The Aging Futures Partnership

For information, contact:
Kathy Bunnell
607-778-2411
kbunnell@co.broome.ny.us
www.agingfutures.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 Aging Futures Partnership is based on 14-year-old collaboration of organizations serving older adults, of older consumers, and of interested citizens; its members include representatives of government, hospitals, home care, mental health providers, nursing homes, educational institutions, advocacy groups, politicians and social service organizations. While these groups always shared data and some recommendations, after the CPFOA funds became available, “people realized that if we all worked together….we could go a lot farther.” Over time the Partnership expanded to 55 people, with a larger number of older consumers particpating than before – operating from the premise that older adults and their caregivers should be the primary sources of information about their needs.

Demographics

• One in five Broome County residents is age 60 or older - 20% of the population. Broome County's senior population is higher than both the national and state averages. Of those over 60, 40% are over 75 years of age. Broome's senior population will continue to grow significantly.
• While known as the birthplace of IBM and the Endicott Johnson Corporation, the mixed rural/urban Broome County suffered a 31% erosion of manufacturing jobs over the last three decades causing a significant out-migration of younger workers.
• This had the impact of decreasing the population of potential caregivers while the population of older adults increased. Tax revenues declined substantially causing shortfalls in funding for many state and local programs.
• Of the large population of older adults here, 58% depend on Social Security as their primary source of income compared to 37% nationally – much of the older population faces the dual challenge of living alone and being low income. (18% are poor or near poor)

Data collected through focus groups, personal interviews and three surveys provided much of the initial information for the Partnership’s analysis and priority setting.

• Participants were asked questions such as, “What makes it possible for a frail older adult to return home and remain at home after a hospital or nursing home stay? What tactics can be used early on to support an elder’s choice of remaining at home? What is available or lacking in Broome County to support stay-at-home options?”
• The Binghamton University Geography department also used GIS software to draft a series of maps showing the demographics of older adults in the county, which was so powerful that the County Planning Office purchased GIS capability so it would be permanently available to the Office for Aging and to the Departments of Mental and Public Health. The GIS mapping graphically portrayed the isolation of elders and the resource challenges present in the county, especially in more rural areas.

So many people wished to attend the Aging Futures Partnership’s first Community Forum that it had to be moved to a larger conference center, where attendance tripled. An IBM consultant facilitated the discussion of the data with the questions: “What did you hear? What do you think is most important? And what else should we consider?” A follow up ranking and survey process yielded key issues, from which the full Partnership selected the first 3 that would be moved into workgroups for detailed review and planning. A crucial aspect of this study process, from which strategy recommendations emerged, was the review of best practices around the country, which became a leadership development tool as members educated each other about what they learned. The Partnership also worked to complement rather than duplicate already existing initiatives like those of hospitals regarding chronic disease management.

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

Findings: Seven concerns affecting the ability of seniors to remain independent were given a high priority for action by participating elders and by the overall Aging Futures Partnership.

• Understanding and accessing services - Continuous efforts are needed to ensure seniors know what services are available and how to use them.
• Managing chronic disease - The public and private cost of providing health care services will increase as people with chronic diseases live longer. Proactive management may prevent decline.
• Caregiver support - Assistance to caregivers often increases the likelihood of an elder remaining at home. High costs of nursing home care can be avoided or delayed.
• Remaining socially connected - 30% of seniors live alone.
• Housing - 12% of seniors need home repairs in order to remain there.
• Transportation assistance is needed to keep medical appointments and maintain social contacts.
• Legal and financial planning - personal and financial planning tools are needed by seniors to anticipate and plan for their long term care needs.

Vision: Aging Futures is successfully linking the active engagement of older people with the collective support of the community to create the essentials for: vital aging, healthy lifestyles, optimal independence, and dignified care. “The Aging Futures Partnership … working together to improve the lives of older adults.” (Communications Tagline)

• The Aging Futures Partnership’s mission is to create and strengthen community systems, thus enabling persons age 60 and over to maintain the highest quality of life.
• “The Partnership's long-range plan is to continuously move to higher levels of collaboration. Integration of strategies for financial and organizational sustainability is expected as the Partnership evolves to the point where members are willing to assume the risk of pooling and jointly securing resources and sharing the results and rewards.”

Structure: This Partnership organized with a Core Management Team and with 3 clusters of work in:

• Partnership Development – using workgroups in data & evaluation and professional education,
• Program Development – through workgroups on Chronic Disease management, Social Connections and an advisory group on Caregiver Support
• Communications – to promote awareness about the Partnership and aging issues through a far reaching communications plan.
  

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

Priority 1: Help seniors stay connected to social supports, support their caregivers

• The Return to Home Caregiver Project, which offered caregivers 3 months of telephone support and education after their elder left the hospital, successfully reduced caregiver stress and burden. 82% said their care recipient was at risk of nursing home placement if supports were not offered at home. 300 copies of a DVD created by the Partnership (“Now that your loved one is home, what do you do?”) were distributed at hospitals to caregivers and placed in libraries.
• The Stay Connected, Stay Well campaign 2006 Calendar won a Mature Media award. The campaign continued in 2007 with a booklet highlighting local activities and events, tips for staying connected, and information on transit options. 650 older adults called for copies of the booklet after a 3-part TV feature.

Priority 2: Chronic Disease management - Reduce the incidence of stroke and untreated depression.

• In the first six months, 93 participants experienced an 11% drop in blood pressure after participating in the Strike Out Stroke program promoting better self management of hypertension to prevent strokes.
• This area has a paucity of mental health services for young people, yet the Partnership was able to help local providers extend their thinking to serving older adults. The Senior Mood Improvement Through Lifestyle and Education program (or SMILE) identified services for seniors with depression, raised awareness that “Depression is not a normal part of aging,” screened 50 seniors for depression, and published a new brochure on “Seniors and Depression: Treatment and Recovery.” 71% of the elders receiving follow-up supports showed improvement.

Priority 3: Use Communications to effectively educate our community

• The Partnership’s multi-media campaign to equip seniors trying to make decisions on health care, housing and long term care issues included a weekly feature on the local CBS affiliate WBNG-TV for 50+ weeks. Every Partner and provider in the Elder Guide went on the air, explaining the services available and how to use them. A promotion on TV of the Elder Guide and information about chronic disease management generated 1430 calls over a 4 day period.
• The process of updating the existing County Elder Services Guide increased listings by 26%, helped the Partnership assess service gaps, enabled them to place the Guide on the web, and created a first product to distribute. Thousands of copies have been distributed and now discharge planners and providers ask elders if they have their “green book” (elder service guide)
• The website has been averaging 43 hits a day. www.agingfutures.org

Priority 4: Develop & strengthen our Partnership to improve our planning for long term care

• The Aging Futures Partnership has successfully developed relationships built upon mutual respect and understanding about each member's priorities, methods, and constraints, contributing to the success of the planning efforts. Members recognize that collaboration and sharing information are in their best interest. The Partnership made two levels of membership available to reflect different levels of involvement and commitment.
• The Partnership conducted 2 surveys using the “Collaboration Factors Inventory” to document satisfaction with the Partnership and make improvements where needed.
• Increased relationships now exist between community based services and medical providers, and also between businesses and community based organizations.
• A direct-mail fundraising campaign, highlighting the Partnership’ successes, resulted in donations from many residents.
• The latest activities of the Partnership focus on health promotion, livable communities, and Partnership development

Priority 5: Promote Livable Communities (a priority which emerged later)

• 24 Planning Boards in the region joined training the Partnership conducted in March, 2007 where they learned about universal design and about how important it is to create homes and communities for a lifetime. A local assembly woman linked regional economic development leaders, home builders and planning staff to the Partnership.
• The Ad-hoc Housing group coordinated zoning training in October, 2007 on how zoning laws work against the needs of seniors. Much collaboration is happening between Binghamton University graduate students, the City of Binghamton and other housing groups in the city.
• The Partnership has partnered multiple times with the Southern Tier Home Builder Association on their annual Home Show, attended by 5,000 people. Aging Future’s booth and seminars focused on universal design, on falls prevention, and on making homes livable for a lifetime. The Builder’s Association won a national award for their educational collaborations with Aging Futures.

Chapter 2: What Difference Did the Community Partnership Make Here?
The Aging Futures Partnership of Broome County, New York

An Interview between  Kathy Bunnell, Director; Dee Dee Camp, Project Manager of the Aging Futures Partnership; and Phyllis Bailey, Senior Information Manager of the National Program Office of Community Partnerships for Older Adults on  11/6/08.          

What Difference Has Working in Partnership Made in Your Community?
2009 is the twenty year anniversary of the origin of our local Partnership, but it functioned with an ebb and flow prior to the Community Partnerships for Older Adults funding from the Robert Wood Johnson Foundation.  We never had staff before this, which has made all the difference.

• Since we received the CPFOA grant, we have worked hard to make the Partnership an effective collaborative resource. 
• We take pride in our data collection, analysis, and priority setting; and we did it more systematically after we received the RWJ resources..  We have built upon what we have learned each time we repeat the planning process. We sometimes can collect data that is longitudinal. now.   We have very rich information compared to what we had before the CPFOA grant.  We can illustrate trends and address problems better because we have both qualitative and quantitative data. There is a great deal of added richness & depth to the story we can tell, both about the aging population, our county, seniors who participated in our initiatives and our Partnership work.   Our work became evidence and data based. 
• We realized that no one agency could have done it alone and many of our projects are continuing.    We have pride in doing things that have staying power. We identify what system change can remain even if a project looses funding.
• Having dedicated staff made the difference.  Staff focused on the success of the Partnership and its projects when others may have beened to address issues within their own agency.
• We have established more workgroups, have involved more community members and new community leaders have come forward as we have worked in Partnership.
• We were able to broaden issues and get people to think more comprehensively, about the community as a whole and not just the narrow silo of their agency.
• Now, we have to be careful of expecting a part-time status staff person to be able to assume a workplan with activities that is similar to what we expected when the staff was full time plus. 
• Kathy has been in the local Partnership for twenty years.  Sometimes the issues affecting seniors, housing, transportation  do not seem any different from the past; what is different is how the community approaches those issues when we better understand what each agency does well, what they and their organization don’t do and their leadership structure.
• When we see an issue – people collaborate now.  The issues is not will we collaborate?  But rather, how will we collaborate?
• We have become friends with each other and are not just colleagues.   We know each others’ families and about each others’ lives. 
• Part of our ongoing work plan is to meet six times a year, because people did not want to meet less when we explored that option while planning for the future.

How do you keep people so hooked and invested in coming to the Partnership meetings?

• Agenda planning is critical. We try to structure the agenda to include celebration of accomplishments and also rich discussion.  For example, we don’t just focus on transportation, but we explore medical transportation, low income or workforce transportation and what opportunities are there to have an impact. You have to be invested in both the issue and the relationships to go deep enough to really begin solving the problem.
• In our last meeting on transportation: One community member said “if I had a better vehicle I could do a better job of transportation”.  Someone else had a van they wanted to get rid of and donated it to the first individual because of that discussion.  We always celebrate early on in meetings, so our members experience a sense of accomplishment and pride in what is happening.
• We also make sure that issues are raised early enough in a meeting to allow time to discuss them.  Sometimes we even dedicate a meeting to one topic. 
• Regular meetings keep us strong. 
• There is local collaborative problem solving and re-leveraging of resources.
• Early in the RWJ/CPFOA development grant, there was much focus on all of the initiatives in our meetings.  Now we go back to the strategic plan and the priorities we set.  We are committed to annual discussion of our 7 priority areas.
• We also never try to cover or re-visit all nine priorities in a single meeting.

Are There Other Differences Made By Working in Partnership in Your Area?

• We are getting things done but this has also been a huge opportunity for leadership and professional development. In the future leaders like Kathy will  begin retiring.  Leadership development has been one of the unintended consequences we did not forsee.
• Binghamton University has become a stronger Partner and opened a downtown center.  This is increasing the interaction between students, faculty and agencies. Longterm this will enhance our geriatric workforce. Our Partnership did a panel for a class there.  The professor said they were specifically trying “to inoculate students against working in silos.” They are trying to give the experience of what value is gained by working in Partnership.

Why Does This Encourage People To Invest in Partnership Work?:

• There is a significant capacity change -  From what one organization can do versus what a larger Partnership can do through people working together.
• Here is an example:  We had a Communication campaign for 52 weeks.  We were on the news & TV weekly.  No one organization could have done that by itself for 52 weeks, but by involving many Partners, all of them got some exposure and we successfully covered the entire year.  Some organizations took responsibility for one week, some took multiple weeks and therefore had multiple exposures. The end result was that seniors were much better informed, the campaign had more impact and we can repeat this model in the future.
• Another Example of this changed capacity is how we staff our booth at the regional Home Show. Through the Partnership, people & organizations sign up to staff the home show booth.  After the Partnership begins the planning, then organizations go back and recruit their own staff and supports to cover some of the booth time.  No one organization could cover such a large time demand of three long days. The annual event gives the Partnership visibility at an event attended by 3,000 -5,000 consumers and many community leaders.
• Partnership has also changed the way of doing business here – for example, it has institutionalized new more effective screening tools across multiple organizations.
• For Example: Regarding our Depression screening initiative - We found out about the Texas Depression Intervention initiative through our involvement with the Community Partnerships Program and joined the national evidence-based initiative.  We initially touched 30 people and are reaching more each year.  This helped us to make the case for the program to other funders.  Many agencies are adopting  a more effective approach to screening older adults for depression such as the geriatric depression scale and short term cognitive intervention.
• A similar story is true with our “Strike out Stroke” program.  We are reaching small numbers of elders, but the organizations’ involved have changed their screening processes and practice about management of chronic diseases that increase the risk of strokes.  After our primary funds for this were exhausted, a local insurance company and some foundations gave money to continue it. We have been able to serve 30 seniors annually.
• To summarize, We have good data; our members understand local issues and speak to community issues, not just to their own agency issues.  We have demonstrated that we can offer evidence based programs, low cost programs that make a substantial difference and we evaluate our own efforts.
• Now we are going back out into planning again to do some visioning about the future.  We have new data emerging on mental health needs and just did a conference on Geriatric Mental Health. We would like to promote education and build the capacity of local agencies to respond.  

Were There Unanticipated Places That Working in Partnership Took You?
The Robert Wood Johnson funds through the CPFOA initiative focused us on frail elders; yet after 3 to 4 years people who were involved asked us “what about me”, meaning seniors who were younger across the board, middle income and healthier.  That led us to the Elder Friendly communities concept which led us to
--livable communities
--Housing
--working more closely with  builders
-- zoning, green space and walkability.
--transportation issues
--working at the township level,

• That led us into our work with realtors.  In their business, they looked at “What’s for sale, what do elders want to buy?”   They began to evaluate the livability of our region. On the “pro” side; we had social connections and chronic disease management happening in the community but housing stock is an issue. Then we had an Assembly woman in the Partnership with energy about this.  She brought people together, including realtors, and talked about what are people looking to sell and to buy.  We started finding our  that older adults wanted ranches or one floor living, but older housing had bedrooms and the bathroom upstairs. 
• So we got builders to think differently about what the older customer wants.  Perhaps planned communities may result from these conversations. 
• Our first home show had a universal design as theme.  Many builders did not know of this concept, which was surprising. 
• So we expanded  the conversation from the individual house level to the broad community level.  We changed it from being about individual homes -to being about the larger community.
• We at the Partnership agreed to be the convener for the county on livable communities.  We have learned that this is hard to manage with a county- wide focus but a neighborhood level offers a better model.  So we now have one neighborhood doing this level of work.  Lots of non-traditional partners  are assessing the livability of particular neighborhoods and what would help.

What have you learned about working with “non-traditional” partners as opposed to the “usual suspects” in the aging services network?

• We try to create strategic partnerships.  If we aren’t going to do housing, it is hard to keep the housing developers in the room.
• It is helpful to work with individual partners to identify specific tasks that they could be involved in, that take advantage of their resources and expertise. Time limited commitments are also appreciated. Often these conversations do not take place at full Partnership meetings.
• We started with initiatives impacting public health.  When we did the depression initiative, the agencies involved came forward.  They left when it wound down and then they came back when it re-surfaced.  We learned that people’s involvement ebbs and flows.
• Priorities are sometimes set when opportunity knocks.  We did not have specific activities about this in our workplan but people and organizations came forward with ideas and then said “I will run with it” and “I have energy about it.”
• We try to keep up to date on evidence-based programs such as – falls prevention.  We can sometimes do an event to push the information out farther, and it keeps us in touch with best practices.
• We learned that you have to be patient for the alignment of resources, staff and interest.
• We also learned that we may be able to promote ideas differently or re-conceptualize work.  Like our work on the importance of “social connections”; we moved it over to our civic engagement work within the livable communities initiatives.

Where are you with regard to sustainability of the Partnership work and neutral table?

• The “New York Connect” program helps support training & education. Aging Futures staff facilitates these projects which tend to overlap with other efforts we support.
• Other organizations apply for grants together because they have learned the value of working in Partnership.
• The Partnership will continue.  It is too important to let go of here.
• Maintaining the Neutral table is really critical.
• Our Partnership continues because the Area Agency on Aging makes it a priority due to Kathy and her leadership.  That could change if a new person ever entered Kathy’s role.  It is just Kathy’s approach that the Area Agency on Aging  “needs to push aging issues into the community.  She makes sure that the resources are dedicated to do this.
• Turnover in any role is really difficult, especially to replace institutional memory and institutional commitment. 
• Other coalitions tend to be primarily focused on information sharing; instead of the data collection, evaluation, planning and action which our Partnership has undertaken.

Are there some things you have learned about working in Partnership that you want to share?

• We learned that you need to pick a lead agency with a commitment to aging issues, though it does not have to be the publicly funded Area Agency on Aging.  The host organization needs to not be too small though – it needs to large enough to shepherd this work. The scope of this work is large.
• Find ways to fund your most important niche role early.  Funding projects is easy.  Funding the functions of the Partnership is less so.  Determine what roles you best fill, ie. Data collection, information sharing, convener etc. and find funding for those key functions.
• The change in relationships has been very powerful.   When we have worked on applications to foundations for different initiatives, the Partnership used a great process to create a concept, put the paper together, who potential contractors might be for needed work.  We knew who to go to for preparation of the budget, text, etc.  Working in Partnership helped us to know how to go through the process – we collaborated as we had before.