Models of Community Collaboration for LongTerm Care

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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

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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

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Social Ecologic Model of Healthy Aging
McLeroy et al., 1988, Health Educ Q Sallis et
al., 1998, Am J Prev Med
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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.

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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

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Our Research Partners

• 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

• 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

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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.

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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.

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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)

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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?

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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.

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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

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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

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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

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14 AoA Demonstration Sites

• East Portland, Maine Hartford Albany
  Philadelphia
• SoutheastSouth Central Miami Houston San
  Antonio
• Central Western Michigan
• Western Los Angeles Portland OR Seattle

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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

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Over 100 Settings

• Senior centers
• Housing sites
• Culturally specific centers
• Faith-based organizations
• Social service agencies
• Case management offices
• Libraries
• Tribal communities

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Its 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

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Examples of Partnership Sessions
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NCOAs 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.

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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

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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

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• Nancy Whitelaw, DC
• www.healthyagingprograms.org