D. McDowell1. Living Well in Wisconsin Donna McDowell, Director Bureau of Aging & Disability Resources Department of Health Services.

D. McDowell 1

Living Well in Wisconsin

Donna McDowell, Director

Bureau of Aging & Disability Resources Department of Health Services

D. McDowell 3

Burden of Falls

Madison – State health officials report…

Deaths from falls have surpassed motor vehicle crashes and suicide as the most common cause of injury-related deaths. (87% elders)

Hospitalizations and emergency visits due to falls cost $800 million per year (70% elders)

70% of costs are Medicaid and Medicare

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Chronic Disease

• Long-term Care costs drive Medicaid• Chronic disease leads to disability• Chronic disease and disability are the

reason for long-term care for most elders and adults with disabilities

• Reforming long-term care requires addressing chronic disease

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Intersection

• Chronic disease is at the intersection of health care and long-term care

• Health care prevents disease• Medical care treats disease• Long-term care supports the person’s

independence and normal lifestyle• Self-management is a key to prevention,

treatment and long-term living

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Self-Management Is Important

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Evidence

• Focus limited resources of Older Americans Act, public health and general revenue.

• Integrated evidence-based prevention into aging, public health, home and community care, primary health care

• Document results• Bring to scale

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State Strategy• Bureau of Aging & Disability Resources• Bureau of Community Health /Family

Health Programs• Chronic disease program coordinators for

arthritis and diabetes• Injury and violence prevention coordinator• AAAging Health Promotion Team• 41 CDSMP Master Trainers

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Living Well July 2010

Trainers/Leaders

'

$

Washburn

Burnett

DouglasBayfield

Sawyer

AshlandIron

Vilas

Oneida1 MT 2 LL

Price

Polk Barron Rusk

Chippewa1 MT1 LL

St. Croix Dunn

Taylor

LincolnLanglade1 LL

Forest Florence

Marinette

OcontoClarkMarathon

Shawano

WoodPortage Waupaca

Menominee

Door

Kewaunee1 MT 6 LL

Brown

Pierce

Pepin

Buffalo Tremp-ealeau

Eau Claire2 MT 5 LL

La Crosse

MonroeJuneau

Adams

Waushara

Outagamie

Manitowoc

Sheboygan

1 LL

SaukVernon

Crawford

Richland

Grant

Iowa

LafayetteGreen Rock Walworth

Kenosha

Racine 9 LL

Washington5 LL

OzaukeeColumbia

Dane

Jefferson

Dodge

Milwaukee

Fond du Lac5 LL

Marquette

Winnebago

Jackson

T-Trainer (TT), Master Trainer, Lay Leader

Master Trainer (MT)

Lay Leader (LL)

Master Trainer & Lay Leader

1 MT2 LL

2 MT 16 LL3 SLL

1 LL

2 LL

1 MT 1 TT13 LL

1 LL

1 TT1 MT6 LL

2 LL

1 MT2 LL

1 MT 3 LL

8 MT 58 LL 5 SLL MT 13 SLL

2 LL

1 MT

1 MT2 LL

3 LL

1 LL

2 LL

2 LL

12LL

1 MT4 LL

4 LL 2 MT

4 LL

1 MT 6 LL

Waukesha

2 MT 4 LL

1 LL

Calumet

1 LL

2 LL

1MT

1 MT

1MT2 LL

3 MT3 LL

1 MT7 LL

2 MT25 LL

2 LL

2 LL

9 LL

2 LL

2 L

1 LL2 LL

1LL

5 LL

Oneida Nation2 MT 5 LL

Green Lake

1 MT 4 LL

Statewide CDSMP262 Lay Leaders

16 Spanish Leaders5 Spanish MT

41 Master Trainers2 T-Trainer

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Stepping on Falls Prevention

• Building Confidence, Reducing Falls• Empower older adults to carry out

healthy behaviors that reduce risks of falls and improve self management

• Community workshop 1x 7 weeks• Improves balance, strength, home and

environmental safety, vision and medication management

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From Oz to Wisconsin

• Dr.Jane Mahoney MD -UW School of Medicine and Public Health

• Dr. Lindy Clemson – Australia• American version of Stepping On• Research in two urban counties led to

statewide adoption.• Sure Step – in home

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Stepping OnJuly 2010

Counties with Trainers/Leaders

'

$

Washburn

Burnett

DouglasBayfield

Sawyer

AshlandIron

Vilas

OneidaPrice

Polk Barron Rusk

ChippewaSt. Croix Dunn

Taylor

LincolnLanglade

Forest Florence

Marinette

OcontoClarkMarathon

Shawano

Wood Portage Waupaca

Menominee

Door

KewauneeBrown

Pierce

Pepin

Buffalo Tremp-ealeau

Eau Claire

La Crosse

MonroeJuneau

Adams

Waushara

Outagamie

Manitowoc

Sheboygan

SaukVernon

Crawford

Richland

Grant

Iowa

LafayetteGreen Rock Walworth

Kenosha

Racine

WashingtonOzaukeeColumbia

DaneJefferson

Dodge

Waukesha

Milwaukee

1 LFond du Lac

Marquette

Green-Lake

WinnebagoCalumet

Jackson

Lead Trainer (LT), Master Trainer (MT), & Leader/Peer Leader (L/PL)

Master Trainer & Leader/Peer Leader (MT/L/PL)

1LT 18L 1 PL1 L

1 LT3 L3 PL

1 L4 PL

Statewide162 Leaders

37 Peer Leaders 1 Master Trainers4 Lead Trainer

5 L

1 MT9 L 2 PL

3 L

3 L 4 PL

Leader/Peer Leader (L/PL)

Master Trainer (MT)

6 L1 PL

2 L3 PL

8 L

4L 1PL 1LT

1 PL

4 L

1 LT 5 L

5 L

11 L

4 L 1 PL

10 L

3 L4 PL

4 L 4 PL

1 L

2 L 1 PL

1 L4 L

2 L

7 L 1 PL

3 L

1 PL 2L

6L 1PL

1L 1PL

2L 2 L 2L2 L

1 L

1 L 1 PL

4L

4 L

4L

2PL

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Training/ Fidelity/Measures

• University and health system partnerships• One statewide CDSMP license from

Stanford• Community Health Educators• Reporting-common data across systems,

locations, funding

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Living Well Data Sample

• 1,717 participants 44% (748) responded• 293 ED visits in previous 6 months• Follow-up showed 231 ED visits post• Decrease of 62 visits• Net savings $60,202

• 151 hospital stays in prior 6 months• Follow up showed 129 visits 6 month post• Decrease of 22 stays• Net savings $457,336• TOTAL savings if most had same

outcomes $1,177,282

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Sustainability, Validity, Efficacy

GRANT FUNDING• AARA• CDC: Arthritis, Injury Prevention,

Stepping On Dissemination• AoA Sustainable Systems x 2• NCOA • Blues/HMOs• State GPR for ADRCs• Contracts for training in other states

(CA, NY, MT)

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Sustainability, Validity, Efficacy

INFRASTRUCTURE• Aging network – 600 meal sites in WI• 35 ADRC prevention culture• Programs address person-specific issues;

not drop in support• Trained peer leaders empower• Public health can provide T-Trainers• University partnerships for data collection,

research and grants

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WIHA Wisconsin Institute for Health Aging

• Non-profit institute affiliated with UW School of Medicine & Public Health

• Board includes university, state, aging network, health care system and consumer reps

• Funding from current and future grants• Dr. Mahoney 50% “in-kind” from UW

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WIHA Wisconsin Institute for Health Aging

LEGISLATION• Authorizes DHS to contract with WIHA to

administer EBPP• Gives WIHA authority to administer state

prevention funds for AAA, public health and ADRCs

• Gives UW authority to contract and partner with WIHA on grants and research

• Recognize WIHA as the organization that coordinates Wisconsin Stepping On

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LEGISLATION (cont.)

• Recognizes WIHA coordinator of WI Chronic Disease Self-Management Program (CDSMP)

• WIHA is clearing house for evidence-based (EB) health promotion for healthy aging;

• Recognizes WIHA as licensing agency for Stepping On North America.

• WIHA to train and assist staff in county/tribal agencies, Area Agencies on Aging, and other aging and public health service providers.

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Testimonials and Resources

• “I was tired. My pain was my boss. It was telling me what I could and couldn’t do. Living Well put me back in charge.”

• “If you’re afraid to fall you won’t go out and you’ve lost your independence.

• http://www.dhs.wisconsin.gov/health/InjuryPrevention/FallPreventionhttp://www.dhs.wisconsin.gov/aging

• Email: [email protected] • Email: Ann [email protected]