Bridging the Gap: Transitioning into the Community as a Stroke Survivor

Presented by: Meghan Foley MS OTR/L St. Luke’s University Hospital

ObjectivesAll clinicians will be able to identify community resources that are appropriate for patients based upon their co-morbidities, secondary diagnoses and deficits.

Understand the different types of community resources and identify at least four of these resources that will allow patients to age in place.

Identify at least two benefits for returning home with community resources

StatisticsStroke is the leading cause of long term disability in the United States

25% recover with minor impairments

40% experience moderate to severe impairments that require special

care

10% require care in a nursing home or other long-term facility

Approximately 14% of stroke survivors experience a second stroke in

the first year following a stroke (Statistics, 2014).

Citation

Citation

Lifeline Medical Alert“One out of three older adults (those aged 65 or older) falls each year” (cdc.gov)

Lifeline offers a way for older individuals to SAFELY age in place

Website provides Ebooks, Ebrochures

Lifeline Medical AlertHome Safe Standard Home Safe Alert Go Safe Response App

Features and Benefits

Help at the press of a button in and around your home

Maximum protection in and around your home

Maximum protection at home and on the go

Convenience for smartphone users

Where it Works In and around your home In and around home Anywhere with AT&T service Anywhere with smartphone

What is Included Pendant

24/7 Access response center

Communicator Unit

Pendant 24/7 Access response

center Communicator Unit

• Mobile Button Pendant 24/7 Access response center

Communicator Unit

Application 24/7 Access response center

Automatic detection of falls No Yes Yes No

Location Capabilities Home Location on file Home Location on file 6 locations Phone’s GPS

Pricing $29.95/month $44.95/monthOne time button purchase of

$149.00$54.95/month

$13.95/month

Neuro-Ophthalmology“Approximately 30% of all stroke patients have visual impairment” (Marek & Antle).

Neuro- Ophthalmologists provide treatment and diagnosis for individuals who experience the following due to brain or nervous system disorders:

• Abnormal eye movements (ophthalmoparesis or nystagmus)• Visual Loss Diplopia• Eye movement disorders• Visual acuity loss• Visual Field loss• Intracranial lesions affecting the visual pathway• Ischemic optic neuropathy• Migraine and related visual complaints• Optic disc swelling• Optic neuritis• Other optic nerve problems• Pupillary abnormalities• Unexplained vision loss

Penn State Hershey Eye Center Penn Neuro-Ophthalmology William A. Cantore, M.D. Dr. Liu at HUP call 215-662-3606 Phone: 717-531-5690 or 800-292-3332 Dr Shindler or Dr. Tamhanker at Scheie Eye Institute call 215-662-8100 *for general appointments call 1800-635-7780

patients seen within two weeks

Support GroupsStroke Club: held every 2nd Monday of the month at St. Luke’s Bethlehem Campus on CW 4th floor in the rehabilitation gym 3:30-4:30pm. For more information call: 484-526-1991

Caregiver Support Group: 3rd Saturday of each month at 11:00am in the Comfort Zone at St Luke’s Warren Campus. For more information call: 908-859-6722

Depression Support Group: 2nd and 4th Tuesday every month at 5:30-6:45pm in Priscilla Payne Hurd Education Center Rm 112 at St Luke’s Bethlehem Campus

“Nearly 30% of stroke patients develop depression, either in the early or in the late stages after stroke” (Paolucci).

Tobacco Cessation ProgramsSt Luke’s Tobacco Program

- Personalized Quit Plan- Follow Up Telephone Counseling- Nicotine replacement therapy

- Ways to cope with stress and nicotine cravings- Techniques to use to help prevent relapse

St. Luke's Community Health1530 8th Avenue Suite 102

Bethlehem, PA 18018484-526-2100

Monday - Friday  St. Luke's Care Now - Jim Thorpe

1104 North St.Jim Thorpe, PA 18229 

484-526-212Tuesday Mornings

Nesquehoning Family Health Center108 West Catawissa St.

Nesquehoning, PA 18240484-526-2120

Tuesday afternoon St. Luke's Family Health Center

1501 Lehigh StreetAllentown, PA 18103

Thursdays

Mercy Suburban ProgramPhiladelphia, PA

- Seven session program1) Understanding addiction2) Behavior change strategies3) FDA medication options4) Coping with urges5) Stress6) Healthy Lifestyle choices7) Relapse prevention

* Registration Required: Call 610-270-8390

“The risk of ischemic stroke in current smokers is about double that of nonsmokers after adjustment

for other risk factors” (Marek & Antle).

Seniors Helping Seniors A unique program where seniors provide services to other seniors in their community

2 – 3 hour weekly check-in

Services: companionship, light housekeeping, cooking, gardening, grooming/dressing, transportation, medication set up, Alzheimer’s and Dementia care, shopping, and overnight stays

Locations

Seniors Helping Seniors Lehigh ValleyPhone: 610-253-3232

Seniors Helping Seniors Luzerne CountyPhone: 570-472-0200

Seniors Helping Seniors Western Montgomery and Upper Bucks CountyPhone: 610-334-4276

Adult Day ProgramsSarah Care Day

Program

Day program

Provide transportation to and from the day program

Evaluated quarterly by the director of nursing for a change in daily functioning

Restorative nursing program available

YMCA Bethlehem

Monday-Friday 8:00am-5:00pm

Adult 60+ years old

Must arrange their own transportation

Crafts, pet therapy, music therapy

Location3893 Adler Place

Building B suite 180 Bethlehem, PA 18017

Other Adult Day Centers

Care Institute of Technology Easton, Pa 610-258-2857AMS Caregivers Emmaus, Pa 610-966-7033

Third Street Alliance: Easton, Pa 610-258-6271Palmerton Hospital: Palmerton, Pa 610-826-1162

Lifespan Adult Day Center: Quakertown, Pa 215-536-6016Westminster Village: Bethlehem, Pa 610-867-4660

The Comfort Zone @ Warren Hospital Phillipsburg, NJ 908-859-6797

Transport ServicesLantaVan

Shared ride transportation program that services Lehigh and Northampton counties

Door-to-door service

65+ pay 15% of fare

If have Medical Access card eligible for MA reimbursable services

Mon-Sat 5:30am-7pm and Sun 7am-7pm

For more information call: 610-253-8333

Angel Flight

Free air transportation for children and adults with medical conditions who need to get to treatment far from home

Must be medically stable and able to board an aircraft

For more information visit: http://www.angelflighteast.org or call 610-940-1717

Adaptive DrivingGood Shepherd Adaptive Driving Program

- To qualify for the program individuals must be seizure free for 6 months, have state required vision quality, and be medically stable - A team of therapists, certified driver rehabilitation specialist and assistive technology professionals work with individuals who are older to obtain and maintain their drivers license 1) Clinical Assessment

2) Behind the Wheel3) Van Evaluations4) Transportation Evaluations5) Training6) Educations

* Report sent to your physician, workman’s compensation, prescription for adaptive driving

Robert & Marian Edwards Center Good Shepherd Center 850 South 5th St.

Allentown, PA 18103 Phone: 1-888-44-REHAB (73422)

Mobility Works - Provides vehicle adaptations such as hand controls, wheelchair lifts, and transfer seat * Mechanical Hand Controls, Spinner Knobs, Electronic Hand Controls Location: 6475 Ruch Rd Bethlehem, PA 18017 Website: http://www.mobilityworks.com/mechanical-hand-controls.php

Driving AssessmentsAAA Senior Driving

• Self Rating Tool: 15 questions self evaluation driving assessment to examine driving performance

• Interactive Driving Evaluation: Online access, to Roadwise Review exercises in the privacy of your home to see if visual, mental and physical conditions affect your driving skills and driving abilities.

* FREE , CONFIDENTIAL self-evaluation based on both accuracy and speed of responses

Website: http://www.roadwiseonline.org/#GSMMSplash3

• Professional Assessment: is organized into two categories:

1) Driving Skills Evaluation: in-car evaluation of your driving abilities and a recommendation regarding any further specialized drivers' training

2) Clinical Driving Assessment: identify underlying medical causes of any

driving performance deficits and offer ways to address them*Cost is approximately $100 to $200. Additional training sessions $75-

150/hr*Contact your local AAA office for more information

Medication ManagementApproximately 30 percent of hospital admissions of older adults are drug related, with more than 11 percent attributed to medication nonadherence and 10–17 percent related to adverse drug reactions (ADRs) (Marek & Antle).

Pill Organizer Boxes- Weekly set up of medications

Several types of organizers (AM/PM, morning, noon, night, bedtime)

Talking Pill Boxes: visually impaired

Large print prescription bottles- visually impaired

Simply label pill boxes

Set alarms as reminder to take medications

Automatic Refill of Medications

In a study of elderly patients at 15 days post hospitalization, 27 percent had not filled their new prescriptions. Patients who participated in programs that provided pharmacy delivery and refill reminders had fewer adverse drug events and higher compliance than those who did not. (Marek & Antle).

CVS Ready Fill- Create an account online or in store

- Automatic Refill of medications- When medication runs out, CVS calls the doctor for a refill prescription

**Offer medication delivery

Wallgreens Pharmacy- Automatic Refills

- Free Shipping or Pick Up in the store

Medication AssistancePrograms voluntarily developed by manufacturers

Financial assistance eligibility determined by each company

Many require a prescription

Private insurance, Medicaid or Medicare may disqualify individuals from this program

Requirements for medication assistance programs:

PACE: Income for single: $14,500 or less for married couple $17,700 or less

PACENET: income for single $14,500-$23,500 for married couple $17,700-$31,500

- Must be 65 years and older

- PA resident for 90 days

Copies of the full directory of participating companies may be obtained by writing to:

Pharmaceutical Manufacturer’s Association 1100 15th Street

NW Washington, DC 20005

OR

Email State Representative Steve Samuelson at: ssmauels@pahouse.net

Mobility and Transfers Beasy Board Transfer Board Transfer Disc

Lift Chair Hoyer Lift Sit to Stand Stair Glide

Ramp CompaniesAmramp

- Specializes in modular steel wheelchair ramps, stair lifts, vertical platform lifts, free-standing lifts, pool lifts, and

portable showers

- Option to rent ramps

- Free on site consultation

- 48 hour set up

Contact: 1-888-715-7598

http://www.amramp.com

Northeast Accessibility

- Specializes in entrance ramps, stair lift and wheelchair lift

installations, bathroom modifications, ceiling lifts, and

electric scooters

-Portable ramps are ideal for thresholds or as vehicle ramps

- Also offer home safety evaluations

Contact: 570-253-7700

http://www.northeastaccessibility.com

PortableShower

Types of Ramps

Ceiling Lifts

Portable Ramps

VerticalWheelchair

Ramp

Portable Car

Ramp

Good Shepherd Wheelchair Clinic

• Third Friday of each month 8am-12pm

• Free service which offers wheelchair repairs: tightening, adjustment or evaluations for needed repairs

• No appointments necessaryLocation:

Harry C. Trexler Center for Assistive Technology, Good Shepherd Health & Technology Center, 850 S. Fifth Street,

Allentown 

Sip and Puff Tilt and Space Stand up wheelchair

Good Shepherd Seating and Positioning Clinic

RJ Foundation Mobility CenterSeating/Positioning completed by therapy staffEvaluation includes: MMT, ROM, coordination, strength, and sensation. Balance transfers and ambulation is considered to identify the most appropriate seating systemComputerized pressure mapping to identify appropriate pressure relief system (cushions)Not vendor specificThe primary doctor is given the results of the assessment

Various wheelchairs and seating systems are available to trial to determine the best seating system:

Location:Harry C. Trexler Center for Assistive Technology

Good Shepherd Health & Technology CenterGood Shepherd Plaza

850 South 5th St.Allentown, PA  18103

Contact:Phone: 610-776-3517

Bathing and Toileting Bath Lifts Shower Chair Grab Bars Shower Mat

Drop Arm Commode Raised Toilet Seat

Toilet Tongs Toilet Aid

Dressing and GroomingTED donner Sock Aid Dressing Stick Button Hook

Toothpaste Holder Reacher

Long Handled CombElastic Shoelaces

Universal Cuff Built Up/Angled Utensils Nosey Cup

Can Opener Cutting Board Pot Stabilizer Scoop Dish

Eating and Cooking

• Sliding Scale payment based on income• Meals Monday-Friday• Weekend package available• Grocery shopping service available• Frozen Meals option• No Age Limit! Do not have to be home bound!• Varying diets available- including dysphagia levels

Contact:Lehigh County 610-398-2563 or 215-679-6949

Northampton County 610-691-103

Schuylkill County 570-668-6954 or 570-621-7201

Meals On Wheels

Online Grocery ShoppingWeis Markets: Place order online at

www.weismarkets.com

Select from one of two store locations: Cedar Crest Blvd Allentown, PA Crawford Drive, Bethlehem, PA

*associates load groceries for carside pickup

Giant: Peapod- in store pickup or delivery

ShopRite: in store pickup or delivery

Walmart Grocery: Delivery to your door, Choice of delivery times

Page Turner Card Holder Knitting loom

Adaptive Leisure

The Strong Arm Fishing Pole

Head PointerAdaptive Shotgun

Sports Adaptations• Adaptive Yoga: increased energy, flexibility, improved posture,

pain management and increased tone and strength. Offered at Sojourn Adult Day Program and Joyful Noises

• Bicycling: Recumbent Bicycling

• Bowling: ramps

• Golfing: adaptive golf carts with swivel seats (allows almost a full stance and free swing

Adaptive Skiing

Jack Frost/Big Boulder call 570-443-8425 extension 2503. Adaptive lessons on weekends only.

Camelback Mountain lessons and state of the art equipment call Jeff McGinnis at the Pennsylvania Center for Adapted Sports, 215-765-5118

Adaptive SwimmingSofao: adaptive swimming flotation chair equipped for individual with significant immobility. Features: hip, chest and head straps for proper positioning.

Transfer ChairsLifevests

Silver Sneakers1 out of 5 people 65 or older is eligible for a SilverSneakers

membershipas part of a Medicare Advantage or Medicare Supplement Health plan

Over 12,000 gyms nationwideMembership Includes:- Access to fitness equipment, pools and saunas- Access to HealthwaysFIT.com to help you track your health progress  - Health education seminars and other events

45-60 minute classes focusing on ROM, flexibility, strengthening, coordination, agility and enduranceHome Exercise Programs available

FLEX programClasses offered in community parks, recreation centers, and older adult living centersline dance and Latin dance, indoor and outdoor boot camp, walking groupsSteel Fitness in Bethlehem, Bethlehem YMCA, Planet Fitness in Allentown, Hanover Township Community Center

BOOM program: advanced fitness program for the active adultFast pace, intense exercise programs

** Currently NOT offered in Pennsylvania

https://www.silversneakers.com/

Pet CareCritter Care Plus

- In Home Pet Sitting

Services offered include:

Dog WalkingPlant care

Newspaper/Mail pick up

Contact:Fountain Hill: 610-867-8780

Allentown: 610-797-5150 Easton: 610-253-9778

  

No Worries Pet Sitting

-In Home Pet Sitting

Services offered include:Dog Walking

Litter Box CareBathing

Nail TrimmingOvernight Sitting

Medication AdministeringInjections

Pet Transportation

Contact:NJ 908-319-3324    PA 484-725-4650

Vocational Rehabilitation“Nearly one third of all strokes occur in individuals under the age of 65. Of those, 1 of 2

survivors will return to a full or part time job” (stroke.org)Pennsylvania Office of Vocational Rehabilitation, or OVR, provides vocational rehabilitation services to help persons with disabilities prepare for, obtain, or maintain employment

Individual Plans of Employment (IPE) are developed (objectives, responsibilities, and services

OVR customers receiving Social Security benefits for their disability (SSI, SSDI) are exempt from OVR’s Financial Needs Test

Trained professional vocational counselors that serve 67 counties

Blind/Visual and Deaf/Hearing deficit services

Allentown Reading Wilkes Barre

45 N. Fourth Street 3602 Kutztown Rd Suite 200 300 G Laird Street

Allentown, PA 18102 Reading, Pa 19605 Wilkes-Barre, Pa 18072

610-821-6441 610-621-5800 570- 826-2011

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Adaptive Program." Pennsylvania Skiing. N.p., n.d. Web. 15 Jan. 2015. <http://www.skicamelback.com/pennsylvania-skiing.aspx>.

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“Fountain Hill, PA Pet and Animal Sitting." Pet and Animal Sitting Fountain Hill, PA Care Plus. N.p., n.d. Web. 14 Jan. 2015. <http://www.crittercareplus.net/>.

"Hand Controls, Electronic Driving Systems and Other Driving Aids." Hand Controls for Vans. N.p., n.d. Web. 14 Jan. 2015. <http://www.mobilityworks.com/mechanical-hand-controls.php>.

"LANtaVan." Lehigh and Northampton Transit Authority. N.p., n.d. Web. 14 Jan. 2015. <http://www.lantabus.com/lantavan/>.

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"Neuro-Ophthalmology." - Penn State Hershey. N.p., n.d. Web. 14 Jan. 2015. <http:/www.pennstatehershey.org/web/eyecenter/patientcare/services/neuro>.

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"OUR TIPS." No Worries Pet Sitting. N.p., n.d. Web. 14 Jan. 2015. <http://www.noworriespet.com/>.

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"Senior Driver Expo." SeniorDriving.AAA.com. N.p., n.d. Web. 14 Jan. 2015. <http://seniordriving.aaa.com/>.

"Seniors Helping Seniors Lehigh Valley." At Home Care. N.p., n.d. Web. 14 Jan. 2015. <http://seniorcarelehighvalley.com/>.

"Shepherd Center." Seating and Wheelchair Clinic. N.p., n.d. Web. 14 Jan. 2015. <http://www.shepherd.org/patient-programs/outpatient-clinics/seating>.

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"SOFAO." Spokes'n Motion. N.p., n.d. Web. 14 Jan. 2015. <http://www.spokesnmotion.com/sofao?form=139>.

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"St. Luke's - Tobacco Cessation Treatment Center." St. Luke's -. N.p., n.d. Web. 14 Jan. 2015. <http://www.slhn.org/Hospitals-Locations/Tobacco-Cessation-Treatment-Center>.

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