Expert Consulting

Capabilities Summary

Memory Preservation Nutrition® program, Healthy Lifestyle Coaching and Consulting, Healthy Aging, Groundbreaking Alzheimer’s Studies, Multi-cultural Health Initiatives, Care Work, & Aging Policy Research
HealthCare Insights, LLC, is an organization dedicated to research and educational efforts designed to (1) improve the life and well being of persons with Alzheimer’s disease and their family and professional care partners and (2) end health care disparities in the US and elsewhere, especially as it pertains to Alzheimer’s disease and related health care concerns (3) improving the overall health and wellbeing of seniors and specifically reducing their risk of Alzheimer’s disease and other brain problems.

Health Care Insights, LLC offers consulting and other services consistent with these objectives. Services include:

• Assist residences and facilities in adjusting nutritional programs for older adults and those with Alzheimer’s disease to be “brain healthy” utilizing the principles of our “Memory Preservation Nutrition”® and “Nutritional Intervention for Persons with Early Alzheimer’s”©
• Presentations and Workshops to education clinicians, staff, families and community publics about “Healthy Lifestyles for a Healthy Brain” and “Nutrition for Healthy Brain”
• Design and conduct program evaluations of nutrition, exercise, cognitive stimulation and other healthy lifestyle or caregiver support programs for older adults as well as persons with memory or cognitive impairment or diagnosis of dementia; write evaluation reports.
• Planning or recruitment/coordinator of faculty for symposia or conferences related to Alzheimer’s disease, family caregiving or other topics related to aging.
• Design and conduct of clinical trials with older adults, persons with Alzheimer’s disease, family care partners and professional care givers
• Design and conduct of policy studies
• Design, development and delivery or participation in educational programs
• Design and conduct or oversight for, scientific and evaluative surveys, instruments or questionnaires.
• Writing proposals for community based organizations and other individuals and organizations. Specialties include caregiving, exercise and other lifestyle programs for seniors, programs or studies related to Alzheimer’s disease, and mental health concerns of seniors.
• Funding or co-funding high risk start-up efforts in AD treatment, prevention and decreasing health care disparities.

Educational topics for which HCI has expertise include

• Brain Healthy Nutrition and Lifestyles, evidence based.
• Alzheimer’s disease and other memory loss concerns (what’s normal, what’s not)
• Caregiving
• Potential role of social workers in primary care including helping seniors initiate and maintain behavioral changes in lifestyle to prevent or slow progression of chronic illnesses
• Diversifying services, reducing health care disparities,
  Nutrition/exercise/stress management and other lifestyle initiatives to improve health and reduce risk, of chronic diseases
• Research findings about cognitive rehabilitation and mental stimulation exercises for both well adults and persons with memory loss, mild cognitive impairment or Alzheimer’s disease.
• Complementary and alternative medicine, especially with persons with AD or their family care partners

Recent clients include Assisted Living facilities, Manor Care in Detroit Michigan, Sunrise Assisted Living, The Atrium, McLean Hospital, several Alzheimer’s Partnerships in Massachusetts, Massachusetts Councils on Aging, Abbington Hospital, Philadelphia, PA, Alzheimer’s Associations headquartered in Dayton, Ohio, Lincoln, Nebraska, Indianapolis, Indiana; Alzheimer’s Disease International, Rogerson Communities, the Greater Boston Chinese Golden Age Center, the Rothschild Foundation, and the Alzheimer’s Disease Centers at the University of Arkansas and at Boston University, HealthVISION and AGES Health Care Services. Pro bono clients include “Put a Swing into Your Life” and Robert Wood Johnson funded exercise and nutrition programs serving African American and Latino seniors sponsored by the Boston Housing Authority, and the Retirement Research Foundation.

BELOW ARE A FEW EXAMPLES OF THE SUCCESSFUL WORK UNDERTAKEN BY Nancy Emerson Lombardo, Ph.D. and her TEAM OF MULTI-DISCIPLINARY PROFESSIONALS.

THE BEST Cognitive Rehabilitation Intervention

The Kenneth Haas Memorial Foundation  funded the Brain Enhancement Strengthening Treatment study conducted at Boston University School of Medicine and the Veterans Administration Medical Center in Bedford, MA. The Brain Enhancement Strengthening Treatment (BEST) study was a prospective pilot randomized controlled trial of a 26 week innovative cognitive rehabilitation intervention program for persons with early stage Alzheimer’s disease who have MMSE scores of 20 and above, at least two years of college education and live with a caregiver willing to be their study partner. The program consisted of cognitive/memory activities and teaching strategies for re-engaging in social situations in conjunction with standard treatment medication. The outcomes evaluated include memory, cognition, social functioning and mood. The central hypothesis is that the intervention will improve functioning or slow rate of decline in these areas.  (For results of this study, see Alzheimer’s Studies on this website.  For additional information and more recent results of research studies conducted on a group version of The Serper Method  in Chicago and Nashville, TN,   go to http://www.serpermethod.com )

Alzheimer’s and Memory Preservation and Nutrition Program

Evidence is mounting each year that modifiable life style elements, such as nutrition, exercise, and cognitive activities, may mitigate the risk of Alzheimer’s disease. AD is increasingly viewed as a chronic disease with environmental as well as genetic risk factors that may be responsive to integrated approaches found successful in treating heart disease, stroke and diabetes. Recent epidemiological and animal studies suggest that diet may help prevent or delay manifestation of AD. Inferentially, diet may also slow cognitive decline of persons in the early stages of AD. Various studies suggest that dietary constituents which may be beneficial or protective include foods rich in omega 3 fatty acids, anti-oxidants, folic acid, B vitamins as well as certain other foods including those with anti-inflammatory properties. HCI offers three hypotheses about the Memory Preservation Nutrition® (MPN®) program.: (1) The Memory Preservation Nutrition® (MPN®) program improves cognition of persons with early stage AD, or slows the rate of cognitive decline, or as measured by the ADAS-cog the primary outcome measure for proposed studies. (2) MPN® achieves its effects in part through the mechanism of reducing oxidative stress and inflammation, (3) MPN® program will improve, or prevent/slow a worsening of behavioral symptoms of dementia, and will improve or prevent/slow a decline in quality of life. Behavioral symptoms and quality of life will be as measured by the Neuro Psychiatric Inventory, and the Quality of Life in Alzheimer’s disease: Patient and Caregiver Report (QOL-AD). We have proposed a randomized clinical trial to test hypotheses one, two and three to determine efficacy of a nutritional intervention for persons with early stage AD. The treatment intervention is comprised by the MPN® nutrition protocol and a coaching protocol to encourage dietary behavioral change and maintenance. The diet includes food rich in B vitamins, vitamin C & E and omega 3 fatty acids; juices, nuts, fruits and vegetables plus multivitamin supplement daily. Regular coaching from a nutritionist/trainer who works both with the person with AD and with their co-residing study partner in individual and group settings to reinforce long-term adoption of successful diet strategies. Clinical Relevance. People with Alzheimer’s disease, their families, and their health care providers, are eager to have safe options for slowing progression of this disease. The proposed diet is based on strong evidence that it might be helpful to brain health and already proven to be helpful in preventing or slowing progression of other major chronic diseases such as CVD, stroke and diabetes. Extrinsic Significance If the Memory Preservation Nutrition® program can delay progression by a few months or years, not only will considerable dollars be saved but also the quality of life of both the person with Alzheimer’s disease and the care partner will be improved. Knowledge gained from this trial of a nutritional intervention for AD may be helpful in planning future prevention oriented clinical trials for persons with mild cognitive impairment (MCI) as well as cognitively intact adults to reduce their risk of developing symptomatic AD.

Policy Research on Achieving Mental Health of Nursing Home Residents

HCI Principal led grants from AARP and NIH to first, determine the availability of, need for, and barriers to obtaining mental health services for nursing home residents, and second to create a consensus conference comprised of all the key stake holders and produced a policy brief summarizing the reality and consensus recommendations of steps needed to rectify the situation and promote mental health of nursing home residents.

Policy Research on In-Home Skills Training, Counseling and Support System Building Interventions for Dementia Caregivers

HCI had co-funded with Retirement Research Foundation and the Helen Bader Foundation and Wellesley College a national study of intervention programs for AD caregivers. To conduct a systematic description and analysis of existing research and clinical/agency programs which include skills training, counseling and support-system building components and include the home as a site of service, examining outcomes reported, and develop programmatic, policy and research recommendations. The Helen Bader study will expand the investigation to include group interventions.

Using State of the Art Technology to Assist AD Caregivers

Nancy Emerson Lombardo, Ph.D. served as evaluation Co-Investigator for HealthVISION’s NIH SBIR funded ACISS study, a controlled Trial of a computerized support program “An Electronic Community for Alzheimer’s Caregivers” offering dementia patient caregivers, with limited outside assistance, access to web information/ education, skills training, behavior management tools, and videoconferencing support links to the Alzheimer’s Association, peer mentors, and other caregivers. Patients and caregivers were supported by a web-based patient medical management system.

Complementary and Alternative Medicine

Nancy Emerson Lombardo,  Ph.D., as Principal Investigator,  conducted the first two clinical trials in the U.S. of acupuncture to treat persons with AD and dementia for depression and anxiety. The first was an uncontrolled trial with 11 persons which demonstrated highly significant results in reducing anxiety. The second was a small pilot randomized controlled trial. The overall purpose of this small pilotwa s to explore the effectiveness in a 13-week trial as a treatment for persons in the early or middle stages of Alzheimer’s or a vascular dementia as compared to standard treatment controls.

“Recognizing and Preventing Elder Abuse in the Chinese Community” and “Improving Mental Health”.

Nancy Emerson Lombardo,  Ph.D.,  served as proposal writer, co-investigator to help organize the educational program and the program evaluation. The objective for Year 1 was to train supervisory staff and create ongoing training resources, identify strategies for community outreach. Wellesley team helped create, implement, and evaluate the training program. Year 2 will focus on community outreach, services to direct care staff, and planning services to vulnerable elders. Sub-contractor on second grant Nov 1 2001 from NEMC to GBCGAC to focus more broadly on mental health issues affecting Chinese American elders in the Boston area.

The Chinese Dementia Awareness and Intervention Project

The Chinese Dementia Awareness and Intervention Project, now complete, accomplished many tasks. It implemented a “train-the-trainer” Chinese Dementia Specialist Education Program (CDSEP), which trained 16 people from various agencies to become bilingual Dementia Specialists. As Dementia Specialists, they were trained to conduct presentations and in-services to share their skills with other families. Within ten months of completing the training program, CDSEP graduates helped over 70 families and participated in 76 workshops, presentations, or formal and informal discussions, reaching over 300 individuals.
A Chinese language dementia telephone Helpline for family and paid caregivers was created. The Helpline offers an immediate solution to people who need information about the process, treatments, and services associated with dementia. We estimate that 40-50 families were helped each year. The issues addressed ranged from home safety concerns to behavior counseling. To further educate the public and to publicize the Helpline, we expanded outreach efforts including radio programs, lectures and workshops on dementia and brain wellness. The team developed and distributed a bilingual Chinese-English brochure on signs and symptoms of dementia and compiled three libraries in GBCGAC branch offices of Chinese language materials on dementia and aging from around the world. The project further created a program of individualized family caregiver interventions. A trained Chinese-speaking social worker made home visits to help teach families skills for caring for their elders who have dementia as well as to offer them information about caregiving options and assistance in securing supportive services. She also offered counseling and emotional support as needed.
Through this project, we were able to identify and successfully serve a group of caregivers and persons with dementia, which probably would not have been identified and served in the main stream service system. The picture our report presents can provide valuable information for policy makers to acknowledge and extend services to underserved minorities, especially non English-speaking populations.

Empowering African Americans to take Leadership in Raising Awareness about Memory Loss and Alzheimer’s disease, and Needs for Diagnosis, Treatment and Participating in Research

Health Care Insights has helped fund the BUADC’s efforts to go beyond recruitment and retention of African Americans in Alzheimer’s disease research. We brought together the CRITICAL MASS of African American leaders of community based organizations and other interested and well connected individuals, including a passionate family member. As a result, African Americans were empowered to take the lead in raising people’s awareness about memory loss and Alzheimer’s disease, and the need for diagnosis, treatment, seeking support and participating in research.

Boston Minority Dementia Outreach and Educational Program

The Black American population of persons over 65 is purported to be growing even faster than the White population in this age group. This suggests that there will be a larger population of Black Americans at risk for Alzheimer’s disease and related dementia (ADRD) in the coming decades. Cultural barriers in Black and White American communities limit knowledge about diagnostic, treatment and supportive services for ADRD. In the early years of our work with minority neighborhoods in Boston, we found, contrary to expectations, which many Black American families and non-clinically oriented professionals did know about dementia and Alzheimer’s disease. Many, however, did not comprehend the impact of having dementia and lacked information on the wealth of non-medical or clinical treatment methods developed over the past 15 years. They also were unfamiliar with available diagnostic and supportive services. In addition, there was a relative dearth of:

• services for persons with dementia in or close to minority neighborhoods
• trained dementia specialists in community-based agencies to deliver services to minority persons with dementia and their caregivers

This suggested an absence of established channels of information flow and training and educational opportunities between mainstream researchers and agencies, and minority-led agencies and individuals.
The Boston Minority Dementia Outreach and Educational Program (BMDOEP) was a 7-year program providing ongoing education and outreach efforts to respond to the unmet needs of professionals and family caregivers of minority elderly patients with Alzheimer’s disease and related dementias (ADRD). Our multi-pronged approach borrowed heavily from public health methods to meet these needs and to overcome potential barriers. Directed by Nancy Emerson Lombardo, Ph.D., and funded primarily by the National Institute on Aging (NIA), the entire program was designed to suit the cultural styles of the targeted community of Black Americans*. Inherent in the program strategy was the belief that successful outreach and education of minority individuals begins with careful needs assessment, community organization, staff education, and targeted outreach. There were three elements to the intervention: community outreach, caregiver training, and training health and social service staff. The Alzheimer’s Association assumed the role of principal partner on this project, with more than 30 other collaborators contributing to its successful implementation. The underlying goal was to improve the infrastructure and system of service for minority persons dealing with ADRD.

Care Work in Eldercare

We are in the midst of a care giving crisis in the United States. The number of elders requiring assistance with daily activities (dressing, bathing, toileting, etc.) has increased dramatically over the last 20 years and is expected to skyrocket by the year 2030 when the baby boom generation hits its eighth decade.

Care Work staff is disproportionately minority, is poorly paid, is unlikely to receive benefits unless within a hospital setting, and suffers from our society’s attitude that devalues care giving. Care work is primarily women’s work (approximately 88%). Yet women today are provided with such an array of employment choices that many ignore this profession because of its lack of fiscal rewards and job satisfaction. Care workers regularly suffer from stress, lack of adequate training, and they perform tasks such as heavy lifting that endangers their own health.

Health Care Insights and its principals are among those advocating for a societal shift to improve the conditions for care workers and for recipients of long term care. By introducing a culture shift based on respect, team support, and fiscal commitment, culture change advocates hope to create a new paradigm for delivery of care giving services. Workers need more training, safer work environments, and access to managers for support, feedback, and involvement in decision making. Ultimately, workers will feel better about their work, their role, and their skills and will provide better services to people in long term care, who are equally as disenfranchised in today’s system.

Culture Change is a Major Part of the Solution to Current and Impending Staffing Crises in Long Term Care, and Key to Mental Health of Seniors in Long Term Care

The culture change movement can also be seen as the natural evolution of the aftermath of the nursing home reform movement when reformers realized that despite all the successes (and frustrations) of the nursing home reform effort, key changes could not be made in the nursing home or in other areas of long term care and aging services without a bottom up and top down change. A change was needed in the way elders and people taking care of elders are regarded and valued by the organizations “serving” them and in a larger sense, by American society. Pioneer principals are strengthened and supported by the combined wisdom of the last three decades of research on long term care staffing and organizational issues, including recruitment and retention issues, and research about what long term clients (and staff) want and are not getting.

For instance staffing research shows that some care workers stay in the work despite it’s being devalued and underpaid because of the meaningfulness of relationships with clients (e.g. Drebing et al, forthcoming) and this is one reason permanent assignments (of same staff to same clients) are so desirable. Other research shows that clients crave better relationships with staff and fellow residents. Teitelbaum, 1995, found that residents want meaningful activities & relationships, to be useful, feel needed and for staff to treat them as adult human beings, and as potential friends rather than as objects, children, or tasks. Still other research shows that staff enjoys and stay with their jobs longer when treated with respect by their supervisors, when given proper training, and when expected to participate in care planning and decision-making. Great strides have been made in understanding the roles and interplay in physical, psychosocial and organizational environments as well as the importance of spirituality and meaning in maintaining health and quality of life. Furthermore, leading geriatric mental health interventionists have begun to realize that their proven innovations cannot be implemented in organizations of turmoil and constant staff turnover. (Emerson Lombardo, AAGP Conference on Mental Health in Long Term Care, June 2000) And finally, aging researchers and providers have been asking, “what do we want for ourselves.” All of these answers point toward culture change. Moreover, the sheer numbers of the baby boomers, together with the baby bust of the 70′s means that our current staffing crises are minute compared to what we will face in the future. A major demographic crunch is coming from too few paid and family caregivers to provide care for increasing numbers of frail elders. U.S. women ages 25-54 have provided most of paid long-term care in nursing homes and in home health care (as well as teaching and care of the nation’s children). The ratio of women ages 25-54, to people (men and women) over the age of 85, was 54 to 1 in 1950, 13 to1 in 2001, and is predicted to be less than 4 to 1 in 2050. (Emerson Lombardo and L’Heureux, August 2001) Changes of all sorts are needed to meet the current and impending care work crisis and to improve the quality of life for elders and their caregivers, including culture change and the attendant improvement in status, power, training, career ladders, pay and benefits of direct care workers—which will help attract more people into the work. More young old (65-80) may have to be recruited, trained & supported to care for “old, old” (80-100), and men will need to take on more caregiving roles. Thus models of care HAVE to change to accommodate all of the labor force realities. Moreover, serious public support is needed for families to be able to continue help care for their elders. (Emerson Lombardo August 2001).