SALSA Partnership
(Seniors Accessing Long-Term
Care through Strategic Planning
and Advocacy)

For information, contact:
Adan Dominguez
915-533-0998
adand@ricog.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?

In the late 1990’s, the state legislature asked for a plan to address the current and future issues relating to the aging of the population in the region. When Adan Dominguez took a job with the Area Agency on Aging, he facilitated the development of this community driven plan in 1999, which unfortunately was shelved after publication, with no further action taken. Stakeholders in the region, upon learning about the RWJ Foundation request for proposals for the Community Partnerships initiative, believed it offered a new opportunity to work collaboratively toward their vision for El Paso, despite the inaction of the State leadership. Local leaders said, “We learned – don’t wait for the state!” However, the Partnership work was also beginning in the context of a prior collaboration called “United El Paso,” which had a wide ranging agenda beyond just aging issues; this prior collaboration failed due to the inability of participants to commit to formal structure. “The prior collaboration choked on memorandums of understanding. People became very gun shy and focused on word-smithing documents rather than moving forward.” With this history in the region, the SALSA Partnership set out to undertake the creation of a Community Partnership to work on the important issues which had been identified in the 1999 community plan.

Demographics: El Paso is the fourth poorest city in the United States, in a state that ranks 49th in the per capita spending for social services, yet the city is described by the project staff as always placing “a high priority on fulfilling the needs of its senior population despite daunting challenges.” “Although El Paso must face extremes of poverty and socioeconomic deprivation that exist in very few U.S. cities, there are great strengths as well…..It is a community with deep respect for elderly; it has the ability – out of necessity – to do a lot with a little; and there is profound understanding of how to negotiate and live well within two distinct cultures.”

• The older adult population increased by 37% in the ten years prior, in a region which is 78% Hispanic.
• The rate of nursing home placement is less than half the national average here, which the Partnership attributes to the “devotion to the elderly that is a hallmark of Hispanic culture” and the availability locally of family members to provide care.
• While Hispanics are a majority of the population in El Paso, they are a minority in terms of accumulated wealth and education. Older Hispanics are frailer, suffer more chronic disease and are more likely to live in “colonias”, which are rural unincorporated housing developments that often lack proper sewage systems and drinking water.
• “Aging on the border also presents unique challenges”. Approximately one quarter of the households of El Paso contain at least one older adult and 41% of these households are below the poverty line.
• Three quarters of El Paso’s population speak a language other than English at home.

Learning about the issues The SALSA Partnership used focus groups, surveys, a database of community resources and “convening forums” to directly solicit information from community members about long term care services. A Community Service Inventory Committee, which was comprised of partners from academic institutions and other organizations, analyzed the information and developed findings presented to the larger Partnership.

Findings

• Lack of knowledge and confusion about the availability of long term care services is widespread. Better access through a “no wrong door” approach is a preferred improvement
• Cultural sensitivity and humility is needed among providers of services to older consumers. Self-directed or self-managed services are desired by potential users.
• Cost of services, long waiting lists, and uncertainty within the service delivery system contribute to great frustration in accessing services. A strength of the region is the willingness and the ability of informal support systems (such as neighborhood and faith-based organizations) to provide supports to older adults, though these groups are also extremely stressed by the funding restraints regionally.
• “As a border community, some older adults and their caregivers are burdened with language barriers, high levels of poverty and illiteracy and …powerlessness derived from living in a historically underserved community.”

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

Vision: “The community’s vision for improving long term care and supportive services includes building an easily accessible, integrated and responsive long-term care and supportive services system. The ‘No Wrong Door’ philosophy inherent in the Partnership’s vision would allow any older adult needing long term care and supportive services entrance into the system through any organization with links to long term and supportive services. The community envisions a system that is proactive in prevention of disease and injury, and maintaining health and independence as well as a system that is responsive to the long term care and supportive service needs of older adults.”

Structure
SALSA initially created a structure of four work groups to “provide valuable input and help with dissemination of information,” representing the constituent groups of: 1) families and consumers, 2) the provider network, 3) the “partnership” network (private organizations, business, civic leaders), and 4) community action panels.
All four of these groups were to be represented in the Core Leadership Group “to provide input into the project design and take information out to the respective groups.”

Shift in Direction - In late 2007 and early 2008, Partnership staff described their Partnership as going through a new cycle of regeneration; during this period they held 5 community roundtables on which to base a new strategic plan in partnership with AARP. This led to a much more formal structure and roles, with a Coordinating Council giving leadership to 5 new workgroups, using memorandums of understanding between partners to clarify commitment. The workgroups focused on the specific topics of: a) Legal, Financial & Protection issues for older adults; b) Education, Volunteerism & Employment; c) Care giving and Community Support; d) Health & Healthy Aging; e) Housing, Transportation & Recreation.

Goals which evolved

1. Increase coordination among service providers to improve service delivery for diverse population needs through education and communications media;
2. Create opportunities for advocacy and for the participation of older adults to participate in the process of policy development and implementation;
3. Maximize long-term care service delivery through the efficiency of service coordination; and
4. Strengthen formalized policies and procedures for SALSA in order to ensure sustainability of the Partnership

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

Priority 1: – To increase communication and coordination

• A client information sharing system was developed and utilized by two organizations, serving over 11,000 older adults.
• The Universal Intake form, originally planned by the Partnership, became unnecessary when agencies which joined the client information sharing system used the intake tool that was a part of that software.
• The proposed Smart Card technology project went away due to lack of interest by providers.
• Provider cross training was delivered to promote broad knowledge of the span of services in the region.
• Cultural humility training was delivered to equip providers to offer culturally sensitive services; the training has spread to many partners and was delivered at the state Department of Human Services in 8/07.
• The goals on creating “No Wrong Door Access” are evolving into the ADRC model.

Priority 2: – Preventative Service Activities

• The Partnership secured expanded coverage of issues affecting older adults through print, radio, and television media in English and Spanish; including a weekly “Viva 3rd Age” newspaper column (199 articles) and weekly radio show on KTEP (191 “Senior Junction” radio programs).
• The “Rings of Age” film festival in September, 2006 resulted in the creation of 15 films on issues affecting older adults presented to 250 people. Some of the films were featured on the local National Public Radio affiliate.
• Distributed 1500 Resource Tool Kits; and the Area Agency on Aging has replaced this with local “Gold Pages” now available on-line.

Priority 3: - To increase the leveraging of public and private resources so that consumers have enhanced choices for self directed programs.

• New relationships have been developed with non-social service provider agencies such as neighborhood associations, faith-based groups, transportation providers, and filmmakers. The Partnership has grown to 80 agencies and over 200 participants.
• The SALSA Partnership refined its advocacy initiative, called “Senior Senators,” to maximize participation from consumers and to give participants training on how to communicate effectively with elected officials and other stakeholders. These consumers were critical to the recent Partnership regeneration and strategic planning process using the 5 roundtables.
• In fall of 2006, the Partnership led a Transportation initiative which resulted in a Summit of elected officials, non-aging providers and consumers; during the summit, elected officials committed resources to improving the coordination of local, state & federal transportation programs. This group has since partnered on grants which indirectly benefit older adults (e.g., a New Freedom grant providing transportation to people with disabilities in the outlying towns of El Paso County).

IV. Challenges the SALSA Partnership faced.

• Death and deployment of Partnership staff
• Consumer advocates were often focused primarily on the issue important to them, and less so, the bigger picture about the issues of an aging population.
• Scarcity of resources in region,
• Stakeholder aversion to formal structure early on.

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

Coming soon!