The Blueprint for Aging Partnership:
Partnership Profile

For information, contact:
Jill Kind
734-712-2032
jkind@csswashtenaw.org

Chapter 1: How did this Partnership get started? How are they structured?  What have they been doing?

Chapter 2: What Difference Did the Community Partnership Make Here?

Chapter 1: How did this Partnership get started? How are they structured?  What have they been doing?

I. WHY Did the Partnership Happen Here?

• The Blueprint for Aging Partnership evolved from a six agency coalition which emerged in the late 1990’s to develop an unmet needs fund for frequent emergency needs of older adults.  A 2002 report from the Southeast Michigan Council of Governments, projecting that the older population would triple over the next 30 years, served as a wake-up call about the need to plan for the overwhelming demands this population growth would cause. 
• Washtenaw County had a history of community collaboration on child welfare, homelessness and housing; the Partnership was welcomed for its ability to focus attention on issues of older adults.  The Partnership was organized to offer “substantive change in the approach, delivery and utilization of long term care systems, (whether  medical, social, personal care and supportive services needed) in Washtenaw county.”
• Under the leadership of the Catholic Social Services; the Area Agency on Aging 1-B, HelpSource, Turner Geriatric Clinic and the Washtenaw County Health Organization formed the original core leadership group.  More than 40 community organizations, businesses, governmental departments and a cross section of older adults worked on the development of the Partnership. Five workgroups emerged out of early community meetings.
• To collect information and set priorities, the Partnership undertook face to face interviews, facilitated 20 focus groups, and conducted surveys and research..  Workgroup members and staff distributed information summaries at meetings of the five workgroups.  Nine community forums with topical breakout sessions solicited input from participants about which issues were the greatest priority.

II. Getting Started: What Findings, Vision, and Goals emerged?

Findings

• Washtenaw County (about 30 miles southwest of Detroit) contains rural, urban and suburban communities. The County typically receives a smaller share of public resources than other more urban areas of Michigan. Job losses from downsizing pharmaceutical and automotive related companies caused significant out-migration of workers and economic hardship.  At the same time, the population most likely to need assistance, those over 85, grew more than 36%.
• Pressing needs of homeless people, children, and those without health insurance created significant competition for public resources.
• The proliferation of for-profit assisted living and home care organizations expanded options for those with financial means, while the economic stress on non-profits severely constrained affordable-care options in the region.
• “Fragmentation of supportive services with many different entry points created a… case for regional systems change.”
• Many at-risk elders and their caregivers remained unaware of and disconnected from resources. Few planned ahead and many elders as well as family members were hesitant to access services for fear of losing control of decision making about their situations or future.

Current Vision: To establish Washtenaw County, Michigan as an elder-friendly community where citizens are fully engaged, consumers have full access to needed services and the priority of independence is the focus for long term care system change. 

“As the proposed plan began to emerge, again, there was a clearly identified core of values that were expected to shape all efforts: 1) Programs will use a neighborhood approach of cultural humility. 2) The program promotes trust.  3) The program will promote interdependence.  4)  The desire for help is self-determined by the consumer.  5)  Agencies and services will work together efficiently for the benefit of the consumer.” 

III. WHAT: Implementing initiatives to address issues. What did they do?

As the Blueprint for Aging Partnership moved towards action, the following Priorities/Goals emerged, from which initiatives developed:

Priority 1: Build a foundation for collaborative change.:

• In its new funds distribution model, the Washtenaw United Way has recognized the Blueprint for Aging Partnership as the entity that defines funding priorities and outcomes for the county’s older adult population, that assigns responsibility for establishing a process to distribute funds, and that evaluates the impact.
• The Partnership created the “Aging with Attitude” Art Show with the University of Michigan School of Art to challenge participants to think about aging in new ways.  Over 500 people attended and organizers produced a CD about the event.  Their public awareness campaign also challenged the community to explore “Aging with Attitude”.
• The Partnership worked with the Public Health Department to include aging issues in the county-wide Health Improvement Plan for the first time.
• A senior data book is being developed that will create a baseline of quality data about older adults that can be used by the Partnership, other County stakeholders and the community to inform decision making about elder care programs.
• The State of Michigan gave the Partnership a Certificate of Recognition for its development and implementation of an “Elder Friendly Community Assessment” for Washtenaw County in 2007.
• Partnership staff and Core Leadership members presented on partnership and aging issues at the national Catholic Charities USA conference and at an international conference on  “Improving the Quality of Care for People with Dementia and their Caregivers.”
• To facilitate county volunteerism, the Corporation for National Service funded a collaborative project between the Partnership and RSVP with the goal of engaging “Baby Boomers” and older adults as volunteers while educating non-profits about maximizing volunteers with high skill levels.

Priority 2: Develop leadership and advocacy skills of seniors.

• The Partnership created the “Senior Advocates of Washtenaw” through a training program on advocacy skills. Graduates of this training progam waged a successful campaign that saved a local program for low-income elders in public housing threatened with loss of funding.   Membership reached 120.  The group recently “spun off” from the Partnership into their own organization so they could “more directly affect legislation.”
• Periodic “Senior Summits” between area legislators and concerned seniors, sponsored by the Partnership, built relationships and increased awareness on both sides.

Priority 3: Improve options that promote the “aging in place” of older adults, especially those at risk

• The Partnership established a pilot transportation voucher program that allowed seniors to spend their vouchers on family and friends giving rides, as well as on traditional providers. This initiative has now been written into the county-wide transportation plan.
• A Community Volunteers Project, piloted by the Partnership, helps seniors stay in their homes for as long as possible by encouraging neighborhoods to create their own support systems.  A resource manual is being created, and four different neighborhood initiatives are underway. 
• At a conference in Boston about setting up a “Beacon Hill Village” model of neighborhood support, a senior partner learned how to develop and implement a village prototype in his own neighborhood.  The partner is advising other neighborhoods about the model through the Community Volunteers pilot.

Priority 4: Promote technology innovations that help older adults and their families to manage long term care issues and services

• The Partnership developed a prototype shared-access point and database to promote electronic referrals and several agencies have been trained in its use.

Currently, a Partnership volunteer is exploring development of a “decision tree” technology for older adults that would help them make decisions about their needs and what services to utilize.  One volunteer is also exploring technology consumers could use to give feedback on providers and on quality of service, much like the “satisfaction with seller” feature of E-Bay.   

Chapter 2: What Difference Did Community Partnership Make Here?
The Blueprint for Aging Partnership of Ann Arbor, Michigan

An interview between Jill Kind, Partnership Project Director, Virginia Boyce, Partnership Project Manager, and Phyllis Bailey, Senior Information Manager of the CPFOA National Program Office on 1/21/09.

How are things going in your community and how has working in Partnership made a difference?

• In terms of the situation in Michigan, finances throughout the state are increasingly desperate and are affecting everyone differently.  The entire non-profit community is very stressed with the fear that many organizations will fail and go out of business.
• The good news is that recommendations from many sources about “what the community needs to do now” are things that the Partnership has identified; especially the need to work together.
• The aging community is well positioned for sustainability—the challenge will be whether the community can move beyond simply meeting the emergency needs of residents

How has working in Partnership changed the way of doing business?

• Before our Partnership existed, aging did not have a place on the community agenda, in fact the most important community survey in the county did not even separate “older adults” from adults and consequently  there was little funding for aging issues.   Our approach is a significant change because in the past, the only issue specifically related to aging included on public health surveys was that of broken hips.  The Area Agency on Aging was the only organization asking about aging issues. 
• Our work in creating a Senior Data Book was primarily to increase the visibility of aging issues. We involved the county government in a very significant way in its production.  The availability and accessibility of this information is meaningful in terms of projecting the need and importance of aging on the community agenda.
• Participants in the workgroup included the Area Agency on Aging, social work students, representatives from the Public Health department, BFA staff, and other county departments.

• The Senior Data Book includes 20 categories – with individual pages on some aspect of senior information i.e: health, census data, Area Agency on Aging data, employment, how older adults travel, income and affluence, poverty, languages and literacy.
• Each page includes a headline for findings for these topical areas, and at the bottom of each page, there is a recommendation for policy that tries to answer the question “what does this conclusion tell us”.

• The workgroup that worked on the data book  first identified  “What do people want to know”; “Where can they get information”; “What topics are emerging”; and “What’s missing. When data were collected they worked to make the information as clear as possible,  into something people can easily use.   The project necessitated an increase in our skills and technology but the workgroup was committed to a tool that was easy to understand and useful to a variety of stakeholders.
• One example of a “new” finding is that 75% of those people over 55 consider themselves to be in good health and an asset to the community rather than being a resource drain.  This is contrary to the often stereotype that most older adults are very frail, and users of many services.
• Washtenaw County may not be suffering as much as other parts of Michigan, but the financial situation is still grim.  Our county needs to attract economic contributors, families, workers to help build the future. This data book provides a snapshot of the role seniors play in our community.
• Another goal for the partnership is to educate the business community about the need to help employees deal with aging parents.  We are currently seeking funding to offer an expo that educates baby boomers about services and options to increase quality of life for themselves and aging parents.

• Has Your Partnership Experienced Changes in the Way of Doing Business in your Area?

• We are not focusing solely on the frail and needy.  This is a community issue which involves families, young people, baby boomers and seniors in all income ranges. Education is necessary to include those who are frail in a responsive vibrant community. Our work includes bolstering the non-profit community so that those in the greatest need can receive the highest levels of service.
• The Partnership has the capacity to go broadly – take a broad view of the issues and involve all segments of the community. That takes education,  we are re-branding aging – what it means, what it can look like. We work to convene conversation about new and emerging issues.  This brings in new partners we might never have approached or have attracted. One example is the environmental folks, the Land Trust. The partnership collaborated on a “green burial” and “family friendly funeral” educational presentation.
• What does green burial mean, what is its impact on the environment, how funerals can serve people & families better,  instead of the funeral business just serving its purposes in the same old way.  Was this an initial goal of the partnership? No, but it is an important conversation that might not have been shared without our work. The presentation wasfeatured on the first page of a recent Sunday paper above the fold in a very prominent way and continues to bring in questions.

Are there other things on the radar of your Community Partnership?

Yes, we are experimenting with Village concept

• We sent a a senior partner who is a retired urban planner to the Village Conference in Boston (about Beacon Hill Village Project).  He came back and developed a project for his own neighborhood.  He works with the partnership to educate other interested neighborhoods, providing information and his own experience. Another neighborhood tried to develop a village project but it eventually did not go forward. But their unsuccessful approach continues to inform the process, identifying pitfalls (too many lawyers!) and will serve to educate others.
• Now the partnership is cautiously supporting a potential village project in a senior high rise village. Time will tell whether this group has the desire the implement a workable project, but the partnership is available to support their efforts.  This is exciting though because many models seem focused on affluent elders.  Here is a model that offers a unique opportunity in a low income setting. Managers of the elder high rise buildings, and older adults living there and approached us;  asking “can we get people meals when they are sick, transportation to the doctor, groceries brought in”.  The apartment manager works for a for-profit property management company and is a social worker who wants to do more.  It looks like this may become a volunteer exchange program model.  Residents do a lot informally for each other within the building and there is some resistance to creating a formal initiative—each situation is unique and requires a specialized approach.

We are also undertaking a new initiative, which is a web based product.

• Core leadership members came up with the idea of creating a senior center network. The resulting  workgroup invited directors of senior centers and community centers to share their needs and constraints.  This focus group represented a 6 county region. Content was compiled in a document and distributed to all for input.  

BFA staff created a beautiful web based directory of all senior centers in our county with with maps & directions, operating hours, congregate meals schedules, and transportation resources to those locations.  Daily programming specifics for each site were not included because they change so often, but we did add a shared special events calendar.  Resources for the public and for the center directors are available on this site (including marketing articles on “how to attract boomers”, etc).  The site promotes fitness, and where to go for exercise across the county.  The 2nd annual focus group of our center directors was held in March and identified the  accomplishments for the year.Especially significant was , increased commitment of directors to the network and each other as demonstrated by non competitive cooperation and sharing to improve programming. Directors feel their work has been enhanced by the interest, support and assistance of the Blueprint for Aging as well as that of Blueprint partner Area Agency on Aging 1B. The BFA Senior Center Workgroup will review results of the Focus Group and decide on possible next steps. Suggestions from the group included rotating quarterly directors’ meeting rotating location to centers and with outreach to those directors who have not attended, training for directors on best use of their Google group for sharing and communication, development of a common brochure as well as a grid that describes various models of all centers in the network to aid in strategic planning for centers.

• The benefit of this work has served to build relationships between directors; building both awareness of them and between them.  Now directors meet once a month and they have even written a grant together for some shared programming.

Are there any products or tools about these initiatives that your Partnership has created?

• We have a produced a guide for other communities to develop a  Community Volunteer  Project – this pilot project identified well connected people and trained them about resources for Older Adults.  Many people don’t know about services or trust the process of getting involved, so this projects gives community members access to information through trusted members of their own networks..In the pilot project, networks included churches, neighborhoods and smaller rural communities.
• The guide has been completed and is ready for distribution.

Are there any other changes in the way Partners do business that resulted from your work in Partnership?

• A very significant change is that The United Way of Washtenaw here has changed how they distribute funding – In the past each agency applied for funding directly. Now the United Way has identified five key community initiatives.  One initiative is “Aging in Place”.  Our Partnership has been given the responsibility to plan distribution of these funds.
• This responsibility required agencies that serve seniors to collectively prioritize issues and outcomes. The Partnership designed a process,  listing priorities identified in our community needs assessment (Blueprint for Aging Services Partnership Report and Recommendations, 2003) and asked partner agencies to review them and  reprioritize, giving us feedback about today’s situation.  This process revealed that case management is needed for seniors in crisis who utilize many different resources from numerous agencies at the same time.  The partnership designed a collaborative“ wrap around” service of case coordination.  Partnership staff manages the process – trying to end duplication and implemented electronic referrals, a shared assessment process and shared care plan to streamline and expedite care.
• The system utilizes a single case coordinator (from any of partner agencies) and matrix of social domains which serves two critical functions. First, each senior is assessed in all social domains (health, housing, etc.) with a rating of minimal need to crisis. Then services of all providers are connected to each relevant domain and can be purchased by the case coordinator for the senior.
• This process reflects a unified approach to assessment, measurement of progress and unit of service provision. We have initiated shared case conferencing to build skills across the partnership and for transparency. The Partnership provides facilitation, does evaluation, and assesses outcomes. 
• Resource allocation has moved from a program and organizational grant approach to a unit of service approach focused on “What do people need the most? How can it be provided without duplication of effort?”
• We hope we are reducing the incidence of one person being served by five agencies.  Funding sources appreciate this.  They don’t want to pay for duplicate case assessment and follow up.   We are able to use existing staff.
• People work differently – identify a lead case manager and expect that they will confer with other agencies and workers in the county.
• So now when an elder calls, the organization receiving the call does an electronic email survey of providers to see who is involved and who will be the lead on a case.
• We are piloting very different way of doing business.  The agency doing the lead case manager role – gets a flat fee for Case coordination of $350.  They have an additional $300 to use for service –from a flexible need fund, which is funded by both the  United Way and the Ann Arbor Community Foundation.,  We were able to bring more money into the system.
• One change regarding funding is pending.  Grandfathered money from United Way to agencies may require distribution from the Partnership – maybe this year or next.  These dollars are agencies’ bread and butter and has been an annual operating allocation.  When United Way makes this change of moving these dollars to the Partnership, agencies face a process that demands even more collaboration and trust. We believe that this initial process will serve to support those more difficult tasks.

Where are you with regard to the sustainability of the Partnership?
United Way funding is an example of how the Partnership acts as a single voice in our county. They have been willing to provide some funding to support the infrastructure of this project. More continuing funding will be required if we want to continue the partnership activities in other areas. We are hearing loud and clear that United Way is telling us that they do not want to support individual agencies anymore.  They want to support functions – the capacity to serve a target population.

• We are almost creating a virtual single agency without actually having to become a single agency.

What have you learned as you worked in Partnership?

• Get the right people at the right meeting. With real systems change it is critical to involve people as high up in a partner agency as possible who can look at services as a system, not program people worried about protecting their jobs.  We need people who can allocate resources and make decisions. However, seniors, family members and direct service staff have far better information about the reality of what seniors need and how processes actually work or don’t work. Without this important input, change cannot move from the idea to successful implementation.

Are there other differences Partnership has made?

• Coordination of scarce resources is occurring.
• We have deepened the skill sets available across the region to serve older adults.
• We want to develop a shared database (on clients and services) and shared technology as most non-profits cannot do this. This is an expensive skill set to purchase and maintain and is not well understood by funding entities.
• We have a commitment to innovation and trying new approaches to big problems.  Aging has gained a reputation for cutting edge approaches to critical community issues .

How does working in Partnership encourage investment in it?

• It makes resources go further from our funders; so the United Way, Ann Arbor Foundation and County are very supportive.

How does your Partnership Assess Systems Level Change?

• At the completion of a project or discussion, have we demonstrated  a clear result – a product or process change or a path to pursue – is it easier, better, more efficient?
• Does it have a chance at sustainability?

Are there other challenges or things that you have learned?

• One challenge we have faced is that Partners sometimes want something for their agency but it is not real systems change.  Or they just want to share the money (that comes in) between organizations. This could be a role of the BFA but our focus within the context of the Community Partnerships for Older Adults is systems change.

We have learned that:

• Working together is not just agreement or consensus, which goes to the least common denominator or is reactive – it is harder and takes more time.
• It is hard to bring new people up to speed about the Partnership, especially as key participants send casual substitutions instead of attending meetings themselves.  It can be a challenge to orient new members of the core leadership group.  This is even harder in workgroups. (PB encouraged her to talk to Rita.)
• We are learning where to take work and to be clear about what the goal is for a particular meeting—that may mean not trying to do a lot of detail work in the large group. We have learned it is more efficient to push those details to a workgroup, while assessing what Partnership staff time is needed or available.
• As a result, we are much more planful about who is in meetings, what we want for the Partnership from a meeting, and what preparation is needed of a Partner. (have had to set norms about orientation and no substitutes for meeting attendance.).

Have there been unexpected opportunities or learnings:

• I (Jill Kind) went to Japan with people in aging to talk with Japanese leaders about how they deal with the demographic reality of a large aging population.
• They presented on the national long term care insurance  program in Japan called Keigo Hoken.  I/Jill presented on the Partnership and the concept of a community of volunteers working together to achieve systems level outcomes. This was new to the Japanese and garnered a lot of interest.
• Our partnership does a lot more convening than we expected.  People call regarding a problem.  One example came from an assisted living/nursing home development which was serving the lowest income older population. They had a policy to not ask people to leave when they ran out of funds.  Yet they knew another similar organization had just gone out of business.  So the first organization said ‘we have to change our policy or we will go bankrupt’.  They then expressed the desire to open a home care services business so they aren’t housing all the folks they encounter, but can serve people at home instead. 
• So the Partnership convened the Core Leadership for a discussion of the issue.  We did not come up with a big answer, but at least we got these issues on the radar.  This experience gave us important information about moderate income folks,  those between the high income and very poor elder.  From there the conversation went on to how to support caregivers as well.

Has your Partnership received any recognition or awards?

• Michigan gives an award to cities & counties on livability. The BFA recieved the award for livability which we presented to the commissioners for Washtenaw County.
• Then we were awarded a subsequent award for our art show about resetting the vision of aging and involving multiple generations – “Aging with Attitude”. These efforts are also “convening” examples, where the larger community gets together and looks at aging in a new and often more positive way.