Models of Community Collaboration for Long-Term Care Nancy Whitelaw, Ph.D. Director, Center for Healthy Aging National Council on Aging March,

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

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

Examples of Partnership Sessions Friday, March 17th Building Evidence-Based Disease Prevention and Health Promotion Into Community-Living Through Modernization of the OAA8: :00 am Public-Academic Partnerships in Geriatric Mental Health10: :00 pm Falls Free Coalition: Making a Difference Through Collaboration10: :00 pm AoA's Integrated Care Management Program10: :00 pm Mental Health Programs for Older Adults: AoA and SAMHSA2:00 - 4:00 pm Saturday, March 18th Healthcare Provider and Aging Network Partnerships10: :00 pm Sustainability Through Collaboration10: :00 pm New Care Management Strategies to Improve Health Outcomes4:30 - 6:00 pm Sunday, March 19th Engaging Frail Elders in Evidence-Based Home Physical Activity9: :15 am

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.

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 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