Bright Spot: A Matter of Balance

Photo by Aziz Acharki on Unsplash

This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

Overview

Detailed Description

A Matter of Balance emphasizes practical strategies to reduce fear of falling and increase activity levels. Participants learn to view falls and fear of falling as controllable, set realistic goals to increase activity, change their environment to reduce fall risk factors, and exercise to increase strength and balance. The program was designed to benefit community-dwelling older adults who:

Are concerned about falls
Have sustained falls in the past
Restrict activities because of concerns about falling
Are interested in improving flexibility, balance and strength
Are age 60 or older, ambulatory and able to problem solve

Expected Outcomes

View falls and fear of falling as controllable
Set realistic goals for increasing activity
Change participants’ environment to reduce fall risk factors Increase strength and balance through exercise

Key Principles

Group discussion
Problem-solving
Skill building
Assertiveness training
Exercise training
Sharing practical solutions
Cognitive restructuring-learning to shift from negative to positive thinking patterns or thinking about something in a different way

Cost Details

Coach Training:

A coach training with 15 participants costs an average of $4,500 statewide, or $300 per coach. Registration fees for coach trainings vary across the state, depending on the partnerships and funding available by location. While 1 coach can facilitate MOB classes, it is recommended that two coaches facilitate together.
Master Trainer Session at a regional training site: $1,550 per person includes 2-day training and all materials. It is strongly recommended that two people be trained from each organization. As an alternative, a MOB Lead Trainer can travel to your site to train groups of Master Trainers.
Fees are based on the size of the group: 11 to 15 participants $16,000. 16 to 20 participants $18,500.
Class materials, staff travel, meals, and lodging will be charged at cost.

Additional Resources

Enough space for each participant to move around comfortably
Tables if possible, preferably set up in a U-shape
Chairs ADA accessible
Space to set up snacks
Equipment and materials
Name tags
Markers and tape
Flip chart and stand TV/DVD
Attendance sheet
Pencils
Participant workbooks
Healthy snacks for each session

Key Steps for Implementation

Group discussion
Problem-solving
Skill building
Assertiveness training
Exercise training
Sharing practical solutions
Cognitive restructuring-learning to shift from negative to positive thinking patterns or thinking about something in a different way

Partnerships

In 2013: Report to Congress by the Center for Medicare and Medicaid Services which evaluated community-based Wellness and Prevention Programs. A Matter of Balance demonstrated a $938 savings with savings in the area of unplanned inpatient hospitalizations, skilled nursing facilities and home health. The program meet the Institute on Healthcare Quality Triple AIMs: Better Health MOB has been shown to increase physical strength and activity Better Care Increased physical therapy and occupational therapy use Improved communication Program participation correlates with reduced mortality rates Lower Cost $938 decrease in total medical cost savings per year $517 reduction in unplanned hospitalization costs $234 reduction in skilled nursing facility costs $81 reduction in home health costs Full CMS Report to Congress with MOB Return on Investment information: ROI information from CMS report.

Required Staffing (FTEs)

Variable depending upon the organization

Special Funding

Aging network providers can use Older Americans Act, Title III-D funds to support these programs as they meet the Administration for community Living (ACLs) Evidence-based program criteria.

Training

Master Training:

Master trainers can train coaches (and are ultimately responsible for those trained). Master Trainers can also teach classes. The training to be a Master Trainer is two full days.

Coach training:

Attend eight hours of coach training taught by the Master Trainer(s) and earning A Matter of Balance Coach Certification.
Attend 2.5 hours of coach training update annually
Agree to coach two Matter of Balance classes within one year of certification
Instructor certification required

Instructor qualifications:

Good communication and interpersonal skills
Enthusiasm, dependability
Willingness to lead a small group
Interest in working with older adults
Life experiences valued, with education or health care experience a plus
Ability to perform range of motion and low-level endurance exercises
Ability to carry up to 20 lbs.

Number of instructors required per class:

Only need one coach or one master trainer to lead a class, best practice is two coaches.

Suggest pairing new coaches with experienced coaches. A healthcare professional (such as a physical therapist, occupational therapist, or registered nurse) serves as a guest lecturer during one or two of the eight sessions. The appropriate class(es) for the guest lecturer is scripted in the curriculum.

Types of Staff

Master Trainer (only need one to offer a coach training and can lead classes alone). Coach (best practice is 2 coaches to lead a class, but it can be taught with one coach). Guest Healthcare Professional for one session

Return on Investment Details

Almost all of the Area Agencies on Aging in North Carolina offer the A Matter of Balance program. Classes are offered in senior centers, housing facilities, parks and rec facilities, community centers, faith-based communities, etc.

Outcome Measures

View falls and fear of falling as controllable
Set realistic goals for increasing activity
Change participants’ environment to reduce fall risk factors
Increase strength and balance through exercise

Process Measures

Initial survey (given during the first class) with questions regarding falls management, exercise levels, and background information. Last class survey; repeat of questions regarding falls management and exercise levels. Last class evaluation with questions concerning comfort in talking about fear of falling, changes made to environment, comfort in increasing activity levels, plans to increase activity levels, and background information. Online data management services (attendance, pre and post surveys and class evaluation) are available. This database is currently managed by NC Division of Aging and Adult Services, although this role may be transitioned to a TBD organization in 2015.