Care for Elders Partnership

For information, contact:
Jane Bavineau
713-685-6506
jbavineau@shelteringarms.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 Care for Elders Partnership is an outgrowth of the Senior Adult Services Coalition that began meeting in 1999 to educate the public, policy makers and funders about aging-related issues, and to coordinate efforts for improving services. Chief Executive Officers from six provider agencies formed a Coordinating Board to solicit input about gaps in services and strategies for systems wide improvement.

The development of the Partnership presented an opportunity to build upon this and other collaborative ventures, to “formally unify previous efforts,” and to take a more comprehensive approach. The Care for Elders Partnership in Houston pulled together a very broad array of consumers, funders, providers, advocacy and minority groups, health care systems, educational institutions, businesses and the media, as well as major public organizations such as the Area Agency on Aging and the Veterans Administration.

Learning About the Issues: In Houston, information upon which to set the direction of the Partnership’s work came from collecting and reviewing existing community needs assessments, from researching best practices and models, from analyzing the results of the initial Mathematica report, and from a follow up survey process undertaken by the Partnership to reach special populations who were under-represented in the Mathematica survey. Focused surveys were conducted for: 1) Those who were not English proficient (in Spanish, Chinese, Vietnamese and Korean), 2)Those living in outlying areas of the county, 3) Those already receiving care and services, 4) Working caregivers, 5) and Gay, lesbian, bi-sexual and transgender individuals.

• After the findings were compiled, stakeholder meetings were conducted in 93 of the region’s zip codes to get feedback on the findings and emerging priorities.
• Information was further analyzed through the work group structure and the consumer advisory council for data regarding access to, availability of, affordability of and quality of services in the Harris county region.
• A very diverse group of 533 older consumers and 200 providers then actually voted on all the possible issues and strategies so the Partnership could begin establishing priorities.
• The Executive Committee developed a Criteria for setting priorities to guide the selection process, and the first draft of Partnership priorities was developed based on the community votes, workgroup recommendations and consensus of the Partnership leaders (Executive Committee, project staff and members of the Consumer Advisory Council).

Findings

• One surprise was the lack of existing data on long term care needs and the capacity of the service system.
• Knowing about services did not necessarily translate into service use by older adults, due to fears of personal safety, low quality of services, rude providers and pride of consumers. Fear was especially high about being robbed by home care workers, or of having physical or mental safety compromised by them.
• Although more than half of Harris county elders participate in religious activities, they did not get information on long term care services from these faith communities.
• There is a need for coordination between services to address systems and consumer barriers to access. Many unmet needs for assistance with activities of daily living were documented.
• Consumers lacked knowledge about where to turn for information.
• There was a need for education of elected officials, policy makers and the broader community about elder issues.
• Transportation, mental health and other critical services for older adults needed expansion.
• There was a need for promotion of personal planning among older adults and caregivers regarding long term care needs.

II. Getting Started: What Vision and Structure emerged?

Vision: Care for Elders is a Partnership of 85 organizations that is committed to systems change that will improve access, availability, affordability and quality in long term care. Goal: To improve care and services provided to vulnerable older adults and family caregivers in Harris County through collaborative problem solving and strategic planning that involves consumers, providers, funding organizations, and other major stakeholders of the long-term care system.

Structure: As the Partnership began its work, it organized itself through an Executive Committee functioning as the core leadership group; there are also eight workgroups on evaluation, communications, government relations, access/coordination, resource development, quality & workforce issues, stakeholder education and volunteer involvement; and there is a Consumer Advisory Council of elders and caregivers to make sure the perspective of older consumers was included.

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

Unexpected priority: Disaster Response to Hurricane Katrina

• After Hurricanes Katrina and Rita hit the Gulf Coast in September 2005, all Partnership efforts were temporarily re-directed to meeting the needs of frail older adults evacuated to Houston. Many elders were displaced (estimated to be up to 60% of all evacuees) with few resources and many had left all local supports and family behind.
• A team of gerontological professionals from the Houston area, including the Care for Elders Partnership, met and devised ways to quickly address the needs present in the Astrodome and to then leverage resources out to where they were needed.
• A rapid screening tool (or SWiFT) was created to assess cognition, medical and social services needs, and physical functioning; it was then used by teams of social workers and medical staff in the Astrodome on older evacuees.
• The Partnership operationalized the system of getting email & phone communications out, recruiting volunteers, listing jobs that needed to be filled at the Astrodome, equipping a central station at the Dome with computers and internet access, and distributing donated cell phones, computers and other resources.
• The Partnership provided the case management services to all older adults and people with special needs in four locations, benefiting at least 2,000 elders who arrived from other parts of the country. The volunteer assessment teams operated for two full weeks until the Astrodome emptied, and then Partner agencies followed up with older evacuees for many months regarding on-going needs and re-uniting them with their families.

Priority 1: Access.

• The Care for Elders Access Network, created to address system fragmentation, is operational with a strengthened community resource base of 759 updated records on service providers. Formal agreements exist between partners to provide “comprehensive assistance in accessing needed services.”
• A flexible funding pool that case managers are using to address special unmet needs of older adults was created through $200,000 made available by the United Way.
• Atlantic Philanthropies & the Hartford Foundation’s Practice Change Fellows program, through selection of Partnership Executive Director Jane Bavineau as a Fellow, is funding the intended next stage of the Access Network – creation of linkages between health care systems and community care in a “Hospital to Home” project.

Priority 2: Quality and Workforce Initiatives –

• In 2007, Houston Community College adopted the 16-hour curriculum for worker orientation developed by the Partnership, and began offering a new Home Care Attendant course to individuals interested in this work. An evaluation of the 550 workers participating in the Partnership’s original training pilot showed that “there was a statistically significant positive relationship between attending the orientation training and the workers staying employed in direct care”, demonstrating that the training could impact retention of workers in the field.
• The Partnership’s advocacy about the need for stricter regulations regarding the screening & hiring of attendant care workers became Texas policy in the last legislative session

Priority 3: Healthy Ideas Depression Management program –

• This evidence-based self-management intervention for diverse elders at risk of un-recognized or under-treated depression clearly demonstrated, when evaluated, that participants experienced reduced levels of depression and gained increased knowledge about how to get help. Three community agencies have imbedded this depression intervention into standard case management practice and consumers became much more aware of resources available through publicity about Health IDEAS, including a feature on KUHF, the Houston Public Radio morning news.

Priority 4: Planning for the Future: Take Charge campaign –

• Because so many older adults and baby boomers were clearly unprepared for the challenges they are likely to face as they age, the Take Charge campaign was developed to provide educational materials and resource tools to help them plan ahead.
• The related Take Charge website was visited by 4,200 people in its first year, and 580 people participated in face to face presentations.

Priority 5: Advocacy –

• The Care for Elders Partnership worked very hard on legislative and regulatory changes that would impact the quality of the direct care workforce, specifically 1) for a more stringent list of criminal convictions that would prohibit an individual from being hired as a direct care worker, 2) that a minimum of 16 hours of orientation be provided to individuals hired to provide direct care to older adults and 3) encouraging improved wages and compensation for direct care workers. The bill passed, defining those criminal convictions that will bar employment as a direct care worker.
• In collaboration with other advocate groups, such as the Texas Senior Advocacy Coalition, legislators were educated and briefed about the flaws in the current background screening and worker training systems. Testimony at public hearings and legislative study groups will continue

Priority 6: Resource Development -

• The Partnership has raised 3.6 million dollars since the start of their CPFOA grant involvement, from local foundations, the United Way, TXU Energy, and the Houston Endowment among many local supporters.
• Funding organizations were attracted to the Care For Elders Partnership because they “1) appreciated the …working collaborative approach to the work, 2) were eager to see change at the systems level …..and 3)Valued evaluation and wanted to know the …impact as a result of their investment.” The inclusiveness and diverse nature of the Partnership also instilled confidence.

Priority 7: Public Awareness/Outreach –

• The Partnership produced and disseminated 2 documents widely in the region: 1) “Meeting the Long Term Care Challenge, a Strategic Plan for Addressing the Needs of Older Adults and Family Caregivers in Harris County” and a shorter version, “Changing Long Term Care into Long Term Hope.”
• Working with a communications firm, the Care for Elders Partnership created a full campaign of outreach on issues of older adults and distributed information about options and resources that included a redesigned website, brochures, messaging guidelines, print ads, a 2007 legislative recommendations document.; the workgroup is about to launch a second phase called “Get Ready for Life.”

Priority 8: Evaluation –

• Throughout the Partnership’s operation, comprehensive work and evaluation plans helped it to measure outcomes as well as specific outputs. An important accomplishment of this Partnership has also been about process as well as direct impact, since many organizations providing similar and complementary services came together to form networks and to improve coordination within the long term care delivery system.

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

An interview between Jane Bavineau, Partnership Executive Director, and Phyllis Bailey, Senior Information Manager of CPFOA national program office in November, 2008.

What is currently going on at your Partnership? What are you working on? What do you see as key impacts of your Partnership?

• At this juncture, we are being challenged “differently” by some funders in that they want to know how we differentiate ourselves from other collaborations – and it remains a challenge to differentiate ourselves from service providers.
• Jane emailed a report she prepared for one funder outlining the differences the Partnership has made which differentiates it from service providers and other collaborative approaches. (the report is inserted below.)
  The report tells the story of “how we are framing our work differently, because people still get confused about whether we are a provider.”
• One local foundation questioned us about our budget growth, when in reality, our budget only got bigger because we took on new work. Jane talked to them about pilot based work, and the fact that the budget wouldn’t have to grow if they were willing to settle for just “more of the same” vs adding new pilots and initiatives.
• Our Partnership’s approach is 1) research and data collection about problems, 2) strategy development to address the problem, 3) piloting a strategy, 4) evaluation, 5) disseminating lessons learned, then 6) moving the strategy out, i.e. imbedding it into community practice.
• We are working on a “Hospital to Home” pilot, but are not sure this funder will support it with a grant.
• As funders have warned us about “tough times ahead” we have told them that we respect that foundations can change directions and /or lose money, but it would help if they told us that up front. Jane also told them “If we need an exit strategy for the partnership because we can no longer attract sufficient funds, then please let me plan for that”.
• Jane also told them that as a Partnership “we do not have fee- for- service options like providers do. That is why we apply for funds.”
• The funder said “other collaborations get around a table and don’t take this amount of money”. Jane responded “if all you want is to get people together for lunch and planning, it’s a lot less dollars. We do more than that – we pilot and evaluate.”
• So we are working on differentiating the Partnership more clearly from other collaborations by articulating what we have defined as our targets for systems improvements, including:
  1) collaboration & leadership;
  2) service delivery and community practice;
  3) policy and legislative action;
  4) direct care work force change,
  5) personal preparedness promotion

The following insert is the special report on differentiation which they prepared.
The Care for Elders Partnership is focused on the systems that must evolve to improve the care and services provided to older adults, and on improving the “way we do business” in the aging network. Partners design, implement, and evaluate pilot projects to inform policy, influence community practice, and ultimately, improve life for older adults and family caregivers. The partnership also embraces consumer level initiatives that provide resources and tools to support personal action for ensuring individual health, independence and well-being.

Success is achieved when improvements are realized in the following areas, and is measured by the indicators below:

• Collaboration and Leadership – the partnership leads key stakeholders in collaborative problem solving and coordinated action that addresses community-wide, aging related challenges.
  Previous Success: United Way called upon Care for Elders to convene and coordinate members of the aging network in addressing the needs of older adults impacted by Hurricane Ike.
  Future Indicator: Care for Elders convenes and leads private and public sector stakeholders in creating and carrying out a collaborative plan of action to address at least one major community-wide elder care concern each year (ex. support for family caregivers).
  
  
• Service Delivery and Community Practice – state-of-the-art or best practice methods or products developed or selected by the partnership are utilized by service providers or embedded into routine community practice.
  Previous Success: Formal (written) linkages were established between 10 public and private sector organizations to create the 211/Care for Elders Access Network that provides consumers with one number to call for resource information and access to professional help in pursuing needed services and solving problems.
  Future Indicator: At least three of the case management agencies participating in Care for Elders Access Network adopt at least one evidence based intervention or best practice into their routine service delivery i.e. medication management, hospital to home care transitions intervention.
  
  
• Policy and Legislation – results of Care for Elders pilot projects are used to inform and affect policy change.
  Previous Success: Results of CFE’s direct care workforce screening pilot provided the basis for Senate Bill 199 that became Texas law in 2006 and makes it more difficult for individuals with criminal convictions to be hired as personal care attendants for older adults.
  Future Indicator: Legislators and policy makers call upon Care for Elders for information about effective ways to meet the needs of older adults and their families and create elder-prepared communities.
  
  
• Direct Care Workforce – frontline, hands on workers serving older adults are trained and adequately prepared to provide quality care.
  Previous Success: The comprehensive orientation curriculum for direct care workers developed by CFE was adopted by Houston Community College for their Attendant Care course and is now offered to interested individuals in the community.
  Future Indicator: All direct care workers are required to complete a minimum of 16 hours of elder care training/orientation within the first six months of employment.
  
  
• Personal Preparedness – individuals plan ahead and take action to improve their readiness for the likely challenges of the aging process.
  Previous Success: A website (www.getreadyforlife.org) was created and provides high quality resources and tools to help older adults and family caregivers gain knowledge and skills that promote “successful aging”.
  Future Indicator: Members of at least two senior groups successfully complete a facilitated process through which they take action in at least two of the four domains (i.e. housing, health, finances, and civic engagement) discussed in Care for Elders Get Ready for Life program.

Is the Partnership being affected by economy? Are funders?
There are budgetary challenges – United Way, corporations, all entities have less to give.

Have you observed any unintended consequences from working in Partnership?
When Hurricane Ike happened – we never intended to lead any part of the recovery effort, but no one else stepped up. There were older adults in high rise buildings with no power who got stuck without water and food for 10 days and could not get out. Right after the storm, FEMA walked around and asked older residents if they wanted to evacuate. People said no – but that’s because they did not envision the impact of living 10 days without power.

With the huge challenges we experienced following Katrina and Rita, we did not want to be the default disaster recovery team ever again. However, United Way called and asked us to convene the aging network to check on the status of the distribution of food, water & ice; and tree removal. We also prepared a post-disaster report that highlighted several recommendations for improving our community’s future disaster response to older adults.

Has your Community Partnership changed the way of doing business in your region?

• We have a new Area Agency on Aging director and we are hopeful. We have been relentless in asking them not to duplicate the work we’ve done, but to complement it. For now at least, the AAA is trying to work with us. 80 partners are hard to ignore and so it seems that the AAA is acknowledging the Partnership now.
• The AAA recently got a grant for an Aging and Disability Resource Center, and this is where there is great opportunity to duplicate and disregard our work. We’ll see, but Jane has been in every loop and the Care for Elder Partnership has committed to providing some staff support to the ADRC if indeed it was set up to complement what we had already done.
• A Hospital to Home Initiative that created a linkage between health and community care has always been on our radar. Now, with the Practice Change Fellows grant we received, we have the chance to do this.
• We hope to roll out this care transitions initiative with new tools for the case management staff across all seven agencies that provide case management through our Access Network.
• So far we are primarily offering practice enhancement tools to case management partners, but no additional money - so enthusiasm is less than expected. So we are also exploring other types of incentives (including perhaps money) to hook their interest, especially if we are asking them to work differently - possibly taking on more work and clients. They may not bite on our incentive – we will see.

What other challenges have faced your Partnership lately?

• Trying to get the Governing Council to narrow the focus of the Partnership – to take on fewer things at one time. They are reluctant to pull back. I’m trying to get them to set priorities – at least “philosophically”. So far, they aren’t biting.
• Determining what our next steps should be regarding our direct care workforce goals. We are moving beyond just training for the workers to how we might influence the supervision and management of this workforce. We are considering a two-day training – with one day for the employers and one day for the direct care workers themselves. We are also thinking about creating an incentive for agencies that put a “best practice” into place – like a career ladder or a mentoring program.

> We are still (in sort of a ‘back door’ way) serving as the Technical Assistance Center for the national dissemination of Healthy IDEAS, an evidence-based depression intervention. It’s not as explicit in our mission as some of our other work, but we developed, implemented, evaluated and disseminated it – but now the money is getting tight. NCOA has been generous but is pushing us to think like a business We are learning a lot about operating in a business model.

> Our Director of Public Policy and Advocacy resigned to go to law school, and that has been a big loss to us. Interns have tried to continue some of this work, but they have different skills and need a different level of supervision. So we are looking at different approaches for doing policy work because I don’t have someone to pick this up.

We’ve done some things with our website to compensate for the lack of a policy director – have added back up documents, issues reports, and a legislative agenda to help people stay up to date on issues. Our policy focus is primarily on the direct care workforce – especially issues of mandated training and improved wages.

Staff changes have required the Partnership executive director to be more ‘hands on’ when what I really need to focus on are things like recruiting new members for the core leadership group – our Governing Council. Right now, there is very little time to be out there driving the community presence the partnership needs to sustain to thrive.

What are some of the lessons you have learned in your Partnership work?

• I wish we had positioned the Partnership to take on one issue a year not five. And to implement the deliberative process for them all. I keep a running list of “emerging issues” we could tackle, but we cannot work on all of them. We use a nominal group technique to help prioritize which issues we should focus on next. I also kept asking everyone ”is this where you want to have impact”?
• We need to find new things to keep people ‘spiced up’ and interested, including staff. And, we need diversity in our staff to make sure our skills complement each other – for example, I am just NOT a maintenance person.
• Emergencies like Hurricanes make it very difficult to stay on top of the regular Partnership work and keep it moving forward. It is chaotic – and thankfully there are folks that thrive on chaos – I’m just not one of them.
• You’ve constantly got to be out there driving the community presence of Partnership
• I am still adamant about having a strong evaluation plan. Our current document actually serves as work plan and evaluation plan. It holds us accountable and provides feedback on our performance.
• We are capturing our costs and budget in such a way that it shows an infrastructure amount, to let funders see what it takes to keep the Partnership going and what each special initiative costs. We need to spread more of the staff costs to the project work.

We believe it takes at least 2.5FTE staff to support and maintain the partnership – any less and you should pack it up.