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Models of Community Collaboration for Long-Term Care

Models of Community Collaboration for 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”

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Models of Community Collaboration for Long-Term Care

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  1. 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

  2. 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

  3. Public Policy Community Organizational Interpersonal Individual Social Ecologic Model of Healthy Aging McLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev Med

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. 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)

  10. 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?

  11. 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 DISEASETeri, L et al. (2003) JAMA.

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. Over 100 Settings • Senior centers • Housing sites • Culturally specific centers • Faith-based organizations • Social service agencies • Case management offices • Libraries • Tribal communities

  18. “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

  19. Examples of Partnership Sessions

  20. 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.

  21. 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

  22. Partnership Resourceswww.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

  23. Nancy Whitelaw, DC www.healthyagingprograms.org

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