Editor’s note: The John A. Hartford Foundation, the Administration for Community Living and The SCAN Foundation fund the Aging and Disability Business Institute, led by the National Association of Area Agencies on Aging (n4a). The mission of the Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Aging and Disability Business Institute, ASA and n4a are collaborating on a series of six articles and case studies in Aging Today that highlight the Age-Friendly Health Systems initiative.
When John Auerbach, president and CEO of Trust for America’s Health (TFAH), Anne De Biasi, TFAH’s director of policy development, and Megan Wolfe, TFAH’s policy development manager, began researching how to engage county health departments in planning for their communities’ burgeoning older adult population, they found that many public health department staffs had no knowledge of organizations that were already assisting older adults with supportive services.
Having worked in public health for 30 years, this lack of knowledge didn’t exactly surprise Auerbach, but it might be news to professionals working in the aging services sector. This disconnect between county health departments and community-based aging services will soon become a thing of the past when TFAH succeeds in fostering The John A. Hartford Foundation’s Age-Friendly Health Systems and Age-Friendly Public Health initiatives, or what Wolfe calls “one big social movement.”
The Mission? Get a Seat at the (Aging Services) Table
Headquartered in Washington, D.C., the TFAH is a 20-year-old nonpartisan, nonprofit public health policy, research and advocacy organization focused on preventing poor health across states’ populations. In its monitoring of major public health issues, TFAH sees aging as being an important area in which to make a significant contribution to public health.
In Auerbach’s previous work at the Centers for Disease Control and Prevention (CDC), he often met with public health officials in various states. “The people in these public health departments, who are so skilled in the work they do … were engaged in overwhelming issues around caring for older adults in their own families, but aren’t addressing issues of older adults at work,” says Auerbach. He pondered what role public health could play in aiding older adults, and wondered if TFAH was too late to the table, or if it would be resented by people already engaged in delivering elder services in the community.
In their initial research, TFAH asked questions of all parties, people involved in county health and in aging services, and asked them “with humility,” Auerbach says. He partnered with The John A. Hartford Foundation to support TFAH’s initial 2017 meeting with county health departments in Florida.
After this two-day meeting, TFAH decided there was an important role for public health: to fill existing gaps in aging services, using the “skills of public health,” as Auerbach calls them. These are skills such as community health needs assessment and planning; program development and implementation; health education; data collection and analysis; work in biostatistics, environmental health and epidemiology; emergency preparedness planning and implementation; and health services administration.
TFAH also did solicit a willingness to support TFAH’s work from area agencies on aging, AARP and several state elder affairs secretaries. The result? TFAH began to understand it would be welcome to participate in serving older adults via public health programming.
A Pilot Launches, Takes Off
TFAH has now developed a framework for engaging public health in healthy aging: to connect and convene sectors and professions that provide supports, services and infrastructure to promote healthy aging; coordinate existing supports and services to avoid duplication, identify gaps and increase access to services and supports; collect data to assess community health status and the aging population’s needs; conduct, communicate and disseminate research findings and best practices to support healthy aging; and complement and supplement existing supports and services, particularly in terms of integrating clinical and population health approaches.
TFAH’s next step in 2018 was to use the framework to help create a multi-county pilot program in Florida, the Age-Friendly Public Health Learning and Action Network. With funding from The John A. Hartford Foundation, Auerbach and the TFAH team worked with Florida’s then State Surgeon General and Secretary of Health Dr. Celeste Philip, with support from the Florida Department of Elder Affairs, to put the pilot program into place in Florida’s county health departments. At most, TFAH had assumed that 17 of Florida’s 67 counties would participate, but was so pleased to secure participation from 37 counties (including both rural and urban counties) across the entire state, representing 65 percent of the older adult population in Florida.
In October 2018, TFAH convened representatives from the 37 county teams to begin implementing the framework as part of the new Learning and Action Network. The work began by exploring existing data, and fielding questions about other data that could help be helpful in planning the pilot program. They looked at issues such as social isolation, dementia, Alzheimer’s and any potential ways public health departments could be of assistance to elders in Florida, zeroing in on a vision and an action plan for each of the 37 counties.
The Learning and Action Network pilot consisted of monthly calls and webinars to share the data it was gathering to identify priorities, provide technical assistance from experts and facilitate the production and release of the Aging in Florida Profiles (FLhealthcharts.com) online data tool, plus instructions for its use. Aging in Florida Profiles detail life expectancy, healthy weight, minority health and health equity, infectious disease rates and many other categories of older adult health and demographics.
After analyzing the data, county health departments quickly began to change their practices. “They all said, ‘Wow, we had an idea that the aging population was growing, but we didn’t fully understand the implications,’ ” says Wolfe.
Some county health departments that are participating in the pilot are creating healthy aging coalitions that include not only aging services sector organizations, but also sheriff departments, faith-based communities and other community stakeholders. They use the Florida Profiles data to assess community health and health needs, and to strategize health improvement plans. They also are taking important action to alter emergency preparedness plans—a critical move in a state prone to natural disasters—that previously had not addressed older adults’ needs.
The Future for Florida and Beyond
TFAH proposes to expand this work nationwide, in collaboration with The John A. Hartford Foundation, to align Age-Friendly Public Health with the National Association of Area Agencies on Aging’s (n4a) efforts and with Age-Friendly Health Systems, as well as with AARP’s Age-Friendly Communities. “Age-friendly initiatives are a natural alignment with our work,” says Auerbach.
One example exists in Florida’s Nassau County, where the county health department has instituted a falls prevention program for which the local hospital pays a case manager, who sits on the Council on Aging. The Nassau County health department helps to coordinate communication about the program, which offers home risk assessments for patients discharged from the hospital and refers them to additional falls prevention programs, such as physical activity and balance classes. “We’re still figuring out how health systems and public health can best collaborate,” says Auerbach.
Auerbach sees great potential for program replication across the country, as more and more states and national organizations have heard about the pilot and contacted TFAH. “We are planning how to scale this up. We have good support nationally from the U.S. Department of Health and Human Services, we are participating in regional meetings that address the work and we have a proposal before Congress to fund the CDC so that agency can ensure that states and local counties have a healthy aging component,” says Auerbach.
“We’re also in close contact and collaborations with city and county health officials nationwide, AARP, the Alzheimer’s Association, n4a and all major organizations whose jurisdiction is public health and aging,” Auerbach adds.
Wolfe is encouraged by the volume of response. “When we first started, we didn’t know where it was going to go, but the reception we’re getting in every sector across the country is ‘Well, of course, why not!?’"