Translating Strong for Life Into the Community Care Program: Lessons Learned

Abstract

We used a randomized controlled trial to test the implementation of Strong for Life (SFL), a resistance exercise intervention, using 32 home care aides (HCAs) as exercise leaders with their 42 homebound older adult clients enrolled in the Community Care Program, a Medicaid 1915(c) waiver program. Mixed-methods were used to analyze outcomes of program satisfaction rates, training session evaluations, program fidelity, and job descriptive index scores. Results indicate that it is feasible for HCAs to implement SFL safely with clients. Participants viewed SFL as highly satisfactory and HCAs were able to adapt SFL for their clients. HCAs have high job satisfaction, and leading SFL enhances work achievement and pride. Our results show it is possible to train HCAs to implement SFL with their clients in addition to providing usual care services, participation positively affects both care partners, and this is a feasible and practical delivery model to provide exercise for adults receiving home- and community-based services.

Design and development of a mobile exercise application for home care aides and older adult medicaid home and community-based clients

“…Clients have pronounced physical limitations and 99% are limited in completing instrumental activities of daily living such as housework, meal preparation, laundy, and activities outside of the home. Our previous work with this population found that 40% of HCAs did not have a high school diploma indicating the low levels of formal education among these formal caregivers (Danilovich, 2016). Based on this demographic profile, our knowledge of client and HCA abilities, and the preferences of clients and HCAs, we worked with the mobile app developers to purposefully create a very simplistic app that would be straightforward for naïve technology users and those without high levels of education.…”

“…Both studies showed HCAs could be trained to lead an exercise intervention and implement it successfully during usual care hours. Importantly, intervention satisfaction was high in both studies and 100% of clients and HCAs stated that exercise programs should be offered for all Medicaid HCBS clients (Danilovich, Hughes, Corcos, Marquez, & Eisenstein, 2016). However, Strong for Life was not originally intended for older adults receiving HCBS and Healthy Moves for Aging Well does not follow the ACSM recommendations for resistance exercise intensity.…”

“…Strong for Life is administered following a DVD supplemented by a paper manual with exercise pictures. One limitation to thjs approaches is the lack of DVD players among HCBS clients and the limitations of paper handouts in explicitly showing real-time exercise technique and modifications (Danilovich, Hughes, Corcos, Marquez, & Eisenstein, 2016). Thus, the development of a mobile app with video instruction may be more beneficial to supplement in-person exercise instruction by detailing modifications and facilitating program sustainability by providing a mechanism for clients to access exercise with or without their HCA present.…”

Functional resistance activities to impact frailty: A protocol for a randomized controlled trial involving home care aide and frail older adult dyads

“…We plan to recruit 63 HCAs and one of their clients per study arm for a total sample size of 126 HCA-client dyads. In our pilot study of 42 clients, overall attrition was 17% [13] . Allowing for similar attrition, we project 50 subjects per arm with complete data at three- and six-month follow-up.…”

“…While it is well established that progressive resistance exercise (PRE) improves muscle strength in both health and disease [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , it is not clear how best to engage frail older adults with limited community access in a PRE intervention [16] . It is also unclear the extent to which PRE can slow or reverse frailty [8] .…”