DNP Paper : Program Planning for the older adult

Program Planning for the Older Adult
Margaret Clark
Walden University
Program Planning for Older Adult
The purpose of this paper is to review the use of the health belief model (Springer & Evans, 2016) to design and develop a program planning to improve access to care for the older adult population. The focus is the older adult with a chronic health disease whom might not have access to care. The lack of access to care has been identified as a national health problem (Healthy People, 2017). The government health plan, Healthy People 2020, is a science-based action plan that has set national objectives for Americans (Healthy People, 2017). The plan measures progress and success of engaged individuals and fosters collaboration within the health care industry and sector. A significant increase in occurrences and costs of health problems such as hypertension, weight management, increase in cholesterol, provide evidence to the importance of the chronic disease as a problem facing older populations (Healthy People, 2017).
Problem and Population
The population is the older adults, aged 65 and older, with difficulty to gain access to care. The vulnerable population is the illest in the nation. This is because persons aged 65 years and above have a high likelihood of suffering from one of two of the chronic illnesses. These illnesses include; diabetes 2 type, cancer, arthritis, heart disease, and high blood pressure. Recent sources further support the United States has a record for the costliest care and highest out of pocket expense.

The danger of chronic diseases is the ability to affect the health and the lifestyle of older persons. What is worse is that the cost of chronic disease and health, in general, is pressing to older populations who have no employment perhaps due to retirement and old age. For example, over 50 % of adults aged 65 and above are prescribed to four or more medications. One out of this category admits to not taking medications due to costs, or difficulty getting access to care for chronic conditions (Osborn, Moulds, Squires, Doty, & Anderson, 2014).
Health Belief Model
The health belief model (Springer & Evans, 2016) was formulated to show the relationship between health beliefs and behaviors and the perception of the belief that can change and shape health-related behaviors. The older adult with lack of access to care for chronic diseases will more than likely not receive the support and resources to shape behaviors to improve their health and prevent disease flare-ups and exacerbations (Osborne et al. 2015). In addition, lack of preventative clinical screenings will be dismissed as non-important since a majority of older populations are unlikely to invest in preventative care. The effectiveness of the Health Belief Model relies on several patient assumptions. These assumptions include healthcare condition can be avoided by following a recommendation. The other is that the recommendation has a positive expectation that by heeding to the healthcare action, intervention, or even professional recommendation, the patient is likely to avoid suffering from a particular illness or condition (Booked-Bassett, Markle-Reid, Mackey, & Akhtar-Danesh, 2017).
An example of the implementation of the Health Belief Model for the older adult would be screening for high blood pressure. If the older adult gets the unfavorable results of high blood pressure and follows the recommendation for dietary interventions to reduce blood pressure, and the clinical visit shows that the blood pressure is within an established normal range, they have changed behavior based on a belief of recommendation. The health belief model is most suited for the older adult with the cues to action as the backbone strategy. This includes readiness, training, promotion, guidance, and self-efficacy with confidence to act. The model looks at the reduction of barriers via reassurance (Aujla, Walker, Abrams, Massey, & Vedhara, 2016). While the Health Belief Model is most suited to older populations, it holds significant effects and implications for other patient groups.
Literature Review
Recent statistics show an increase in the number of aging persons. For example, the number of people turning 65 years daily is estimated to be ten thousand each and every day. By 2030, 20% of the population will be age 65 and older. That is a significant jump from 13% today (Osborne et al. 2014). The younger population to provide the care is decreasing and forecasted to not be able to meet the demands in the next decade. The healthy People 2020 resource supports that 20% of those aged 65 and older have poor glycemic control, 45% have hypertension that is not controlled, and only 76% have a usual primary care physician. Indeed, the above figures have remained constant with little change from 2007 (HealthyPeople.gov, 2017). Lack of access to care and services will decrease the cues to action to move in a positive direction.
Needs Assessment
The target population for this needs assessment is the older adult and the problem is limited access to health care services. A comprehensive needs assessment begins by looking at the quality of life and health status of the population (Kettner et al. 2017). A comprehensive needs assessment will be of paramount significance as a response to the growing health problems impacting the quality of life for older adults. The priority focus for conducting the assessment begins with the health problem that negatively impacts the quality of life. Gathering, considering, and analyzing a vast amount of data can determine assets and purpose of setting goals. Painting the picture by use of checklists can assist with organization of the assessment (Hodges & Videto, 2011). A method to conduct the assessment would be choosing a framework for problem analysis to understand the history, theory, research, and cause-effect relationships. The next step would be the application of a theoretical understanding of the needs of the population. An example would be Maslow’s theory of needs with lower needs [needs with the least preference] must be satisfied first prior to higher level needs that are addressed later. In the older adult with the chronic disease, it may be challenging to move beyond the safety and psychological needs.
The second theorist for consideration with this population would be Ponsioen who defined needs as the minimum standard determined by the community that no one should fall behind (Kettner, Moroney, & Martin, 2017).The theorist further goes ahead to note that the basic needs of the older adults such as food, lodging, must be met prior to seeking medical care and treatment. This would be appropriate for the older population as the interventions and services can be the driving force for interventions that improve access to care or the older adult.
The needs assessment has both qualitative and quantitative dimensions. To start a review of existing resources that look at demographics, comorbidities statistics, services in surrounding counties, and older adults accessing services. These trusted sources include; Bureau of Labor Statistics, National Center for Health Statistics and finally the Center for Disease Control. The second data collection would be a public forum to invite the community to discuss and share issues that relate to older adults and their access to care and services. The third method would be a social survey to the age 65 and older population (Kettner, Moroney, & Martin, 2017). Challenges that may be encountered could be buy-in from the public, exact numbers and data to share with officials, and transparency from the high-risk population. Intervening positive health promotions and strategies provide a foundation for planning. The credo of doing no harm can harness and activate the interventions in efforts to address the problem of poor access to care by older populations (Springer, Evans, 2016).
Conclusion
The aging older adult is faced with a multitude of chronic diseases. This could lead to up to 40% more premature deaths. Active engagement in one’s own person-centered care can result in improved quality of life, a decrease in chronic disease, and prevent premature death. A community health program designed for this vulnerable population to improve access to care can have significant benefits. This analysis believes that a health needs assessment plan is altogether tantamount to solving a major healthcare crisis discussed above. As discussed, the needs assessment will include identifying particular factors that aggravate lack of access to quality care. Also, social surveys with members of the public to fully identify and address the aforementioned concerns.
References
Alexander, G., & Bonaparte, N. (2008). My way or the highway that I built. Ancient Dictators, 25, 14-31. doi:10.8220/CTCE.52.1.23-91
Aujla, N., Walker, M., Sprigg, N., Abrams, K., Massey, A., & Vedhara, K. (2016). Can illness beliefs, from the common-sense model, prospectively predict adherence to self-management behaviors? A systematic review and meta-analysis. Psychology & Health, 31, 931-958. doi:10.1080/08870446.2016.1153640
Bookey-Bassett, S., Markle-Reid, M., Mckey, C. A., & Akhtar-Danesh, N. (2017). Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: A concept analysis. Journal Of Advanced Nursing, 73, 71-84. doi:10.1111/jan.13162
HealthyPeople.gov. (2017). Objectives: Access to Care, Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/ access to care.
Hodges, B. C., & Videto, D. M. (2011). Assessment and Planning In Health Programs (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.
Kettner, P. M., Moroney, R. M., & Martin, L. L. (2017). Designing and managing programs: An effectiveness-based approach (5th ed.). Thousand Oaks, CA: Sage.
Osborn, R., Moulds, D., Squires, D., Doty, M. M., & Anderson, C. (2014). The international survey of older adults finds shortcomings in access, coordination, and patient-centered care. Health Affairs, 33, 2247-2255. doi:10.1377/hlthaff.2014.0947
Springer, A. E. & Evans, A.E. (2016). Assessing environmental assets for health program planning: a practical framework for health promotion practitioners. Health Promotion Perspectives, 6, 111–118. doi:10.15171/hpp.2016.1
Program Planning for the Older Adult
Margaret Clark
Walden University
Program Planning for the Older Adult
The purpose of this paper is to share a revenue and expense budget for the program planning for the older adult who has difficulty with access to care and services. The fictitious company name for purposes of this project is titled Older Adults Access to Care (OAAC). A financial analysis with a review of the positive outcomes for the population will be shared with the reader. Three key aspects must be considered for the program to be effective and functional to the targeted audience. These include; the Financial control, management, and effective planning. To derive the quality measurements for success the three aspects must be given equal priority (Ketttner, Moroney & Martin, 2017). The company is a not for profit and the OAAC program has no impact on the budget about funding or borrowing. This budgetary plan postulates that the funding resources for this particular program will be fetched from community and state programs. This will be done based on demographics to support the elder adult with moderate to low income with lack of access to health care services. The lack of access to services is now a national priority with the federal government (Health People, 2017).
Older Adult Access to Care Budget
Access to Healthcare Improvement Program Budgetary Plan
Jan Feb March April May June
Income or Revenues Government Contracts 155,000.00 155,000.00 155,000.00 155,000.00 155,000.00 155,000.00
Third Part Funds 14,850.00 14,850.00 14,850.00 14,850.00 14,850.00 14,850.00
169,850.00 169,850.00 169,850.00 169,850.00 169,850.00 169,850.00
Expenses Telephone 1,000 1000 1000 1000 1000 1000
Posters 2,000 2000 2000 2000 2000 2000
Clipboards 5,000 5000 5,000 5000 5000 5000
Advertising 10,000 10,000 10,000 10,000 10,000 10,000
Public Advocacy 5,000 5,000 5,000 5,000 5,000 5,000
Meeting Hall 2000 2000 2000 2000 2000 2000
Total 25,000 25,000 25,000 25,000 25,000 25,000
Older Adult Access to Care Financial Analysis
The money in the OAAC program will have a positive impact on the older population. The program considers those in specified counties who would be classified as indigent and those on fixed incomes whom do not have resources to access necessary care (Vandiver, Anderson, Boston, Bowers, & Hall, 2018) Chronic disease is now considered the costliest of all health conditions and accounts for 86% of all healthcare spending (Vandiver, Anderson, Boston, Bowers, & Hall, 2018). Most community health programs have a social aspect and the goal of the OAAC is to bridge the gap that exists between the demand for care and the availability of care services and solutions in the current healthcare system. The services will include transportation and a healthcare navigator who can specifically help with chronic disease prevention education, resources, motivational interviewing, and encouragement for each unique individual. Ultimately, the quality of life for the older adult will greatly improve (Vandiver et al., 2018). The OAAC will use a cost-benefit analysis to determine the point in time when the benefits have just repaid the costs. The allocated costs and physical resources, human efforts are factored into the analysis. The organization planned, and actual expenses were budget break even for the first six months.
Table Number 2 Financial Analysis to Illustrate Break Even Budget
Expenses Category Planned Expenses [$] Actual Expenses [$]
Salaries and Remuneration 542, 806 542, 806
Office Costs 69, 247 69, 247
Marketing 67, 800 67, 800
Training and Travel 48, 000 48, 000
Total 1, 609, 630.00 1, 609, 630
Conclusion
If the lack of access to care for the older adult continues the path that currently is being followed, the health care expenses will continue to skyrocket. Chronic disease accounts for 7 out of 10 deaths in the United States (Burke, Cumbler, Coleman, Levy, 2017) Chronic disease is largely preventable and can be detected and treated with appropriate screenings. The right care for the older adult can prevent the chronic disease from getting worse and provide appropriate timely treatment (Vandiver, Anderson, Boston, Bowers, & Hall, 2018). A greater significance of mortality from the chronic disease, increase in disability and quality of life will be impacted if continuing without access to care continues. The loss of productivity for chronic disease is equivalent to 260.00 billion annually (Burke, Cumbler, Coleman, Levy, 2017). Stronger control over funded programs such as the OAAC could impact the burden of the deficits the government is now facing.
References
Burke R.E. Cumbler E.E. Coleman E.A. Levy C. (2017). Post-acute care reform implications. Journal of Hospital Medicine, 12, 46 – 51. 10.1002/jhm.267
Kemerer, D., & Cwiekala-Lewis, K. (2017). Leading by walking around in long-term care and transitional care facilities. Nursing Management – UK, 24(3), 25-29. doi:10.7748/nm.2017.e1467
Kessler, C., Tsipis, N. E., Seaberg, D., Walker, G. N., & Andolsek, K. (2016). Transitions of Care in an Era of Healthcare Transformation. Journal of Healthcare Management / American College Of Healthcare Executives, 61, 230-241.
Rahman, M., McHugh, J., Gozalo, P. L., Ackerly, D. C., & Mor, V. (2016). The Contribution of Skilled Nursing Facilities to Hospitals’ Readmission Rate. Health.
Sullivan, G. J., & Williams, C. (2017). Older Adult Transitions into Long-Term Care: A Meta-Synthesis. Journal of Gerontological Nursing, 43(3), 41-49. Doi: 10.3928/00989134-20161109-07
Toles, M., Colón-Emeric, C., Naylor, M. D., Barroso, J., & Anderson, R. A. (2016). Transitional care in skilled nursing facilities: a multiple case study. BMC Health Services Research, 16, 186. doi:10.1186/s12913-016-1427-1
Vandiver, T., Anderson, T., Boston. Bowers, C., & Hall, N. (2018). Community -Based Home Health Programs and Chronic Disease: Synthesis of Literature. Professional Case Management,23(1), 25-31.doi:10.107/NCM.0000000242
Verhaegh, K. J., MacNeil-Vroomen, J. L., Eslami, S., Geerlings, S. E., de Rooij, S. E., & Buurman, B. M. (2014). CHRONIC CARE. Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses. Health Affairs, 33(9), 1531-1539. doi:10.1377/hlthaff.2014.0160
Evaluation Model for Older Adult Access to Care Program
Margaret Clark
Walden University
Abstract
The purpose of this paper is to share the evaluation model that includes both components of an evaluation planning and evaluation methods for the older adult with lack of access to healthcare and services. In addition, a performance measurement, monitoring and evaluation timeline will be discussed as part analysis. The first step will be the identification of an evaluation program or theory that is well-aligned with the program’s goals and objectives. Also, the development of a program monitoring and evaluation timeline that will be used to examine the effectiveness and the sustainability of the program. Of special concern for this evaluation model will be to identify and distinguish between the long-term and the short-term effects on health outcomes as a result of the program implementation. This evaluation model paper will further demonstrate the appropriate use of program management and implementation to enhance readers’ understanding. Also, to contribute to enhancing the access of care by older populations and other patient groups.

Evaluation Methods
A program evaluation is used to monitor and document program implementation and can aid in understanding the relationship between specific programs elements and design. Program lack of success could be attributed to many program-related reasons or personal delivery of the program. The purpose of this discussion is to identify a theory or model to evaluate the older adult and lack of access to care program. The model chosen for evaluation of this program is the Getting to Outcomes Model (GTO). Getting to Outcomes strengthens the knowledge, attitudes, and skills practitioners need to carry out the various tasks required for strong implementation of EBPs (Lewis, 2017).Getting To Outcomes does this by posing a series of steps practitioners should follow in order to obtain positive results and then providing practitioners with the guidance necessary to complete those steps with quality.
The 10 GTO steps roughly correspond to four general areas: (1) diagnosing problems and setting priorities (2) choosing, planning and using EBPs; (3) evaluating programming and outcomes; and (4) improving and sustaining changes. These steps are designed to be logically linked. Goals and performance targets are associated with program activities that will meet those targets, which are linked to process and outcome measures to assess if the targets are being met, which are linked to quality improvement activities that make use of the process and outcome data. This application was had been used successfully with health practice and prevention promotion with teenage pregnancy, smoking cessation, obesity, and homelessness. The GTO has been used by technical schools elementary and high schools in addition to nursing.
The power of the GTO is tools to assist with motivational interviewing and behavioral change. GTO has recently served as a model to support VA homeless services providers’ planning, implementation, and self-evaluation of evidence-based practices (Chinman, Acosta, Ebener, Clifford, Corsello, & Tellett-Royce, 2012). The GTO model aligns with the lack of access to healthcare for the older adult because it replicates a prevention support system designed to bridge the gap between prevention science and practice. Originally developed by the Rand Corporation in 2004 as an empowerment evaluation theory. The rural population needing the access to health care often have increased poverty, lower education and poorer health outcomes and status. Self-management and understanding chronic disease are essential to the prevention of complications. The rural areas often experience up to 77% of a healthcare shortage. In the year 2010 1.7 million rural Americans had a hospital close to them close, therefore making the access to care more difficult.
Timeline and Key Components of Evaluation Plan
 Data for consideration of the program outcome effectiveness would be the improved health status of the population by having access to care. A measurement of quality of life for the population, with a goal of improvement of the quality of life. A timeline for engagement of various elements of evaluation:
 1/15/2018 Choose which problem(s) to focus on
Age 65 and older who have difficulty with access to healthcare
2.1/25/2018 Identify goals and target population and desired outcomes
 Improve older adult access to healthcare and community resources
             Increased likelihood that patients will receive appropriate care
 Prevent disease and disability
       Detect and treat illnesses or other health conditions
       Increase quality of life
       Reduce the likelihood of premature death
 Increase life expectancy
3. 2/15/2018 Find existing programs and best practices worth replication
4. VA homeless Project
Healthy People 2020
Community-Based Support Programs for Older Adults
Office of Aging Transition Program 
5. 3/10/2018 Modify project or best practice to fit needs
6. 4/10/2018 Access capacity, staff, financial data to implement
7. 4/15/2018 Make a plan for getting started who, what, when, where, and how
8. 8/10/2018 Evaluate and Implementation how did it go?
9. 9/10/2018 Evaluate programs success in achieving desired results
10. 10/10/2018 Make a plan for continuous quality improvement
11. 11/10/2018 Consider how to keep the program sustainable.
(Chinman, Acosta, Ebener, Clifford, Corsello, & Tellett-Royce, 2012)
Gantt chart

Milestone graph ( insert or add as attachment)
Summative Evaluation
 

Long Term Impact Evaluations versus Short Term Outcomes
The long term outcomes of using impact evaluation will include the program attributes that are applicable to the population as a whole. An example would be an increase in number of older adults that have access to care in local rural counties. The older adult population would have a decrease in health care complications from the chronic disease. The short term outcomes would have a direct tie to the immediate interventions. An example would be the older adult obtains a primary care provider, and has accessed the healthcare system. A more intermediate outcome would be evidenced of self-management of chronic disease with improved quality of life. A summative evaluation includes attainment of higher quality of life that is free of disability and preventable chronic diseases, injuries and premature deaths. Overall the program would decrease disparities and promote a good healthy environment. The interventions of regular checkups, access to health care screening such as weight management, screenings for blood pressure, blood glucose, heart disease and hearing and vision loss all contribute to good health promotion.
Evaluation Plan

Reference
Buck, H. G., Kolanowski, A., Fick, D., & Baronner, L. (2016). Improving rural Geriatric Care Through Education: A Scalable, Collaborative Project. Journal of Continuing Education in Nursing, 47(7), 306-313. doi:10.3928/00220124-20160616-06
Center for Rural Pennsylvania. (2014). looking ahead: Pennsylvania population projections 2010 to 2040. Retrieved from http://www.rural.palegislature.us/documents/factsheets/ projections _2010-2014.pdf
Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs (2nd
ed.). Sudbury, MA: Jones & Bartlett Learning.
Toles, M., Colón-Emeric, C., Asafu-Adjei, J., Moreton, E., & Hanson, L. C. (2016). Transitional
Care of older adults in skilled nursing facilities: A systematic review. Geriatric Nursing
(New York, N.Y.), 37(4), 296-301. doi: 10.1016/j.gerinurse.
Vandiver, T., Anderson, T., Boston, B., Bowers, C., & Hall, N. (2018). Community-based Home
Health Programs and Chronic Disease: Synthesis of the Literature. Professional Case
Management, 23(1), 25-31. doi:10.1097/NCM.0000000000000242