The document discusses a Strength, Mobility, and Balance (SMB) program designed to improve physical activity and reduce falls in senior living residents. Data shows the SMB program significantly improved residents' ability to stand up from a seated position, walk, and maintain balance. It reduced falls and hospitalizations. A new Fox Optimal Living program aims to further advance wellness through individualized plans and more data collection. The program seeks to shift senior living culture towards prevention and higher functioning to benefit residents and healthcare providers.

1. MEDICAL VS. FUNCTIONAL WELLNESS WHITE PAPER
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By Andre Gomez, PT, DPT and Ben Figueroa, MSc SMB-Program Manager
Fox Better Living Strength, Mobility, & Balance
Program an Evidenced Based Approach To
Reducing Incidence of Falls in Senior Living
Residents
Author Affiliations
1. Andre Gomez (andre.gomez@foxrehab.org) is the Director of Senior Living Operationsat FOX Rehabilitation in CherryHill, NJ.
2. Ben Figueroa (ben.figueroa@foxrehab.org)is a Senior Exercise Physiologist/Program Manager at FOX Rehabilitation in CherryHill, NJ.
Abstract. The Strength, Mobility, & Balance (SMB) Program is a structured, dynamic, and progressive
wellness program designed to address the physical activity level needs of residents within Assisted &
Independent Living Communities. The SMB program offers a proactive approach to improving strength,
mobility, and balance deficits using evidence-based, objective assessment tools. These deficits have a
strong correlation to incidence of falls. Collaborative strength, mobility, and balance plans of care are
designed by the health care team and implemented for each resident. The SMB program was launched
in 2010 from Fox regional HQ in New Jersey. From its inception to the present time, the SMB program
has consistently evolved in order to provide the best possible outcomes to our partner communities
along with foreseeing healthcare industry trends. The next step to truly address the fluid needs of our
partner communities has been developed and this enhanced program is known as The Fox Optimal
Living (FOL) Program. The Fox Optimal Living Program will shift healthcare culture from antiquated
“correction” to innovative “prevention.” By preemptively addressing risk factors, Senior Living residents
will demonstrate an increased quality of life and decreased recidivism. All residents will function at a
higher level and the costly effects of falls and medical intervention for those with chronic sedentary
lifestyles will be greatly reduced. The US Healthcare system ranks 37th in the world for quality, yet
endures the highest cost per patient. While 72% of diseases are preventable, we continue to allocate
only 3% of our healthcare budget to prevention. Proactive rehabilitation delivers a higher level of care
by emphasizing the importance of wellness and prevention. It is a market innovation that serves the
interests of both consumers (Senior Living Residents) and suppliers (healthcare providers). The Fox
Optimal Living Program will enable us to apply this proactive model to geriatric rehabilitation and
redefine wellness in the Senior Living industry. Evidence-based, individualized wellness plans, carried
out by clinical experts will allow patients to achieve optimal health, beyond that defined by any
insurance company. The culture of our older adult demographic will be one of vibrancy, vigor, and
vitality. Fox Optimal Living will appropriately position all Senior Living communities in a progressive
Post-Acute Care Continuum designed to meet all needs of current and prospective residents. For
years, we have prided ourselves on delivering excellence in our nursing and support services. The
miracles of science and technology in healthcare have afforded us many benefits, such as the
remarkable advances in modern medicine. Few recognize that just as remarkable advances also exist
in modern rehabilitation. In order to be truly well, Senior Living must focus on functional wellness just
as urgently as the medical wellness of their residents. The Fox Optimal Living Program will form a
synergistic relationship between nursing and rehabilitation teams that will be revolutionary and
imperative to all Senior
Living residents.

2. MEDICAL VS. FUNCTIONAL WELLNESS WHITE PAPER
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he Strength, Mobility, & Balance (SMB) Program
data analysis within this paper was done to
understand the effectiveness of SMB since its
inception across all communities that have had SMB
for at least 4 months from 2010 to May of 2013. The
collective average for various markers was analyzed.
SMB FOM values for (n=751) individuals displayed
positive gains: Sit to Stand scores increased by
38.7%; Timed Up and Go scores decreased by 16.6%;
Functional Reach scores increased by 16.4%. Fall and
hospitalization rates also displayed positive gains;
Average Yearly Fall Rate (AYFR) decreased against
Average Monthly Fall Rate by 23.8%; Average Yearly
Chronic Faller Rate (AVYCF) decreased against
Average Monthly Chronic Faller Rate by 33.3%. The
Yearly Average Hospitalization Rate (YAHR)
decreased by 30.7%, when compared against the
Average Monthly Hospitalization Rate.
Data Results
1. SMB Data Values:
A) The values in this paper represent (n=751)
individuals who completed at least (1) cycle of SMB
during 2010-May of 2013. The original (n) value in the
range of (n=800), but individuals were excluded due to
low FOM Pre & Post values along with not completing
a full (12) week cycle of SMB.
B) Length of Stay- Up to the present time, we have
only been formally collecting data for the first cycle of
SMB. However, moving forward we will collect data for
multiple cycles of SMB. We do have data on
individuals who completed (3-10) cycles of SMB
spread across the team’s cumulative data, and based
off these values; (4-5) cycles of SMB is the mode. We
have an 89.33% average attendance rate for SMB
(2010-2013): AVG=21.44 SMB classes attended out of
(24). More effective communication and collaboration
with the local Activities Department teams will improve
participation in the future and has been implemented.
C) A large contributing factor in the success of SMB
FOM values is that the Exercise Physiologist can
control who participates in the program based on the
specific parameter set forth. Several communities
have throughout the years pressured various EPs to
“allow” any one or very low-level residents into the
standard SMB Program. Dilution of the SMB class
population will ultimately affect all collective FOM
values hence stratification was employed to meet the
needs of the “whole” community via numerous options
and the development of Fox Optimal Living.
Successful Aging
Discussion
One of the more common distribution-based change
indexes is the minimal detectable change (MDC), also
called the reliable change index. The MDC is
T

3. MEDICAL VS. FUNCTIONAL WELLNESS WHITE PAPER
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considered the minimal amount of change that is not
likely to be due to chance variation in measurement
and translates to significant improvement in function.
This is the minimal amount of change in an FOM
score to show confidently that it occurred due to
provider treatment. Respectively, for the Sit to Stand
(S/S) test the MDC is 3.3 reps, for the Timed Up and
Go (TUG) test the MDC is 2.5 seconds, and for the
Functional Reach (FR) Test the MDC is 4cm. All data
presented in this analysis exceeded the MDC for all
FOM values. It is evident that the SMB program was
able to positively affect the physical activity levels of
the (n=751) participants relative to the Functional
Outcome Measures they were tested against. The
largest achievement occurred with the Sit to Stand
(S/S) Test with an increase of 38.77% when
comparing pre-SMB scores cumulative average
scores to post-SMB cumulative average scores. Note
that a full cycle of SMB is comprised of 12 continuous
weeks of SMB, delivered twice a week within the
specified weeks. Therefore a full SMB cycle has 24
SMB classes within its 12-week macro-cycle. The
Timed Up & Go (TUG) Test and the Functional Reach
(FR) Test also displayed positive results when
comparing pre and post-SMB cumulative average
values. The TUG scores increased by 16.68% and the
FR scored decreased by 16.41%. For the TUG Test, a
decrease in time is associated with increased lower
body strength, gait speed, and improved functional
mobility. Fall rate values were also influenced by the
SMB program but these values had extrinsic variables
which the Fox clinical team and or the local Exercise
Physiologist could not always address. Specifically if
the partner community had fragmented data, poor fall
tracking, and a lack of or unwillingness to adopt SMB
program wellness/rehabilitation recommendations
then the ability for the SMB program to adequately
influence fall variables was suppressed.
Conclusion
Since the SMB Program’s inception, it has been an
effective tool in addressing the physical activity needs
of participating residents living within a spectrum of
Assisted Living & Independent Living Communities.
The largest contributing factor to the success rate of
the SMB program across multiple variables measured
is the participation levels of the partnering
communities. If the community was open and
receptive as well as willing to adhere to SMB
recommendations along with allowing the operating
Exercise Physiologist access to accurate fall records,
effective management of extensive variables was
possible. However, if a community was resistant to
cooperate with the Fox regional team and/or Exercise
Physiologist more modest gains were associated with
those particular communities across a host of
variables. If allowed to operate within a constructive
and open dialogue environment the SMB program can
be an effective tool in promoting the overall well-being
of the residents of the partnered community. With the
evidence indicated, the FOL program is an evolved
and further enhanced wellness program designed to
deliver boutique and individualized level services to
the partnering community and for every resident. As
such the FOL program is more labor intensive relative
to data collection, analysis, and extrapolation. Due to
the structure of the FOL program, it has the real
potential to set new precedents within structured
wellness programming and achieve detailed
community specific goals. Specifically the FOL
program through its higher level of data collection and
analysis will record multiple quality of care variables,
and more paramount increased life expectancy via the
application of the FOL program. This has extensive
Return on Investment (ROI) benefits for both parties
relative to producing new geriatric research and viable
business operations modeling in order to meet the
challenges of the current Healthcare & Senior Living
Industries. The application and installment of the FOL
program with a partnering community can be
facilitated in a timely and organized manner ensuring
transparency and variable specific reporting done on a
timeframe that is mutually agreed upon. This model
has been initiated in 2 Senior Living Communities and
data collection has begun. The preliminary results
have shown community wide fall reduction and
decreased hospital recidivism of over 70%, as well as
increased community satisfaction of over 95% and
additional lower extremity strength gains in some
cases of over 400%.
NOTES
ABOUT THE AUTHORS: ANDRE GOMEZ & BEN
FIGUEROA