1. The National Association of County and City Health Officials (NACCHO) Presents Building and Maintaining Local Health Department Partnerships with Area Agencies on Aging and Other Local Aging Organizations Thursday, February 23, 2006 3:00–4:30 pm (ET) 2:00-3:30 PM (CT) 1:00-2:30 PM (MT) 12:00-1:30 PM (PT)

2. Aging 101 Plugging into the Aging Network to Better Reach Older Adults William F. Benson Health Benefits ABCs NACCHO Webinar February 23, 2006

3. 1965 – A Remarkable Year Medicare (SSA, Title XIX) Medicare (SSA, Title XIX) Medicaid (SSA, Title XVIII) Medicaid (SSA, Title XVIII) Older Americans Act (OAA) Older Americans Act (OAA)

4. Many Other Major Laws Enacted Benefiting Older Americans ADEA -- 1967 Social Security Rescue of 1983 OBRA 87 – Nursing Home Provisions Medicaid Spousal Impoverishment Protections Medicaid Waivers Medicare Modernization Act (Part D)

5. Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population Copyright 1996, Watson Wyatt Worldwide. 0 5 10 15 20 25 1930195019701990201020302050 Year Percentage of Population An Aging Population Percentage of U.S. Population over Age 65

6. Percent of Population Over Age 65, United States, 2000 Source: U.S. Census Bureau, 2003. 5.0–9.9 10.0–14.9 15.0–19.9 20.0–30.0 Percent

7. Percent of Population Over Age 65, United States, 2015 Source: U.S. Census Bureau, 2003. 5.0–9.9 10.0–14.9 15.0–19.9 20.0–30.0 Percent

8. Percent of Population Over Age 65, United States, 2025 Source: U.S. Census Bureau, 2003. 5.0–9.9 10.0–14.9 15.0–19.9 20.0–30.0 Percent

9. The future aint what it used to be. - Yogi Berra

10. Older Americans Act 7 Titles – Approx. $1.8 Billion Annually 7 Titles – Approx. $1.8 Billion Annually Statement of Objectives Administration on Aging – DHHS Aging Network – SUAs, AAAs & Community Services State & Local Innovations & Programs of Natl Significance (Discretionary Funds) Senior Employment Program (DoL) Grants to Tribes Elder Rights

11. Older Americans Act Title III State Units on Aging – GA Division of Aging III-B: AAAs – ARC in Atlanta III-B – Community Services: e.g., I&R, Transportation, Case Management, Legal Assistance, Senior Centers

12. Older Americans Act Title III (Cont.) III-C – congregate & home-delivered meals III-D – Disease Prevention & Health Promotion III-E – National Family Caregiver Support Program

13. Older Americans Act Title III – Part D DP/HP services defined as: –Risk assessments –Routine screenings –Nutrition counseling and education –Health promotion programs –Physical fitness, music, art/dance therapy –Home injury control –Depression screening –Education on preventive health services under Medicare –Medication management –Info on age-related diseases/chronic disabling conditions –Counseling In carrying out the program, the Assistant Secretary for Aging shall consult with the directors of the CDC and the NIA...

14. Older Americans Act Title III – Part D Funding –FY 2005 & FY 2006 -- $21,616,000 $5 million for medication management Presidents FY 2007 Budget -- $0 for Part D

15. Community Orgs 655 AAAs 57 SUAs AoA 3,000 LHDs 58 SHDs CDC Department of Health and Human Services CDD Chronic Disease Program Directors NACCHO National Asso of County & City Health Officials NASUA Natl Assn of State Units on Aging N4A National Assn of Area Agencies on Aging Community Orgs Parallel Networks: Aging Services and Public Health

16. At national, state, and local levels, partnerships between the aging and public health networks... can make a difference in the health of older adults. Public Health and an Aging Population: A Call to Action (1994)

17. Potential Areas for Collaboration: Assess and monitor needs of older adults Collect and share data Fill gaps in service and funding Implement health promotion/disease prevention interventions Deliver cross-training Unified voice to policy makers

18. Guide to State Health Departments and State Units on Aging Working Together ( 1996) A growing body of evidence indicates that health promotion can postpone or prevent disease and disability, maintain or improve health status, contain costs, and enhance the quality of life of older adults.

19. Guide to State Health Departments and State Units on Aging Working Together should work together cooperatively in program planning and service delivery in order to achieve common goals and objectives. encourage collaboration between local health departments and AAAs in planning and implementing health promotion programs.

20. Aging States Project : Needs Assessment (2001-2003) Jointly funded by AoA and CDC Administered through National State Units on Aging, and State Chronic Disease Directors To identify health-related needs, activities, and partnerships in SUAs and SHDs To help determine mutual areas of interest and opportunities for collaboration

21. Aging States Project - Recommendations Promote improved collaboration between SHDs and SUAs Support health promotion/disease prevention programs for older adults Provide needed training and technical assistance

22. CDCs Aging Program Within CDCs Chronic Disease Center Focal point for aging work at CDC Outreach to aging network Collaboration with national organizations, e.g., n4a, NCOA, ASA Research on prevention measures CDC aging website: www.cdc.gov/aging

23. Healthy Aging: Opportunities to Make a Difference Promote healthy lifestyles Increase use of early detection Increase adult immunization rates Reduce injuries Increase use of disease self- management techniques Using Evidence-based Interventions

24. Public Health and Aging Partnerships: A Formula for Healthy Aging Aging: In-depth knowledge of those served Broad range of issues addressed Providing variety of essential services Extensive outreach capability Public Health : Experience in state-based disease prevention programs Scientific expertise Collection and application of data Prevention research (identifying what works)

25. The Aging Network: An Established Infrastructure In virtually every community in America 3 Decades + of knowledge of their communities and elders, & experience in planning & delivering a diverse array of services Great flexibility Mandate for Health Promotion & Disease Prevention Long history of partnerships Leadership eager to expand & strengthen those partnerships

26. Five Key Challenges for Our Aging Society Promoting healthy living among the older population Promoting healthy living among the older population Engaging elders in meaningful and vital action Engaging elders in meaningful and vital action Making sure our communities are elder friendly or elder ready Making sure our communities are elder friendly or elder ready Focusing like a laser beam on the young to be sure they are going to be vital as they age and in their old age Focusing like a laser beam on the young to be sure they are going to be vital as they age and in their old age Sustaining the necessary support for a much larger older population Sustaining the necessary support for a much larger older population

27. Creating Partnerships for Healthy Aging Presented by: Pamela Piering, Director Seattle Human Services Department Aging and Disability Services Cheza Collier Garvin, PhD, MPH, MSW Program Director, Chronic Disease Prevention and Healthy Aging Prevention Division, Public Health Seattle and King County

28. Evidence-based Healthy Aging On-going Program Development On-going Program Development Healthy Aging Partnership Healthy Aging Partnership Sound Steps Sound Steps Chronic Disease Registry Chronic Disease Registry Program Development and Dissemination Program Development and Dissemination Enhance Fitness Program Enhance Fitness Program Enhance Wellness Program Enhance Wellness Program REACH (Racial/Ethnic Approaches to Community Health) Program REACH (Racial/Ethnic Approaches to Community Health) Program Healthy Eating for Healthy Aging (HEHA) Healthy Eating for Healthy Aging (HEHA) Senior Farmers Market Senior Farmers Market PEARLS – research partnership PEARLS – research partnership Other Partnerships and Partnership Highlights Other Partnerships and Partnership Highlights

29. Key Partners Local Area Agency on Aging, Aging and Disability Services Local Area Agency on Aging, Aging and Disability Services Public Health - Seattle & King County Public Health - Seattle & King County Healthy Aging Partnership Healthy Aging Partnership Comprehensive Health Education Foundation Comprehensive Health Education Foundation University of Washington Health Promotion Research Center University of Washington Health Promotion Research Center Aging Network community agencies Aging Network community agencies Senior Services Senior Services

30. Area Agency on Aging Aging and Disability Services Aging and Disability Services Seattle-King County : 240,000 60+ Seattle-King County : 240,000 60+ Three-way sponsorship Three-way sponsorship City of Seattle, Human Services Dept City of Seattle, Human Services Dept King County King County United Way of King County United Way of King County Guided by Area Plan on Aging 2004-07 Guided by Area Plan on Aging 2004-07 $34 million state/federal/local $34 million state/federal/local Key initiatives – nutrition & health promotion Key initiatives – nutrition & health promotion

31. Area Agency on Aging (AAA) One of 655 in the nation One of 655 in the nation Core funding from the Older Americans Act: Core funding from the Older Americans Act: nutrition, information/assistance, legal svcs, transportation, family caregiver support nutrition, information/assistance, legal svcs, transportation, family caregiver support Additional Medicaid-funded services: Additional Medicaid-funded services: Case Management for in-home clients Case Management for in-home clients Home Care services Home Care services Adult Day Care/Day Health Adult Day Care/Day Health

32. AAA Roles Planning to meet community needs Planning to meet community needs Community Advisory Councils Community Advisory Councils Convene partners in building an elder- friendly community Convene partners in building an elder- friendly community Allocation of discretionary resources, primarily Older Americans Act, some state/local Allocation of discretionary resources, primarily Older Americans Act, some state/local Advocacy for older Americans with policymakers Advocacy for older Americans with policymakers

33. Public Health – Seattle & King County Healthy People, Healthy Communities Healthy People, Healthy Communities MISSION: To achieve and sustain healthy people and healthy communities throughout King County by providing public health services which promote health and prevent disease. MISSION: To achieve and sustain healthy people and healthy communities throughout King County by providing public health services which promote health and prevent disease.

34. Partnerships As Key Strategy for: Collaboration and Shared Power Collaboration and Shared Power Sharing Limited Resources Sharing Limited Resources Assurance of Inclusiveness Assurance of Inclusiveness Maximizing Effectiveness Maximizing Effectiveness Capacity Building Capacity Building Everybody Benefits Everybody Benefits

35. Chronic Disease Prevention & Healthy Aging, Prevention Division Started 1997 Started 1997 Quickly realized benefits of collaboration Quickly realized benefits of collaboration Value multiple expertise/perspectives Value multiple expertise/perspectives Ability to provide planning, technical assistance, program development, other skills, even a little $ Ability to provide planning, technical assistance, program development, other skills, even a little $

36. Chronic Disease Prevention & Healthy Aging, Prevention Division Heart health Heart health Asthma Asthma Cancers Cancers Diabetes Diabetes Nutrition Nutrition Physical Activity Physical Activity Disparities Disparities Obesity Obesity Lifespan Healthy Aging Lifespan Healthy Aging

37. Healthy Aging Partnership Focus on improving health status and quality of life for older adults Focus on improving health status and quality of life for older adults Natural link with local AAA, Aging and Disability Services Natural link with local AAA, Aging and Disability Services

38. Beginning the Partnership: 1995 Public Health report Living Longer, Staying Healthy: the Health Status of Older Adults in King County Living Longer, Staying Healthy: the Health Status of Older Adults in King County Chronic diseases leading causes of death Chronic diseases leading causes of death Injuries from falls Injuries from falls Immunization rates Immunization rates Suicide and social support Suicide and social support

39. Assessing Seniors Needs Conference Conference Planning consultant Planning consultant Focus groups Focus groups Results Results A single information source with a real person providing customer service (1-888- 4ELDERS) A single information source with a real person providing customer service (1-888- 4ELDERS) Health information needed – falls, immunizations, depression, physical activity Health information needed – falls, immunizations, depression, physical activity Web site: www.4elders.org Web site: www.4elders.org

40. HAP Members (40) City/County Public Health Department City/County Public Health Department Local Area Agency on Aging: Aging & Disability Services Local Area Agency on Aging: Aging & Disability Services State Department of Health State Department of Health Housing Authority; Mental Health; Social/Human Services, Parks and Recreation Housing Authority; Mental Health; Social/Human Services, Parks and Recreation Large non-profits (Senior Services, AARP, Comprehensive Health Education Foundation, etc.) Large non-profits (Senior Services, AARP, Comprehensive Health Education Foundation, etc.) Smaller non-profits (Latino & Asian organizations; Visiting Nurse Services; Services for the Blind, Dental Foundation) Smaller non-profits (Latino & Asian organizations; Visiting Nurse Services; Services for the Blind, Dental Foundation) Public & non-profit hospitals and health insurance companies Public & non-profit hospitals and health insurance companies

41. Information Campaign Promotional Efforts Brochure (English, Spanish, Asian languages) Brochure (English, Spanish, Asian languages) Posters, magnets and other giveaway items Posters, magnets and other giveaway items Physical activity brochure Physical activity brochure Direct mail (stuffers in property tax statements) Direct mail (stuffers in property tax statements) Partner agency publications Partner agency publications Web site Web site Free media Free media Paid advertising: Radio, newspaper, bus ads Paid advertising: Radio, newspaper, bus ads Val Pak insert Val Pak insert

42. 2004-2005 HAP Goals Continue public health messagesContinue public health messages Continue training/educational workshopsContinue training/educational workshops Increase involvement of older adultsIncrease involvement of older adults Focus on older adult civic engagementFocus on older adult civic engagement Focus on policy involvementFocus on policy involvement Address needs of older adults in multiple racial/ethnic communitiesAddress needs of older adults in multiple racial/ethnic communities Encourage collaborations with business communityEncourage collaborations with business community

44. Sound Steps Walking program Walking program 2003, 6 sites in Seattle, 500 participants 2003, 6 sites in Seattle, 500 participants 2004, 15 sites countywide 2004, 15 sites countywide Sponsored by HAP, funded by Aging Blueprint grant Sponsored by HAP, funded by Aging Blueprint grant ToolKit http://www.chef.org/ ToolKit http://www.chef.org/

45. I love this walking thing. Ive been here every week that I could since I started…It made me enjoy walking so much that I dont mind going by myself. -- Sound Steps walker Sound Steps Sound Steps …

46. Chronic Disease Registry 1,000 case management clients 1,000 case management clients Collaboration with REACH Diabetes Project Collaboration with REACH Diabetes Project Home-based interventions Home-based interventions Homestretch Homestretch Nutrition counseling Nutrition counseling Medication management Medication management PEARLS – depression intervention PEARLS – depression intervention Community interventions Community interventions Exercise classes Exercise classes Chronic disease support groups Chronic disease support groups

47. Enhance Fitness (EF) Encourage adaptation in community Encourage adaptation in community ADS provided one-time grants for weights ADS provided one-time grants for weights Physical activity component now required at each nutrition site (41 sites) Physical activity component now required at each nutrition site (41 sites) EF at 18 meal sites. EF at 18 meal sites. HPRC support to refugee/ immigrant programs in SE Seattle HPRC support to refugee/ immigrant programs in SE Seattle

48. Enhance Wellness (EW) HPRC research with Senior Services, Northshore Senior Center HPRC research with Senior Services, Northshore Senior Center Results drove awareness in ADS Results drove awareness in ADS In 1997, ADS shifted Older Americans Act funding (health promotion) to HEP In 1997, ADS shifted Older Americans Act funding (health promotion) to HEP EW expansion, now receives $130,000 annually from ADS EW expansion, now receives $130,000 annually from ADS www.projectenhance.org www.projectenhance.org

49. Celebrate healthy successes.

50. REACH (Racial/Ethnic Approaches to Community Health) Diabetes Project MISSION MISSION The mission of the REACH Coalition is to reduce diabetes health disparities experienced by communities of color. Through strong partnerships, we will support the empowerment of individuals, families, and communities, and create sustainable long-term approaches to prevention and control of diabetes utilizing all appropriate community resources in King County.The mission of the REACH Coalition is to reduce diabetes health disparities experienced by communities of color. Through strong partnerships, we will support the empowerment of individuals, families, and communities, and create sustainable long-term approaches to prevention and control of diabetes utilizing all appropriate community resources in King County.

51. MULTIPLE CULTURES WORKING TOGETHER TO REACH FOR HEALTH REACH COALITION African American Asian American/ Pacific Islander American Latino/Hispanic European American CDC Funding 1999-2007

52. Coalition Challenges and Solutions Multiple Cultures and Languages Multiple Cultures and Languages Differences of Opinion Differences of Opinion Distribution of Funds Distribution of Funds Authority Hierarchy Authority Hierarchy 7 Languages, Hire Bilingual/Bicultural Staff, Listen and Learn 7 Languages, Hire Bilingual/Bicultural Staff, Listen and Learn Consensus Decision Making; Bring Concerns back to the Coalition - (Ops) Consensus Decision Making; Bring Concerns back to the Coalition - (Ops) Coalition Selection Committee Coalition Selection Committee Process Discussion; Take Backseat Process Discussion; Take Backseat

53. COMMUNITY ACTION PLAN ELEMENTS Interventions conducted by sub-contracting community agencies Interventions conducted by sub-contracting community agencies Support Groups Support Groups Education Classes Education Classes Self Management Classes Self Management Classes Enhanced Diabetes Registry use Enhanced Diabetes Registry use Case Coordination Case Coordination Community Campaigns Community Campaigns Evaluation Evaluation

54. ENHANCED DIABETES REGISTRY USE Tracking of Tracking of HbA1c HbA1c blood pressure blood pressure eye exams eye exams foot exams foot exams urine tests urine tests referrals referrals

55. CASE COORDINATION Complete diabetes registry Complete diabetes registry Communicate with providers Communicate with providers Communicate with patients about recommended procedures for them Communicate with patients about recommended procedures for them Refer patients to community activities and resources Refer patients to community activities and resources

56. Healthy Eating for Healthy Aging (HEHA) Come! Taste! - cooking demonstrations Come! Taste! - cooking demonstrations Promotional Items Promotional Items Newsletters for Senior Farmers Market Produce Delivery Program Newsletters for Senior Farmers Market Produce Delivery Program Medical Nutrition Therapy Pilot Program Medical Nutrition Therapy Pilot Program 7-Language Diabetes Food Guide Pyramids 7-Language Diabetes Food Guide Pyramids Collaboration with REACH Program Collaboration with REACH Program Senior Nutrition Forum Senior Nutrition Forum Planning, Presentations, Training, etc. Planning, Presentations, Training, etc.

57. Healthy Eating for Healthy Aging Come! Taste! Preparation… Having a Taste!

58. Somali Diabetes Food Guide Pyramid

59. Senior Farmers Market Fresh produce baskets for 800 seniors June – October. Fresh produce baskets for 800 seniors June – October. 2,000 seniors receive farmers market vouchers. 2,000 seniors receive farmers market vouchers. Participants eat more fruits & vegetables. Participants eat more fruits & vegetables. Public Health- NewsLetter Public Health- NewsLetter

60. Senior Farmers Market Many community partners Many community partners HPRC evaluation HPRC evaluation 3-year Vitamin Settlement Trust Fund $600,000 3-year Vitamin Settlement Trust Fund $600,000 2005-6 State budget includes $680,000 statewide 2005-6 State budget includes $680,000 statewide

61. PEARLS (Project to Encourage Active, Rewarding Lives for Seniors) First-time for AAA as research partner First-time for AAA as research partner Challenge to bring research into workplace Challenge to bring research into workplace Competing demands: Competing demands: workload workload pace of change pace of change control group model control group model Referral process challenges Referral process challenges

62. PEARLS Five year study Five year study Positive results, offer to controls Positive results, offer to controls Interventionist selection, training Interventionist selection, training Build on existing psych consultant Build on existing psych consultant New Medicaid assessment tool identifies minor depression scale New Medicaid assessment tool identifies minor depression scale

63. PEARLS Future Promote results: conferences, board meetings, Advisory Council, newspaper Promote results: conferences, board meetings, Advisory Council, newspaper Train new interventionists Train new interventionists Secure funding: Secure funding: AAA Discretionary funding, part-time AAA Discretionary funding, part-time Seek Medicaid Client Training funding Seek Medicaid Client Training funding Promote to other AAAs in Washington Promote to other AAAs in Washington Testimonials – funders, community events Testimonials – funders, community events

64. Other Partnership Activities Mutual Consultation and Planning Mutual Consultation and Planning Review of AAA Local Plan incorporating healthy aging activities with case management Review of AAA Local Plan incorporating healthy aging activities with case management Mutual involvement in projects, e.g. UW Health Promotion Research Center depression project: Project to Encourage Active, Rewarding Lives for Seniors (PEARLS) Mutual involvement in projects, e.g. UW Health Promotion Research Center depression project: Project to Encourage Active, Rewarding Lives for Seniors (PEARLS) ET CETERA – Imagination is the limit, well sometimes resources too! ET CETERA – Imagination is the limit, well sometimes resources too!

65. Challenges: Maintaining Involvement Meeting attendance - sometimes sporadic Meeting attendance - sometimes sporadic Email communication Email communication Steering committee structure for detailed planning and decision making Steering committee structure for detailed planning and decision making Reaching constituencies through member agencies Reaching constituencies through member agencies

66. Challenges: Funding Fundraising a constant concern Fundraising a constant concern Maximizing scarce resources through in- kind contributions Maximizing scarce resources through in- kind contributions Balancing with other fiscal needs Balancing with other fiscal needs

67. Challenges: Clarifying Identity Creating visual identity - logo, colors, etc. Creating visual identity - logo, colors, etc. Sharing use of the logo Sharing use of the logo Internal perceptions Internal perceptions Public perceptions Public perceptions

68. Characteristics of Effective Partnerships Environment Environment History of collaboration, cooperation History of collaboration, cooperation Membership Membership Mutual respect, appreciation of input Mutual respect, appreciation of input Complementary expertise Complementary expertise Willingness to contribute time and effort Willingness to contribute time and effort Process and structure Process and structure Members share a stake in outcome Members share a stake in outcome Flexibility Flexibility

69. Characteristics of Effective Partnerships Communication Communication Regular schedule Regular schedule Open and frequent problem solving Open and frequent problem solving Time spent building relationships Time spent building relationships Purpose Purpose Attainable goals, objectives Attainable goals, objectives Shared vision, mutual commitment Shared vision, mutual commitment Resources Resources Sufficient funds, staff, time Sufficient funds, staff, time

70. New Opportunities Continuing to seek new partners Continuing to seek new partners Washington Alliance for Healthy Aging Washington Alliance for Healthy Aging Statewide Statewide Annual Summit Annual Summit Bridging Systems Bridging Systems Creatively developing new program ideas Creatively developing new program ideas Workshops Workshops Civic engagement Civic engagement Moving beyond diabetes Moving beyond diabetes Seeking funding through grant opportunities Seeking funding through grant opportunities

71. Favorable Climate Increasing older adult population Increasing older adult population Increasing awareness of the needs of older adults Increasing awareness of the needs of older adults Increasing focus on the prevention and/or management of chronic diseases Increasing focus on the prevention and/or management of chronic diseases Increasing focus on cost savings Increasing focus on cost savings

72. It is not the years in your life but the life in your years that counts.

73. For More Information Contact Contact Pamela.Piering@seattle.gov Pamela.Piering@seattle.gov Pamela.Piering@seattle.gov Cheza.Garvin@metrokc.gov Cheza.Garvin@metrokc.gov Cheza.Garvin@metrokc.gov Healthy Aging Partnership www.4elders.org Healthy Aging Partnership www.4elders.orgwww.4elders.org Aging and Disability Services www.seattle.gov/humanservices/ads/areaplan Aging and Disability Services www.seattle.gov/humanservices/ads/areaplan www.seattle.gov/humanservices/ads/areaplan REACH: www.metrokc.gov/health/REACH REACH: www.metrokc.gov/health/REACHwww.metrokc.gov/health/REACH Health Promotion Research Center http://depts.washington.edu/hprc/ Health Promotion Research Center http://depts.washington.edu/hprc/ http://depts.washington.edu/hprc/

74. The National Association of County and City Health Officials (NACCHO) Presents Building and Maintaining Local Health Department Partnerships with Area Agencies on Aging and Other Local Aging Organizations Question & Answer Session There are 2 ways to ask a question: 1) Click on the Q&A tab in NetSpoke and type in your question; the speakers will address your question via phone 2) Ask your question via phone

75. The National Association of County and City Health Officials (NACCHO) Presents Building and Maintaining Local Health Department Partnerships with Area Agencies on Aging and Other Local Aging Organizations Thank you for participating in this webcast! We will be emailing you the link to a quick online evaluation. Please take a few moments to complete it!