HEARTH(Holistic Environmental Assessment for Return to Home)

By Melissa Chang, Paige Hays, Erin Henshaw, Carrie Pommeranz, and Jackie Webel

Opening the doors to full living

Opening the doors to full living

Program Overview

• Mission Statement:– Our mission is to promote independence and participation in our

clients’ daily lives and to improve their quality of life by implementing universal and accessible environmental design through client-centered and evidence-based assessment and services.

• Vision:– Our vision is to be a community leader advocating for and providing resources

to promote universal and accessible design in the home environment. • Values:

– To collaborate as a team with clients and their families– To treat clients and their families with respect and dignity– To be client-centered– To base services on the best available evidence– To advocate for accessible and universal design to promote participation and

quality of life– To advance research on the efficacy of the role of environment in performance

and participation

Opening the doors to full living

Current Trends

• A limited number of hospital-based environmental modification programs exist nationwide (Pynoos et al., 1998).

• Increased rate of chronic and acquired conditions in the aging population profoundly impact perceived quality of life and overall participation (U.S. Census Bureau, 2004; Whiteneck et al., 2004; World Health Organization, 2006).

• Environmental barriers in the home limit participation (Lowery, Buri, &

Ballard, 2000). • Environmental interventions improve independence and decrease

functional decline (Mann et al., 1999). • Health professionals must bridge the gap between discharge from

the hospital and home in order to decrease environmental hazards that contribute to disability and limit functional independence within the home environment.

Opening the doors to full living

Population Served

• Inpatient and outpatient clients at a rehabilitation hospital who want to remain living at home– Examples:

• Aging adults

• People with acquired injuries

• People with chronic conditions

Opening the doors to full living

Services Disciplines delivering service: Occupational Therapists • Initial assessment in OT clinic (1 hr)

– Occupational profile, assessments, goal establishment• Assessment of client’s performance within home (1 hr)

– Comprehensive Assessment and Solution Process for Aging Residents (CASPAR)

– Home Occupation-Environment Assessment (HOEA)– Home Observation Measure of the Environment (HOME)– Canadian Home Mortgage Housing Corporation (CHMHC)

• Tx session: discuss recommendations for modifications (1 hr)– Written recommendations, sketch drawings, contractor contacts,

vendor resources, funding sources, and legal advise• During construction, OT will be available for consultation

– Services provided are not direct OT treatment and are not billable • Follow-up/training visit in the home after the modifications (1 hr)

– Measure outcomes through re-administration

Opening the doors to full living

Staffing

• The 4 FTEs will be licensed and registered occupational therapists

• Training– Standard employee training

– On-the-job mentorship program

Opening the doors to full living

Budget• Based on interview with OT at Barrier Free Design Program at Rusk

Institute for Rehab in New York City

• Expected volume/ year: 1000 people• Revenue/ year: $1,250,080

– Assessment: $325– Treatment: $300

• Expenses/ year: $615,680– Includes the following costs: assessment,

administrative, salaries, supplies, marketing, overhead, and start-up

• Profit is 50.7% (before contractual allowances)

Opening the doors to full living

Marketing Plan: Competition

• Competitive services include the following:– Private contractors– Private home modification businesses– Occupational therapists in private practice

• Other factors that may influence our business: – Lack of perceived need for modifications– Reluctance to incur the costs and inconvenience associated

with the construction or modification process– Preference for independent research – Possible move to another living arrangement, such as assistive

living facility or nursing home

Opening the doors to full living

• Unique Program Features:– Association with reputable hospital system– Evidence-based practice– Client-centered and family-directed services– Comprehensive assessment of the person’s occupational

performance in the home environment• Use of standardized and functional measures for assessment and

outcomes

– Performance driven goals– Provide recommendations for home modifications, including

information on funding, legal rights, and building codes– Partnership with contractors and vendors– Follow-up and training for client and family

Competitive Advantage

Opening the doors to full living

Marketing Plan

• Educate hospital consumers and local community

– Goals:

• Recognize our name and know our service product

• Initiate contact with HEARTH

– Methods:

• Brochures in hospital waiting rooms

• Posters in public hospital spaces

• Main focus: Promote our name and our slogan

• Educate hospital personnel: Physicians, therapists, social workers, nurse practitioners, and hospital public relations office– Goals:

• Recognize our name and know our service product

• Refer clients to our service• Attend 1 weekly in-service

– Methods:• In-services • Hospital Newsletter• Establishing Personal

Contacts• Brochures, posters, website

Opening the doors to full living

Marketing Materials: Brochure

Opening the doors to full living

Website

• C:\Documents and Settings\haysp\My Documents\HEARTH\hearth.html

Opening the doors to full living

Performance Improvement Plan

• Indicators:– Documentation will reflect current standards of

competent practice in occupational therapy – Clients will have the resources/ information to

implement recommended home modifications – HEARTH will be reimbursed for direct patient care– Staff will improve efficiency of service provision to

increase productive hours (hours available for direct billing)

– Clients will show improvements in and satisfaction with functional performance outcomes

– Clients will show improvements in home safety and accessibility