The Problem: The American population is growing older and living longer, placing elder care issues at the center of the country's future. The long-term care system, characterized by gaps in essential services and funding, is ill prepared to meet these challenges, according to the Care for Elders website. The consequences for older adults may include reduced quality of life, unnecessary health problems and premature disability.
Grantee Background: Jane Bavineau had no intention of working with the elderly when she graduated in 1978 with a bachelor's degree in social work from the State University at Albany, N.Y. Her dream was to reform the criminal justice system. However, a few weeks after graduation she found herself in Houston with a job as an intake worker at Sheltering Arms Senior Services, one of the city's oldest social service agencies. Almost overnight, she fell in love with her new population of clients. "As a group they are some of the most interesting people," she says. "They ask for very little, are so grateful, and have such pride about all they have done and survived. I found I liked them very much, and I admired them. I also found that much more needed to be done to help them maintain dignity and independence in their lives."
Apart from the five years as director of volunteers at the local American Red Cross, Bavineau has worked at Sheltering Arms ever since. She has been responsible for various agency services-from intake and case management to home care and adult day center services, and now housing and energy management.
More than 54,000 older adults and families are helped annually through Sheltering Arms' services. It is the largest independent Lifeline Medical Alarm provider in Texas, and it established Houston's first Alzheimer's day center, as well as a Medicare-certified home health care agency. Yet no matter how many inroads the agency made, Bavineau was always struck by how much unmet need still existed among the elderly.
An 83-year-old client remains in her memory: "What Grace wanted more than anything was a ride to the store so she could pick out her groceries—herself. What a small 'ask' for something that would make such a big difference! But our community didn't have a transportation service it could offer Grace."
Bavineau also remembers an elderly wife caring for her bedridden husband in their dilapidated house: "I was humbled by her graciousness and how hard she worked with what little she had. We could offer them a little bit of help at home, but nothing could be done about their house or their poverty."
With the new millennium came an unexpected opportunity. The Robert Wood Johnson Foundation put out a call for proposals for a $20-million national program calledCommunity Partnerships for Older Adults to help communities develop innovative solutions to meet the current and future needs of older adults.
At the time, Bavineau was involved in a coalition that was just starting to lay out a strategic vision for Houston's senior population and had not yet begun to raise funds. The timing of RWJF's call for proposals was too coincidental to let pass, and Bavineau rallied coalition members to jump at the chance.
In 2002, RWJF selected the new group, Care for Elders, a partnership of more than 80 organizations and individuals from the public, private and nonprofit sectors, as one of the original eight program grantees, with Sheltering Arms serving as the lead agency. The diverse partnership—which includes representatives with different social, ethnic and political interests from the legal, public policy and corporate sectors, transportation planners and providers, faith-based organizations, academic and health care leaders, mental health and substance abuse experts, and local funding organizations—coordinates resources and services, implements new strategies and advocates for policy change.
"We worked feverishly on the whole partnership approach. We had our share of political battles and could have said, 'Let's just walk away,' but we didn't. Our mantra became, 'Lead, follow or get out of the way because we have people here who are willing to work.' I never thought we'd be able to do this. It surprised me. The award was proof that we were doing the right thing."
Today, Care for Elders is the Houston area's largest, most diverse and most experienced partnership focused on elder care issues. The partnership's two goals—to inform policy and to influence practice—are guided by the belief that everyone deserves to age with options, independence, well-being and dignity. Included among its accomplishments thus far are:
State legislation barring criminals from employment with the elderly.
A bill requiring extensive training of care workers.
A formal network of organizations that ensures access to needed services for older adults.
Another RWJF grant to care for elders who were evacuated to Houston after Hurricane Katrina.
Healthy IDEAS, a program that addresses depression in at-risk older adults, is being replicated in five states; it won a 2007 award from the federal Substance Abuse and Mental Health Services.
Bavineau has a particularly long-standing interest in the welfare of clients with Alzheimer's disease and other forms of dementia: In 1992, when RWJF created its national program, Partners in Caregiving: The Dementia Services Program, Sheltering Arms was one of 50 sites selected to test new ideas, and Bavineau served as project director.
Bavineau believes successful leaders should "spend time in the trenches." Rather than make her office on the administrative floors of Sheltering Arms, Bavineau keeps it downstairs next to the adult day center for Alzheimer clients. One evening, she heard someone singing hymns in the hallway, and found an elderly woman awaiting her ride home. "Now, this is a woman with whom you couldn't have conversation that made any sense whatsoever, but there she was, happy and singing every single hymn she had ever known, and I thought, 'Oh, yeah, that's why I'll keep doing this a while longer.'"
The Award: The Practice Change Fellows program, which is supported by the Atlantic Philanthropies and the John A. Hartford Foundation, will provide Bavineau with $90,000 to implement a new geriatric project. Her project, Hospital to Home (H2H), will support elderly heart patients in their transition home from the hospital by coordination between hospital and community-based care and home visits by social workers.
"Customized care during this critical time is expected to improve older adults' health status, and reduce the costs associated with emergency room visits and hospital readmissions," says Bavineau.
The fellows program aims to build a cadre of health care professionals with the leadership skills to influence care for the elderly population on a national scale. Bavineau's goal—besides carving out a new niche for case management in health care—is to explore new styles of effecting change.
"I know different ways to motivate people but I want to learn how to inspire them," she says. "I know how to delegate and to put goals out there, but I think there is a better way to get the work done. We don't always have enough money to do things differently in this field, so you have to inspire people to want to do it."
RWJF Perspective: The Robert Wood Johnson Foundation believes the best solutions to improve long-term care and supportive-services systems for older adults will originate through strong community partnerships. Under its national program, Community Partnerships for Older Adults, grantees are provided financial and technical assistance to develop and implement community-generated approaches unique to each of their local needs. The program continues RWJF's longstanding effort to help older adults continue to live full lives in their homes and communities.
One test of a program's value to a community is its ability to sustain itself over the long term. Care for Elders' grant from RWJF ends in early 2008, and Jane Isaacs Lowe, PhD, senior program officer and team leader of RWJF's Vulnerable Populations Portfolio, believes Care for Elders is primed to be self-sustaining, thanks to Bavineau's leadership.
"She brought a willingness to think differently about the issues of community-based long-term care for elders and to look for different kinds of partners, especially among people whose primary interest is not older adults, like [those at] an energy company," says Lowe.
"She is not afraid to take risks. A lot of people see the glass as half full or the glass as half empty. Jane looks at the glass, and sees that the container is the problem that impedes innovation and creativity. She is someone who is not afraid to say, 'The problem is the container.' Care for Elders is certainly meeting all our demands to be innovative in improving community-based partnerships for older adult by the breadth of partnership and the innovation in strategies."