Monday, December 17, 2012

Wednesday, December 12, 2012

Foreword to Final Exhibition

Most people, if given the choice, would choose to age in place. That means they would remain in their homes, taking care of themselves for the duration of their life. What we know is that there are a few elements that must exist in order for that to happen: 1) one must have a home, 2) one must be in fairly good health, and 3) one must have access to the services they need. Additionally, today’s 65-year olds have different needs and expectations than those who turned 65, 30 years ago.

Housing and community development researchers have linked stable housing to education, health, and employment. Many supports are put in place to support families and children living in low-income neighborhoods. Children living in poverty have more stress, less resources, and unstable housing, which results in a disadvantage when it comes to learning, focusing, and growing. Putting supports in place such as early learning centers, health clinics, parenting supports, after-school supports and activities, gives children a better chance at being healthier and successful in school.

Consider the other end of the spectrum - our community’s elders. Elders, in general, are considered a vulnerable population. With families living in different geographical locations more and more, elders tend to be without family support nearby. They tend to have increased health issues to cope with. Many become socially isolated, which leads to a decline in their health due to depression; and, many don’t seek primary care causing unaddressed health issues to worsen. Considering that stable housing was one of the three elements to aging in place, these issues are chronically worse for homeless elders. Elders face the reality that they may need to access elder housing options or long-term care at some point.

Now, I’m not trying to paint a glim picture of elder-hood. Certainly, income factors and supports can significantly impact the challenges an elder faces. However, regardless of means, all elders need the three elements named earlier in order to age in place: stable housing, fairly good health, and access to services.

Consider, now, another vulnerable community of elders: lesbian, gay, bisexual, and transgender (LGBT) elders. Although there is no concrete way to determine the exact number of LGBT elders in the US, the census estimates about three million Americans are LGBT and about 1.5 million of them are LGBT elders. The number of LGBT adults is expected to grow to eight million by 2030. What we know is that being LGBT in earlier decades was socially unaccepted by society. For me, it is hard to imagine a time that being LGBT was considered a mental illness and even a crime. Elders, who are LGBT, have higher health risks than straight elders including depression, social isolation, substance abuse, physical abuse, and neglect. Because they are likely candidates for alcohol abuse and smoking, alcoholism and diseases associated with smoking are increased.

When they were growing up, many LGBT elders had to separate from their families because of their sexuality. Although some were forced to live a straight life, having a spouse and children, many LGBT elders never had children. For these reasons an LGBT elder’s support social network is generally small. And because many spent their lives “in the closet” so to speak, they’ve become even more socially isolated as they’ve aged. Many shy away from health care and are more likely not take advantage of other services - in fear of discrimination perhaps.

There is an important need to support this aging population. As LGBT elders age in place, there is an urgent need to help the industry more effectively coordinate health, housing and social services to ensure that these older adults can age safely and independently in their homes. We know that affordable housing with services is an effective strategy for keeping older adults living independently. Researchers have also proven that services delivered through affordable housing can prevent unnecessary hospitalizations or prematurely placement in higher and more expensive levels of care.

Today is a new day! Why not envision a world where all older adults, regardless of income, or sexual orientation, will have the choice to age in place in their communities with the appropriate supports and services.

Interview: Joe Garlick, NeighborWorks

On December 3, 2012, I had the opportunity to meet with Mr. Joe Garlick, Executive Director of NeighborWorks Blackstone River Valley in Woonsocket, RI. Neighbor Works restores abandoned houses, builds new homes, and revitalizes neighborhoods to improvement the quality of life for Woonsocket residents. They are committed to rebuilding neighborhoods and communities!

Mr. Garlick gave me a thorough overview of public housing and low-income housing, and highlighted their newest development an 80-unit, affordable, elderly housing project, called the Meadows. He talked about the development, which took five years to get off the ground. The Meadows also provides the residents with a full range of social services to older adults over 62 years of age.  Residents' payment sources consist of social security and pension payments.

We toured the new facility, which was incredibly beautiful on a gorgeous lot with a wonderful view. The building, itself, was designed to encourage community through activities and functions.  Mr. Garlick also gave me a tour of many of their family housing projects, which were equally impressive including a newly renovated after-school program (building), in which, the teachers also live in the building - rent free!

I left the meeting feeling energized and excited about the look and feel of the new elderly housing project.  Mr. Garlick also provided me with the name of a colleague, who is involved in LGBT Housing (Cheryl Gladstone - The Enterprise Foundation).   I will follow up with Mr. Garlick with a thank-you note. I will contact Ms. Gladstone in the coming weeks.

Friday, December 7, 2012

Internship Narrative - Final

Internship Narrative

By: Melissa Miranda

Descriptive analysis of the agency

Healthcentric Advisors develops and provides innovative and evidence-based consultation, education, tools and resources that measure and improve the quality, safety and value of person-centered health care in communities we serve. We don’t provide direct health care — we work with those who do (locally and nationally) to achieve their goals.

My role at Healthcentric Advisors is Senior Program Administrator. That means I am a project (or program) manager. Together, with a team of clinicians and administrative specialists, we provide quality improvement services in hospitals, nursing homes, home-health agencies, and physicians’ offices throughout Rhode Island. I have focused, primarily, for over twelve years, in nursing home quality improvement with just over four years of hospital-focused quality improvement.

For the second year in a row, Healthcentric Advisors was named as one of the 2012 Best Places to Work in Rhode Island, ranking number 5 out of 12 in the small business category. This recognition sums up exactly how I feel about being part of the organization. My supervisor, Gail Patry, has been supportive since the first day we worked together, which was just about thirteen years ago. She has always taken the time to teach as we work. I’ve asked hundreds of questions over the years; and, Gail took the time to respond to each one. Gail is far from a micromanager. She and I developed a trust almost immediately. I know that I’d follow Gail wholeheartedly; because, I trust that she always has the best intentions for the project and the people involved. I am fortunate to feel supported and empowered at work from our entire leadership team.

Statement of learning

As I sat with my professional mentor to discuss the internship, we talked a lot about continuing a focus on elders in long-term care. We knew that the internship was an opportunity to explore the topic in a way that we had never done before. In previous years, our scope of work included the opportunity to focus on disparities. Although the current scope of work did not have a large disparate component, it seemed appropriate to include one as a focus in this internship.

Earlier this year, Healthcentric Advisors donated space for a local community group, Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE RI) to hold their member meetings. SAGE RI is RI’s first Lesbian, Gay, Bisexual, and Transgender (LGBT) elder advocacy group. They officially received their RI Chapter designation in October 2012. My professional mentor and I began talking about the LGBT-elder community, which is nationally recognized as a vulnerable group of elders. Working on a project, which is focused on LGBT elders is related to what I currently do at work because it is elder focused; yet, it’s very specific focus makes it different. Next, we talked about the needs of this elder community. Research reveals that this population of elders has specific health needs and is at risk for specific health conditions. A combination of LGBT-elder community (and their healthcare needs) and an “aging in place” concept supported through the Accountability of Care Act seemed to be a good fit. In summary, my internship would be focused on housing options or alternatives for the LGBT-elder community. Both the target audience (LGBT elders) and the component on housing (alternative to nursing homes) were not included in any of the work that I perform for Healthcentric Advisors.

Once the internship topic was identified and my Personal Learning Plan was finalized, it was shared with my professional mentor, the Chief Executive Officer, a colleague, and our Human Resources representative. The support from my employer has been overwhelming. First, they demonstrated their support through my formal educational benefit. Second, they recognize my internship as if it was an element in our scope of work; although it is clearly outside of the scope. Although, the internship doesn’t impact my employer through monetary gains, they recognize my personal growth and knowledge in the subject as an opportunity for future endeavors.

My academic liaison helped me to identify which courses would be most supportive of my internship and in alignment with my prospective degree in Housing and Community Development. The first was Social Gerontology. Social Gerontology has been a focus in my work for over twelve years and is highlighted in the internship through the focus of the LGBT-elder community. Learning outcomes from this course included the understanding of social needs and health risks associated with LGBT elders. The Housing and Community Development course allowed me to gain knowledge about housing and community development, in general, including a focus on elder housing, as well as the relationship between health and housing. The Writing and Public Speaking course was incorporated to support the report writing, PowerPoint presentation development and delivery, and the weekly homework assignments. The homework assignments were related to the internship, the housing and community course, and the Big 10 learning goal lessons.

Evaluation Statement

As a participant in College Unbound and a student of Roger Williams University this semester, I have begun to make a distinct connection between my passions and my career. Specifically, the Big 10 Learning Goals have forced me to evaluate myself, personally and professionally, and to identify improvement opportunities. Even with the years of experience I have in my field and with my current employer, I realized there is always an opportunity to better myself. I focused on networking this semester, which is not an area that I am comfortable in doing. The readings were impactful by offering specific tips on how to network and the importance of it. Most importantly, I learned to have belief in what I “bring to the table” so to speak. I networked with a RI Senator (Sen. Whitehouse), a professional at the Central Falls Housing Authority, and a professional at NeighborWorks RI. Not only did I gain something from each experience, they resulted in next steps. As a result, I am expected to have follow-up communication with each going forward.

My semester was divided into two phases, which included specific tasks for each. Task 1 focused on the Healthcare for Lesbian Elders Final Report (September 17 – October 15, 2012). Task 1 involved a general literature search on the topics of LGBT elders, LGBT elders and healthcare, and LGBT elder housing. It also involved SAGE-RI’s draft, Final Report (71 pages), for which I provided support by: checking grammar, formatting, and re-organizing information into a readable and compelling Final Report (66 pages). Once the “final version” of the report was completed, I created an Executive Summary and a PowerPoint presentation of the findings, which was shared with SAGE-RI; and, I presented at a SAGE-RI event (Visible Lives: Caring for LGBT Elders – October 24, 2012).

The second phase of the semester focused on elder housing research (October 15 – December 31, 2012.) This tasked involved attending in-person lectures and included a lot of reading. The learning can be categorized into a few topic areas: Housing and Community Development – General, Elder Housing, LGBT Housing/Community Development, Elder Health and Housing, LGBT Health, and Key Concepts. Information that fell into the Key Concepts category included concepts that I’d like to refer to in Task 3 next semester as I begin to identify and describe concepts for an alternative housing plan to support LGBT. As a result of the second phase of this semester, I developed an annotated bibliography and Final Exhibition presentation. Through my internship, I’ve met specific course outcomes including the following:

Course	Outcomes
Housing and Community Development	· Completed reading assignments, participation in lecture discussions · Bibliography of researched information including literature, articles, websites, and videos.
Writing and Public Speaking	· SAGE-RI: Lesbian Elder and Healthcare Professional Assessments - Final Report. The draft was in a “rough draft” state. I rewrote many of the sections and reformatted the entire 66-page report. · A PowerPoint was developed to deliver the key findings from the report, which was presented on October 24, 2012 during the Visible Lives event. · Mid-Term and Final Exhibition presentations · Blogging my progress and completed assignments.
Social Gerontology	· SAGE-RI: Lesbian Elder and Healthcare Professional Assessments - Final Report · In-person presentation of the Final Report results at the Visible Lives event on October 24, 2012. · Bibliography of researched information including literature, articles, websites, and videos.

Additionally, in studying the LGBT- elder community, I’ve learned how to be a “Straight Ally” for this disparate group of elders. I will continue to work with SAGE-RI well beyond this internship and hope to assist them as they develop learning materials and educate care providers in all healthcare settings.

Most important to me (and most unexpectedly), I have awakened my interests in and passion for community development. I would like to continue to pursue this topic in my education and professional projects.

Sunday, December 2, 2012

Reflection: People or Place?

I read the article, "People or Place? Revisiting the Who Versus the Where of Urban Development."
Community development is based on either people-based or place-based strategies to combat poverty and community decline.

Simply put, people-based means that resources would go directly to the people, who needed it; and, place-based means that resources would support specified areas (or locations), such as a specific city, town, or region. One of the arguments related to place-based support is that residents would be forced to remain in low-income, impoverished neighborhoods in stead of receiving the needed aid and utilizing it in a neighborhood of their choice.

From this article and additional articles on the support, it seems that a balance of both people- and placed-based strategies is the most beneficial. To truly build a better community, resources addressing poverty, must also support employment and training, education, health care, and other social services.

Resource: Lincoln Institute of Land Policy, Land Lines. People or Place? Revisiting the Who Versus the Where of Urban Development. July 2008.

Reflection: Positive Deviance

The concept of Positive Deviance for behavior and social change caught my attention immediately because it is closely related to my specialty at work - quality improvement. As a quality improvement specialist, I can identify an area for improvement, conduct a root-cause analysis, identify potential improvement strategies, and spread successful strategies. Rather than beginning with identifying a problem, issue, or barrier, positive deviance focuses on an unexpected, sustainable success, studies the root of the success, and spreads the strategies in areas that are not as successful.

Positive Deviance is based on the observation that in every community there are certain individuals or groups (the positive deviants), whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers. These individuals or groups have access to exactly the same resources and face the same challenges and obstacles as their peers1 (1www.positivedeviance.org).

The approach enables the community to discover existing solutions to complex problems within the community. I will use this approach as I begin to identify potential concepts for an alternative housing plan for the LGBT elder community.

To learn more about Positive Deviance,go to:
http://www.positivedeviance.org/about_pdi/index.html

Updated Personal Learning Plan

Updated: 12/02/12
https://docs.google.com/a/bigpicturelearning.org/document/d/1Un_EuSy_n-QT-lwDeYuAAa9CqqKIuRG5YQdTBJAfijs/edit

Melissa's Blog Log