HomeMy WebLinkAbout20032388.tiff RESOLUTION
RE: APPROVE APPLICATION FOR INTERDISCIPLINARY COMMUNITY FALL RISK
PREVENTION PROGRAM AND AUTHORIZE CHAIR TO SIGN - U.S. DEPARTMENT
OF HEALTH AND HUMAN SERVICES
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Application for Interdisciplinary
Community Fall Risk Prevention Program between the County of Weld, State of Colorado, by
and through the Board of County Commissioners of Weld County, on behalf of the Department
of Human Services, Area Agency on Aging, and the U. S. Department of Health and Human
Services, commencing October 1, 2003, and ending September 30, 2004, with further terms
and conditions being as stated in said application, and
WHEREAS, after review, the Board deems it advisable to approve said application, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Application for Interdisciplinary Community Fall Risk Prevention
Program between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency
on Aging, and the U. S. Department of Health and Human Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said application.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 18th day of August, A.D., 2003.
BOARD OF COUNTY COMMISSIONERS
�� � W CO NTY, COLORADO
ATTEST:
D id E. ong Chair
�y ounty Clerk to the Board
ELi Ro ert as n, Pr Tem
1861 rk to the Board
M. J. eile
2),02.:2 1, i
Willi H. Jerke
County At .rney iyCGaw! l�-ea-
Glenn Vaad
Date of signature: 17-D-3-°3
2003-2388
HR0074
(r: fh2
An Interdisciplinary Community Program to Prevent Falls Among Older Adults
Grant Proposal
Submitted to
U.S. Department of Health and Human Services
Administration on Aging
Washington, CO 20201
Eva Jewell, Director
Weld County Area Agency on Aging
Interdisciplinary Community Fall Risk Prevention Program
The Weld County Fall Prevention Partnership (WFaPP) will conduct a 3-year
interdisciplinary fall prevention program targeted to older adults who have demonstrated
that they are at high risk for falls or have restrictions due to their fear of falling. The
program involves two phases — 1) intake/assessment and 2) physical training/group
meetings (education, social support, and focus groups) — and a follow-up/evaluation.
The goal of this project is to enhance the physical and psychological coping skills of
older adults through implementation of an interdisciplinary fall prevention program.
Expected outcomes are: Participants will 1) reduce the total number of falls, 2) decrease
the measured fear of falling, 3) improve assessment measures for efficacy,
balance/mobility/strength/flexibility, nutrition, and social support; and 4) adhere to a
prescribed intervention program long term. Products will include intake and evaluation
tools used, physical training schedule, and lesson plans for the support group and focus
group meetings.
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Interdisciplinary Community Fall Risk Prevention Program
Problem Statement
Falls among the elderly are a significant health care concern, impacting the social, emotional,
physical, and economic well being of the individual, the caregiver, and the community. As much as
35% of the population over age 65 reports one or more falls a year(Shumway-Cook, Baldwin,
Polissar& Gruber, 1997). The cost of falls is estimated at 75-100 billion dollars annually
(Commodore, 1997). Falling and the fear of falling profoundly impacts the health and well-being of
many older people, robbing the individual of independence, feelings of safety, and confidence in the
ability to care for oneself appropriately. Among older adults, falls are the leading cause of injury
deaths (CDC, 2002).
Evidence-based guidelines for fall prevention among community-dwelling older people
suggest approaching the problem of falls and fear of falling using multiple strategies, including
exercise-based interventions, environmental modifications, and various risk-factor assessment and
reduction strategies (Rose, 2002-2003; Rubenstein, et al, 2002-2003). A number of studies have
investigated this interdisciplinary approach to reducing falls (Berg, Alessio, Mills & Tong, 1997;
Day, et al., 2002; Commodore, 1995; Ryan & Spellbring, 1996; Schoenfelder&Van Why, 1997;
Shumway-Cook et al., 1997; Tennstedt, et al., 1998; Tinetti, et al., 1994). Unfortunately, the link
between evidence based research and practice has not been frequently made and in addition, many
fall prevention programs only focus on one component— such as an educational component or an
health assessment component—that are limited in scope and duration. A successful fall prevention
program must link those evidence-based factors found to be successful in reducing falls to a
multidimensional on-going individualized community intervention program.
This project proposes to bring together a partnership of organizations—Weld County Fall
Prevention Partnership—that will develop and implement an evidence-based program targeted to
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improving the quality of life for community-based older individuals, both English and Spanish-
speaking. Through this project the Weld County Area Agency on Aging, interdisciplinary faculty in
Nursing, Sports & Exercise Sciences, Therapeutic Recreation and Gerontology at the University of
Northern Colorado College of Health and Human Services, Weld County RSVP, and the
Rehabilitation and Visiting Nurse Association Home Health Care, will implement a program that
utilizes the interdisciplinary expertise of these four partner groups to prevent falls and fear of falling
for older adults. Lessons learned from this program will provide the basis for future cooperation
among other Area Agency's on Aging and aging network providers in providing fall prevention and
risk factor intervention and education to improve the quality of life for older individuals.
Weld County Fall Prevention Partnership
The Weld County Fall Prevention Partnership (WFaPP) consists of personnel from several
local agencies that have worked together on many projects in the past to provide services to the older
population of Weld County. The major partners consist of:
• Weld County Area Agency on Aging as the submitting partner and administrator of funds,
equipment, personnel, overall program management and coordinate with the aging services
network to recruit participants;
• Weld County Retired Senior Volunteer Program (RSVP) as the CASP organization responsible
for coordination of services, identification of at risk clients in need of intervention, work with
other agencies to identify at risk clients, and assist with transportation of clients for intervention
services, and refer clients to other community support agencies (e.g., grocery shopping program,
congregate meal programs, senior centers, etc)
• Rehabilitation & Visiting Nurses Association (RVNA) as the agency that will assure quality and
appropriateness of the interventions to be provided in the program, and
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• University of Northern Colorado College of Health and Human Sciences (UNC-HHS) as the
research organization with faculty and students from a variety of different departments being in
charge of providing fall prevention interventions to clients as well as conducting the program
evaluation. The specific departments involved in the program are:
o School of Nursing
o School of Sport and Exercise Science
o Department of Human Services—Gerontology and Therapeutic Recreation Programs
Goal and Objectives
The goal of this project is to implement an interdisciplinary fall prevention demonstration
project that enhances the physical and psychological coping skills of older adults through a
partnership of Aging Services Organizations. The following objectives have been established as the
means of achieving the goal of the project for the individual participants.
1. Reduce the total number of falls for participants;
2. Reduce the measured fear of falling for participants;
3. Demonstrate improved assessment measures for efficacy,
balance/mobility/strength/flexibility, nutrition, and social support
4. Promote long-term adherence of older individuals to a prescribed intervention program.
Proposed Intervention
Previous evidence-based research has identified numerous factors that lead to falling or fear
of falling such as muscular weakness, gait and balance impairment, sensory impairment, medication
side effects, chronic illnesses, and environmental hazards. Therefore a successful intervention
program must integrate these different elements into an individualized assessment process and on-
going treatment of the problem.
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This project is an interdisciplinary program designed to use the expertise of personnel from
various social service agencies and health care disciplines to assess and design intervention strategies
to help prevent falls in older people using recommendations from various sources including the
Evidence-Based Guidelines for Falls Prevention: Summary of the Bi-National Panel (Generations,
Winter 2002-3, pp 38-40). Through involvement in this project,participants will fall less often,
experience less severe injuries with falls, and lessen their fear of falling, thus, preventing some of the
co-morbidities related to immobility and isolation so often seen in people who have fallen.
Participant Recruitment
The project begins with meetings of partnership (WFaPP) members to begin recruitment of
participants who are at risk for falls or whose fear of falling has significantly impaired the quality of
life of these individuals. The project director, Eva Jewell (AAA) and project coordinator, Bernie
Gorek Retired Senior Volunteer Program (RSVP) will work with members of each of the agencies in
the partnership to assure consistency of information and outline responsibilities for each organization.
RSVP will take the lead in identifying potential participants for the falls prevention interventions.
More specifically, the criteria for participant inclusion requires that that individual has had a fall in
the past 12 months or the person expresses that he/she has had to change the activates of daily living
substantially because of his/her fear of falling. Initial assessment for inclusion in the project include
documentation of the total number of alls in the past 12 months and/or a score on the Fear of Falling
Index that suggest a high level of fear that affects routine daily activities..
The project coordinator(RSVP), Bernie Gorek, will recruit participants by networking with
service and health care organizations such as Meals-on-Wheels, Greeley Senior Center, Rodarte
Senior Center(Hispanic senior center), RVNA and other home care agencies, parish groups, local
emergency rooms and private physician offices, senior housing facilities, and their own RSVP
volunteers. Additionally, arrangements will be made with the assistance of RSVP volunteers to
provide transportation to the facility for both the physical training and the group meetings. When
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environmental changes are necessary, such as installing hand rails, to help prevent falls, RSVP will
make attempts to assist individual participants with environmental changes through their
"Handyman"program. The partnership anticipates that in excess of 100 people will be enrolled in the
program over the 3-year funding period. Some attrition is expected to occur due to failing health,
loss of interest, and death of the participants. As participants are lost from the program additional
participants will be recruited throughout the initial 24 months of the program.
Program Intervention
As previously mentioned, this program addresses the need for a fall prevention program that
is on-going, multidisciplinary in nature to reduce falls and the fear of falling among a group of elders
who are at high risk of injury. The program director, Bernie Gorek will explain the program to those
individuals who consent to participate. Those elders who agree to participate will receive an
assurance of confidentiality regarding their health information in accordance with HIPPA
requirements. In addition, the evaluation staff(Jan Martin, Susan, Collins, and Megan Babkes) will
submit IRB paperwork for the research phase of the project and will ask participants if data from their
assessments can be included in the aggregate findings. Failure to consent might require exclusion
from the project given all participant data are needed for the full evaluation of the project.
Participants will be asked to follow the prescribed program and maintain contact with the team over
the course of the project.
The project coordinator will organize participants and students assigning meeting times and
facilities as needed. Staff from the RVNA will be notified of assessment,physical training, and group
meetings times so that they are able to assess the appropriateness of interventions and assure that
evidence-based practices are being used. The UNC—HHS group will also give the RVNA reports on
the progress of participants avoiding identification of any of the participants as individuals.
The intervention consists of two phases as listed below:
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• Phase 1: Intake/Assessment—Once volunteer participants have been identified and have
agreed to participate they will enter the Intake/Assessment Phase of the project. Once the Project
Coordinator has completed the initial screening paperwork,the Project Coordinator will schedule an
appointment with an assessment team. Assessment teams,made up of trained students from
Exercise Science,Nursing,and Therapeutic Recreation, and Drs. Martin, Babkes, and Carter,will
conduct individualized assessments. Attempts will be made to assure that minimally English
speaking participants (primary language being Spanish)will be assigned to groups together to assist
with social support needs among the group members. Each participant will undergo a thorough
interdisciplinary assessment that includes a physical and psychosocial evaluation as well as an
environmental assessment. Analysis of the assessments will result in individualized interventions
prescribed for the participants. Table 1 contains the suggested assessments to be made during the
initial and follow-up assessments. Trained students under faculty supervision will conduct the
following assessments. The instruments used in the assessments were selected from other evidence-
based studies and have high validity and reliability.
Table 1. Assessment Components 1'/2 to 2 hours time commitment
Component Potential Measurement tool
Demographics • Age
• Race/ethnicity
• Sex
• Height/weight/BMI
• SES
Falls and fear • Number of falls in last 12 months
• Fear of Falling index
Balance&Mobility • Rhomberg Exam
■ 8' Up and go test
Strength&Flexibility • Sit and reach test
Vital signs • Blood pressure
■ HR
■ Orthostatics
Sensory ■ Schilling test
■ Whisper test
• Assessment of understanding _
Habitual Physical Activity • modified asking questions
o activities
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Component Potential Measurement tool
o decades
Mental status • Mini Mental Status
Environmental safety Home Safety Checklist
Medications • Listing of current drugs—checking
those with potential for orthostasis
Diet Nutrition • Fluid hydration
■ Nutritional Screening Tool
Self Efficacy(SE) • Physical Self Efficacy scale
• Falls Self Efficacy
Well-being(formerly social support • Ryff—Scale of Psychological Well-
and life satisfaction) _ being.
Qualitative Assessment of the • Individual interview of participants to
Meaning of Falling gather data on the meaning of falling for the
individual
Phase 2: Physical Training and Group meetings—After the initial assessment the LTNC-HHS
faculty and students will review the findings and make recommendations for a"Prescription"(Rx)to
follow during the intervention phase(see Table 2 for examples of Prescriptions). Both physical
training and group meetings will be tailored to the particular needs of the participants as determined
in the prescriptions. Groups of three to four people with similar needs will be involved in physical
training together. Physical training sessions will be held in the physical exercise science clinic at
UNC. Sessions will be about one hour and will be conducted twice weekly over the year of
enrollment in the program. . Participants will be encouraged to remain in the program after they
reach their optimal functioning level in order to maintain their highly level of functioning.
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Table 2. Example Case description #1:
Assessment Results:
• Demographics: Male, 75 years old , x • , O k vu cs a vuC ez
• Mental status: normal/healthy for age ` J V t v
• Sensory: wears glasses, hearing is fine, feels feet just • Stretching program with focus on flexibility
fine, minimal orthostatsis • No balance issues or treatment
• VS/Medication/Cardio: A few medications - one for • Strength training with increased cardiovascular focus
blood pressure, heart is moderately healthy (Goal = long and low) and integration of why activity is
• Balance, Mobility, Strength & Flexibility: Balance important
okay, decreased flexibility and decreased range of motion, o Begin with 10 minute sessions progressing to 30
moderate strength throughout body
o Deconditioned due to low habitual activity minute sessions of cardio
o Only doing ADS, walks a little but not on a o 3 times a week
regular basis • Example:
•
• Environment Safety: Lots of clutter in house, no throw lhour session
•
rugs but carpet-hardwood-carpet transitions throughout, Stretch Strength Cardio
•
steps to house, one story but avoids basement when 40 min 10 min 10min
possible. • 30 min 15 min 15 min
• Fear of Falling: moderate, speaks/expresses increased •
• 20 min 20min 20 min
fear, starting to decrease the amount going outside but not • 20 15 min 25 min
phobic just a bit concerned that he is going to fall again. • 15 15 min 30 min
• Number of Falls: Two in last year • Cardio — foam walking to music
• Nutrition/hydration: concern regarding hydration • Discussion with training — efficacy and
• Physical/Fall Efficacy: Low efficacy doesn't believe he reasons for strength, flexibility, and bone
can prevent or catch himself effectively if he falls maintenance.
• Social support: wife, friends available, previous falls felt • Hydration Safety:
"rescued" o raise slowly
• No osteoporosis o drinking more water
• Medication adherence
• Educational Session — Awareness and Efficacy
• Recommend changing environment, move materials
from basement to main floor
Table 2. (cont.) Example Case description #2:
Assessment Results:
• Demographics: Female, 86 years old 1 )( : vl ci r t/ 1 (few Vt
• Mental status: has declined with age / l V` t 1; r ow
• Sensory: decreased, uses trifocals worn for more than 7 • Recommend eye examination and treatment for
years, some macular degeneration resulting in loss of central movements with central vision loss
vision as well. • Ambulation with cane (fashionable) to detect
• VS/Medication/Cardio: several cardiac medications, no ground not for balance and teach how to use
problems, also takes arthritis medications and just started
Fosomax for osteoporosis (discovered in hospital), MD • Weight bearing exercise, movement, light
prescribed Fall Prevention Program strength, minimal flexibility
• Balance, Mobility, Strength & Flexibility: • Focus on ROM exercises especially with sensory
o Balance: medium loss training
o Strength: decreased • Sensory training — movements with eyes closed
o Flexibility/ROM: 4,, mobility, not active o Sitting ball
• Environment Safety: favorite small dog often under foot, o tapping foot
lives independently, no clutter, no steps environmentally OK o passing ball with eyes closed
• Fear of Falling: Not afraid of falling • Activities to increase cane use efficacy
• Number of Falls: 1 fall resulting in broken wrist and o Take dog out for walks (short)
hospitalization in the last year • Education/Social Support — for increase in life
• Nutrition/hydration: okay, sometimes forgets to eat satisfaction and subjective well-being
• Physical/Fall Efficacy: Low fall efficacy—"if I fall I'll get • Reminders regarding nutrition
hurt(again)"Social support: daughter and grandchildren in
town but"busy"
• Osteoporosis: Yes- significant
Additionally, participants will be asked to participate in three different group meetings
through out the month. These group meetings, conducted by Dr. Susan Collins with assistance from
Gerontology graduate students, will include an educational session, a support group discussion, and a
focus group for discussion and data collection. Meetings will be offered twice a week but participants
are being asked to participate in only one session weekly. The suggested rotation for group meetings
includes weeks 1 and 3 educational, week 2 support group discussion, and week 4 focus group data
collection. Participants will be encouraged to include caregivers, family members, or other
individuals in their social support network in group meetings. All group meetings will be held in
classrooms at UNC.
Proposed content for different group meetings
Educational Groups:
• Environmental safety issues and how to resolve
• Medications, potential problems, and simple ways to avoid problems
• Nutrition as a means of gaining strength
• Hydration: keeping the brain floating
• So you wear bifocals—how to keep the floor in focus
Focus Groups:—will bring in issues related to educational and physical training as well
• What it means to fall
• Fear of falling
• What pushes your buttons about falling and injury
• Physical changes as we age
Special Target Populations and Organizations
Weld County is a rural, agricultural county with an elderly population of approximately 15%.
Additionally, the agricultural businesses of the area attract a large Hispanic workforce and
approximately 25% of the population is Hispanic, with an estimated 5% of Hispanics over age 60.
The target audience for this program are those elders who have already demonstrated that they are at
risk of or have experienced a diminished quality of life due to falling or fear of falling. Through the
services and contacts of the participating CASP —the RSVP -- people who fall into these categories
will be recruited for participation. Members of the WFaPP provide services to the Hispanic
community and special attention will be made to include those Hispanic people who are in need to
these preventative services. The Project Coordinator and Project Director will work with a wide
variety of community agencies in Weld County so as to target elders who meet the screening criteria
from various social and economic backgrounds. These agencies include the Rodarte Center (serves
Hispanic elders), Weld County Senior Coordinators located in 12 small rural communities in Weld
County, Meals on Wheels, the Ministerial Association of Weld County, and other service
organizations in the area.
Outcomes
The following objective outcomes will be achieved by the end of the project period:
1. Reduce the total number of falls for participants through use of an interdisciplinary fall prevention
program.
Outcomes:
a. Falls reduced by at least 40% in a sample of 25 elderly adults by the end of the first year of
the project.
b. Falls reduction by at least 50% in all participants by the end of the project period.
2. Reduce the measured fear of falling for participants
Outcomes:
a. Aggregate measure of fear of falling decreased by at least 40% in a sample of 25 elderly
adults by the end of the first year of the project.
b. Aggregate measure of fear of falling decreased by at least 50% in all participants by the end
of the project period.
3. Demonstrate improved assessment measures for efficacy, balance/mobility/strength/flexibility,
nutrition, and social support
Outcomes:
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a. Aggregate measures for efficacy, balance/mobility/strength/flexibility, nutrition, and social
support will improve by 40% during the first year of the project.
b. Aggregate measures for efficacy, balance/mobility/strength/flexibility, nutrition, and social
support will improve by 50% over the length of the project
4. Promote long-term adherence of older individuals to a prescribed intervention program.
Outcomes:
a. At least 50% of the participants will adhere to their prescribed program as measured at the
end of the first year.
b. At least 60% of the participants will adhere to their prescribed program during the overall
project period.
c. At least 70% of the participants will report the experience with the program as a positive one
d. At least 50% of the participants will state their commitment to continue the prescribed
program after the project is over.
WFaPP's Interdisciplinary Fall Risk Prevention Program addresses a significant chronic
health care concern with older adults while also identifying strategies to promote individual
participant well-being. The project uses a collaborative approach among several disciplines and the
community partners to enable an individualized approach to fall prevention while promoting self-
responsibility. The anticipated outcomes of the project is the identification of effective exercises,
education, and social supports to reduce the number of falls,the reoccurrence of falls, and fear of
falling, and facilitate in-home self-management by the older individual. In addition, a creation of a
project that combines the expertise of faculty from several common health care disciplines will have
a positive impact on the health and well-being of individual community elders. The use of an
interdisciplinary team will also serve as a model for other communities as a means of preventing
falls.
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Project Management—
Administrative responsibilities for the project are the responsibility of the AAA and include:
budget management, hiring of consultants, assisting the project coordinator with their duties,
equipment purchase, review of assessments and interventions conducted by UNC —HHS faculty and
students, and overview of the activities of the project. The AAA personnel will consist of the project
director and the fiscal management staff of the grant. The project director will be involved in
planning meetings for the partnership and will be apprised of client participation and evaluations as
these data become available.
Recruitment of participants will be the responsibility of staff from the RSVP, particularly the
project coordinator. The project coordinator will contact various social and health care agencies to
determine people who might best benefit from participation in the project.
UNC —HHS faculty and students will be responsible for assessment, intervention, and
evaluation of the participants. The project coordinator will be assigned workspace in the university
and will be responsible for management of services for those people through RSVP that she has
recruited. The project coordinator will need to assist with setting up the meetings/rooms for the
educational sessions, working with faculty to assign students to be responsible for assessments,
physical training, and educational sessions. Additionally, the project coordinator will be responsible
for organizing WFaPP meetings. UNC —HHS faculty are responsible for data collection, input, and
evaluation. The faculty will report findings to the WFaPP meetings and make adjustments in
"prescribed" treatments as necessary to improve outcomes that are seen as in jeopardy of not being
met. Nursing faculty and students are primarily responsible for initial physical and psychosocial
measurements made on the participants with the assistance of the gerontology and therapeutic
recreation students. Sports and exercise science faculty and students are primarily responsible for the
physical training activities. Gerontology and therapeutic recreation students and faculty are
15
responsible for taking the lead in providing the educational sessions and the social support sessions
with the assistance of faculty and student from other departments.
Finally, the RVNA staff will review the interventions to assure that these interventions are
consistent with the evidence-based practice guidelines outlined in the literature. RVNA staff will
periodically interview participants to assure they are being treated fairly and feel they are learning
from the experience. RNVA staff will review outcomes along with other members of the WFaPP.
Evaluation
Evaluation will be an integral part of the project and is designed to assure that the overall goal
of reducing falls and the fear of falling among community dwelling older adults is met and to
determine the effectiveness of the program process. The evaluation and analyses of all project
component data will be collected over the course of the project period by Dr. Martin with assistance
from Drs. Babkes, and Collins, who have experience in program evaluation as well as various other
types of research endeavors (See staff vitae). One graduate student will be hired to assist with data
collection and computer input. Evaluation will be conducted as outlined in Table 3.
Table 3 Evaluation Schedule
Initial 3 months 6 months 9 months 12 months/exit
Demographics
Mental status Mental status Mental status
Sensory Sensory
Social support
Vital Vital Vital Vital Vital
Signs/Medications/ Signs/Medications Signs/Medications Signs/Medications Signs/Medications
cardiovascular /cardiovascular /cardiovascular /cardiovascular /cardiovascular
Balance, mobility, Balance, mobility, Balance, mobility, Balance, mobility, Balance, mobility,
strength, flexibility strength, flexibility strength, flexibility strength, flexibility strength, flexibility
Environmental Environmental Environmental
safety safety safe
Fear of falling Fear of falling Fear of falling Fear of falling Fear of falling
Number of falls Number of falls Number of falls Number of falls Number of falls
Nutrition/hydration Nutrition/hydration Nutrition/hydration Nutrition/hydration Nutrition/hydration
Physical/fall efficacy Physical/fall Physical/fall Physical/fall Physical/fall
efficacy efficacy efficacy efficacy
Osteoporosis Osteoporosis Osteoporosis Osteoporosis Osteoporosis
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Data will be collected related to falls, fear of falling, efficacy,
balance/mobility/strength/flexibility, nutrition, and social support. These data will be analyzed and
compared against the performance indicators to determine satisfactory achievement of objectives.
Additionally, participants will be evaluating the perceived effectiveness of and satisfaction with the
program at the conclusion of the project. During the final part of the project, investigators will begin
to evaluate differences among the participants who were able to reduce their falling and fear of
falling and those who were not able to reduce their fear. The groups will be evaluated for differences
in prescribed treatment regimes, demographic data, and adherence. This evaluation will allow the
investigators to determine the best combination of interventions designed to reduce falls and the fear
of falling.
In order to evaluate the objective of long-term adherence to a fall prevention program, data
regarding adherence will be collected during all phases of the project. These data will be used during
the project period to revise and adjust participant's individual intervention program and will be used
at the end of the project period to determine adherence rates. Again, comparisons will be made
between the people who were able to adhere to the program for the full year and those who were not
able to continue on the basis of demographics, falls history, and the prescribed regimen. This will
allow the investigators to better predict who is most likely to benefit from this type of fall prevention
program as well as the specific type of therapeutic regimen that leads to long-term adherence. Figure
1 illustrates the different phases of the Interdisciplinary Community Fall Prevention Program.
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Figure 1 —Interdisciplinary Community Fall Prevention Program
Recruitment
based on# of falls and fear of falling by RSVP and other service
organizations
Initial assessment—Phase 1
- physical, psychosocial, & environmental evaluation
Interdisciplinary Review
• Sports and Exercise Sciences
■ Therapeutic Recreation
• Gerontology
■ Nursing
IC
- Individualized Prescriptive Plan
Oep
Variations of the following components.
• Physical training
v r„ I • Environmental assessment
a — P„ Educational sessions �r„ _
OOs g - r "r„ • Social support groups r l,„
p„ • Focus groups
�
— RX � Rx
C
ecs
V
Initiation Physical Training and Group Meetings— Phase 2
• Physical training
• Environmental changes
• Education al meetings
• Social support meetings
• Focus groups
Follow- up Assessments/Evaluation
- 3, 6, 9, & 12 months
1
Evaluation & Reporting
Data evaluation by research team, UNC —HHS
faculty and students, RVNA, RSVP and AAA
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Dissemination
A final report containing a review of the fall prevention literature, a detailed description of the
program, including training materials and assessment tools, and a description of the program's
effectiveness will be written. In addition to submitting the report to Administration on Aging, this
report will be made available to interested parties. Furthermore, the Weld County AAA will be able
to share results with regional AAAs and discuss possible implementation of the program in their
areas. The AAA will work with the Region 8 Administration on Aging to deliver the workshop
specifically to AAA directors. The WFaPP group will be able to produce workshops around the
region to both service organizations and educational facilities as to ways they too can implement the
program using existing resources. We will also publish the results of the program in professional
journals in gerontology, nursing, therapeutic recreation, and exercise science and make presentations
at national conferences (e.g., Gerontology Society of America, American Society on Aging, Journal
of Gerontological Nursing, Western Institute of Nursing, Therapeutic Recreation Journal,National
Therapeutic Recreation Society, Journal of Physical Education, Recreation, and Dance, The
American Association of Health Physical Education Recreation, and Dance.). In addition. UNC
students will create a website describing the project with links from all the partners'
Work Plan—see attachment
Organizational Capability Statement
AAA
RSVP provides a variety of opportunities for individuals age 55 and over to participate more
fully in the life of the community through significant volunteer service. RSVP is characterized by its
flexibility to respond to the unique needs of the county, and strives to ensure that they identify the
needs of the county and coordinates those needs with the talents of senior volunteers. Locally
sponsored by the University of Northern Colorado, the program is funded by the Corporation for
19
National Service, and United Way of Weld County. In addition to matching volunteers with non-
profit and civic organizations in Weld County, RSVP administers several community service
programs for seniors, children, and disabled persons. Community service programs utilizing
volunteer talents provided by older adults through Weld County RSVP are the "America Reads"
reading program for elementary school students, a Grocery shopping service, handyman service,
income tax counseling, Medicare counseling, and supplemental food programs. There are currently
over 700 registered volunteers in the RSVP program of Weld County, serving over 50 non-profit
organizations. RSVP was named Weld County United Way Agency of the Year for 2002,
Weld County RSVP staff have established a pattern of working in partnership and/or
collaboration in aging-related activities at the University of Northern Colorado, as well as in aging
services organizations and other Human Service organizations in the county, and will be a trusted and
responsible source of referral and transportation for the falls prevention project.
As the CASP organization for this falls prevention project, RSVP is capable of being responsible for
coordination of services, identification of at-risk clients in need of intervention, working with other
agencies to identify at-risk clients, assist with transportation of clients for intervention services, assist
with social support needs of clients, and help organize the assessment/invention/evaluation activities.
UNC—HHS
The College of Health and Human Sciences is committed to providing health services and
support in the community through various programs and clinics. The College supports the
Community Certified Nurse Aid Training Program, a program that provides CNA training and
continuing education to nursing homes, the local hospital, and home health agencies. The College
also supports The Rocky Mountain Cancer Rehabilitation Institute that provides state and regional
cancer patients with a prescriptive rehabilitation program and provides a Speech and Audiology
Clinic. The creation of a fall prevention program is in keeping with the mission of the College. The
College will provide clinic space, clerical and computer support for this project.
20
The College of Health and Human Sciences houses health services faculty from a variety of
disciplines including Gerontology, Therapeutic Recreation, Sports and Exercise Science, and
Nursing. The interdisciplinary nature of the research team capitalizes on the expertise faculty have in
their various disciplines. Faculty from Gerontology are able to understand the social and
psychological needs of older people living in the community. Sports and Exercise Science faculty
are able to assess physical strength, endurance, balance, and gait and assign special exercise programs
to meet the individual needs of the older participants. Faculty from the Therapeutic Recreation
program are able to further assess the environments of individuals, and make comparisons between
environmental constraints and functional ability. The School of Nursing faculty are able to provide a
comprehensive physical/medical assessment and make recommendations to other health care
providers related to medication management and disease treatment as a means of decreasing fall
potential. Faculty will also be able to involve Gerontology, Therapeutic Recreation, Sports and
Exercise Science and Nursing students who will play a key role in the assessment and intervention
phases of this project and that are essential to the long-term adherence phase. Students from each of
the listed disciplines will participate and not only learn from the project but also provide an
invaluable service.
Vitae for Key project personnel—see attached
21
Work Plan — Interdisciplinary Community Fall Risk Prevention Program
Goal: The goal of this project is to enhance the physical and psychological coping skills of older adults through implementation of an
interdisciplinary fall prevention program.
Objectives & Key Tasks Lead Person C` ACJF ' h A f J ;3 .A S.
Measurable.Outcomes C .b_ e a e a p a :u. u. .u. e:.
t vc. n b. r i :y n. i gp
Key: PD=Project Director; PC=project coordinator; UNC=UNC Faculty; RNVA=CQI person
1. Reduce the total • Develop information management system for use with PD H4 H <a
number of falls for project
participants. • Schedule times for meetings among the partners and the PC H H 4-)
Outcomes: fall prevention team
• Falls reduced by at • Recruit participants PC <a <-3 H H 4-) H 4-) H H
least 40%in a sample • Recruit student participants for project UNC H 4-) 4-) H H H H H H
of 25 elderly adults by • Train students to work with older adults in performing UNC H H H H H 4-) 4-) H 4-3
the end of the first assessments and interventions
year of the project. • Reproduce assessment tools to be used. UNC H H H
• Falls reduction by at
least 50% in all • Perform initial assessment UNC H 4-) H H <->
participants by the end • Review criteria for establishment of different prescribed RVNA <a <-> 4-) *4 4->
of the project period. interventions
AND • Compile assessment data and whole team review of data. UNC <a 4-) H H 4->
2. Reduce the measured • Develop individualized prescriptive plan for each UNC <a 4-> H <-) 4->
fear of falling for participant along with participant&care provider, if
participants. appropriate. _
Outcomes • Establish regular team meeting times PC H H H H 4-)
• Aggregate measure of • Initiate educational, support,and focus groups UNC <a 4-) 4-) H H, H H <a 44
fear of falling • Initiate physical training sessions per prescription UNC <a H H <-) 4-> 4--> 4->i H <a
decreased by at least • Continue with assessments as planned UNC « +4 H,
40% in a sample of 25 • Forms audit,site visit,and discussions with participants to RVNA H 4-) 4--) H H H 4-> « 4->
elderly adults by the determine if evidence-based practices is being used
end of the first year of -
the project • Suggest environmental modifications to assist with fall UNC <> H 4-) H H H H 4-> H• Aggregate measure of prevention
fear of falling
decreased by at least
50% in all participants _
by the end of the
nroiect period.
Work Plan — Interdisciplinary Community Fall Risk Prevention Program
Goal: The goal of this project is to enhance the physical and psychological coping skills of older adults through implementation of an
interdisciplinary fall prevention program.
Objectives & Key Tasks Lead Person C I C J F h A N J J AS
Measurable Outcomes c o e a e a p a u u u e
t v c n b r , i yn I g p
project period.
3. Demonstrate improved ■ Schedule meeting times for participants for education, PC H H H 4-) 4-) H H H H
assessment measures social support, and focus groups
for efficacy, ■ Perform baseline assessment on participants UNC H H H H H H H H H
balance/mobility/stren • Perform follow up assessments UNC H H
gth/flexibility, • Discuss educational needs and social support needs in UNC H H H 4-) H H H 4-) H
nutrition,and social group meetings.
support • Train students to assist older participants with improving UNC H H 4-) H H H +3 4-) H
training and education
Outcomes • Foster development of support clusters within each of the UNC H H H H H H H H H
• Aggregate measures groups to assist with affective behavioral changes
for efficacy, ■ Develop reward or recognition system for program UNC
balance/mobility/stren y p g H 4-) H 4-) H H
participants
gth/flexibility, • Forms audit, site visit,and discussions with participants to RVNA H H H H H 4-) H H H
nutrition,and social determine if evidence-based practices is being used
support will improve • Com ile and analyze aggregate for re reporting at the end of PC
by 40%during the first year y p g H H
first year of the
project. -
■ Aggregate measures for efficacy,
balance/mobility/stren
gth/flexibility,
nutrition, and social
support will improve
by 60%over the
length of the project
Work Plan -- Interdisciplinary Community Fall Risk Prevention Program
•
Goal: The goal of this project is to enhance the physical and psychological coping skills of older adults through implementation of an
interdisciplinary fall prevention program.
Objectives& Key Tasks Lead Person C Pt C J F h A N .J J A S
Measurable Outcomes c C e. a e a _ p a u u u e
t v C n b r i y 'n . .l°: :g: p
4. Promote long-term • Goals for adherence established with participants PC i _ 4-> H 4-> H H H 4-) H 4-y
adherence of older • Give participants forms to keep daily record of activities UNC H H H H H H H H < 4
individuals to a and adherence to prescribed intervention—nutrition,
prescribed exercises,environmental changes,etc.
intervention program ■ Collect daily records from participants each month UNC < > H 4-) 4-) 4-) 4-) H H H1
Outcomes • Monitor &record attendance at educational, support and UNC H H H H H H 4-> H 4-)
• At least 50%of the focus group meeting by participants
participants will • Follow up with participants that miss two meetings to UNC H H H H H H H H H
adhere to their determine cause and possible remedy for attendance
prescribed program as • Changes made in prescribed intervention program made RVNA H H H H 4-) 4-) 4-) 4-) 4-)
measured at the end of based on adherence problems.
the first year. • Focus group discussion on adherence issues UNC 4-> 4-> H H H H H H H
• At least 60%of the • Evaluate experience with participants during Phase 2 to RVNA 4—) H He H H H H H
participants will determine effectiveness and their feelings about the
adhere to their project.
prescribed program • Follow up with all participants on a weekly basis to UNC 4—) 4—) H H H H H 4—> H
during the overall determine continued adherence to prescribed activities
project period. I through the Phase 3 period. I
• At least 70%of the .
participants will report • Collect post-program participation data and analyze PC H H H H H H H 4-> H
the experience with - ,
the nrnoram asa
I 1
U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES-ADMINISTRATION ON AGING OMB Approval No.0348-0044
PART III -BUDGET INFORMATION .
SECTION A-BUDGET SUMMARY
• Grant Program,
Function Federal Estimated Unobligated Funds New or Revised Budget
or Catalog No.
Activity Federal Non-Federal Federal Non-Federal Total
(a) (b) (c) (CO (e) ‘ (t? (g) -
1. $0.00 $0.00 $0.00 $0.00 $0.00
2. $0.00 $0.00 $0.00 $0.00 $0.00
3. $0.00 $0.00 $0.00 , $0.00 $0.00_
4. $0.00 $0.00 $0.00 $0.00 $0.00_
5. TOTALS $0.00 $0.00 168,396 66,291 234,687
SECTION B-BUDGET CATEGORIES
Weld Counter Area Agency on Aging
6. Object Class Categories -Grant Program,Function or Activity Total
(1) ; (2) (3) 14) (5)
a. Personnel 4 $0.00 24,744 $0.00 24,744
b. Fringe Benefits $0.00 $0.00 J 7,289 $0.00 7,289
c. Travel $0.00 $0.00 2,000 $0.00 2,000
d. Equipment $0.00 $0.00 $0.00 $0.00 $0.00
e. Supplies $0.00 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 119,341 66,291 185,632
f. Contractual*
_9. Construction $0.00 $0.00 $0.00 $0.00 $0.00
h. Other $0.00 $0.00 15,022 $0.00 15,022
i. Total Direct Charges $0.00 $0.00 $0.00 $0.00 $0.00
• j. Indirect Charges $0.00 $0.00 $0.00 $0.00 $0.00
k. TOTALS $0.00 $0.00 168,396 66,291 234,687
I. Program income
$0.00 I $0.00 1 $0.00 $0.00 $0.00
*see separate Section B Categories for detailed information Page 3
Authorized for Local Reproduction
Standard Form 424A(Rev. 7-97)
Previous Edition Usable Prescribed by OMB Circular A-102
SECTION B-BUDGET CATEGORIES .
University of Northern Colorado-College of Health and Human Sciences
6. Object Class Categories -Grant Program,Function or Activity Total
(1) (2) (3) (41 (5) .
a. Personnel $0.00 $0.00 90,803 22,526 113,329
b. Fringe Benefits $0.00 $0.00 10,603 1,240 11,843
c. Travel $0.00 $0.00- $0.00 $0.00 $0.00
d. Equipment $0.00 $0.00 $0.00 10,000 10,000
e. Supplies $0.00 $0.00 7,680 10,025 17,705,
f. Contractual $0.00 $0.00 $0.00 $0.00 $0.00
g. Construction $0.00 $0.00 $0.00 $0.00 $0.00
h. Other $0.00 $0.00 10,255 22,500 32,755
i. Total Direct Charges $0.00 $0.00 $0.00 $0.00 $0.00
j. Indirect Charges $0.00 $0.00 $0.00 $0.00 $0.00
k. TOTALS $0.00 $0.00 119,341 66,291 185,632
I. Program Income W $0.00 $0.00 $0.00 $0.00 $0.00
Page 3
Authorized for Local Reproduction
U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES-ADMINISTRATION ON AGING OMB Approval No 0348-0044
SECTION C-NON-FEDERAL RESOURCES
(a)Grant Program (b)APPLICANT (c)STATE (d)OTHER SOURCES (e)TOTALS
8. $0.00 $0.00 $0.00 $0.00
9. $0.00 " $0.00 $0.00 $0.00
10. $0.00 $0.00 $0.00 $0.00
11. $0.00 " $0.00 $0.00 $0.00
12.TOTALS $0.00 $0.00 66,291 66,291
SECTION D-FORECASTED CASH NEEDS
Total for 1s`Year 1s`Quarter 2n°Quarter 3"°Quarter 4th Quarter
13.Federal $0.00 $0.00 $0.00 $0.00 $0.00
14.Non-Federal $0.00 $0.00 _ $0.00 $0.001 $0.00
15. TOTAL $0.00 $0.00 __ $0.00 $0.00 $0.00
SECTION E-BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a)Grant Program FUTURE FUNDING PERIODS(YEARS)
•
(b)FIRST (c)SECOND (d)THIRD (e)FOURTH
16. $0.00 $0.00 $0.00 $0.00
' 17. $0.00 $0.00 $0.00 $0.00 "
-
18 $0.00 $0.00 $0.00 $0.00
19. $0.00 ' $0.00 $0.00 $0.00
20.TOTALS $0.00 175,132 182,137 $0.00
SECTION F-OTHER BUDGET INFORMATION
(Attach additional sheets if necessary
21 Direct Charges:
22. Indirect Charges:
23. Remarks:
PART IV PROGRAM NARRATIVE(Attach per instruction)
Page 4
Authorized for Local Reproduction Standard Form 424A(Rev.7-97)
Prescribed by OMB Circular A-102
Budget Justification —Year 1
•
Object Federal Funds Non- Non-Federal In- `I'ota! Justification
Class Federal Kind
Category Cash
Area Agency on Aging Personnel
Personnel $10,033 $10,033 Project Director Eva Jewell= .20 FTE @$50,167 yr=$10,033
Overall grant management and coordination
$11,621 $11,621 Financial Director,Marilyn Carlino= .20 FTE @$58,103 =
$11,621
Fiscal oversight,budget tracking,cost allocation and fiscal
reporting
$3,090 $3,090 Fiscal Technician= .10 FTE @$30,904=$3,090
Purchasing,Accounts Payable
Fringe $7,289 $7,289 Fringes on AAA Personnel @ 30%=$7,290
FICA (.0765%)=$1,892
Retirement(.06)=$1,485
Health/Dental(.15)=$3,712
Disability(.0039)=$96
Life(.000307%)=$8
Workers comp(.0039%)=$97
Travel $2,000 $2,000 Travel for meetings, follow-up training and monitoring
Other $15,022 $15,022 Overhead for noted staff.Includes operating, utilities, space costs,
etc based on allocation history=$8,782
RVNA Consultant by OT,PT or Skilled Nurse for Continuous
Quality Improvement and adherence to evidence based practice
80 hours @$78 per hour=$6,240
Contractual
University of Northern Colorado College of Health and Human Services.and RSVP
Personnel $30,000 $30,000 Project Coordinator Bernie Gorek .5 FTE @$60,000=$30,000
Organize partnership meetings with Project Director,participant
screening,coordinating referrals, conducting outreach;working
with project faculty to coordinate services provided to
participants, scheduling of group education, support,&focus
groups, coordinating with faculty and Project Director to assure
•
that equipment is located and purchased
•
$17,404 $6,526 $23,930 Nursing faculty Dr. Jan Martin
.2 FTE @$69,615 =$17,404
.1 FTE @ $69,615=$6,526 in-kind
Train students to conduct assessments; organize initial
assessments to be completed by nursing students, sports and
exercise science students, therapeutic recreation students and
gerontology students. Make decisions about the "prescriptive"
plan for participants; work with RVNA to monitor quality
assurance of interventions; Assist with planning focus group
meetings. Analyze data for program evaluation.
$11,333 $11,333 Sport and Exercise Science(SES)faculty Dr. Megan Babkes .2
FTE @$45,333 = $11,333
Organize physical training program and train and oversee SES
students and conduct follow up assessments/evaluation. Make
decisions about the "prescriptive" plan for participants. Plan
focus group meetings. Analyze data for program evaluation.
$11,333 $11,333 Gerontology faculty Dr. Susan Collins .2 FTE @ $45,333 =
$11,333
Organize and teach educational and support group sessions for
participants with assistance from gerontology,therapeutic
recreation, SES, and nursing students. Analyze data for program
evaluation.
$15,733 $15,733 Therapeutic Recreations faculty Dr. Marcia Carter .2 FTE @
$62,933 =$15,733
Organize, train and assign students to do home visits for
participants to assess environmental risks. Organize and teach
educational and support group sessions for participants with
assistance from gerontology, therapeutic recreation, SES, and
nursing students. Make decisions about the "prescriptive" plan
for participants. Analyze data for program evaluation.
Fringe $10,603 $1,240 $11,842 Fringes on UNC Personnel @ 19%- $10,603
$16,000 $16,000 RSVP Volunteers—
Assist with transportation and mailings
2 hours per day/5 days per week @ 40 weeks @$8.00 per hour
$5,000 $5,000 Graduate Assistant-assist in data collection, focus groups data
collection, follow-up calls with participants
.40 FTE=$5,000
Equipment $10,000 $10,000 Equipment being used—
Ambulatory Blood pressure monitor with software $5000
Universal Weight Machine $5,000
Supplies $7,680 $10,025 $17,705 Training Equipment
Walker belt 6 @$35 =$210
Exercise Balls 6 @$25 =$150
Balance Boards 6 @$75 =$450
Therabands 2 sets @$200=$400
Mats 6 @$375 =$2250
Minitramps 3 @$600=$1800
Fitness bar 6 @$130=$780
Foam Balls 10 @$10=$100
Steppers 6 @$65 =$390
Small weights 10 @$5 =$50
Foam Rollers 6 @$70=$420
Hand exercisers 6 @$10=$60
Exercise pulls 6 @$20=$120
Total$7180
Office supplies -
general supplies e.g.,pens,paper,etc. $500
Total S500
Physical Assessment Equipments—In-Kind
3 Blood pressure cuffs @$60=$1800
3 Stethoscopes @$25 =$75
Vision Screening equipment$150
Miscellaneous physical assessment equipment(e.g. tuning
forks, percussion hammers, etc.)_ $1000
Total=$3,025
Exercise Equipment— In-kind
Treadmills (2) =$4000
Free Weights $3000
Total $7,000
Construction NA
Other $7,000 $7,000 Copying-
Costs for advertisement, educational materials, brochures,
testing forms, assessment data, release of information, AAA
director's workshop materials. $7,000
Postage—
$1,000 $1,000 Mailing of brochures, reminder cards, special encouragement
notes, etc $1,000
$22,500 $22,500 Room costs—In-kind
Exercise room—($75 per day x 3days x 50 weeks)=$11,250
Classroom space for educational sessions- ($75 per day x 3days
x 50 weeks)= $11,250
$1,000 $1,000 Computer—$1,000
To be used for project coordinator; appointment scheduling,
$1,255 $1,255 data collection and analyses
Phone -$1,255 (set up,toll free number and monthly charges)
Total $168,396 $66,291 $234,687
Direct
Charges
Indirect *The Weld County Area Agency on Agency does not have a
Charges previously agreed upon indirect rate, and overhead costs appear
earlier in the budget
Totals $168,396 $66,291 $234,687
MEMORANDUM
rstk;
DATE: August 13, 2003
ITO: David E. Long, Chair, Weld County Board of Commissioner
C. FROM: Walter Speckman, Executive Director, Division of Human
COLORADO
services
SUBJECT: Federal Grant Application for: A Community
Program to Prevent Falls Among Older Adults
Enclosed for Board approval is a federal grant proposal to the U.S. Department of Health and
Human Services, Administration on Aging.
The Weld County Area Agency on Aging, in partnership with the University of Northern Colorado
and other key community senior serving agencies, proposes to summit a grant application to U. S
Department of Health and Human Services, Administration on Aging. This grant, if funded, will
allow the development and implementation of a interdisciplinary fall prevent program that will target
older adults who have demonstrated a high risk for falls or have significant restrictions due to their
fear of falling. If successful this would greatly reduce the cost for ambulance/hospital/nursing home
and other services that fall victims would require. The project will start (if awarded) on October 1,
2003 with a proposed budget of$168,396 per year.
If you have additional questions, please contact Eva Jewell, Director Weld County Area Agency on
Aging at 353-3800, extension 3331.
2003-2388
Hello