1. 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

2. 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

3. 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.

4. 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

5. 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 clients 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

6. 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

7. 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)

8. 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

9. 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 persons 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

10. 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

11. Opening the doors to full living Marketing Materials: Brochure

12. Opening the doors to full living Website C:\Documents and Settings\haysp\My Documents\HEARTH\hearth.html

13. 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