The challenge. The scenic mountain vistas of southern Appalachia have attracted a steady stream of retirees and second homeowners in recent years—and with them a dilemma. In the mid 2000s, home prices were surging in Waynesville, N.C., and the surrounding Haywood County, even as declines in farming and industry were pushing long-time residents close to poverty.
The newcomers and the longstanding residents had at least one thing in common—they were growing older. One quarter of the county's population was over 60, a figure that was predicted to increase to 57 percent by 2020. Through its Community Partnerships for Older Adults national program, the Robert Wood Johnson Foundation (RWJF) funded the Haywood County Council on Aging to connect older adults with the services they needed to age with dignity.
Background. Sometimes surviving a storm brings people together. In 2004, with its planning grant, Haywood County Council on Aging Program Director Victoria Young and Program Coordinator Yvonne Gold spearheaded a countywide information gathering process that included 32 town meetings and 46 community forums, and 2,500 mailed community surveys and 52 agency surveys. With this input, the partnership created a strategic plan for making life more hospitable for older adults.
Then, disaster: the head of the Haywood County Council on Aging was charged with embezzlement and resigned. The agency itself dissolved a few months later.
Young was certain the Community Partnerships project, which they called Community Connections, was dead in the water. But Laura Lowenthal Bly, co-director of the national program office, encouraged her to press on. "The Council on Aging was just one partner," she said. "There are others, but you will have to work really hard to prove that the partnership is still together. And then we'll come down and do a site visit and see what we think."
Picking up the pieces. Young and Gold visited aldermen in towns around Haywood County, asking if they would appropriate local funds to meet the match required by RWJF's implementation grant, and were surprised to get a "yes."
Partners that had pulled away as the scandal broke were willing to come back and Mountain Projects, a community action agency founded in 1965, agreed to serve as the new lead agency. Two new partners also signed on—the United Way and the local newspaper, the Mountaineer.
By the time national program office staff came to visit, the partners had picked up the pieces and moved forward. "They supported each other in their decisions," Young said. "That was the start of something really amiable. To this day they are all still at the table, and more have come on."
The project. National program office staff also emphasized that the RWJF funding was to be used for a "ground-up" effort to improve long-term-care services, not to provide direct services.
Neighbors helping neighbors. The solution came to Young, she says, in the middle of the night: Create "senior resource teams" to connect older adults to existing services that would help them remain in their homes.
"We have the nooks and crannies, the coves and the hollers," Young said. "When we did our first community survey, people said, 'I'm not going into town, I don't trust them. I get all my information from my neighbors, my church, my doctor and my family.'"
The resource teams would allow the community to get back to "neighbors helping neighbors, something we had gotten away from," Young thought. Her brainstorm led to a collaboration with the local community college to create a Senior Leadership course to train retirees as community liaisons. As of 2010, the course had been offered seven times.
"The first class got on a bus and over the course of 13 weeks went all over the county to learn about services for older adults," Young recalled. "They learned about communities they had never been in, even though they had lived here all their lives—and they couldn't believe the resources out there."
When they found gaps, the teams stepped in to fill them—opening a food pantry in a low-income senior housing complex, sponsoring a senior safety day in collaboration with a local fire department, and launching a caregiver support group, a library and a durable medical equipment loan closet.
"They did remarkable things…far beyond what we asked them to do," Young said. "We came to realize that we were not the mamas here. They were in charge. They were self-directed."
As of October 2011, 73 volunteers were serving on resource teams in 13 communities, helping seniors and their caregivers find needed resources. In a single year, team members logged more than 9,000 hours of service, a contribution valued at almost $190,000 (based on a national average wage of about $21 for independent workers).
Bringing Bertie home. Janice Liner and her husband, Bud, took one of the early leadership courses and what she learned got her thinking. Liner's mother, Bertie Battle Wilde, bright and functional at 101, had lived in a long-term-care facility in Waynesville for years. She wasn't unhappy there, but the daily drives to visit were wearing her daughter out.
Liner realized that with the help of the Community Alternative Placement program and other county agencies, she could bring her mother home.
Wilde is now safely ensconced in her own room in the Liner home, and she told a reporter for the Mountaineer, "I love it." Home health aides visit daily to provide care and help her exercise. The bathroom has been retrofitted with a special toilet and shower accessories to insure her safety and comfort.
"She goes in her room and writes poetry," Young said. "And it has made Janice's life so much easier. They are all thrilled."
Collaborations bear fruit. Haywood Community Connections also created countywide workgroups to address common concerns, such as policy advocacy, caregiver support, transportation, housing, dental care, senior abuse and neglect, wellness, and community outreach and information. For example:
- The caregiver workgroup established a "Day by Day" program to encourage the faith community to reach out to caregivers and collaborated with law enforcement to create a countywide Alzheimer's training component.
- The advocacy workgroup helped get state funding for Project C.A.R.E. (Caregiver Alternative to Running on Empty), a respite program.
- The transportation workgroup helped to bring new transportation routes to rural areas in the county.
- The housing work group helped to establish Barefoot Ridge, a low-income housing development.
Other collaborations led various partners to establish a community kitchen, a computer lab where older adults could learn computer skills, and a "Senior-Friendly Business" program that linked college design students with local businesses to identify ways they could better accommodate seniors. The health department also proved responsive to their needs, establishing a dental clinic for adults with Medicaid after the partnership discover no dental services were available for indigent seniors, and health services at the adult day care center.
Everybody is equal at the table. By the end of the grant period, Community Connections had some 100 partners, with about 40 attending meetings regularly. To work effectively with such a large and diverse group of people the partnership adopted explicit rules of engagement outlining the expectations for partner involvement.
Initially, the partnership met monthly and later, as the work got established, every other month. But when Young suggested cutting back the meetings to four times a year, the partners said no. Part of the reason, Young believes, is that they knew their time was well-spent. "I always say, three things make a good meeting—a facilitator, food and fun. We have a facilitator whose purpose is to run a good meeting. We never go over an hour and half, there is no one that dominates or talks too much, and everybody is equal at the table. That has made a huge difference."
Young also learned not to expect every partner to contribute at the same level. "Originally, the memorandum of understanding essentially stated, 'If you don't come to meetings you are going to get a visit from me, and we will kick you out.' There are partners who do not come to meetings, but they are always there for us. We realized that we need to take our partners for what they bring to the table," Young said.
Next steps. Despite economic strains, Community Connections has maintained county support and attracted new funders. In 2010, the partnership received a federal grant to establish an Aging and Disability Resource Center—a "no wrong door" system for clients seeking services. Participating agencies agree to share information so that clients do not have to tell the same story over and over wherever they go.
The county voted to give the partnership a permanent rent-free home, strengthening its capacity to collaborate and "birth" new initiatives. One unusual collaboration, involving the Autistic Society and the police department, provided wristbands to track Alzheimer's sufferers and autistic children who may wander. The partnership also developed a depression screening and intervention project for culturally and socioeconomically diverse populations of older adults.
"When the community comes to us with an idea," Young said, "we are open. We think out of the box and we bring people together to join them and make it work. The partnership has been a catalyst in getting things off the ground and birthed and now they are being maintained and grown by other agencies."
RWJF perspective. Community Partnerships for Older Adults was an eight-year, $28 million national initiative of the Robert Wood Johnson Foundation that supported 16 communities to create collaborative partnerships to address the many gaps and inefficiencies in long-term care and supportive systems for vulnerable older adults.
RWJF Director of the Vulnerable Populations Team and Senior Program Officer Jane Isaacs Lowe notes, "One of the goals was to make what is a patchwork of long-term-care services in communities behave more like a coordinated system. We wanted to make sure that along that continuum of care, elders in communities had the breadth of services they needed.
"In general, the partnerships have demonstrated that innovations are possible in communities across the country—that allow people to age in place and that make for better care delivery for people with long-term-care needs."
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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