Models of Community Collaborationfor Long-Term Care

Nancy Whitelaw, Ph.D.

Director, Center for Healthy Aging

National Council on Aging

March, 2006

www.healthyagingprograms.org

Guiding Principles for Our Work*

Make Prevention a Priority Start with the Science – “Evidence” Work for Equity and Social Justice Foster Interdependence

Aging network Health care Public health Long term care Mental health Research

* James Marks, MD

Social Ecologic Model of Healthy Aging

Individual

Interpersonal

Organizational

Community

Public Policy

McLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev Med

What the Social-Ecological Perspectives Says

The health and well-being of older adults will be improved only if we work from a broad perspective.

Comprehensive planning and partnerships at all levels are required.

Harassing individuals about their bad habits has very little impact.

Changes at the individual level will come with improvements at the organizational, community and policy levels.

Our National Partners

Robert Wood Johnson Foundation The John A. Hartford Foundation of NY Administration on Aging Centers for Disease Control & Prevention Substance Abuse and Mental Health Services Adm. Centers for Medicare and Medicaid Services Merck Institute on Aging and Health Archstone Foundation Home Safety Council California Endowment

Our Research Partners SUNY – Albany U Conn U of Houston Baylor College of

Medicine U of Southern

California Thomas Jefferson Univ U of S Maine Oregon Research Inst

U of WA U of North Carolina Texas A & M U of Ill, Chicago U of Ill, Urbana UCLA Stanford Texas Diabetes Inst PRC Healthy Aging

Research Network

Choices for Independence

Empowering individuals to make informed decisions about their long-term support options

Providing more choices to help moderate and low-income individuals at high-risk of nursing home placement to remain at home

Enabling older people to make behavioral changes that will reduce their risk of disease, disability and injury.

AoA Evidence-Based Prevention Initiative

Older adults are largely ignored by health promotion/prevention initiatives and funding.

Recognize the importance of promotion and prevention for older adults – make it a priority.

Replicate “evidence-based” models by carefully adapting them to your community.

Engage community organizations in this endeavor to maximize reach to at-risk populations.

AoA Initiative - Evidence-Based Programs

Disease self-management (5) Diabetes Heart disease Depression Chronic Disease Self-Management

Program (2)

Physical activity (3) Falls prevention (2) Nutrition (2) Medication management (1)

Changing the Question

Old question: Does what we are doing work?

New question: Can we do what is known to work?► What do we know works?

► How well do we know it and understand it?

► About whom do we know it?► Who do we need to make this a success?

Interventions That Work

CHRONIC DISEASE SELF-MANAGEMENT PROGRAM Lorig KR et al. (1999) Medical Care.

MULTIFACTORIAL INTERVENTION: Tinetti ME et al. (1994) New England Journal of Medicine.

MATTER OF BALANCE: Tennsdedt, S et al. (1998) Journal of Gerontology.

PEARLS: Ciechanowski, P et al. (2004) Journal of the American Medical Association.

IMPROVING MEDICATION USE: Meredith, S et al.(2002) Journal of the American Geriatrics Society.

EXERCISE PLUS BEHAVIORAL MANAGEMENT IN PATIENTS WITH ALZHEIMER DISEASE Teri, L et al. (2003) JAMA.

Involve Key Community Organizations as Full Partners in Design, Implementation, and Evaluation Community Aging Service Provider

► To provide the Evidence-Based Prevention service► To coordinate service components from other providers, such as

health care providers AAA

► To link the program to appropriate collateral services► To promote the adoption and expansion of successful programs

in the community Health Care Organization

► To assure the quality and appropriateness of the health components of the program

► To enhance and promote coordination between the aging network and the health care service system

Research Organization► To assist with the translation of the research into the program

design► To assist with training and evaluation

Keys to Success

Self efficacy, active learning and self care► use effective self-management support strategies► assessment, goal-setting, action planning, problem

solving, follow-up, positive reinforcement► peer support groups; peer health mentors

Social and familial context Cultural context Connections to health care Outcomes focus - social, mental, physical,

functional

Skills and Expertise of the Aging Network

Outreach Screening, assessment Health education; health promotion Attention to social and cultural context Peer support Supportive services Accessible, affordable programs

14 AoA Demonstration Sites

East: Portland, Maine; Hartford; Albany; Philadelphia

Southeast–South Central: Miami; Houston; San Antonio

Central: Western Michigan Western: Los Angeles; Portland OR; Seattle

Local Partners Community aging service providers Area Agencies on Aging Hospital, health system, physicians, health plan Faith-based groups and organizations Culturally-specific centers Consumers Research centers, universities County/City social services State Unit on Aging Health departments Local foundations Others

Over 100 Settings

Senior centers

Housing sites

Culturally specific centers

Faith-based organizations

Social service agencies

Case management offices

Libraries

Tribal communities

“It’s all about relationships and having similar goals.”

Relationships, relationships, relationships► Give them time► Program champions

It starts with values. ► Improving the health of participants► Building a positive image of our organization► Establishing common goals

Program outcomes matter. Program and organizational reputations and

competence may matter even more. Partnership process

► Regular forms of communication► Agreements, whether formal or informal► Staff on board► Recognition of efforts and celebrating successes

Examples of Partnership Sessions

Friday, March 17th  

Building Evidence-Based Disease Prevention and Health Promotion Into Community-Living Through Modernization of the OAA 8:00 - 10:00 am

Public-Academic Partnerships in Geriatric Mental Health 10:30 - 12:00 pm

Falls Free Coalition: Making a Difference Through Collaboration 10:30 - 12:00 pm

AoA's Integrated Care Management Program 10:30 - 12:00 pm

Mental Health Programs for Older Adults: AoA and SAMHSA 2:00 - 4:00 pm

Saturday, March 18th  

Healthcare Provider and Aging Network Partnerships 10:30 - 12:00 pm

Sustainability Through Collaboration 10:30 - 12:00 pm

New Care Management Strategies to Improve Health Outcomes 4:30 - 6:00 pm

Sunday, March 19th  

Engaging Frail Elders in Evidence-Based Home Physical Activity 9:45 - 11:15 am

NCOA’s Center for Healthy Aging Collaborate with diverse organizations to

contribute to a broad-based national movement.

Identify, translate and disseminate evidence on what works – scientific studies and best practices.

Promote community organizations as essential agents for improving the health of older adults.

Advocate for greater support for strong and effective community programs.

Center for Healthy Aging Increase the quality and accessibility of health

programming at community agencies serving older adults National Resource Center on Evidence-based Prevention Evidence-based Model Health Programs Falls Free: National Falls Prevention Action Plan Moving Out: Best Practices in Physical Activity MD Link: Connecting Physicians to Model Health

Programs New Connections: Partnerships between PH and Aging Get Connected: Partnerships between MH and Aging Collaborative Care for Aging Well

Partnership Resources www.healthyagingprograms.org

Checklists, Questionnaires and Tests► Collaboration Math: Enhancing the Effectiveness of Multidisciplinary Collaboration

Manuals and Guides► Eight Steps to Effective Coalition Building ► Partnering to Promote Healthy Aging: Creative Best Practice Community

Partnerships ► Promoting Older Adult Health: Aging Network Partnerships to Address Medication,

Alcohol, and Mental Health Problems ► The Tension of Turf: Making it Work for the Coalition ► Working With Your Local Physicians

Reports► The Aging States Project: Promoting Opportunities for Collaboration Between the

Public Health and Aging Services Networks Toolkits

► MD Link: Partnering Physicians with Community Organizations ► The Community Toolbox

Websites – Organizations► Community Partnerships for Older Adults

Nancy Whitelaw, DC

www.healthyagingprograms.org