Aging Atlanta Partnership

For information, contact:
Cathie Berger
404-463-3235
cberger@atlantaregional.com

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?

While many of the partners have worked together in different capacities over the past two decades, the Aging Atlanta Partnership began to exist as a formal entity in September, 2001. Creation of a Community Partnership built on a long cooperative tradition at the Atlanta Regional Commission. The Partnership was sparked by a physician, Dr. Nathan Flacker, working in the Medicaid waiver program of the Grady Memorial Hospital. Dr. Flacker became aware of the CPFOA grant opportunity while exploring ways to make the acute care and long term care components of health systems work more effectively for his older patients. Upon discovering that the hospital was not eligible to apply for the grant, the Atlanta Regional Commission applied for it, and then offered to host the Aging Atlanta Partnership which emerged.

Demographics

• Atlanta has experienced explosive population growth in the last decade; including a rapidly increasing older adult population that is about to triple in size and that has very different expectations about life in their later years, especially with regard to staying in long-term communities they love.
• 12% of older adults in the region live below the poverty line and, among low income elders, 75% are women and 47% are African American.
• In 10 years time, the population of the 10-county metropolitan area grew 36%, while the population of the oldest old, (over 85) grew 65%! Three of the ten counties (Cobb, DeKalb, and Fulton) tend to be older, more diverse and poorer; and they contain half of the region’s population.

Learning about the Issues: An exhaustive review by the Aging Atlanta Partnership of available local & state data, and personal stories formed the foundation for a comprehensive regional data base on older adults.

• The Partnership compiled census data, county surveys, a survey of service providers, Medicaid data, profiles of nursing home residents, regional housing trends, labor supply information, data from the information & referral hot-line, as well as data on national trends with regional significance in order to build the picture of aging in Atlanta.
• GIS mapping was used to identify high concentrations of older adults who were living alone, who were below the poverty line, or who were over the age of 85 and paying high housing costs.
• 35 focus groups comprised of 1,000+ older adults brought a personal face to the statistics. Additionally, deliberate steps were taken to gain information from underserved populations.
• Findings from all of these sources were then presented in “Sessions for Comment” to committees of the Partnership and to 20 outside organizations for feedback, including the 35 member Atlanta Regional Commission Board.
• Based on all of this information, Workgroups and Core Leadership drafted priorities in collaboration with the Partnership Planning group, taking care to develop work plans that complemented the work of other groups such as the Naturally Occurring Retirement Community (NORC) programs of the Jewish Federation.

Findings
1) Overwhelming lack of knowledge about services. Older adults did not look to a hotline for assistance and did not really like asking for help. “I need a little help now and then”.
2) The great mystery of hospital discharge – both older adults and their caregivers reported being completely unprepared and had little time or guidance to prepare for fast discharges, in terms of making decisions, or arranging services. Gaps existed between doctor’s offices, community providers, hospitals and long term care providers.
3) Public funds do not favor community based services. Budgets of organizations were being reduced, and service caseloads increased.
4) Budget reductions are driving services to the sickest and poorest, often leaving few affordable choices for middle and moderate income people. Members of diverse populations were often underserved.
5) Older adults want to be more involved, giving back to their communities as well as receiving supports. Many needed transportation to do this.

II. Getting Started: What Vision and Structure emerged?

Vision: To shape services and infrastructure of the Atlanta region to a) ensure that older adults can remain in their communities and b) respond to the changing needs of the older adult population. (2008 Annual Report)

Structure: The Aging Atlanta Partnership developed an umbrella Planning Group and a Core Leadership group to which workgroup reported.
The Planning Group was responsible for the overall vision of the Aging Atlanta Partnership and membership included 35 organizations representing very diverse populations, county and state government, regional groups, universities and a number of large organizations.
The Core Leadership Group – was “responsible for reviewing and guiding activities of workgroups; providing overall leadership to Partnership, setting & evaluating Partnership goals. Membership included 6 regional, county and state planning or resource organizations, several large aging organizations, one corporation, the United Way and VNA.
Workgroups developed in Public Awareness, Health Systems Partnership/Change, Neighborhood Based Service Delivery and Underserved Populations to drive action forward.

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

Priority 1: Public Awareness

• Aging Atlanta Partnership launched the “Mapping Your Future” campaign to promote comprehensive planning for retirement by “Baby Boomers.” Delivered in conjunction with the Georgia Governor’s initiative on life-long planning, over 50 presentations have been made through civic organizations, businesses, and faith based entities.
• The Partnership educated elected officials and policy makers regarding the impact of an aging population and the potential policy ramifications in housing, zoning, community design, and transportation: They provided research and technical assistance to multiple communities interested in developing senior housing ordinances. The first zoning ordinance was successfully passed in Cobb County to promote senior housing alternatives for local elders who wish to downsize within their long term communities; it has now been adopted by 6 more jurisdictions and 1500 units have been built.
• The Partnership worked closely with the Area Agency on Aging to create the LifeLong Communities Initiative, which convenes a local partnership in each of the 10 counties. Led by county chair people, commissioners and mayors, these local partnerships gather for the purpose of 1) promoting housing & transportation options, 2) encouraging healthy lifestyles and 3) streamlining access to information about services. Local Partnership meetings are occurring in Cobb, Cherokee, Rockdale and Douglas counties; the remaining six counties will be convened in 2008 and 2009.
• Over 200 people attended a 2005 Partnership Symposium on “Aging and Community Design.” The Partnership and the Community Housing Resource Center, a Partner member, received the Georgia Planning Association Award for the Aging in Place Toolkit.
• At an 8 week Civic Institute for Creating Age-Friendly Communities, Atlanta older adults learned how to advocate for senior issues and how to educate policy makers. Because participants have been so successful at educating City Council Members and other decision makers about housing, transportation and safety, the City of Atlanta has created a Senior Advisory Council to assist on an ongoing basis with issues facing older adults.

Priority 2: Health Systems Partnership/Change

• To build better bridges between hospitals, health organizations, housing groups and community based organizations, this Workgroup surveyed 600 older adults within 48 hours of a hospital discharge about their challenges and access to supports. The Post Hospitalization Management Study identified opportunities to improve the post-discharge experiences of elders; its findings were discussed in a series of community forums for local hospital and home care providers. One pilot “Care Transitions” Program at Piedmont Hospital is being evaluated for expansion to other settings.
• The Health Systems Workgroup tested a web-based care coordination system and concluded the software package was too cumbersome to use for client information sharing. However, the software is being used for networking and sharing information on resources.

Priority 3: Neighborhood Focused Services

• Aging Atlanta Partnership created a successful transportation voucher program and secured funding to expand the program to six additional counties for seniors with mobility challenges.
• A Safe Homes for Seniors minor home repair project in one neighborhood is now offering major home repairs through the “Rebuilding Together Atlanta” organization; it is also partnering with one neighborhood’s Fire Department on information programs for elders about the prevention of falls and fire hazards.
• The Partnership established walking clubs in multiple neighborhoods and developed a tool kit for other neighborhoods to increase wellness and social contact.
• A collaboration with the Atlanta Housing Authority explored increasing services and supports to frail, low-income elders “aging in place”; this collaboration helped the Area Agency on Aging secure a $375,000 ROSS grant to expand services at the Marion Road high rise and 2 other locations.

Priority 4: Underserved Population

• During a Door to Door survey of isolated elders with the Fire Department of East Point and N. Fulton County, the Partnership gave out information on services that exist and how to use them. They also trained the early responders who went door to door on how to recognize and refer at-risk elders.
• The region’s first Symposium on the needs of older Gay, Lesbian, Bisexual and Transgender adults was sponsored by the Partnership, reaching 100 people from 80 organizations. 20 agencies have received sensitivity training about some of the needs and issues of GLBT individuals as they age and the workgroup is partnering with a senior center in Fulton County on programs and activities serving this population.

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

The Aging Atlanta Partnership of Atlanta, Georgia

An interview between Cathie Berger, Director of the Area Agency on Aging at the Atlanta Regional Commission (ARC), host agency to the Aging Atlanta Partnership; and Phyllis Bailey, Senior Information Manager of the Community Partnerships for Older Adults (CPFOA) National Program Office conducted on 10/28/2008.  

What Difference Has Working in Partnership Made in Your Community?

The Aging Atlanta Partnership has made a big difference, first, because it provided the tools, the mindset, and the background to propel us into the Lifelong Communities initiative we are now taking to ten counties.

The products of working in Partnership are great: 

• We now have fully functional Naturally Occurring Retirement Communities (NORCs).
• We have made great strides in our work to support Gay & Lesbian (LGBT) elders.
• Our Health System Workgroup brought together long term care services, hospitals and other providers interested in working on issues related to an elder’s transition home and care coordination.  The software we tested did not work, but the success of this effort was that people got to know each other, identified common areas of interest & concern, and then sought solutions.  They still meet once a month on for education and discussion of issues people are facing.  Our staff person puts the agenda and logistics together to keep it going.   The meetings give people a view on critical issues like the lack of mental health services for older adults, or the threat faced by seniors of eviction from their homes.  The workgroup delivers education on topics and offers free lance discussion – very open discussion together.  The value for participants is getting out of the isolation of our agencies.   So lots of education, support to each other and shifting in how people approach problems occurs through these meetings.  We will continue to do these.

Are There Any Other Differences Working in Partnership Made?
Another important thing that the Community Partnership did was to give recognition and a forum to the issue of a growing aging population.

• While the Area Agency on Aging had an awareness of the aging future, the Partnership provided a way to move the whole Atlanta region forward.  It prepared us for a broader regional approach and gave us the ability to move forward the whole Lifelong Communities initiative based on our Partnership work.  The leftover Robert Wood Johnson money from CPFOA provided seed money to start the Lifelong Communities Initiative.
• Because we integrated the Aging Atlanta Partnership into our regular activities at the Area Agency on Aging (and Regional Commission), it broadened our approach and the way we operate.
• We submitted an application  and received HUD money for the NORC initiatives.  We expanded the NORC concepts from the first East Point neighborhood focus to one housing authority building with older residents.  Now we have expanded to two more housing authority buildings serving seniors. 
• Through this we have expanded basic case management to a full overlay of NORC services – full support services.
• Partnership gives an umbrella and an ability to coordinate with other agencies.  We participate in umbrella meetings – with organizations working on NORCs  such as the Jewish Federation. We take the idea of Community Partnership into these meetings and create partnership between agencies providing  services, whether they are from home health, mental health, case management, etc. Groups of agencies are meeting who did not before.

City and regional planners are meeting with the Georgia Conservancy and NORC representatives on how to look at the exterior of buildings and actively connect these developments to amenities in the neighborhood, whether by walking paths, green space, park benches, etc.

What has this experience taught you?

If we want to create livable communities, we must go beyond services! 

We are integrating services, community supports, funding resources and the environment to make livable communities.

This was highlighted when we started working with the three Housing Authority buildings.  The challenge was that the property management companies of the buildings did not understand the reality of frail elders.  Past practices had been to move an elder out when they needed more support.  We were concerned that they were not providing services, yet the property management company wanted us to do case management.  We applied for and got a HUD ROSS grant to strengthen service coordination, with a broader reach.  We overlaid the property with the idea of what it would take to be a naturally occurring retirement community, and then worked to connect the buildings to their local community.

Changes are now planned.  A Georgia Tech professor created a school project – they organize “Blueprint Projects”; which develop Greenway Plans about what can be done.  So far they have taken two of these Housing Authority facilities and did charettes with input from residents and providers.  They found out that crosswalk times  were too short for people to get across the street safely.   Residents showed us how they sit outside in the parking lot in folding chairs because there is no other exterior space -  the students have now started a vegetable garden for them where they can spend time outside.

Another “On the ground” change is underway. There were no street signs.  That is where it was important to have planners to work with the professor and students.  The planners knew who to talk to in city to get these street signs. 

Through the Partnership, we were able to link people who did not have relationships before.

So how did you move from the initial Partnership work to this much bigger effort – the Lifelong Community Initiative?

• We went to each community.  In each county, we identified people who need to get together and talk about the aging future they face by  2030.  We educated and talked about what we learned in the work of the Aging Atlanta Partnership.
• Under the  leadership of the county commissioners, each of the 10 counties is doing something different.  For example in Cherokee County,  Kathryn Lawler helped them to create a housing plan that responds to the needs of seniors now and in the future.

The three basic goals of the Lifelong Community Initiative are:

• Creation of housing  & transportation options,
• Promotion of healthy living,
• Ease of access to information and services

Have there been any unintended consequences of your Partnership work?

It strengthened our capacity for collaboration. For example, it supported  SPARC (Sickness Prevention Achieved Through Regional Collaboration) a program designed to deliver immunizations and health screenings.  SPARC is based on a collaborative effort, bringing together aging service organizations, public health departments, home health agencies, hospitals and other community organizations that have a stake in delivering preventive care.  No one gets funding, yet all have an interest in delivering this service.  We started with 5 events in 2006.    So far, this year there have been 40 events offering  preventive  services.

The Partnership has changed the way of doing business, because now people & organizations are working together.  It is touching the self interest of each organization.  While delivering something, they are getting something too.

• The public health department needs to deliver immunizations and health screenings and now knows where they can reach their target audience.
• Hospitals coordinate with flu shot delivery to decrease hospital days and prevent unnecessary emergency room use.
• The involvement of home health agencies helps to show their ability to deliver service and create a community presence.
• The aging network is involved to make sure preventative services are delivered to  the elders who need them.

Also, if someone comes for a flu shot, the mammogram van is often in proximity with the capacity to schedule or do a mammogram while recipients are waiting for their shot.

This is a great convergence of three agendas.
1) Bring people around the table who share interests.    2) Get the work done collaboratively.  3) Serve multiple interests.

Some other unexpected things happened as we focused on Access to Services, which is the third goal of the Lifelong Communities initiative (on a handout Cathie sent)

• We consistently find out that older adults don’t know what services are available and how to access them.  We want to make sure older adults   have the right information, and the right level of information; for instance, which Medicare drug plan covers the drugs they use.
• So the Atlanta Regional Commission applied for a Retired Senior Volunteer Program grant in five counties.  We looked for volunteers to educate seniors on the most critical services you need to know about to keep you at home and healthy.  We changed the paradigm a bit and pushed this into a civic engagement program, engaging older volunteers in meaningful work.   
• Working together, we and they created county specific information on older adult services – food stamps, energy assistance, housing, etc.  With a preventative service focus, we have trained volunteers to educate at high rises, garden clubs (really anywhere) about what puts you at risk and here’s how to prevent issues.

How did you plan and start up the ten county Lifelong Communities initiative?

• Our planning was very purposeful.  We did focus groups & surveys, we developed a framework, tested it in two counties and got feedback.  It was intentional, and based on what we learned.
• We started with the County Commission Chairs who are key members of the Altanta Regional Commission board asking for their support in making changes from the ground up. We did not want to write another plan for the Aging Atlanta Partnership region which would once again sit on a shelf.
• With the help of the County Commissioners we convened meetings of  a broad range of stakeholders including planners, mayors, developers, community organizations, advocacy groups and older adults.
• We brought them together to identify and solve issues of their own communities.
• We undertook a concerted effort to go to each of the 10 counties.

When Commissioners and others asked us for best practices, we were able to draw on our experiences with the Aging Atlanta Partnership and speak from place of confidence! 

The Partnership has really changed the way we do business in my agency and my community. The Atlanta Regional Commission as the Area Agency on Aging, has for the past 30 years built a strong and very viable  service delivery system – we now have to broaden our scope and  we have to deliver these services within the context of the entire community  - as a result, we have broadened our agency mission statement.

Can you give some more examples of how the way you do business has changed due to your Partnership work?
a) Now, we provide service to keep people in their homes in the community.
b) We have broadened our scope.  If we see a housing deficit, we can respond with a broader initiative.  Many counties did not have senior housing ordinances so Kathryn drafted the first one.  We are up to 10 now and each ordinance is better than the last.

• All counties have to do comprehensive plans, with large housing component.  They are proud to show us how elders’ needs are being addressed in these plans.
• We have been driving  the needs of older adults into all aspects of planning – housing, transportation, services and health care.
• We are directing  them (the counties)  to integrate – not isolate elders.
• DPZ Company, a nationally known architectural firm will be coming to Atlanta in February, 2009 to do a housing charette to develop conceptual design plans for  six communities in hopes of creating models which we and the rest of the country can use to create integrated housing.  (Reflective of the New urbanism movement).

What are some of the challenges you have encountered?
The Aging Atlanta Partnership does not exist per se, since the completion of the grant and grant funds. 

• The Atlanta Regional Commission/Area Agency on Aging has  a big contract network and we are in a change mode redirecting our vision and goals to create communitites where older individuals can age in place, where inidivudals can life throughout their lifetime. 
• We must provide a vision of what is shifting, support our partners to see the need for change, internalize and respond accordingly.   We have a critical role to get the message out.  In aeach of the  10 counties, we have one major provider agency which provide services suchs as senior centers, homedelivered meals inhome support and ltransportation, services. Our challenge is to help providers see the delivery of their services in the broader context of their communities, the need for integrating the needs of aging into all aspects of life - not all of the aging network gets this shift.
• Many  are so tied up with day to day operations, it is hard for them to see the broader picture and seek new opportunities for collaboration. There are waiting lists & shortages.
• We fear aging providers will not be at the table when landuse, transportaion and community  planners are already ready to think about the aging future. You’d think our issue is getting planners and land use professionals to the table.  It is not.  Our challenge is “how do we move the aging network”.

We need  them to serve  as a catalyst sending the messages about the needs of older adults beyond the aging network to see ‘the community’ as also the physical environment, with physical assets and amenities that impact how we live and the quality of our lives.

Do you have any other thoughts about Challenges and how to face them?

• The message we have to send about aging is positive.  Boomers are to a great extent healthy,  active educated, and often  have resources. (sort of).
• Elected officials in the Atlanta Region deal heavily with the issues of congestion, sprawl and droughts.  In contrast, the aging issue is very positive,  and for many a personal issue.. 
• We talk a lot about the active older person who wants to contribute and engage.
• Our challenge is that we need to ride this wave now, plan and develop communities before the heavy service demands develop.

Has The Aging Atlanta Partnership Ceased Operations?

• Our projects all have new homes.
• Yes the Aging Atlanta Partnership is out of business, but not the collaborative way of operating.  That is a basic expectation now.

What happened to the “Neutral Table”?

• That is what we took to 10 counties – and it is essential.  Our ten Lifelong Community stakeholder groups are each a Community Partnership
• We bring them together through the Atlanta Regional Commission, the county commissions and the county aging programs.
• Our staff now has meetings in 10 counties.  Next year we may have a regional meeting of all the county groups.
• The Atlanta Regional Commission has adopted the language of the Lifelong Communities resolution as a policy, which all Commissioners signed . This is a very Big Win.