Building an Aging-Prepared Community: Lessons from an Ongoing Evolution (Session #36)

1. Building an Aging-Prepared Community:Lessons from an Ongoing Evolution (Session #36) NY SOFA Conference “Empowering Communities” November 13, 2008 Saratoga Springs, NY

2. What We'll Cover • Our community needs and our vision • Our first foray: the Senior Information Center • Social services delivery and lessons learned • Building social capital efforts and lessons learned • Preventive therapy and lessons learned/results • Current efforts

3. What We'll Cover Merchant Project Launched 2005/06 Lightbulb Team launched 2004 Social Capital Experiments 2004/05 Gatekeeper Takes Over 2007 Visioning: 2001 Preventive Therapy Launched 2004/05 Opened SIC 2002 NNORC Takes Over SIC 2007 NNORC adds Preventive Tpy 2009 Care Advocate launched 2004

4. Seniors in the Downtown Communities: What we Know • VOICES Longitudinal Survey • Rising depression symptoms • More chronic pain • Rising IADL assistance needed • "No one to turn to" • Village Nursing Home Admits • Falls and Accidents • Dementia • No safe discharge from hospital/ no caregiver

5. Vision of Reforming LTC Frailty can be intermittent or permanent. Aim to intercede upstream with early detection, prevention and wellness initiatives

6. NYS LTC Demonstration • Make growing old in the community a better proposition by : • Providing services and supports that are affordable, safe, and combine medical and non-medical interventions. • Building community capacity that supports diversion and transition • Enlisting “natural community contacts” as collaborators • Redirect and reinvest Medicaid savings toward home and community-based services. “Everything that can be done in the community will be done in the community”

7. "Throwing the Pebble": Opening the Senior Information Center • Responding to the need for "someone to turn to" when you have issues or questions • Opened May 2002 • Brochures / Applications • Computer training and access • Social Worker in the window

8. Computer Classes and Access • Seniors' Reaction • 20 – 25 attendees per computer class • Info Center daily visits climbed • June 2005: average 3/day • June 2006: average 18/day • Easy path to ask for help • Familiarity with Info Center staff • "Since I'm here . . ." • First year: 250 SCRIE applications

9. Computer Classes and Access Among community-dwelling older adults, computer users reported significantly fewer depressive symptoms than their counterpartswho were not computer users. They also had better perceived emotional support.

10. Social Services: Needs Found • Housing: landlord difficulties • Financial difficulties • Difficulty with chores / physical frailty • Feelings of isolation • Caregiver burden • Hoarding and home safety • Vision and hearing impairment

11. Social Service Responses: Lightbulb Team • Volunteers available to assist with changing light bulbs and batteries • Able to enter home and perceive other needs • Hoarding • Physical frailty • Lessons Learned: • Clients receptive to home visits and community referrals • Volunteering interest declined over time

12. Social Service Responses: Care Advocacy • Facilitates care across time, place and discipline • Key collaborations with hospitals, nursing homes, CHHA, adult day, supportive housing, HCBS • Intent: nursing home diversions and transitions. • Role is part advocate, part systems-change-agent. • Tools to identify vulnerabilities and frailty • Patient tracking essential • Challenges: housing; reluctance to think outside the box/try something different (providers and patients)

13. Care Advocate Case Study • SNF resident: cognitively intact with ambulation difficulty • CA and resident care planning: • Identified ongoing physical therapy program • Completed housing applications and tours • Facilitated transition communications • Provided informal counseling • CA facilitated move to Assisted Living and purchased some household necessities • Follow-up with AL Social Worker to ensure information and resident preferences are understood

14. Social Service Evolution: NNORC • Neighborhood NORC: Provide supportive services to a geographical area defined by density of seniors • "Heart of Greenwich Village" • 1,700 seniors over age 60 • 50% live alone (compared to 28% nationally) • 30% live above first floor without an elevator • 29% meet criteria for depression • 51% report chronic pain • Provide social service assistance and added exercise classes and nursing

15. Social Service Evolution: NNORC continued • Biggest Value: Social services assistance with benefits, entitlements, linkages • Members also appreciate the ongoing education through monthly newsletter and quarterly publication • However: no interest in Nursing • Two "Ask-a-Nurse Days" and 1 attendee • Confusion as to why a nurse should visit them • NB: White, well-educated community with long-standing physician relationships

16. Building Social Capital: Learning the Model • Research Base: • Kennedy School, Harvard University: social networks and the inclinations that arise from these networks to do things for each other • Existing Models Explored: • NORCs • Successful Aging in Caring Communities (Asset-Based Community Development Model) • NCOA's Civic Engagement Initiative

17. Building Social Capital: Community-Building Groups • Advisory Group picked appealing efforts • Assigned a senior to "champion" each group • Staff member assigned to each group to facilitate relationship-building SEVEN PILOT GROUPS "Out and About" Greenwich Village Oral History Project Walking for Fitness School Support Intergenerational Playwriting Film Club Helping Hands Group

18. Building Social Capital: Reasons for Failure • The usual declining interest pattern • Ideas and champions all planned—nothing "organic" • Fears generated by mixing ages / abilities • Fear of finding the "excessively needy"

19. Building Social Capital: Intergenerational Issues • Seniors Dropped Out Because: • "Children not respectful" • "Didn't have enough energy to be with them" • "Those bigger kids are frightening" • One individual was requested to leave because grooming habits scared the children • Children Dropped Out Because: • "Didn't give us any say" • "Boring"

20. Building Social Capital: The Merchant Project • Originally, requests for member discounts • Trained merchants on how to be a "senior-friendly" establishment and why its good business • Window sticker to signal themselves to potential senior customers • Trained merchants to be "Eyes and Ears" to find and help seniors in need

21. Merchant Project Case Study • Local ice cream shop owner who was trained to call APC with "seniors-of-concern" • APC Staff found Mrs. C and got consent for home assessment • Needs identified: nutritional services, cleaning services and financial management • Mrs. C now on: Meals on Wheels and APS for home care and financial management

22. Merchant Project Evolution: Downtown Gatekeeper Program • 2007 OMH/SOFA RFP • Village Care Merchant Project together with St. Vincent's Behavioral Health Assessment Program • Train merchants, building staff and others in the community to identify potentially mentally-ill seniors and refer them the "Gatekeeper Coordinator"

23. Merchant Project Evolution: Downtown Gatekeeper Program, continued • Gatekeeper Coordinator LMSW with mental health background • Reaches out to the identified senior and encourages formal mental health assessment • Makes appointment for –or walks the senior over to—St. Vincent's Behavioral Health

24. Preventive Therapy • 2003 AoA RFA for Evidence-Based Prevention • Village Care builds on the Yale Center on Aging's "Prehabilitation Study.“ • Identify seniors at-risk of functional decline with extra-simple screening tools • Provide "exercise prescription" to improve gait, balance and strength • Physical activity in the context of "therapy" • AoA team rejects, but AoA officials ask NYC DFTA to find funding • 2004, NY Community Trust funds one-year program replication

25. Preventive Therapy: Design and Results

26. Preventive Therapy : Next Steps • NNORC exercise classes continue their popularity but can't sell the nursing so . . . • Convert NNORC nurse to Preventive Therapist • PT to provide exercise classes • PT to screen for risk • PT to do home assessment and exercise prescription • PT and NNORC support staff to do follow-up phone calls and home visits

27. Where the APC stands now: Keeping What Works Best • Senior Information Center • Computer access • Walk in information-and-referral • Social service assistance • In-home visits and supportive counseling for complex cases (folds in Care Advocacy) • Exercise Classes at Senior Center (and now Preventive Therapy) • Gatekeeper Program

28. Where APC stands now: Staffing and Partnerships • APC — Senior Social Services – Director • BSW-towards-MSW NNORC Coordinator • MSW Gatekeeper Coordinator • BSW Senior Information Center • PT for Exercise Classes and Preventive Therapy • Partnerships: St. Vincent's Behavioral Health, St. Vincent's Senior Health, The Caring Community Meals-on-Wheels and Senior Centers,

29. Where the APC stand now: Contact information Renee Cottrell, Director of Senior Social Services 212 - 337 – 5897 Reneeco@vcny.org Allison Nidetz allisonn@vcny.org and Allison Silvers allisons@vcny.org Senior Information Center 220 W. 26th St. NY, NY 10001 212 - 337 – 5900 Downtown Gatekeeper Program 212 - 337 - 5905