1. CHALLENGE CENTER Filling the Gap in the Continuum of Care

2. Background Information about Challenge Center Non profit Community Based Physical Therapy/Fitness Center Non profit Community Based Physical Therapy/Fitness Center Founded-1987 Founded-1987 Located in City Park Located in City Park Primary population served-Physically Disabled Primary population served-Physically Disabled Secondary-Served Ambulatory Seniors Secondary-Served Ambulatory Seniors

4. Emerging Role of Health Promotion for People with Disabilities Traditional managed care invests financial resources in diagnosing and treating/ curing disease Traditional managed care invests financial resources in diagnosing and treating/ curing disease Research shows investment in health promotion is cost effective, beyond the “absence of disease” or acute recovery.[Rimmer JH. Health promotion for people with disabilities] Research shows investment in health promotion is cost effective, beyond the “absence of disease” or acute recovery.[Rimmer JH. Health promotion for people with disabilities]

5. Healthy People 2000 A clear opportunity exists for health promotion and disease prevention efforts to improve the health prospects and functional independence of people with disabilities page 41

6. Continuum of Care + the GAP ER/ Acute Care Community Health and Wellness Gyms Fitness Specialist THE GAP ---Not trained to meet special needs CHALLENGECENTER Accessible Equipment Trained Personnel PHYSICAL THERAPY

7. The need for health promotion While medical technology has increased the life span of those with disabilities, little has been done to improve their health span. While medical technology has increased the life span of those with disabilities, little has been done to improve their health span. Fewer than 10% of adults participate in structured physical activity. Rimmer JH, et al Fewer than 10% of adults participate in structured physical activity. Rimmer JH, et al

8. Greater number of trauma Survivors ER- Trauma care increasing rates of survival ER- Trauma care increasing rates of survival Acute care – advancements in medicine increasing levels of acute recovery Acute care – advancements in medicine increasing levels of acute recovery In-Patient Rehabilitation – longer stays replaced with limited home health and outpatient services In-Patient Rehabilitation – longer stays replaced with limited home health and outpatient services

9. Continuum of Care Home Health services – help bridge the gap in acute recovery Out-patient services expanding To Include Cardio and Pulmonary Education and Training Challenge Center concept is similar approach for neurological patients

10. Continuum of Care  Driven by consumers need for training and self-empowerment in recovery  Increased perception of responsibility for self-health and fitness

11. Continuum of Care Ideal outcome of continuum of care is commitment to healthy lifestyle and regular exercise by the patient Ideal outcome of continuum of care is commitment to healthy lifestyle and regular exercise by the patient There is a gap in the plan … There is a gap in the plan …

12. Challenge Center Helps Fill the Gap for Persons with Disabilities and Special Needs Challenge Center Helps Fill the Gap for Persons with Disabilities and Special Needs

13. Promoting Health in Persons with Disabilities Perception of “healthy disabled” gradually changing Perception of “healthy disabled” gradually changing Health is not static for all populations – dynamic and multi-factorial in nature. Rimmer JH,et al Health is not static for all populations – dynamic and multi-factorial in nature. Rimmer JH,et al

14. Promoting Health in Persons with Disabilities Lifetime health cycle and benefits in healthy lifestyle choices similar for able & non disabled populations Lifetime health cycle and benefits in healthy lifestyle choices similar for able & non disabled populations Physical disability and functional frailty creates risk for fitness centers and disabled clients Physical disability and functional frailty creates risk for fitness centers and disabled clients Lack of skilled physical therapists, trainers, specialized equipment, eliminates many with disability from conventional fitness centers Lack of skilled physical therapists, trainers, specialized equipment, eliminates many with disability from conventional fitness centers

15. Physical Challenges Require Specialized Approaches  Skilled physical therapists,  Trainers, specialized equipment  Transportation  Participation of care givers  Peer support

17. Secondary Complications, Partial List Decubitus Ulcers, pressure sores =$30,000 X 3 Decubitus Ulcers, pressure sores =$30,000 X 3 Inactivity, isolation Inactivity, isolation Obesity Obesity Diabetes/Insulin Sensitivity Diabetes/Insulin Sensitivity Chronic Pain Chronic Pain Depression Depression Loss of Functional Ability Loss of Functional Ability Premature Institutionalization Premature Institutionalization

18. Health Promotion/ Wellness and Fitness for persons with Disabilities Health Promotion/ Wellness and Fitness for persons with Disabilities Persons with disability Persons with disability Insurers Insurers Family and care givers Family and care givers Buyers of insurance Buyers of insurance Acute care resources Acute care resources  The government and tax payer Persons with disability Persons with disability Insurers Insurers Family and care givers Family and care givers Buyers of insurance Buyers of insurance Acute care resources Acute care resources  The government and tax payer Who Benefits?

19. Why is post acute therapy not a priority ? Reasons for the gap Medical focus on primary diagnosis Medical focus on primary diagnosis Insufficient prevention efforts in chronic populations Insufficient prevention efforts in chronic populations do health maintenance organizations do health maintenance organizations really “maintain health”? really “maintain health”? Acute care system not designed for chronic care Acute care system not designed for chronic care Misguided cost assumptions Misguided cost assumptions Lack of awareness of recent advances in physical medicine Lack of awareness of recent advances in physical medicine Disability & health seen as an oxymoron? Disability & health seen as an oxymoron? The move from institutional to community care model The move from institutional to community care model

20. CHALLENGE CENTER Supported in large part by philanthropic dollars Supported in large part by philanthropic dollars Special events Special events Contractual agreements Contractual agreements Sliding scale for cash payment Sliding scale for cash payment Client-specific sponsors Client-specific sponsors We pray a lot ! We pray a lot ! How it Works on $$$$

21. CHALLENGE CENTER Our Goal If we are to intervene with health promotion practices which prevent functional declines in clients with long term disabilities, we will realize significant costs saving and prevent unnecessary human suffering.