New Report from Grantmakers in Aging Explores Impact of the Opioid Epidemic on Rural Aging

Written by GlobeNewswire, August 24, 2017

“Heartache, Pain, and Hope: Rural Communities, Older People, and the Opioid Crisis: An Introduction for Funders” examines who is affected, how we got here, and what’s working.

The opioid crisis is a story of many types of pain, and how individuals, families, and entire communities – particularly small and rural ones – are becoming collateral damage. A new paper released today by Grantmakers In Aging -- Heartache, Pain, and Hope: Rural Communities, Older People, and the Opioid Crisis: An Introduction for Funders -- looks at the problem with a fresh perspective, focusing overdue attention on the damage to rural communities, particularly the lives of older people, and describing proven programs, innovative partnerships, policy recommendations, and scientific and medical responses that governments, communities, nonprofits, and philanthropies can support and expand.

Read the full paper here.

Rural communities tend to be tight-knit and self-reliant, but their infrastructure and resources are often limited, their populations are older than the rest of the country, and they are frequently overlooked in national policymaking. This has been a dangerous mix when it comes to opioids. According to the CDC, for example, people in rural counties are nearly twice as likely to overdose on prescription painkillers as people in cities, and the wider impact is enormous as well.

"Community-Wide Aftershocks" of the Opioid Epidemic

“This crisis has caused community-wide aftershocks -- in child welfare, elder abuse, public safety, criminal justice, the workforce, the economy, caregiving, housing, and, of course, health care, and many older people are suffering as a result, often without care, attention, or support,” says John Feather, PhD, CEO of Grantmakers In Aging (GIA). “Some older people do suffer from opioid misuse and addiction problems, but the fallout reaches well beyond the addicted individuals, and the response from foundations and service providers must be broader as well, to address that wider set of needs.”

Putting the Needs of Older People on the Opioid Agenda

Some issues of particular concern to older people include:

  •   High rates of chronic pain, which is sometimes treated with opioids. This must be considered when making changes to the regulation and prescribing of opioids, and more alternative treatment options are needed.

  •   Cultural and generational sensitivities that may stop older people from seeking help when they do have a dependency. Reducing stigma and improving access to specialized help in rural communities are key objectives.

  •   Increased risk of elder abuse, and the need for stronger prevention and intervention options.

  •   Recognition and support for older people who take on additional responsibilities, such as raising grandchildren whose parents cannot care for them.

Rural communities bring certain unique strengths to this challenge, such as cohesive, supportive kinship and community networks and flexible, innovative local institutions. By understanding both the needs and the potential of rural communities, funders of all kinds can form better funding relationships and achieve greater impact on this sweeping national problem.

“Tivity Health has made a commitment to help address complex issues related to rural aging, and the impact of the opioid epidemic on rural seniors is truly catastrophic,” said Donato Tramuto, CEO of Tivity Health. “I know that rural communities have strengths that those outside the community may not recognize, and many are dealing with these issues with compassion, hard work and through innovative programs. I commend Grantmakers In Aging for bringing increased focus to this important issue with such a timely and provocative publication.” 

Creating a Network for Rural Aging

Heartache, Pain, and Hope: Rural Communities, Older People, and the Opioid Crisis: An Introduction for Funders is made possible by funding from Tivity Health and Empire Health Foundation and is the second paper GIA has published as part of its rural aging initiative. 

Tribal Partnerships: A Health Foundation Balances Relationships And Results With Native American Communities

Published by: Health Affairs

Written by: Brian Myers, EHF Vice President of Rural Health and Capacity Building, and Mike Yeaton, EHF Chief Strategy Officer

The chairman of the tribal council pointed to the rusting van and the community garden gone to seed. Outsiders often come here with good intentions, he observed, but when they leave, our Tribe is no better off. This encounter has framed all of Empire Health Foundation's (EHF's) subsequent work with Native American partners in profound ways.

We work for this health foundation in Eastern Washington, the goal of which is to make measurable improvements in our region’s health. Given the profound disparities in health outcomes between Native Americans and the general population, this has inevitably led us to focus on our local tribes, including Spokane, Colville, and Kalispel.

EHF has a decidedly quantitative evaluation culture, whether we are focused on adverse childhood experiences (ACEs), obesity in public schools, or the uninsured rate in our community. What is clear is that tribal partnerships cannot focus solely on numbers but must strive for good results within a context of mutual trust and action. After several missteps (“burn to learn”), we have found a successful strategy based on three basic tenets:

  1. Build trust first.
  2. Develop mutually beneficial outcome measures.
  3. Always leave something behind.

Build Trust First

At our very first meeting with one group of tribal partners, we were asked what insurance products we were selling! From that inauspicious beginning, we have returned again and again to build a dialogue and relationship. One of the clear lessons learned is that there can be no firewall between their goals and ours, and we must actively resist the tendency toward an asymmetric funder–grantee relationship. Because of their openness and our benign persistence, we now are linked in increasingly deep ways: members of our leadership team serve on the boards of several tribal nonprofits, while representatives from all three local tribes serve on our foundation’s board. We were deeply gratified when EHF board member Tawhnee Colvin recently observed: “Our relationship with EHF and their staff has been very positive and rewarding. Face to face communication and open transparency has made our relationship successful. I appreciate that EHF has been very sensitive to the Spokane Tribe’s traditions and customs, and has been overwhelmingly resourceful and respectful to our aging community.”

Develop Mutually Beneficial Outcome Measures

One of our tribal initiatives is Health Coaching for Activation, which seeks to improve the health, wellness, independence, and quality of life for seniors living on the reservations. Tribal Health Coaches visit the elders’ homes, conduct assessments, set goals, and provide resources and connections within the community to address a variety of needs, primarily related to social determinants of health. Research has demonstrated a strong link between improvements in patient activation and improved health outcomes in measures related to emergency department (ED) visits, obesity, smoking, blood sugar levels, and more.

Hal Harvey wrote in the Chronicle of Philanthropy, “Reporting must benefit, in obvious ways, the grant maker, the grantee, or, ideally, both.” As we work with tribes, we look for outcome measures that balance the need for objective evaluation with the goals and constraints of our partners. The Patient Activation Measure (PAM) survey measures activation through a simple, ten-question instrument, which is administered every three months and is easily incorporated into regular home visits. For Tribal Health and Human Services (HHS), it provides regular feedback on the well-being of participants and the efficacy of Tribal HHS’s program in partnership with the foundation. For our foundation, it provides empirical data to evaluate the effectiveness of our grants and guide future funding decisions.

Always Leave Something Behind

Leaving something behind does not always mean a physical asset. Early in our work with one tribe, we met a young mother of four who was working as a driver taking seniors to and from the community center for meals and other activities. Two things quickly became evident: she had the trust and respect of the seniors, and she was bright and eager to build new skills. With the support of Tribal HHS leadership, we provided training that enabled her to become a certified nursing assistant. She now serves as the Lead Health Coach for her tribe, and the Health Coaching for Activation program has achieved our shared objective of a 20 percent improvement in activation while reducing hospital readmissions by 65 percent. Regardless of the future of this program, she has grown her qualifications, skills, and confidence in important ways.

Of course, no two tribes are alike, and what we are suggesting here is not offered as a one-size-fits-all formula. Yet, we think these principles can be powerful guides to building effective program partnerships with our country’s first communities. Our journey began as one to address health disparities but has blossomed into a rich tapestry of relationships with vastly greater potential for impact.

Read the original article here.

In pursuit of health and equity for all

Darkness cannot drive out darkness; only light can do that.  Hate cannot drive out hate; only love can do that.”  -Martin Luther King Jr.

In the wake of the tragic events in Charlottesville this past week, we believe that hate and racism has no place in America, in Eastern WA, or in any healthy community.  It is in these key moments that all of us, whether individuals or organizations, need to express our values.  So that our neighbors and partners and children do not interpret our silence as agreement with those who act on hate.  

While we may not have any Confederate monuments to tear down, our community is sadly not immune to hateful action.   In the past year, Spokane headlines have included racist vandalism scrawled on the Martin Luther King childcare center, desecrating a Sikh temple being mistaken for Muslim, anti-Semitic and racist flyers posted multiple times on the Community Building, hateful words of “Get out!” spray painted on the garage of a refugee family, and hateful graffiti on the Salish School.  While the community and leadership have come together in support in each incident, we all go back to our busy lives the next day.  Never stopping to notice that what used to be a once a year headline is now nearly monthly - are hate crimes now normal in our community?

As non-profits with health missions, we believe that advancing healthy communities means advancing equity.  At our leadership team meeting this week, we asked the question:  it’s not if but when the next tragic incident happens either nationally or locally, and will we sit back and wait for it, or will we be proactive and do something to advance equity?  And if we are proactive, what does that mean?

Equity is integrated into our grant making, and our services.  We are challenging ourselves to ask tough questions and use an equity lens in our work. It's a journey.  For example in our Adverse Childhood Experiences work, we went in with a  broad "reduce suspensions for everyone goal" when at the time African American students were getting suspended at 3x the rate. That disparity has since almost been eliminated, thanks to significant attention and effort by Spokane Public Schools.  From that lesson we are now partnering with Catholic Charities to prevent children from entering foster care, with an explicit goal to reduce the disparity for Native American children. While these are great efforts, the current crisis demands fresh ideas and greater proactive action.

Ideas to be proactive include:  

  • Pilot grants to non-profit and grass roots organizations working towards equity in our community, such as NAACP, YWCA, and the Interfaith Council.
  • Convening a community conversation on how to discuss national events like Charlottesville, Orlando, Atlanta and Ferguson with your children or in the classroom.  
  • Grant investments to help county and city law enforcement to adopt best practice in identifying, tracking and prosecuting hate crimes.  Or other collaborations to meaningfully reduce hate crimes.
  • Having mental health experts on standby to work phone banks for people who are worried, hurt, angry or confused.

What are your thoughts?  We would love to hear from you.

Leveraging Resources for Greater Impact

From the Rural Health Information Hub by Kay Miller Temple

The Rural Health Care Coordination Network Partnership connects federal funders with local philanthropic organizations to help rural areas get the necessary funding they need to improve health in their communities. Learn more in Rural Health Philanthropy Partnership: Leveraging Public-Private Funds to Improve Health, in the Rural Monitor.

Empire Health, Catholic Charities team up to keep Spokane kids out of foster care

From The Spokesman-Review by Rachel Alexander

It’s no secret that kids placed in Washington’s foster care system often struggle later in life.

Statewide, fewer than half of children in foster care graduate from high school. Former foster children are more likely to end up in jail or homeless, and their rates of college attendance are in the single digits.

“There’s a lot of research now to support this fact that kids who go through foster care tend to end up with lifelong consequences,” said Nadine Van Stone, the vice president of crisis response and shelters at Catholic Charities.

After years of work, Empire Health Foundation believes it’s found a solution: keep those kids from entering foster care in the first place.

The foundation is partnering with Catholic Charities to open a new program called Rising Strong, which will offer support to parents in danger of losing their kids to the foster care system. It’s an all-encompassing program designed to help parents kick drug or alcohol addiction, which are the main contributors to losing custody.

“We also believe in the power of families to help each other,” said Mike Yeaton, chief strategy officer for Empire. “Often these parents, they don’t want to stay in an addictive life.”

A pilot program, focusing on 20 families, will start in October at the former site of the Sisters of the Holy Names of Jesus and Mary convent. Families will live together on-site and have access to mental health care, substance abuse treatment, parenting classes, work training, GED programs and more.

“The foster care entry rate in Spokane County has been significantly above the state average,” Yeaton said.

The system itself is overtaxed, and social services to keep families out of it are lacking, he said.

“If you can help those parents to restore their family functioning, that’s the best way to help those things,” he said.

Rising Strong is modeled on a similar program in Los Angeles called Exodus, which has a 90 percent success rate in keeping families together.

The goal is to eventually serve 50 families in one of the permanent supportive housing units Catholic Charities is building on the former convent site, Van Stone said. Families would live in an apartment on-site and receive ongoing support for roughly 12 to 18 months, though the length will depend on individual needs.

It’s estimated to cost about $1 million a year, which would be about $20,000 per family served. That’s significantly cheaper than the cost of court visits, arrests and other costs associated with keeping a child in foster care for a year, Yeaton said.

Funding has come from Providence Health Care and Premera Blue Cross, which announced a two-year, $175,000 grant this week. The team is looking into state and federal grants as well.

Empire has partnered with Washington State University to collect data on the pilot program and demonstrate its effectiveness, both in terms of family outcomes and cost savings.

Families will receive peer support and can come back to Rising Strong for services if they need them, Yeaton said.

“You are there for those families in the future too,” he said. “It’ll be a sustained involvement in these families’ lives.”