Federal funds will support multi-agency network
Jamie’s Place, the long-term senior care community in Winthrop, has received a $1.2 million grant from the federal Health Resources & Services Administration (HRSA) to develop the Methow Valley Community Based Long-Term Care Network.
The network was established last year to ensure that the valley has adequate capacity to meet the needs of its senior population, and has its roots in the Senior Assessment for Support and Housing (SASH) conducted in 2021.
The SASH Steering Committee was created to evaluate the needs of the fast-growing population of seniors in the Methow Valley. After several months of research, outreach, analysis and discussion, the group released a report that explained the challenges facing the community and offered a set of recommendations.
Those recommendations call for building capacity in a number of areas, including aging in place, facilities development, and workforce development.
The seven organizations that collaborated to develop the SASH report remain at the heart of the Network. They include three core organizations — Jamie’s Place, Methow At Home, and Family Health Centers — and five collaborating organizations: Room One, the Lookout Coalition (now a program of Methow At Home), Okanogan Palliative Care, the Methow Housing Trust and TwispWorks.
Okanogan Palliative Care was not one of the original SASH partners, but now operates under the umbrella of Family Health Centers and provides a link to other county-wide senior-support organizations such as hospitals and Enhabit Home Health & Hospice. The Network is also partnering with other organizations to develop the supports that will be needed as the valley’s residents age.
If that sounds complicated, it is, and the complexity highlights the need for coordination among the many entities and care providers that, together, meet the needs of seniors as they age and their needs change.
The Winthrop ZIP code reportedly has one of the oldest populations in the state. The SASH Steering Committee found the Methow Valley’s 65-plus cohort to be growing at eight times the rate of the valley’s population as a whole. By 2025, the group found, seniors will make up more than 30% of the valley’s residents. A large majority of residents surveyed — 80% — said they’d prefer to age at home, and the SASH report noted that that is “the least costly strategy for individuals and society.”
The SASH report’s recommendations focus on what the valley will need to support seniors who are aging at home, ensure an adequate supply of suitable housing, and care for elders who can no longer live on their own. The report also lays out a phased approach to building the community’s capacity to implement those recommendations and meet seniors’ health and human service needs.
Areas of focus
Understanding the nature and magnitude of the Methow Valley’s senior care needs, developing recommendations, and sharing that information with the community is described as Phase 1 in the SASH steering committee’s report.
Once that phase was complete, Jamie’s Place secured a one-year planning grant that enabled the partners to coalesce as a network and complete the second phase of work contemplated in the SASH report — developing a roadmap and timeline, fleshing out recommendations, and ultimately crafting a strategic plan.
With a functioning network and plan in hand, Jamie’s Place was able to secure the much larger HRSA development grant that will enable the Network to begin implementing its plans — Phase 3 from the SASH report. The new HRSA grant provides funding for four years of work. It will support a grant director to coordinate the network as well as some of the costs of beginning to meet identified senior care needs.
One of the Network’s objectives is to establish stable organizational infrastructure. That structural work will be one of the Network’s first jobs, said Jamie’s Place Executive Director Rana Clarke — members will do things like establishing decision protocols and deciding how to bring in new collaborators.
Noting that Network members have committed to four years of collaboration, Clarke said “We need to make sure that we can all successfully work together to make this process work effectively.” Network members will also work on structuring the Network to ensure long-term sustainability, so that the cooperative relationships it establishes will continue after the grant period has ended.
The Network members have formed work groups focused on the other four objectives in the group’s strategic plan, which address caregiver workforce development, aging-in-place strategies, case management and care coordination, and supported housing. Each group engages different partners to tackle a piece of the valley’s senior-care puzzle.
Developing and supporting a caregiver workforce is key to meeting seniors’ needs, agreed Clarke and Dr. Raleigh Bowden, a Jamie’s Place board of directors member and Acting Network Development Grant Director. It’s also a multi-faceted task that involves educating, recruiting and retaining caregivers, and ensuring their needs for adequate and affordable housing and transportation are met.
Clarke estimates a need for some 36-72 caregivers to meet the valley’s need for care in residential settings over the coming years, and the SASH report anticipates a need for part-time caregivers for some 200 seniors living at home.
With a grant from the Washington State Department of Health’s Office of Rural Health, the Network has already begun working with Liberty Bell High School to train interested juniors and seniors as caregivers, and Jamie’s Place has partnered with Wenatchee Valley College on a bridge program to help the organization’s home care aides become certified nursing assistants, said Clarke.
Making information about available caregivers is part of the Network’s work, as well. A caregiver liaison now assembles and maintains information about caregivers in the valley, and makes it available through Methow At Home and the Lookout Coalition, providing a clearinghouse for anyone looking for a caregiver.
In the face of the valley’s housing crisis, the Network is also investing energy in caregiver housing. “Housing is a major impediment,” said Bowden. “We can’t really bring caregivers from out of the valley unless we can figure out how to house them.”
Last fall, Jamie’s Place installed two tiny homes to support recruitment and retention of caregivers, funded in part by a Game Changer grant from the Community Foundation of North Central Washington’s Methow Valley Fund.
In addition, Jamie’s Place is actively searching for rental housing that could accommodate caregivers, including seeking unoccupied accessory dwelling units whose owners might be willing to rent to caregivers, said director Patty Spencer. As a collaborating organization, the Methow Housing Trust is using its membership in the Network to gain an understanding of current and projected housing needs, which may help the trust plan for and meet some of those needs.
Bowden also spoke of the need to elevate the perception of caregiving as a career. “Stigma associated with being a caregiver” was cited in the SASH report as an obstacle to developing the workforce that the valley needs.
“Solving the caregiver workforce problem [entails] building esteem in the profession,” said Bowden. According to the SASH report, “Physical, social, and emotional demands of the work” also present an obstacle, as do “Inadequate compensation and lack [of] professional recognition.”
Aging in place
When it comes to supporting seniors who want to age at home, “Methow At Home is tackling the biggest part of that … they’re really doing the bulk of the work,” said Clarke. That work includes everything from home modifications like grab bars and ramps, to the Stay Active and Independent for Life (SAIL) program that helps seniors improve strength and balance, to facilitating conversations about end-of-life decisions.
Methow At Home has also been working to promote home sharing as a means for seniors to get help with housekeeping and yard work, companionship, and the security that comes with having another person in the house.
Case management and care coordination was not among the recommendations in the SASH report, but it’s emerged as a significant challenge that, if well met, can have a powerful effect on senior health. The Lookout Coalition, Okanogan Palliative Care, Family Health Centers and Room One are all engaged in the daunting project of bringing collaboration and communication into the senior health-care equation.
Their intent is to “make sure there’s a safety net for the most vulnerable, complex patients who can’t get their needs met in a 15-minute office visit,” said Bowden, referring to elders who may be in the care of several specialists, using multiple medications, and in need of a navigator to make sure all their health needs are met, or those who may be dealing with dementia-related challenges that the health care system is not equipped to address.
At Room One, where 28% of the people who receive direct services are over the age of 60, “We work with individuals who have really complex situations and they really need to be working with several entities to get their unmet needs addressed,” said Executive Director Kat Goering. “We also see that as clients are working with all of these entities, they often need to share the same sensitive and often traumatizing information repeatedly which can be very triggering. This is why care coordination is so important. It helps the systems be connected, which can alleviate the load on the client.”
Most of the work group’s focus is in the Methow Valley, said Bowden, “but that aim has to go across Okanogan County because it involves hospitals and Enhabit [Home Health & Hospice]” — out-of-valley services that provide care in the valley.
The findings reported by the SASH Steering Committee include the numbers of elders who will need to be accommodated when they can no longer live at home. According to the SASH report, the valley needs to be able to provide residential care for at least 28 people in addition to the 12 for whom there are already rooms at Jamie’s Place, and also needs 16 independent-living units — although demand could be reduced by 10-20% if there’s adequate support to meet the needs of people who are aging in place and allow them to stay longer in their own homes.
Jamie’s Place is looking into expanding to meet the need for skilled caregiving. HRSA grant funds will enable the Network to make plans for expansion, said Bowden, and begin to raise funds for construction. As a nonprofit, Jamie’s Place doesn’t have the means to meet its expansion needs on its own, said Clarke. However, the organization has “launched a feasibility study to determine if we could get the funds to be able to do that,” she said, citing grants, loans, and community support as possible sources.
Once the valley’s future needs had been articulated, “Jamie’s Place felt a moral obligation” to work toward meeting those needs, said Bowden.
As the work got underway, the Network adopted a vision: “Seniors in our community will have access to a sustainable, high-quality continuum of care that supports aging in the Methow Valley.”
Bowden summarized the outcomes the Network would like to achieve in the course of the four-year HRSA funding period, to advance each of its objectives and realize that vision:
• Establish stable organizational infrastructure. Success is engaged partners who each take on responsibility to attend meetings (stay engaged) and bring forth opportunities and ideas to forward the mission of the group.
• Caregiver workforce. Success is that we have a fully staffed workforce at Jamie’s Place (AND to meet the at home care needs of the community) with a pipeline for recruits.
• Keeping seniors in their homes. That valley residents (80%-plus) will successfully age at home because they have the caregiver support they need. It will become clear when transition to long term care (Jamie’s Place) is appropriate and there will be enough space there.
• Case management. All members of the community will have seamless health care to assist in management of chronic conditions and the aging process. All providers will communicate with each other to provide the best safety net for vulnerable patients.
• Jamie’s Place expansion: Success is that we will have enough beds available, and caregivers to staff them, so valley residents, regardless of ability to pay, will rarely have to leave the valley for long-term care.
That sounds like a tall order. Fortunately, the valley has a long history of facing challenges successfully and caring for its own.
“It’s going to take all of us working together to address the barriers that prevent seniors from getting the care and resources they need to live a joyful life here in the valley,” said Room One’s Goering.