San Francisco Partnership for
Community-based Care & Support

For information, contact:
Bill Haskell
415-355-6782
bill.haskell@sfgov.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?

San Francisco is a service-rich city, yet it came out on the bottom in terms of consumers’ knowledge of services available to them as documented by the results of a survey early in the Partnership’s development. This helped “hook” people to the Partnership and to gain support for Partnership work, including a public awareness campaign to improve knowledge of and access to services.

Another aspect of the context for the Partnership was a consolidation of functions in a new public department to serve elders. The Department of Aging and Adult Services (DAAS) was created in July 2000 to consolidate county services for older adults and adults with disabilities, pulling together services of the Office for Aging, Public Administrator, Public Guardian, Public Conservator, Representative Payee services, County Veterans office, Adult Protective Services, and the Senior Escort program.

A “Silo” mentality existed, as organizations had their own funding streams and service delivery models. Before the existence of the Partnership, collaboration did not consistently happen here and there was no single entity to oversee improvements in community-based long term care. Communication was crucial to “Bringing the community to the table.”

The Region’s Demographic Imperative – Of San Francisco County’s 770,000+ residents, 14% were already over 65 in the year 2000 and that number will grow to 19% by 2025. The Bay Area is projected to become one of the oldest in California with 41 seniors for every 100 working age adults. Due to the increased longevity of women, they outnumber older men 2 to 1, though they often have fewer financial resources with which to negotiate advanced age. San Francisco’s older population is also very diverse (37% Asian Pacific Islander, 9% Latino, 8% African American, and over 17,000 are estimated to be Gay, Lesbian, Bi-Sexual, or Transgender), increasing the need to ensure cultural sensitivity in service delivery and access. Since 29% of seniors do not speak English at all or as a first language, further barriers to information and services challenge them. One third of the 65+ population has incomes at or below $14,453 annually, (which is 175% of the federal poverty rate) in the midst of a region with one of the highest costs of living in the United States.

• The Partnership learned through its early assessments and community discussions that housing, transportation, homelessness and long term care service delivery were the four top issues for vulnerable adults and their caregivers. The Partnership made the choice that the first three were city-wide issues beyond the scope of their work, but that they could have an impact on long term care service delivery, and decided to focus on the most vulnerable older adults as defined by low income, lack of informal support, frailty and minority status by race, ethnicity or sexual orientation.
• To determine priorities, the Partnership reviewed historic data, newly collected information, national best practices, focus-group results; they met with community based service providers and consumers from various underserved populations. To include the perspectives of those who could not attend meetings, surveys were distributed to older adults through the home meals delivery program. All information was reviewed and analyzed, with findings presented to key stakeholders in the Partnership, the Strategic Plan Committee, the Living with Dignity Policy Committee, the Aging and Adult Services Commission and the Advisory Council on Aging, as well as a variety of caregivers. Key areas for strategic system improvements were identified and the Partnership then undertook a consensus-based discussion of potential priorities.
• The priorities were presented to key stakeholders throughout the long term care and supportive services system, which helped define objectives and strategies further. Through these discussions, participants came to agreement about collaborating and sharing responsibility for the work to come. Participating individuals and organizations eventually came to consensus about priorities, and what workgroups were needed. Leadership developed for the workgroups, though some changed over time.

II. Getting Started: What vision, strategies and structure emerged?
Vision: Living with Dignity – Implementing strategic system improvements to create a coordinated model of service delivery for vulnerable older adults in San Francisco.

Strategies – Improve access to community-based services for older adults and adults with disabilities by:

• Increasing awareness of community-based long term care services.
• Enhancing collaboration among public & non-profit service providers
• Expanding financial resources for community based long term care services.

Goals of the Project:

• Improve coordination of home and community-based long term care services for vulnerable older adults
• Advance quality of life, and quality of home and community based care for vulnerable older adults and caregivers.
• Promote home and community-based long term care services for vulnerable older adults.

Structure – This Partnership of 70 member organizations operates with a Core Leadership group and four workgroups driving out initiatives: 1) the Public Relations & Marketing Workgroup, 2) the Home Care Workforce Workgroup, 3) the Case Management Collaboration Workgroup, and 4) The Neighborhood Partnership Workgroup. The Neighborhood Partnership Workgroup has 5 subgroups of its own. Four of these subgroups are “teams or partnerships,” focused on the issues of specific underserved older populations in the African American, Latino, Asian Pacific Islander, and Lesbian Gay Bi-sexual Transgender communities. The fifth subgroup is focused on the Services Connection Pilot Project for improving service access for diverse elders in public housing buildings. Most of this Partnership’s members are service providers.

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

Priority 1: Strengthen and sustain community partnerships responsive to under-served populations.

• The Partnership developed a senior to senior peer advocate program across the under-served communities to help vulnerable elders negotiate long term care services and now has 30+ trained advocates doing outreach to isolated and homebound elders. They also conducted cultural humility training across the four groups that was cited as a turning point in promoting collaborative thinking.
• The African American community partnership created a report on social service disparities and presented it to the city and DAAS to stimulate discussion on how to improve services. They are now working on the priorities of Transportation, Health Access, and Health Education. Members conducted a successful advocacy campaign that resulted in improved sanitary conditions and food quality at FoodsCo, the only market in the African American Bayview-Hunters Point neighborhood.
• The Asian Pacific Islander (API) community partnership published a Community Resource Guide for API Seniors, with a detailed list of agencies serving the API communities in San Francisco and the languages spoken by each service provider. Development of the city-wide electronic rolodex improved networking between many distinct groups.
• The Lesbian Gay Bi-sexual Transgender (LGBT) community partnership advocated for LGBT sensitivity training for local service providers, which resulted in a partner agency receiving a two-year grant of $186,000 from a private foundation to develop a LGBT training curriculum that equips non-LGBT specific agencies to deliver more culturally sensitive services. The San Francisco Planning Commission approved Openhouse, another Partner agency, to develop LGBT senior housing.
• The Latino community partnership created the “Latinos Visibles” support group and networking coalition for Latino case workers; in addition, providers produced a report on the needs of Latino older adults. They also published a resource directory of Spanish speaking providers and used information on the lack of bilingual workers to successfully advocate for an increased number of Spanish speaking social workers. All of this was featured on the Spanish language news.
• Diversity and cultural sensitivity training - In September of 2007, the San Francisco Partnership sponsored a training day for the four Community Partnerships (“Cultivating Cross Cultural Alliances”), facilitated by Veronica Neal, a diversity educator. As a result, the four Community Partnerships agreed to form new topic-driven collaborations with each other and to develop a diversity action plan.
• Services connection pilot project – After a Partnership survey revealed that many isolated, homebound elders in public housing buildings lacked access to the supports they needed, the Partnership initiated the service connection project. Service Teams were created to work with residents in two high-rise buildings, and providers were invited into each building resulting in many new connections to transportation, home care, medical care, meals, exercise programs, etc. Service Teams were created for two new senior buildings in 2008 and this project has broken through many organizational silos. Initially the Housing Authority had been reluctant to let the Partnership survey its older residents because they were often the subjects of research from which little had come. Partnership staff and partners persisted in developing the relationships with both the Housing Authority and the residents, to the point that when the survey findings were published and the Housing Authority faced staff reductions, it asked the Partnership for help in getting supports to residents. This resulted in the pilot project, and then collaborative preparation of an application for a HUD ROSS grant based on one prepared by the Atlanta Partnership. $375,000 was awarded.

Priority 2: Enable better transitions between home, community-based and institutional services.

• Improve how case management programs work together – Under the auspices of the Case Management Collaboration Workgroup, the S.F. Partnership, DAAS, and the S.F. Department of Public Health (DPH), initiated a pilot project to improve how case management programs work together to coordinate services. 16 case management programs under contract to DAAS or DPH are partnering to coordinate services for their clients through the use of an Electronic Rolodex. This tool enables them to get contact information for all case management programs serving the same client, which also gives them the capacity to get additional information about other services being provided to that client, improving care coordination.
• Community Living Fund – In July, 2007, based on extensive advocacy of members of the San Francisco Partnership and the Long Term Care Coordinating Council, the Mayor and Board of Supervisors created a $3 million Community Living Fund which is annualized in the DAAS budget. This fund is intended to reduce unnecessary institutionalization by increasing options for how and where older and disabled adults receive services. Adults of all ages with disabilities and at risk of institutionalization now have real choices about where and how they will receive services. A very broad array of supports can include case management, community based services, money management and home modification.
  • Enhance recruitment and retention of In-home supportive services workers – Originally, this workgroup planned to develop a Home Care Training Institute, but after three years of extensive work and research, they determined that a new model for development and operation of the institute would be needed and so created a new financial model. In March 2008, the Workgroup hosted a meeting of Bay Area and California Foundations, entitled “Workforce Development and the Home Care Tsunami”, to secure financial support for operation of a model home care training institute that sets the gold standard for training high quality paraprofessionals.

Priority 3: Create & implement improved communications strategies for LTC and supportive services, improved public relations and marketing mechanisms.

• Due to its success in 2006, the Home Alone PR Campaign was repeated three times in 2007, and will be continued by DAAS in the future. This joint effort of the Partnership, DAAS, and United Way’s 211 Community Services information line placed ads in mainstream media like the San Francisco Examiner, ethnic and cultural news media, and on MUNI bus lines. The posters and ad campaign used multi-cultural images of aging, giving a positive and diverse face to age, as well as demonstrating the need for communication in different languages. The resulting 300% increase in calls to the information line demonstrates how the campaign increased awareness of older adults and their caregivers that services exist to help people to live independently in the community.
• The San Francisco Examiner newspaper has asked the Partnership to take over their “Senior Spotlight” column on an ongoing basis.

Priority 4: Support leadership and collaboration among community based service providers, consumers and other organizations.

• In October, 2007, over 120 people, representing a wide range of service providers and consumers, attended the Partnership’s annual meeting to plan for the future. In advance of the meeting, all workgroups participated in a Strategic Facilitation process to identify: (1) Accomplishments, (2) Work To Be Done, (3) Challenges Facing Older Adults, (4) Possible Collaborative Actions, and (5) Potential Future Roles for the Partnership. This has created a foundation for sustaining the Partnership’s collaborative work here.

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

Coming soon!