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LIBRARY
Michigan State

Unwersrty

 

 

 

This is to certify that the
dissertation entitled

SUSTAINABILITY OF COMMUNITY INITIATIVES THAT
ADDRESS AGING ISSUES

presented by

JOAN L. ILARDO

has been accepted towards fulﬁllment
of the requirements for the

PhD degree in Social Work

 

 

[my 577%

Major Professor’s Signature
‘5- 409/
Date

MSU is an Afﬁrmative Action/Equal Opportunity Employer

 

._ _.—.—.-.--u-u--.-.-.-.-.-.—.-...v_ _ 4

 

PLACE IN RETURN BOX to remove this checkout from your record.
To AVOID FINES return on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

DATE DUE

DATE DUE

DATE DUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5/08 K:lProj/Acc&Pres/ClRC/DateDuo.indd

SUSTAINABILITY OF COMMUNITY INITIATIVES THAT ADDRESS
AGING ISSUES

By

Joan L. llardo

A DISSERTATION
Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
SOCIAL WORK

2009

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ABSTRACT

SUSTAINABILITY OF COMMUNITY INITIATIVES THAT ADDRESS
AGING ISSUES

BY
Joan L. llardo

The motivation for this research is that in the next several decades, almost
every community will contend with aging issues due to demographic trends. The
study’s ﬁrst line of inquiry identiﬁes what it is that compels individuals and groups
in a community to recognize that they should address issues related to their older
residents. The second line of inquiry examines ways in which these groups
garner the support of others in their communities to work together to accomplish
a set of goals. The third line of inquiry determines the factors that help or hinder
partnerships to sustain their activities and momentum. The unit of analysis is a
community that generated a partnership that addresses aging issues.

Case studies were conducted on three grassroots community partnerships
for older adults that received no external funding. The case study used a protocol
that included coding observations, documents, and structured interviews. Criteria
used to select the case study sites were the length of time the partnership had
been active, the activity level of the partnership, socioeconomic diversity of the
community, and willingness to be studied. In addition A Key lnforrnant Survey
was conducted to capture internal and external factors that have an impact on
thefsustainability of community partnerships, perceptions of partnership formation

and activities, goals, effectiveness, and sustainability.

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The overall conclusion drawn from the research is that each of the
partnerships formed around a genuine concern for its older residents. The
overarching goal of each partnership was to enhance the quality of life of its
community’s older residents. Each partnership achieved a set of necessary and
sufﬁcient conditions required to maintain sustainability. It took each of the
partnerships time to determine its purpose, but each one eventually developed a
coherent mission and ways to accomplish its goals. The groups all had ups and
downs, ﬂuctuations in member engagement, and times when they took a hiatus
from pursuing their goals. What was important for their communities is that a core
group of stakeholders in each of the communities pursued and sustained the
idea that there should be a group of people actively promoting advocacy for
senior issues, service coordination, collaboration, and ways to ﬁll gaps in the

service continuum.

Copyright by
JOAN L. lLARDO
2009

Tor

Than

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DEDICATION

To my daughters, Antonia and Amelia, who are my biggest fans and critics.
Thank you for bearing with me while I attained this lifetime goal. To my friend,
Susan, who cheered me on and thoughtfully read drafts and provided insightful
comments. To Linda and Carly who have been steadfast friends to our family
since we met in 1998. Finally, to my parents who taught me the value of

perseve ra nce .

 

ACKNOWLEDGEMENTS

I wish to acknowledge all those who have been with me through this journey: my
committee members; Rena Harold, Barbara Ames, Sally Rypkema, Clare Luz
and Paul F reddolino; and the Michigan Society of Gerontology Board with whom
I have the honor of serving and who supported my efforts to learn more about

what sustains grassroots community initiatives that address aging issues.

vi

TABLE OF CONTENTS

LIST OF TABLES .................................................................................... Ix
LIST OF FIGURES .................................................................................. XII
CHAPTER 1: INTRODUCTION ................................................................. 1
BACKGROUND OF THE PROBLEM ................................................................. 1
STATEMENT OF THE PROBLEM ................................................................... 2
DEFINITION OF KEY TERMS ........................................................................ 3
PURPOSE OF THE STUDY .......................................................................... 4
IMPORTANCE OF THE STUDY ...................................................................... 6
SCOPE OF THE STUDY .............................................................................. 9
RESEARCH QUESTIONS ........................................................................... 11
LIMITATIONS OF THE STUDY .................................................................... 11
SUMMARY ............................................................................................... 13
CHAPTER 2: REVIEW OF THE LITERATURE ....................................... 15
SOCIAL MOVEMENT THEORY .................................................................... 15
COMMUNITIES MOVEMENT THEORY .......................................................... 21
COMMUNITY PARTNERSHIP LITERATURE .................................................... 27
NECESSARY AND SUFFICIENT CONDITIONS FOR SUSTAINABLE COMMUNITY
PARTNERSHIPS ....................................................................................... 37
SUMMARY OF THE LITERATURE REVIEW .................................................... 39
CHAPTER 3: RESEARCH METHODOLOGY ......................................... 41
STUDY STRUCTURE ................................................................................. 41
CORE QUESTIONS OF THE DISSERTATION RESEARCH STUDY ...................... 42
DATA SOURCES ...................................................................................... 48
DATA ANALYSIS ...................................................................................... 61
CHAPTER 4: RESEARCH FINDINGS ..................................................... 74
KEY INFORMANT SURVEY ......................................................................... 74
CASE STUDIES ........................................................................................ 84
ANALYSIS AND SYNTHESIS OF KEY INFORMANT SURVEY AND CASE STUDY
FINDINGS .............................................................................................. 104

vii

CHAPTER 5: CONCLUSIONS, DISCUSSION, AND SUGGESTIONS

FOR FUTURE RESEARCH ................................................................... 124
CONCLUSIONS ...................................................................................... 124
DISCUSSION .......................................................................................... 136
SUGGESTIONS FOR FUTURE RESEARCH .................................................. 144
PERSONAL REFLECTIONS ON THE DISSERTATION RESEARCH ................... 148

APPENDIX A - CASE STUDY SYNOPSIS FOR SITE

RECRUITMENT ..................................................................................... 151
APPENDIX B - KEY INFORMANT SURVEY ......................................... 157
APPENDIX C - CODING GUIDE FOR THE CASE STUDY ................... 164
APPENDIX D— SYNOPSES ................................................................... 200
BIBLIOGRAPHY ....................................................................... . ............ 236

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LIST OF TABLES

Table 1: Population Trends in Aging in the United States, 1900 to 2050 (in
thousands) ............................................................................................................ 2

Table 2: Summarizations of Research Studies ................................................... 35

Table 3: Relationship of the Eight Research Sub-questions to the Four Core
Research Questions ............................................................................................ 45

Table 4: Bent F vabjerg's Strength of Case Study Research (F lyvberg, 2006)....48

Table 5: Interview Questions for Community Members and Their Relationship to
the Research Questions ...................................................................................... 54

Table 6: Survey Questions for Key Informants and Their Relationship to the

Research Questions ............................................................................................ 59
Table 7: Example of Coding and Memoing ......................................................... 65
Table 8: Data Gathered for Case Studies ........................................................... 68
Table 9: Number of Years Respondents Have Been Active in Aging .................. 75

Table 10: Survey Responses Regarding Activities and Services to Improve
Quality of Life for Older Adults by Number of Respondents ................................ 76

Table 11: Activities Where Community Partnership Takes An Active Role by
Number of Respondents ..................................................................................... 77

Table 12: How Partnerships Work Together to Improve Quality of Life for Older
Adults by Number of Respondents ...................................................................... 78

Table 13: Effectiveness of Partnerships Activities by Number of Respondents ..79

Table 14: Ways Partnerships Could be More Effective by Number of

Respondents ....................................................................................................... 80
Table 15: Availability of Funds by Number of Respondents ................................ 81
Table 16: Expanding Funding by Number of Respondents ................................. 82

Table 17: Relevance of Sustainability Factors by Number of Respondents ........ 83

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Table 18: Site A County Demographic Data, 2003, 2007 and 2008, Source:
Michigan Estimated Population of Michigan Counties, 2000-2008, Michigan
Department of Community Health ....................................................................... 89

Table 19: Site A Partnership Timeline ................................................................. 91
Table 20: Site B County Demographic Data, 2003, 2007, and 2008, Source:
Michigan Estimated Population of Michigan Counties, 2000-2008, Michigan
Department of Community Health ....................................................................... 94
Table 21: Site B Partnership Timeline ................................................................. 97

Table 22: Site C County Demographic Data, 2003, 2007, and 2008, Source:
Michigan Estimated Population of Michigan Counties, 2000-2008, Michigan

Department of Community Health ..................................................................... 100
Table 23: Site C Partnership Timeline ............................................................... 102
Table 24: Promoting Service Coordination - Improve Quality of Life for Older
Adults ................................................................................................................ 107
Table 25: Developing Coordinated Systems of Care - Partnership Takes an
Active Role ........................................................................................................ 108
Table 26: Comparison of Case Study Sites Mission Statements ...................... 108
Table 27: Partnership Members Can Get Things Done .................................... 110
Table 28: Partnership Structure and Goal Achievement ................................... 111
Table 29: Support of Community Stakeholders ................................................. 112
Table 30: Conducting Health Promotion and Health Fairs ................................ 113
Table 31: Increase Knowledge of Community Services and Resources ........... 114
Table 32: Partnership Can Achieve Results ...................................................... 115
Table 33: Overcoming Turf Issues .................................................................... 116
Table 34: Working with Faith-based Organizations ........................................... 117
Table 35: Partnership as Integral Part of Community for Aging Issues ............. 119
Table 36: Partnership Viewed in Positive Terms by Community ....................... 121

.........

Table 37: Partnership Viewed in Positive Terms Outside of Their Community .121

Table 38: Norm-oriented Movement Elements Compared to Community
Movement ......................................................................................................... 131

Table 39: Advantages and Disadvantages to Becoming a 501(c)(3) Organization
.......................................................................................................................... 141

Table 40: Example of a Toolkit Preliminary Outline ........................................... 147

xi

LIST OF FIGURES

Figure 1: Relationship of Core Research Questions and Sustainability of
Partnerships ..................................... . .................................................................. 44

xii

Chapter 1: Introduction

The topic for this dissertation research relates to the sustainability of
community initiatives and partnerships that address issues regarding the aging of
a community’s residents. The Background of the Problem section provides data
that demonstrate the trajectory of population changes that will put pressure on
communities to modify the manner in which they approach accommodating the

needs of older adults, their families, and caregivers.

BACKGROUND OF THE PROBLEM

According to the Administration on Aging (2004), the proportion of US.
residents who are older is increasing dramatically. As shown in Table 1, in 1900,
the percentage of residents age 65 and over was 4.1%, while in 2000 it was
12.4%. In the ﬁrst half of the 213t century, this upward trend is continuing as the
percentage is projected to reach 20.7% in 2050. As early as 2020, the percent of
the US. population age 65 and over is projected to be 16.3%, or 55 million
people, compared to 35 million in 2000. Of the 65+ population, the proportion of
those who are 85 years old and older increased from 4.0% in 1900 to 12.1% in
2000. It is projected to reach 13.3% in 2020 and 24.1% in 2050, or almost 21
million people.

As the number of older adults increases as a proportion of the total
population, their needs will have an increasing impact on national and local
agendas. These needs vary extensively based on racial and socioeconomic

characteristics as well as health status, gender, and geographic location. Older

 

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adults' impact on social and economic structures such as families and the labor
force will mandate changes in those systems. Their service needs will require
realignment of resources, especially at the community level (U. S. Administration
on Aging, 2005).

Table 1: Population Trends in Aging in the United States, 1900 to 2050 (in

thousands)

 

65-74 75-84 85+ 65+ as a
Total 65 Percent Percent Percent percent of
Census 65-75 75-84 85 years years and Total of 65+ of 65+ of 65+ Total

Year years years and over older Population years years years Population

1900 2,187 772 112 3,081 75,995 71.0% 25.1% 4.0% 4.1%
1950 8,415 3,277 577 12,269 150,697 68. 6% 26. 7% 4. 7% 8. 1%
2000 18,391 12,361 4,240 34,992 281,422 52.6% 35. 3% 12. 1% 12.4%
2020 31,779 15,584 7,268 54,631 335,805 58.2% 28. 5% 13. 3% 16.3%
2030 37,948 23,903 9,603 71,454 363,584 53.1% 33. 5% 13.4% 19. 7%
2050 37,943 27,902 20,861 86,706 419,854 43.8% 32. 2% 24.1% 20. 7%

 

 

 

 

 

 

 

 

 

 

 

 

 

Source: United States Administration on Aging, 2004

The baby boomer generation in the United States is deﬁned as those born
between 1946 and 1964, and consists of 76 million people. In the United States,
it is projected that there will be 70 million baby boomers aged 65 and older by
2030, when almost one-ﬁfth of the population are 65 and older. Given this
signiﬁcant increase, it has been projected that the current infrastructure will not

be sufﬁcient to meet their needs (Rice & F ineman, 2004).

STA TEMENT OF THE PROBLEM

The premise for this dissertation research is that in the next several
decades nearly every community will have to contend with aging issues due to
these demographic trends. Trend analyses project that the proportion of older

adults in the population will increase steadily until 2050. Most communities will be

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compelled to face this challenge without the beneﬁt of an infusion of external
funding, technical assistance, and expertise.

Many communities have responded to these trends by engaging in a
variety of activities to address them. However, comprehensive studies have not
been conducted to determine the effectiveness of their efforts. Without an
understanding of the strategies that are most beneﬁcial in addressing issues
related to older adults becoming an increasing proportion of the population,
communities will not have the opportunities to learn from each other’s successes

and failures.

DEFINITION OF KEY TERMS

A “community” is a group that bands together to advocate for something
that will improve the lives of community members. Communities are deﬁned
according to geography such as a neighborhood or county; common interests
and commitments such as advocacy groups; or collective relationships such as
colleagues, friends, neighbors or classmates (Netting, Kettner, McMurtry, 2008).
For the purposes of the dissertation, community is deﬁned as geographically
based, with the geographic area deﬁned by the individuals and groups that come
together to improve the quality of life of the older adults who live in their
catchment area. Communities can be neighborhoods, towns and cities, counties,
or several counties. The communities in this study are counties.

A “community partnership or initiative” is deﬁned as a voluntary
collaboration of diverse community organizations or groups with a shared interest

that join together to work toward accomplishing a set of agreed upon objectives

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and goals (Mitchell & Shortell, 2000). Those involved in the partnership can
represent not-for-proﬁt organizations, government agencies, universities, and
advocacy groups. Partnerships are multisectoral in nature; that is, they transcend
traditional service and jurisdictional boundaries. Partnerships can include
coalitions, alliances, consortia, and other interorganizational relationships that
purposefully form to pursue these common goals (Mitchell & Shortell, 2000).
Community partnerships engage in activities around topics such as child welfare
and safety, health promotion, substance abuse prevention, environmental clean-
up, and aging of residents. Throughout this document, “partnership” will be the
term used to identify the coalitions, collaboratives, alliances and initiatives that

address aging issues in communities.

PURPOSE OF THE STUDY

The purpose of this research study is to explore three communities’ efforts
to address the needs of the increasing number of older adults in their catchment
areas through partnerships. Speciﬁcally, this study examines grassroots
partnerships for older adults that receive no external support or funding. The
literature on partnerships for older adults is based on partnerships that are a part
of pilot projects. It describes the structures and activities of partnerships that
receive external funding, primarily supported by foundations.

This study assumes that community partnerships are an effective vehicle
for promoting positive changes. It is predicated on literature about the
effectiveness of community partnership in addressing a host of issues. For

example, the evaluation of the Arkansas Aging Initiative (AAI) determined that

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the AAI had a positive impact on encouraging older adults “to engage in healthy
lifestyles and empower them to actively participate in their own health care”
through educational and clinical offerings (Beverly, McAtee, Chernoff, Davis,
Jones, Lipschitz, 2007, p. 243). Elise Bolda, National Program Director for the
Robert Wood Johnson Foundation Community Partnerships for Older Adults
program states that “community partnerships from coast to coast are helping
move housing-with-services issues to the forefront—and keeping them there”
(Bolda, 2005, p. 63). A healthy community coalition in North Quabbin, MA, over a
ﬁfteen-year period, created the Interfaith Housing Council for the Homeless,
Cape Cod Children’s Place, Health Connections, Lower Outer Cape Community
Development Corporation, and Ellen Jones Community Dental Center. All told, in
addition to the services provided, these programs generated $2.4 million and 33
jobs on an annual basis (Wolff, 2003).

The ﬁrst line of inquiry for this research seeks to identify what it is that
compels individuals and groups (actors) in a community to recognize that they
should address issues related to their older residents. The second line of inquiry
examines the ways in which these actors garner the support of other individuals
and groups in their communities who are willing to work together to accomplish
an agreed-upon set of goals. The research explores demographic factors,
socioeconomic factors, and factors such as the service continuum, presence of
advocates, and precipitating events to ascertain whether communities that have
embarked on partnerships that address aging issues have identiﬁable

commonalities. The third line of inquiry determines the factors that are present

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that help or hinder partnerships sustain their activities and their momentum over
time. The unit of analysis for this study is the community that has generated a

partnership that addresses aging issues.

IMPORTANCE OF THE STUDY

Chapter 2 provides a review of the literature conﬁrming that sustainable
community partnerships for older adults have made some strides in the
communities in which they are located. These strides include improving
communication regarding available home- and community-based long-term care
services, housing, transportation, caregiver supports, and paraprofessional
workforce development (Bolda, Lowe, Maddox & Patnaik, 2005) and clinical and
educational programs (Beverly et al, 2007). However, these strides appear to be
isolated to those communities that generated a community partnership for older
adults. The aging baby boomers most likely will strain almost every community’s
service systems and infrastructure. Therefore, the fact that there currently is a
fairly limited number of communities that have attempted to address aging issues
in a concerted, systematic manner is problematic for the quality of life of older
aduﬂs.

The funders of demonstration or pilot projects that study partnerships
require the participating entities to maintain data sets that are analyzed and
assessed by foundation staff or external evaluators.

“Although coalitions have become an increasing venue for

addressing public health issues, documentation of the process that

coalitions go through from formation to achievement of outcomes is

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scarce. How coalitions work is not widely understood...Other

authors have given extensive detail to deﬁning elements that will

lead to a successful coalition. Although these tips are helpful to

forming a community group, the processes used by coalitions in

attaining this success have not been provided” (Downey, Ireson,

Slavova & McKee, 2008, p. 131).

While these data provide valuable lessons learned by the study
communities, because of the nature of the projects, it is often not feasible to
employ rigorous scientiﬁc research methods to assess them. Therefore, the
results of the studies inform other communities about methods used, barriers
encountered, and implementation effects in individual communities, but do not
produce truly replicable designs due to the unique characteristics of each
community. The studies form a set of case studies that can be used by other
communities to inform them of best practices and potential landmines as they
embark on creating partnerships.

This dissertation research study adds to the current body of knowledge by
increasing the understanding about the factors that prompt communities. to
address the issues related to the aging of their residents through grassroots
partnerships that do not receive external funding. The literature about community
partnerships posits that one of the primary similarities in the current set of
communities that have formed aging partnerships is that they have been able to
procure funding and technical assistance from a foundation that is supporting

community efforts to build partnerships (Bolda, Lowe, Maddox & Patnaik, 2005;

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Mitchell & Shortell, 2000). This dissertation study goes beyond that group to
examine grassroots community partnerships for older adults that do not have
external funding or technical assistance.

The dissertation research identiﬁes internal and external factors the three
case study communities encountered that have both positive and negative
effects on the sustainability of their efforts. This information will assist
communities in which there is little or no concerted effort to maintain or improve
the quality of life of their older residents to learn from communities that have
made progress in doing so. The information from this study should assist
communities and advocates as they encourage stakeholders in their
communities to take action on aging issues.

The results of this research can provide the foundation for a toolkit
communities can use to create partnerships and guide their planning and
implementation activities by identifying some of the necessary and sufﬁcient
conditions that must be present for a community partnership to sustain its efforts
in a productive manner. Communities can use the toolkit to develop their own
mission and vision that will attract the attention of decision makers in their
communities. Making their mission and vision known in their community should
enable the primary actors to recruit a core group or steering committee that can
prepare a strategic plan for developing and nurturing an enduring community
partnership that addresses the needs of older adults.

Another way in which this dissertation adds to the knowledge base is that

it links three distinct bodies of literature; social movement literature, communities

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movement literature, and community partnership literature. These three areas of

research have not been associated in other studies.

SCOPE OF THE STUDY

This dissertation research draws upon the theoretical framework of social
movements and communities movements that are presented in the literature
review chapter. The framework centers around the aspect of social movements
related to resource mobilization as a means by which communities generate
multisectoral grassroots partnerships that address aging issues within their
catchment areas (McCarthy & laid, 1977). Within this framework, the research
cited in the literature review demonstrates that issues related to social and
economic systems, biomedicalization of aging, insufﬁcient appropriate resources,
and quality of life can provide sufﬁcient impetus for community members to
mobilize to address aging issues in their community by forming a collaborative
partnership.

Community partnerships that address aging issues form as a reaction to
these and other issues and become the means of addressing identiﬁed issues on
a local level. The literature cited in Chapter 2 presents examples that
demonstrate how the Communities Movement Project links the collective
interests of the social movement actors. In this study, those community members
who have a strong interest in improving systems related to aging are the social
movement actors in their localities. This linkage causes these community
members, agencies and organizations to pool their resources to achieve their

goals of changing elements of their community’s social structures and/or reward

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distribution systems that inﬂuence the delivery of services to older adults
(Achenbaum, 2005; Bradshaw, T. K., 2000; Couto, 1998; Kaufman, Shim &
Russ, 2004; Mitchell 8. Shortell, 2000; Wolff, 2001).

This dissertation research explores the necessary and sufﬁcient conditions
that must exist for communities to plan, implement and sustain partnerships that
address issues that are germane to the needs of their older residents. Many of
these conditions reﬂect aspects of social movements and communities
movements. Sufﬁcient recognition of the issues by a critical mass of individuals
and/or groups can lead them to mobilize around the issues in such a manner that
they can implement positive changes to the infrastructure through resource
reallocation and perhaps even generation of new resources.

The lines of inquiry of this dissertation research are based on two
assumptions. The ﬁrst assumption is that the presence of necessary and
sufﬁcient conditions and their recognition by key stakeholders, will induce
community members to form a grassroots partnership to address their
community’s unique aging issues and infrastructure without seeking external
assistance. The second assumption is that sustainability of a partnership occurs
when those community members involved recognize the value of their efforts as
they form closer collaboration structures of community services and observe
improvements that their efforts have brought upon the systems that have an
impact on the quality of life of their older residents. The research questions in this
exploratory study are designed to provide data that conﬁrm or refute these

assumptions (Patton, 1990).

10

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RESEARCH QUESTIONS

There are four core research questions that address the lines of inquiry of
the study. The ﬁrst line of inquiry is addressed by the following core research
question: What factors prompted the community to be interested in addressing
aging issues (e.g., demographics, economic, social, event-based) ?

The second line of inquiry is addressed by the second core research
question: What factors helped sustain the community’s efforts to create a
partnership in aging (e.g., ﬁnancial resources, positive past community
endeavors, leadership, partnership accomplishments, stakeholder buy in, political
will, a community champion)?

The third line of inquiry is addressed by the ﬁnal two core research
questions: What factors encountered by the partnerships hindered or ended the
community’s efforts (e. g., ﬁnancial constraints, turf battles, stakeholder distrust,
no driving force, community apathy)? What other internal and/or extemal factors
did partnerships report encountering that had a bearing on the success or failure
to sustain their collaborations efforts?

The results of this dissertation must be viewed as exploratory. The
information gathered in response to the research questions will be used as a

launching point for further research.

LIMITATIONS OF THE STUDY

The limitations of the dissertation study design concern the methods used
to recruit the case study sites and the respondents of the Key Informant Survey.

Recruitment for both the case studies and the survey was conducted using

11

Iistservs and email lists that target professionals who work in aging policy and
macro practice. The recruitment strategy included sending information about the
dissertation study, as well as an invitation to participate, to 1) the Elder Friendly
Communities Iistserv; 2) the Michigan Society of Gerontology Iistserv; 3) the
directors of the 18 regional Area Agency on Aging in Michigan; and 4) the
members of the Michigan State University School of Social Work Aging
Consortium. There is probably some cross-over among the member of these
groups. These four groups were chosen because the recipients of the emails
were assumed to be people who are actively involved in macro practice in aging
in Michigan.

A convenience sample of case study communities was used based on the
following selection criteria: 1) partnerships had been active for a minimum of 4
years; 2) partnerships met at least quarterly and were engaged in at least one
signiﬁcant activity a year; 3) communities had socioeconomic diversity that adds
to the complexity of the partnership’s efforts; and 4) the willingness of the
partnership to participate in the study. The application of the criteria limited the
pool of communities that would be eligible to participate in the study. In addition,
the study design did not include a group of communities that had generated
partnerships for older adults but did not sustain their efforts.

The three case study communities used in the dissertation research met
the selection criteria. However, they shared a common characteristic in that they

were all initiated by the human services collaborative body in their counties.

12

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Therefore, the research study did not gather information from communities that
were not afﬁliated with a local collaborative body.

These limitations reduce the generalizability of the dissertation research.
However, the purpose of the study is to explore the necessary and sufﬁcient
conditions that were present and shared across the case study communities that
led to their ability to generate and sustain partnerships for older adults. The
intention is not to produce a generalizable model, therefore, the limitations were

viewed as acceptable in light of the purpose of the study.

SUMMARY

This chapter presents the problem that is explored by this dissertation
research, namely, demographic trends mandate that, in the next several
decades, nearly every community will have an increased number of older
residents for which it must provide adequate and appropriate services and
supports. One way communities can address the problem is through grassroots
multisectoral community partnerships for older adults that mobilize resources to
provide those adequate and appropriate services. The ability of these
partnerships to sustain their efforts for as long as they are needed by their
communities is explored through three lines of inquiry that result in four core
research questions.

This dissertation research adds to the current body of knowledge in two
ways. The ﬁrst is by examining communities where grassroots partnerships for
older adults formed and were sustained in spite of the fact that they did not have

the beneﬁt of external funding and supports. The second is by relating social

13

mover
panne

grassr

movement literature, communities movement literature, and community
partnership literature to help explain the formation and sustainability of

grassroots community partnerships for older adults.

14

Ch

Chapter 2: Review Of The Literature

In each community that attempts to enhance the quality of life of its older
residents, there is typically a driving force that brings aging issues to the attention
of decision makers. This driving force might be an event or series of events that
highlight deﬁciencies in the local systems of care, a person with a vision about
aging services and sufﬁcient standing in the community to be heard, or a
conﬂuence of factors that brings aging issues to the fore (Mitchell & Shortell,
2000)

The theories upon which this dissertation research study are anchored are
social movement theory, with particular emphasis on collective action frames and
resource allocation and mobilization (McCarthy & Zald, 1977), and communities
movement theory (Kesler & O’Connor, 2001). In addition, the body of literature
that pertains to community partnerships was explored to provide the context for
the formation and sustainability of the three grassroots community partnerships

in the case study.

SOCIAL MOVEMENT THEORY

A social movement is a “set of opinions and beliefs in a population which
represents preferences for changing some elements of the social structure
and/or reward distribution system” (McCarthy & Zald, 1977, p. 1218). In their
seminal work, Resource Mobilization and Social Movements: A Partial Theory,

McCarthy and Zald depart from traditional social movement theory which is

15

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to

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based on the grievances of an interest group being the precipitating factor for
forming a social movement. The resource mobilization approach

“emphasizes both societal support and constraint of social

movement phenomena. It examines the variety of resources that

must be mobilized, the linkages of social movements to other

groups, and dependence of movements upon external support for

success, and the tactics used by authorities to control or

incorporate movements” (McCarthy and Zald, 1977, p. 1213).

The social movement process has three steps in which social movement
actors, those individuals and groups with a common preference for making
changes to the current social structure or rewards distribution system, come
together to affect change. These steps include:

1. Actors becoming aware of their common identity, direction, and shared
interests. They realize they are not alone and explore their commonalities.

2. The actors recognize that the scope of the various actors’ actions is
consistent, becoming a collective action. They understand that they want
the same things and decide to work together.

3. Actions taken by the actors occur in a concentrated period of time, thus
becoming a collective episode. The actors realize that it is time to work
together to advance their shared interests (McCarthy and Zald, 1977).
According to Smelser’s Value-Added Theory developed in 1962, a social

movement is described as having “a clear awareness of common identity,

direction, and shared interests... [it] is sufﬁciently coherent and concentrated in

16

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time and social strata that it constitutes a collective episode,” (Miller, 2000, p.
419). The theory deﬁnes a noun-oriented social movement as one that “is a
collective attempt to restore, protect, modify, or create norms in the name of a
generalized belief,” (Miller, 2000, p. 419). The types of norms that a social
movement might endeavor to change can be economic, political, educational,
religious, or lifestyle (Miller, 2000). Miller gives the example of the environmental
movement that is based on the value of quality of life. An example of one of the
ways the environmental movement seeks to improve quality of life is by
challenging industrial practices that lead to pollution through the improper
disposal of hazardous waste (Miller, 2000).

Stallings interprets Smelser’s theory by deﬁning the components of a
norm-oriented social movement as:

“(1) ambiguity resulting in (2) anxiety which is (3) attached to some

agent, the threatening character of which is exaggerated, followed

by (4) the emergence of a generalized belief that (existing)

normative regulation is inadequate, followed in turn by (5) the

emergence of a belief that normative change can solve the

problem, thereby (6) neutralizing the agent responsible and (7)

reducing the original causes of ambiguity” (Stallings, 1973, p. 467).

Applying Stallings’ components to the grassroots partnerships for older
adults, the recognition of the demographic trends and their impact on the quality
of life of older residents relates to the ﬁrst component. The second component is

the initial reaction of not knowing how to solve the problem. The third component

17

..th s HA

is the current systems that are perceived as obstacles to addressing the
challenges brought about by the increasing number of older residents. The fourth
and ﬁfth components relate the recognition that by there are things that can be
done to address the challenges. Banding together in a partnership to address the
challenges helps to neutralize the agent (component 6) and reduce the original
ambiguity (component 7).

The collective behaVior and collective action aspects of social movement
theory were developed by observing demonstrations and marches as well as
detailed historical case studies of social movements and protest cycles such as
the Civil Rights Movement (Miller, 2000). There are three collective action
theories. The ﬁrst is “Social Behavioral lnteractionist Theory”, based on the work
of Clark McPhail, that views collection actions as purposive activities that connect
peoples’ goals, experiences or perceptions, and their actions. (Miller, 2000). The
second collective action theory is “Resource Mobilization Theory” that comes
from case studies of social movements, particularly the Civil Rights Movement.
Resource Mobilization Theory, based on the work of John McCarthy and Mayer
N. Zald, states that social movements are “manifested through organizations that
succeed in mobilizing social networks and material resources” (Miller, 2000, p.
55). The third collective action theory is “Political Process Theory”, based on the
work of Doug McAdam, William Gamson, and Michael Lipsky, that explains how
people “frame their discontent into articulate grievances and offer hope for

successfully resolving them: (Miller, 2000, p. 55).

18

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RESOURCE MOBILIZATION THEORY

This dissertation research uses Resource Mobilization Theory (RM) to
explain the collective actions of grassroots community partnerships for older
adults. RM theory is based on the concept that actors involved in social
movements employ “rational actions oriented toward clearly deﬁned, ﬁxed goals
with centralized organizational control over resources and clearly demarcated
outcomes that can be evaluated in terms of tangible gains” (Jenkins, 1983, p.
529). The types of resource mobilized by movements include money, facilities,
labor and legitimacy.

Social movement organizations (SMO), such as grassroots community
partnerships for older adults, have a set of target goals, or preferred changes,
upon which they focus their activities. The SMO needs resources to use to
achieve its goals. The level of activity of the SMO relates to the resources it
controls which are those it can mobilize to meets its goals (McCarthy & Zald,
1977). RM theory describes the “interaction between resource availability, the
preesixting organization of preference structures, and entrepreneurial attempts to
meet preference demand” (McCarthy & Zald, 1977, p. 1236).

Social movement supporters “act in terms of internalized values and
sentiments as well as calculations of self-interest. The major task in mobilization,
then, is to generate solidarity and moral commitments to the broad collectivities
in whose name movements act” (Jenkins, 1983, p. 538). Applied to the
grassroots community partnerships for older adults, the social movement

supports are those individuals and agencies that have internalized the value that

19

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the older residents in their communities deserve to have a decent quality of life.
These supporters come together around that purpose and act upon it by
developing and employing strategies to maintain and/or improve the quality of life

of their older residents.

SOCIAL MOVEMENT FRAMES

Social movements employ movement frames as a means of garnering
support. Frames are developed by interest groups as they consider how to
deliver their message effectively. David Snow deﬁnes a frame as a “conscious
strategic effort by groups of people to fashion shared understanding of the world
and of themselves that legitimate and motivate collection action” (Miller, 2000, p.
6).

Movement frames have two essential elements; 1) deﬁning the problem
and its sources, and 2) identifying the strategy for addressing the problem.
Frames are developed by interest groups as they consider how to effectively
deliver their message (McAdam, McCarthy & Zald, 1997). Community
partnerships frame issues pertaining to aging as ones for which older adults
should not be held accountable. These partnerships View the crux of the
problems encountered by their older residents as caused by societal
dysfunctions that are outside of the older adults’ sphere of control, and therefore,
not the fault of the individual experiencing the problem. This creates a movement
frame that focuses on systemic issues as a means of addressing problems

encountered by individual older residents.

20

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Collective action frames are “action-oriented sets of beliefs and meanings
that inspire and legitimate the activities and campaigns of social movement
organizations” (Benford & Snow, 2000, p. 614). There are several types of
collective action frames: 1) diagnostic frames that identify and attribute problems,
2) prognostic frames that propose solutions to the problems, and 3) motivations
frames that provide the rationale for participating in collective actions that strive
to ameliorate the identiﬁed problems. Collective action frames also vary in their
degree of resonance, deﬁned as the effectiveness of their efforts to mobilize
resources, much of which is based on their credibility and relevance (Benford &

Snow, 2000; Couto, 1998).

COMMUNITIES MOVEMENT THEORY

The proliferation of multisectoral coalitions in America has been named
the “communities movement” (Kesler & O’Connor, 2001; Norris, 2001; Wolff,
2003). These groups undertake to address what appear to be intractable
problems that no individual sector, agency, or program could hope to solve
successfully on its own. The backbone of the communities movement is the
broad-based community coalitions that form to address local problems together
rather than individually. The communities movement is “a local phenomenon,
mobilizing innate creativity and underutilized (or misallocated) resources to
initiate and sustain positive change” (Norris, 2001, p. 302). The communities
movement uses resource mobilization, one of the bases of social movement
theory, as the manner through which to attain positive change (Kesler &

O’Connor, 2001; Norris, 2001; Wolff, 2003).

21

The study conducted by Kesler and O’Connor, The Communities

Movement Project, included a series of ﬁve dialogues that took place in Des

Moines, Iowa; White River Junction, Vermont; Jacksonville, Florida; Salt Lake

City, Utah; and Washington, DC. The groups involved in the dialogues included

seven community-based movements: Health Communities, Sustainable

Communities, Community Building, Civic Democracy, Livable Communities, Safe

Communities, and Smart Growth. These movements were chosen because they

provided a sample of the most inﬂuential movements over the past decade. The

common themes found during the dialogues across the movements were:

1.

2.

Shared sense of community;

Social justice that assures the full diversity of the community is included in
deliberation, collaboration and decision making;

Sense of the natural environment as it relates to the interconnectedness of
personal, community and environment so they can all ﬂourish;
Commitment to the process of community building so that it supports
dialogue, has continuous feedback mechanisms, and practices inclusive
collaboration and decision making;

Inclusion of all stakeholders in a deliberative process conducted in terms
of shared vision and values to elicit a sense of the common good;

Need for measurement tools that produce indicators so initiatives could be
funded;

Need to lay the ground work for public policy development; and

22

8. Need a basic level of organizational competency such as fundraising and
sustainability strategies, inclusiveness and engagement of major
stakeholders, ability to develop long-range goals and strategies, and
determination to overcome political and bureaucratic barriers (Kelser &
O’Connor, 2001 ).

The communities movement unites disparate groups of people and
organizations by appealing to their enlightened self-interest, allowing them to see
that they will accrue beneﬁts from their efforts, even if those beneﬁts are indirect.
This asset-based human and community development approach links the
beneﬁts perceived by individuals and organizations to those of the partnership as
a whole. It serves as the cement that holds partnerships together by allowing
them to see how the fruits of their labors relate to the results of the partnership
(Kesler & O’Connor, 2001; Norris, 2001; Wolff, 2003).

The conclusion drawn from the information gathered for The Communities
Movement Project was that nationally based movements are not what fuel the
interest of local actors.

“People care about issues and not movements. It is possible that

the next stage of the civic sector will combine the values and tools

of national movements with the energy of citizens engaged with the

critical issues affecting their communities to create a dynamic entity

that fulﬁlls a new and much needed role in today’s society” (Kesler

& O’Connor, 2001).

23

APPLICATION OF SOCIAL MOVEMENT AND COMMUNITIES MOVEMENT THEORIES IN THIS

RESEARCH STUDY

The principles of the communities movement and social movement
theories apply when community partnerships mobilize resources to affect positive
systems changes in their locales. The communities movement links the collective
interest of the social movement actors and the pooling of their resources
(McAdam et al., 2004; Benford & Snow, 2000; Miller, 2000). These movements
strive to change elements of social structures and/or reward distribution (Norris,
2001). The activities of community partnerships that mobilize around the issues
involving older adults in their locales do just that. They target systems that
require adaptation or change so they can provide a more comprehensive
continuum of services for their older residents, thus providing the infrastructure to
allow these residents to have an acceptable quality of life.

Health care delivery systems are often the target of community
partnerships’ activities. The Communities Movement has its roots in public health
initiatives. Therefore, it comes as no surprise that the partnerships for older
adults in this dissertation study each has as one of its primary goals enhancing
coordination of services in their communities as an improvement of their service
delivery system.

The partnerships recognize that the quality of life experienced by older
adults is inﬂuenced greatly by their physical and mental health status. Many of
the physical and cognitive conditions that were once thought to be unavoidable

byproducts of the aging process can be prevented or delayed. For example, in a

24

study about the biomedicalization of aging, the authors state that American
society has lost the sense of what the normal lifespan is and that knowledge of
aging and disease have become intrinsically linked to interventions. They go on
to state that the social environment is permeated by the desire to thwart aging by
using medical interventions, thus stretching middle age into later life (Kaufman,
Shim, Russ, 2004). Biomedicalization of aging is tied directly to resource
mobilization and utilization. It can have a profound impact on how a community
conﬁgures its service continuum. The stretching of middle age into later life can
affect how partnerships for older adults determine their goals and priorities.
Community partnerships have also focused on health disparities among
their residents. There are a number of studies that identify racial disparities in
health care provision that have a negative impact on minority populations. These
studies include:
0 distribution of African Americans in residential care, assisted living and
nursing homes (Howard, Sloane, Zimmerman, Eckert, Walsh, Buie,
Taylor, Koch, 2002);
O racial, ethnic, socioeconomic, and access disparities among women
using preventive services (Sambamoorthi & McAlpine, 2003);
O racial differences in diagnosing dementia (Husaini, Sherkat, Moonis,
Levine, Holzer, Cain, 2003);
0 racial differences in the prevalence of dementia among patients
admitted to nursing homes (Weintraub, Raskin, Ruskin, Gruber—Baldini,

Zimmerman, Hebel, German, Magaziner, 2000);

25

<> racial patterns in disabled older person’s use of medical services (White-
Means, 2000);

0 race, quality of care, and outcomes of older patients hospitalized for
heart failure (Rathore, Foody, Wang, Smith, Herrin, Masoudi, Wolfe,
Havranek, Ordin, Krumholz, 2003);

0 socioeconomic and racial disparities in the quality of nursing home care
(Mor, Zionn, Angelelli, Teno, Miller, 2004); and

o racial patterns in use of formal home health care (White-Means & Rubin,
2004).

Access, or lack thereof, to the full continuum of services in a community has
direct implications for how community partnerships assist their older residents
attain a quality of life that is consistent among all racial and socioeconomic
groups.

Other examples of community partnerships exist within the public health
system. These partnerships take an active role in promoting healthy lifestyles
through physical activity, good nutrition, smoking cessation, and other lifestyle
factors that have positive impacts on health. In Economic Implications of
Increased Longevity in the United States, Rice and Fineman contend that there
are three essential characteristics of healthy aging; “maintaining a low risk of
disease and disease-related disability...maintaining a high level of mental and
physical functioning...and maintaining an active engagement with life” (Rice &
Fineman, 2004, p. 460-461). They conclude that continued improvements in

health status of older adults are crucial because fewer older adults with chronic

26

diseases translates into lower use of health care services and, therefore, slower
spending growth.

Public health efforts vary widely among communities, depending on
resources available and the level of political will of decision makers to allocate
resources to prevention projects. Many community partnerships work with their
local public health agencies to address ways in which the community can
implement these positive interventions (Wolff, 2003). Healthy communities
approaches often come from initiatives sponsored by state health departments,
hospital associations, and universities and are funded in large measure by
states, foundations, and Medicaid. Some of the states in which healthy
communities experiments occurred are California, Colorado, Massachusetts,

Maine, South Carolina and New Mexico. (Wolff, 2003).

COMMUNITY PARTNERSHIP LI TERA TURE

SOCIAL CAPITAL AND CIVIC ENGAGEMENT

Social capital relates to social movement theory. In his article, A Bottom-
Up Perspective on Innovations: Mobilizing Knowledge and Social Capital through
Innovative Processes of Bricolage, Anderson ties social capital to resource
mobilization theory when he states “what really matters is whether those
experiencing problems and challenges are motivated, and also able, to
mobilization assets, material as well as nonmaterial, to craft efﬁcient and
innovative solutions” (Anderson, 2008, p. 60). He goes on to talk about
knowledge and social capital as sources for innovative problem solving. He
deﬁnes social capital as “the social stock of trust, norms and networks that

27

facilitate coordinated actions” (Anderson, 2008, p. 62). He stipulates that trust is
imperative among the actors as they work together.

Social capital is viewed as an asset used by the actors as they develop
new solutions. The actors view each other as people who can be trusted and,
therefore, are willing to expend their energies toward their common goals.
Finally, Anderson states that as partnerships “succeed in their coordinated efforts
and manage to cope adequately with problems and challenges of mutual
concern, they have an incitement to progress further in cooperation” (Anderson,
2008, p. 64). Therefore, Anderson views social capital as a by-product of
successful problem solving (Anderson, 2008). I

With the advent of funding for community partnerships from major
foundations such as the Robert Wood Johnson Foundation, research has been
conducted to determine how community coalitions generate social capital,
advocate for reallocation of ﬁnite resources, affect public policy through
advocacy, and mobilize resources that would otherwise not be employed to
improve the quality of life of their older residents (Bolda et al., 2005, Mitchell &
Shortell, 2000). These results can be studied by communities and decision
makers who are (considering ways in which to improve their infrastructure to
enhance the quality of life for their older residents.

Recent research examines the actors, their roles, their goals, and the
strategies they implement to attain them, as well as their governance and
management structures (Bolda et al, 2006; Mitchell & Shortell, 2000). Findings

indicate that actors in each community can vary considerably but are usually

28

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comprised of groups and individuals who have either a direct or indirect stake in
the outcomes. For example, actors can be agency administrators, elected
ofﬁcials, advocates and advocacy groups, neighborhood associations, business
leaders, healthcare organizations, and service beneﬁciaries.

A crucial aspect of the research conducted by Elise Bolda and her
colleagues has been to determine the types of barriers encountered by
partnerships for older adults and how they are addressed (Bolda & Wetle, 2005;
Bolda, 2005; Bolda et al, 2005; Bolda et al, 2006). One of the barriers identiﬁed
was that progress of a partnership can stall if governance and management are
not addressed early in the life of a partnership (Bolda et al, 2006). Another is that
power imbalances can occur because of the size and role of individual partners
which, if not addressed early on, can have a negative impact on how the
partnership functions (Bolda et al, 2006). Awareness of obstacles they might
encounter helps partnerships anticipate their presence and overcome them by
adapting the infrastructure and programs in their communities to optimize
resources and maximize outcomes.

As to the actors, those groups and individuals who band together to tackle
this complex issue, recent research has revealed a set of motivations for
becoming involved. For example, in their article on management and governance
of partnerships, Bolda and her colleagues discuss that “At their root, collaborative
partnerships have as their mission the enhancement of social capital and the
development of a sense of collective efﬁcacy to improve their communities”

(Bolda et al, 2005). Therefore, while most of the actors might not term their

29

efforts as such, the goal of their endeavors is to increase social capital and
collective efﬁcacy. Bolda describes social capital as the ecologic characteristics
of a community that have a direct inﬂuence on the health and well being of its
older residents through access to services and impact on psychosocial
processes (Bolda et al., 2005). It is the resources available through social
connections that form linkages within and outside the community. These linkages
create collective efﬁcacy ”the mutual belief in the capacity to intervene to achieve
common good—adds the dimension of local informal social control to social
capital and addresses the psychosocial mechanism through which social capital
inﬂuences health” (Bolda et al., 2005, p. 412).

The relevance of social capital to aging is twofold: ﬁrst, older adults are at
risk of losing critical social ties through social isolation, death or illness of peers,
lack of stimulating interactions, loss of mobilility and transportation, and ﬁnancial
insecurity; and second, the level of social capital in US. communities appears to
be declining as people are less connected to those immediately around them
(Cannuscio et al, 2003). The decline in social capital is a generational
phenomenon in which the cohort who attended school during the Great
Depression and lived during World War II have, “maintained high levels of civic
participation, community involvement, and social trust throughout their lives”
(Cannuscio et al, 2003, p. 396). AS this cohort becomes smaller due to the death
of its members, social capital has declined because subsequent generations do
not have the same level of civic engagement. “Access to social capital within the

broader community, derived through norms of mutual assistance between

30

neighbors and the involvement of local groups, becomes important for this large
group of elderly persons who have limited opportunity for social engagements
within their homes” (Cannuscio et al, 2003, p. 395). By taking measures to
reduce the impact of these factors, communities can increase social capital of
individuals and, therefore, improve the quality of life of their older residents.

The goal of the actors who band together to address aging issues in their
community is to build community capacity that empowers older residents to attain
an adequate quality of life by mobilizing pertinent assets to beneﬁt the community
as a whole. In this paradigm, the community development process leads to
increased civic engagement and social capital. “Building community capacity is
both a goal and a method that is embedded in a number of innovative initiatives
designed to promote elder-friendly communities (AdvantagAge Initiative;
Community Partnerships for Older Adults; Experience Corps). These efforts
recognize the current reality of civic disengagement, the resulting decline in
social capital and the concomitant decrease in the sense of community” (Austin,
Des Camp, Flux, McClelland & Sieppert, 2005, p. 402). The initiatives listed are
attempts to build community capacity.

The actors are members of a social movement organization or interest
group, such as a community partnership, that bands together to address the
needs of older residents and their families. The interest group or community
partnership envisions older adults as complete people and productive citizens
rather than simply objects of compassion (Austin et al, 2005). In this dissertation

research study, the actors are those community members in the case study

31

communities who banded together to form a partnership for the beneﬁt of the

older adults who reside in their communities.

PARTNERSHIP SYNERGY

“The synergy that partners seek to achieve through collaboration is more
than a mere exchange of resources. By combining the individual perspectives,
resources, and skills of the partners, the group creates something new and
valuable together—a whole that is greater than the sum of the individual parts”
(Lasker, Weiss & Miller, 2001, p. 184). Partnership synergy is a complex set of
dynamics that has an impact on relationships, procedures, and structures in
which the partners operate. It encompasses the ability to combine the disparate
perspectives, resources and skills of individuals and organizations to tackle
problems and generate solutions that would be impossible within their limited
spheres of inﬂuence and operation. “Partnership synergy is a product of the
group interaction” ( Lasker et al, 2001, p. 187).

The components of synergy are those individuals and organizations in the
community that form the partnership. When these components include diverse
participants who have heterogeneous traits, abilities and attitudes, the
partnerships are more likely to succeed. By using partnership synergy as a
proximal outcome of partnership functioning, researchers believe they can
determine what it is that gives collaboratives their advantage over entities
working only within their traditional spheres of practice. (Lasker et al, 2001). In

this dissertation research study, partnership synergy was realized when the

32

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members of the coalitions identiﬁed goals, developed strategies to address them,
and implemented those strategies which then produced their achievements.

As entities realize that they must collaborate with other agencies,
disciplines, and organizations, they can fear loss of control over outcomes for
which they are accountable. In this context, diversity can be a double-edged
sword. On one hand, it can lead to interventions that none of the individual
participants could have envisioned without the synergy generated by the
partnership. The determinants of partnership synergy include resources, partner
attributes, relationships among partners, partnership characteristics, and the
external environment. High levels of partnership synergy lead to comprehensive
and complex interventions that increase the probability that the group’s efforts
will produce changes in community programs, policies, and practices (Lasker et
al, 2001).

On the other hand, contention can arise that places more demands on the
partnership leaders, increases the difﬁculty of coordination, and thus requires a
different form of management and organizational structure. It is estimated that up
to half of partnerships do not survive their ﬁrst year and of those that do survive,
a signiﬁcant number ﬂounder when it comes to developing plans and
implementing interventions (Lasker et al, 2001; Bolda et al., 2006, Mitchell &
Shortell, 2000; Wolff, 2001).

Thus it can be shown that it is not only partnership formation that is
important. Their ongoing existence or sustainability cannot be assumed. The

entities involved need to recognize the ongoing beneﬁts of their endeavors or

33

they will discontinue their participation. In this dissertation research, each site
came to a time after several years of collaborating when it re-examined its
reason for being. Each site decided, after taking a hiatus, that the goals of the
partnership were still valid and that the partnership should continue its efforts.
Actors’ participation in partnerships is inﬂuenced by the beneﬁts and
drawbacks perceived by potential participants. If they believe the goals of the
partnership relate well to the mission and economic viability of their entity and
that the partnership will be successful in achieving its goals, they are very likely
to become active members. Therefore, partnerships should strive to minimize
drawbacks to being involved such as 1) entities’ perceived diversion of time and
resources from their primary interventions; 2) reduction in their independent
decision making; 3) perceived or real power differentials among the members; or
4) feeling that their efforts will be marginalized by the partnership. Minimizing the
impact of these disadvantages can encourage groups and individuals to become
active members of a partnership (Bolda et al., 2005; Kelly, 2004; Mitchell &

Shortell, 2000; Mosley, 1998).
ASPECTS OF SUSTAINABLE COMMUNITY PARTNERSHIPS

The three studies upon which this dissertation research’s premises
regarding sustainable community partnerships are based are summarized in

Table 2. These studies relate to governance and management structures and

partnership synergy.

34

Table 2: Summarizations of Research Studies

 

 

 

 

 

Autho 5 Study Purpose Groups Studied
Shannon To apply a multidisciplinary Community Care Network
Mitchell perspective to construct a typology Demonstration Project
Stephen of effective governance and Community Health Intervention
Shortell management characteristics of Partnership,

community health partnerships Comprehensive Community
based on the notion of external and Health Models Project,
internal alignment Healthy Communities,
Community Program for
Affordable Health Care,
Turning Point Partnerships,
Coalition for Healthier Cities
and Communities in the US.
CDC PATCH model,
CITY-NET Healthy Cities,
North Carolina Community-
based Public Health Initiative,
Ohio Center for Healthy
Communities,
Arizona Partnership for Infant
Immunization
Elise Bolda Describe efforts of four community Robert Wood Johnson’s
Paul Saucier partnerships in Boston, El Paso, Community Partnerships for
George Houston, and Milwaukee—grantees Older Adults Program funded
Maddox of Robert Wood Johnson’s partnerships in Boston, El
Terrie Wetle Community Partnerships for Older Paso, Houston, and
Jane lsaacs Adults Program-- to address Milwaukee
Lowe governance and management
structures in ways that promote the
sustainability of innovative
community-based long-term care
3 stem improvements.
Roz Lasker To build on literature related to Analysis of literature on
Elisa Weiss collaboration to identify synergy as studies on collaboration

Rebecca Miller

the proximal outcome of partnership
function that gives collaboration its
unique advantage. Previous
research lacked an explanation of
the pathway through which
partnership functioning influences

 

partnership effectiveness.

 

around health issues such as
federal Community Access
Program and Kellogg
Foundation’s Turning Point

 

The research studies cited in the literature review demonstrate that

sustainable partnerships are ones that foster respect, trust, inclusiveness and

openness (Lasker et al, 2001). These attributes provide the foundation upon

35

 

which the participants can build an enduring partnership. Another determinant of
sustainability cited is that the motivation for collaboration is generated within the
community rather than by external mandate. “Overreliance on external support,
especially nonlocal ﬁnancing, can also have its drawbacks. Most sources of
money have strings attached, and exclusive reliance on them inevitably subjects
the partnership to increased outside control” (Mitchell & Shortell, 2000, p. 253).
When the various actors have ownership in the endeavors and outcomes of the
partnership, it provides the impetus around which they can coalesce their efforts
(Bolda et al., 2006; Lasker et al, 2001; Mitchell & Shortell, 2000; Wolff, 2001).

In their 2001 study, Lasker, Weiss and Miller suggest the determinants of
partnership synergy. It is these determinants upon which this dissertation
research bases its research questions. The determinants include:

1. Resources — funding; facilities; Skills and expertise; information;
connections with people, organizations, and groups; endorsements,
and convening power

2. Partner characteristics - heterogeneity; level of involvement

3. Relationships among partners - trust; respect; conﬂict; and power
differentials

4. Partnership characteristics - leadership; administration and
management; governance; and efﬁciency

5. External environment - community characteristics; and public and

organizational policies (Lasker et al, 2001).

36

It is interesting to note how well these determinants of partnership synergy
relate to McCarthy and Zald’s Resource Mobilization theory where the
“interaction between resource availability, the preesixting organization of
preference structures, and entrepreneurial attempts to meet preference demand”
are the major factors involved (McCarthy & Zald, 1977, p. 1236).

It would be improbable for the actors to collaborate in a community in
which there had been strong competition among and within the various sectors
that need to be involved to address a common problem. It is also difﬁcult to
envision a sustainable collaboration occurring in which the group has not
garnered the support of the prominent leaders and principal players in the

community and/or has not elicited strong grassroots support (Lasker et al, 2001).

NECESSARY AND SUFFICIENT CONDITIONS FOR SUSTAINABLE COMMUNITY
PARTNERSHIPS

From the characteristics and determinants identiﬁed in the previously cited
studies, a set of necessary and sufﬁcient conditions was developed. These are
conditions that must be present for a partnership to form and then sustain its
efforts. There are conditions that are vital to sustainable partnerships that include
1) respect, trust, inclusiveness and openness among the partners; 2) motivation
at the grassroots level for working together; and 3) the ability to collaborate for
the good of the community rather than to compete over “turf” issues--those
issues that arise from the heterogeneous perspectives of the partnership
members as they weigh the potential of the partnership to assist them in attaining
their groups’ missions. These become the set of necessary conditions for

partnerships to succeed in their endeavors (Beverly et al, 2007; Bolda et al.,

37

pahr
those
have
bade
place
Bolda

Kelly.

mesh
licssil
mISSII
on IOI
are p,
3’6 at
hCIist,
Imﬂer
Genny

hate:

2006; Bolda & Wetle, 2004; Couto, 1998; Evashwick & Ory, 2005; Kelly, 2004;
Mitchell & Shortell, 2000; Provan, Veasie & Staten, 2005; Wolff, 2001).

The presence of these necessary conditions does not guarantee a
partnership’s sustainability. That is dependent on a set of sufﬁcient conditions—
those conditions that tilt the balance in favor of sustainability. These conditions
have been identiﬁed in the literature. They include 1) successful collaborative
leadership, 2) effective management structures, and the 3) attainment of a pivotal
place for the collaboratives’ efforts in their communities (Beverly et al, 2007;
Bolda et al., 2006; Bolda & Wetle, 2004; Couto, 1998; Evashwick & Ory, 2005;
Kelly, 2004; Mitchell & Shortell, 2000; Provan, Veasie & Staten, 2005; Wolff,
2001).

By implementing effective management structures and coordination
mechanisms, partnerships pave the way to achieve their goals by decreasing the
possibility that their efforts will be fragmented and, therefore, lose sight of their
mission and their ability to fulﬁll it. Sustainable collaborative leadership is based
on four principles: 1) leaders are able to inspire commitment and action; 2) they
are peer problem-solvers; 3) they garner broad-based involvement; and 4)they
are able to maintain hope and participation (Wolff, 2001). These leaders have a
holistic perspective as they focus on facilitating the process among members
rather than controlling it. They have to be risk takers to spearhead such a
complex and politically charged venture, understanding that rewards cannot be

reaped unless chances are taken (Mitchell & Shortell, 2001).

38

As these partnerships begin to accomplish their goals, they attain
centrality. that is, their efforts and achievements become pivotal and integral
parts of their communities. Centrality “is a critical dimension for
sustainability...high centrality may beneﬁt from more extensive links and greater
exposure, which may help them to raise funds and gain support” (Mitchell &
Shortell, 2001). As partnerships are deemed to be accountable and as they
justify their existence and actions to their communities, they are able to achieve
centrality (Beverly et al, 2007; Bolda et al., 2006; Bolda & Wetle, 2004; Couto,
1998; Evashwick & Ory, 2005; Kelly, 2004; Mitchell & Shortell, 2000; Provan et
al,2005)

For the purpose of this research study, data were collected to ascertain
whether community partnerships attain the necessary and sufﬁcient conditions to
sustain their efforts. Were they able to address aging-related systems that
require adaptation or change, and thus provide a more comprehensive
continuum of services for their older residents through these sustained efforts?
The partnerships’ efforts, then, could produce the community infrastructure that
enables older residents to have a reasonable and an acceptable quality of life
thus allowing them to achieve their goals (Kesler & O’Connor, 2001; Norris,

2001; Wolff, 2003).

SUMMARY OF THE LITERATURE REVIEW

The literature review provided a picture of sustainable community
partnerships as grassroots local social movements. These partnerships form and

remain together through their ability to foster respect, trust, inclusiveness, and

39

openness among their members. It showed that partnerships increase social
capital and collective efﬁcacy through their partnerships’ synergy, which is
consistent with Resource Mobilization Theory. In addition, the literature review
identiﬁed the necessary and sufﬁcient conditions requisite for successful
partnerships.

Where these characteristics and determinants are present in a community
partnership, it should result in communities that are able to enhance the quality of
life of their older residents through the activities of the partnership as it addresses
infrastructure and community norm changes that need to occur. What the
literature did not address was what it is that keeps the community partnerships
going—their ability to sustain their efforts over the time period necessary to
achieve their goals. Further, the literature review revealed gaps in knowledge,
namely, the lack of studies examining partnerships without external funding.

The next chapter, Research Methodology, describes how this dissertation
research study is designed to provide information about how grassroots
community partnerships without external funding can sustain their efforts over

time, thus allowing them to attain their goals.

40

Chapter 3: Research Methodology

Chapters 1 and 2 provide the basis for the research design. The literature
review provided a picture of sustainable community partnerships as
organizations that foster respect, trust, inclusiveness, and openness among their
members. These partnerships increase social capital and collective efﬁcacy
through their partnerships’ synergy, thus producing both the necessary and
sufﬁcient conditions requisite for successful partnerships. The question then,
which relates to the lines of inquiry, is whether the attainment of the necessary
and sufﬁcient conditions results in communities that produce partnerships able to

sustain their efforts to enhance the quality of life of their older residents.

S TUDY STRUCTURE

Community partnership research is extremely complex because there are
multiple relevant systems and conditions over which the partnership has little or
no control. Socioeconomic conditions, other initiatives, and new state and federal
laws and regulations, are only a few of the external factors that can inﬂuence the
outcomes of initiatives (Bradshaw, 2000; Coulton, 2005; Mitchell & Shortell,
2000; Provan et al., 2005).

This research study concentrates on community partnerships for older
adults in Michigan. The unit of analysis for the study is a community that has
generated a partnership that addresses aging issues. The three case study
communities in the dissertation study include two for which the catchment area is

a single county and one for which the catchment area is two adjacent counties.

41

Two types of data were gathered: case studies of three strategically
selected communities and responses to the Key Informant Survey. The Key
Informant Survey data complement the data gathered in the case studies by
providing the perspectives of people involved in addressing aging issues in
Michigan. The survey was conducted from mid-August 2008 to December 2008.
The case studies were conducted late August 2008 through November 2008.

The lnstitutionaI'Review Board process commenced when the dissertation
study proposal was approved by the dissertation committee in June 2008. The
application was submitted electronically to the Michigan State University Ofﬁce of
Regulatory Affairs, Human Research Protection Programs (IRB) on July 21, 2008
under the expedited review category. The letter of approval from the IRB for the
study was dated August, 8, 2008. No data were gathered for the dissertation

prior to receipt of the IRB approval letter.

CORE QUESTIONS OF THE DISSERTATION RESEARCH STUDY

There are four core questions under which the research questions can be
categorized:
1. What factors prompted the community to be interested in addressing
aging issues (e.g., demographics, economic, social, event-based)?
2. What factors helped sustain the community’s efforts to sustain a
partnership in aging (e.g., ﬁnancial resources, positive past community
endeavors, leadership, partnership accomplishments, stakeholder buy in,

political will, a community champion)?

42

3. What factors encountered by the partnerships hindered or ended the
community’s efforts to sustain a partnership in aging (e.g., ﬁnancial
constraints, turf battles, stakeholder distrust, no driving force, community
apathy)?

4. What other internal and/or external factors did partnerships report
encountering that had a bearing on the sustainability of their
collaborations?

Figure 1 shows how the study incorporates the data gathered by the
dissertation study to address the core questions. Core Question 1 (CQ1) gathers
factors that prompted a group of community members to initiate a community
partnership. Core Questions 2 (CQ2) and 3 (C03) gather information about
factors that help or hinder the sustainability of the partnerships. Core Question 4
(CQ4) looks for internal and external factors that address organizational
structures as well as local, state, and federal policies, regulations and economic
issues that affect the partnerships. Ultimately, the responses gathered to these
four core questions provided insights into the reasons why some partnerships are

able to sustain their efforts.

43

Figure 1: Relationship of Core Research Questions and Sustainability of

 

 

 

 

 

Partnerships
Community Partnership (CP)
Addressing Aging Issues
Factors that Factors that Factors that
helped prompt community hindered or
sustain the to be interested in ended some
CP’s efforts- addressing aging or all of the
CQ2 issues-CQ1 CP’S efforts-
CQ3

 

 

 

 

 

 

   

  

 
    
 

  
 

External
Factors-
CQ4

lntemal
Factors-
CQ4

 
 

 

 

   

 
  

Some/all CP efforts I
I NOT sustained I

Figure 1 demonstrates the relationships among the research questions

  

sustained

 

 

and information the data gathered provides regarding the sustainability of the
community partnerships that address aging issues in each of the three‘case
study communities. The arrows indicate the linkages among the core research
questions. The solid arrows suggest direct relationships between the factors that
help or hinder the partnerships to sustain their efforts. The dotted arrows suggest
the more subtle inﬂuences on the sustainability of partnerships by internal and

external factors.

44

RESEARCH QUESTIONS

Eight research questions were designed to gather data in response to the
four core research questions. Table 3 lists the four research questions in the
columns and the eight research sub-questions to which they relate in the rows.
The purpose of having the eight research questions was to provide a ﬁner
delineation for analysis. A structured interview tool and a Key Informant Survey
were developed speciﬁcally for this dissertation research based on these 8 sub-
questions.

Table 3: Relationship of the Eight Research Sub-questions to the Four Core

Research Questions

 

 

 

Research What factors What factors What factors What other
Question prompted the helped encountered internal and/or
community sustain the by the external factors
to be community’s partnerships did partnerships
interested in efforts? hindered or report
addressing (C02) ended the encountering
aging community’s that had a
issues? efforts? bearing on the
(CQ1) (CQ3) sustainability of
their
collaborations?
(CQ4)
1 What factors
prompt
communities
to decide to
address aging
issues?

 

 

 

 

 

45

 

Table 3 Continued

 

 

 

 

 

Research What factors What factors What factors What other
Question prompted the helped encountered internal and/or
community sustain the by the external factors
to be community’s partnerships did partnerships
interested in efforts? hindered or report
addressing (CQZ) ended the encountering
aging community’s that had a
issues? efforts? bearing on the
(CQ1) (CQ3) sustainability of
their
collaborations?
(CQ4)

2 Who are/were Who are/were Who are/were
the the the
stakeholders stakeholders stakeholders
involved in involved in involved in
community community community
initiatives that initiatives that initiatives that
address address address
aging? aging? aging?

3 Who is/was Who is/was Who is/was the
the driving the driving driving force for
force for force for collaboration on
collaboration collaboration aging Issues in the
on aging on aging community?
issues in the issues in the
community? community?

4 What are the What are the
demographic, demographic,
economic or economic or social
social similarities and
similarities differences among
and the communities
differences that establish
among the community
communities partnerships in
that establish aging?
community
partnerships
in aging?

 

 

 

 

 

46

 

Table 3 Cr

 

Research
Question

Table 3 Continued

 

 

 

 

 

 

 

communities
that have
sustainable
collaboratives
in aging have
previous
success with
other
community
partnerships
or initiatives?

 

 

Research What factors What factors What factors What other
Question prompted the helped encountered internal and/or
community sustain the by the external factors
to be community’s partnerships did partnerships
interested in efforts? hindered or report
addressing (CQZ) ended the encountering
aging community’s that had a
issues? efforts? bearing on the
(CQ1) (CQ3) sustainability of
their
collaborations?
E (CQ4)

6 How do the
communities
deﬁne
success and
determine
whether and
when it has
been
achieved?

7 What is the What is the What is the impact
impact of impact of of external funding
external external on partnerships?
funding on funding on
partnerships? partnerships?

8 Do Do communities

that have
sustainable
collaboratives in
aging have
previous success
with other
community
partnerships or
initiatives?

 

47

 

DATA Sou

RATIONALI

Ca:
enhance
things fror
the case“
to code
document

The
toward wt
leaders It
general pl

Aer
developm.
wIIlCh oer
Cases” (2;
Study resl
c(”Tender

Table 4: E

Misu
tndEIIQI'IdE
Iamable II

\

DA TA SOURCES

RA TIONALE FOR USING THE CASE STUDY METHOD

Case studies are in-depth studies in which the researcher attempts to
enhance his/her understanding of the studied phenomena. “We do not infer
things from a case study; we impose a construction, a pattern of meaning onto
the case” (Ruddin, 2006, p. 800). This is done through an iterative process used
to code and analyze data gathered through interviews, observations and
documents.

The strength of the case study method is that it leads the researcher
toward what is idiosyncratic about the subject. It directs the researcher and the
readers to the important issues rather than trying to provide evidence for a
general phenomenon.

According to Bent Flyvbjerg, “This type of research is also essential for the
development of social science, for example, in understanding the degree to
which certain phenomena are present in a given group or how they vary across
cases” (2006, p. 241). Flyvbjerg delineates ﬁve misunderstandings about case
study research and then provides what he terms “evidence” that refutes the
contentions. Table 4 summarizes his ﬁndings.

Table 4: Bent Flyvbjerg's Strength of Case Study Research (Flyvberg, 2006)

 

 

 

 

 

‘Misunderstandiggs (p. 221) Evidence
1. General, theoretical (context- Predictive theories and universals
independent) knowledge is more cannot be found in the study of human
valuable than concrete, practical affairs. Concrete, context-dependent
(context-dependent) knowledge. knowledge is, therefore, more valuable
than the vain search for predictive
theories and universals. (p. 224)

 

 

48

Table 4 l

2. One c:
of an Indl
case stur
scientiﬁc

3. The ca
generatir
ﬁrst stage
whereas
suitable I
theory bl.

\
4. The ca
toward ve
I0 Conﬁrn
Timonce

\
.5. It IS oft
de'VEIOp C
theories E
Studies.

Table 4 Continued

 

Misunderstandings (p. 221)

Evidence

 

2. One cannot generalize on the basis
of an individual case; therefore, the
case study cannot contribute to
scientiﬁc development.

One can often generalize on the basis
of a single case, and the case study
may be central to scientiﬁc
development via generalization as
supplement or alternative to other
methods. But formal generalization is
overvalued as a source of scientiﬁc
development, whereas “the force of
example” is underestimated (p. 228)

 

3. The case study is most useful for
generating hypotheses; that is, in the
ﬁrst stage of a total research process,
whereas other methods are more
suitable for hypotheses testing and
theory building.

A case can be simultaneously extreme,
critical and paradigmatic. The
interpretation of such a case can
provide a unique wealth of information
because one obtains various
perspectives and conclusions on the
case according to whether it is viewed
and interpreted as one or another type
of case (p. 233)

 

4. The case study contains a bias
toward veriﬁcation, that is, a tendency
to conﬁrm the researcher’s
preconceived notions.

x

The case study contains no greater
bias toward veriﬁcation of the
researcher’s preconceived notions than
other methods of inquiry. On the
contrary, experience indications that
the case study contains a greater bias
toward falsiﬁcation of preconceived
notions than toward veriﬁcation (p. 237)

 

5. It is often difﬁcult to summarize and
develop general propositions and
theories on the basis of speciﬁc case
studies.

 

 

It is correct that summarizing case
studies is often difﬁcult, especially as
concerns case process. It is less
correct as regards case outcomes. The
problems in summarizing case studies,
however, are due more often to the
properties of the reality studied than
the case study as a research method.
Often it is not desirable to summarize
and generalize case studies. Good
studies Should read as narratives in
their entirety (p. 241)

 

 

Given Flyvbjerg’s supportive evidence, case studies were one of the

research methodologies employed by this study to develop hypotheses regarding

49

Tria'

stat

Sur

the sustainability of community partnerships for older adults. The triangulation of
methods strengthened the trustworthiness of hypotheses generated by the study.
Triangulation was achieved by 1) conducting structured interviews of
stakeholders at each of the three case study; 2) conducting the Key lnforrnant
Survey; 3) observing the case study communities’ partnership meetings; and 4)
conducting an extensive document review. The results of the case studies
showed that there were general themes among the three sites that demonstrated
the factors that led to their sustainability. The responses to the Key Informant

Survey validated information gathered during the case studies.

COMMUNITY PARTNERSHIP CASE STUDIES

The case studies were conducted on three currently functioning
community partnerships for older adults, alternatively referred to as Sites, using a
case study protocol that was applied to each of the partnerships. Criteria used to
select the case study sites included 1) the length of time the partnership had
been active using 4 years as a minimum to provide time for groups to form,
establish management and governance structures, and operate under those
structures; 2) the activity level of the partnership as deﬁned by how often they
met and the activities in which they were engaged using a minimum of quarterly
meetings ‘ and engagement in at least one signiﬁcant activity a year; 3)
socioeconomic diversity because it adds to the complexity of the partnership’s
efforts and should produce plans and interventions that address a broad
spectrum of issues related to aging, some of which are related to social justice

issues in their community (Kesler & O’Connor, 2001); and 4) the willingness of

50

activ

recor
curre
grout
Socie
Dracti
phnn
recon
positic
them

attivitl.

I. 3).

the partnership to be studied. As an inducement to be involved in this dissertation
research, prospective sites were told that the researcher would provide a case
study synopsis, a visit by the researcher to present the ﬁndings to the
partnership, and the Key Informant Survey results.

Communities were identiﬁed by the researcher by asking people who are
actively involved in aging at state and local macro practice level for their
recommendations of communities that have partnerships for older adults that are
currently functioning and whose communities have socioeconomic diversity. This
group of macro practitioners included members of the board of the Michigan
Society of Gerontology and Michigan State University Extension Ofﬁce. Macro
practice is deﬁned as “professionally guided intervention designed to bring about
planned change in organizations and communities”, thus the individuals who
recommended communities for the study work in policy and administrative
positions rather than providing direct service to individual clients which provides
them with a broader perspective of the issues and more information about
activities in which communities are engaged (Netting, Kettner, & McMurtry, 2008,
p. 3).

The Key Informant Survey was posted on two Iistservs, Elder Friendly
Communities and the Michigan Society of Gerontology and sent to individual
Area Agency on Aging Directors, and members of a consortium of professionals
in aging. Email recipients were asked whether they would like to have their

community be one of the case study sites. A three-page synopsis of the research

51

study (Appendix A) was attached to the invitation email invitation that provided
information about the study and what involvement in the case study would entail.
From the email solicitation and recommendations of macro practitioners,
four sites were identiﬁed that were interested in participating in the dissertation
research. Of the four sites, three were chosen based on the selection criteria.
Each of the three strategically selected communities had a partnership
addressing aging issues that had been active for at least 4 years and had
socioeconomic diversity within its catchment area. The partnerships participated
in an in-depth case study using the rapid assessment process (RAP). The RAP is
a method for “going in and getting on with the job of collecting data without
spending months developing rapport. This means going into a ﬁeld situation
armed with a list of questions that you want to answer and perhaps a checklist of
data that you need to collect” (Bernard, 2000, p. 323). Communities were

provided with the synopsis and the structured interview tool prior to the site visit.

COMMUNITY PARTNERSHIP CASE STUDY PROTOCOL

The protocol for the case study was applied to each site. The protocol for
conducting the case studies to answer the 8 research sub-questions included the
following activities:

1. Stnrctured individual and group interviews with members of the
partnership — Table 5 presents the questions asked during the interviews.
Interviewees were selected based on their leadership role in the partnership such
as the chair person or committee chairs and/or the length of time they had

actively participated.

52

2. Structured individual and group interviews with community
stakeholders some of whom were also members of the partnership— Table 5
Questions 1-3, 14, 15 and 17 were asked of community stakeholders. Among the
stakeholders were health care providers, service providers, senior citizen
advocates, local human service agency staff, local media staff, and local
government ofﬁcials. Interviewees were selected based on their knowledge of the
partnership’s activities.

Four to six face-to-face interviews of partnership members and community
stakeholders were conducted for each site. Each interview was recorded using a
digital audio recorder.

3. Observation of community meetings and events - during the site
visits, the researcher observed at least one partnership meeting and committee
meetings deemed essential to the case study. The meetings to observe were
identiﬁed by partnership leadership. During the meetings, ﬁeld notes were taken.

4. Document review - community partnerships were asked to gather
materials regarding their partnerships such as the strategic plan, implementation
documents, memoranda of understanding, bylaws, press releases, newspaper,
local radio, and local television reports, publications by and about the partnership
and its activities such as annual reports and brochures, meeting minutes,
presentations made by partnership members, and evaluations of partnership

activities and outcomes.

53

Table 5: Interview Questions for Community Members and Their

Relationship to the Research Questions

 

Interview Questions for Community Members Research
Question

 

1. What speciﬁc issues or events prompted community members 1, 4
to determine it was time to address aging issues in a concerted
effort?

2. What particular local demographics, economic, political and/or
social service histories had an impact on your community’s
decision to make a concerted effort to address aging issues?

 

3. I would like to ask you about your community’s history of 8
citizen involvement in community initiatives and partnership.
What initiatives have there been related to changing
community infrastructures to improve quality of life for your
residents (children, families, education, employment)? What
about initiatives that address disparities among groups?
PROBE: Does your partnership collaborate with other

 

 

 

L community initiatives or partnerships?

 

54

in II In}. .

Table 5 Continued

 

Interview Questions for Community Members

Research
Question

 

Who was involved (individuals and groups) in getting your
partnership started?

What individuals or groups were not initially involved who you
thought should have been? PROBE: Did they ever become
involved? Why or why not?

What individuals and/or organizations took the lead in shaping
your partnership’s goals? PROBE: Are they still involved? Why
or why not? How were the goals set?

What individuals and/or organizations took the lead in shaping
your partnership’s structure? PROBE: Are they still involved?
Why or why not? How was the structure determined? How has
itchanged?

How were additional participants recruited by the initial
members? What were the reasons why they were recruited?

2, 3, 5, 6

 

 

9.

How is the partnership currently being funded?

10. What other sources of funding did you try to access? Were you

successful?

11.ls ongoing funded required for your partnership to continue?

PROBE: What are your plans for future funding sources? What
ways have you determined to ensure ongoing funding?

 

 

55

 

I Li I"

Table 5 Continued

 

 

 

Interview Questions for Community Members Research
Question
12. How does your community partnership deﬁne success? 1, 5, 6

PROBE: How is success measured? Who is monitoring your
partnership’s measures of success?

13. How has the partnership implemented strategies to address
your priorities? How is the implementation process going?

14. How do you learn about the needs of all older community
residents? PROBE: Are the needs of older adults who live in
poverty and those who are racial or ethnic minorities
speciﬁcally addressed in your strategic plan? Are these older
adults and their advocates represented in your partnership?

15. How would you assess the current status of your partnership’s
efforts? PROBE: Is the general community aware of your
efforts?

16.What barriers or obstacles did you need to surmount when you

started your partnership? How did you address them? PROBE:

What obstacles arose later on and how did you address them?

17. Has the partnership been able to increase awareness of aging
- issues in your community? How is awareness measured?

 

 

KEY INFORMANT SURVEY

In addition to the interviews of community partnership members, a Key

lnforrnant Survey was conducted. The reason for developing and conducting the

Key Informant Survey was to compare its results with those of the 3 case studies

to determine whether the sites appeared to be operating as people involved in

56

 

macro practice in aging would expect. In other words, were the sites in the
dissertation research outside of the mainstream or were they fairly representative
of partnerships for older adults?

The Key Informant Survey was developed for this dissertation research
using the 8 research sub-questions. It was designed to capture some of the
internal and external factors that have an impact on the sustainability of
community partnerships as well as gathering data on the key informants’
perceptions of partnership formation and activities, goals, effectiveness, and
sustainability. Respondents were asked about the factors they have observed
that have an impact on whether community partnerships are able to sustain their
efforts. .

The reason for asking questions of key informants is that they have
knowledge of aging services around the state which provides them with a
broader perspective about what has been tried by communities, what has been
successful, and the barriers and obstacles communities have encountered.
Because of their macro praCtice orientation, key informants are aware of state
and federal policies, regulations, funding, restrictions, and opportunities that have
an impact on local communities’ efforts.

Key informants were contacted by email messages sent to the 2 Iistservs
asking them to respond to the survey. Permission to send the invitation to
participate was obtained from the “owners” of the 2 Iistservs. The key informants
included members of the Michigan Society of Gerontology listserv (sent to 139

members), Directors of the Area Agencies on Aging Michigan (email message

57

was sent to the 18 directors), the Michigan State University School of Social
Work Aging Consortium (email message was sent to the 33 consortium
members), and members of the Elder Friendly Community Iistserv (sent to 139
members). Another way key informants were recruited was that the messages
sent to the groups listed previously asked them to send out a notice about the
study to others who might be interested in responding. This method elicited 70
responses from key informants across Michigan. The total number of potential
respondents was 329 for a response rate of 21%.

Key informants were surveyed using SurveyMonkey
(www.8urveyMonkey.com) to obtain their opinions regarding community
partnerships for older adults. SurveyMonkey (SurveyMonkey.com) is software
that produces online surveys. The sampling method was a snowball sample
where those who received the notice of the survey from their state-wide
organization could pass the notice on to others they thought would provide useful

insights.

58

Table 6: Survey Questions for Key Informants and Their Relationship to the

Research Questions

 

Survey Questions for Key Informants Research
Question

 

 

1. Please type the titles of individuals and/or names of groups of 2, 3
which you are familiar that are actively working on aging
issues. The questions in the rest of the survey relate to your
knowledge of these individuals and groups activities and
effectiveness. (open-ended list)

2. A community partnership in aging is a group that comes
together to strengthen the local service-delivery infrastructure
related to services for older adults such as health care,
housing, transportation, meals, caregiving, respite services,
provider training, and social engagement.

According to this deﬁnition, which of the groups identiﬁed in
Question 1 would you consider community partnerships?

Please type them in the space provided.

Finally, please tell us with which one of these community

 

 

partnerships are you most familiar. (open-ended list)

 

59

Table 6 Continued

 

Survey Questions for Key Informants Research
Question

 

3. Please rate how important YOU think the following activities 1, 5, 6
and services are to improve the quality of life for older adults in
Michigan. (Likert choices very important, somewhat important,
not important). See detailed list in Appendix B.

4. Now please think about the community partnership you
identiﬁed in Question 2 with which you are most familiar.

Rate the activities of which you are aware in which the
community partnership takes an active role. (Likert choices
very active role, somewhat active role, no active role). See
detailed list in Appendix B.

 

 

5. Please rate how well the individuals and/or groups in the 5, 6
community partnership Question 4 work together to improve
the quality of life for older adults. (Likert choices Most often
work well together, Sometimes work well together, Hardly ever
work well together). See detailed list in Appendix B.

6. Please rate how effective the community partnership in
Question 4 is in assisting older adults through the following
activities. (Likert choices very effective, somewhat effective,
not effective). See detailed list in Appendix B.

7. Rate the ways the community partnerships you listed in
Question 2 could be more effective. (Likert choices Need to be
much more effective, Are fairly effective currently, Are very
effective currently). See detailed list in Appendix B.

 

 

60

 

Table 6 Continued

 

Survey Questions for Key Informants Research
Question

 

8. Rate the availability of funds for community partnerships that 6, 7
address aging issues. (Likert choices Readily available,
Available under most circumstances, Available under limited
circumstances, Not available). See detailed list in Appendix B.

9. Rate how feasible it would be to expand the pool of funds
available to community partnerships that address aging issues
using the following methods. (Likert choices Very feasible,
Somewhat feasible, Not feasible). See detailed list in Appendix
B.

 

 

10. Rate how relevant you think the following factors are with 2, 3, 5
respect to whether community partnerships can sustain their
efforts. (Likert choices Very relevant, Somewhat relevant, Not
relevant). See detailed list in Appendix B.

 

 

 

In addition to these questions, respondents were asked to provide their
catchment area and occupation or title, and how long they have been active in
aging issues. Respondents were assured that their responses were conﬁdential

and that only aggregated information would appear in publications.

DA TA ANAL vsrs

ANALYSIS OF INTERVIEW DA TA FROM CASE STUDIES

The interview data were analyzed using the “interpretive phenomenology
approach” (Maggs-Rapport, 2000). This approach is used for exploratory

research in which interviews with both open-ended and structured question

61

methods are employed. “Interpretive phenomenology tries to uncover concealed
meanings in the phenomenon, embedded in the words of the narrative (Maggs-
Rapport, 2000, p.219-220). In this approach, the researcher is the interpreter of
the data where the ‘meaning’ of the data is based on the researcher’s
understanding.

The thrust of interpretive methodologies is to understand the meaning of
human experiences and actions. Interpretive phenomenology embraces the idea
that an individual’s world view is based on her or his subjective interpretation of
the social, cultural and historical forces at play in their sphere (Fossey, Harvey,
McDermott & Davidson, 2002).

The three stages of interpretive phenomenology are 1) fore-
understanding, an initial understanding of the area of inquiry—in this case the
sustainability of community partnerships in aging; 2) interrogation, comparing
emerging themes both across and within the interview data in this case across
the three sites and the Key Informant Survey; and 3) reﬂection, where the
researcher identiﬁes where her or his understanding is conﬁrmed or negated by
the content of the interviews and where the researcher delineates any biases she
might have. During the reﬂection stage of this study, the researcher built upon
her fore-understanding of social movements, communities movements,
community partnerships in general and in aging in particular, to form new ideas
about the factors involved in sustaining community partnerships’ efforts to

address aging issues (Maggs-Rapport, 2000).

62

The interviews were coded using the interpretive phenomenology
approach to determine the categories and subcategories that emerged by using
an iterative process that further reﬁnes the categorization in each step of the
analysis. In such “meaning-focused approaches”, the emphasis is on
comprehension of the subjective meaning of experiences and situations to the
study participants rather than the researcher’s preconceptions (Fossey, et al,
2002).

The interview process in this study was designed to elicit responses
through open-ended questions that were then coded to extract categories and
themes (Bowen, 2005; Creswell, 2007; Bernard, 2000; Padgett, 2004). The
interviews gathered community partnership members’ ideas regarding the
research questions that directly relate to the four core questions of the study.

The ﬁrst step in the analysis employed “open coding” to designate
categories based on the phenomenon being studied: in this study the formation,
organization, activities, and sustainability of community partnerships for older
adults. Once the open coding was complete, the data were re-analyzed to
develop a set of subcategories and to “dimensionalize” the data by
demonstrating the breadth of differences within each subcategory, a process
referred to as “axial coding”. Finally, the research employed “selective coding” to
integrate the results of the analyses into a story line. Selective coding develops
theoretical constructs in the form of sub-themes that connect the axial codes.

The data were grouped according to repeated relationships and patterns that

63

became evident throughout the coding process. (Bowen, 2005; Creswell, 2007;
Fossey, et al, 2002; Kendall, 1999; Scott, 2004; Soulliere et al., 2001).

Coding allows the researcher to determine labels that identify themes
within and across the data, enabling the researcher to group themes into
categories that describe patterns and connections (Fossey, et al, 2002). Once
the researcher developed a set of codes, a second person, an MSW student,
listened to several of the interviews and coded them using the codes provided by
the researcher. This process was put into place to identify any problems and/or
gaps in the codes and to assure the trustworthiness of the coding process. The
process did not identify any signiﬁcant problems or gaps but did point out that the
number of codes was perhaps too ambitious. Appendix C includes the complete
set of codes and the codes for each site.

Throughout the coding process, “memoing” occurred in which alternative
directions for the research and hypotheses that result from the coding were
noted. Memoing is the process of keeping running notes by writing down
thoughts that occur that identify relationships among themes as the researcher
codes the data. One of the major products of the memoing process is directions
for future research (Bernard, 2000). Table 7 provides an example of how the
coding and memoing was documented by the coders. Appendix C includes all of
the memos written by the coders as they coded the interviews, site visits

observations, ﬁeld notes, meeting minutes and other documents.

64

Table 7: Example of Coding and Memoing

 

 

 

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
2. Factors 2.1 Financial 2.1.1 Area aging funding, 2
that resources millage/county homeless funding
helped funds from the county
sustain
community
efforts to
address
aging
2.1.2 in-kind staff, Staff volunteers, 3
facilities interns, volunteers
2.1.4 has local They spoke about 1
foundation funds applying for grants,
but didn’t mention if
they had any
currently
2.1.7 has pooled DHS, CMH 3
local agency funds
2.1.8 has state MSHDA, DHS 2
funds
2.1.9 receives Fundraising 1
private donations

 

The results of the analyses of the interviews were assessed to develop a
hypothesis regarding the factors that inﬂuence community partnership
sustainability. The results were based on the themes, patterns and relationships

among them that emerged from the coding of the interview data.
DA TA ANALYSIS CODING SCHEME

The coding scheme used in the case study is based on the one developed
by Kurasaki in 1997 (Bernard, 2000). This scheme develops ﬁrst-order and

second-order categories and assigns a numeric code that incorporates both. As

applied in this sustainability research, there were three orders of categories. The

65

ﬁrst-order category was based on the four core questions. The codebook
developed from this coding scheme was applied when coding the interviews,
observations and documents reviewed.

An example of the coding scheme for the sustainability research study
follows: For the core question regarding the factors that helped sustain the
community’s efforts, there was a second-order category of ﬁnancial resources. A
third-order category was local foundation funding. Hence, the code 2.1.1 would
represent sustaining factors/ﬁnancial resources/local foundation funding. A
second ﬁnancial resource identiﬁed was fund-raising events, thus the code would
be 2.1.2, sustaining factors/ﬁnancial resourcesxfund-raising events. The coding
guide is provided in Appendix C.

The codes were tested and reﬁned throughout the analysis of the data
during which time codes that were not used were assessed to determine whether
they should remain part of the scheme. The codes developed by the researcher
were tested by an MSW student to determine whether an independent person
could listen to the interviews and apply the codes. The MSW student listened to
interviews from all three sites and coded them using the coding scheme provided
by the researcher. The researcher coded the same interviews using the coding
scheme and then noted any discrepencies with the MSW student’s coding. She
discussed the MSW student’s interpretation of the interviews with her to
determine whether particular codes required adjustment. This intercoder
reliability check assured that the coding scheme was valid and contributed to

data trustworthiness. The discussion of the interpretation of the codes led to a

66

few changes in how the codes were used. For example, in category 2.4.4
increased community awareness of aging resources, the coders conferred and
decided to include the health fairs and websites in this code. Under 2.4.5,
increased services for older adults, the coders decided to include educational
materials and the activities of one of the site’s senior support team, a committee
that allocates one-time emergency funds to older adults in their catchment area,
since the funds purchase services such as home repairs and utility payments.
Appendix C includes the complete list of codes as well as the codes used for

each cite.

ANALYSIS OF OBSERVATIONS DA TA FROM CASE STUDY

Participant observations were undertaken using rapid assessment
procedures rather than anthropologic ﬁeldwork. This method was selected
because of the design of the study in which the participants are professionals
and volunteers who have willingly agreed to take part in the research study, most
of whom had met the researcher during their individual or group interviews. The
rapport-building process that is crucial in anthropologic ﬁeldwork is truncated in
this type of study because the participants are speciﬁcally informed about the
purpose of the research, its duration, and their role in the study. The research
questions were deﬁned in advance of the site visits, thus providing the framework
to select which situations to observe (Cole, 2002; Bernard, 2000). The selection
of situations was based on the topics of the meeting and who would be present
so that the researcher would be able to observe “typical” circumstances under

which the partnerships operate.

67

The participant observations took place before, during and after the
partnership meeting(s) attended by the researcher. The researcher made
observations during individual and group interviews that were conducted.

The discussions that took place during the meetings were digitally
recorded. The researcher took ﬁeld notes during the meetings that included the
key points made during the meeting, observer’s impressions of the mood of the
meeting participants, who was engaged and who was not, decisions reached and
the processes used. The coding techniques described in the interview section

were employed in the analysis of the observation data.

DA TA GA THERED FOR THE CASE STUDY

Data for the case studies were gathered between August and November
2008. Each site provided the meeting minutes it could locate and other
documents pertinent to the study as identiﬁed by the researcher. Each site was
visited at least once during the data collection phase.

Table 8: Data Gathered for Case Studies

 

NSite Data Gathered

Site A 4 Interviews of 4 agency directors— Conducted October 27, 2008
Observations - Monthly meeting of Multi-purpose Collaborative Body
(MPCB), October 8, 2008

Documents — meeting minutes, action plan, mission and goals,

 

 

letters written, resource guide, expo materials, membership roster
j\ Google search on name of partnership

 

 

 

 

68

Table 8
, Site

Ste B

"

Site C

>l
«i

Table 8 Continued

 

Site

Data Gathered

 

Site B

4 interviews of 3 agency directors and 1 program manager-
Conducted October 27, 2008 and November 19, 2008

Observations — Monthly meeting of partnership, November 19, 2008
Documents — meeting minutes, strategic plan, strategic plan
implementation documents, website, membership roster, brochures
from local senior services providers, budget, Prime Time publication,
advocacy paper

Google search on name of partnership

 

 

Site C

 

6 Interviews of 3 agency directors, 2 program managers, and 1
senior-oriented publication editor- September 15, 2008 to
September 29, 2008

Observations — Monthly meeting of partnership, August 25, 2008 and
September 29, 2008

Documents - meeting minutes, community report card, Senior Times
publications, surveys and results, membership roster, brochures
from local senior services providers

Google search on name of partnership

 

ANALYSIS OF DOCUMENT REVIEW DA TA FROM CASE STUDY

The materials provided by the sites regarding their partnerships were

coded and analyzed using the coding techniques described in the interview and

coding scheme sections. When documents were provided in advance of the visit,

the researcher reviewed the documents prior to conducting the interviews and

observations to learn the issues and “language” of each partnership. An internet

search was conducted about each site to gather external information about the

69

 

partnerships. The search yielded press coverage of the sites’ events and
activities as well as the website that had been developed by Site B.

The researcher requested that the sites provide speciﬁc documents when
they were available: strategic plan, implementation documents, memoranda of
understanding, bylaws, annual reports, reports to funders, budgets, brochures,
meeting minutes, and evaluations of partnership activities and outcomes. These
documents assisted the researcher in describing the goals, activities and
structure of the partnership. Other documents such as public service
announcements, press releases, and newspaper articles and notices were coded

using the coding scheme in Appendix C.

VALIDITY AND TRUS TWORTHINESS

Trustworthiness in qualitative research is based on “credibility,
transferability, dependability, and conﬁrmability that parallel internal and external
validity, reliability, and objectivity” (Fossey, et al, 2002, p. 723). Credibility is the
conﬁdence the audience has in the “truth” of the ﬁndings. Transferability means
that other researchers can use the ﬁndings. Dependability is the “stability of the
ﬁndings over time.” Conﬁnnability is the “internal coherence of the data in relation
to the ﬁndings, interpretations and recommendations” (Bowen, 2005, p. 215-
216).

Validity or trustworthiness in a study such as this dissertation research is
based on the ability of the researcher to “persuade the audience that the study
ﬁndings are worthy of notice” based on the credibility, transferability,

dependability, and conﬁrmability of the data being presented (Maggs-Rapport,

70

2000.
conﬁr
daﬁi
posts
dudk
hfoni
vaﬁ0t

ﬁudy

ANALI

They
twist
online
'OQSM
the CE
aware

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2000, p. 220). In this study, the credibility, transferability, dependability, and
conﬁrmability of the data were determined through transparent links among the
data, the ﬁndings related to the data, and the interpretations of the ﬁndings
posited by the researcher (Fossey, et al, 2002). Data from the individual case
studies were compared among the sites as well as to the responses to the Key
Informant Survey as a means of triangulating the results. The results among the
various data sources were consistent, which can persuade the audience that the

study ﬁndings are credible and worthy of note.

ANALYSIS OF SURVEY DA TA

Seventy key informants participated in the online survey (Appendix B).
They comprised a convenience sample of those individuals contacted through
the statewide organizations previously mentioned whochose to participate in the
online survey. Conducting the survey online made responding simple, quick and
logistically easy for respondents. The survey was conducted simultaneously with
the case studies after IRB approval was received. Case study partnerships were
aware of the Key lnforrnant Survey and encouraged their members to complete
the survey. Sixteen respondents in Site B’s two counties and fourteen from Site
C’s county responded to the survey. None of the respondents speciﬁcally
identiﬁed Site A’s catchment area.

Given the small sample and the nature of the survey data collected, the
data were presented using descriptive statistics. The survey is comprised of one
open-ended question that asks respondents to identify individuals, groups, and

partnerships active in addressing aging issues. The next eight questions are

71

matrices that contain a total of 71 Likert-scale questions. Descriptive statistics
were used to describe the responses to the Likert-scale questions, and the open-
ended responses were coded into categories based on the types of positions
held by individuals and the types of groups named as partnerships. The ﬁnal
question asks respondents to identify their geographic area, title, and number of
years they have been active in aging issues.

The survey gathered data regarding external factors (QB-9), infrastructure
(03-5), and internal factors (Q6-7,10). Table 6 provides the speciﬁc survey
questions, and the complete survey can be found in Appendix B. Data gathered
from the survey provided areas in which the key informants believe the quality of
life for older adults should improve due to the efforts of community partnerships.
The areas identiﬁed include health and wellness, social opportunities,
transportation, housing service coordination, respite care, and home modiﬁcation
and repair. They also include advocacy and fund raising.

These data were compared to the types of activities in which the
partnerships are involved as identiﬁed in the case study. This allowed the
researcher to compare the key informant survey responses with what the
interviewees and documents reported their partnerships did or planned to do.
The comparison was used ‘to inform the researcher regarding the Similarities and
differences in perceptions between the key informants and the interview
participants from the community partnerships. Since the rationale for conducting
the Key lnfonnant Survey was to determine whether the case study communities

were within the parameters perceived by aging macro practitioners, this

72

comparison provided another method by which to assess the trustworthiness of
the data.

Based on the data gathered from the community partnership case studies
and the Key Informant Survey, the two initial assumptions about the factors that
inﬂuence the sustainability of community partnerships in aging were revised.
These assumptions were reﬁned based on the analyses of the data found in
Chapter 4: Research Findings. This resulted in the development of 2 hypotheses
that emerged from the data analyses.

The ﬁrst hypothesis is that the composition of the members of a
community partnership in aging has a direct impact on the goals set by the
partnership and the activities in which it chooses to engage to accomplish those
goals. This satisﬁes the necessary condition that there is motivation at the
grassroots level for working together. It also satisﬁes the sufﬁcient conditions that
there is successful partnership leadership as well as effective management
structures in place.

The second hypothesis generated by the research study is that support of
community leaders is vital to the sustainability of a community partnership in
aging. This satisﬁes the sufﬁcient condition of attainment of a pivotal place for the
collaboratives’ efforts in their communities. The next chapter, Research Findings,
presents a detailed analysis of the Key Informant Survey and case study data

gathered throughout the dissertation study.

73

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Chapter 4: Research Findings

The ﬁndings for this dissertation research stem from the two sources of
data described in detail in Chapter 3: the Key Informant Survey and the
strategically selected case studies. In this chapter, the data from each source is
presented and described. The Key Informant Survey results are presented ﬁrst.
The Key Informant Survey provides opinions of macro practitioners who work in
aging and thus helps frame the data gathered in the case studies. The analysis
of the case study data follows. The ﬁnal section of this chapter reports the
analysis and synthesis of the information gathered from the Key Informant

Survey and case studies.

KEY INFORMANT SURVEY

The respondents to the Key lnfonnant Survey were those who received
the email invitation and chose to respond to the online survey. The geographic
distribution of the respondents represented all areas of the state with a
concentration of responses in the southWest, central and northern lower
peninsula sections of Michigan. Many of the 54 respondents who provided their
occupation or title indicated that they are in high level administrative positions
such as agency directors or chief executive ofﬁcers (22) and assistant directors
or program managers (15). Several others indicated that they are social workers
(6).

Of the 70 respondents, 54 identiﬁed how long they have been active in

aging issues. Table 9 shows the distribution of how long respondents have been

74

engaged in aging issues. No logic was built into the survey to require a question
to be answered before the respondent could continue. Consequently, of the
seventy respondents, only 55 (78.6%) answered the entire survey. The entire
survey and responses are located in Appendix B.

Table 9: Number of Years Respondents Have Been Active in Aging

 

 

 

 

 

 

 

 

Number of Years
Respondents
Active in Aging Number of Percent of
Issues Respondents Respondents

Under 5 10 18.5%
5 to 10 years 9 16.7%
11 to 20 years 14 25.9%
21 to 29 years 12 22.2%
30 years and over 9 16.7%

otal Respondents 54 100.0%

 

 

 

 

The ﬁrst question on the survey asked respondents to identify a
community partnership for older adults with which they were familiar. Throughout
the survey, they were asked to think about that partnership as they responded to
the questions. Thirteen distinct partnerships were identiﬁed as well as some
respondents who referred to state-level initiatives. Sites B and C were among the
13 partnerships identiﬁed by the respondents. All of the survey question tables
are sorted in descending order of the ﬁrst response category (very important,
very active role, very effective). The tables present the number of respondents

who selected each response.

75

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Table 10: Survey Responses Regarding Activities and Services to Improve

Quality of Life for Older Adults by Number of Respondents

 

 

 

 

 

 

 

 

   
   
 
 

 

 

 

 

 

 

 

   
 
  

 

 

 

 

02 Importance of Activities and Services to

Improve Quality of Life for Older Adults in Very Somewhat Not
Michigan important important important
Providing transportation to those who need it. 61 7 0
Educating caregivers about services available to

them and their family member. 58 10 0
Providing healthy meal delivery. 55 13 0I
Training caregivers to cope with providing care to

la family member. 52 15 1
Assisting with instrumental activities of daily living.

Eon as physician visits, appointments,

banking/bill paying, shopping... 51 17 0
Promotin service coordination. 50 18 0
Providin care ivers with respite opportunities. 48 20 0I
Providin home modiﬁcations and repairs. 45 22 1
Connecting older adults with community groups

that provide social interactions. 44 22 2
Providingadult day care services. 40 26 2
Providing a matching service for community

volunteers that can meet older adults' needs for

light housekeeping, shopping, companionship. 33 28 7
Developing a volunteer service to assure older

adults are doing well (taking meds, eating, using

roper hygiene). 30 33 5

Promotin a single point of entry into services. 27 32 7
Other (please specify) 22
Ianswered question 68
[skipped question 2

 

 

 

 

 

Table 10 provides the responses regarding what the respondents thought
about a list of thirteen activities and services that target quality of life
improvements for older adults. Providing transportation to those who need it and
educating caregivers about services available to them and their family member
had the highest number of respondents rate them as very important. Promoting a
single point of entry into services, developing a volunteer service to assure older
adults are doing well, and providing a matching service for community volunteers

that can meet older adults’ needs for light housekeeping, shopping,

76

companionship were seen by the respondents as less important than the other
activities and services. This could be because those activities and services are
already being provided by other entities or it could be that the respondents did
not ﬁnd them as valuable as the other activities and services listed.

Table 11: Activities Where Community Partnership Takes An Active Role by

 

 

Number of Respondents

E? Activities in which Community Very active Somewhat No active
Partnerships Take an Active Role role active role role
Develoging coordinated systems of care. 35 26 5|

 

Working with health care providers to
make them aware of community resources
available to their older patients. 30 30: 7

Holding media campaigns to make older
adults and their families aware of

 

 

 

 

 

 

community services available to them. 25 33 9h
lTraining caregivers in self-care
techniques. 1 7 30 1

 

negative impact on older adults such as
and use regulations. 11 33 2
Expanding volunteer training and
opportunities for community members who
want to assist older adults. 9 37 21
Working with faith-based organizations to
make them aware of community resources

[Vorking to change policies that have a
I

SL__J

 

 

 

 

 

 

 

 

 

 

 

 

available to their congrggants. 7 40 20
IOther (please specify) 1
Ianswered question 6ﬂ
[skipped question 3|

 

Table 11 asks respondents to rate the activities in which a partnership
takes an active role. None of the partnership activities listed was viewed by the
preponderance of the respondents as having a very active role. Of the activities
listed, developing coordinated systems of care received the highest number of
very active role and somewhat active role responses. This is consistent with the

data gathered during the case studies where all three of the partnerships viewed

77

networking to promote service coordination as one of their principal goals. Over
one-third of the respondents indicated that the partnership had no active role in
working to change policies that have a negative effect on older adults such as
land use regulations. Almost a third responded that the partnership had no active
role in expanding volunteer training and opportunities for community members
who want to assist older adults.

Table 12: How Partnerships Work Together to Improve Quality of Life for

Older Adults by Number of Respondents

 

Hardly
04 How Well Individuals/Groups in Most often Sometimes ever work
Partnership Worked Together to Improve work well work well well
Quality of Life for Older Adults together together together

They develop referral systems for community-
based services. 35| 13|
They develop health promotion and wellness I I
mgrams for older adults. 29 19
They provide access to healthy foods and I
meals. 27 19
They provide volunteer and social opportunites
so older adults can stay connected to others in
their communities. 24 24
They improve transportation options for older
adults. 21 25
They provide respite opportunities for
_ca_regivers of older adults. 21 24
They develop Single point of entry for services
for older adults. 1 1 30
They work to change zoning laws to expand
housing options for older adults. 5L
Other (please specify) I

|

|

 

 

 

 

 

 

 

 

 

 

 

 

16

 

 

answered question
skipped question

 

 

 

_L _g N
2£:LJLLLL_LL£

 

 

Table 12 shows the activities in which respondents think partnerships
work well together. Developing referral systems for community-based services
was the activity on which respondents thought partnership members most often

worked well together (n=35) with another 13 responding that partnerships
78

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hrs

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WEE

..th‘vi n:~ _b.

Ate .m.~ uur

P ~Pis~ .CFON

he

DE

sometimes work well together. Once again, this is consistent with the case study
ﬁndings. Working to change zoning laws to expand housing options for older
adults received the most responses (28) for “hardly ever work well together”.
Developing health promotion and wellness programs for older adults received 29
“most often work well together” responses and 19 “sometimes work well
together" responses.

Table 13: Effectiveness of Partnerships Activities by Number of

Respondents

 

05 Effectiveness of Partnerships in Very Somewhat Not
Assisting Older Adults effective effective effective

IConducting health promotion and health
fairs that are accessible to older adults. 34 12
Educating service providers on the
special needs of older adults. 21 29
Providing opportunities for social
Linteractions for older adults. 19 27
[Providing opportunities for exercise and
wellness activities. 19 25
Providing intergenerational interaction andl .
support opportunities. 10 20
Promoting awareness of the need for
cultural appropriateness of activities and
services. 9 27
Providing a media campaign about
mealthy lifestyle choices. 7 27
Ether (please specify)
Ianswered question
[skipped question

 

 

 

 

 

 

 

A

 

A

 

 

 

ELLLLL—LL

AA

 

E

 

 

 

 

.65

 

Table 13 provides the results for how effective the respondents think a
partnership is in assisting older adults, with the preponderance of respondents
indicating that partnerships are very effective at conducting health promotion and
health fairs that are accessible to older adults. Each of the three case study

partnerships hosted health fairs with Site B’s health fairs generating a substantial

79

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E... Di ~l

n ..O t: g pH

ﬁrm. mill

. ... .1.
ae- v ....

.4
.C a

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..U

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PIN.

amount of its revenues. At the other end of the spectrum, 19 of the respondents
indicated that a partnership was not effective providing intergenerational
interaction and support opportunities and 15 indicating they were not effective
providing a media campaign about healthy lifestyle choices. For the other
activities listed, about half of the respondents indicated a partnership was
“somewhat effective”.

Table 14: Ways Partnerships Could be More Effective by Number of

Respondents

 

Need tobe

QB Ways Partnerships Could Be More
Effective

Are very
effective
currently

Are fairly
effective
currently

much
more
effective

 

 

15 25' 11

Providing healthy aging programs.
Providing more information to community
members to increase their knowledge of

community services and resources.
Being more involved in advocating for
changes in policies that have an adverse
impact on older adults.

 

 

 

12 26

 

11

B
N
L2

 

Developing relationships with local, state and
federal ofﬁce holders and policy makers.
Providing more opportunities for community
input

Developing and implementing a strategy to
expand health care coordination.

Providing a volunteer matching and referral [
. prggram. 5
Developing and implementing a strategy to
.expand housing and living choices for older
aduns. 4
Developing and implementing a strategy to
recruit and retain service providers. 3
Other (please specify)
answered question
skipped question

21

N
N

 

 

 

 

29I

_L

 

26'

A

 

21

N

MELL—LLQ—

 

23l

 

 

29

—
A

 

 

 

 

401

 

 

 

Table 14 demonstrates that a large number of respondents thought a

partnership needed to be much more effective:

80

o in being more involved in advocating for changes in policies that have

an adverse impact on older adults;

0 in providing a volunteer matching and referral program;

9 in developing and implementing a strategy to expand housing and living

choices for older adults; and

o in developing relationships with local, state and federal ofﬁce holders

and policy makers.

The responses about whether a partnership is very effective currently in a
speciﬁc area range from 3 to 15, suggesting that most of the key informants do
not ﬁnd the partnerships with which they are familiar to be very effective in their
present conﬁguration.

Table 15: Availability of Funds by Number of Respondents

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Available Available
under under
most limited
Readily circum- clrcum- Not

Q7 Availability of Funds available stances stances available
Community Foundation(s) 5 19| 28| 1
Local government funds 4 12| 29| 7
Federal government funds 4 1 1| 28] 10
Statggovernment funds 3I 14| 28|
National Foundation(s) 0 6| 40 5|
Local agencies pool funds 0 17| 25 ml
Private donations 0 16| 34 2|
Other (ﬂease Specify) | 8|
answered question | 54]
skipped question | 16[

 

 

 

Table 15 shows responses that rate a partnership’s availability of funds.
The preponderance of the responses for all categories of funds was that the
partnerships ﬁnd funds only available under limited circumstances, especially
funds from national foundations, those pooled from local agencies, federal funds

81

and private donations. This is consistent with the ﬁndings from the three case
study partnerships where they rely mostly on in-kind contributions of staff, ofﬁce
services, and meeting space.

Table 16: Expanding Funding by Number of Respondents

 

 

 

 

 

 

Q8 Feasibility of Expanding Pool of Very Somewhat Not
Funds feasible feasible feasible [
Sansonng local fund-raising events 21 30| 3|
Writing proposals for foundation funding 19 35| 1|

 

Soliciting donations (ﬁnancial and in-kind)
[from civic groups, businesses, and faith-
19

based organizations 3|
Soliciting donations from individuals 18| 30] 7|

Working with local policy makers to
9|
5%
1%

determine whether there are untapped
Table 16 reports the results for how feasible it would be for partnerships to

 

 

sources of funds 16
[Working with state-level agencies to

determine whether there are sources of
funds 15
Other (please specify) I
answered question I
skipped question [

 

 

 

 

 

 

 

 

 

expand their pool of funds, with the majority of responses for all categories being
somewhat feasible. Very few of the respondents indicated that expanding funds
by the various means suggested would not be feasible. Between 15 and 21 of
the respondents think expanding funds through the activities listed is very

feasible.

82

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mthnhlh.

nWT

Wm— Tl.

W.t~ .-.l

Table 17: Relevance of Sustainability Factors by Number of Respondents

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Very Somewhat Not
Q9 Relevance of Sustainability Factors relevant relevant relevant

The membership of the partnership includes the
individuals and/ogoups that can get Ms done. 54 1 0
The community partnership is structured so that it can
set goals and achieve them. 51 4 0
The community partnership has become an integral

art of the community with regard to aging issues. 45 10
The community partnership members are able to work
toward the 'greater good' with rgard to aging issues. 45 10
The community partnership has the support of
stakeholders in the community. 44 11 0
Members of the community partnership all feel they
have a voice in matters concerniﬂ the partnership. 44 10 0
There is a synergy that has occurred among the
icommunity partnership members. 42 11 1
[The community partnership has shown the community
that it can achieve results. 42 13| 0
The community partnership is viewed in positive terms
by the community at large. 42 12 1
The community partnership is able to overcome 'turf'
issues. 41 14 0
The community partnership members are able to
participate in the activities of the partnership without
feeling that the mission of their group has been put on [
the back burner. 39: 16 0
The community partnership is viewed as inclusive by
community stakeholders. 38 14 2]
The community partnership is viewed in positive terms ]
gy_groups and individuals outside of the community. 29. 23
answered question | 5,
skipped question [ 1a

 

 

 

 

Table 17 provides insights of respondents regarding the relevance of
various sustainability factors. In general, all of the factors listed were viewed as
relevant by the vast majority of the respondents. According to the respondents,
the two most relevant factors are that the membership of the partnership includes
the individuals and/or groups who can get things done and that the partnership is

structured so it can set goals and achieve them. Only 29 of the respondents

83

hough
individi

found i

respor
within
hpes
weﬁei

secﬂo

CASE

resea
geog
the i
Choc
as(~
retire
limh
win
sites
Pilich

Sigd.

thought that the partnership being viewed in positive terms by groups and
individuals outside of the community is a very relevant sustainability factor but 23
found it somewhat relevant.

In general, the results of the Key Informant Survey indicate that the
respondents are familiar with community partnerships that address aging issues
within a speciﬁed catchment area. The responses provide insights into how these
types of coalitions are viewed and the expectations for their efforts. The results
were consistent with the case study ﬁndings that are provided in detail in the next

section.

CASE STUDIES

Case studies were conducted to gather detailed data to answer the
research questions. The three case study sites are located in different
geographic areas of the state. Site A is rural, has a military base that is used by
the National Guard for training, and has an increasing number of seniors who
choose to retire there. Site B is in northwest Michigan and is a tourist destination
as well as being a large fruit-growing area and also attracts a large number of
retirees. Site C is the most urban of the three sites and is located in south central
Michigan. It is the home of several large manufacturers and a large foundation
with a focus on child and family issues. The percentage of each of the case study
sites’ population age 65 years and older was higher than that of the state of
Michigan. Demographics for each site are provided in a table preceding the case

study synopsis.

84

RECURRENT THEMES AMONG THE CASE STUDIES

There were several themes that emerged in each of the case study sites.
The ﬁrst theme was that each site had looked at demographic trends and was
concerned about whether its infrastructure would be able to accommodate the
needs of an increasing number of older residents. Each of the three case study
sites had a higher percentage of older adults that the state. In 2003, the most
current year for which data are available, the percentage of residents age 65 and
older in Michigan was 20.0%. In contrast, the percentage in Site A was 26.5%,
Site B was 26.8% and Site C was 22.7%. Since Sites A and B are in areas that
attract retirees, they are working under the assumption that these percentages
could increase at an even faster pace than the state in future years.

Another recurrent theme from the case study sites was that the aging
initiative was associated with their community’s coordinating council or multi-
purpose collaborative body (MPCB). These groups are prevalent in Michigan and
are encouraged to be active by state-level departments including public health,
mental health, education, and human services.

It is perhaps important to provide a brief history of multi-purpose
collaborative bodies in Michigan to place this theme in context. The MPCBs are
comprised of professional and other interested community members with the
purpose of coordinating multidisciplinary services within their community. The
MPCBs facilitate identiﬁcation Of service gaps and duplication of services in their

communities (Ludtke, 2007).

85

slartin
Coord
being
approe
comml
would

comm:

 

 

Michigan has a long heritage of promoting community collaboration,
starting in 1987 with the establishment of county-level Human Service
Coordinating Bodies. These groups viewed coordinated, holistic programming as
being a more effective way to deliver services than through categorical
approaches. By the early 1990s, there was a large number of state-sponsored
community initiatives that required local interagency coordinating groups that
would develop and implement services to a speciﬁed population group in the
community (Ludtke, 2007).

By October 1995, each Michigan county was expected to have a Multi-
purpose Collaborative Body that would make decisions about how to coordinate
human services within the community. In 2004, the State Human Services
Directors decided to change the name from MPCBs to Community Collaboratives
(CCs). These CC groups are charged with consolidating community collaborative
groups, as well as community planning, information sharing, and managing state-
funded collaborative initiatives (Ludtke, 2007). The preponderance of the efforts
of the MPCBs is on behalf of children and families. The fact that each of the case
study sites had strong support from its MPCB demonstrates that the MPCBs
were able to interpret their mission of enhancing collaboration more broadly so
that they embraced increasing collaboration for older adults, their families, and
caregivers.

Each of the threecase study sites exhibited a sense of shared purpose
and goals which is consistent with the Communities Movement Project (Kesler &

O’Connor, 2001). Partnership members felt that being part of the partnership

86

added

in their

disserr
networ
eﬁechi
Comm
Spmn
hahna
wthth
shes vv
waysir
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Zald, 1!

|
multi-p
cmkhe

their in

 

 

 

added value to their individual efforts to improve the quality of life of older adults
in their communities.

Each site identiﬁed networking as deﬁned as information sharing and
dissemination, as a paramount purpose for their partnership. They felt that
networking leads to service coordination which in turn increases the
effectiveness of their agency’s efforts. Among the ﬁndings of The Healthy
Communities Movement study were that collaborative problem solving, focus on
systems change, and building capacity using local assets and resources were
hallmarks of successful partnerships (Wolff, 2003). These ﬁndings are consistent
with the outcomes of information sharing and networking where the case study
sites worked collaboratively on how to address identiﬁed problems and pursued
ways in which they could build systems capacity by using their local assets and
resources. This is consistent with Resource Mobilization Theory (McCarthy &
Zald, 1977).

Each of the sites’ aging initiative was part of its coordinating council or
multi-purpose collaborative body (MPCB). The MPCBs usually work on behalf of
children and families. The MPCBs in the case study communities interpreted
their mission of enhancing collaboration to include older adults, their families, and
caregivers. This is also consistent with the ﬁndings of the Communities
Movement Project where being inclusive and engaging major stakeholders were
identiﬁed as organizational competencies (Kesler & O’Connor, 2001).

The case study partnerships’ members are volunteers, which creates a

pull on their time. They have full-time positions, so in many instances, the work

87

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Non
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expe

part

from

men

them.
Danni

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they do for the partnerships is above and beyond their already busy schedules.
None of the case study sites’ partnerships had paid staff. For administrators of
public agencies in the case study communities, there appeared to be an
expectation that they be involved, and in most cases; the leaders of the
partnerships are from public agencies.

Each of the case study sites’ partnerships had a time when it took a hiatus
from its activities. The hiatus provided a time during which the partnership
members stepped back to determine the causes of impediments they had
encountered to achieving their goals. Some of the reasons identiﬁed for taking a
hiatus were a lull in interest among partnership members when they felt they
were not having enough of an impact in their community to make participation in
the partnership worth their while. One of the sites experienced turf issues when
for-proﬁt entities became involved in the partnership and wanted to change its
direction. All three sites had a period when they experienced a lack of consistent
leadership. The lack of continuity made functioning as a partnership difﬁcult for
them. Finally, to some extent, each case study site had a time when its
partnership lost sight of its mission which led to a time of reﬂection about their
goals and priorities.

The following three sections provide a synopsis of each case study site.

Detailed data from each site is provided in Appendices 2 and 4.

SYNOPSIS OF CASE STUDY SITE A

Site A has the smallest population of the three case study sites. As Table

18 demonstrates, the population remained steady from 2003 to 2008. In 2003,

88

the if.
consis
those
has ar
less if
to 12.!
its une
an Ufll
exiens
meetin

Eaden

 

 

 

the most recent year for which data are available, the county’s population
consisted of 2,500 (17.1%) residents age 65 and older, with 1,102 (7.5%) of
those age 75 and Older, and 268 (1.8%) age 85 and older. It is a rural county that
has an increasing retiree population. Site A’s 2006 per capita income is $10,667
less than the state’s. Its January 2009 unemployment rate was 12.8% compared
to 12.5% for Michigan. Its per capita income is the lowest of the three sites and
its unemployment rate is the highest. Site A is the only one of the three sites with
an unemployment rate that is higher than the state’s. Appendix D provides an
extensive narrative derived from materials provided by Site A that include
meeting minutes and other documents as well as interviews of the partnership

leadership team.

Table 18: Site A County Demographic Data, 2003, 2007 and 2008, Source:
Michigan Estimated Population of Michigan Counties, 2000-2008, Michigan

Department of Community Health

 

 

 

 

 

 

 

Site A Michigan

2008 Population Estimate 14,463 10,075,217

2007 Population Estimate 14,550 10,071,822

2003 Population Estimate 14,617 10,075,217

January 2009 Unemployment Rate 12.8% 12.5%

2006 Per Capita Income $22,318 $32,985

2003 Population Estimates by Sex for % of Total % of Total
Elderly Age Categories Number Population Number Population
Females 65 years and older 1,348 9.2% 724,800 7.2%
Females 75 years and older 651 4.5% 384,002 3.8%
Females 85 years and older 196 1.3% 113,168 1.1%
Males 65 years and older 1,152 7.9% 511,701 5.1%
Males 75 years and older 451 3.1% 230,001 2.3%
Males 85 years and older 72 0.5% 48,833 0.5%
Total Site A Residents 65 years and older 3,870 26.5% 2,012,505 20.0%

 

89

 

Summary Of Site A’s Findings

Site A was the only one of the 3 sites where the initial group of partnership
members consisted of direct service workers rather than agency directors and/or
program managers. They were assigned to participate in the partnership by their
respective agency’s administrators. The original partnership structure and
membership of Site A was productive, allowing them to develop protocols for
case collaboration, produce a community resource guide, and host health fairs.
When the group members felt they had accomplished their goals after several
years of working together, they took a hiatus during which time they sought to
have the task of addressing agency issues subsumed by the MPCB. This move
provided the partnership with more standing among community leaders. It also
provided the opportunity to effect changes to the community’s infrastructure for
aging services that was not available to the original group.

Site A had adequate access to ﬁnancial resources to conduct its activities.
It had successful past community collaborations efforts that included
homelessness, public health, and the state’s Strong Families/Safe Children
initiative. Site A’s accomplishments include conducting health fairs, developing
protocols for case collaboration, conducting case conferences, and developing
and publishing a community resource guide. The partnership members took a
hiatus when they felt they had accomplished their goals and turned to the MPCB
for direction for the community’s next steps in addressing aging issues. Through
the MPCB, the leadership team of the partnership was reconﬁgured and includes

the heads of three local agencies: human services, economic development, and

90

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Oﬁmei

whd.l
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208

council on aging as well as a member of the Michigan State University Extension

Ofﬁce whose plays a major role in aging advocacy in that region of the state.

Table 19 is the timeline of Site A’s activities. It provides a snapshot of

what happened each year for which meeting minutes were available. The

number of participants, discussion topics and accomplishments were gleaned

from the meeting minutes provided by the partnership.

Table 19: Site A Partnership Timeline

 

 

 

 

Year Highest Lowest Issues Discussed Accomplishments
Number of Number of and/or Addressed
Participants Participants
2001 N/A N/A 0 How to influence 0 Sent letter to state
development of senator
local coalitions expressing budget
cuts to Medicaid
Home and
Community Based
Waiver program
2002 N/A N/A 0 Developed <> Coordinated
mission resources at
statement and monthly meetings
action plan of agency
0 Action plan representatives
called for 0 Exchanged

 

 

 

development of
a crisis response
network

 

information about
available
resources, agency
policy changes,
and service
delivery

0 Hosted health fair
on 5/9/02

0 Distributed holiday
boxes for older
adults who would
otherwise not
receive gifts

 

91

 

Table 19 Continued

 

 

 

 

 

Year Highest Lowest Issues Discussed Accomplishments
Number of Number of and/or Addressed
Participants Participants
2003 15 8 0 Discussed crisis 0 Coordinated
response resources at
effectiveness monthly meetings
0 Solutions to of agency
gaps and representatives
identiﬁed 0 Worked on
problems aggregation of
protocols for crisis
response for each
agency
0 Hosted health fair
on 5/15/03
2004 13 5 0 Hardships cased 0 Hosted health fair
by high cost of on 6/10/04
prescription 0 Developed
drugs, programs protocol for
to recommend to resources and
clients emergency
0 Need from responses
transportation to 0 Distributed holiday
out—of-county boxes for older
medical facilities adults who would
otherwise not
receive gifts
2005 13 6 O Problem-solving <> Hosted health fair
discussion about on 6/9/05
prescription drug 0 Free clinic
costs steering
<> Discussed committee formed
disbanding due 0 Produced a
to lack of community
members willing resource guide
to hold ofﬁce and
reconvening as
an informal
resource council
0 Discussed
becoming part Of

 

 

 

 

 

92

 

Tat

MI

in the
grew
are a
65 at
85 air
JanU
highs
Thes
and [

qUaht

Table 19 Continued

 

Year Highest Lowest Issues Discussed Accomplishments
Number of Number Of and/or Addressed
Participants Participants

 

2006 17 N/A 0 N/A 0 In January 2006
reconvened in
new format as
subcommittee of
MPCB

<> lnfonnation
dissemination
about Medicare
Part D,
MichiganWorks,
Elder Friendly
Communities, and
housigq

 

2007 N/A N/A N/A N/A

 

 

 

 

 

 

2008 N/A N/A N/A N/A

 

SYNOPSIS OF CASE STUDY SITE 8

Site B is the two-county site and in the middle of the three case study sites
in the size of its combined population. As Table 20 demonstrates, the population
grew by 4.1% from 2003 to 2008. In 2003, the most current year for which data
are available, the counties’ population consisted of 18,328 (17.7%) residents age
65 and older, with 7,403 (7.1%) of those age 75 and older, and 2,010 (1.9%) age
85 and older. Site B’s 2006 per capita income is $2,504 more than the state’s. Its
January 2009 unemployment rate was 10.8% compared to 12.5%. Site B has the
highest per capita income of the three sites and the lowest unemployment rate.
These are rural counties with a very strong tourism industry and upscale resorts
and housing. The natural beauty of the area, combined with its quaint shops and
quality restaurants, serve to attract retirees to become. full-time or part-time

93

 

residents. Appendix D provides an extensive narrative derived from materials
provided by Site B that include meeting minutes and other documents as well as
interviews of the partnership leadership team.

Table 20: Site B County Demographic Data, 2003, 2007, and 2008, Source:
Michigan Estimated Population of Michigan Counties, 2000-2008, Michigan

Department of Community Health

 

 

 

 

 

 

 

Site’s Michigan
2008 Population Estimate 107,854 10,003,422
2007 Population Estimate 107,377 10,071,822
2003 Population Estimate 103,610 10,075,217
January 2009 Unemployment Rate 10.8% 12.5%
2006 Per Capita Income $35,489 $32,985
2003 Population Estimates by Sex for % Of Total % of Total
Elderiy Age Categories Number Population Number Population
Females 65 years and older 8,552 8.3% 724,800 7.2%
Females 75 years and older 4,499 4.3% 384,002 3.8%
Females 85 years and older 1,408 1.4% 113,168 1.1%
Males 65 years and older 9,776 9.4% 511,701 5.1%
Males 75 years and older 2.904 2.8% 230,001 2.3%
Males 85 ears and older _602 0.6% 48,833 0.5%
Total Site B Residents 65 years and older 27,741 26.8% 2,012,505 20.0%

 

SummaIy Of Site B ’3 Findings

Partnership B member organizations represent a wide range of entities
involved in the continuum of senior services. The member organizations include
local governmental agencies that provide senior services such as the Area
Agency on Aging, Commission on Aging, Health Department, Community Mental
Health, Human Services, Council of Governments, Senior Center, Transportation
Authority, and the District Library. Local advocacy group members include AARP,
Citizens for Better Care, Disability Network, and Parkinson’s Support Group.
Among service provider members are home health agencies, various levels of

residential care providers, rehabilitation services, durable medical equipment

94

vendors, ﬁnancial institutions, a funeral home, hospice, legal services, and
senior-focused publications. In addition, there are not-for-proﬁt agencies such as

Catholic Human Services.

The diverse member organizations provide breadth to the group and
enhances the networking and information dissemination opportunities. The
Partnership B member organizations represent most of their community’s
continuum of care for older adults. However, out of this diversity comes two
clusters of members holding divergent ideas about the purpose of Partnership B
and what it should accomplish. Thus far, the partnerships has been able to
maintain its focus on achieving its stated goals through its management structure

and leadership.

Partnership B members, over the past eight years, have focused on the
Senior Expo, an expanded health fair, as their major “product.” The event
provides a focal point for members and allows them to link community members
with community services of both not-for-proﬁt and for-proﬁt providers. The Expo
provides seniors and their caregivers with information about the service
continuum in the area which educates them about their options. This ultimately
can increase the number of older adults who are able to age in place because
they and their families are aware of the services available and how to access

them.

Site B had adequate access to ﬁnancial resources with a major source of
funds derived from fees associated with the Senior Expo. Site B’s leadership is

agency directors and program managers. These leaders are dedicated to

95

advocacy for seniors and view the partnership as a means of expanding their
advocacy efforts.

Site B has a “big tent” mentality. Its 60 members include the local
Chamber of Commerce, an HMO, public and private agencies, and for-proﬁt
vendors with a target market of older adults. Site B’s accomplishments include
hosting their annual Senior Expo; developing and distributing educational
materials; providing support for individuals and groups in their community
through their Senior Support Team and mini-grants; and advocating for changes
in policies that have an adverse affect on their older residents.

Site B took a hiatus when it experienced a substantial number of
leadership changes in a fairly short period of time. The hiatus ended when new
people became involved and were willing to take on leadership roles. There was
a change of leadership that invigoated Site B’s partnership when it reconvened.

Table 21 is the timeline of Site B’s activities. It provides a snapshot of
what happened each year for which meeting minutes were available. The
number of participants, discussion topics and accomplishments were gleaned

from the meeting minutes provided by the partnership.

96

Table 21: Site B Partnership Timeline

 

 

 

 

 

 

 

 

 

 

Year Highest Lowest Issues Discussed Accomplishments
Number of Number Of and/or Addressed
Participants Participants
1995 17 N/A 0 Explore ways to WA
increase cooperation
among service
providers
0 Increase agency
collaboration
0 Identify potential
service duplication
<> Developed mission
statement
1998 21 N/A N/A 0 Received
Governor’s
Innovaﬁon
Recognition Award
0 Developed and
distributed regional
resource guide in
conjunction with
community mental
health agency
0 Hosted a health
fair
2000 N/A N/A 0 Changed name of O MPBC recognized
group to make it group’s efforts
simpler
2001 N/A N/A MA 0 Hosted Senior
Expo
2001 N/A N/A N/A 0 Hosted Senior
Expo
2002 N/A N/A N/A 0 Hosted Senior
Expo
2003 N/A N/A N/A 0 Hosted Senior
Expo
2004 MA N/A N/A 0 Hosted Senior
Expo

 

 

 

 

 

97

 

Table 21 Continued

 

 

 

 

Year Highest Lowest Issues Discussed Accomplishments
Number Of Number of and/or Addressed
Participants Participants
2005 33 13 0 Developing a formal <> Hosted Senior
budget Expo
0 Revised meeting 0 Promoted
format to stay networking
focused on mission 0 Developed and
0 Moved from distributed
consensus decision educational
making to voting materials
0 lnforrnation
dissemination
about member
agencies and
senior-related
community issues
0 Prepared position
paper about
community's
senior issues and
recommendations
for addressing
them
2006 38 22 0 Poor dental care in O lnforrnation

 

 

 

nursing homes

0 Advocacy work
group developed 3
goals: more
involvement with
senior lobbyists; set
up local electronic
advocacy network;
promote Senior
Count data collection

0 Inviting other senior
service providers
(tribe, law
enforcement,
legislators) to join
group

0 Chamber of
Commerce

 

dissemination and
networking

0 Hosted Senior
Expo

0 Create website

0 Senior Support
Team

0 Published and
distributed
education
materials

 

98

 

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if. .....q. . . . w... . . . . . . , . . . . , . ., . . . , . t . . ... . . s...
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. . .. a $5.52....“

 

Table 21 Continued

 

 

 

 

Year Highest Lowest Issues Discussed Accomplishments
Number Of Number Of and/or Addressed
Participants Participants
2007 34 26 o Revisit strategic plan 0 Joined Chamber of
and priorities Commerce
0 Hosted Senior
Expo
o Formed livable
community task
force
0 Senior Support
Team
2008 44 28 0 Strategic planning 0 Hosted Senior
process Expo
0 Leadership 0 Senior Support
nomination process Team
implemented 0 Provided mini-
grants

 

 

 

 

 

SYNOPSIS OF CASE STUDY SITE C

Site C has the largest population of the three case study sites. As Table
22 demonstrates, the population grew slightly by a scant .3% from 2003 to 2008.
In 2003, the most current year for which data are available, the county’s
population consisted of 18,956 (14.0%) residents age 65 and older, with 9,368
(6.9%) of those age 75 and older, and 2,474 (1.8%) age 85 and older. Site C’s
2006 per capita income is $3,123 less than the state’s. Its January 2009
unemployment rate was 11.1% compared to 12.5% for Michigan. This puts Site
C in the middle of the three sites for both per capita income and unemployment
rate although it is much closer to the ﬁgures for Site B than those of Site A. The
county has historically had a strong industrial base that includes food processors

and pharmaceuticals. Both of these industries have downsized their presence in

99

 

 

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hi

the county over the paSt decade. The county also has a large foundation with a
national and international focus on child and family programs. Appendix D
provides an extensive narrative derived from materials provided by Site C that
include meeting minutes and other documents as well as interviews of the

partnership leadership team.

Table 22: Site C County Demographic Data, 2003, 2007, and 2008, Source:
Michigan Estimated Population of Michigan Counties, 2000-2008, Michigan

Department of Community Health

 

 

 

 

 

 

 

 

Site C Michigan

2008 Population Estimate 135,861 10,003,422

2007 Population Estimate 136,615 10,071 ,822

2003 Population Estimate , 135,510 10,075,217

January 2009 Unemployment Rate 11.1% 12.5%

2006 Per Capita Income $29,862 $32,985

2003 Population Estimates by Sex for % of Total % Of Total
Elderly Age Categories Number Population Number Population
Females 65 years and older 11,160 8.2% 724,800 7.2%
Females 75 years and older 5,889 4.3% 384,002 3.8%
Females 85 years and older 1,737 1.3% 113,168 1.1%
Males 65 years and older 7,796 5.8% 511,701 5.1%
Males 75 years and older 3,479 2.6% 230,001 2.3%
Males 85 years and older 137 0.5% 48,833 0.5%
[Total Site C Residents 65 years and older 30,798 22.7% 2,012,505 20.0%

 

Summary Of Site C’s Findings

Although Partnership C had a mission statement from prior to its hiatus,
the interviewees stated they were not aware of it or whether the group had
speciﬁc goals to accomplish. The interviewees viewed Partnership C as a venue
in which senior issues in the county were discussed and information was Shared
among agencies that serve Older adults. They engage in problem-solving

discussions when issues about advocacy or service delivery issues arise during

100

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their monthly meetings. Interviewees expressed concern that Partnership C not
commit to doing extensive projects for which it did not have stafﬁng. They stated
that Partnership C members were already extremely busy with their jobs and
could not take on signiﬁcant projects or ongoing community activities and did not

view doing so as Partnership C’s mission.

The interviewees ﬁnd the ability to meet monthly to update each other on
their activities and to learn about the breadth of services as well as unmet needs
in the county extremely useful to their work with local seniors. The activities in
which they do participate as a group such as information dissemination, data
gathering and analysis, health fairs and the community report card, are
consistent with the mission developed for the group in 1998—to educate,
coordinate, and assess senior services and needs while promoting dignity and
quality of life for all seniors throughout the county.

Site C has adequate ﬁnancial resources to conduct its activities. Site C
has Senior Millage that generates over $2 millions a year in ﬂexible funding for
services for Older adults. Millage funds are distributed through a grant proposal
process. The Director of the Senior Millage is an active member of the
partnership.

Site C’s leadership is agency directors but was inconsistent prior to hiatus
due to stafﬁng changes at various local agencies. Prior to Its hiatus, for-proﬁt
entities whose target market is older adults separated from the partnership to
form their own group because their mission was not in sync with that of the

partnership. The hiatus occurred when the partnership had an identity crisis as

101

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members lost sight of the mission/charge of MPCB. Site C reconvened at the
urging of the MPCB. The timing was good because there was a change in
leadership several of the local agencies (AAA, Senior Millage, and PACE). The
new leaders brought energy and new ideas to the partnership and resumption of
activities.

Site C’s partnership has formed links to the regional health alliance and
elder abuse task force. It hosts annual health fairs and produces the section of
the community report card describing the county’s senior services. It provides a
venue for information sharing, networking and advocacy for the communities’
older residents.

Table 23 is the timeline of Site C’s activities. It provides a snapshot of
what happened each year for which meeting minutes were available. The
number of participants, discussion topics and accomplishments were gleaned
from the meeting minutes provided by the partnership.

Table 23: Site C Partnership Timeline

 

 

 

Year Highest Lowest Issues Discussed Accomplishments
Number of Number of and/or Addressed
Participants Participants
1998 N/A N/A 0 Formed as N/A
workgroup of MPCB
2000 N/A N/A 0 Work group N/A

disbanded in March
but reconvened in

 

 

October
2001 N/A N/A 0 Determined mission 0 Developed survey
0 Determined top for front-line staff

senior needs based
on survey results

 

 

 

 

 

102

 

Table 23 Continued

 

 

 

 

 

 

 

 

 

 

Year Highest Lowest Issues Discussed Accomplishments
Number of Number of and/or Addressed
Participants Participants
2002 21 8 0 Developed goals and 0 Draft document of
outcomes for group home repairs
to accomplish outcomes
0 Selected home
repairs as single
focus area
2003 10 7 0 Tracked number of O Recruited
requests for home organizations and
repairs and yard individuals to help
work with yard work
0 Recruited Home
Builders
Association (HBA)
to do home repairs
2004 NIA N/A N/A 0 Finalized
partnership with
HBA
0 Sent letters to
service clubs
requesting $500
donation to
purchase supplies
for home repairs
2005 19 6 0 Goals provided to 0 Evaluated
MPCB were 1) prescription drug
seniors referred to use
home repair program 0 Developed
would be served 2) prescription drug
seniors receive evaluation by
access to health pharmacist brown
information and bag programs
services
0 Pet care program

 

103

 

Table 23 Continued

 

Year

Highest
Number of
Participants

Lowest
Number of
Participants

Issues Discussed
and/or Addressed

Accomplishments

 

2006

16

10

0 Regular attendance
at meetings was
urged

0 07/06 frustration
mounting regarding
inconsistent member
participation, lack of
goals, stress Of
taking on projects
too large for group to
accomplish

N/A

 

2007

NIA

N/A

0 Group only met in
January

NIA

 

 

2008

 

19

 

 

0 Reconvened in 01/08

0 New leadership

0 Active focus on data
collection

 

<> Conducted senior
survey that
identiﬁed an
unmet need
among caregivers
whose needs are
not met by existing
services

0 Information
dissemination and
networking

0 Enhanced senior
services
information in
community report
card published by
MPCB

 

ANALYSIS AND SYNTHESIS OF KEY INFORMANT SURVEY AND CASE STUDY FINDINGS

The three partnerships shared several key commonalities. One of the

recurrent themes was the central role of networking. Each site allocates a

signiﬁcant portion of its monthly meeting time to information sharing among the

104

 

 

members. This provides a forum to talk about new programs being introduced in
the community, waiting lists for services, personnel changes, funding
opportunities, community events, and calls for assistance from other agencies.
The meetings include problem solving among the members when one of the
member agencies has encountered a situation for which it would like input from
others who serve older adults.

Another major theme was that of information dissemination both among
the members and to the community at large. Community information
dissemination occurred through health fairs/senior expos, printed
materials/brochures, resource guides, speakers bureaus, and articles in local
publications. The primary intention was to educate and inform older adults,
caregivers, and community stakeholders about issues involved in aging, services
available to meet the needs of older adults, and as a means of advocating for
their older residents.

The ﬁnal theme to emerge was that each partnerships demonstrated that
its efforts led to political action and advocacy around issues that could have a
deleterious effect on its community’s older residents. For example, Site B invited
legislators to join their partnership and to be a part of their health fair. Sites A and
C advocated for older adults at the local and state governmental levels by
sending letters regarding the reduction in the Medicaid Home and Community-
based Waiver program. The partnerships’ involvement with their communities’
MPCB provides a direct link to leaders of human services and health care

providers where they advocated for local policy changes.

105

FACTORS THAT PROMPTED THE COMMUNITY TO BE INTERESTED IN ADDRESSING AGING

ISSUES

Each case study site had speciﬁc reasons for forming a partnership to
address aging issues. Among the reasons noted were the recognition that the
number of older adults in their communities was on the rise and would continue
to increase over the next several decades. Those entities in the communities that
work with other adults sought out others with whom they could discuss how to
approach planning their service array. Their plans included how to create
opportunities to accommodate the needs of older adults and improve their quality
of life. They were especially interested in increasing opportunities for their older
residents to age in place.

Collaboration among community agencies in Michigan has become the
way in which communities have operated for over twenty years, ﬁrst through the
Human Service Coordinating Bodies and then through the Multi-Purpose
Collaborative Bodies which have become Community Collaboratives (Ludtke,
2007). Thus, working together on a common issue has become fairly standard
practice in many communities. However, what the case study communities have
done extends that practice through their grassroots partnerships that address
aging. These communities took it upon themselves to form aging collaboratives
as an outgrowth of the MPCBs that primarily focus on child and family issues.

Responses to the key informant survey were consistent with information
gathered during the case studies. Table 24 provides information about how

important the key informant survey respondents consider promoting service

106

coordination as an activity that improves the quality of life for older adults in
Michigan. All respondents chose either very important (1) (N=50) or somewhat
important (2) (N=18) with a mean of 1.26 and a standard deviation of .44
demonstrating a high level of support for promoting service coordination which
was one of the primary activities in which the three case study sites engaged at
their monthly meetings. All of the case study site partnerships engaged in efforts
that led to increased service coordination.

Table 24: Promoting Service Coordination - Improve Quality of Life for

Older Adults

 

Promoting service coordination

Mean 1 .2647
Standard Deviation 0.4445
Count 68

 

Table 25 provides information about how active the partnership was in
developing coordinated systems of care. Over half of the respondents (N=35)
responded the partnerships took a very active role (1) and 26 responded they
took a somewhat active role (2). Only 5 responded that the partnerships took no
active role. The mean is 1.55 with a standard deviation of .64. This corresponds
well with the data gathered from the case study partnerships that described their
efforts to coordinate services that target older residents through networking and

information sharing.

107

Table 25: Developing Coordinated Systems of Care - Partnership Takes an

Active Role

 

Developing coordinated systems

 

of care.

Mean 1 .5455
Standard Deviation 0.6369
Count 66

 

FACTORS THAT HELPED SUSTAIN THE COMMUNITY’S EFFORTS

The case study data identiﬁed several ways in which the partnerships
were able to sustain their efforts, most of which have to do with their missions,
goals, and organizational structures.

Table 26: Comparison of Case Study Sites Mission Statements

 

Site Mission Statement

 

Site A Creating a network of resources and contacts to inform and assist
those adults with unmet needs while preserving the individual’s
conﬁdentiality.

 

Site B To support and enrich the lives of older adults through collaboration.

 

 

Site C To educate, coordinate, and assess senior services and needs while
promoting dignity and quality of life for all seniors throughout the
county. .

 

 

 

Source: Partnership Monthly Meeting Minutes

As can be seen in Table 26, even though each partnership autonomously
developed its own mission statement, similarities of purpose exist among the
sites. Site A’s mission of creating a network of resources relates to Site B’s
mission of accomplishing its goals through collaboration as does Site C’s mission
to coordinate senior services. Site A’s mission includes informing adults with

unmet needs while Site C’s mission pertains to educating seniors about services

108

that meet their needs. Site B interprets its mission of supporting and enriching
the lives of older adults in part through its Senior Expo and the educational
materials it produces.

Finally, all of the sites’ mission statements refer to the outcome they
desire through their partnerships’ efforts. Site A’s outcome is to address unmet
needs of adults. Site B’s outcome is to support and enrich the lives of older
adults. Site C’s outcome is to promote the dignity and quality of life for their
seniors. Having mission statements that can be operationalized is one factor that
provides sustainability to the partnerships’ efforts. The mission statements
provide the overarching, broad goals that the partnerships then use to develop
their objectives and strategic plans. Having mission statements was a way in
which the partnerships could center their efforts as they reconvened after their
respective hiatus.

All of the sites have a fairly ﬂat organizational structure as beﬁts
organizations that depend on volunteers. There is little room for hierarchy in such
entities. Committee membership is ﬂexible, although each site had members who
volunteer to lead committees, knowing that they would probably bear the brunt of
the work. Each site had a mechanism in place to designate its chair person. Site
B implemented a nomination process for its ofﬁcers as it has sixty members from
which to choose. The other case study partnerships have less formal processes
for selecting ofﬁcers which could be due to having fewer members from which to

choose.

109

Responses on the key informant survey were consistent with information
gathered during the case studies in that they expressed the importance of
various factors they ﬁnd relevant to partnerships’ sustaining their efforts. Several
of the survey questions involved the structural organizations of partnerships for
older adults. Table 27 indicates that key informants responded that partnership
membership needs to include individuals or groups that can get things done as a
relevant sustainability factor. Their response was overwhelming with 54 of the 55
respondents rating it as very relevant (1) and the other respondent as somewhat
relevant (2). This translates to a mean score of 1.02 with a standard deviation of
only .13.

Table 27: Partnership Members Can Get Things Done

 

The membership of the
partnership includes the
individuals and/or groups that

 

cmet thiqus done.

Mean 1.0182
Standard Deviation 0.1348
Count 55

 

This is consistent with what was learned from the case study partnerships.
Interviewees repeatedly identiﬁed key members of their groups as leaders to
whom other members looked for guidance and upon whom they could rely to
assure that the goals of the partnership were met. These leaders often serve as

the face of the partnership to the community.

110

Table

The l
3th
acme

Meal
Stan

 

 

Table 28: Partnership Structure and Goal Achievement

 

The community partnership is
structured so that it can set goals and
achieve them.

Mean 1 .0727
Standard Deviation 0.2621
Count 55

 

Another sustainability factor the key informants identiﬁed as crucial is that
the community partnership is structured in such a way that it can set goals and
achieve them. Table 28 shows that the mean score for this factor is 1.07 with a
standard deviation of only .26. None of the key informants found this factor to be
“irrelevant”, while 51 rated it as “very relevant”, and 4 as “somewhat relevant”. As
the case study demonstrated, each of the three partnerships in the study found a
structure that allowed it to set goals consistent with its mission and to put
activities in place to accomplish its stated goals.

Each of the three partnerships grappled with how much effort reasonably
could be expected from its members when it was in the process of determining
what activities the group could successfully accomplish. One interviewee gave an
example of how the partnership tried to develop a volunteer corps of high school
students to help older residents with yard work and snow removal. The
partnership sent letters to local schools to generate a cadre of youth who would
like to be involved. However, it soon became apparent to the partnership
members that coordinating a volunteer corps of youth would take more time and

effort than they could expend on one activity.

111

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Community support for the goals and efforts of the partnerships was
another key component in the sustainability of the partnerships and their ability to
consistently achieve their goals. The link each partnership has to its community’s
MPCB played a tremendous role in garnering community support, especially
among community leaders who are involved in health and human services. The
formality of the relationships between the partnership and its MPCB varied, but
each partnership identiﬁed the support of the MPCB as crucial to its efforts.

Table 29: Support of Community Stakeholders

 

The community partnership has
the support of stakeholders in the

 

community.

Mean 1 .2
Standard Deviation 0.4037
Count 55

 

The responses of the key informants correspond to the case study results
where the partnerships valued their relationships to their MPCBs. Table 29
suggests that the key informants recognize the relevance of stakeholder support
to the viability of partnerships. Once again, none of the respondents found that
stakeholder support was “irrelevant”, while 44 rated it as “very relevant”, and 11
as “somewhat relevant”. The mean score was 1.2 with a standard deviation of
.40.

Being able to accomplish what it sets out to do is one way in which a
partnership sustains is efforts. The synopses of the case studies provide
examples of projects and ongoing activities in which the partnerships are

engaged that keep members connected and active. What became apparent from

112

 

 

 

 

 

the partnership minutes is that when activities wane, so does member interest
and involvement. A prime example of this is when Site A partnership members
felt they had accomplished their goals and no longer felt the need to continue
meeting.

Table 30: Conducting Health Promotion and Health Fairs

 

Conducting health promotion
and health fairs that are
accessible to older adults.

Mean 1 .4
Standard Deviation 0.6389
Count 50

 

Each site sponsored a health fair or senior expo annually in its community.
These events helped educate local older adults and caregivers and provided a
way for local service providers to connect with people who might need their
services. However, the senior expos served as a rallying point for the members
of the partnerships as well. The review of the meeting minutes of each
partnership showed that attendance was greatest in the months preceding the
senior expos when most members had assignments to complete and reported
their progress at the monthly meetings. The attendance at monthly meetings
decreased after the expo was held.

The key informants were asked to rate the effectiveness of the partnership
as it engaged in various activities. For conducting health promotion and health
fairs, the respondents had a mean score of 1.4 with a standard deviation of .64.
There were 4 respondents who did not ﬁnd the partnership effective (3), 12 who

thought it was “somewhat effective”, and 34 who thought it was “very effective”.

113

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With regard to providing more information to community members to
increase their knowledge of community services and resources, the key
informants had more varied responses than they did to other activities of the
partnerships. The mean score was 2.02 with a standard deviation of .71. There
were 13 respondents who rated the partnership as “needing to be much more
effective”, with 26 replying that the partnership was “fairly effective currently”, and
12 who thought the partnership was “very effective currently”.

Table 31: Increase Knowledge of Community Services and Resources

 

Providing more lnfonnation to
community members to increase
their knowledge of community
services and resources.

 

Mean 2.0196
Standard Deviation 0.7068
Count 51

 

As the partnership synopses demonstrated, each site produced
informational materials that targeted older adults. Site A developed the resource
guide. Site B was extremely active when it came to developing educational
materials for older adults, producing several informational brochures and the
Senior Help Card. Site C concentrated its efforts on its portion of the community

report card to provide information to older adults and their caregivers.

FACTORS ENCOUNTERED BY THE PARTNERSHIPS THATHINDERED OR ENDED THE

COMMUNITY'S EFFORTS

All three of the case study partnerships were able to achieve results

stemming from their endeavors. However, each of the partnerships experienced

114

a time when it was not accomplishing what it thought it should to be effective.
This led them to step back to determine what it was that was causing the
impediments to achieving their goals. Most of the time the cause was due to a lull
in the interest of partnership members, when the faithful few did not have the
time or the energy to carry the group on their own. This dilemma presents a
chicken and the egg scenario where it is difﬁcult to discern whether membership
apathy came from lack of results or the lack of results was a function of
membership apathy.

Table 32: Partnership Can Achieve Results

 

The community partnership
has shown the community
that it can achieve results.

Mean 1 .2364
Standard Deviation 0.4288
Count 55

 

Table 32 provides insights of the key informants related to results
achievement with 42 respondents rating this factor as “very relevant”, and 13
rating it as “somewhat relevant” with none rating it as “not relevant”. The mean is
1.24 with a standard deviation of .43 thus afﬁrming the case study ﬁnding
regarding the necessity of achievement of its goals as a factor in the

sustainability of a partnership.

115

 

Table 33: Overcoming Turf Issues

 

The community partnership is
able to overcome 'tun" issues.

 

Mean 1 .2545
Standard Deviation 0.4396
Count 55

 

Turf issues can be an obstacle that is difﬁcult to overcome. Individual
agencies each have their own missions, resources and stakeholders. At times
they can ﬁnd it difﬁcult to be open to coordinating their efforts for fear of losing
their identity or control over their program activities (Lasker et al, 2001). Breaking
down the barriers to collaboration can be a long and delicate process of ﬁnding
the right balance among the various entities involved in the collaboration. One of
the factors that had a positive inﬂuence on collaboration of the case study
partnerships was the support of the MPCBs whose purpose it is to promote
community collaboration.

Table 33 provides key informant responses regarding turf issues that
indicate the importance placed on being able to overcome these problems as a
factor in sustaining a partnership’s efforts. No one rated turf issues as
“irrelevant”, with 41 rating them as “very relevant”, and 14 as “somewhat

relevant” for a mean score of 1.25 and a standard deviation of .44.

116

Table 34: Working with Faith-based Organizations

 

Working with faith-based
organizations to make them
aware of community resources
available to their congregants.

 

Mean 2. 1 940
Standard Deviation 0.6090
Count 67

 

The ability to reach out to other organizations outside of the health and
human service sectors is a way in which partnerships for older adults can extend
their efforts. However, none of. the partnerships in the case study had actively
pursued a connection to its community’s congregations. Although some faith-
based human service agencies were members of the partnerships, there was no
representation by ministerial alliances or other groups that could bring in
volunteers from congregations and provide a means of disseminating information
about community resources to older adults and caregivers.

An example of an untapped resource to reach older adults and their
caregivers that the partnerships are missing is that 696 congregations in
Michigan have Stephen Ministries. Stephen Ministries train lay people to provide
one-on—one care through formalized relationships that use their caregiving skills.
The ﬁfty-hour training program for the lay people includes listening, feelings,
assertiveness, conﬁdentiality, and ministering to people who are experiencing
difﬁcult life situations such as terminal illness and grief (Stephen Ministries,
2000). Providing information to the Stephen lay ministers about community

resources would be another mode of information dissemination to people who

117

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have direct contact with care recipients who might not know what is available to
them in their community.

Table 34 provides key informant insights about working with faith-based
organizations to make them aware of community resources available to their
congregants. The responses are consistent with the case study ﬁndings in that
the faith community is a fairly untapped resource. Only 7 respondents think
working with faith-based organizations is “very relevant”, while 40 think it is
“somewhat relevant”. Interestingly, 20 think it is “not relevant” which is consistent
with the majority of respondents being from the health and human service
sectors. Some of this might be due to a practice model that separates publicly
funded professional services from faith-based organizations that provide
volunteer services.

Individual health care providers and their local professional associations
such as the county medical society are another way in which partnerships for
older adults can provide educational assistance but was not used by any of the
case study sites. The informational materials produced by the case study
partnerships would be useful tools for physicians to provide to their patients and
their caregivers as they make decisions that have a direct impact on the quality
of the older adult’s life. The events hosted by the partnerships such as health
fairs/senior expos would be a valuable way for physicians to introduce their

patients and their caregivers to the array of available community services.

118

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OTHER INTERNAL AND/OR EXTERNAL SUSTAINABILITY FACTORS ENCOUNTERED

Responses on the key informant survey were consistent with information
gathered during the case studies. Table 35 provides key informants’ rating of the
relevance of a community partnership being an integral part of its community
when aging issues are involved. The mean is 1.18 with a standard deviation of
.39. None of the respondents rated being an integral part as “irrelevant”, with 45
rating it as “very relevant”, and 10 as “somewhat relevant”. This is consistent with
the case study results where the partnerships had become the place where
coordination for services for older adults occurred, where problem-solving
discussions about the strengths and weaknesses of the local service array were
held, where information was shared among agencies, and where educational and
informational materials were produced and disseminated to community
members.

Table 35: Partnership as Integral Part of Community for Aging Issues

 

The community partnership has become
an integral part of the community with

regard to aging issues.

 

Mean 1 .1818
Standard Deviation 0.3892
Count 55

 

Key informants indicated that the partnerships about which they were
responding were viewed in positive terms by their communities-at-large, with a
mean score of 1.28 and a standard deviation of .48. The number who rated being
viewed positively by the community at large as “very relevant” was 42, with 12

rating it as “somewhat relevant” and 1 respondent rating it as “not relevant”. The

119

case study partnerships were viewed in positive terms by their local MPCBs, the
groups that purchased booths at the health fairs/senior expos, the older adults
and their caregivers who attended the health fairs/senior expos, and the older
adults and their caregivers who directly and indirectly beneﬁted from the activities
of the partnerships. The community-at—Iarge having a positive perception of the
partnership provides evidence that the results being achieved by the partnership
are appreciated by those in their community.

None of the case study communities seemed to be reaching its full
potential through engaging the community-at-large in aging issues thus not
employing social capital that could be used to beneﬁt their communities’ older
residents. One place in which they could ﬁnd community leaders and
stakeholders is service organizations such as Rotary Clubs, Civitan Clubs, Lions
Clubs, Elks Clubs, Kiwanis Clubs, Masonic Lodges, Optimist Clubs, Veterans of
Foreign Wars, and the American Legion. By connecting with these local
organizations, the partnerships for older adults would reach more community
leaders and stakeholders. Since these groups support and conduct service
projects, including them could increase the capacity of the partnerships. In
addition to direct involvement in the partnerships, these service organizations
and their members could become advocates for the partnerships in the business
and governmental sectors of the communities. This would increase the
partnerships’ inﬂuence in the communities by bringing awareness of their
activities to a broader and often well connected group of involved citizens. Yet

another beneﬁt of engaging these groups is that it presents another forum for

120

 

QUE

educating community stakeholders about aging issues and how their community

can respond to the needs of its older residents.

Table 36: Partnership Viewed in Positive Terms by Community

 

The community partnership
is viewed in positive terms
by the community at large.

 

Mean 1 .2545
Standard Deviation 0.4799
Count 55

 

Table 37 relates to whether the partnership is viewed positively outside of
its community. There is more variation in key informant responses than for other
questions having to do with the relevance of sustainability factors. The mean is
1.5 with a standard deviation of .57. Two respondents found being viewed
positively outside the community as “irrelevant” to the sustainability of the
partnership with 29 ﬁnding it “very relevant” and 23 replying that it was

“somewhat relevant”.

Table 37: Partnership Viewed in Positive Terms Outside of Their

Community

 

The community partnership
is viewed in positive terms
by groups and individuals
outside of the communigl.

 

Mean 1 .5
Standard Deviation 0.5746
Count 54

 

On one hand, none of the case study partnerships chose to brand itself
and its efforts to such an extent that it would become the face of aging services

in its communities. Rather, they all kept a fairly low proﬁle, not actively

121

adv

thei

infc
par
par
per
cor
the

the

the
iss

be

 

 

advertising their accomplishments but letting their achievements speak for
themselves. Media coverage of the partnerships’ activities was positive.

On the other hand, neither the case study partnerships nor the key
informants found being viewed in positive terms outside of their communities
particularly relevant to the sustainability of the partnership. The case study
partnership interviewees were much more focused on their community’s
perceptions of their efforts than on those outside of their community. This is
consistent with being local grassroots organizations whose purpose is to improve
their local community’s services and infrastructure that target older adults and
that do not depend on external supports to achieve their goals.

Overall, the case study and the Key lnforrnant Survey provide information
that helps delineate the factors that sustain communities’ efforts to address aging
issues through grassroots partnerships. Four distinct sustainability factors have
been discussed in the ﬁndings:

1. Mission statements provide partnerships with overarching, broad
goals that can be used to develop their objectives and strategic
plans. The process used to develop mission statements provides a
forum for members to express their hopes for the partnership.

2. Partnership members needs to include individuals and/or groups
with the wherewithal to accomplish the group’s goals. These are
the people who “can get things done”.

3. It is crucial that the partnership be structured in such a way that it is

able to set goals and achieve them. This is the way in which the

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group operationalizes its mission statement and sets forth on a path
that allows it to attain its mission.

4. A hiatus from partnership activities can lead to reinvigorated efforts
if the time is used to assess the partnership’s goals, activities and
management structure. The assessment should determine the
methods to use to maximize the partnerhip's effectiveness given
internal and external constraints.

5. Community support for the goals and efforts of the partnership is

major component in the ability of a partnership to achieve its goals.

The ﬁnal chapter of the dissertation presents the conclusions, discussion

and suggestions for future research derived from the literature review, the case

study and the Key Informant Survey.

123

Chapter 5: Conclusions, Discussion, and Suggestions

for Future Research

CONCLUSIONS

The overall conclusion that can be drawn from the case studies is that
each of the partnerships formed around a genuine concern for the older residents
in its community. It took each of the partnerships a while to determine exactly
what its purpose should be, but each one eventually developed a coherent
mission statement and ways in which to accomplish its mission. The groups all
had ups and downs, ﬂuctuations in member engagement and involvement, and
even times when they took a hiatus from meeting and pursuing their goals. What
was important for their communities is that there was a core group of
stakeholders in each of the case study communities that pursued and sustained
the idea that there should be a group of people actively working to promote
advocacy for senior issues, service coordination and collaboration as well as
ascertaining ways in which gaps in the service continuum could be ﬁlled.

Each of the three partnerships found a level of involvement for its
members that balanced the needs of older adults with the reality of the time and
resource limitations inherent in all-volunteer organizations. After a trial-and-error
period where they pursued different types of activities, each partnership settled
on activities that would allow it to achieve its goals and maximize its impact
without over-burdening its members. At the time of this writing, each partnership

is still operating.

124

The overarching purpose of each of the partnerships was to improve the
quality of life of seniors in its community. Partnership members felt that
networking among senior services providers and other entities that have an
interest in the quality of life of older adults was the primary reason for their
existence. Networking brought information dissemination, opened channels of
communications, negated misconceptions about other organizations’ missions
and services, and provided opportunities for collaboration. Networking also
strengthened their sense of purpose that the efforts of their partnerships were
meaningful and resulting in positive changes in their respective communities.

None of the partnerships sought recognition in the community. Their
purpose did not include becoming a recognizable entity in their communities but
rather to be a group that could inﬂuence agencies, governments, and community
members to engage in activities and provide services to enhance opportunities to
improve the quality of life for their older residents. The members’ goal was to use
and augment the current array of available services through collaboration rather
than to create an additional layer. While the groups pondered whether to become
not-for-proﬁt entities for such reasons as being able to apply for grants, they
concluded that being a formal legal entity would create a signiﬁcant amount of
complexity without adding sufﬁcient value to their endeavors.

Partnership synergy determines how the partnership functions and is
based on the relationships among partnership members, the procedures
employed by the partnership, and the structures under which members choose to

operate. Since at least half of all partnerships that form disband before they

125

achieve their ﬁrst anniversary, the longevity of the case study partnerships is
impressive in and of itself (Lasker et al, 2001).

The duration of the case study partnerships and their ability to set goals
and accomplish them provide evidence that the synergy within each of the three
case study partnerships exists. This synergy promoted the development of a
mission, a set of goals, and a management structure that allowed the
partnerships to identify and achieve activities that they and their communities
embraced. The case study partnerships continue to evolve as they attract new
members, encounter challenges, and identify new ways of enhancing the quality
of life of their community’s older residents.

The fact that these community partnerships volunteered to be part of this
dissertation research study demonstrates their desire to learn about themselves
through the lens of an external observer. When agreeing to be part of this study,
each site sought to learn more about itself and how it could be more effective.
They willingly provided documents and time to talk with the researcher. Even
though the sites were demographically and geographically different, they shared
the common desire to enhance the quality of life of their older residents and
found management structures, sometimes through trial and error, under which

they could set themselves on a path to achieve this overarching goal.

NECESSARY AND SUFFICIENT CONDITIONS OBSERVED DURING THE CASE STUDY

Necessary Conditions

As identiﬁed in the literature review, the conditions necessary for
sustainable partnerships that were observed in each of the case study sites

126

include respect, trust, inclusiveness and openness (Lasker, et al., 2001). Their
meetings and discussions were open to members, guests and non-members.
Their discussions were animated and productive. Each group had a published
agenda that included a substantial amount of time dedicated to information
sharing about what was occurring in the community and the state that could have
an impact on their older residents. For example, one of the groups had a
productive discussion about ways they could assist seniors who do not ﬁle tax
returns to avail themselves of the services of a community group that was
helping citizens ﬁle the appropriate paperwork for the 2008 economic stimulus
checks before the deadline.

The second condition necessary for sustainability is motivation for working
together at the grassroots level and, once again, each of the communities met
this condition (Anderson, 2008). None of the communities had external funding
for developing its partnership. This lack of external funding is a good news/bad
new scenario. On the bad news side, the partnerships all had to operate on very
limited budgets and without the beneﬁt of paid staff. The primary role of paid staff
would be logistical, thus providing the volunteer members more time to
concentrate of achieving the partnership’s goals. Staff would arrange meetings,
send out notices, be responsible for meeting minutes, maintain the budget, and
coordinate activities such as health fairs and production and distribution of
educational materials. The unfunded grassroots partnerships in the case study

also did not beneﬁt from technical assistance and expertise provided by some

127

funders such as Robert Wood Johnson Foundation’s Community Partnership for
Older Adults.

The good news side is that external funding comes with some strings
attached (Mitchell & Shortell, 2000). By not pursuing external funding, the
grassroots partnerships were able to “do their own thing” at their own pace. This
provided these grassroots partnerships with the opportunity to set their own goals
and develop their own structures. It also relieved them of having to comply with
prescribed timelines imposed by the funder. When the partnerships ﬂoundered,
the communities were the ones to determine how to proceed without going
through a formal corrective action planning process that most likely would have
been required by an external funder. ‘

The partnerships were a natural outgrowth of the community-wide
collaboratives that are prevalent in Michigan, the role of which is to improve the
quality of life of their residents. The community partnerships for older adults
expanded the role of the MPCBs, that typically stress collaboration on child and
family issues, to including promoting collaboration among entities that address
aging issues.

The ﬁnal condition necessary for sustaining a partnership’s efforts is the
ability to overcome turf issues for the good of the community. Through reading
the case study partnerships’ materials and attending their meetings, turf battles
were not mentioned as an issue in their post-hiatus conﬁgurations. Rather, a
Spirit of addressing identiﬁed issues together was observed. Issues that

challenged the partnerships were more related to limitations on the members’

128

time and resources as well as setting priorities than the inability to overcome the

tendency to protect their home organizations’ interests.

Sufﬁcient Conditions

Sufﬁcient conditions include successful collaborative leadership (Bolda et
al, 2005). In the case study sites, it was evident that when a partnership
encountered the lack of consistent leadership, it thwarted the ability of the
partnership to meet its goals. The analysis of the meeting minutes for all of the
sites Showed that when strong leadership was not evident, membership numbers
decreased, and activities were sporadic at best. 1

The second sufﬁcient condition is that partnerships have effective
management structures (Mitchell & Shortell, 2000). Each of the partnerships in
the study made adjustments to its management structures. Site C went to a co-
chair leadership structure when it reconvened after its 2007 hiatus. Site B went
from a consensus model to a voting model to make decisions as its membership
grew in both number and diversity of the member organizations. In 2008, Site B
implemented a formal nomination process for ofﬁcers. Site A went from a fairly
autonomous workgroup to becoming part of the community’s MPCB. All of these
changes were made to improve the management of the partnerships so they
would be more effective in achieving their goals.

The ﬁnal sufﬁcient condition is the attainment of a pivotal place for the
partnerships’ efforts in their communities (Mitchell & Shortell, 2000). With their
links to their counties’ MPCBs, the case study partnerships are assured of a

place at the table, especially among publicly funded human service agencies.

129

Site

exr

SGI

 

 

Site B went one step further when it joined the local Chamber of Commerce, thus
exposing business leaders to the needs of local older adults and the current
service array. With the support of the MPCBs and the recognition of the role the
partnerships play in their respective communities, they can be considered to
have attained centrality, meaning that their efforts are pivotal and integral parts of

their communities’ efforts to serve their older residents (Bolda et al., 2006).

CASE STUDY PARTNERSHIPS As NORM-ORIENTED SOCIAL MOVEMENTS

As deﬁned in the literature review, a norm-oriented social movement “is a
collective attempt to restore, protect, modify, or create norms in the name of a
generalized belief,” (Miller, 2000, p. 419). To determine whether community
partnerships addressing aging issues constitute a norm-oriented social
movement as deﬁned by the value-added theory, the following table has been
constructed (Miller, 2000). The seven components of norm-oriented social
movements were described in the literature review. These components include
recognition that there is a problem (components 1-4) and developing a
generalized belief that through collective action the problem can be addressed
(components 5-7) (Stallings, 1973).

Table 38 ﬁrst identiﬁes the elements of a norm-oriented social movement
and then describes its attributes using the value-added theory. Finally, the table
provides examples of how the three case study sites’ actions relate to the
attributes. The numbers in the Examples From the Case Study column

correspond to those of the attributes in the center column.

130

Table 38: Norm-oriented Movement Elements Compared to Community

 

 

Movement
Elements of Attributes Examples From the Case
Value-Added Study
Sequence of a
Norm-oriented
Movement
Structural 1. Specific program for 1. Age-based programs are
Conduciveness normative regulation implemented through local
2. Encouraged by agencies such as Area Agencies
decentralized on Aging, Senior Centers, local
authority structures health systems and county
3. Lack of opportunity for human service departments
individualized 2. Community-based social and
response economic systems adapt to

increasing number of older adults
including housing and
transportation

3. Biomedicalization of aging and
ethics that standardize clinical
protocols thereby removing
ability for older adult and family
to make care choices that involve
less aggressive treatment—being
addressed by partnerships
through collaboration and
advocacy

 

 

Structural Strain 1. Decline in availability 1. Insufﬁcient appropriate
of material resources community-based services
2. Shift in deﬁnition of (transportation, housing, medical,
major roles dental, home repair and
3. Rise of new values maintenance)
2. Change from producers to
retirees, employees to
volunteers, spouse to widow/er,
caregiver to care receiver, driver
to non-driver
3. Quality of life over
maximization of life, ability to age
in place, maintaining lifestyles on
ﬁxed incomes, maintaining the
dignity of older residents

 

 

 

 

131

Table 38 Continued

 

 

Elements of Attributes Examples From the Case
Value-Added Study
Sequence of a
Norm-oriented
Movement
Generalized 1. Place blame on 1. Right to die with dignity
Belief speciﬁc groups and usurped by medical profession

their policies for
conditions of strain

and courts

1. Pursuit of tax cuts rather than
building infrastructure for aging
has limited community-based
services

1. Right to maintain a quality
lifestyle in retirement

1. Right to seek alternative
treatments for physical and
behavioral conditions

1. Right to age in place

 

 

Mobilization for 1.

Action

 

. Real phase - program

. Derived phase -

Incipient phase -
searching activity

is discussed
throughout society

widening or shift in
aims

 

1. Community members found
shared interests regarding
services for older adults,
advocacy for older adults’ issues,
and collaborating their efforts

2. Goals and objectives of the
partnerships were disseminated
throughout the community
through the MPCBs, especially
reaching stakeholders and policy
makers who are involved in older
adults issues

3. As partnerships achieved their
goals, new ones were taken on

 

132

 

Ta

‘ chh

Ac

 

 

Table 38 Continued

 

 

 

Elements of Attributes Examples From the Case
Value-Added Study
Sequence of a
Norm-oriented
Movement
Action of Social Authorities can 1. Encourage healthy lifestyles at
Control 1. Encourage the health fairs and through
2. Redirect educational materials
3. Co-opt 1. Encourage preventive medical
4. Suppress care through health fairs and

 

 

working with health systems

1. Encourage volunteerism,
especially of healthy older adults
to give back to the community
1. Encourage savings for
retirement and wise use of
retirement funds

2. Redirect by passing limited
prescription drug bill - national
policy with local impact on how
people get medications and
which medications are on the
formulary of their Medicare Part
D plan

3. Co-opt by presenting social
security reforms that do not
beneﬁt all recipients - national
policy that affects individuals’
economic security

4. Suppress by not taking action
on national long-term care needs
which left local service systems
to create their own, many times
inadequate, long-term care
systems that depend on
categorical fundirg

 

 

Table 38 demonstrates that each of the three case study partnerships for
older adults has sufﬁcient elements and attributes to be considered a norm-

oriented social movement, the purpose of which is to enhance the quality of life

133

of older adults. Many of the Examples listed in Table 38 that have an impact on
older adults are most efﬁciently addressed at the community level. To do so,
communities require a freer hand to allocate scarce resources than many federal
and state policies currently allow under categorical funding regulations.
For example, changes from categorical to ﬂexible funding could widen older
adults’ housing options, transportation, in-home services, health care, and
human services choices by providing communities with the ability to reallocate
resources to optimize their beneﬁts for the communities’ older residents. For
example, Site C’s senior millage provides non-categorical funds to the
community for services for older adults. This ability provides services and

supports that can assist older adults to age in place.

REFINEMENTS OF THE ASSUMPTIONS

The two assumptions upon which the exploratory research was designed
were reﬁned as a result of the data that were gathered and analyzed during this
dissertation research. The analyses generated hypotheses that relate to the
structure of the partnerships and the level of support they receive from
community leaders. -

Hypothesis 1 - The composition Of the organizational and individual
members Of a community partnership for Older adults has a direct impact on the
goals set by the partnership and the activities in which it chooses tO engage to
accomplish these goals.

As the research study demonstrated, the ability of the case study

communities to achieve their goals had a strong relationship to the size and

134

 

structure of their partnerships. Ultimately, successful goal attainment promoted
sustainability of the community partnerships since it provided them with concrete
examples of the positive results their efforts wrought. The partnerships tended to
have ﬂat organizations that selected several members to be leaders or ofﬁcers.
They each had committees in place that were responsible for carrying out the
decisions of the partnership and formed ad hoc committees as required. The
constellation of committees varied depending on the goals and priorities of the
partnership. For example, Site B reconﬁgured its committee structure several
times to reﬂect its evolving priorities.

Each case study partnership experienced a time when it took a hiatus
from its efforts. These times of inactivity served to Show both the partnership
members and community stakeholders in the MPCBs that the work of the
partnerships was a community asset and should continue in some form. Each
partnership reconvened and determined a structure that ﬁt its needs better with
regard to how best to use limited resources to accomplish its goals.

Hypothesis 2 - The support of community leaders is vital to the
sustainability Of a community partnership for older adults.

Both the case study and the key informant survey results strongly suggest
that support of community leaders is a key sustainability factor. The support of
community leaders assists partnerships in their role of local social movements for
older adults with both resource allocation and resource mobilization (McCarthy &
Zald, 1977). Without the support of community leaders, a partnership for older

adults probably never will reach its full potential. Community leaders can tap into

135

their community’s political will, ﬁnancial and human resources, and can advocate
for older adults in a variety of venues. This increases the inﬂuence of the

partnership and its ability to accomplish its goals.

DISCUSSION

Throughout this dissertation, a number of issues have been enumerated
that have a bearing on whether a community partnership can sustain purposeful
efforts with regard to enhancing the quality of life of the older adults it sets out to
serve. Several implications for the social work profession come to the fore with
regard to community partnerships for older adults and how macro social work

practice is affected by their presence or absence in a community.

IMPLICATIONS FOR SOCIAL WORK MACRO PRACTICE: EXPANSION OF THE SCOPE OF
PARTNERSHIP ACTIVITIES THROUGH ENGAGEMENT OF COMMUNITY MEMBERS AND

GROUPS

This dissertation research demonstrates the great potential of grassroots
community partnerships that address aging offer to the older residents of their
communities. In an era of ever decreasing ﬁnancial resources, communities
cannot afford to duplicate efforts or to miss opportunities to engage willing
volunteers. Partnerships have the ability to coordinate these limited resources
and ensure that they are employed in the most efﬁcient, effective, and efﬁcacious
manners. As was indicated in the literature review, resource mobilization and
allocation, such as that demonstrated by the community partnerships, are core

elements of social movements (McCarthy & Zald, 1977).

136

The partnerships in the case studies and the respondents to the Key
lnforrnant Survey stress the power of networking and information dissemination
that partnerships possess. However, networking and information dissemination is
often limited to agencies whose role it is to serve older adults. The examples
provided in Chapter 4 establish that there are groups in communities whose
missions are service to others. These groups include faith-based organizations
such as churches, temples and mosques as well as service groups such as
Rotary Clubs, Civitan Clubs, Lions Clubs, Elks Clubs, Kiwanis Clubs, Masonic
Lodges, Optimist Clubs, Veterans of Foreign Wars, and the American Legion. In
addition, as Site B discovered, there was substantial interest by the local
Chamber of Commerce to be a part of the solution to the community’s aging
issues.

The case study partnerships’ limited scope was mirrored in the responses
to the Key Informant Survey regarding the activities and services partnerships
should provide for older adults. It is interesting to note that only 49% of the
survey respondents indicated that “providing a matching service for community
volunteers that can meet older adults' needs for light housekeeping, shopping,
companionship” was very important (02). “Developing a volunteer service to
assure Older adults are doing well (taking meds, eating, using proper hygiene)”
(02) was selected as very important by only 44% of the respondents. Since
public agencies provide services through staff rather than volunteers, these
responses reﬂect that mindset. With so many of the members of the partnerships

being from publicly funded agencies, there appears to be an outlook that

137

precludes reaching out to community groups that are not professional
organizations that serve older adults. This professionalization of the coalitions
can limit the scope of the activities that come under the auspices of the
partnerships.

There is untapped volunteer service capacity in many communities that
could assist older residents to age in place if a matching process were available.
There might be policies that preclude public agencies from tapping into these
resources. However, one of the strengths of the community partnership model is
that any such restrictions to using volunteers from community groups should not
apply if those groups are members of the partnership.

Community partnerships’ scope of activities could be greatly increased if
they encouraged these groups to be involved in a community-wide vision and
mission for serving older adults. The example of Stephen Ministries was given in
Chapter 4 as a cohort of trained lay people who have an interest in working with
individuals who are experiencing difﬁcult life situations, many of whom are trying
to cope after the loss of a spouse or caregiver and are trying to maintain
residence in their homes. It is not difﬁcult to imagine how a community
partnership for older adults could help link the skills of this cadre of volunteers to
its older residents.

Other potential sources of volunteers are physicians, nurses, pharmacists,
social workers, both retirees and those who are still employed. Community

members from the helping professions who are willing to volunteer to make home

138

visits or to provide consulting services can help caregivers provide basic care in
the home.

There are other groups and associations in communities that provide an
array of services. There are groups such as Second Harvest, local food banks,
and Food Movers, whose mission it is to distribute food to low-income people.
Site C’s arrangement with its local Home Builders Association is an innovative
way in which to assist older residents to age in place by making home
maintenance and repair safe and affordable.

An example is that a faith-based congregation might take on the task of
soliciting donations of durable medical equipment that is no longer in use, storing
it in their facility, and providing a matching service for older adults who have been
screened by other members of the partnership or referred by community service
providers, and who need such equipment but do not have the ﬁnancial means to
purchase it. Inclusion of these types of groups in partnerships for older adults
would be a great boon to communities as the number of their older adult
residents increases.

A partnership with a “big tent” approach to coalition building that includes
disparate community groups, public and private agencies, and not-for-proﬁt and
for-proﬁt entities could become unwieldy without the proper organizational
structure and leadership base (Mitchell & Shortell, 2000). Therefore, it is
imperative that potential and existing partnerships weigh the beneﬁts and
challenges of accomplishing their goals through such a broad-based coalition.

Even though the members seek to accomplish the agreed-upon goals, they might

139

have extremely different approaches as to how they would achieve them. Without
proper decision-making structures in place and without leaders who can mediate
among the members’ approaches, the partnership could become bogged down.
To have a successful broad-based coalition, the partnership would need to
employ mechanisms for developing and implementing strategies that lead to

activities that accomplish its goals and objectives.

IMPLICATIONS FOR POLICY RELATED TO THE QUALITY OF LIFE OF OLDER ADULTS

This dissertation research identiﬁed several policy-related issues with
regard to community partnerships. These policies relate to tax status and ﬂexible

funding options.

Tax Code Changes

The ﬁrst is a “to be or not to be” question of whether it is necessary for
community partnerships to become 501(c)(3) organizations to maximize their
impact. Table 39 lists the advantages and disadvantages to becoming a
501(c)(3) organization. In addition to the advantages listed, it Should be noted
that many foundations limit grant awards to only those organizations that have
501(c)(3) status. This was one of the reasons the case study partnerships
identiﬁed for contemplating whether to go through the process. Another is the

ability to solicit donations.

140

Table 39: Advantages and Disadvantages to Becoming a 501(c)(3)

Organization

 

Advarﬁges Disadvantages

 

Exempt from tax on dues, interest, Prohibited from all political activities
dividends, royalties, rents and any other than lobbying

other income not derived from
conducting an unrelated business

 

Exempt from State tax, including sales Complex regulations on certain
and real estate tax transactions and complex
compliance requirements

 

May receive contributions deductible Compliance burden for federal, state
from the taxable income of the donor and local income tax and
informational ﬁlings

 

 

Eligible for 3rd class postal rate Increased public scrutiny and
criticism from for-proﬁt sector for
unfair competition

 

 

 

Source: American Water Works Association website

The grassroots community partnerships in this dissertation research all
appeared to be operating without the need for external funding, particularly
grants from foundations. Site B was able to garner a signiﬁcant amount of funds
through its Senior Expo. Sites A and C both operated on in-kind contributions
from their MPCBs and members. Each partnership in the study generated what it
needed to operate within its given scope to accomplish its mission. Unless such
grassroots partnerships expand their scope of operations to such an extent that
they would need to hire staff and procure ofﬁce space and equipment, it seems
unlikely that they would ﬁnd much beneﬁt to becoming 501(c)(3) organizations,
given the disadvantages such as the extensive reporting requirements.

This leads to the question of whether the tax code should be revised so

that grassroots community partnerships come under a different category than

141

not-for-proﬁt agencies and charitable organizations that are direct service
providers or congregations. Implementation of a tax classiﬁcation that allows
grassroots community partnerships and other such loosely structured service
groups to have the advantages provided under the 501(c)(3) tax code such as
tax exemptions and accepting untaxed contributions, would allow these groups to
collect donations and act as their own ﬁduciary agent rather than having to patch

together procedures that work around tax code restrictions.

Flexible Funding

Funding that follows the older resident rather than categorical funding for
speciﬁed services could greatly enhance the work grassroots community
partnerships are able to accomplish on behalf of their older residents. For
example, much time is spent by partnerships determining how to fund services
that are not typically part of the continuum of care but could assist older adults to
maintain the ability to live in their homes. Categorical funding limits the options of
agencies to employ innovative strategies for procuring what the older adults
need. An example of this is the home maintenance and repair program Site C
developed that did not use categorical funding streams but relied on donations of
contractors’ time and materials.

One of the ways in which policy can be changed to facilitate the use of
innovative service delivery is through block grants to the communities rather than
through categorical funding. Block grants allow local governments to design
programs speciﬁc to the needs and diversity of their constituents and provide

simpliﬁed administration of funds. The major drawback identiﬁed by the federal

142

agencies responsible for the how funds are used is the type of mechanisms
employed to assure accountability for how the funds are expended and the
outcomes they produce. Federal block grants were ﬁrst initiated in 1966 for
health programs and expanded in subsequent years to include job training,
housing, social services, health services, low—income energy assistance,
substance abuse, mental health, and child care. In 1996, welfare reform was
enacted as a block grant program (Brookings, 2005: Urban, 2004).

The use of block grants could expand prevention services related to
healthy lifestyles, healthy nutrition, and home safety. It could also expand mental
health services for older adults related to depression, dementias, and provide
opportunities for caregiver respite and support groups. Community partnerships
have a unique window into the service needs of community residents because of
their systemic approach and knowledge of the range of services available to
residents.

By providing a mechanism with which they could develop a more
comprehensive service array, community partnerships could greatly enhance the
quality of life of their older residents. A byproduct of this expansion of services is
that cost-effective and efﬁcacious services would be more readily available than

they currently are because of the limitations imposed by categorical funding.

IMPLICATIONS FOR SOCIAL WORK RESEARCH

There is a paucity of research on grassroots coalitions that address aging

issues, yet this is an issue that is looming over all communities. The increasing

143

number of older adults in each community will stress every sector—human
services, health care, education, housing, transportation, roads, and retail.

The National Association of Social Workers Code of Ethics provides the
rationale for conducting research on community partnerships for older adults.
This statement highlights the ethical obligation of social workers to help meet the
needs of vulnerable older adults and the society, or in the case of this study, the
community in which they reside and whose support they might require to age in
place there.

The primary mission of the social work profession is to enhance

human well-being and help meet the basic human needs of all

people, with particular attention to the needs and empowerment Of

people who are vulnerable, oppressed, and living in poverty. A

historic and deﬁning feature of social work is the profession ’8 focus

on individual well-being in a social context and the well-being of

society (NASVV, 2008).

Communities with partnerships for older adults have great potential to
meet the needs of vulnerable older adults and emphasize individual well-being in
a social context. To that end, understanding how partnerships form, what
sustains them over time, and how they achieve their goals is critical to the

knowledge base of macro practice social work.

SUGGESTIONS FOR FUTURE RESEARCH

The two hypotheses generated by this study can be tested in subsequent

research projects that further explore how grassroots community partnerships for

144

older adults sustain their efforts. The subsequent study would expand the pool of
communities in the case study and use a revised version of the coding scheme.
The questions asked of the communities in the next iteration of the research
would be based on the categories and themes that emerged from this study and
would act as a means of further testing their trustworthiness. The second round
of data gathering would allow the researcher to further reﬁne the hypotheses
generated in this study. This reﬁnement will increase the beneﬁts to those
communities that choose to use the hypotheses as a guide for their efforts to
plan, implement, and sustain community partnerships that improve the quality of
life for their aging residents.

The use of the hypotheses should allow community members to learn
from the other communities, not just through lessons learned and best practice
models, but through application of the factors that undergird those lessons and
practices. This will bolster the ability of community members to advocate for
forming a partnership to address aging issues, to develop structures that promote
the sustainability of their efforts, and to recruit and retain partnership members.

The results from this study are the ﬁrst step in designing a community
partnership for older adults toolkit. The toolkit would be employed by
communities that desire to address aging issues through a grassroots
partnership of community members, public and private agencies, governmental
units, and community stakeholders without requiring technical assistance and

funds from external sources.

145

The themes that emerged from the case study and the Key Informant
Survey were related to the four core research questions and form the basis for
the design of the toolkit. The themes that emerged provide insights into the
factors that provide a catalyst for communities to act on aging issues, how
communities maintain their momentum, the possible pitfalls that could emerge
and how to address them, as well as other factors from within the partnership
and external to it that can have an impact on its sustainability. In short, the toolkit
would walk the community through the process of assuring that the necessary
and sufﬁcient conditions required for a successful, sustainable community
partnership are present.

A longitudinal study of communities that adopted the toolkit would yield
information regarding the relevance of the procedures and assessment strategies
of which the toolkit is comprised. The toolkit would be based on the two
hypotheses generated by this research study. It would provide guidance to
grassroots community partnerships regarding strategies to employ to recruit and
retain members, develop a mission statement, set goals, develop bylaws, and
implement a strategic planning process. In addition to these internal activities, the
toolkit would provide the grassroots partnership for older adults with strategies to

garner support from community leaders.

146

Table 40: Example of a Toolkit Preliminary Outline

 

 

Objectives Topics
1. Concept of having - Deﬁnition of a community partnership for Older
community adults

partnerships for
older adults and
their beneﬁts

- Examples of different types of community
partnerships for older adults (front-line staff,
agency administrators, community leaders)
and their different purposes

 

2. Ways to start a - Where to start: determining the type of
community partnership, its purpose, its initial goals
gzﬁgsershrp for older - How to engage the right core people

- How to determine member roles

- Preparations that need to be done to get the
partnership ready to function: organization and

 

 

 

 

resources
3. Strategies to use to - Determining who should be invited to
recruit and retain participate
partnership - How to engage the right core people and
members -
determrne roles
- What preparations need to be done to get the
partnership ready to function
- How to keep members involved for the long
term
4. Strategies for - Going from a general purpose to creating an
determining the operational mission, feasible goals, and
partnership’s activities that will engage members to remain
mission, goals and involved
activities to achieve
the goals
5. Strategies to monitor - How to assess the partnership’s activities to
the partnership’s make sure its on course to achieve its goals
progress

 

 

 

Table 40 provides a preliminary outline for the structure of the toolkit. The
toolkit will include information about grassroots community partnerships and what

147

they can expect to accomplish. It will provide methods that a partnership can
employ to promote open and inclusive processes that assure all of the
stakeholders who should be at the table are persuaded to become engaged as
active members of the partnership. The toolkit will include suggestions for
creating a broad-based coalition of public, private and volunteer organizations, all
of which have an interest in maintaining and improving the quality of life of the
older residents of their communities and that are willing to work in collaboration

to achieve this goal.

PERSONAL REFLECTIONS ON THE DISSERTATION RESEARCH

When I envisioned assessing the factors that sustain community
partnerships in aging as a dissertation topic, I had a view of structured
partnerships such as the ones funded by foundations. I was the evaluation
director for two community partnership initiatives in the mid to late 19905. One
was a rural health initiative funded by a national foundation that helped six multi-
county groups form partnerships to address their health issues. The foundation
provided technical assistance and funding for staff and other resources as well
as an external process evaluation. The second was an initiative that promoted
the wraparound process as a means of coordinating services and natural
supports for families with a child who was diagnosed with severe emotional
disturbance. This initiative had 18 sites that encompassed 22 counties. National
experts on the wraparound process provided technical assistance to the sites as

did the state department staff. An external evaluation was conducted to

148

determine the effectiveness of the wraparound process and its implementation by
the sites.

Based on these experiences and the review of the literature, I had
preconceived notions about the way the case study sites would be structured, the
types of activities in which they would be engaged, their roles in their respective
communities, and their aspirations. What I learned as I interviewed the leaders of
each of the partnerships and became familiar with their evolution through
reviewing their meeting minutes and other documents, was not what I expected
to ﬁnd.

AS the dissertation explains, the case study sites deﬁned their niche in
their communities as primarily through networking among those agencies
involved in delivering services to older adults and through information
dissemination—both to other services providers and to community members. At
ﬁrst, I was surprised by the sites’ ﬁnding that this was enough to sustain their
efforts. Each site had some activities it performed, particularly health fairs or
senior expos, but did not feel its role was to provide or arrange for services to ﬁll
unmet needs.

As I became more familiar with what the case study partnerships
accomplished, I came to see that the roles they deﬁned for themselves met their
communities’ need for determining the services they had and other services they
required. The fact that each partnership relied on all-volunteer labor to attain its

goals, that none of them had external funding or technical assistance, and yet

149

accomplished their goals, showed me the strength of these grassroots
partnerships’ efforts.

Two of the partnerships experienced times when they had come to an
impasse and took a step back to determine whether they should keep going. As
they assessed their roles and activities, they decided that what they
accomplished was valuable and therefore, should ﬁnd ways in which their
partnerships could continue their efforts. The third site is in the process of coming
back from its hiatus and is in the process of determining what conﬁguration it will
take. Once again, the support these partnerships have from their respective
MuIti-purpose Collaborative Bodies conﬁrms their value to their communities and
provides some of the impetus they have to pursue their goals.

I have learned a great deal about grassroots community initiatives through
this dissertation research that I will bring to my future research projects. I learned
that, in its own way, each of the community partnerships in the case study had a
“where there’s a will, there’s a way” mindset that helped it sustain its efforts and
pursue achieving its goals. My future research plans, which includes the
community partnership in aging toolkit, will venture to assist communities as they
generate that will, apply it to improving the quality of life of their older residents,

and sustain their efforts.

150

Appendix A - Case Study Synopsis For Site Recruitment

151

Sustainability of Community Initiatives that Address Aging Issues

Joan llardo, Ph. D. Candidate,
Michigan State University School of Social Work

The topic for the dissertation research relates to the sustainability of
community initiatives and partnerships that address issues regarding the aging of
the community’s residents. The premise for this dissertation research is that
every community will have to contend with aging issues due to the demographic
trends in the next several decades. Trend analyses project that the proportion of
older adults in the population will increase substantially by 2050 and that most
communities will be compelled to face this challenge without the beneﬁt of an
infusion of external funding, technical assistance, and expertise.

“Community” is usually deﬁned by the group that bands together to
advocate for something that will improve the lives of their community members.
Communities can be geographically based or interest-group based. For the
purposes of the dissertation, community is deﬁned as geographically based, with
the geographic area deﬁned by the individuals and groups that come together to
improve the quality of life of the older adults who live in their catchment area. For
example, communities can be neighborhoods, towns and cities, counties, or
several counties.

Deﬁnition of Community Partnerships

A community partnership or initiative is deﬁned as a voluntary
collaboration of diverse community organizations or groups with a shared interest
that join together to work toward accomplishing a set of agreed-upon objectives
and goals. Partnerships can include coalitions, alliances, consortia, and other
inter-organizational relationships that purposefully form to pursue their common
goals. Community partnerships engage in activities around topics such as child
welfare and safety, health promotion, substance abuse prevention,

environmental clean-up, and aging of their residents.

152

Strategically Selected Communities - Beneﬁts from Participating in the
Case Study

The detailed results of the case study will be provided to each community
that participates in the study. The interviews will be coded and the identity of
each interviewee will be conﬁdential. The coded results and interpretation of the
interviews, observations and documents will be provided to the partnership for
their review and comment prior to publication. Nothing will be published without
the communities’ knowledge. Communities will not be named in the dissertation
or any journal articles.

For communities that do not have a formal evaluation of their efforts, the
information gathered during the case study will provide them with an external
assessment of their efforts. This assessment can be used to help them as they
proceed with their activities and can be used to inform their communities of their
progress. The information can also assist to garner resources such as new
members and additional funding. I am willing to come to a meeting in each case
study community to present the ﬁndings.

Goals of the Dissertation Research

The long-ten'n goal of this research is to develop a tool kit for those
communities that do not have external resources available to them to facilitate
the initial steps modeled by successful communities. The results of this research
will provide a path toward developing the toolkit by identifying some of the
necessary and sufﬁcient conditions that must be in place for a community
partnership to sustain its efforts in a productive manner. The tool kit will
demonstrate methods communities can use to develop a mission and vision that
will attract the attention of decision makers in their communities. The primary
actors will then be able to recruit a core group or steering committee that can
prepare a strategic plan for developing and nurturing an enduring community
partnership that addresses the needs of older adults.

Study Structure

The ﬁrst line of inquiry for the research is to seek out what it is that

prompts individuals and groups (actors) in a community to recognize that they

153

should address issues related to their older residents. The second line of inquiry
is to examine the ways in which these actors garner the support of other
individuals and groups in their communities who are willing to work together to
accomplish an agreed-upon set of goals. The research will explore demographic
factors, socioeconomic factors, and factors such as the service continuum,
presence of advocates, and precipitating events to ascertain whether
communities that have embarked on partnerships that address aging issues have
identiﬁable commonalities. The third line Of inquiry is to determine the factors that
are present that help or hinder partnerships sustain their activities and their
momentum over time.

The proposed study concentrates on community partnerships for older
adults in Michigan. The unit of analysis for the study is a community that has
generated a partnership that addresses aging issues. Two types of data will be
analyzed; case studies of three strategically selected communities and
responses to the Key lnforrnant Survey.

Strategically Selected Communities — Case Study Data Gathering

The design of the data collection for the study is to do a case study of
three communities that have functioning community partnerships that are
addressing aging issues. I am looking for three communities that would like to be
involved in the case study. The protocol for the case study will be applied to each
site. The protocol for conducting the case studies will consist of the following
activities:

9 Structured individual and group interviews with active members Of the
partnership — all Table 1 questions will be asked during the interviews.

9 Structured individual and group interviews with community stakeholders -
Table 1 Questions 1-3, 14, 15 and 17 will be asked of community
stakeholders. Among the stakeholders will be health care providers,
service providers (meals, housing) faith community leaders, senior citizen
advocates, local human service agency staff, local media staff, local

government ofﬁcials.

154

0 Observation Of community meetings and events — during the site visits, the
researcher will Observe a partnership meeting and other meetings of
community groups deemed essential to the case study. These might
include such venues as the planning commission, county commission,
public health board, housing commission, and area aging agency board.

0 Document review - Prior to the site visits, community partnerships will be
asked to gather materials regarding their partnerships such as the
strategic plan, implementation documents, memorandum of
understanding, bylaws, press releases, newspaper, local radio, and local
television reports, publications by and about the partnership and its
activities such as annual reports and brochures, meeting minutes,
presentations made by partnership members, and evaluations of
partnership activities and outcomes.

Table 1: Interview Questions for Community Members and Stakeholders

 

Interview Questions for Community Members

 

18.What speciﬁc issues or events prompted community members to determine
it was time to address aging issues in a concerted effort?

19.What particular local demographics, economic, political and/or social service
histories had an impact on your community’s decision to make a concerted
effort to address aging issues?

 

20.l would like to ask you about your community’s history of citizen involvement
in community initiatives and partnership. What initiatives have there been
related to changing community infrastructures to improve quality of life for
your residents (children, families, education, employment)? What about
initiatives that address disparities among groups? PROBE: Does your
partnership collaborate with other community initiatives or partnerships?

 

 

21 .Who was involved (individuals and groups) in getting your partnership
started?

22.What individuals or groups were not initially involved who you thought should
have been? PROBE: Did they ever become involved? Why or why not?

23.What individuals and/or organizations took the lead in shaping your
partnership’s goals? PROBE: Are they still involved? Why or why not? How
were the goals set?

24.What individuals and/or organizations took the lead in shaping your
partnership’s structure? PROBE: Are they still involved? Why or why not?
How was the structure determined? How has it changed?

25. How were additional participants recruited by the initial members? What
were the reasons why they were recruited?

 

 

155

Table 1 Continued

 

Interview Questions for Communig Members

 

26. How is the partnership currently being funded?
27.What other sources of funding did you try to access? Were you successful?

28. Is ongoing funded required for your partnership to continue? PROBE: What
are your plans for future funding sources? What ways have you determined
to ensure ongoing funding?

 

 

29. How does your community partnership deﬁne success? PROBE: How is
success measured? Who is monitoring your partnership’s measures of
success?

30. How has the partnership implemented strategies to address your priorities?
How is the implementation process going?

31. How do you learn about the needs of all older community residents?
PROBE: Are the needs of older adults who live in poverty and those who are
racial or ethnic minorities speciﬁcally addressed in your strategic plan? Are
these older adults and their advocates represented in your partnership?

32. How would you assess the current status of your partnership’s efforts?
PROBE: Is the general community aware of your efforts?

33.What barriers or obstacles did you need to surmount when you started your
partnership? How did you address them? PROBE: What obstacles arose
later on and how did you address them?

34. Has the partnership been able to increase awareness of aging issues in your
community? How is awareness measured?

 

 

 

 

I —_———

Joan llardo, LMSW evaluated two community partnership initiatives in Michigan
when she was a Senior Consultant at Health Management Associates: The Rural
Health Project (1994-1997) and the Michigan lnteragency Family Preservation
Initiative (MIFPI) (1996-1998). She has been a faculty member at the MSU
School of Social Work since 2001 and is a member of the Hartford Faculty for
geriatric social work education. For more information about Ms. llardo, please go

to: http://wwwsocialworkmsu.edu/about/ilardo.html

 

 

If your community is interested in being involved in the study or would like
more information about what involvement in the study entails, please
contact Joan llardo at ilardowuedu.

 

156

 

 

Appendix B - Key Informant Survey

157

Community Initiatives and Partnerships for Older Adults

1. A community partnership in aging is a group that comes together to strengthen
the local service-delivery infrastructure related to services for older adults such
as health care, housing, transportation, meals, caregiving, respite services,
provider training, and civic and social engagement. According to this deﬁnition, in
the space provided below please list groups you would consider to be community
partnerships that are working on aging issues? Please include groups in all
phases of development (just starting up, actively implementing objections, have
suspended activities/disbanded and type them in the space provided. Finally,
please tell us with which one of these community partnerships you are most

familiar.

answered question

skipped question

Appropriateness of Community Partnership Activities

Very
important
0
Providing transportation to those who need it. (8691'; A)
0
Providing home modiﬁcations and repairs. (6465'? A)
0
Promoting service coordination. (75365); /°
0
Promoting a single point of entry into services. 2207'? A)
Educating caregivers about services available 85.3%
to them and their family member. (58)
0
Providing caregivers with respite opportunities. (748? /°
Training caregivers to cope with providing care 76.5%
to a family member. (52)
0
Providing adult day care services. (5480? A
Assisting with instrumental activities of daily 75 00/
living such as physician visits, appointments, (51') °

banking/bill paying, shopping...

158

66
4

Somewhat Not
important important

10.3% (7) 0.0% (0)
32.4% (22) 1.5% (1)
25.5% (18) 0.0% (0)
48.5% (32) 10.6% (7)
14.7% (10) 0.0% (0)
29.4% (20) 0.0% (0)
22.1% (15) 1.5% (1)

38.2% (26) 2.9% (2)

25.0% (17) 0.0% (0)

. . . - 80.9% o o
Provrdrng healthy meal delrvery. (55) 19.1 /0 (13) 0.0 /o (0)

Developing a volunteer service to assure older 44 10/
adults are doing well (taking meds, eating, (36) ° 48.5% (33) 7.4% (5)
using proper hygiene).

Connecting older adults with community groups 64.7% o 0
that provide social interactions. (44) 324 /° (22) 2-9 /° (2)

Providing a matching service for community 48 5y
volunteers that can meet older adults' needs for (35) ° 41.2% (28) 10.3% (7)
light housekeeping, shopping, companionship.

Very active Somewhat No active
role active role role

Working to change policies that have a
negative impact on Older adults such as 16.4% (11) 49.3% (33) 34.3% (23)
land use regulations.

Developing coordinated systems of care. 53.0% (35) 39.4% (26) 7.6% (5)

Training caregivers in self-care o o 0
techniques. 25.8 /o (17) 45.5 /o (30) 28.8 A: (19)

Holding media campaigns to make older
adults and their families aware of 37.3% (25) 49.3% (33) 13.4% (9)
community services available to them.

Working with health care providers to
make them aware of community 44.8% (30) 44.8% (30) 10.4% (7)
resources available to their older patients.

Working with faith-based organizations to
make them aware of community 10.4% (7) 59.7% (40) , 29.9% (20)
resources available to their congregants.

Expanding volunteer training and
opportunities for community members 13.4% (9) 55.2% (37) 31.3% (21)
who want to assist older adults.

Community Partnership Effectiveness

Most often Sometimes Hardly ever
work well work well work well
together together together

They improve transportation options 0 o o
for older adults. 41.2 /o (21) 49.0 /0 (25) 9.8 /o (5)

159

They work to change zoning laws to

expand housing options for older 10.2% (5) 32.7% (16)
aduﬁs.
They develop single point of entry for 22 0% (11) 60 0% (30)

services for older adults.

They provide respite opportunities for

O
caregivers of older adults. 41'2 /° (21)

They develop referral systems for

O O
community-based services. 67'3 /° (35) 25'0 /° (13)
They provide access to healthy foods 0 o
and meals. 52.9/o (27) 37.3 /o (19)
They develop health promotion and 54.7% (29) 35.8% (19)

wellness programs for older adults.

They provide volunteer and social
opportunities so older adults can stay
connected to others in their
communities.

47.1% (24)

Very
effective

Educating service providers on the

0 0
special needs of older adults. 38‘9 /° (21) 53'7 /° (29)

Providing opportunities for social

interactions for older adults. 380% (19) 540% (27)

Conducting health promotion and
health fairs that are accessible to older68.0% (34) 24.0% (12)
aduﬂs.

Providing opportunities for exercise

and wellness activities. 380% (19) 500% (25)

Promoting awareness of the need for
cultural appropriateness of activities
and services.

18.4% (9) 55.1% (27)

Providing intergenerational interaction 0 o
and support opportunities. 20'4 /° (10) 40-3 /° (20)

Providing a media campaign about

0 0
healthy lifestyle choices. 14'3 /° (7) 55-1 A“ (27)

160

47.1% (24)

47.1% (24)

Somewhat
effective

57.1% (28)

18.0% (9)
1 1.8% (6)
7.7% (4)
9.8% (5)
9.4% (5)
5.9% (3)
Not

effective

7.4% (4)

8.0% (4)
8.0% (4)
12.0% (5)
28.5% (13)

38.8% (19)

30.6% (15)

Are very Are fairly Need to be
effective effective much more
currently currently effective

Provrdlng more opportunities for 154% (8) 55.8% (29) 28.8% (15)

community input.

Providing more information to

community members to increase their
knowledge of community services and

resources.

23.5% (12) 51.0% (25) 25.5% (13)

Being more involved in advocating for

changes in policies that have an 20.0% (11) 40.0% (22) 40.0% (22)
adverse impact on older adults.
Providing healthy aging programs. 29.4% (15) 49.0% (25) 21.6% (11)

Providing a volunteer matching and 100% (5) 42.0% (21) 48.0% (24)

referral program.

Developing and implementing a strategy 0 O o
to recruit and retain service providers. 5'9 A” (3) 56'9 /° (29) 37'3 /° (19)

Developing and implementing a strategy
to expand housing and living choices for 7.8% (4) 45.1% (23) 47.1% (24)

older adults.

Developing and implementing a strategy 0 o o
to expand health care coordination. 15'4 /° (8) 50'0 /° (26) 34'6 A (18)

Developing relationships with local, state
and federal ofﬁce holders and policy 20.4% (11) 38.9% (21) 40.7% (22)

makers.

Community Partnership Funding Options

Community
Foundation(s)

National
Foundation(s)

Local government
funds

Available under Available under

852;: :Iye circumggnces circlliimistteaices avaNiloatble
9.4% (5) ' 35.8% (19) 52.8% (28) 1.9% (1)
0.0% (0) 11.8% (8) 78.4% (40) 9.8% (5)
7.7% (4) 23.1% (12) 55.8% (29) 13.5% (7)

161

Local agencies pool

funds 0.0% (0)
State government 0
funds 5'7 A) (3)
Federal government 0
funds 7'5 /° (4)
Private donations 0.0% (0)

Writing proposals for foundation funding

32.7% (17) 48.1% (25)
26.4% (14) 52.8% (28)
20.8% (11) 52.8% (28)
30.8% (16) 65.4% (34)
Very Somewhat
feasible feasible
34.5% (19) 63.6% (35)

Working with local policy makers to

determine whether there are untapped

sources of funds

29.6% (15) 84.8% (35)

Working with state-level agencies to

determine whether there are sources of

funds

Sponsoring local fund-raising events

Soliciting donations from individuals

27.8% (15) 66.7% (36)

38.9% (21) 55.6% (30)
32.7% (18) 54.5% (30)

Soliciting donations (ﬁnancial and in-kind)
from civic groups, businesses, and faith- 34.5% (19) 60.0% (33)

based organizations

19.2% (10)

15.1%(8)

18.9% (10)

3.8% (2)

Not
feasible
1 .8% (1)

5.6% (3)

5.6% (3)

5.6% (3)
12.7% (7)

5.5% (3)

Factors that Help or Hurt the Sustainability of Community Partnerships

Very Somewhat
relevant relevant

The membership of the partnership Includes the 98.2%

individuals and/or groups that can get things

done.

The community partnership is structured so that 92.7%
it can set goals and achieve them.

The community partnership has the support of

stakeholders in the community.

Members of the community partnership all feel
they have a voice in matters concerning the

(54)

(51)

80.0%
(44)

81.5%
(44)

162

1.8% (1)

7.3% (4)

Not
relevant

0.0% (0)

0.0% (0)

20.0% (11) 0.0% (0)

18.5% (10) 0.0% (0)

partnership.

The community partnership is viewed as 70.4%
inclusive by community stakeholders. (38)
There is a synergy that has occurred among the 77.8%
community partnership members. (42)
The community partnership has become an 81.8%

integral part of the community with regard to (45)
aging issues.

The community partnership has shown the 76.4%
community that it can achieve results. (42)

The community partnership members are able to 81 8‘7
work toward the 'greater good' with regard to (45') o
aging issues.

The community partnership is able to overcome 74.5%
'turf‘ issues. (41)

The community partnership members are able to
participate in the activities of the partnership 70.9%
without feeling that the mission of their group (39)
has been put on the back burner.

The community partnership is viewed in positive 76.4%
terms by the community at large. (42)

The community partnership is viewed in positive 53 70/
terms by groups and individuals outside of the (29) 0
community.

25.9% (14) 3.7% (2)

20.4% (11) 1.9% (1)

18.2% (10) 0.0% (O)

23.6% (13) 0.0% (0)

18.2% (10) 0.0% (0)

25.5% (14) 0.0% (0)

29.1% (16) 0.0% (0)

21.8% (12) 1.8% (1)

42.6% (23) 3.7% (2)

10. Please tell us the following information about yourself.

In what geographic area of Michigan (city or county) do
you work or in which area does your agency operate?

What is your occupation or title?

How long have you been active in aging issues?

163

Appendix C - Coding Guide for the Case Study

1 . Complete List of Codes

2. Codes and Coders’ Memos — Site A
3. Codes and Coders’ Memos - Site B
4. Codes and Coders’ Memos — Site C

Times Cited Column Includes All Data Sources (Interviews, Site Visits,
Meeting Minutes, Other Documents)

164

Complete List of Codes

 

Level1

Level2

Level3

 

1. Factor that prompted
community to be
interested in addressing
aging issues

1.1 Economic

1.1.1 more low income seniors in
community

 

1.1.2 economic value of senior

services

 

1.1.3 economic value of healthy
seniors

 

1.1.4 increasing ability to keep
seniors in the community (stem

out-migration)

 

1.2 Demographic

1.2.1 aging boomers

 

1.2.2 increased age span

 

1.3

Social/political

1.3.1 seniors have more political
status

 

1.3.2 increasing ability for
seniors to age in place

 

1.4 Events

1.4.1 event occurred that
highlighted the need to address
senior issues

 

 

1.4.2 events occurred that
accelerated changes in services
for older adults

 

1.5 Leadership

1.5.1 coordinating council/MPCB

 

1.5.2 change in leadership at
agencies

 

 

 

1.5.3 change in leadership in
community

 

165

 

 

 

to address aging

Level 1 Level 2 Level 3
2. Factors that helped 2.1 Financial 2.1.1 millage/county funds
sustain community efforts resources

 

2.1.2 in-kind staff, facilities

 

2.1.3 has sufﬁcient resources

 

2.1.4 has local foundation funds

 

2.1.5 has national foundation

funds

 

2.1.6 has federal funds

 

2.1.7 has pooled local agency

funds

 

2.1.8 has state funds

 

2.1.9 receives private donations

 

2.2 Positive past

and present
collaborations

2.2.1 access to health care

 

2.2.2 teen pregnancy

 

2.2.3 chronic disease

 

2.2.4 elder abuse

 

2.2.5 health and wellness
promotion

 

2.2.6 community has a positive
impression of partnerships from
pastexpenence

 

2.3 Leadership

2.3.1 stable leadership

 

 

2.3.2 leadership dedicated to
systems change

 

 

 

 

2.3.3 leadership dedicated to
advocacy for seniors

 

166

 

 

Level1

Level2

Level3

 

2.3.4 able to recruit and retain
members

 

2.3.5 members of partnership
represented most or all sectors
that address senior issues (i.e.,
service providers, faith
community, government,
housing, transportation)

 

2.3.6 solicits community input on
how to address the issues,
community members feel the
have a voice

 

2.4 Partnership
accomplishments

2.4.1 developing indicators for
improvements in quality of life of
older residents

 

2.4.2 networking/info
dissemination regarding senior
issues

 

2.4.3 increased community
awareness of aging issues

 

2.4.4 increased community

awareness of aging resources

 

2.4.5 increased services for
older residents

 

2.4.6 increased collaboration
among service providers

 

 

 

 

2.4.7 partnership was able to
affect policy change

 

167

 

 

Level1

Level2

Level 3

 

2.5 Stakeholder

buy in

2.5.1 agency leaders support the
partnership

 

2.5.2 community leaders support
the partnership

 

2.5.3 community members
support the partnership

 

2.5.4 community media supports
the partnership

 

2.5.5 faith community support
the partnership

 

2.6 Community

champion

2.6.1 at least one inﬂuential
community leader openly
supports the partnership giving it
standing in the community

 

2.7 Political will

2.7.1 community leaders support
the partnership’s goals and/or
efforts

 

2.7.2 community members
support the partnership’s goals
and/efforts

 

2.8 Community

recognition

2.8.1 community members are
aware of partnership’s
contributions to aging issues

 

 

 

 

2.8.2 partnership hosts or
participates in community events
involved in senior issues and/or

aging

 

168

 

 

Level1

Level2

Level3

 

2.8.3 community leaders
recognize the partnership’s
goals and activities

 

2.8.4 partnership is a
recognizable entity addressing
aging issues in the community

 

3. Factors that hindered
community efforts to
address aging

3.1 Financial
constraints

3.1.1 partnership does not have
sufﬁcient resources to
accomplish its goals

 

3.1.2 partnership does not have
sufﬁcient resources to maintain
its administrative functions

 

3.2 Turf battles

3.2.1 key partnership members
have different priorities

 

3.2.2 memberships in
partnership is skewed toward
service providers

 

3.3 Stakeholder
distrust

3.3.1 other entities in community
do not approve of partnership’s
goals and/or efforts

 

3.3.2 other entities in community
view partnership as a threat

 

3.4 No driving

force

3.4.1 lack of partnership
leadership

 

 

3.4.2 frequent changes in
partnership leadership

 

 

 

 

3.4.3 no champion for the
partnership has emerged in the

community

 

169

 

 

Level1

Level2

Level3

 

3.5 Community

apathy

3.5.1 community does not view
services for older residents as a
high priority

 

 

3.5.2 community is not aware of

impacts of senior issues

 

3.5.3 faith community has not
been involved in partnership
activities or involvement is

minimal

 

3.6 Lack of
information

3.6.1 lack of data about
community needs

 

3.6.2 lack of data about service
continuum

 

 

3.6.3 lack of data information
about alternate funding sources

for services

 

4. Internal factors that
had a bearing on ability
to sustain collaboration

 

4.1 Changing

membership

4.1.1 coalition membership
changes

 

4.1.2 agency leadership/stafﬁng
changes

 

4.1.3 coalition membership is
stable

 

 

4.2 Membership

representation

4.2.1 partnership has geographic
representation of community

 

 

 

4.2.2 partnership has
racial/ethnic representation of
community

 

170

 

 

Level1

Level2

Level3

 

 

4.2.3 partnership has
socioeconomic representation of

the community

 

 

4.2.3 community members are
represented in the partnership

 

4.2.4 partnership members
include entities other than health
and human service providers
(businesses/Chamber of
Commerce, mass transit, faith
community, community
foundation, United Way, DHS,
veterans’ groups, )

 

4.3 Partnership

purpose

4.3.1 partnership has deﬁned its

role in the community

 

4.3.2 partnership has stated
mission

 

4.3.3 partnership has stated
goals and objectives

 

4.3.4 partnership has
determined measurable
outcomes for its goals

 

 

4.3.5 partnership has and uses a
strategic plan to fulﬁll its mission
by achieving its goals and
objectives

 

4.3.6 partnership has NO stated
mission

 

4.3.7 partnership has NO stated
goals and objectives

 

 

171

 

 

 

Level 1

Level2

Level3

 

 

4.3.8 partnership has NO
strategic plan

 

 

 

5. External factors that
had a bearing on ability
to sustain collaboration

5.1 Funding
changes

5.1.1 reductions in available

funds for services

 

 

5.1.2 reductions in funds
available for partnership
activities

 

5.1.3 more funds available for

services

 

5.1.4 more funds available for
partnership activities

 

 

5.2 Policy
changes

5.2.1 federal level changes
affect partnership activities

 

5.2.2 state level changes affect
partnership activities

 

5.2.3 local level changes affect
partnership activities

 

 

5.3 Community
priorities

 

5.3.1 changes in community
support for services for Older
aduﬁs

 

172

 

Site A List of Codes Used and Coders’ Memos

 

 

   
  
 
   
  

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
1. Factor 1.1 1.1.1 more low Retirees moving 3
that Economic income seniors in into community,
prompted community increased number
community of aging boomers
to be
interested
in
addressin
9 aging
issues
1.1.2 economic 1
value of senior
services
1.1.3 economic 1
value of healthy
seniors
1.1.4 increasing 1
ability to keep

seniors in the
community (stem
out-migration)

 

1.2 1.2.1 aging 1
Demographi boomers
c

 

1.2.2 increased age 1
span

 

1.3 Social/ 1.3.1 seniors have 1
political more political status

 

1.3.2 increasing 1
ability for seniors to
a e in place

 

 

 

 

 

 

173

 

 

 

 

 

 

  
    
 
  

 

 

 

 

[ Level 1 Level 2 Level 3 Coders’ Memos Times
Ched
1.4 Events 1.4.1 event 2 groups merged 3
occurred that and began
highlighted the discussing these
need to address issues, funding
senior issues mostly focused on
other issues, so
they tried to work in
programs for older
adults as well, 2002
leﬁersentto
agencies, HCBW
funding cuts
1.4.2 events 2002 letter to 1
occurred that agencies asking to
accelerated be involved in
changes in services senior issues
for older adults collaboratively
1.5 1.5.1 coordinating A group of people 7
Leadership council/MPCB came together to
address these
issues. Merging 2
groups, Michigan
Think Tank, 4/03
asked MPCB chair
to meet with them
2. Factors 2.1 Financial 2.1.1 Area aging funding, 2
that resources millage/county homeless funding
helped funds from the county
Sustain
Community
eWorts to
address
ing
2.1.2 in-kind staff, Staff volunteers, 3
facilities interns, voluneers
2.1.4 has local They spoke about 1
foundation funds applying for grants,
bmdMntmeMbnﬁ
they had any
currently
217twspoded DHS,CMH 3
localagencyfunds
218hasﬂme MSHDA,DHS 2

 

 

 

funds

 

 

 

174

 

 

 

 

 

 

 

 

 

 

 

F Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
r 2.1.9 receives Fundraising 1
private donations
2.2 Positive 2.2.1 access to Health department- 1
past and health care health survey
present
collaboration
3
2.2.5 health and 1995 collaborative, 2
wellness promotion strong families/safe
children
2.2.6 community Homelessness, 2
has a positive Children’s issues
impression of
partnerships from
past experience
2.3 2.3.1 stable DHS/CMH, has a 6
Leadership leadership PT paid coordinator
through MPCB
2.3.4 able to recruit Letters sent for 1
and retain recruiting, but there
members is a lot of burnout
now, so retention is
difficult...
2.3.5 members of Original group 3
partnership sounded very
represented most diverse
or all sectors that
address senior
issues (i.e., service
providers, faith
community,
government,
housing,
transLortation)
2.4 2.4.1 developing Survey, 3
Partnership indicators for Assessment model
accomplish- improvements in for communities
ments quality of life of

 

 

older residents

 

 

 

175

 

 

 

 

 

 

 

 

 

 

 

LLevel 1 Level 2 Level 3 Coders’ Memos Times
Cited
2.4.2 Among agencies, 16
networking/info with courts, Expos,
dissemination case conferencing
regarding senior
issues
2.4.3 increased Among agencies, 2
community but not widespread,
awareness of aging intern spoke to
issues community about
aging issues
2.4.4 increased Not currently, but in 3
community the past, resource
awareness of aging directory published
resources 10/00 and revised
6/04
2.4.5 increased Free clinic, program 11
services for older for Kinship
residents caregivers, Expos
2.4.6 increased Getting group 13
collaboration together to discuss
among service the
providers issues/brainstorm,
Expos, case
conferences, goal
of group 2003
2.5 2.5.1 agency Same agencies are 5
Stakeholder leaders support the involved in all
buy in partnership collaboratives.
Don’t have
manager level
individuals, but only
worker level.
2.5.2 community Sub-committee of 1
leaders support the MPCB
partnership
2.5.3 community A lot of citizen 1
members support involvement in
the partnership collaboratives
2.5.4 community Member of group 5

media supports the

and attended

 

 

 

 

 

partnership meetings

2.5.5 faith Individual churches, 1
community support but not collectively,

the partnership not well organized

 

176

 

___1

i Level 1

.
l
l
l

l
l _
l

m
that

hindered
Communiﬁ
efforts to
address

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
2.6 2.6.1 at least one Directors of DHS, 3
Community influential COA, Economic
champion community leader Development,
openly supports the University
partnership giving it Extension ofﬁce
standing in the
community
2.7 Political 2.7.1 community MPCB is supportive 1
will leaders support the of efforts
partnership's goals
and/or efforts
2.8 2.8.2 partnership Expos 10
Community hosts or
recognition participates in
community events
involved in senior
issues and/or aging
3. Factors 3.1 Financial 3.1.1 partnership People are 3
that constraints does not have stretched too thin,
hindered sufﬁcient resources not enough money
community to accomplish its for senior center,
efforts to goals seeking grant
address funding
aging
3.1.2 partnership Members stretched 1
does not have too thin
sufﬁcient resources
to maintain its
administrative
functions
3.2 Turf 3.2.1 key “victim mentality” in 2
battles partnership the community,

 

 

members have
different priorities

 

when courts were
involved, they didn’t
like to work directly
with clients,
difﬁculty in involving
different priorities in
plan

 

 

177

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
3.2.2 memberships Government, law 4
in partnership is enforcement,
skewed toward schools not
service providers involved, purpose
of group to
collaborate—case
conference key
3.3 3.3.1 other entities Community 1
Stakeholder in community do reluctant to move
distrust not approve of forward sometimes,
partnership’s goals funders focus on
and/or efforts children, difﬁcult to
find elder-specific
focus
3.3.2 other entities There are so many 1
in community view collaboratives in a
partnership as a small community,
threat makes funding
difﬁcult
3.4 No 3.4.1 lack of 2005 started to 1
driving force partnership slow down
leadership
3.5 3.5.1 community Seems like there is 2
Community does not View some resistance,
apathy services for Older no support for
residents as a high senior center, Expo
priority attendance down
3.5.2 community is Community not 1

not aware of
impacts of senior
issues

aware of resources,
ignorant of what is
available in their
own community

 

 

 

 

3.5.3 faith
community has not
been involved in

 

They have not been
collectively involved
in partnership, but

partnership will support

activities or coalition with

involvement is donations when
L minimal approached

 

 

178

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
4. Internal 4.1 4.1.1 coalition Decreasing 1
factors Changing membership membership from
that had a membership changes burnout
bearing on
ability to
sustain
collaborati
on
4.1.2 agency Agency staff 1
leadership/stafﬁng attended meetings
changes rather than
directors-no
decision makers
4.1.3 coalition Most meetings 7
membership is involved same staff
stable people able to
follow cases
through
conferences
4.3 4.3.1 partnership 2003 Bylaws 2
Partnership has defined its role instated
purpose in the community
4.3.2 partnership Restructuring, 4
has stated mission created one at
beginning
4.3.3 partnership Used for grant 8
has stated goals writing, 9/03
and objectives discussed goals
and
accomplishments
4.3.5 partnership Each year they 3
has and uses a create a strategic
strategic plan to plan
fulﬁll its mission by
achieving its goals
and objectives
5. External 5.1 Funding 5.1.1 reductions in Because of 1
factors changes available funds for increased number
that had a services of aging boomers
bearing on
ability to
sustain
collaborati
on

 

179

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
5.2 Policy 5.2.2 state level 11/01 letter sent to 2
changes changes affect legislator
partnership
activities
5.3 5.3.1 changes in Either too many or 1
Community community support too few volunteers
priorities for services for at times, does not
older adults use/support
volunteers as
needed

 

 

 

 

 

180

 

Site B List of Codes Used and Coders' Memos

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
1. Factor 1.1 1.1.1 more low Poverty Reduction 1
that Economic income seniors in Initiative
prompted community
community
to be
interested in
addressing
aging
issues
1.1.3 economic Issue Brief and 2
value of healthy Strategic Plan
seniors
1.1.4 increasing In-migration of 3
ability to keep seniors, Chamber
seniors in the of Commerce,
community (stem Strategic Plan
out-migration)
1.2 1.2.1 aging Strategic Plan 4
Demograp boomers
hic
1.3 Social/ 1.3.2 increasing Chamber of 3
political ability for seniors Commerce, Issue
to age in place Brief and Strategic
Plan
1.4 Events 1.4.1 event 1
occurred that
highlighted the
need to address
senior issues
1.5 1.5.1 coordinating 1993 Senior 6
Leadership council/MPCB Service Committee

was a provider
networking group.
Group got together,
became multi-
purpose
collaborative,
workgroup BASA
created

 

 

 

 

1.5.2 change in
leadership at
agencies

 

 

 

181

 

 

Zme
mane
wdan
mmmu
eﬁonsl
address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
1.5.3 change in Workgroup has 1
leadership in evolved
community
2. Factors 2.1 2.1.1 1
that helped Financial millage/county
sustain resources funds
community
efforts to
address
aging
2.1.2 in-kind staff, Volunteers, Ofﬁce 6
facilities space of agencies,
leadership comes
from local
agencies, free
advertising,
assistance from
Human Services
Collaborative
2.1.3 has Able to give away 6
sufﬁcient $10,000 last year,
resources not program driven-
volunteer based.
Sources are
member dues and
Senior EXIL
2.1.4 has local Campbell Fund 1
foundation funds
2.1.7 has pooled Dues 1
local agency
funds
2.1.8 has state MDCH-LTC 1
funds Initiative grant
$40,000
2.1.9 receives Foundation grant, 8
private donations fundraising-expo,
member dues
2.2 2.2.1 access to 1
Positive health care
past and
present
collabora-
ﬁons

 

182

 

 

 

 

 

 

 

 

 

 

L Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
2.2.5 health and 1
wellness
promotion
2.2.6 community Community college, 6
has a positive renovation/preserva
impression of tion of buildings,
partnerships from poverty initiative
past experience
2.3 2.3.1 stable Original agencies 6
Leadership leadership still involved
2.3.2 leadership 5
dedicated to
systems change
2.3.3 leadership 2005 Town hall 21
dedicated to meeting, 2006
advocacy for position paper,
seniors 2007 task forces,
2006 advocacy
paper development
2.3.4 able to 11
recruit and retain
members
2.3.5 members of 2007 HMO joined 8
partnership 2007 joined
represented most Chamber of
or all sectors that Commerce
address senior
issues (i.e.,
service providers,
faith community,
government,
housing,
Maﬁportatiol
2.3.6 solicits 2006 community 3
community input needs assessment
on how to
address the
issues,
community
members feel the
have a voice

 

 

 

 

 

 

183

 

_______
6V6

, I 7.17.; E El. F L- - ,-\ L

\

 

 

 

 

 

 

 

 

 

 

\ Level 1 Level 2 Level 3 Coders’ Memos Times
_ Cited
I 2.4 2.4.1 developing 1
Partnershi indicators for
p improvements in
accomplish quality of life of
-ments Older residents -
2.4.2 Senior expo, 39
networking/info pamphlets,
dissemination speakers bureau,
regarding senior 2006 EMS, 2005
issues ways to get word
out about activities
2.4.3 increased Expo-“Ideas for 6
community Life”, through
awareness of Chamber of
aging issues Commerce
2.4.4 increased Expo-for seniors, 24
community orientation paper,
awareness of senior help card,
aging resources website,
educaﬁonal
brochures
2.4.5 increased Delivered meals, 20
services for older mini-grants given to
residents organizations,
senior support
team, unmet needs
committee
2.4.6 increased 8
collaboration
among service
providers
2.4.7 partnership Support home and 5
was able to affect community based
policy change services waiver,
advocated against
budget cuts that
hurt seniors
2.5 2.5.1 agency Human Service 6
Stakeholde leaders support Coordinating
r buy in the partnershja Council
2.5.2 community Joined Chamber of 6
leaders support Commerce

 

 

 

the partnership

 

 

 

184

 

 

‘ Level 1

Level2

Level3

Coders’ Memos

Times
Cited

 

2.5.3 community
members support
the partnership

Senior Expo

 

2.5.4 community
media supports
the partnership

Senior Times,
Prime Time News

 

2.6
Community
champion

2.6.1 at least one
inﬂuential
community leader
openly supports
the partnership
giving it standing
in the community

HSCC support,
Chamber of
Commerce support

 

 

2.7
Political
will

2.7.1 community
leaders support
the partnership’s
goals and/or
efforts

HSCC support,
Chamber of
Commerce support

 

2.7.2 community
members support
the partnership’s
gals and/efforts

Senior Expo

 

2.8
Community
recognition

2.8.1 community
members are
aware of
partnership's
contributions to
ggingissues

 

2.8.2 partnership
hosts or
participates in
community events
involved in senior
issues and/or

gins

Senior Expo

12

 

 

 

 

2.8.3 community
leaders recognize
the partnership's
goals and
activities

 

HSCC, Chamber Of
Commerce

 

 

185

 

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
2.8.4 partnership 6
is a recognizable
entity addressing
aging issues in
the community
3. Factors 3.1 3.1.2 partnership Money for research 2
that Financial does not have study, all volunteer
hindered constraints sufﬁcient group
community resources to
efforts to maintain its
address administrative
aging functions
3.2 Turf 3.2.1 key The chair last year, 3
battles partnership 61 members with
members have different agendas,
different priorities projects versus
networking as
purpose of group
3.2.2 5
memberships in
partnership is
skewed toward
service providers
3.5 3.5.1 community Stated in strategic 1
Community does not View plan
apathy services for older
residents as a
high priority
3.5.2 community Stated in strategic 1
is not aware of plan
impacts of senior
issues
3.5.3 faith Other than 5
community has Salvation Army and
not been involved local Catholic

 

 

in partnership
activities or
involvement is
minimal

 

Human Services
but not churches or
ministerial council

 

 

186

 

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
3.6 Lack Of 3.6.1 lack of data Decided to do a 2
information about community community needs
needs assessment so
could apply for
Community for a
Lifetime
4. Internal 4.1 4.1.1 coalition Went from 36-61 9
factors that Changing membership last year
had a membershi changes
bearing on p
ability to
sustain
collaboratio
n
4.1.2 agency Changes among 2
leadership/stafﬁn some agency staff
9 changes
4.1.3 coalition Stable and growing 1
membership is
stable
4.2 4.2.1 partnership Services from both 8
Membershi has geographic counties
p representation of represented
representa community
-tion
4.2.2 partnership Does not have this 1
has racial/ethnic
representation of
community
4.2.4 partnership For-proﬁts, non-for— 11

 

 

members include
entities other than
health and human
service providers
(businesses/Cha

mber of

Commerce, mass

transit, faith
community,
community
foundation,
United Way,
DHS, veterans'
groups, L

 

proﬁts, government,
2006 invited law
enforcement and
the local tribe to
join, 2007 joined
Chamber of
Commerce

 

 

187

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
4.3 4.3.1 partnership Increasing quality 6
Partnershi has deﬁned its of life, service
p purpose role in the coordination and
community collaboration, help
meet unmet needs
4.3.2 partnership Original mission 4
has stated statement was
mission conﬁrmed in 2006
strategic plan
4.3.3 partnership In strategic plan 4
has stated goals and implementation
and Objectives documents
4.3.5 partnership 5 year plan 7
has and uses a
strategic plan to
fulﬁll its mission
by achieving its
goals and
objectives
5. External 5.1 5.1.4 more funds Senior Expo is 5
factors that Funding available for raising increasing
had a changes partnership amounts of money,
bearing on activities increased number
ability to of members means
sustain increase in amount
collaboratio received from dues
n
5.2 Policy 5.2.1 federal level Medicare Part D, 2
changes changes affect Medicaid LTC
partnership home and
activities community based
waiver, meals on
wheels budget cuts
5.2.2 state level Medicaid LTC 2
changes affect home and

partnership
activities

community based
waiver

 

 

 

 

5.2.3 local level
changes affect
partnership
activities

 

meals on wheels
budget cuts

 

 

188

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Memos Times
Cited
5.3 5.3.1 changes in Homeless person 1
Community community who died affected
priorities support for efforts to help

 

 

services for older

aduﬁs

 

 

 

189

 

Site C List of Codes Used and Coders’ Memos

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
1. Factor 1.1 1.1.2 economic value Increased 1
that Economic of senior services knowledge Of
prompted the number of
community seniors
to be
interested in
addressing
aging
issues
1.2 1.2.1 aging boomers Mentioned 2
Demograp population
hic changes, how
there is an
increase in older
adults
1.3 Social/ 1.3.1 seniors have 1
political more political status
1.3.2 increasing 1
ability for seniors to
age in place
1.4 Events 1.4.1 event occurred Strategic plan 1
that highlighted the
need to address
senior issues
1.4.2 events PACE program 1
occurred that startup and Outs
accelerated changes in services
in services for older
adults
1.5 1.5.1 coordinating MPCB was 5
Leadership council/MPCB mentioned a lot.
Partnership
chair member of
MPCB
1.5.2 change in Change in staff 3
leadership at impacted
agencies leadership of
partnership.
1.5.3 change in 1
leadership in
community

 

190

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
2. Factors 2.1 2.1.1 millage/county Senior millage 4
that helped Financial funds
sustain resources
community
efforts to
address
aging
2.1.2 in-kind staff, Clerical support 5
facilities provided by
MPCB. Meeting
space provided
by AAA
2.1.3 has sufﬁcient Partnership 3
resources does not
expend funds
on staffing and
receives support
from member
agencies when
required
2.2 2.2.1 access to 2008 Pathways 6
Positive health care to Health
past and program
present
collabora-
tions
2.2.2 teen pregnancy 2
2.2.3 chronic disease 3
2.2.4 elder abuse 3
2.2.5 health and 1
wellness promotion
2.2.6 community has Health fairs 3
a positive impression
of partnerships from
past experience
2.3 2.3.1 stable AAA, PACE 2
Leadership leadership current leaders,
CMH in past
2.3.2 leadership Through MPCB 4

 

 

dedicated to systems
change

 

 

 

191

 

 

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
2.3.3 leadership Advocating for 8
dedicated to MIChild to apply
advocacy for seniors to senior. Senior
millage
2.3.4 able to recruit Membership 4
and retain members has been
reconstituted.
For-proﬁt
providers
formed a spin-
off group
2.3.6 solicits Provider and 13
community input on Consumer
how to address the surveys
issues, community conducted
members feel the
have a voice
2.4 2.4.1 developing Assessment 1
Partnershi indicators for survey, Report
p improvements in Card for the
accomplish quality Of life of older community
-ments residents
2.4.2 networking/info Dental 11
dissemination Partnership,
regarding senior Regional Health
issues Alliance, 211,
Health Fair
2.4.3 increased Funders 4

 

 

community
awareness of aging
issues

 

needing more
awareness, the
report card,
advocacy for
senior issues

 

 

192

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
2.4.4 increased 2-1-1, referrals 10
community to other member
awareness of aging agencies as
resources services
become known
through
networking,
distributing the
Senior Times
and networking
at monthly
meetings
through member
updates
2.4.5 increased Home repair, 6
services for Older home
residents maintenance,
and health fair
2.4.6 increased Especially 12
collaboration among through updates
service providers and discussions
at monthly
meetings
2.5 2.5.1 agency leaders Several 7
Stakeholde support the members are
r buy in partnership agency leaders
2.5.2 community MPBC, Home 5
leaders support the Builders
partnership Association
2.5.4 community Senior Times is 2
media supports the very supportive
partnership of efforts and is
an active
member of the
artnershg)
2.6 2.6.1 at least one Support of 5
Community influential community MPCB
champion leader openly
supports the

 

 

partnership giving it
standing in the
community

 

 

 

193

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
2.7 2.7.1 community Support of 5
Political leaders support the MPCB,
will partnership’s goals increased space
and/or efforts in community
report card,
made sure
group continued
after hiatus in
2007
2.8 2.8.1 community Community 3
Community members are aware members are
recognition of partnership’s not aware of the
contributions to aging partnership by
issues design
2.8.2 partnership Health fair 9
hosts or participates
in community events
involved in senior
issues and/or aging
2.8.3 community MPCB leaders 5
leaders recognize the support
partnership’s goals partnership
and activities
2.8.4 partnership is a People don’t 3
recognizable entity know
addressing aging partnership

 

 

issues in the
community

 

exists so don’t
bring issues to
the table

 

 

194

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
3. Factors 3.2 Turf 3.2.1 key partnership Contention 5
that battles members have arose between
hindered different priorities service vendors
community and public
efforts to agencies and
address service
aging providers
because of
different visions
for the
partnership.
Sometimes
there was a lack
of collaboration
among the
members.
3.2.2 memberships in Mostly service 15
partnership is providers.
skewed toward
service providers
3.3 3.3.1 other entities in No common 2
Stakeholde community do not purpose at
r distrust approve of times This
partnership’s goals caused changes
and/or efforts in membership
3.4 No 3.4.1 lack of Leadership was 4
driving partnership not stable which
force leadership caused lapse of

 

 

 

partnership
activities and
lack of a
meaningful
purpose. 2008-
new leadership
dedicated to
helping
partnership
succeed

 

 

195

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
3.4.2 frequent Dues to 7
changes in changes in
partnership agency
leadership leadership,
change in focus
of partnership
when more
vendors
became
involved
3.5 3.5.1 community Funders like the 3
Community does not view community
apathy services for older foundation and
residents as a high United Way.
priority
3.5.2 community is 3
not aware of impacts
of senior issues
3.5.3 faith community Partnership 4
has not been supports work of
involved in local church but
partnership activities faith community
or involvement is is not among
minimal membershig
3.6 Lack of 3.6.1 lack of data Especially 6
information about community outside of the
needs largest city in
the county. No
needs
assessment
done
3.6.2 lack of data No mechanism 4
about service in place to
continuum gather and/or
aggregate
service data
3.6.3 lack of data Look to 2
information about categorical

 

 

alternate funding
sources for services

 

funding streams

 

 

196

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
4. Internal 4.1 4.1.1 coalition Change when 6
factors that Changing membership changes vendors left in
had a membershi 2006-07
bearing on p
ability to
sustain
collaboratio
n
4.1.2 agency Several key 6
leadership/stafﬁng agencies that
changes serve seniors
have had
leadership
changes over
the past several
years
4.1.3 coalition As the group 4
membership is stable has reconvened
in 2008,
membership
has increased
but the core
member
organizations
are still involved
4.2 4.2.1 partnership has Not as much 6
Membershi geographic representation
p representation of from
representa community communities
-tion outside main
urban area but
trying to correct
that through
recruiting
4.2.2 partnership has Not 4
racial/ethnic representative
representation of of community
community
4.2.3 partnership has Not 4
socioeconomic representative
representation of the of community

 

 

community

 

 

 

197

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
4.2.4 partnership Have tried to 6
members include recruit members
entities other than from outside
health and human traditional senior
service providers serving
(businesses/Chambe agencies.
r of Commerce, mass
transit, faith
community,
community
foundation, United
Way, DHS, veterans’
groups)
4.3 4.3.1 partnership has As prescribed 6
Partnershi defined its role in the by the MPCB
p purpose community since
partnership is a
sub-committee
of MPCB
4.3.2 partnership has There was a 4
stated mission mission
statement in the
Older
documents but
the current
leadership
stated they did
not have a
mission
statement
4.3.3 partnership has Goals and 4

 

 

stated goals and
objectives

 

objectives were
included in the
older
documents but
the current
leadership
stated they had
not been
developed yet.

 

 

198

 

 

 

 

 

 

 

 

 

 

Level 1 Level 2 Level 3 Coders’ Times
Memos Cited
4.3.6 partnership has There was a 4
NO stated mission mission
statement in the
older
documents but
the current
leadership
stated they did
not have a
mission
statement
4.3.7 partnership has Goals and 4
NO stated goals and objectives were
Objectives included in the
older
documents but
the current
leadership
stated they had
notbeen
developed yet.
4.3.8 partnership has Not yet 4
NO strategic plan
5. External 5.1 5.1.1 reductions in Cuts in funding 3
factors that Funding available funds for and available
had a changes services grants.
bearing on
ability to
sustain
collaboratio
n
5.1.4 more funds Senior millage 5
available for was referenced
partnership activities by interviewees
5.2 Policy 5.2.1 federal level
changes changes affect
artnership activities
5.2.2 state level Funding cuts, 4

 

 

changes affect
partnership activities

 

potential state
shutdown

 

 

199

 

Appendix D- Synopses of Case Studies

200

SYNOPSIS OF CASE STUDY SITE A

In July 2000, a letter was sent to local service agencies introducing the
concept of organizing and facilitating a multi-agency meeting where human
service professionals working with adults, primarily older residents of the county,
could meet on a regular basis to create a network, promote open communication
among those providing community resources, prevent service duplication,
become familiar with services provided by each agency, and to collaborate to
meet the needs of their clients. The response to forming a group with these goals

was very positive.

At the September 2001 meeting, Partnership A members discussed the
progress made during the previous year through information sharing and
collaboration and how to proceed in the future. 'They pondered how members
could inﬂuence development of local coalitions and how they could support each
other in the development process. In November 2001, Partnership A sent a letter
to their state senator that expressed concern about proposed budget cuts to the
Medicaid home and community-based services waiver program. The letter
provided information about the effectiveness of home and community-based
services in decreasing the number of more expensive services clients used for
acute and chronic care. The letter asked the senator to support funding the home
and community-based waiver for older and disabled adults without cutting the

FY2002 expenditure.

In February 2002, the Director of the Department Of Human Services sent

an invitation letter to other agencies asking them to join Partnership A. Members

201

represented a broad spectrum of providers such as the local hospital, probate
court, MichiganWorks, community mental health, department of human services,
home health care, commission on aging, a local bank, and law enforcement.
Partnership A’s mission statement was “Creating a network of resources and
contacts to inform and assist those adults with unmet needs while preserving the
individual’s conﬁdentiality.” The vision statement was “a safe community with
coordinated and constant resources for adults with unmet needs” (from meeting

minutes).

To accomplish its mission, Partnership A developed an action plan that
included coordinating resources through a monthly meeting of agency
representatives and exchanging information regarding available resources,
agency policy changes and service delivery. The action plan also called for
development of a crisis response network where each agency would provide a
protocol for crisis response and quarterly meetings where response effectiveness

would be discussed and problem solving would occur.

As early as January 2002, Partnership A members were planning a health
fair for seniors and vulnerable adults in the community to be held on May 9,
2002. The fair was marketed under the name of Adult Community Resource
Expo (ACRE). Also in 2002, the group distributed holiday boxes for older adults

who would otherwise not receive Christmas gifts.

Attendance at the monthly meetings in 2003 ranged from eight to ﬁfteen
members. Member agencies included Human Services, MichiganWorks,

Community Mental Health, Commission on Aging (COA), residential programs,

202

health care agencies, hospital, hospice, probate court and sheriff department.
The action plan developed by the partnership had two elements. The ﬁrst was
coordinating resources in the monthly meetings with agency representatives and
updating information by exchanging information about resources, changes in

agencies’ policies and service delivery.

The second element was developing a crisis response network. This
would be an aggregation of protocols for crisis response from each agency, a
quarterly meeting to discuss crisis response effectiveness, and developing
solutions to gaps and problems identiﬁed in the quarterly meetings. Developing
what the group referred to as the protocol was discussed. The protocol would
include assisting the older and vulnerable population through providing
information about tax credits, substance abuse, legal services, housing, funeral
services, probate courts, law enforcement, food pantry, mental health services

and other senior-speciﬁc services.

The Expo was held on May 15, 2003, and boasted 21 booths including
local public agencies (human services, community mental health,
MichiganWorks, Council on Aging), care management, adult education, volunteer
services, probate court, Alzheimer’s Association, Habitat for Humanity, home
health agencies, and aroma therapy for stress management. Speakers’ topics
included estate planning, foot care, exercise, diet, Medicare/Medicaid,

Aromatherapy, depression, and substance abuse.

In 2004, the Expo was planned for June 10‘“. Attendance at meetings in

2004 ranged from 5 to 13 members with attendance being lower at the end of the

203

year. The Expo consisted of over 30 local agencies, educational seminars, a
limited clinic provided by the local hospital, and a light lunch. The other project in
2004 was development of a protocol for resources and emergency response. In
the fall of 2004, Partnership A took on a new project that addressed ﬁnancial
exploitation of seniors. Several banks were invited to attend the October meeting
to discuss ﬁnancial exploitation. The group had a discussion at the November
meeting about the hardships caused by the high cost of prescription drugs and
programs they could recommend to clients to help defray some of the cost. They
also discussed the need for transportation to out-of-county medical facilities. The
group decided to distribute 100 holiday boxes for seniors who would not receive

a gift through other programs.

In 2005, attendance at Partnership A meetings ranged from 6 to 13
members. In January, another problem-solving discussion was held about ﬁnding
funds to assist seniors with prescription drug costs. The Expo date was set for
June 9. The Expo had 16 booths representing a wide array of services including
home health, free clinic, residential, mental health, volunteer opportunities,
hospital, hospice, care management, legal services, law enforcement and
probate court. A free clinic steering committee was formed in 2004 to start a free
clinic to serve four adjacent counties. The committee’s target was to open the

clinic in June of 2005, on Wednesdays from 5:00 to 7:00 PM.

In September 2005, the group had a discussion about disbanding because
of the lack of members willing to hold ofﬁce and reconvening as an informal

resource council that would not do case sharing. In October, the group decided

204

to dissolve. Looking at the Partnership A action plan, it was determined that the
group had met its goal of producing a resource guide. They discussed becoming
part of the multi-purpose collaborative body of the county with the new goal being
to network to bring together people who work to support the well-being of county

residents.

In January 2006, Partnership A reconvened in its new format as a
subcommittee of the MPCB with 17 people in attendance. The meeting consisted
of information dissemination about Medicare Part D, MichiganWorks, Elder

Friendly Communities, and housing.

ASSESSMENT OF SITE A DA TA

Site A provided meeting minutes, resource guides and health expo
programs as documents for the case study. A group interview was conducted
with the four leaders of Site A’s partnership in November 2008. The researcher
attended the October 2008, Site A MPCB meeting where she facilitated a
discussion about aging services in the county. The full coding table is located in
3. Analysis of the coded data is presented below. Numbers in parentheses are

the code number(s) in 3.

Site A interviewees talked about how their geographic area of the state
was becoming more attractive to retirees and that this would have an impact on
the service continuum over the next several decades (1.1.1). Site A interviewees
commented that the partnership was a natural outgrowth of the interest held by

several agency staff who worked with older adults to learn more about what other

205

agencies had to offer and to coordinate their efforts. Over time, the people
involved in the partnership thought they should reach out to the MPCB, which
was funded by Strong Families/Safe Children dollars, to determine whether their
mission would ﬁt under the rubric of the community collaborative (1.4.1-1.4.2,

1.5.1).

Financial Resources

Access to ﬁnancial resources appeared to be adequate. Neither the
interviews nor the review of doCuments identiﬁed any times when the partnership
could not proceed due to lack of funds (2.1.1-2.1.9). The community has had
successful collaborations in the past that involved homelessness, public health
initiatives, and the state-sponsored Strong Families/Safe Children initiative

(2.1.9-2.2.6).

Leadership

Regarding the leadership of the partnership, it was primarily agency staff
rather than agency directors. This had an impact on what types of decisions the
group could make around committing agency personnel and other resources.
When the partnership ﬁrst formed, it had fairly broad representation among
community agencies and organizations but in later years, involvement decreased
(2.3.1-2.3.5). When the partnership reconvened, the leadership consisted of

agency leaders and the chair of the MPCB.

206

Partnership Accomplishments

The partnership held several senior expos that had broad representation
of community services. The expos introduced Older community residents to the
Options available to them locally rather than seeking services outside of the
county. The monthly meetings each featured case conferencing where the
members presented issues involved in speciﬁc cases and the group worked
together to see how they could resolve the issue using their various agencies’
resources. The group members signed conﬁdentiality agreements for each
meeting to assure the clients’ right to privacy. The purpose of the initial
partnership was to coordinate community resources so it did not seek to get its
name recognized in the community. The senior expos and the production and
dissemination of the resource directory were the primary ways in which the

partnership increased awareness of aging resources (2.4.2-2.4.6).

Stakeholder Buy In

Interviewees discussed the fact that this is a sparsely populated county
and as such, people who work in human services tend to know each other and
work together on many issues. When interviewing agency leaders, they
mentioned that the original aging partnership was staffed by workers. This led to
the ability to conduct productive case conferences but policy and procedural
changes could not be made by the members nor could they commit the
resources of their respective agencies. Agency leaders supported their staff
being involved in the aging partnership (2.5.1-2.5.2). The partnership has since

been absorbed into the MPCB which brings agency leaders and community

207

representative to the table. This broadens the base of the partnership and
provides a larger forum in which to discuss issues and infrastructure allowing

members to address problems in a concerted way (2.5.3-2.8.2).

Hindrances to Sustainability

As stated previously, having partnership members at the staff level
provided a productive venue for case problem-solving but did not offer a forum
for discussing infrastructure issues among decision-makers. Interviewees
commented that human service professionals in the county are stretched very
thin which caused them to scale back on activities they ﬁnd are not as productive
as others (3.1.1-3.1.2). The members of the original partnership were indeed
service providers and after several years of activity, in 2006, they decided to
become part of the MPCB. With absorption of the aging partnership into the
MPCB, the partnership base is much broader. However, Since the MPCB has
historically focused its efforts on child and family issues, its members have to
adjust to being more inclusive as they explore the community’s aging issues and
how they can address them. They are exploring new types of funding and looking
into bringing more senior-related organizations into the MPCB (3.3.1-3.4.1).
When the interviewees discussed the county having a victim mentality, they said
that community members reacted strongly to the actions of outside forces that
have negative impacts on economic conditions (3.2.1).

Code series 3.5 relates to community apathy. The interviewees expressed
frustration with what they view as resistance to some of the senior services,

especially funding for them from community coffers. They talked about how

208

community residents seek services, especially medical care, outside of the
county when quality services are available to them much closer to home. The
faith community has not been actively involved but the MPCB is considering

ways in which they can approach it to become active members (3.5.1-3.5.3).

lntemal Factors Inﬂuencing Sustainability

The Site A aging partnership started with great enthusiasm but after
several years of operating, the agency staff members who attended the
partnership meetings, hosted the senior expos, developed the crisis protocol, and
developed and distributed the community resource directory experienced
burnout. As they reﬂected on their accomplishments, they decided that they had
achieved the purpose stated in their bylaws and disbanded but reconvened as a

subgroup of the MPCB (4.1.1-4.3.5).

External Factors Inﬂuencing Sustainability

The external factors cited by interviewees that had a bearing on the aging
partnership’s sustainability were the availability of funding in light of the
increasing number of older adult residents and changes in the Medicaid Home
and Community Based Waiver program (5.1.1-5.2.2). In addition, interviewees
discusSed how community support for services for older adults in the form of

volunteers waxed and waned over time (5.3.1).
SYNOPSIS OF CASE STUDY SITE B
The group was originally formed when the Senior Services Committee of

the Human Services Coordinating Council, the area’s Multi-purpose Collaborative

209

Body (MPCB), recommended that a senior services provider networking group
be formed in 1993. Partnership B ﬁrst met on June 5, 1995 with 17 people in
attendance with the purpose of exploring ways to increase cooperation among
service providers, increasing agency collaboration, and identifying potential
service duplication. The group developed its ﬁrst mission statement: “To support
and enrich the lives Of Older adults and their families, through collaboration,

planning and advocacy’ (from meeting minutes).

In February 1998, the group received a Governor’s Innovation Recognition
Award of $1,000 which provided group members with validation of the value of
their efforts. In 1998, the group had 21 members representing both counties in
the catchment area. The standing committees were: senior services complex,
public relations, consumer advocacy, and an assisted living task force. The
year’s accomplishments included collaborating with the local community mental
health agency to develop and distribute a regional resource guide; hosting a
Senior Health Day; developing a partnership orientation packet; and developing a

minimum core outcome strategic plan for the MPCB.

In October of 2000, the MPCB recognized the group’s effortsat their
annual meeting. Also in 2000, the group changed its name to one that was

simpler to remember and had a better acronym.

In 2005, attendance at the Partnership B monthly meetings was 17 in
January and by November grew to 33. During 2005, Partnership B was
discussing developing a formal budget. They were discussing how their revised

meeting format would help meetings to stay focused on their mission. One major

210

change was that Partnership B moved from a consensus decision-making model
to voting. The 2005 committee structure included work groups on advocacy
including technology and senior power, networking including the senior expo,
annual meeting, grant opportunities, and Partnership B networking, and
educational materials on topics such as assisted living, long-term care, respite
care. Information dissemination about member agencies and issues in the
community related to seniors was a large part of the meetings. The education
work group produced the following information brochures for seniors and their
families: “Top 10 Things Seniors Need to Know”, “Legal Issues”, and

“Prescriptions Drugs” as well as the “Senior Help Card” about long-term care.

In 2005, Partnership B was also preparing a position paper that articulated
issues related to the community’s seniors and recommendations for addressing
them. The position paper was to be used as talking points so that all those
representing Partnership B would respond to inquiries in the same manner. The
networking work group planned and implemented the Senior Expo themed “Ideas
for Life” that Partnership B has hosted every spring since 2001. In 2005,

Partnership B launched a website.

In 2006, monthly meeting attendance ranged from 22 to 38 with a
consistent group of about 20 of the same members attending each meeting.
Partnership B meetings still dedicated a signiﬁcant portion of time to information
dissemination including outside speakers on pertinent topics. The website now
included the Partnership B membership registration form. The annual Partnership

B membership fee was $35 per organization. The major outreach event was

211

once again the Senior Expo in May. As Partnership B membership grew and the
membership diversiﬁed, the group was intent upon solidifying its purpose. At the
February 2006 meeting, the identiﬁed purpose was networking/sharing, hosting
the Senior Expo, supporting the work of the Senior Support Team and

developing and distributing informational brochures.

The Senior Support Team’s purpose was to ﬁll unmet needs for seniors
when all other avenues had been exhausted by providing emergency funds of up
to $300 per case. The Steering Committee was to determine the Partnership B
work group/committee structure and meeting format and agendas. An issue
identiﬁed by Senior Support Team was poor dental care in nursing homes and
general lack of affordable dental care for seniors. They decided to address this
by working with other groups in the community. Educational materials included
the Senior Help Card, Assisted Living Check List, Prescription Drug brochure,
Legal Assistance brochure, and File for Life (pertinent information for EMS to be
kept on seniors’ refrigerator doors). The advocacy work group developed three
goals: more involvement of senior lobbyists; setting up a local electronic

advocacy network; and promoting Senior Count data collection.

The Senior Expo had 66 vendors ranging from funeral homes, massage
therapy, and ﬁtness programs to real estate ﬁrms, banks, housing, and
legislators with over 350 seniors in attendance. The Senior Expo raised over
$6,000 for the partnership to use to support its activities. In November 2006, the
group discussed inviting other senior service providers such as the local Indian

tribe, law enforcement, and legislators to join Partnership B. The advocacy paper

212

was to serve as a platform for advocating for older adults and thus was
distributed to all Partnership B members and was a part of the new member
packet. The group also discussed joining the Chamber of Commerce to further
the cause of Partnership B and to get senior issues in front of the business
community. The year ended as it began with the group discussing who they
were, what they wanted to accomplish and where they were heading as an

organization.

In 2007, Partnership B monthly meeting attendance ranged from 26 to 34
and by November there were 52 member organizations. In January, three task
forces—senior issues, community planning, and Partnership B action—were
developed. A grant proposal was written to augment the funds available to the
Senior Support Team. By March, Partnership B had joined the Chamber of
Commerce and the president of the Chamber started to attend Partnership B
meetings. Partnership B was asked to send a representative to Chamber board
meetings. The Chamber identiﬁed three priorities related to seniors—economic
development, legislation, and land use. The advocacy work group was sending
out advocacy alerts. In May, representatives from Partnership B, the Chamber
and other local organizations met to explore the livable communities initiative in
which a regional perspective would be developed to make the area more senior
friendly, remove generational barriers and improve quality of life. Partnership B
formed a livable communities task force to explore how they could promote the

community’s adoption of the initiative.

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At the April Partnership B meeting, the group decided to revisit its strategic
plan and priorities. The September 2007, strategic planning meeting yielded a
change in the mission statement to “To support and enrich the lives of Older
adults through collaboration” (from meeting minutes). It was noted that there
were two distinct clusters of members, those who saw Partnership B primarily as
place for networking and sharing ideas and the other who felt Partnership B
should be involved in projects that produced products or services. The strategic
directions identiﬁed in the strategic plan were to 1) heighten awareness of senior
issues and increase action; 2) integrate senior issues with community planning;
and 3) strengthen Partnership B’s capacity for action. These directions
accommodate the views of each of the two clusters as to Partnership B’s focus

and Objectives.

In 2008, attendance ranged from 28 to 44 with a membership of 60
organizations. The grant proposal written in 2007, was funded ($3,500). Dues
remained constant at $35 per member organization. The strategic planning
process continued and a mini-grant program was implemented. A nomination
process was put into place to select Partnership B Chair and Chair-Elect. In
2008, two mini-grants were funded for a total of $5,000. The programs funded
were Camp 911, a one-day emergency services event attended by 180 seniors
with representatives from over 15 agencies that presented information about
urgent and emergency services for seniors including self-defense, K-9 Cops, and
a rescue demonstration. The other mini-grant was awarded to RSVP/United Way

for volunteers’ mileage reimbursement. A representative from the Prime Time

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publication was at the November 2008 meeting to take a picture of the

Partnership B members for a cover story in the April 2009 issue.

The Senior Expo continued to grow and in 2008, it received a $7,500
sponsorship from AARP along with almost 20 other sponsorships, and had a
media connection with a live on-air radio program broadcast from the Expo. The
Senior Expo had over 100 vendors, mental and physical health screenings;
seminars on reverse mortgages, identity theft, legal services for seniors, and
building solutions for an aging community. The Senior Expo generated over
$7,000 in proﬁts that Partnership B could use to fund its activities including the
mini-grants and Senior Support Team fund distributions. The Senior Expo has its
own website that provides information about the event for community members

and vendors as well as information about Partnership B.

ASSESSMENT OF SITE 8 DA TA

Site B provided meeting minutes, strategic planning documents, position
paper, advocacy paper, and brochures as documents for the case study. A group
interview was conducted with three leaders of Site B’s partnership and an
individual interview was conducted with the partnership’s chair in November
2008. The researcher attended Site B’s November 2008 partnership meeting and
observed the meeting’s dynamics. The full coding table is located in Appendix C.
Analysis of the coded data is presented below. The numbers in parentheses are

the code number(s) in Appendix C.

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Factors That Prompted Site 8 to Form a Partnership

The ﬁrst set of codes relates to the factors that prompted the community to
become interested in addressing aging issues. The MPCB was integral to the
ongoing efforts of the partnership. The aging of the baby boomer generation also
played a role in getting Site B interested in doing something about its aging
infrastructure. Providing ways for seniors to stay in the community was also

identiﬁed several times (1.1.1-1.5.3).

Financial Resources

The bulk of the codes for Site B relates to the second core research
question identifying factors that helped Site B sustain its efforts. In the ﬁrst set of
codes, the coders interpreted ﬁnancial resources identiﬁed in the documents and
by interviewees. The coders placed grant funding, the Senior Expo, and member
dues in this category. This relates to code 2.1.3-has sufﬁcient resources because
Site B consistently has had a carry-over for the next year. Of the three case
study sites, Site B generated the most revenue and was able to fund services on

an individual on-time crisis basis through its Senior Support Team allocations.

Leadership

The six citations for Code 2.3.1-stable leadership came from a longitudinal
assessment of the meeting minutes that showed that the core group of leaders
remained involved in the partnership. New leaders emerged but the original ones
kept their involvement on the steering committee and through chairing

committees. Leadership dedication to advocacy for seniors is by far and away

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the most prevalent tOpic in the leadership category. The coders indicated that the
partnership held a town hall meeting, wrote a position paper, convened task
forces to address problems, and developed an advocacy paper so members of
the partnership could have talking points and speak with one voice in the
community (2.3.3). The relatively high number of citations for Code 2.3.4-recruit
and retain members, indicates that the data showed that consistent efforts were
made to keep current members engaged while consistently increasing the
number of new members. Code 2.3.5-members represented most or all sectors,
shows that Site B reached out to entities beyond government agencies and
service providers when a regional HMO and the local Chamber of Commerce
became members. Having these entities involved in the partnership signiﬁcantly

broadens its base and provides different perspectives.

Partnership Accomplishments

Networking and information dissemination are major activities conducted
by Site B. As Codes 2.4.2-2.4.5 indicate, the coders found numerous references
to the Senior Expo, pamphlets and brochures developed and distributed, the
speakers bureau, meal delivery, Senior Support Team, mini-grants and
discussions about how to get news of the partnership’s activities out to the
general public. As can be seen from the coders’ comments, the Senior Expo is a
driving force for Site B. Through it, they are able to engage service providers,
educate community members and their families through seminars, provide a
place for community members to learn about services provided by a broad range

of providers, and ﬁll their coffers to support their other projects such as the

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Senior Support Team and the mini-grants. Code 2.4.6-increased collaboration
among service providers, shows the signiﬁcant number of incidents cited that
relate to the reports made in the monthly meetings, activities Of the various
member organizations and the discussion that ensued about how the member
groups could work together.

Code 2.4.7-partnership was able to affect policy change, indicates that
Site B became involved in the political process on behalf of the older adults in
their area. This was particularly apparent when they had campaigns to educate
their state legislators on issues such as the drastic cuts to the Medicaid home
and community based services waiver for long-term care and other budgets cuts
for services used by seniors that could have a deleterious impact on their health

and well being.

Stakeholder Buy In, Community Champions, Political WIII, and Community

Recognition

The 2.5 code series pertains to stakeholder buy in for the partnership’s
efforts. In this regard, Site B has done well with the support it received from the
Human Services Coordinating Council (MPCB), Chamber of Commerce, Senior
Expo from both vendors and community members, and local media that
Specializes in aging issues. Code 2.6.1-at least one inﬂuential community leader
openly supports the partnership is fulﬁlled by the long-standing support of the
MPCB and the more recent engagement of the Chamber of Commerce.

The ﬁnal series of codes under the factors that sustain community efforts

to address aging concerns political will and community recognition. The coders

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identiﬁed the support from the MPCB and the Chamber of Commerce as
evidence of the political will of the community’s leaders for the partnership’s
goals and efforts. The consistent large attendance at the Senior Expo
demonstrates the community’s support for the efforts of the partnership.
Community recognition in large measure comes through the Senior Expo, the

MPCB and the Chamber of Commerce (2.8.1-2.8.4).

Hindrances to Sustainability

The next set of codes relates to the third core research question regarding
the factors that hindered the community’s efforts to address aging. Code 3.1.2-
partnership does not have sufﬁcient resources to maintain its administrative
functions was not found to be the case for Site B. One time in the meeting
minutes, it was mentioned that it would be nice to have money to have a
research study/needs assessment conducted but this did not impede the general
functioning of the partnership. It was mentioned that Site B is an all volunteer
organization with in-kind donations of meeting space and ofﬁce functions so its
overhead costs were very low.

Codes 3.2.1 and 3.2.2 are concerned with turf battles. AlthOugh the
partnership was indeed skewed toward service providers (3.2.2), the group was
open to other types of entities as members to broaden the base and bring other
perspectives and expertise to the table. Site B was effective in doing this. The
only turf battle mentioned pertained to the purpose of the group. Some members
thought the partnership’s purpose was predominantly networking while others

thought it should be project-oriented. The members found a compromise position

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by doing both of these. AS the membership grew, there were sufﬁcient people
involved so that the partnership could diversify its efforts. The partnership spent a
considerable part of its monthly meetings sharing member updates in addition to
hosting the Senior Expo and sponsoring Senior Support Team.

The code series 3.5 regards community apathy. This was not mentioned
in the documents or by the interviewees to any great extent. The strategic plan
brieﬂy mentioned that there needed to be more of an effort to expose the
community to the issues surrounding aging. Code 3.5.3 pertains to involvement
of the faith community. The interviewees were asked about this speciﬁcally since
it was not mentioned in the documents. They stated that although the faith-based
service providers were involved in the partnership, members of congregations,
denominations or the ministerial alliance were not involved because they had not
been actively recruited.

Code series 3.6 regards lack of information. The only mention of this is
that they did not have a current needs assessment for the area and needed to do
one, especially so they could complete the Community for a Lifetime application

which requires a signiﬁcant amount of detailed information.

lntemal Factors Inﬂuencing Sustainability

Code level 4 is the ﬁrst part of the fourth core research questions. It
identiﬁes internal factors that had a bearing on the partnership’s ability to sustain
the collaboration. Codes 4.1.1 to 4.1.3 involve changing membership. The coders
both identiﬁed the tremendous growth in membership as a change that occurred,

albeit a positive one. The membership grew from 36 to 61 in one year. This

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caused some disruption as the new members integrated into the partnership but
it provided much positive momentum to the group. The leadership changed not
only because of agency staff changes, but because of time commitments of
those who had led the group and new people coming into the partnership who
were willing to take a leadership role.

The core group of people who have been involved for a decade remains in
tact. This has provided great stability and institutional memory to the group. Once
local entities become member organizations, they have a tendency to maintain
their membership so very little attrition was noted. New members have joined
and become involved in the information sharing, problem-solving, information

dissemination, and projects such as the Senior Expo.

As to racial and ethnic diversity (4.2.2), it was not apparent at the monthly
meeting, however, there is age diversity among the members. The community is
somewhat ethnically diverse because it has a large number of migrant workers
and a tribal band. The migrant workers tend to be younger than the population
targeted by the partnership. The tribal band has been invited to participate but as
yet had not been actively involved. Code 4.2.4 pertains to the breadth of the
organizations involved in the partnership. As stated previously, Site B has been
successful in recruiting and retaining members from not-for-proﬁt and for-proﬁt
agencies, government agencies, transportation, and has a regional HMO as a
member. Not only has the Chamber of Commence joined the partnership, the

partnership has joined the Chamber so there are considerably more linkages to

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other groups and organization in the community than when the partnership

originally formed.

Codes 4.3.1-4.3.5 relate to the partnership’s purpose. Site B has deﬁned
its role as increasing the quality of life for the area’s older residents, increasing
service coordination and collaboration through networking and problem solving,
and helping to meet unmet needs through mini-grants and the Senior Support
Team. Site B has a mission statement that informs its goals and guides its
strategic planning development and implementation, including the development

of a ﬁve-year plan to accomplish its goals.

Extemal Factors Inﬂuencing Sustainability

The second part of the fourth core research question (5.1-5.3) relates to
the external factors that have a bearing on the ability of the partnership to sustain
its collaboration. For Site B, external factors did not appear to have much
inﬂuence on the workings of the partnership. Site B is able to generate revenue
with which to operate and support its projects. It did seek some external grant
funds but those were to augment its ability to increase the amount of money it
has to meet unmet needs of older residents. With regard to policy changes, these
had an impact on the advocacy efforts of the partnership but not its ability to
Operate or generate revenue to support its activities. The interviewees and the
documents did not mention changes in community priorities regarding older
adults. The level of support remains steady in regard to the support of the MPCB,
the Chamber of Commerce, and service vendors and community residents who
participate in the Senior Expo.

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SYNOPSIS OF CASE STUDY SITE C

The Partnership C was formed in April 1998 as a workgroup of the
coordinating council, the county’s Multi Purpose Collaborative Body (MPCB). A
growing awareness of the need for a senior focus in the county prompted the
formation of the partnership of Site C. The original mission of Site C was “to
educate, coordinate, and assess senior services and needs while promoting
dignity and quality Of life for all seniors throughout the county’ (from meeting
minutes). The goals of the original group were: 1) to provide information,
education and outreach to the community and seniors which includes being a
resource network for seniors and the community and developing strategies for
reaching isolated seniors; 2) to promote coordination and networking among
providers including developing a resource network for agencies and decreasing
unnecessary duplication among agencies/providers; and 3) to offer an ongoing
assessment of current and future services, needs and resources which includes
awareness of local, state, and federal funding issues; determining why some
services are under-accessed; and determining what programs are needed to ﬁll

gaps in the current system (from meeting minutes).

The workgroup disbanded in March 2000, but was encouraged to regroup
in October 2000. In December 2000, a survey was distributed to workgroup

members, the results of which demonstrated that they supported regrouping.

In 2001, the workgroup met 11 times to determine its mission, begin
education regarding services, determine the top senior needs and to develop a

survey. The survey was distributed in December 2001, to senior and human

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service agencies, senior living residences, churches, physicians, politicians, and
other community members. Seven hundred surveys were sent and 52 responses
were received (5.7% response rate). Survey respondents were front-line staff
working with seniors. Survey topics included transportation, prescription
medications, in-home services, and major and minor house repairs. The results
of the survey were used to determine the areas upon which the Partnership C
would focus its efforts; to develop goals and objectives in the focus areas; and to

monitor and measure progress on the goals and objectives.

In April 2002, the results of the survey were discussed by Partnership C
members. They identiﬁed several outcomes they wished to accomplish: 1)
identifying seniors who have needs that were not being met; 2) raising senior
awareness of available services; 3) raising awareness of others who touch
seniors’ lives; 4) raising awareness of governmental decision makers; and 5)
raising awareness regarding prescriptions at senior living facilities. During the
May 2002 meeting, the group further discussed the goals it wanted to
accomplish. They decided to select four areasutransportation, home services,
prescriptions, and home repair--on which to work and to narrow their scope to
target seniors who needed services. Partnership C members determined that
they would identify the services that would have the greatest impact on the target

group (from meeting minutes).

At the August 2002 meeting, it was decided that home repairs would be
the single focus area, primarily because seniors were accessing the other three

areas with few problems. Seniors appeared to have a difﬁcult time accessing

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home repair services. There was also the possibility that seniors could be
victimized by vendors doing poor work, making unnecessary repairs, and
overcharging seniors for their services. The outcomes identiﬁed with the home
repair project were to identify a reputable contractor to provide assessments and
estimates; develop a resource page for the telephone book; develop a booklet or
handout; identify a community person to explain available services and match
seniors to them; and develop a preferred provider list. By their November 2002
meeting, a draft document delineating home repair outcomes was reviewed. The
primary outcome was that seniors have access to quality major and minor home
repairs. The concomitant goals were that all seniors referred to programs are
able to get major and minor home repairs; that there would be coordination
among local resources to provide quarterly home repair/service; and to increase

availability of home safety equipment.

Attendance at the Partnership C meetings lessened as 2002 progressed.
The attendance during the ﬁrst three months of the year ranged from 15 to 21
members. By the last three months of the year, attendance ranged from 8 to 10

members.

In January of 2003, 7 members attended and the average 2003
attendance hovered around ten members. During 2003, Partnership C kept track
of the number of requests made by the county’s seniors for home repairs and
yard work as it discussed various scenarios on how to address the need,

including contact with the local Home Builders Association (HBA). By the end of

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2003, Partnership C was recruiting organizations such as schools as well as

individual community members to assist seniors with yard work.

It took until October of 2004, to ﬁnalize the partnership with the Home
Builder Association. Requests for services would come through 2-1-1 and be
provided to a designated Partnership C member. The member would batch the
requests and provide them to the HBA monthly. For emergency repairs, the
requests would be brought to the HBA Executive group. In December 2004,
Partnership C sent letters to 21 service clubs throughout the county requesting a
$500 donation to support home repair for the county’s Seniors. The donations
would fund supplies for repairs done by members of HBA. Some donations were

received to fund this project.

The 2004-2005 Partnership C goals provided to the MPCB were 1) all
seniors referred to programs are able to get home repairs and maintenance and
2) all seniors are able to receive access to health information and services.
Measurement indicators were not identiﬁed, stating that baseline information was
being gathered by 2-1-1. Strategies for addressing the goals were to work with
HBA for home repairs and local high schools to recruit volunteers) for yard
maintenance. The second goal was still in the workgroup phase, determining
what recommendations to make with regard to increasing education about pet

therapy, ﬁre safety, substance abuse prevention, and health screening.

The attendance at the beginning of 2005 was higher with 19 members in
February. By the end of 2005, attendance was down to 6 in November and 9 in

December. In February 2005, discussions were held regarding a pet care

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program but the issue did not appear in subsequent meeting minutes. The
group’s activities centered around evaluating prescription drug use with the
development of a SMART goal to complete prescription evaluations by a
pharmacist for at least a quarter of the county’s residents through conducting
brown bag programs in three separate geographic areas during November,
December and January 2006. The programs would work with a local pharmacy in

each area and would be assessed in February to determine their effectiveness.

Partnership C met eight times during 2006 with attendance ranging from
10 to 16 members. The attending members represented public agencies, not-for-
proﬁt groups and for-proﬁt service providers. For-proﬁt agency representation on
Partnership C increased during 2006. Since Partnership C was founded as a
workgroup of the MPCB, this represented a shift in membership that brought a
different interpretation of the purpoSe for Partnership C. At the June meeting, it
was noted that regular attendance was necessary to keep the group moving
forward and that if Partnership C had a strong focus, members would come more
regularly. At the July 2006 meeting, frustration was mounting regarding the
inconsistency of member participation, lack of goals, and stress of taking on
projects that were too big for such a group to accomplish. The group decided that
it should be a fact-ﬁnding committee and create a universal senior survey to meet
data needs of the member organizations so that a gap analysis of community

services could be conducted.

In 2007, Partnership C met in January but did not meet during the rest of

the year. By January 2008, Partnership C met again at the urging of the MPCB.

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Attendance ranged from 9 to 19 members throughout 2008. In 2008, Partnership
C had new leadership and an active focus on data collection through surveys of
seniors and service providers. The results of the 312 senior (customer) surveys
received were timed so they could be used to respond to a request for proposal
in July. In addition to conﬁrming what the group had perceived about the
community, the survey results indicated that there is an unmet need among
caregivers in the community whose needs are not well addressed by existing
services. Partnership C members presented the results of the survey to their

various home organizations.

The 2008 Partnership C meetings were viewed by members as an
information dissemination platform for local agencies to discuss their projects and
services. The group became more of a problem-solving venue where member
organizations could explore manners in which they could refer clients to each
other as well as learn about services available through other agencies that would
beneﬁt their clients. A signiﬁcant accomplishment of Partnership C in 2008, was
greatly to enhance the senior services information in the community report card
published by the MPCB that was allocated two pages rather than the previously
allocated one page. Partnership C plans to expand the focus even further in
2009. Partnership C will gather information from 2-1-1 on calls received

regarding senior issues as another element of its data collection strategy.
ASSESSMENT OF SITE C DA TA

Site C provided meeting minutes, surveys and survey results, brochures,

and event announcements as documents for the case study. Six individual

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interviews were conducted with leaders of Site C’s partnership in September
2008. The researcher attended the August and September Site C’s partnership
meeting and observed the meeting’s dynamics. The full coding table is located in
Appendix C. Analysis of the coded data is presented below. The numbers in

parentheses are the codes in Appendix C.

Factors That Prompted Site C to Form a Partnership

Demographic trends and events were what prompted the MPCB to
establish a sub-committee to address aging issues (1.5.1). It is recognized that
the baby boomers aging in their community (1.2.1) made it important to promote
ways for older residents to age in place (1.3.2). Site C experienced more

leadership changes than were noted by Sites A and B.

Financial Resources

The interviewees all commented about the fact that the county has had a
senior millage (property tax) over ten years and it has always been renewed by
the voters. The millage garners over $2,500,000 a year to support senior
services through a grant process. Many of the grantees are actively involved in
the partnership (2.1.1). Because the partnership is a sub-committee of the
MPCB, it has provided support staff to produce meeting minutes and other
documents through the MPCB (2.1.2).

The partnership does not have paid staff. Ofﬁce supplies and services are
provided in-kind so it has sufﬁcient resources to maintain its current level of

activities (2.1.3). The county has a large international foundation located within

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its boundaries and thus has been involved in several collaborative initiatives,
most of which pertain to health issues. The interviewees commented that
previous initiatives have been positively received by community members (2.2.1

- 2.2.6).

Leadership

In some ways, the partnership has had stable leadership in that it has
consistently reported to the MPCB and the primary senior serving agencies in the
county have continued to be involved (2.3.1-2.3.2). The primary means of
soliciting community input has been through surveys, one targeting frontline
providers and the other consumers of senior services (2.3.6).

The partnership went through an identity crisis where it seemed to move
away from the mission set forth by the MPCB. In fact, when asked about the
mission, goals and objectives of the partnership, the interviewees said they
needed to develop those. However, these were located in some of the early
documents from the partnership (2.3.3-2.3.5). The change in partnership
leadership since the group reconvened in early 2008, explains the lack of

institutional memory.

Partnership Accomplishments

The partnership accomplishments center around its information gathering
through the provider and consumer surveys, its links to the regional health
alliance, elder abuse task force, hosting events such as the health fair, and other

community initiatives (2.4.1). The enhancement of the senior section of the

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community report card produced by the MPCB is also viewed as an
accomplishment because it disseminates valuable information to community

members (2.4.1).

The reconvened partnership, as described by the interviewees, seems to
view itself as an information conduit where members share information during the
monthly meetings about their agencies and what the agencies have to offer.
Issues are brought to the table and the members discuss ways to solve the
problem, especially about ways they can help address the problem or by

describing other options that could be available (2.4.6).

Stakeholder Buy In

As far as stakeholder buy in is concerned, as part of the MPCB, Site C
has a strong support base among inﬂuential members of the county’s human
services community. The MPCB connection provides the partnership with
resources as well as entrée into the community at large (2.5.1-2.5.2, 2.6.1,
2.7.1). The arrangement the partnership developed with the Home Builders
Association (HBA) is innovative (2.5.2). It is one of the projects in which the
partnership provides a linkage between seniors and a community service. By
arranging quality, cost-effective and non-exploitative home repair services to
seniors, the partnership provides one of the services necessary for seniors to
age in place. It also raises awareness of housing issues in the business
community through the local HBA’s involvement. One of the long-term members

of the partnership is the editor of the Senior Times which provides space in its

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publication for news and public service announcements about the activities of the

partnership and its member organizations (2.5.4).

Community Recognition

On one hand, Site C’s intention is not to promote itself and its work and
therefore, there is not much community recognition of its efforts. On the other
hand, Site C does host events under its name such as the health fair. As a sub-
committee of the MPCB some of the actions of the partnership are recognized

under that umbrella organization (2.8.1-2.8.4).

Hindrances to Sustainability

Code level 3 pertains to factors that hindered community efforts to
address aging issues. As noted previously, there was a parting of the ways in
2006, about the purpose of the partnership with vendors deciding to form a
separate group that addressed their speciﬁc needs. The partnership’s purpose as
stated in the 1998 mission statement (to educate, coordinate, and assess senior
services and needs while promoting dignity and quality of life for all seniors
throughout the county), is consistent with the present partnership’s activities.
Although the current members did not realize they have a formal mission
statement, their present activities are closely aligned to the original intent for the
group (3.2.1-3.3.1). As discussed previously, the leadership of the group has not
been consistent over its decade of existence. Some of this was due to personnel
changes at agencies, the expansion of membership to include service vendors,

and the tragic death of one of the driving forces for senior services in the county.

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Two very well respected agency directors have co-chaired the group since it
reconvened in January 2008 after the hiatus that took place in 2007. The group
has been reinvigorated and membership has increased under the new leadership
(3.4.1-3.4.2).

Code series 3.5 concerns community apathy. Interviewees talked about
how the community at large has not embraced senior issues or the negative
effects that lack of attention to seniors can cause for the whole community. The
partnership is working to disseminate information about these issues to the
general community through media pieces, health fairs, seminars, and its portion
of the community report card produced by the MPCB. Members of the faith
community have not been included in the reconvened partnership but the
partnership is aware of faith-based activities and services for seniors and
promotes them when feasible (3.5.1-3.5.3).

Code series 3.6 regards lack of data. The partnership has conducted
surveys of frontline providers and community members. The data from the
surveys were aggregated and discussed at partnership meetings. The data were
used to determine priorities for the partnership’s efforts. An interesting source of
information the partnership receives is from the county’s 2-1-1 call center. Once
again, this data informs the group’s decisions on how it should proceed (3.6.1-
3.6.2). The partnership does not provide direct services and therefore does not
seek out a signiﬁcant amount of external funding. When they do look at external

funding, their discussions tend to emphasize categorical funding scurces (3.6.3).

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lntemal Factors Inﬂuencing Sustainability

Code series 4.1 is about membership changes. As discussed previously,
Site C has had a number of leadership and membership changes over its ten
year existence. These changes culminated in a lack of engagement by a
substantial number of members that led to the group not meeting from February
through December of 2007. At the urging of the MPCB, the group restarted in
January 2008, under new management and with a renewed sense of purpose
(4.1.1-4.1.3). The membership of the partnership is mostly from the largest city in
the county which is where the monthly meetings are held. The interviewees
expressed a desire to have representation from some of the smaller communities
throughout the county and are discussing ways to engage them. Site C has age
diversity but not racial or ethnic representation although the county is racially
diversity (4.2.1-4.2.2). The partnership members represent agencies that serve a
wide variety of socioeconomic groups (4.2.3). The member organizations are
heavily weighted toward publicly funded agencies that are members of the MPCB
and the health care and residential care sectors are well represented (4.2.4).

Code series 4.3 presents data about the partnership’s purpose. The
partnership is a sub-committee of the MPCB with the express purpose of
educating, coordinating, and assessing senior services and needs as they
promote dignity and quality of life for all seniors living in the county. As discussed
previously, the current membership and leadership of the partnership is re-
examining its roles and functions within its charge from the MPCB (4.3.8). The

member organizations share information and address issues at their monthly

234

meetings as a means of collaborating and identifying service needs and gaps in

the county (4.3.1-4.3.7).

External Factors Inﬂuencing Sustainability

External factors did not play a great role in the sustainability of Site C’s
partnership. Since they have sought little in the way of external funding, there
was not a reduction in available funds to the partnership although funds were
reduced for member organizations (5.1.1). Several of the interviewees mentioned
that the decrease in housing values could have a negative impact on the amount
of senior millage funds generated and therefore would reduce availability of funds
granted to partnership activities through the senior millage (5.1.4). State-level
policy changes cited by interviewees were associated with funding cuts and the
memory of the looming state government shutdown when there was such

contention in the legislature over the budget (5.2.2).

235

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