.

Brochures – Available in the Wellness Suite and Fitness Center explaining the program and contact information for questions Wellness Chats – coordinated with wellness team Cooking Demo – (with Chef) Easy recipes for residents who still like to cook or minimal preparation for those who don’t want to cook. Highlights the dietitian’s choice on the menu or a new item on the menu.

Shopping List Creation Session - Spotlight on nutrient dense items to create a shopping list for the resident’s next grocery trip Snack Carts/Produce Stands – Featuring nutrient dense snacks and fruits and/or vegetables available to sample and purchase.

Coffee Talk/Happy Hour – Small group, casual discussion on a focused topic that includes coffee/tea or mocktails and nutrient dense snacks that tie back to the discussion Tech Cafes – (with IT) Encouragement and training to get residents comfortable with the resident portal, the K4 app, to access nutrition information or other resources in groups available at the community Farmer’s Market Outing – (with LEC) During season, to promote purchase of nutrient dense items for meals at home Group Coaching – 4 week sessions to help residents stay on track or explore other goals coordinated by RD or Wellness Coach MyPlate.gov Workshop – Assist residents in accessing MyPlate resources to develop their own eating plans, recipes, and tools for shopping

• • •

Check In Sessions – scheduled periodically, can be group or individual sessions with RD or Wellness Coach Apply menu framework with minimum numbers of entrees and sides, fruit-based desserts, and guidelines for increasing bean and grain options.

Arrange cafes to make healthier items visible and easy to access (e.g. chips not at eye level or by register).

Dietitian Licensure Information •

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Several states licensure statutes describe that a physician or a health care provider authorized to prescribe dietary treatments initiate a referral for nutrition services. It will be noted, therefore, that the referral of a qualified health care provider, such as a physician, is apparently an essential antecedent to the RDN's ability to practice dietetics or nutritional services of any kind. The statutes of some other states also contain references to a physician's participation or supervision in the nutrition care process, but they are not nearly as restrictive as Alabama and California.

Alabama "[A] dietitian/nutritionist or registered dietitian … may [provide such dietetic services as nutritional assessments and nutrition counseling] upon referral by a health care provider authorized to prescribe dietary treatments", and "[d]ietitians/nutritionists may offer advice and counsel on dietetics and nutrition as adjunct medical therapy when advice and counsel is given upon referral of a licensed physician." Ala. Code 1975 §§ 34-34-2 and 34-34A-5 (emphasis added). ["Adjunct medical therapy" is not otherwise defined.]

Certain states, while not requiring referrals in all cases, have included statutory provisions designed to address conduct when physicians are already involved.

Florida "[A] licensee under this part shall not implement a dietary plan for a condition for which the patient is under the active care of a [licensed] physician … without the oral or written dietary order of the referring physician," except that "[i]n the event the licensee is unable to obtain authorization or consultation after a good faith effort to obtain it from the physician, the licensee may use professional discretion in providing nutrition services until authorization or consultation is obtained from the physician." West's F.S.A, § 468.516(1)(a).

Some states mandate the involvement of a physician when the treatment or the condition being treated becomes what the state defines as medical in nature.

South Carolina "Nutrition care services" will include, among a number of other things, "implementing a physician's written and verbal orders which pertain to the practice of dietetics, if the practice of dietetics is specifically authorized by the medical director and the health care facility where the care is taking place. In the delivery of dietetic home care, this care must be authorized specifically by the physician sponsor…." Code of Laws of South Carolina Anno., Sec. 40-20-20.

SECTION 10 Mental Health Services

Mental Health Through the Annual Health and Wellness Evaluation (AHWE), the community’s Nurse Practitioner will complete assessments that will determine the potential need for mental health intervention or services. The Acts Mental Health Clinicians (MHC) serve as key members of the interdisciplinary care team and provide behavioral health, assessments, care planning, therapy services, behavioral intervention, and case management to the independent living population.

The MHCs are clinical licensed Social Workers or Psychologists that conduct diagnostic interviews to identify psychosocial strengths and weaknesses and inform care planning. They also provide individual, family and group psychotherapy services, as indicated through assessment and care planning processes; they offer caregiver support and education to family members and provide educational programs to the Acts community staff.

Referrals for the Annual Health and Wellness Evaluation can be scheduled by birthday month, unless identified as needing an assessment sooner.

The cognitive assessment(s) that are recommended for an annual visit are either a SLUMS or MOCA SLUMS- St. Louis University Mental Status Exam* MOCA- Montreal Cognitive Assessment * *See SECTION 6, Primary Care Services for a copy of the SLUMS and MOCA exam.

The MiniCog and GPCOG are two additional options for cognitive screenings. If a severe cognitive deficit is detected, a KELS might want to be considered.

- KELS is the Kohlman Evaluation of Living Skills- it is a more detailed assessment of all aspects of independent living skills.

In addition to a cognitive screen a mental health screen should also be conducted - GDS- Geriatric Depression Scale- this is a yes/no questionnaire which has 30 questions.

A point is given for each question that is indicative of depression, up to 9 is considered within normal limits.

- If someone scores above the normal threshold, they can be referred to the LCSWC If the assessments indicate a cognitive deficit or depression the Wellness team should discuss the findings with the resident and/or family, the primary care practitioner should be made aware if it is not an ACTS provider and develop a plan of care to make provisions for the resident to safely continue to live in Independent Living, such as ACTS Home Health or make arrangements to transition to a higher level of care. A detailed assessment should also be conducted either by the ACTS practitioner or other primary practitioner to obtain a proper diagnosis.

STAFF • • •

LCSWC Psychologist LPC

MENTAL HEALTH SUPPORT All incoming residents will have a basic mental health screen that includes a SLUMS, PHQ9 and GDS as well as a short mental health questionnaire (separate questionnaire or part of another assessment as to not overwhelm) •

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Support new IL residents without mental health issues o prior to admission and within 30 days meet with resident to discuss services offered to support mental health Support new IL residents with mental health concerns o Prior to move in the LCSWC will meet with the resident to go over results of assessments and what supports we offer and what we feel they need to assimilate into the community successfully. o connect them with the wellbeing coach Support existing residents with mental health concerns o annual review or team referral or self-referral as a way of identifying those living with mental health concerns and develop a custom plan of support o frequency of visits and by whom o other team members to be involved, i.e. nurse practitioner o goal setting LCSWC to provide ongoing programs and education o mental health newsletter articles o group counseling o workshops o individual counseling Educational programs o Fitness o wellness coach to develop a fitness routine (exercise has been proven to be a more effective antidepressant than medication for mild depression) Stress management o support groups o wellness groups ▪ self-care- Emotional Wellbeing Resource Guide (Melanie and I will be working on this) ▪ spiritual groups ▪ pet therapy Nutrition o eating for better mental health Social engagement o finding a purpose- volunteering o book clubs o happy hour o game clubs (mahjong, rumi, bridge)

FORMS AND ASSESSMENTS o o o o

PHQ9 GDS SLUMS KELS (as needed)

SECTION 11 Memory Support Services

Memory Support SUMMARY Acts Lifestyle Empowerment program provides structured guidance for residents experiencing mild cognitive impairment and their spouses. Through participation in a comprehensive, individualized lifestyle program, members experience empowerment, purpose, wellbeing, and joy while maintaining independence to live their best life, as well as they can, as long as they can. A Memory Support Navigator will guide member engagement in the program that addresses the following lifestyle factors: • Cognitive Engagement • Social Engagement • Physical activity and exercise • Nutrition • Stress management • Sleep • Environmental sensitivity STAFF • Memory Support Navigator: Licensed clinical social worker (LCSW) credential with additional wellness/personal coaching certification and case management certification.

One LCSW for every 50 residents.

• Expressive Therapist: Master’s Degree in Expressive Arts Therapies • Administrative assistant • Beautician (CDP credentialed) • Massage Therapist (CDP credentialed) • Day Care Staff (CDP credentialed) (Program members could be volunteer staff) ADDITIONAL SERVICES: ON-SITE ACTS TEAM MEMBER CHILD DAYCARE TECHNOLOGY and EQUIPMENT • Playground equipment for child Daycare • Devices that play recorded reminders (e.g., time to take medication, attend program, etc.)

• Talking clocks • Pill dispensers • Location tracking devices (shoe inserts, wrist bands, numerous options) • Virtual assistants (Alexa, Siri) • Simple remote control • Simple music player • Digital photo frame • Fur-real pets (later stage) • Dementia-friendly cellphones • Dementia-friendly watches • Dementia-friendly scale • Dementia-friendly food scale

• • • • • • • • • •

Dodow sleep aid Aromatherapy essential oil diffuser Ambient sound machine Virtual reality Weighted blanket Bright light therapy Ring Doorbell Personal Golf Cart Adult tandem 3-wheeled bicycle Apps: o Brain stimulating apps: My Reef 3D Aquarium, Lumosity, Greymatters: Reaching Beyond Dementia, AmuseIT, Constant therapy, SingFit, Let’s Create Pottery, MindMate, Flower Garden o Apps promoting independence/organization: It’s Done, Iridis, Nymbl o Care partner support apps: Teepa Snow GEMs, A Walk Through Dementia, Alzheimer’s Daily Companion.

LIFESTYLE EMPOWERMENT PROGRAM PROCESS Part 1a: Support to new IL residents without MCI Within 30 days of move-in, the Memory Support Navigator welcomes new independent living residents and presents a general overview of services available to promote brain health and address modifiable risk factors.

Part 1b: Support to new IL residents with MCI Prior to move-in, the Memory Support Navigator meets with the resident and their care partner/spouse and presents an in-depth overview of Lifestyle Empowerment programming and services available that will support their transition plan and assimilation into the community.

Part 1c: Support to existing IL residents that develop MCI The Memory Support Navigator engages residents identified as living with mild cognitive impairment either through team referral or self-referral. The Navigator meets with the new member and their spouse (if applicable), either individually or with the spouse/care partner in their home: • The Navigator initiates membership in the program with a detailed review of program offerings and assessment of needs to design a custom, person-centered plan of support with action steps to extend the duration of independent living and overall quality of life. o The Navigator and member/spouse decide frequency of contact. o Action steps may include connecting with other disciplines e.g., nurse practitioner, rehab (Thrive assessment if needed), implementing a home safety evaluation, identification of IL program buddy/mentor, etc.

•

•

•

Lifestyle Empowerment Program Member Portal (similar to “My Chart”): Resource Center that provides online platform with educational resources, weekly chat opportunities, schedule appointments/request a visit, interface with other members, program reminders, etc.

Members and their care partners will work with their Navigator to engage in the multidisciplinary curriculum. Goal setting is implemented upon initial assessment and monitored continuously to address changing abilities, track progress and review and adjust frequency of touchpoints as needed.

As part of their participation in the Lifestyle Empowerment Program, members and their care partners will be afforded the opportunity to participate in research opportunities aimed at improving the lives of individuals living with MCI.

The Memory Support Navigator will have the ability to build respectful and trusting relationships with IL residents through an ongoing and notable presence in IL community life by offering engagement programs and educational opportunities that include: • Quarterly resource and information seminars • Workshops on care partnering • Support groups for individuals living with memory loss or care partners • Memory Café • Safety assessment (in partnership with rehab) • Information on advanced directives • Connections Program (respite care) • Home Health support • Legal planning • Financial counseling • Support of dementia-friendly community initiatives • Lending Library Engagement programs will be evidence-based and reflect current research regarding beneficial practices for people living with MCI. Programming will be offered in-person and virtually and will involve interdisciplinary team members with expertise in the following areas: o Fitness • Walking club • Trips in the community at large, e.g., Boardwalk, area parks • Yoga • Tai Chi • Self Defense classes • Bike Riders Club o Stress Management • Caregiver support group • Grief/Loss support group • Connections (respite opportunity)

•

• • • • • •

Self-care – resources to support and encourage self-care (Emotional Wellbeing Resource Center on Member portal will have printable handouts on Understanding Stress, Strategies to Manage Stress, Mindfulness, Deep Breathing, Progressive Muscle Relaxation, Stretching).

Spiritual support Daily Devotional for community Prayer groups – centering prayer Cognitive/Behavioral Therapy to address issues contributing to stress Community gardens Pet therapy

o Nutritional education • MIND Diet – Culinary options offered in dining room and Bistro • Weight checks • Nutritional counseling • Healthy snacks • Meal reminders • Kitchen – safety assessment • Cooking classes • Community cookbook featuring healthy recipes • Food Demos • Meal planning class • Coupon swap for groceries o Sleep • Sleep specialist – presentation to community • Resources for improving sleep (portal) • Nutritional recommendations to improve sleep (limit caffeine, sugar, and alcohol in afternoon) • Cognitive/Behavioral Therapy to address emotional issues affecting sleep • Sleep environment – guidance on how to create an environment that supports sleep o Rehab-functional independence o Creative arts engagement • Visual art classes • Movement/dance • Dramatic arts performances • Guided Affective Imagery • Music therapy • Museum visits o Cognitive engagement • Total Brain Health • Linked Senior (on IL resident’s iPad)

• • • • • • • • •

Book Clubs Language classes (including sign language) Music classes Life-Long Learning Series Great Courses Series New hobby club University/Community Colleges offerings – courses at local universities Game competitions (similar to OlympiActs) Community trips to concerts, orchestra, opera, theatrical productions, museums (with class offered prior to the event to prepare residents to enjoy the experience) • Visiting artists o Education on how to live well with MCI o Social engagement • Volunteer opportunities (Acts community {Gift Shop} and larger community) • Intergenerational programming (Members have a “Job” at in-house child daycare) • Happy Hour • Prom • Memory Café • Travel Club – plan group trips • New resident welcome group • Buddy system (seasoned care partner paired with a new care partner) o Support groups o Technology classes o Spa Services (specific to this program) • Aromatherapy • Music therapy • Massage FORMS/ASSESSMENTS/TEMPLATES 1. My Life Journey document – electronic (technology component under investigation) 2. Transition plan form 3. Best Friends assessment 4. Care Partner guidebook 5. Mind Diet scorecard 6. Modifiable risk factors checklist 7. Member Portal Guide

• Best Friends Assessment

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MIND Diet Scorecard

Example

• Modiafiable Risk Factors

SECTION 12 Acts Signature Well-Being Product Process Outline

Acts Signature Well-Being Product Process Outline A. INITIAL VISIT WITH WELL-BEING HEALTH COACH and CONCIERGE 3. Introduction of the Acts Signature Well-Being Product 4. Review resident’s My Story. Discuss the role of the Well-Being Concierge and the transition to My Life Journey.

5. Discuss the seven dimensions of Wellness (Physical, Spiritual, Vocational, Environmental, Intellectual, Social and Emotional).

6. Evaluate the resident’s lifestyle, determining likes and interests. Expand capabilities and opportunities for accessing interests and provide new avenues to pursue, connect with other residents with similar likes.

7. Update HIPAA form and Advanced Directives 8. Conduct Global Well-Being Assessment 9. Schedule each of the following: a. Schedule Spiritual Life Assessment with the community chaplain b. Schedule the Thrive Assessment with Rehab c. Schedule the Pre-Annual Health and History Intake Visit with the Wellness Suite d. Schedule the Fitness Screening with the Fitness Staff e. Schedule the Annual Visit with Nurse Practitioner B. SPIRITUAL LIFE ASSESSMENT VISIT WITH THE COMMUNITY CHAPLAIN • Complete the Spiritual Life Assessment C. THRIVE ASSESSMENT VISIT WITH REHAB • Complete THRIVE Assessment D. PRE-ANNUAL VISIT, HEALTH HISTORY AND INFORMATION INTAKE WITH THE WELLNESS OFFICE NURSE 1. Update health history information, include all recent change 2. Update medication list and preferred pharmacy 3. Complete the Mini Nutritional Assessment and height and weight measurements 4. Draw blood for routine bloodwork 5. Baseline vitals/pulse ox 6. Complete an EKG 7. Complete a urinalysis E. FITNESS SCREENING 1. Provide training on the use of the tracking devise 2. Review tracking device data at predetermined intervals 3. Complete assessment and goal setting 4. Develop and schedule an exercise plan

F. DATA GATHERING BY THE WELL-BEING COACH 1. Gather all results and data from the above listed visits and provide them to the Nurse Practitioner prior to the Annual Initial Visit 2. Schedule and meet with the NP prior to the scheduled Annual Initial Visit G. ANNUAL VISIT WITH THE NURSE PRACTITIONER The NP will review all of the data provided by the Well-Being Coach prior to the resident’s scheduled visit. The NP will conduct a physical exam and complete the following assessments: 1. High blood pressure screening 2. High cholesterol screening 3. Depression screening 4. Abnormal blood glucose/diabetes screening 5. Stress management assessment 6. Osteoporosis screening 7. Hepatitis C screening 8. Sexually transmitted infections screening 9. Audio screening 10. Visual screening 11. In-Home Risks and Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) 12. Provide Sleep Assessment Cognitive function test 13. Behavioral risk assessment 14. Psychosocial risk assessment 15. Incontinence assessment 16. Polypharmacy assessment 17. Chronic conditions assessment 18. Signs of elder mistreatment assessment The NP will finalize the visit: with a review of medical, legal and advance care planning Following the visit, the NP will provide the Well-Being Coach with a recommended personalized resident health advise and referral plan H. WELL-BEING PORTFOLIO PLAN (WELL-BEING HEALTH COACH) 1. Create the Acts Signature Well-Being Portfolio Plan to include Personalized Education, Preventive Counseling, Support Services, Resident Health Advise and Referral Plan and (ongoing) Engagement Opportunities.

2. Schedule specific personalized touchpoints based on the Portfolio Plan.

3. Complete referrals as identified: a. Specialist (Cardiology, Dermatology, Psychiatry, etc) b. Memory Support Services c. Home Health Services d. Spiritual Life e. Nutritional Services f. Rehab services g. Fitness 4. Work with the Well-Being Concierge to discuss the resident’s My Life Journey to date. Determine a meaningful engagement platform with frequent touchpoints to maximize resident engagement and record additional milestones.

SECTION 13 Acts Signature Well-Being Product Protocols Sub-task force established to discuss and request creation of protocols for each discipline

SECTION 14 Acts Signature Well-Being Alpha Pilot St. Andrews Estates -Getting Started-

Acts Signature Well-Being Alpha Pilot – St. Andrews Estates Getting Started - Agenda I. Overview and Goals – Alpha Pilot Team Meeting (October 2022) II. Well-Being Staff • Well-Being Coach Job Description • Well-Being Concierge Job Description III. Resident Letter of Interest (distribution to all IL residents to gain level of initial interest) IV. Selection Criteria – (SAE Alpha Pilot Team to evaluate and determine resident selection) V. Participation Introductory Letter for Residents – Thank you for your participation and description of the Acts Signature Well-Being Product - drafted VI. Consent Form (treatment, PHI and wearables) – drafted VII. Process discussion – modifications needed to start

Status Report (11/3/22) •

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Recruitment is in progress for the Well-Being staff identified above. Both positions have been posted and resume gathering is ongoing. A former Acts employee is under consideration for the Concierge position. Several interviews are in the process of being scheduled.

The initial letter of interest was distributed on 10/26/22 to SAE IL residents. Thirty-three (33) residents have responded with interest to date. Twenty five (25) from South campus, eight (8) from North campus. SAE leadership will continue to promote the Well-Being Product for additional interest.

A live meeting will be scheduled in early November 2022 with the residents selected for the pilot along with members of the Well-Being Task Force. An overview of the Acts Signature Well-Being Product will be discussed, documentation (Participation Introductory Letter) and consent forms will be distributed and questions will be answered.

Initial implementation of the well-being product for the alpha pilot will be modified to correlate with existing systems, staff and equipment. Therefore, primary care services along with the THRIVE assessment will be the initial focus. Additional components of the well-being product (spiritual life, engagement/lifestyle, fitness, nutrition and others, will be incorporated as processes are confirmed and new technologies are established and implemented). The initial process will be as follows: 1.

2.

3.

Pre annual visit -- health history and information intake with the Wellness Office Nurse THRIVE assessment visit with the Rehab Department Annual visit with the Nurse Practitioner

DOCUMENTATION Overview and Goals – Alpha Pilot Team Meeting (October 2022) Acts Well-Being Product Overview: The “Acts Life Care” Product Has Been Redefined as “Acts Well-Being”. The history of the Acts Life Care product offering has been anchored in the concept that seniors want to manage the future uncertainty of needing long term care and other support services. The Acts Life Care product has met that need in providing a complete continuum of care that is affordable and accessible, offered in desirable facilities and provided by an organization that embraces Christian values, all together providing “peace of mind” and security.

As we look to the post-pandemic future, the product offering needs to change its emphasis to a model of enhanced wellness (often viewed as “come here to live”) from a continuum of care model (often viewed as “come here to die”). The new “Acts Well-Being” product will focus on extending an active, vibrant, full lifestyle for all those choosing to live with us by engaging them in a variety of physical, mental, and spiritual activities that have been personally scripted by analyzing their preferences and monitoring their existing and/or changing medical condition, data, and issues.

From the moment prospects sign a Resident Contract, we will assist them in designing their well-being lifestyle experience and frequently review and adjust this personalized well-being portfolio as they age and their abilities change throughout their life at Acts.

An “experience portfolio plan” is created with (not for the resident) the resident, while data analytics inform the community staff on adjustments to meet each resident’s needs and desires.

The “continuum of care” as a term is dropped, and now is viewed as continuing “supportive services” which include home health, telemedicine, therapy, counseling, and much more.

The success of the Acts “Well-Being” program will be ultimately measured and promoted in statistics that demonstrate a reduced utilization of assisted living/memory care/skilled care and extended life expectancy compared to alternative senior living/care options. This is an evolution of the Life Care model to one that is more flexible and pro-active – and more inclusive of other services to potentially delay or even remove the need to move into a higher-level care setting.

Ultimately this adds control and flexibility for our residents to the foundation of providing peace of mind and security.

The Acts Well-Being Lifestyle Fully Challenges Our Greatest Competitive Threat: “Aging-inPlace” The pandemic experience has left many seniors feeling like the safest and happiest place to age is in their own homes. As service delivery became more readily available and customary during the pandemic, aging adults became more comfortable with managing the delivery of needed services (food, groceries, pharmacy supplies, telemedicine, home repair, etc.). Prior to the pandemic, the many channels of social interaction available via the explosion in restaurants, theater, fitness, outdoor/nature--along with accessibility of in-home entertainment via streaming--made walkable towns, on-demand transportation and social interaction even more easily accessed and desirable. Along with this change in lifestyle came an increasing fear that congregate living was now dangerous (from an infection perspective). Post-pandemic, it is expected that businesses specializing in enabling seniors to age-in-place (at home) will become

even more prominent, and seniors could themselves now find virtual ways to stay connected and social. Fortunately, the attractiveness of a CCRC environment, offering senior-tailored amenities and services and the opportunity to extend one’s quality of life and life expectancy, will remain.

To compete with the “aging-in-place” product offering, we will need to demonstrate to seniors, and to their adult children who may be the decision makers to their parents that aging-in-place outside a CCRC falls short in meeting the social and overall well-being needs of seniors who are living in isolation left to manage their own supportive services and that the offering is limited in providing all the necessary healthcare needs in a home environment.

Our Goals for the Well-Being Product: Design the “Well-Being” product to replace “Life Care,” centered on customized lifestyle experience planning with each resident, with a simple and flexible contract with pricing options for al a cart services.

Develop new service packages for onsite dining and concierge services (travel, transportation, housekeeping, shopping, entertainment, education, etc.) customizable for each resident.

Repackage the continuum of care, adjusting to an umbrella of support services and guidance for thriving-in-place through the Wellness Clinic (e.g. utilization of the nurse practitioner).

Develop programs designed to reduce utilization of OBT and WBC stays (fitness, nutrition, home health, therapy, counseling, etc.), applying resources from OBT/WBC to clinic staffing and services.

Design a nurse navigator program to provide clinical coordination for residents needing medical care, with medical and home health assistants providing routine healthcare and follow up services to IL residents.

Evaluate what should be added to on-campus services that enhance the comprehensive solution we offer to seniors such as dental, vision, hearing, pharmacy, supplies, telemedicine, counseling, therapy, and technology.

Develop or obtain technology designed to capture data and monitor resident activities and utilization of resources daily and in alerting areas of concerns.

The community resources are redefined/reallocated to provide professional services to meet the demands of the “Well-Being” product (model operational budget).

Implement the “Well-Being” product as a pilot, with assessment and adjustments identified to ensure success and growth/expansion.

Build Acts Well-Being Lifestyle Pathways for multiple applied research opportunities to gain recognition in Acts being a Center/s of Excellence for various individual needs: Example: BrainHealth: Dementia prevention/maintaining and building one’s Cognition reserves; others?

Well-Being Staff Job Descriptions – Well-Being Coach POSITION DESCRIPTION Position Title: Reports To:

Well-Being Health Job WBHC FLSA Coach Code: Status: Corporate Director of PCS, dotted line to ED Department:

Exempt Special project fund dept.

Summary Statement: The Well-Being Coach serves as the key leader of the interdisciplinary well-being team, oversees the well-being comprehensive assessment and coordinates the resident’s well-being portfolio plan. Provides the oversight and coordination of well-being interdisciplinary assessments, facilitates the interdisciplinary well-being portfolio (care and services) planning; and may provide individualized mental health services and behavioral interventions to the independent living population, as needed per the well-being assessment.

Essential Job Functions: Describe the specific Duties and Responsibilities of the position from most critical to least.

Job Functions 1. Provides leadership for the interdisciplinary person-centered well-being services, including

2.

3.

4.

5.

observation and analysis, referrals, aiding in the creation of well-being portfolio with individualized support plans, and provides caregiver education regarding recommended interventions and provides touchpoints to progress Conducts diagnostic interviews to identify psychosocial strengths and weaknesses and incorporates these into the resident’s well-being portfolio plan Provides individual, family, and group psychotherapy services, as indicated through the wellbeing assessment and portfolio plan Participates in interdisciplinary team well-being meetings and resident’s well-being portfolio planning, serving as the wellbeing coach that can also provide behavioral health to ensure that psychosocial aspects of IL residents are identified and addressed Offers caregiver support and education to spouse/family members as determined necessary

6. Offers quarterly educational programs as a support to residents and a means of highlighting services and benefits of the Well-Being Services and the Wellness Suite 7. Offers a monthly well-being caregiver support group for caregivers within the community

8. Responsible for timely and accurate documentation of all medically necessary visits; providing mental health services in compliance with applicable federal and state regulations and policies for any billable services with third-party payors 9. Responsible for remaining abreast of emerging research, best practices and therapeutic approaches related to meeting the psychosocial needs of individuals living with mental health needs, cognitive disorders, and for their caregivers’ needs 10. Actively participates in re-evaluating the well-being services to ensure quality of well-being outcomes and create continuous service evolution 11. Participates in and supports quality improvement activities, community outreach, marketing, and other operational processes to benefit the Well-Being services being provided and adding new services as identified 12. Works closely with and supervises the Well-Being Concierge

13. Other duties as assigned `

Education & Experience: The critical skills and knowledge required to successfully perform the functions of the position are normally obtained thru:

•

•

•

Education Level: Masters or doctoral degree in social work with experience with older adults. A Board certification in Geriatrics and expertise in serving people living with dementia is preferred, but not necessary.

Required Credentials: Maintains a state license as a mental health services provider, i.e., Licensed Clinical Social Worker. Eligible for National Provider Identification number AND credentialing as a behavioral health clinician by Medicare and other third-party payors.

Years of Relevant Work Experience: At least 3 years of experience as a licensed behavioral health clinician providing assessment and psychotherapy treatment services.

Critical Skills and Necessary Knowledge: • • • • • • •

Expertise in assessment, therapy, behavioral intervention and case management for older adults.

Expertise in supporting people living with dementia.

Comprehensive knowledge of state and federal related to provision, documentation and billing for behavioral health services.

Excellent interdisciplinary collaboration skills.

Effective in providing education and public presentations.

Effective group facilitation skills.

Must have good analytical, educational, and communication skills

• • • • • • •

Must be proficient in Microsoft Office Must be able to meet deadlines as required Excellent written, verbal and grammatical skills within the English language Exceptional customer service, quick evaluation and decision making Work efficiently with minimal supervision Must be able to manage multiple projects and should be organized Can operate all office equipment (including telephone, computer, copier)

Physical Demands • • • •

Frequent sitting Occasional standing and walking Occasional operation of hand controls Occasional reaching from below knees to above shoulder level

•

Lifting, pushing and pulling 50 pounds occasionally General visual skills

• • •

Frequent fine finger dexterity Ability to make presentations to large and small audiences

Environmental Conditions • •

Inside 95% Hazards -- infectious diseases

• • • • • • •

Frequent talking and hearing Frequent near acuity Sitting, standing and walking occasionally.

Bending, squatting and kneeling occasionally.

Climbing stairs occasionally Able to use hand to perform frequent grasping, writing and typing.

Talking and hearing in person and on phone

Incumbent Statement & Acknowledgement for Receipt of Job Description

I understand that I am responsible for performing the duties and responsibilities of my position in a manner that is consistent with the Acts Culture of Loving-Kindness.

I will observe safety guidelines and perform essential tasks in line with the company's safety policy and procedures.

By my signature, I acknowledge that I have received a copy of the Job Description and have read and understand its contents.

Employee Name (Please Print)

Date

Employee Signature

Date

Employer’s Signature

Date

Equal Employment Opportunity and Americans with Disabilities Act: Company provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, sexual orientation, or non‐disqualifying physical or mental handicap or disability in each aspect of the human resources function. Applicants as well as employees who are or become disabled must be able to perform the essential job functions with or without reasonable accommodation. The Company shall determine reasonable accommodation on a case‐by‐ case basis in accordance with applicable law.

Job Responsibilities: The following statements reflect the general duties and responsibilities considered necessary to perform the essential functions of the job and should not be considered as a detailed description of all the work requirements of the position.

Company may change the specific job duties with or without prior notice based on the needs of the organization.

Well-Being Staff Job Descriptions – Well-Being Concierge POSITION DESCRIPTION Job Code: WBCG Position Title: Concierge Well-Being Reports To: Well-Being Health Coach

Departme nt:

FLSA Status:

Nonexempt

2200 resident services

Summary Statement: The Well-Being Concierge develops highly engaged resident relationships to facilitate an individualized approach to residents’ health and wellbeing by coordinating access and awareness to services and events inside and outside the campus that supports sustainable well-being and behavior changes. This position will work closely with the Well-Being Health Coach, Life Engagement, fitness, spiritual, culinary, and clinical staff to inspire residents to enhance their lifestyles by developing healthy habits and reaching health and well-being goals. The Concierge is motivated and passionate about working with residents to live healthier, happier, more fulfilled lives. This position also embraces the hospitality culture of Acts by acknowledging all residents, staff, and guests according to company standards.

Essential Job Functions: Describe the specific Duties and Responsibilities of the position from most critical to least.

Job Functions 1. Uses effective communication, engaging techniques, and positive encouragement to engage residents and interact with clinical and non-clinical staff regarding programming to enhance health and wellbeing.

2. Provides informal coaching elements to provide residents with the opportunity to experience a personalized approach to wellbeing 3. Uses motivational techniques to assess needs based on physical, emotional, intellectual, social, and spiritual wellbeing 4. Works with residents to determine areas of interest, setting goals, identify obstacles, implement effective solutions, and create a comprehensive well-being plan to achieve their individual health and wellbeing goals 5. Applies appropriate motivational techniques to encourage residents to adopt sustainable behavior changes 6. Coordinates with clinical and non-clinical staff and the resident to determine the best services or events that are available to provide a personalized, well-rounded experience to achieve health and wellbeing goals.

7. Promoting resources available in the community and in the outside general community to meet the health and wellbeing needs of the residents 8. Communicates any noticeable or reported changes in the status of residents to the Well-Being Coach and other interdisciplinary team members 9. Proficiency in Microsoft Word, Calendar, and Outlook and the ability to use technology to communicate and encourage resident participation in events that lead to behavior change 10. Facilitates access to events and services and communicates with residents in person, virtually or through email to these events and services 11. Creates and distributes informational flyers, email alerts, and other electronic means of communication to promote programs and information related to wellbeing 12. Develops and conducts presentations for residents, guests, family members and employees who are interested in learning more about health and wellbeing events.

13. Other duties as needed.

Time % 10 10 10 10 10 10 10 10 5 5 5 5

Education & Experience: The critical skills and knowledge required to successfully perform the functions of the position are normally obtained thru: Education Level: • •

Associate or bachelor's degree in psychology, counseling, or health sciences preferred Health Coach Certification (American Council on Exercise)

Years of Relevant Work Experience: Two years' experience in the hospitality industry as a concierge or experience as a health coach, previous experience working with seniors or working in a retirement community is very desirable.

Critical Skills and Necessary Knowledge: • • • • • •

(The following bullet points are samples to use if they apply) Efficient organization skills Effective interpersonal & communication skills Must be able to work well in a team-oriented environment Exceptional customer service orientation Adept evaluation and decision-making skills

• • • • •

Excellent written, verbal and grammatical skills within the English language Computer software knowledge (MS Word, Excel, Outlook, AOD, Millennium) Must be able to meet deadlines as required Work effectively with minimal supervision Proficient with office equipment (telephone, computer, copier)

Physical Demands (adjust as appropriate) Activity a. Sitting b. Walking c. Standing d. Bending e. Squatting f. Climbing / Working at heights g. Kneeling / Crawling h. Twisting i. Typing j. Repetitive hand / finger motion k. Talking on the phone l. Driving m. Other: n: Other: o. Other: p. Push/Pull (up to 25 lbs.) q. Pulling (up to 25 lbs.) r. Lifting (up to 20 lbs.) q. Pulling (up to 25 lbs.) r. Lifting (up to 20 lbs.)

Frequency of Occurrence Continuous Frequently Occasionall N/A y Comments

Environmental Conditions (adjust as appropriate) Y/N Inside Outside Climate controlled work area Travel Amount Other

%

Exposure to:

Continuous

Frequency

Occasionally

N/AComments

Heat Cold Fumes Dust Noise

Incumbent Statement & Acknowledgement for Receipt of Job Description I understand that I am responsible for performing the duties and responsibilities of my position in a manner that is consistent with the Acts Culture of Loving-Kindness.

I will observe safety guidelines and perform essential tasks in line with the company's safety policy and procedures.

By my signature, I acknowledge that I have received a copy of the Job Description and have read and understand its contents.

Employee Name (Please Print)

Date

Employee Signature

Date

Employer’s Signature

Date

Equal Employment Opportunity and Americans with Disabilities Act: Company provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, sexual orientation, or non‐disqualifying physical or mental handicap or disability in each aspect of the human resources function. Applicants as well as employees who are or become disabled must be able to perform the essential job functions with or without reasonable accommodation. The Company shall determine reasonable accommodation on a case‐by‐ case basis in accordance with applicable law.

Job Responsibilities: The following statements reflect the general duties and responsibilities considered necessary to perform the essential functions of the job and should not be considered as a detailed description of all the work requirements of the position.

Company may change the specific job duties with or without prior notice based on the needs of the organization.

Introduction Letter to Residents RE: Well-Being Pilot Dear Resident, We are excited to announce an opportunity for you to participate in the Acts Well-being pilot at St. Andrews Estates! The Acts Well-being pilot provides each participant an opportunity to create a personalized well-being plan. Our well-being coach and concierge collaborates with each resident to create an individual plan designed to promote health and enhanced wellness. The new Acts Well-being pilot focuses on extending an active, vibrant, full lifestyle by engaging residents in a variety of physical, mental, and spiritual activities that have been personally scripted based on individual preferences and monitoring existing and/or changing medical conditions.

The plan may include personalized education, preventive counseling, supportive services, health advice and referral plans, as well as fitness, spiritual, nutrition and life engaging goals. Access to specialized health and wellness screenings, comprehensive nurse practitioner physicals, specialty medicine, and health sensor devices such as an Apple watch are just some of the opportunities available to residents in the pilot.

As we develop our well-being program, we are looking for thirty residents to participate in the pilot project. Enrolled residents will partner with Acts to create a well-being product designed to transform life-care by focusing on prevention and creating proactive plans to enhance health and wellness. If you are interested in joining our pilot, please sign-up at the front desk. If we have more than thirty resident volunteers, we will randomly select the initial participants.

Please feel free to contact Joya Marotta at (561) 210-0188 or Susan George at (561) 210-0293 for additional information.

Sincerely,

Participation Introductory Letter Acts Well-Being Program Pilot DRAFT (ALPHA Pilot group of initially 30 IL residents at St. Andrew Estates) (Up to a 60/90-day pilot period, starting on 11/01/2022 Date Dear (resident name): Thank you for your willingness to participate in this Acts Well-being pilot at St. Andrews Estates! Please read the following outline of the Well-Being Program and what to expect during this pilot.

Well-Being Program Overview: {Insert the well Being Philosophy Statement here} Acts Well-being Program provides personalized preventative wellness and health promotion well-being services for an individuals’ body, mind, and spirit by offering direct access to customized diagnostic and consultative well-being and health services to build your customized well-being portfolio pan with routine touchpoints by the Acts Well-Being Coach and Concierge being completed throughout the year to assist you in meeting your personalized well-being goals.

Your Active Participation in Collecting and Sharing Your Health and Wellness Information and Data: 1. You will need to use a wearable well-being tracking device during this pilot period: i.e.

Apple Watch, Fit-Bit, Samsung Watch, etc. and if so, you will be asked for your consent in to sharing this iwellness-fitness informational data with the Acts Wellness Coach, Nurse Practitioner, and other key well-being team members at St. Andrews Estates in order to monitor your progress and in utilizing your data in creating your personalized Well-Being portfolio plan and established goals.

Note: If currently do not own a tracker device- a “loaner” device will be provided to you “free” during this initial pilot. Your health and wellness data will only be shared as needed and only with the interdisciplinary team members in the formation of your personalized portfolio plan with you.

2. You are asked to keep a food and health journal for the time leading up to your initial well-being assessment. It is recommended that this journal will be utilized throughout the pilot period. This journal will be included in your Acts Well-Being welcome packet.

Program’s Health and Medical Components: Providing customized health promoting experiences and services on maintaining health and mitigating the impact of existing medical conditions. The health and medical program of the

Well-Bing offers direct care access to customized diagnostic and consultative health services, including a comprehensive assessment by the Acts nurse practitioner, laboratory and radiologic testing, sophisticated screening procedures and update evaluations for Rehab, nutrition and fitness.

A Global Well-Being Assessment will be Completed Prior to Your Initial Customized Well-Being Health and Medical Assessment: The Acts Well-Being Coach, a licensed clinical social worker, will conduct a scheduled pre-visit in home consultation and review your current medical and life story records that are currently available at St. Andrews Estates. The Well-Being Coach will consider your entire well-being picture, taking into account your social and medical history; age and genetic predispositions; psychosocial needs; and identify any risk factors. The in-home consultation will provide a forum for you to discuss any concerns about your health and well-being and allow your Coach to consider any additional interdisciplinary screenings or referrals that may be indicated. Your Coach will schedule a THRIVE assessment with a trained, licensed therapist prior to your WellBeing Assessment appointment with your Acts Nurse Practitioner.

Additional In-house Well-Being Services: If indicated and decided upon your pre-visit consultation with the Acts Well-Being Coach, other in-house Acts well-being consultations can be arranged by the Well-Being Concierge in implementing your unique and personalized Well-being portfolio plan: • • • • •

• • • • •

Spiritual consultation with the Chaplain at St. Andrews Estates Mental health services and counseling provided by a Licensed Clinical Social Worker, Well-Being Coach Chronic Care Management by the Nurse Navigator at St. Andrews Estates Detailed cognitive assessments and testing by the Acts Nurse Practitioners and/or a Licensed Speech Therapist at St. Andrews Estates More detailed standardized assessments and testing by the Acts in-house rehabilitation team at St. Andrews Estates including a personalized THRIVE exercise prescription that will be shared with the Fitness Coach at your community More in-depth fitness evaluation, training, and in implementing the personalized created exercise plan by your Fitness Coach Life Engagement Director at your community to review additional activities, clubs, volunteerism opportunities, and events based on your interests More nutritional consultations provided by the Acts Registered Dietitian to meet your dietary goals, weight management plans, etc.

Referral to Acts Home Services/Care Management and Acts Medicare Home Health Agency A Well-Being Concierge is readily available to assist in accessing these services at St. Andrews Estates and services in the general outside community

On the Day of Your Scheduled Initial Health and Well-being Assessment: You will arrive at the Wellness Suite on the _________ side of the campus. You will be welcomed by the Wellness Office staff who will escort you to a comfortable, private exam suite. Depending

on your appointment time and if you are fasting for the initial blood work panel a lite healthy breakfast or snacks will be provided after your fasting blood work is obtained.

Your initial visit with the Acts nurse practitioner will include a complete medical history, family history, risk assessments, and a thorough physical examination. A review of any necessary immunizations and vaccines will also be provided. An Acts THRIVE initial assessment will be completed prior to this visit by a trained, licensed therapist, your fitness assessment will be managed by a trained, certified fitness instructor and in taking a full body composition analysis screen, while the initial nutrition assessment will be conducted by a licensed dietitian, aimed at optimizing your diet for good health and to reduce the risk of illness.

Laboratory and Radiologic Screenings will be conducted based on your individual needs and risk factors: • • •

• • • • • • • • • •

Vital signs, heigh and weight, pulse oximetry (oxygen saturation level) Complete blood count to evaluate for anemia and other hematologic disorders Complete metabolic panel to assess for diabetes, kidney disorders and other metabolic problems- A1C is included. If clinically indicated, a continuous blood glucose monitoring for two weeks will be ordered by the nurse practitioner.

Cardiac risk profile, including lipid panel and advanced studies, to assess for cardiovascular and cerebrovascular risk Urinalysis to screen for urologic and kidney disorders. Use of a bladder scan may also be indicated Thyroid testing for over or underactive thyroid disorder Prostate specific antigen (PSA) to screen for prostate cancer, if necessary, as decided between you and the nurse practitioner Electrocardiogram (EKG) to screen for cardiac disease, including coronary and electrophysiologic problems Audiometric testing to detect hearing problems Spirometry testing to detect lung or pulmonary problems Vision testing and evaluation for ocular health Chest Xray can be scheduled for a date and time after your initial health assessment, if indicated by the nurse practitioner for suspected cardiac or pulmonary issues If indicated, a referral for a GYN exam will be initiated and/or an order for receiving a mammogram will be provided by the NP

Additional Outside Healthcare Provider Consultations: If indicated and decided upon your consultation with the Acts Well-Being Coach and based on the full comprehensive assessment completed by the Acts Nurse Practitioner, other outside healthcare consultations may be arranged by the Well-Being Concierge in implementing your unique and personalized Well-being portfolio plan: This include but not limited to• • • • •

Podiatrist/Audiologist/Ophthalmologist/Dentist Other specialized medical consultants, i.e. dermatologist, Gastroenteric physician Reflexology/Massage/Chiropractic/ and other complementary alternative treatments Dexascan to screen osteoporosis for those individuals identified being at risk Psychologist/Psychiatric services

• •

Professional counseling services- grief, depression, alcohol use, etc.

Comprehensive Cognitive Screening and Assessment at Florida Atlantic University (FAU)

Findings, Recommendations and Future Well-being Plan and Follow-Ups: At the end of your comprehensive Well-Being Assessment: • •

•

•

You will receive a person directed goal setting and coaching session.

You will also receive a personalized report including exam findings, internal lab test results and other external lab results will be shared upon their receipt, and nutrition, Rehab and fitness advice, and additional nurse practitioner clinical findings and recommendations.

If follow-up care with outside healthcare professionals and advance diagnostic testing is recommended or requested, our Acts Well-Being team can assist in making those appointments.

You will also receive a personalized Well-Being Support Plan that will assist you in implementing your own well-being plans and goals to reach your optimum you!

The Acts Well-Being Coach and Well-Being Concierge will both be reaching out to you throughout the year to assist you in your progress and in making any adjustments to your plan and your goals and in accessing any other well-being services.

We thank you again for your active ongoing participation in the Acts Well Being Pilot at St. Andrews Estates!!

For more information and in scheduling your Comprehensive Well-Being Assessment, please contact the Acts Well-Being coach, by calling # ( ), or by email at _________@actslife.org

Acts Signature Well-Being Product, Alpha Pilot Consent To Participate DRAFT You have expressed interest in participating in the Acts Signature Well-Being Product, Alpha Pilot. The following information will be helpful and important to you in consenting to participate in this pilot project. You may choose to revoke your participation at any time.

The Acts Well-Being Health Coach (or designee) will talk with you about this document as well as describe in detail the Well-Being product, the alpha pilot and the expectations of your involvement.

The alpha pilot will consist of 30 active participants, volunteer residents from the alpha pilot site, St. Andrews Estates.

Summary The Acts Signature Well-Being Product is a multidisciplinary integrated approach to develop a person-centered, holistic scope of a well-being experience for the independent living resident, accomplished by coordinating health and wellness services into an all-encompassed signature well-being product with the goal of delivering a personalized Acts Signature Well-Being Portfolio for each resident. The Acts Signature Well-Being Product consists of various components including Engagement, Lifestyle, Spiritual Life, Nutrition, Fitness, Primary Care, Rehab and more. A healthier, active, engaged life to promote longevity and aging in place.

Consent – Protected Health Information As described above, the Acts Signature Well-Being Product includes participation with several disciplines/service departments within the community, including primary care (Wellness Office), rehab, fitness and nutrition, in addition to potential referrals or recommendations for specialty providers outside of the community (such as cardiology, dermatology, neurology, etc.) as well as memory support and mental health services. Any information obtained about your health, physical or mental (Protected Health Information (PHI)), will be stored in a HIPAA compliant electronic health record system. PHI is any information we receive or create that identifies (or could identify) you and deals with your physical or mental health, any healthcare services that we provide you and/or payment for such services. Select services may be billable to your health insurance carrier. As part of this pilot project, you will not be responsible for payment of any services that may be denied by your health insurance carrier.

By signing below, you are consenting to our use of your PHI to provide treatment, payment or healthcare operations in conjunction with the Acts Signature Well-Being Product.

Name (please print)

Date

Signature

Date

Consent for Treatment I hereby give my permission for treatment as may be deemed necessary or advisable for diagnosis or continued care.

Signature

Date

Wearable Devise Consent As a participant in the Acts Signature Well-Being Product, we will make available to you (on a loaner basis) a wearable device, such as an Apple Watch, with instructions on how to use the device. The purpose of the wearable device is to monitor progress and in utilizing your data for creating your personalized Acts Signature Well-Being Portfolio Plan. Use of a personal device is also acceptable if you so choose. Use of the wearable device is a recommendation, it is not a requirement for participation in the Acts Signature Well-Being Product Alpha Pilot.

Wearable Mobile Health (mHealth) is the method of delivering healthcare through mobile technology. The use of mobile technologies will allow for the collection of data from the participant when s/he is not physically present in the Wellness Suite or other clinical settings within the community, allowing for a significant and efficient increase in data collection.

Wearables are worn technologies that have sensors built in. These sensors can connect to the web (e.g., wi-fi) or be plugged into a computer to track information. mHealth can include mobile devices and apps (e.g. laptop, tablet, iPhone, Android) and wearable technology (e.g. Fitbit). mHealth allows for the collection of data in real-time, such as pulse, temperature, blood pressure, heart rhythm, blood glucose, sleep patterns, stress indicators, range of motion and others.

Wearable devices generally have technologies that have sensors built in and can often be connected to other devices via app or other interface.

While wearables are not used to diagnose medical conditions or illnesses, they are often used to track the activity of a participant. This technology is seen to decrease the burden on a participant who would typically track their activities in a journal or diary. It can also allow for the collection of additional research data such as heart rate, temperature, body fat composition etc., without the use of separate medical equipment.

Risks There is a possibility of minor skin irritation associated with wearable devices. We recommend taking it off occasionally, not wearing it too tightly, and keeping it clean and dry. You should regularly clean your wearable device, especially after working out or sweating, following the manufacturers guidelines. Always dry the wearable device well before putting it back on. If you start to experience skin irritation, we suggest you remove the device and contact the Well-Being Health Coach or Concierge to discuss the issue.

Confidentiality To ensure your confidentiality while wearing the wearable device to the extent permitted by law, data collected will be stored in the community’s secured, HIPAA compliant electronic health record system. The company that manufactures the wearable device will have access to your data, but they will not have access to your identity because medical record numbers will be used rather than names. Your data would be anonymous to the manufacturing company.

By signing below you are acknowledging your understanding of the use and risks associated with a wearable device.

Name (please print)

Date

Signature

Date

SECTION 15 Acts Signature Well-Being Portfolio Sample (to be drafted)

SECTION 16 Technology & Equipment

Technology & Equipment, Resources and Demo’s ►Apple Health Report https://actsretirementlife.sharepoint.com/:b:/r/sites/NewWell20/Shared%20Documents/Technolog y%20Solutions/Health-Report-July-2022.pdf?csf=1&web=1&e=McD0w9 ►Rockley Wearable Sensors https://www.fiercebiotech.com/medtech/rockley-photonics-unveils-clinic-wrist-system-offering-aglimpse-at-apple-watch-s-future ►Great Age Roboot https://www.greatagereboot.com/ ►Netsmart Patient Portal https://www.ntst.com/Offerings/myHealthPointe-Consumer-Portal ►Orion Health - https://orionhealth.com/us/ (Health Data Management Platform) Built to collect and share population health data in a centralized place for organizations to view resident data and for residents to view their complete health information in one location. Robust APIs and integrations to easily push and pull data out of the system are in place and was the primary focus of Orion in the past as a Datawarehouse.

(Demo recording requested from vendor). ►TSO Life - https://tsolife.com/ (Business intelligence platform) ►PDHI – https://www.pdhi.com/corporate-wellness.html (Global Assessment) Built to support various program designs for occupational and population health. Configurable to support corporate wellness & benefits programs. ConXus Profile is a configurable health risk assessment (HRA) engine that delivers PDHI’s NCQA-certified assessments and can also be used to deploy client-developed assessments.

ConXus Profile supports question completion from any PC, tablet, or smartphone. The questionnaire may also be completed using paper forms or facilitated by a health navigator.

PDHI has received Wellness and Health Promotion (WHP) 5 certification from the National Committee for Quality Assurance (NCQA) for health risk assessments for the following populations: • Commercial — adult and pediatric • Medicaid — adult and pediatric • Medicare — seniors

These health appraisals use evidence-based guidelines and aim for a sixth-grade reading level.

They follow the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care in their use of texts and images. To ensure currency with clinical

guidelines, PDHI reviews and updates assessments annually, or more frequently when a guideline changes.

The online health assessment can be completed on any PC, tablet, and smartphone. The questionnaire uses conditional branching logic to present relevant question sets to each user based on age, gender, and program options. Clients may configure the questionnaire to add or remove questions.

Data is saved automatically, and the participant may stop and return to complete the questionnaire at a later date. The questions can be switched between over 100 languages at any time using the Google Translate feature.

Upon completion, responses are locked before the personalized report is displayed to the participant. Optional review mode delays the display of the report until biometric data is available. https://grahamcpdhimy.sharepoint.com/personal/davida_pdhi_com/_layouts/15/stream.aspx?id=%2Fpersonal%2Fdavi da%5Fpdhi%5Fcom%2FDocuments%2FRecordings%2FPDHI%20Wellness%20Platform%20Capa bilities%2D20221019%5F110203%2DMeeting%20Recording%2Emp4&wdLOR=c2FA4BC09%2D FB8B%2D4E83%2DB37F%2D41F4747A76D6&ct=1667574208742&or=OutlookBody&cid=1827956B-FB0D-4F7B-AAB2-9C439617DEE6&ga=1

WELLNESS PORTAL DEMO SITE - https://cxp.pdhi.com/Portal/Member/dcb2ca9e-d299-401a9026-5ac64c49f625

Pilot Fees: To provide fees it would be very helpful if you could provide a project overview to include: 1) Project duration 2) Number of residents 3) How will residents be enrolled into the program?

4) Will residents and / or health coaches complete the heath assessment 5) What are the pilot project performance measures? a. Ease of completion and review of results b. Reporting Contracted Fees: In summary, our clients can brand their solutions. You can deploy any combination of modules. You only pay for for the modules deployed. Groups and modules can be added at any time during the contract term.

Our fees comprise of: • • •

License Fees – Annual per participant per year license fee for each module deployed.

Setup Fees - Fees to deploy the solution Ongoing Fees - Fees to support the solution

License Fees: Each module has a per participant per year fee (PPPY). A resident is an example of a participant.

To support your business model, we are proposing a population-based fees option or a usage fees option.

(The usage fee option is the most likely preferred initial option.)

•

•

Population Fees Option: Fees are based on the total eligible participants in the pre-loaded eligibility file and the modules deployed. For example, if a group has 1,000 participants and the program includes ConXus Profile and ConXus Connection then the annual fee for this group is: 1,000 participants X ($3.27 + $4.29 = $7.56) = $7,560 Usage Fees Option: Fees are based on when a module is activated by the participant and the health coach. The usage PPPY fees are billed in the month occurred. The participant has 12 months access to and use of the application for 12 months from the month usage. The usage fees in RED.

Minimum monthly license fee. The minimum monthly license fee is $2,500 or $3,750 when usage coaching is selected.

1. The minimum monthly license fee is NOT in addition to population fees. The total license fees for all ConXus modules are counted toward the minimum annual fee.

Core modules are: Module

Description

Pop PPPY Fees Option

Usage PPPY Fees Option

ConXus Profile

Health assessment

$3.27

$4.91

ConXus Steps

Health action plans

$4.29

$6.44

ConnXus Connection

Challenges / Trackers

$4.29

$6.44

ConXus Direct

Health coaching system

$3.47

$13.20

ConXus Knowledgebase

Health information

$1.03

$1.55

Notes: 1) ConXus Knowledgebase does not contribute to minimum monthly fees.

2) Volume discounts are available when aggregate populations exceed 10,000 for one or more modules (Refer to the fee schedule for details): Setup Fees: Setup fees apply for: • •

Client Setup - $1,500 Wellness Portal to include support of single-sign-on from a client portal or direct registration and logon at the ConXus Portal -- $2,000

Setup fees may apply for: •

•

Third-party integration. Outbound single sign-on (SAML 2.0) allows third-party applications to be connected with the Hub. To support integration with third-party applications such as scheduling or benefits app -- $2,500 per application (estimate) ConXus Direct health coaching system configuration -- $3,000 (estimate)

Note: Addition of new groups does not typically incur any additional set up fees.

Ongoing Fees: Ongoing service fees apply for: •

All eligibility files in excess of one full eligibility file per month and one incremental or partial eligibility file each week during the month other than the week of the full update, and for all other files.

The license fees client support. You will be assigned a Client Services Consultant who is the main point of contact at PDHI to support the delivered solution.

Invoicing: • •

• • •

Invoicing for license fees commences on the System Acceptance date, 45 days after submission for Acceptance Testing or 90 days after the contract Effective Date, whichever is sooner.

Population license fee option. At the end of each billing month, the actual population license fees will be reconciled, and license fees will be billed at one-twelfth of the applicable PPPY fees. If committed population discounts have been elected and license fees do not meet the committed population fee, one-twelfth of the applicable committed fee will be billed.

Usage fee option. Usage fees are billed in full at the end of each month for the usage incurred in the month.

Service Invoicing: Invoicing for services occurs at the end of the month in which the service is delivered.

Payment: Payment of license and service fees is required by ACH transfer within 30 days of receipt of the invoice.

REHAB EQUIPMENT/TECHNOLOGY ►WellSky/Raintree https://www.raintreeinc.com/ https://wellsky.com/

FITNESS EQUIPMENT/TECHNOLOGY ►Matrix Fitness - https://www.matrixfitness.com/us/eng Recording: https://actsretirementlifemy.sharepoint.com/:v:/g/personal/83505_actslife_org/Ee4fUXATjktCuh_f2a4cnckBXiaazV50xXj7j zDLTA_WcA?e=Pu7aOm ►Keiser - https://www.keiser.com/ Recording: https://actsretirementlifemy.sharepoint.com/:v:/g/personal/83505_actslife_org/EeMoT2NoUAFHkz7xVuu9lHgBoZL5SKi1Ii 4QaF41Etm6hw?e=YeDVXC ►NuStep - https://www.nustep.com/ Recording: https://actsretirementlifemy.sharepoint.com/:v:/g/personal/83505_actslife_org/EVxCykBQVzRGlCH8VYz7cYMB4FMF4kq caUwHA0nf5ykmbQ?e=RihKIm

PRIMARY CARE EQUIPMENT/TECHNOLOGY ►NextGen Software Solutions (Primary Care Electronic Health Record System – implementation in progress. 3-phase rollout to all Wellness Suites) https://www.nextgen.com/ehr?utm_source=Online_Advertisement&utm_medium=GA&utm_campaign=br and-toplevel&utm_content=145852561328&utm_term=nextgen%20healthcare&creative=617051539840&device= c&placement=&gclid=CjwKCAjw8JKbBhBYEiwAs3sxN8_M3_rzT0HQmtOlG1IYb64dPBzgtInPQiJG2FD 49BWvd1tsTJ0oSRoCWCsQAvD_BwE&gclid=CjwKCAjw8JKbBhBYEiwAs3sxN8_M3_rzT0HQmtOlG1IY b64dPBzgtInPQiJG2FD49BWvd1tsTJ0oSRoCWCsQAvD_BwE

►InBody •

Body Comp Analyzer

InBody 570 body composition analyzer provides standard outputs like Percent Body Fat, Skeletal Muscle Mass, and BMR, plus total body water, visceral fat assessment, and other vital measurements.

Application Bariatrics Cardiology Corporate Wellness

Diabetes Disease Prevention Fraility and Aging

Intensive Cre Unit Lymphdema Nephrology Nutrition

Oncology Peds Personal Training Rehabilitation and Physical Therapy

Starting at $10,290

Segmental Lean Analysis Get an in-depth analysis of an individual’s lean body mass. Evaluate if an individual has a sufficient level of lean body mass in each segment of the body (arms, legs, and trunk) and spot any imbalances between the limbs.

ECW/TBW Analysis Understand how body water impacts an individual’s body by identifying swelling and other types of water retention in the body.

Visceral Fat and Segmental Fat Analysis Where your body fat is located is just as important as how much you have. Focus on important areas like Visceral Fat, the type of fat that surrounds your vital organs, and help individuals reduce their levels for long-term health benefits.

Body Composition History Track changes in Weight, Skeletal Muscle Mass, and Percent Body Fat over time. Spot trends and make timely adjustments to keep your clients headed in the right direction.

InBody 570 Result Sheet

Every InBody Test includes a full-page Result Sheet printout that details muscle, fat, and water measurements and highlights specific areas to focus on.

InBody Academy Clients get exclusive access to a personal online learning platform with over 7 hours of self-paced learning. Master the fundamentals, including testing and Result Sheet breakdown, and become InBody Certified.

Dedicated Account Management Every client gets a dedicated account manager focused on helping you achieve your goals with InBody.

From onboarding training to advice on improving your test experience, we will put you in a position to succeed.

Service and Support from InBody Experts Whether you need technical support or you have a question about a Result Sheet, we are here to help.

Our experts are available by phone, email, or online chat.

Knowledge Base & Resources

We have the blogs, ebooks, and resources to help you further your understanding of body composition and get the most out of your InBody.

Other models: InBody 270 – starting at $6260 InBody 770 – starting at $19,360 InBody 970 – starting at $29,595

►Piccolo Xpress Chemistry Analyzer, Blood Analyzer The Piccolo Xpress is a portable clinical chemistry system designed for accurate, near-patient testing. With the Piccolo’s 12-minute test time, healthcare providers can diagnose and treat within the span of a single office visit, thereby increasing the efficiency of care, reducing costs, and improving patient management.

The menu features 31 blood chemistry tests that range from liver, kidney and metabolic functions to lipids, electrolytes and other specialty analytes. These 31 tests are conveniently configured into 16 completely self-contained reagent discs, 11 of which are CLIA waived.

FAST, EASY, ACCURATE ON-SITE CHEMISTRY ANALYZER Abbott Point of Care is proud to be the exclusive US distributor of Piccolo Xpress, a fully-automated advanced diagnostic instrument that provides lab-accurate results within minutes for a wide range of clinical chemistry needs.

BENEFITS OF THE PICCOLO XPRESS • Enables results in just 12 minutes • Stores up to 5,000 patient records • Requires only 0.1 cc (100 ul) of blood, serum, or plasma • Supports electronic medical records (EMR) connectivity • Includes a broad diagnostic menu for routine testing, general health screening, and chronic conditions Easy Operation • Requires very little maintenance • CD Software makes testing upgrades easy • Operates from line or 15-volt battery power • Every reagent disc automatically self-calibrates • Self-contained, disposable reagent discs are easy to handle • The Piccolo Xpress procedure is quick and easy to perform • No special operating skills are needed to run the Piccolo Xpress • Flexible alpha-numeric data entry options and analyzer settings • Easy to use color touch screen guides the operator through the process • Integrated intelligent Quality Control (iQC) checks performance and accuracy • Direct compatibility supported with USB peripherals including bar code readers, keyboards, personal computers and printers.

Cost per Analyzer:

$17,000

•

Urine Analyzer

CLINITEK Status+ Urine Analyzer -- for simple, enhanced clinical information for urinalysis results The CLINITEK Status®+ Analyzer is an automated point-of-care urinalysis analyzer that aids in the assessment, diagnosis, and monitoring of chronic conditions.

Features & Benefits Increases workflow efficiency • • •

Frees staff for patient care with true walkaway convenience.

Add sample and the analyzer does the rest.

Provides results in 1 minute. No waiting for lab results.

Eliminates error sources • • •

Accurately times test for you—no watching the clock!

Automates and removes subjectivity of result interpretation.

Automatically transmits test results to minimize transcription errors (when interfaced).

Improves data integrity • •

Proprietary Auto-checks® technology will automatically identify Siemens Healthineers strip type and detect test strip humidity for overexposure.

Operator lockout prevents use by unauthorized users.

Future-ready—ask about our upgrade kit for adding connectivity and bar-coding.

Cost per analyzer -- $1700

SECTION 17 Costs, Projected Expenses, Revenue Opportunities

Well-Being Project Billing and Reimbursement Opportunities ANNUAL IL CLINIC VISIT The Acts Annual IL Review for independent living residents is a commitment to residents to conduct a face-toface clinic visit each year. This visit is unbillable unless the resident is a Medicare (part B) or Medicare Advantage beneficiary AND has elected the community’s NP as their Primary Care Provider. In addition, Medicare (part B) and Medicare Advantage beneficiaries are eligible for Medicare’s Annual Wellness Visit (AWV) for the purpose of creating or updating a personalized prevention plan that may help prevent illness based on current health and risk factors. The Acts NPs may also complete an AWV for Medicare beneficiaries when a resident is not their primary care patient so long as the AWV has not been conducted by the resident’s PCP or other healthcare provider. In these cases, the AWV is completed in lieu of the Annual IL Review and billed to Medicare for reimbursement. ►AWV billing codes and reimbursement rates: Description Annual Medicare Wellness Visit, initial Annual Medicare Wellness Visit, subsequent Advanced Care Planning (same day as AWV), first 30 minutes Advanced Care Planning (same day as AWV), additional 30 minutes

CPT Billing Code G0438 G0439

Medicare NP Reimbursement Reimbursement* $169.23 $143.85 $133.64 $113.59

99497

$ 85.84

$72.96

99498

$ 74.32

$63.17

*NPs are reimbursed at 85% of the Medicare Fee Schedule.

LABORATORY STUDIES ►Bloodwork is not currently included in the Annual IL Review but there are options for low cost lab studies to be conducted on campus.

Recommended testing options to be added to the Annual IL Visit: • CBC panel** • Basic metabolic panel • Comprehensive metabolic panel • Lipid panel Bloodwork/Panel Details • CBC panel (anemia, autoimmune disorders, bone marrow problems, cancer, dehydration, heart disease, infection, inflammation, vitamin and mineral deficiencies • Basic metabolic panel (Medication side-effects, kidney function, lung function, severe infection, undiagnosed diabetes or inadequately controlled diabetes, hypoglycemia.

• Comprehensive metabolic panel (cognitive dysfunction, problem with the liver, malnutrition, gallstones or another issue blocking the bile ducts, problem affecting bone metabolism • Lipid panel (total cholesterol, triglycerides, for the evaluation of cardiovascular risk in older adults) Equipment Identified: Manufacturer:

Piccolo Xpress Chemical Analyzer Abbott Labs

Cost per Analyzer: Shelf Life:

$17,000 Approximately 7-10 years

**The Piccolo Xpress does not process the CBC panel (CLIA moderate complexity test) ►Supply costs and reimbursement rates (costs supplied by McKesson and based on minimal purchase orders): Test Name Supply CPT Billing Code Medicare NP Cost/test Reimbursement Reimbursement* Routine Venipuncture -- 36415 $3.00 $3.00 Comprehensive Metabolic $9.7 80053-QW $10.56 $8.98 Panel Basic Metabolic Panel $9.7 80053-QW $8.46 $7.19 Lipid Panel $9.7 80061-QW $13.39 $11.38 80061-QW, 82947Lipid Panel Plus $12.98 QW, 84460-QW, $27.80 $23.63 84450-QW *NPs are reimbursed at 85% of the Medicare Fee Schedule. ►Urine Analyzer – current process is manual with urine dip stick. Urine analyzer eliminates human error.

Easy to use, convenient, improves data integrity. Touchscreen and interfaces with EHR. Equipment Identified: Manufacturer: Cost per Analyzer:

Clintek Siemens $1700

►Reimbursement varies based on test and test strips. Range $2.25 - $9.70/test.

REFERRAL SERVICES As a result of the annual visit, NPs may provide referrals for additional medical care or support services. Select referral services are billable to insurance. ►Behavioral Health Services – services performed by Licensed Certified Social Workers (LCSW) are billed and reimbursed as follows: CPT Billing Code Diagnostic Evaluation 90791 Psychotherapy (16-37 minutes) 90832 Psychotherapy (38-59 minutes) 90834 Psychotherapy (60+ minutes) 90837 Family psychotherapy w/patient 90847 Group psychotherapy 90853 Interactive Complexity 90785 Neuropsychological Testing (first hour) 96116 -- each additional hour 96121 96127 Health & Behavior Assessment *LCSWs are paid at 75% of the Medicare Fee Schedule Description

Medicare LCSW Reimbursement Reimbursement* $180.75 $135.56 $77.81 $66.14 $103.28 $77.46 $152.48 $114.36 $102.59 $76.94 $27.57 $20.68 $15.00 $11.25 $97.00 $72.75 $82.35 $61.76 $4.89 $3.67

►Nutritional Services – select services performed by a Registered Dietitian (RD) are billable to insurance, as follows: Description Medical nutrition, individual, initial Medical nutrition, individual, subsequent Medical Nutrition, group Malnutrition therapy subs therapy for change in diagnosis Group malnutrition therapy 2 or more 30 mins

CPT Billing Code 97802 97803 97804 G0270 G0271

Medicare Reimbursement $37.69 $32.45 $17.10 $32.45

RD Reimbursement* $30.15 $25.96 $13.68 $25.96

$17.10

$13.68

*RDs are paid at 80% of the Medicare Fee Schedule ►Rehab/Therapy Services – select services performed by a Licensed Physical Therapist or Occupational Therapist are billable to insurance as follows: Description Therapeutic exercises (based on units) Neuromuscular re-education Gait training therapy Therapeutic activities Self care management training

CPT Billing Code 97110 97112 97116 97530 97535

PTs/OTs are paid at 90% of the Medicare Fee Schedule

Medicare Reimbursement $30.36 $35.24 $30.36 $39.43 $33.85

PT/OT Reimbursement* $27.32 $31.72 $27.32 $35.49 $30.47

SECTION 18 Research & Resources

Research and Resources ►The Medicare Annual Visit https://actsretirementlife.sharepoint.com/:b:/r/sites/NewWell20/Shared%20Documents/Technolog y%20Solutions/Health-Report-July-2022.pdf?csf=1&web=1&e=McD0w9 https://actsretirementlife.sharepoint.com/:b:/r/sites/NewWell20/Shared%20Documents/Annual%2 0Visit/Prevounce-AWV-rates-White%20Paper.pdf?csf=1&web=1&e=NFSpnH https://actsretirementlife.sharepoint.com/:b:/r/sites/NewWell20/Shared%20Documents/Annual%2 0Visit/Wellness-visit.pdf?csf=1&web=1&e=rx2sKJ https://actsretirementlife.sharepoint.com/:b:/r/sites/NewWell20/Shared%20Documents/Annual%2 0Visit/Wellness-visit.pdf?csf=1&web=1&e=rx2sKJ https://actsretirementlife.sharepoint.com/:b:/r/sites/NewWell20/Shared%20Documents/Annual%2 0Visit/Prevounce-AWV-Checklist.pdf?csf=1&web=1&e=NLJCcs ►New Aegis Living Community Pilots Wellness Program https://www.mcknightsseniorliving.com/home/news/new-aegis-living-community-pilots-wellnessprogram-incorporates-nature-into-design A Long Life Does Not Always Mean a Happy Life in Old Age https://www.census.gov/library/stories/2021/05/long-life-does-not-always-mean-a-healthy-life-inold-age.html ►Hospital At Home White Paper https://www.fiercebiotech.com/medtech/rockley-photonics-unveils-clinic-wrist-system-offering-aglimpse-at-apple-watch-s-future ►Matthers Wellness Coaching https://actsretirementlife.sharepoint.com/:b:/r/sites/NewWell20/Shared%20Documents/General/M ather_WellnessCoaching_FINAL.pdf?csf=1&web=1&e=zhl9qU ►AI Technology for Residents https://www.youtube.com/watch?v=hDcnbL7FM9o ►Book -- "The Handbook of Structured Life Review" by Barbara K. Haight and Barrett S. Haight. ►CVS Health and Microsoft Announce Strategic Alliance to Re-Imagine Personal Care https://news.microsoft.com/2021/12/02/cvs-health-and-microsoft-announce-new-strategic-allianceto-reimagine-personalized-care-and-accelerate-digital-transformation/ ►When You Control Your Health Data, You Control Your Options https://www.ciitizen.com/ ►Creating a Personalized Model for Senior Living https://info.seniorlivinginnovationforum.com/blog/creating-a-personalized-model-for-senior-living

►Person Centric Wellness Orange Paper https://info.seniorlivinginnovationforum.com/blog/creating-a-personalized-model-for-senior-living ►A Primer for Evaluation and Integration of Dietary Intake and Physical Activity https://info.seniorlivinginnovationforum.com/blog/creating-a-personalized-model-for-senior-living ►Forward’s Innovative Doctor’s Office Visit https://youtu.be/_h8QvIoSTsE ►Florida Atlantic University (FAU), Center for Advanced Nursing https://youtu.be/_h8QvIoSTsE ►FAU Research Driving 2022 https://youtu.be/_h8QvIoSTsE ►ICAA State of the Wellness Industry https://files.constantcontact.com/b6e71aa6201/e3b7c56f-e6d1-46e2-b952-fe4fc7ebbae2.pdf ►Array of Technology Helps Providers Better Serve Residents https://www.qgdigitalpublishing.com/article/Array+of+technology+helps+providers+better+serve +residents/4283589/749152/article.html ►ACAR Brain Health Intervention Study https://www.youtube.com/watch?v=bk4Mc5ukYw8 ►REACT Neuro, A Brain Health Tool https://reactneuro.com/ ►How Scientists are Shifting their Search for Links Between Diet and Dementia https://www.sciencenews.org/article/diet-food-dementia-alzheimers-disease-research ►American Council on Exercise’s Health Coach Certification https://www.acefitness.org/fitness-certifications/health-coach-programs/

►Canyon Ranch - https://www.canyonranch.com/ ►Chip Conley - https://www.modernelderacademy.com/ ►Exercise and Dementia https://www.drperlmutter.com/new-medication-50-percent-risk-reduction-fordementia/?inf_contact_key=1b9c71adc61cec2c225bfa813a069a77680f8914173f9191b1c0223e68310bb1 https://jamanetwork.com/journals/jamaneurology/fullarticle/2795819