Hospital Elder Life Program (HELP)

Hospital Elder Life Program (HELP)
Yale University School of Medicine
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Product ID: 20712

Abstract: 

DELIRIUM PREVENTION:  THE HOSPITAL ELDER LIFE PROGRAM (HELP)

These materials provide background, organizational, and training materials that will allow you to set up a Hospital Elder Life Program at your institution. This is an innovative model of care designed to prevent delirium and functional decline, and is available for your use free of charge. Setting up a HELP program is not a small undertaking, and will require considerable commitment on your part.  We hope these materials will help you on your journey. 

Sharon K. Inouye, MD, MPH

Documents associated with this product:

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URL where the product can be viewed: 
http://www.hospitalelderlifeprogram.org
Product Viewing Instructions: 
You will need to register for an account and fill out a brief questionnaire before gaining access to the materials.
Educational objectives: 

Background on Delirium:  

Delirium, an acute decline in attention and cognition, is a common, life-threatening, and potentially preventable clinical syndrome in older persons.  The development of delirium often initiates a cascade of events culminating in loss of independence, increased morbidity and mortality, and accelerated health care costs.  Delirium in older hospitalized patients has assumed particular importance because patients age > 65 years currently account for more than 49% of all days of hospital care.  We estimate that delirium complicates hospital stays for at least 20% of the 12.5 million persons age ≥ 65 years hospitalized each year, and increases hospital costs by $2,500 per patient, an amount that extrapolates to over $6.9 billion (2004 USD) of Medicare hospital expenditures attributable to delirium.  Substantial additional costs accrue after hospital discharge because of the need for institutionalization, rehabilitation services, formal home health care, and informal caregiving.  These figures underscore the vast clinical and health policy implications of delirium (Inouye SK, NEJM  2006;354:1157-65).  Moreover, with the aging of the U.S. population, delirium is a problem that is likely to increase in the future.  Finding ways to prevent delirium, such as the Hospital Elder Life Program (HELP) program, will allow us to improve quality of life and healthcare for these vulnerable patients. 

The Hospital Elder Life Program: 

The Hospital Elder Life Program (HELP) is an innovative model of care, designed to prevent delirium and functional decline in hospitalized older persons (Inouye SKNEJM 1999;340:669-76; JAGS 2000; 48:1697-706; JAGS  2006;54:1492-9).  The program trains skilled interdisciplinary staff and volunteers to carry out intervention protocols targeted toward six delirium risk factors: orientation, therapeutic activities, early mobilization, vision and hearing protocols, oral volume repletion, and sleep enhancement.  The program is designed to be superimposed on existing hospital units, and does not require a separate, dedicated geriatric unit.  HELP has been demonstrated to be effective for prevention of delirium, as well as for prevention of cognitive and functional decline. Cost-effectiveness has been demonstrated previously for both acute hospital costs (Rizzo JAMed Care. 2001;39:740-52; Leslie DL JAGS 2005; 53:405-9) and for long-term nursing home placement costs.  In addition, cost savings of over $1.25 million per year (on one hospital unit) were demonstrated at a U.S. hospital where HELP was established (Rubin FH JAGS2006;54:969-74)and in Australia in a capitated system (Caplan GA. Int Med J 2007; 37:95–100).  These cost savings were attributed to a shorter length of stay and reduction in variable costs of over 50%.   Finally, the HELP model is effective for prevention of falls, pressure sores, and other iatrogenic complications of hospitalization (Bradley EH.Journal of Healthcare Management 2006; 51:323-37).  The unique strengths of the HELP model, which contribute to its effectiveness, include the targeted nature of the interventions, early intervention focusing on prevention, well-trained staff dedicated to the program, standardized intervention protocols, tracking of adherence to all protocols, and built-in quality assurance procedures.  As of 2010, the program has been disseminated to over 64 hospitals in the U.S., Canada, United Kingdom, Australia, Netherlands, Singapore and Taiwan. 

Importantly, the Hospital Elder Life Program has been successful at returning older adults to their homes or previous living situations with maintained or improved ability to function, and results in a high degree of satisfaction with care. 

Additional information/Special implementation requirements or guidelines: 

Program Materials

You will find on this website the manuals and DVD which are designed to help you implement the HELP model of care.  There are other tools/materials presented that are available on the HELP website (hospitalelderlifeprogram.org). To access these materials on the HELP website you will have to create a user account. Once you do so you can go to the link on the left side of the page labeled "Program Materials". To assure program effectiveness, we hope that you will implement this model carefully and with close fidelity to the original model.  

Business Tools (HELP Website)

The first step for successful implementation of the Hospital Elder Life Program is to convince key decision-makers at your organization of its value. This involves putting yourself in the position of these decision-makers and providing convincing arguments for the program. HELP is demonstrably effective in preventing delirium but "selling" your administration on the program involves translating this improvement in the quality of care into measures that are meaningful to decision-makers—measure such as reductions in length of stay or in re-hospitalizations. 

The HELP Business Tools provide you with what you need to build support for HELP in your organization. Included in this resource are:

  • A Power Point presentation that you can use in your hospital
  • A questionnaire designed to help you collect relevant data about patient demographics and hospital utilization that will help you design a program with maximum impact
  • A set of excel worksheet tools

Manuals

There are 4 Hospital Elder Life Program Manuals included here. We have provided capsule descriptions of each below.

The Organizational and Procedural Manual (Overview and Structure) provides a comprehensive administrative overview of the program. The manual covers: program goals; establishing facility support; setting up the program; administrative structure; quality assurance procedures; strategies to improve adherence; and the volunteer component. 

The Organizational and Procedural Manual (The Clinical Process) contains a detailed overview of the clinical components of HELP as they relate to older people. Sections are arranged chronologically (in order of how procedures would be applied in the hospitalization of an individual patient). The sections include: the screening and enrollment process, the interventions, and discharge and post-discharge procedures. Interventions are organized by the personnel involved (volunteer, geriatric nursing and interdisciplinary). Also included are educational interventions to improve geriatric expertise and references.

The Database Manual provides all of the assessments and data collection forms required for the program. Sample forms and worksheets are provided for all members of the HELP team.  This paper-based system will allow any program to operate even without computer support initially. 

The Volunteer Training Manual covers all program interventions for the volunteers who will perform them. Separate sections in the manual cover the daily visitor program, the therapeutic activities program, the early mobilization program and the feeding assistance program. The manual includes information on the overall volunteer responsibilities, and provides step-by-step training instructions for the volunteers. This manual is designed to be used in conjunction with the volunteer training DVD. 

DVD

This DVD provides an overview of the HELP program for staff, as well as an introduction for volunteers.  It also illustrates each of the HELP volunteer interventions visually for training purposes.  The DVD sections are:

  • Overview for Staff
  • Volunteer Introduction
  • Daily Visitor
  • Therapeutic Recreation
  • Early Mobilization
  • Feeding Assistance

For Assistance

Please note that Dr. Inouye is not available to answer your questions directly.  The HELP website provides a wealth of resources to support you as you implement the Hospital Elder Life Program delirium prevention model.  More resources—including a complete listing of HELP Centers of Excellence and a discussion forum--will appear on the website in the near future.  Welcome on board!

<www.hospitalelderlifeprogram.org>

For brief questions only, you can email us at:  ElderLife@hrca.harvard.edu. A HELP consultant will answer targeted email questions within about 5 working days.

Date posted: 
Fri, 01/01/2010
Date last updated: 
Thu, 07/29/2010
CME credits available: 
No
Has this product been peer reviewed?: 
Yes
If yes, where was it peer reviewed?: 
Journal of the American Geriatrics Society, New England Journal of Medicine, Medical Care
Learning resource types: 
Intended learner audience: 
Other Intended Learner Audiences: Hospital administrators

Contact person/corresponding author: 
Dr. Sharon K Inouye (elderlife@hrca.harvard.edu)
Creative Commons License: 
CC BY-NC-SA
NLM Citation:
Hospital Elder Life Program (HELP). POGOe - Portal of Geriatric Online Education; 2010 Available from: http://www.pogoe.org/productid/20712
APA Citation:
(2010). Hospital Elder Life Program (HELP). POGOe - Portal of Geriatric Online Education. Retrieved February 05, 2012 from http://www.pogoe.org/productid/20712