The Lifestyle Engagement Activity Program (LEAP) : implementing social and recreational activity into case-managed home care

Objectives: The Lifestyle Engagement Activity Program (LEAP) incorporates social support and recreational activities into case-managed home care. This study's aim was to evaluate the effect of LEAP on engagement, mood, and behavior of home care clients, and on case managers and care workers. Design: Quasi-experimental. Setting: Five Australian aged home care providers, including 2 specializing in care for ethnic minorities. Participants: Clients (n=189) from 5 home care providers participated. Intervention: The 12-month program had 3 components: (1) engaging support of management and staff; (2) a champion to drive practice change; (3) staff training. Case managers were trained to set meaningful social and/or recreational goals during care planning. Care workers were trained in good communication, to promote client independence and choice, and in techniques such as Montessori activities, reminiscence, music, physical activity, and humor. Measurements: Data were collected 6months before program commencement, at baseline, and 6 and 12months. The Homecare Measure of Engagement Staff report and Client-Family interview were primary outcomes. Secondary outcomes were the Cohen-Mansfield Agitation Inventory; apathy, dysphoria, and agitation subscales of the Neuropsychiatric Inventory-Clinician Rating; the geriatric depression scale; UCLA loneliness scale; and home care satisfaction scale. Staff provided information on confidence in engaging clients and the Utrecht Work Engagement Scale. Results: Twelve months after program commencement, clients showed a significant increase in self- or family-reported client engagement (b=5.39, t[113.09]=3.93, P<.000); and a significant decrease in apathy (b=-0.23, t(117.00)=-2.03, P = 045), dysphoria (b=-0.25, t(124.36)=-2.25, P = 026), and agitation (b=-0.97, t(98.15)=-3.32, P = 001) on the Neuropsychiatric Inventory-Clinician. Case managers and care workers both reported significant increases in their confidence to socially and recreationally engage clients (b=0.52, t(21.33)=2.80, P = 011, b=0.29, t(198.69)=2.58, P = 011, respectively). There were no significant changes in care worker-rated client engagement or client or family self-complete measures of depression or loneliness (P > .05). Client and family self-rated apathy increased over 12months (b=0.04, t(43.36)=3.06, P = 004; b=3.63, t(34.70)=2.20, P = 035). Conclusions: LEAP demonstrated that home care providers can incorporate social and recreational care into usual practice for older clients, and that this benefits clients' engagement, dysphoria, and agitation.