2013 INTERIM GRANT REVIEW Aging and Health Program

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1 2013 INTERIM GRANT REVIEW Aging and Health Program Grantee: Title: The Tides Center San Francisco, CA Eldercare Workforce Alliance Prior Award: $400,000 Current Award: 12/12 $400,000 2 years Paid to Date: $100, Rating: #2 (Accomplishments as expected) 2012 Rating: #2 (Accomplishments as expected) Action: Continue to monitor, link to the pending Hartford Change AGEnts Initiative Reviewers: BACKGROUND/OBJECTIVES Consultant: Rebecca R. Rittgers, MA Foundation Staff: Christopher A. Langston, PhD John L. Grammer (Summer Intern) Corinne H. Rieder, EdD Rachael A. Watman, MSW The Eldercare Workforce Alliance (EWA) was created to be an advocacy coalition for implementation of the Institute of Medicine s (IOM) report, Retooling for an Aging America: Building the Health Care Workforce. EWA was designed to draw on the credibility of diverse stakeholders engaged in coordinated action. With new members added since its inception, EWA now comprises 29 organizations concerned about health care for older adults. It represents four main interests: consumers of care, paraprofessional direct-care workers, health care professionals (both generalists and geriatric specialists), and the health care industry. The Alliance s top priorities are: 1) increasing compensation and training for direct-care workers in order to improve the quality of long-term care, and 2) increasing competence in geriatric care among health professionals through expansion of funding for federal training programs. EWA is led by Nancy E. Lundebjerg, MPA, of the American Geriatrics Society, and Michele Saunders, DDS, a past president of the Gerontological Society of America. The project was reviewed by Rebecca R. Rittgers, MA, program officer at The Proteus Fund

2 with extensive experience supporting advocacy coalitions. Her report follows. PROGRESS TO DATE As the consultant s report describes, EWA continues to be an effective voice for improved care of older adults. Despite very challenging economic and political conditions, it has made measured gains on a variety of fronts. While other health professions education programs (e.g., the rural Area Health Education Centers) have been zeroed out in budget proposals, geriatric education programs have maintained their funding, albeit with no growth. In addition, EWA has had input into recently introduced legislation, including Senator Susan Collins Positive Aging Act. Given the political climate in Washington, DC, EWA has focused on regulatory issues as planned, including workforce aspects of changes to health care delivery under health reform. Notably, it prepared 50 state-specific geriatric workforce issue briefs and engaged stakeholders involved in efforts to create new integrated health plans covering those eligible for both Medicare and Medicaid. In addition, despite frustrating delays, it still seems likely that the administration will issue proposed new rules for extending wage and overtime protections to home-care workers. FINANCES Funds have been spent in accordance with the approved budget. Matching support from The Atlantic Philanthropies and members has been provided as promised. RECOMMENDATIONS The members of the coalition are to be commended for their commitment, execution, and gains so far. They should carefully consider the consultant s recommendations, particularly the first three (developing champions, broader alliances, and pooling members communications capacity). Regarding long-term continuation, EWA and the Foundation should carefully consider the viability of a coalition based upon a 2008 report and the needs and opportunities present at the end of the grant. September 11,

3 Interim Grant Review The Tides Center Eldercare Workforce Alliance I. Progress to Date The Eldercare Workforce Alliance (EWA) continues to provide a strong and effective voice in Washington, DC, advocating for a comprehensive and high-quality eldercare workforce. Its 29 member groups are engaged and understand their responsibilities, as well as the added value they gain by working in a coalition. EWA s staff have done well setting appropriate priorities and obtainable goals and continue to produce and coordinate the research, documentation, and advocacy critical to their advancement. In the months since the last Hartford Foundation evaluation in September 2012, this coalition of consumer, professional, provider, and direct-care worker groups has continued along its anticipated trajectory. They have met the challenges of present-day Washington well, including those of political bifurcation and sequestration. They were able to protect a core of the Title VII and Title VIII funding for geriatrics training and education. They continued to give voice to eldercare concerns within the context of the Affordable Care Act. They have also worked closely to ensure that eldercare workforce protections and support are included in several current pieces of pending regulations and legislation, including the anticipated reauthorization of the Older Americans Act. II. Impact/Dissemination By engaging directly with key stakeholders as well as its continued production and dissemination of high-quality and accessible op-eds, issue briefs, and other analyses EWA has deepened its reputation as the premier resource and authority on workforce issues for congressional staff and regulatory agencies. Its opinions and validations are referred to and sought after, and increasingly lawmakers and

4 bureaucrats are reaching out to EWA as a go-to source for information and analysis on eldercare workforce issues. A secondary but important lasting impact of EWA is the community it has created for its member groups. Groups come together on calls every other week to openly share policy priorities, challenges, and opportunities. Groups cite these calls, as well as the other meetings coordinated by EWA, as valuable sources of information and analysis. Working in a coalition has also resulted in strong bilateral relationships between individual member groups. Increasingly, EWA members are reaching out directly to each other for support and counsel when needs, questions, common concerns, or opportunities arise. III. Recommendations The Eldercare Workforce Alliance has matured into a cohesive, well-functioning, and focused coalition, highly valued by its member groups. In the years ahead, EWA will be presented with no shortages of opportunities to improve the delivery of appropriate health care for older adults. The systems it has put into place for determining the substantive agenda of the coalition seem efficient and work well for its membership. Rather, in the next few years, the key challenges that EWA faces represent its need to intensify its ability to move an agenda forward, increase tangible impact, and sustain itself through anticipated financial challenges. Several recommendations that might support these goals of increasing impact and sustainability include: 1) As its reputation becomes more institutionalized in both Congress and among key agencies, EWA staff and membership should give particular emphasis to deepening relationships with champions key persons of influence both in government and in the press. In the White House, in each agency or subcommittee, and among the press, EWA should have its own stable of go-to friends who are familiar with the issues, know and trust EWA, and could act on EWA s behalf. 2

5 2) EWA might also consider building alliances with groups outside of the eldercare world. When possible, these allies groups that share a specific policy, regulatory, or appropriations goal of EWA membership should be cultivated as partners in EWA s advocacy. This might include groups that represent various cultural, ethnic or racial constituencies, workplace or health advocates, as well as think tanks or policy institutes. Increasing the diversity of those voices advocating for change, as well as being able to increase and coordinate the resources devoted to this advocacy, has the potential to significantly augment EWA s impact. 3) EWA may consider bringing together the communications staff of EWA member organizations to explore a coalition communications strategy. Effective words, metaphors, and stories can quickly and efficiently guide the listener to understand why action is necessary. The repetition of these words, heard from multiple sources, helps messages be retained, by creating an echo chamber and dominant narrative. EWA is dealing with complicated issues that, unless a person has had direct contact with the system, are often misunderstood or not given due priority. Creating a new narrative around why a qualified eldercare workforce matters to everyone, and increasing its outreach in Washington and nationally will make EWA s other advocacy investments go farther. 4) Continue to focus on regulatory opportunities to impact policy delivery and appropriations. Little is anticipated to move forward in Congress during this next term as the partisan gridlock continues. EWA should do its best to continue to cultivate and educate champions among members and their staffs, but real opportunities for short- to medium-term impact most likely will present themselves at the regulatory and agency levels. 5) EWA faces tough financial challenges in the years ahead. Its openness to adapting to these challenges, and finding the best path forward given available resources, is laudable. However, given the nature of EWA s work to date, the policy 3

6 goals and the challenges it faces as a broad coalition, sustaining support for dedicated staffing will be critical to EWA s future. The coalition model EWA has adopted succeeds primarily because it has dedicated staff that is unaligned with any single member organization. As EWA considers its sustainability, the minimal go/no go decision threshold may well be whether or not support for this staffing can be continued so as to maintain its current level of impact. 6) To help support itself, EWA membership should also consider a rotating hosting or perhaps a virtual office arrangement, as a means to minimize overhead. For two-year terms, a member group could formally host EWA, providing office space and other supports as needed. Alternatively, EWA staff might explore the virtual office model increasingly being used by nonprofit groups (where staff work virtually from home). Both models could also eliminate or diminish the need for outside fiscal sponsorship. 7) Reconsider membership dues structures. A modest increase say 10 percent as a means of supplementing revenue should be considered. In summary, EWA has established itself as a strong and trusted voice for the eldercare workforce. With its reputation in place, high-functioning staff, and member organizations committed and accessing the Alliance, its potential for impact will only increase in the years to come. Rebecca R. Rittgers, MA September 11,