Silo-busting

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Dr. Eleanor Barbera
Dr. Eleanor Barbera

Ideas from an interview with Dr. Donna Corrado, Commissioner of the New York City Department for the Aging

Within long-term care, overcoming the problems caused by silos can lead to better care coordination, increased interdepartmental cooperation and reduced work redundancy.

My 1-on-1 interview with Donna Corrado, PhD, Commissioner of the New York City Department for the Aging, suggests there are also benefits to breaking down silos between public and private aging services.

Area Agencies on Aging (AAA)

There are 622 area groups in the National Association Area Agencies on Aging (n4a). According to its website, “the primary mission [of n4a] is to build the capacity of our members so they can help older adults and people with disabilities live with dignity and choices in their homes and communities for as long as possible.”

While n4a's mission might seem diametrically opposed to the business interests of long-term care, this isn't the case in a capitated model. When an organization offers a continuum of care with the goal of maintaining people outside of the hospital and at the least expensive level of care, then private and government (and personal) interests align.

My conversation with Dr. Corrado revealed ways of making the most of this alignment of interests, as well as ways to boost the census in long-term care.

AAA offerings

While NYC is the largest Area Agency on Aging in the country, each AAA has it's own assortment of programs directed toward the needs of their community. There are core issues common everywhere.

Food insecurity is addressed through congregate meals in senior centers and through organizations like Citymeals on Wheels, which provides 8 million meals to New Yorkers Monday through Friday. At the National Readmission Prevention conference I wrote about last month, the speaker from Abbott Nutrition reported that proper nutrition resulted in a 28% decline in hospital readmissions over a six-month period.

Every community has a case management program that assesses individuals and offers home care services.

Senior centers (NYC has 270 of them!) can reduce the epidemic of loneliness and help identify health problems before they become medical emergencies. Funding for senior centers varies greatly, creating opportunities for collaboration.

In addition, AAAs offer a wide variety of evidence-based programming. These include falls prevention, diabetes care and other health and wellness offerings. As Dr. Corrado put it, “The government has been doing [these programs] forever.”

Rather than reinvent the wheel, LTC organizations can partner with local efforts already in place, including contracting with their local AAA to provide services.

Mutually beneficial alliances

The age-friendly cities movement provides additional options for partnership and ways to market your organization. This global effort includes enhancing accessibility, improved community support systems, increased social participation and greater access to healthcare. Install benches in your neighborhood, finance a local yard work crew for elders, organize an educational event for caregivers, sponsor a fundraiser for the local senior center — there are countless possibilities.

As an example, I initially met Dr. Corrado at an event on “Transforming Care for Older Adults” sponsored by Age-Friendly NYC, the New York Academy of Medicine — and HealthFirst Insurance.

Maintaining the census

I asked Dr. Corrado the question that could be asked of all AAAs in order to identify service gaps: “What can local nursing facilities do to meet the needs of those in our area?”

She explained that AAAs assist not only elders but also people with disabilities. She indicated that units focusing on respite care for disabled individuals as well as elders would be highly utilized.

In addition, Dr. Corrado and I pondered the dearth of community programs offered by nursing homes given the excellent marketing opportunity they afford and the increased likelihood that someone attending an event at a facility would subsequently choose it for care.

As we concluded our interview, I asked Dr. Corrado, “Is there anything you'd like to tell long-term care facilities?”

“Yes,” she said, adding her voice to those of residents, families, staff, ombudsmen and the results of years of research — often written about here: “Increase staffing.”

Given that she and other directors of AAAs are in the position of referring residents, it would be wise to heed her advice.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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