Translating Strong for Life Into the Community Care Program: Lessons Learned

Danilovich MK, Hughes SL, Corcos DM, Marquez DX, Eisenstein AR
Source: J Appl Gerontol
Publication Year: 2017
Patient Need Addressed: Long-term services and supports
Population Focus: Medicaid beneficiaries
Demographic Group: Adult
Intervention Type: Staff design and care management
Study Design: Randomized Controlled Trial (RCT)
Type of Literature: White

We used a randomized controlled trial to test the implementation of Strong for Life (SFL), a resistance exercise intervention, using 32 home care aides (HCAs) as exercise leaders with their 42 homebound older adult clients enrolled in the Community Care Program, a Medicaid 1915(c) waiver program. Mixed-methods were used to analyze outcomes of program satisfaction rates, training session evaluations, program fidelity, and job descriptive index scores. Results indicate that it is feasible for HCAs to implement SFL safely with clients. Participants viewed SFL as highly satisfactory and HCAs were able to adapt SFL for their clients. HCAs have high job satisfaction, and leading SFL enhances work achievement and pride. Our results show it is possible to train HCAs to implement SFL with their clients in addition to providing usual care services, participation positively affects both care partners, and this is a feasible and practical delivery model to provide exercise for adults receiving home- and community-based services.

Insights Results

Overview of article

  • Embedding physical activity (PA) programming within existing home care aid (HCA) services may effectively engage homebound older adults in PA. HCAs visit their clients regularly and have established relationships on which to build. Therefore, the potential exists to expand the job role of these important paraprofessionals to include the provision of PA programming for their clients
  • Strong for Life (SFL) is an evidence-based progressive resistance exercise program originally designed for frail and/or functionally impaired older adults. Although SFL has demonstrated benefits in the broader community, this is the first known study to test the implementation of SFL with Community Care Program clients using HCAs as exercise trainers for clients to determine whether this mode of PA delivery is feasible for this population
  • The goal of this study was to determine the feasibility of training HCAs to lead SFL with their Community Care Program clients. Results support that HCAs can be trained to offer a 12-week resistance training intervention with clients and can implement it successfully and safely
  • This study recruited HCAs and clients through the Cook County office of Community Care System, Incorporated (CCSI). CCSI is a home care vendor that has a contract to participate in the Community Care Program statewide. The authors recruited from the approximate 125 HCAs employed in the Cook County office through direct mailings and presentations at staff in-services. HCAs participated in a telephone screen to determine eligibility. Once a HCA was deemed eligible, all clients on the eligible HCA’s caseload were mailed study information. Research staff telephoned clients 2 weeks later to provide further study information
  • The study initially enrolled and randomized HCAs (n = 34) for training: 15 HCAs in the control group and 19 HCAs in the intervention group. Ultimately, 42 clients enrolled in the study
  • For the statistical analysis portion, the primary author analyzed answers to open-ended program evaluation questions through conventional content analysis using a spiral approach


  • Overall, clients were able to perform SFL safely and all HCAs and all clients recommended that SFL should be implemented with all Community Care Program client
  • The study findings are notable for 4 following reasons: 1) The program was able to engage homebound older adults in a PA program without any reports of adverse events; 2) HCA job satisfaction did not appear to be adversely affected by the increased workload of leading SFL; 3) Acceptability of the intervention was high; Both HCAs and clients had positive reactions to the intervention and voiced the opinion that SFL should continue; and 4) HCAs were able to adapt the SFL intervention appropriately given clients’ individual physical or environmental challenges

Key takeaways/implications

  • For researchers, this study points to an implementation mechanism that requires further investigation on a larger scale. For policy makers, this research suggests an effective means of offering PA programming to an underserved population within an existing delivery framework. The study indicates that SFL can be successfully implemented within the Community Care Program by training HCAs to lead the program
  • Limitations: This study is based on a small sample that received services from a single provider and are not representative. The study also has limited information on participant cognition and adherence during the short duration of the interventions