The picture of good health: Bringing focus to persons with disabilities

1. The picture of good health: Bringing focus to persons with disabilities Amber Eisfeld & Ashley Oolman Program Directors Legacy Endeavors, Inc. Nancy Flinn Director of Outcomes and Research Courage Center

2. Objectives • Participants will learn about the Courage Center’s and Legacy Endeavors’ wellness programs. • Participants will learn about the outcomes that demonstrate the value of accessible wellness programs for people with disabilities. • Participants will evaluate current life situations using the healthy lifestyle wheel.

3. Who is Legacy? • Founded in 1999 • Adult Foster Care • Expanded in 2010 • Individualized Supports and Services • In-home • Independent Living Services • Personal Supports • Supported Employment • Housing Coordination

4. Healthy Lifestyles Initiative • Ramsey County • Oregon Health & Science University • Staff Training • Individual Training

5. Ensuring Balance!

6. Healthy Lifestyles Wheel

7. How does the wheel apply to you? • Emotional Health • Know what stresses you • Express your feelings • Be good to yourself

8. Emotional Health

9. How does the wheel apply to you? • Physical Health • Get regular exercise • Avoid addictions • Get regular doctor checkups • Eat healthy foods • Get enough sleep

10. Physical Health

11. How does the wheel apply to you? • Social Health • Make lasting relationships • Have friends to go out with • Visit with family

12. Social Health

13. How does the wheel apply to you? • Meaningful Activities • Do work you enjoy • Get involved with hobbies

14. Health Through Meaningful Activities

15. How does the wheel apply to you? • Spirituality/ • Living Your Values • Know your values • Live your values • Be who you are

16. Spiritual Health/Living Your Values

17. Healthy Lifestyles Wheel

18. How does the wheel apply to you?

19. An Individual’s Perspective

20. An Individual’s Perspective

21. Is healthy lifestyle maintenance more challenging for our individuals? Because of • Lack of education • Need for proper assistance • Lack of transportation • Lack of money

22. The people we serve are more likely to experience: • Poor health due to secondary conditions • Medication side effects • Early death

23. How do we evaluate the individuals in relation to the wheel?

24. How will you apply these concepts? • Take a moment to come up with one goal that you would like to work towards within your organization.

25. Healthy Lifestyle’s Legacy

26. Questions? • Amber Eisfeld-Program Director • aeisfeld@legacyendeavors.com • Ashley Oolman- Program Director • aoolman@legacyendeavors.com

27. Courage Center is a Minnesota-based non-profit rehabilitation, advocacy and resource center that empowers people with disabilities to realize their full potential in every aspect of life. Recently merged with Allina Health, now known at Courage Kenny Rehabilitation Institute. Courage Center

28. Spina Bifida Fibromyalgia Autism Chronic Pain Post Polio Muscular Dystrophy Spinal Muscular Atrophy Spinal Cord Injury Brain Injury Stroke Cerebral Palsy Arthritis Parkinson’s ALS MS Populations Served in Health, Wellness and Fitness

29. Adults with disabilities should get at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic activity. (2008 Physical Activity Guidelines for Adults with Disabilities from the U.S. Department of Health and Human Services) But… 56% of people with disabilities report engaging in no physical activity 22% engage in regular moderate exercise 14% engage in regular vigorous exercise (US Dept of Health, 2000) Fitness Engagement

30. Physical Activity has been shown to decrease: Secondary conditions Chronic disease development Symptom days Health care utilization Health care costs Functional impairment Depression (Boslaugh, 2006; Warburton, 2006) A high BMI/waist circumference can lead to reduced recovery from a disability. (Walter, 2009) Physical Activity Benefits

31. Physical Activity has been shown to improve: Overall independence Functional abilities (mobility, ADL, strength) Independent living Endurance Mood (Pang, 2006; Teixeira-Salmela, 1999; Rietberg, 2004) Physical Activity Benefits

32. Defined as medical, social, emotional, family or community problems that a person with a primary disabling condition likely experiences Includes chronic pain, pressures sores, but also social sequelae such as isolation, depression, and accessibility problems (Ravesloot et al., 2007) Consequences of secondary conditions are amplified in individuals with disabilities i.e. gaining 10 pounds may impact mobility and transfers in this population, but not effect able-bodied individuals significantly Secondary Conditions

33. Prevention of secondary conditions has become a major component of health promotion for people with chronic disabilities. High rate of inactivity may partially account for the increased rate of accumulation of secondary conditions. 3.6 in a population with mobility limitations versus 1.3 for the general population with no mobility limitations (Rasch, 2008). 87% of individuals with disabilities report at least one secondary condition, versus 49% of individuals without disabilities (Kinne, 2004). Secondary Conditions

34. The high number and prevalence of secondary conditions leads to: Increasingly complicated medical needs More frequently in need of medical attention (high utilization) Typically high cost users Secondary Conditions

35. The 50% of the population that costs the least. The 5% of the population that costs the most.

36. “Thin margin of health” “Accelerated aging” There is a high rate of increase of secondary conditions in individuals with disabilities Much of the cost of care for persons with disabilities is the cost of secondary conditions Increased morbidity and mortality in this population related to secondary conditions Consequences of Secondary Conditions

37. Poor accessibility Lack of privacy Fear of injury Public exposure of their injuries Cost Lack of experience among staff at fitness centers in dealing with persons with SCI (would apply to other disabilities as well). Only 8% of facilities provided adequate accessibility around exercise equipment. (Lavis, 2007; Rimmer et al., 2004) Barriers to Fitness

38. Therapeutic Pool at 2 sites (Golden Valley and Courage St. Croix) Fitness Centers at 3 sites (adults at Golden Valley and Courage St. Croix, pediatrics at Burnsville) Classes (for example, water Tai Chi, yoga, etc.) Services Courage Center Provides

39. 92 degree therapeutic pool Independent exercise Classes: arthritis, stroke, MS, fibromyalgia, whole body conditioning, tai chi, prenatal, water aerobics, back moves 1:1 therapeutic exercise sessions (Stay Fit) Personal training Adapted swim team Aquatic Bodywork (watsu, aquatic integration) Aquatics

41. Accessible Fitness Center Independent Exercise (staff supervised) Classes: Adapted Yoga, Teen Fitness, Silver Sneakers Class, Nutrition and Weight Loss 1:1 therapeutic exercise sessions (Stay Fit and Stay Fit FES Bike) Personal training Wellness and Fitness

42. Exercise Program is designed by fitness staff certified to work with individuals with disabilities and complex health conditions Flexibility Strength Cardiovascular fitness Clients receive a fitness program to address all three areas, as well as a recommendation for level of assistance Assessment

43. Exercise programs are available in 3 levels of assistance: Stay Fit Extra – for individuals who need assistance with their exercise program from 75% to 100% of the time. Stay Fit - for individuals who need assistance with their exercise program from 25% to 75% of the time. Independent Exercise – for individuals who need assistance less than 25% of the time. Fitness Assistance Levels

44. Weight Management Program • Individuals who are receiving stay fit or stay fit extra can participate in the Courage Center Weight Management program • After 10 weeks in the program, individuals who were trying to lose weight lost a significant amount of weight (average of 2.7 pounds) • Combined exercise and weight management program • This is offered free for all program participants • Designed for persons with disabilities and for those on limited incomes.

49. Turning radius for power chair High-low matts Hoyer lifts available Shower facilities Accessible locker rooms