Citation
Planning for services to the elderly

Material Information

Title:
Planning for services to the elderly
Creator:
Kolm, Patricia A
Denver Regional Council of Governments
Place of Publication:
[Denver]
Publisher:
[Denver Regional Council of Governments?]
Publication Date:
Language:
English
Physical Description:
vi, 64 leaves : map ; 28 cm

Subjects

Subjects / Keywords:
Older people -- Colorado -- Arapahoe County ( lcsh )
Older people -- Colorado -- Douglas County ( lcsh )
People with disabilities -- Services for -- Colorado -- Arapahoe County ( lcsh )
People with disabilities -- Services for -- Colorado -- Douglas County ( lcsh )
Older people ( fast )
People with disabilities -- Services for ( fast )
Colorado -- Arapahoe County ( fast )
Colorado -- Douglas County ( fast )
Genre:
bibliography ( marcgt )
theses ( marcgt )
multilocal government publication ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 63-64).
General Note:
Submitted in partial fulfillment of the requirement for the degree, Master of Planning and Community Development, College of Design and Planning.
General Note:
On cover: A study of informal support networks serving the elderly, physically disabled and blind adults in Arapahoe and Douglas Counties, Colorado.
General Note:
"Prepared for the Denver Regional Council of Governments."
Statement of Responsibility:
prepared by Patricia A. Kolm.

Record Information

Source Institution:
University of Colorado Denver
Holding Location:
Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
10445162 ( OCLC )
ocm10445162
Classification:
LD1190.A78 1983 .K64 ( lcc )

Full Text
PLANNING FOR SERVICES TO THE ELDERLY
A Study of Informal Support Networks Serving The Elderly, Physically Disabled and Blind Adults In Arapahoe And Douglas Counties, Colorado
Submitted by Patricia A. Kolm
In partial fulfillment of the requirements for the Degree of Master of Planning and Community Development University of Colorado at Denver Professor Herb Smith Thesis Advisor August 1983
ENVIRONMENTAL DESIGN
Auraria library


PLANNING FOR SERVICES TO THE ELDERLY
A Study of Informal Support Networks Serving the Elderly, Physically Disabled and Blind Adults in Arapahoe and Douglas Counties, Colorado
By
Patricia A. Kolm
In Cooperation With
Denver Regional Council of Governments 2480 West 26th Avenue, Suite 200B Denver, Colorado 80211
July 1983


To Ken Kolm
my husband and partner, who provided advice, unceasing support and understanding throughout the duration of my graduate work, and most importantly, for his encouragement to me to fulfill my potential.


ABSTRACT
In an attempt to more effectively meet the needs of elderly and physically handicapped and blind adults, the Colorado State Legislature recently passed Senate Bill (S.B.) 138, Home and Community Based Services Program Alternatives to Nursing Home Care. The Denver Regional Council of Governments (DRCOG) is implementing S.B. 138 through its Local Operational Plan for Case Management in Arapahoe and Douglas Counties.
This paper examines a component of the Local Operational Plan for Case Management in Arapahoe and Douglas Counties the Informal Support Network (ISN). The ISN is defined and its significance in providing services to the elderly and handicapped is discussed. The Formal Agency Survey developed for identification of ISN participants is presented and evaluated. Linkages between formal agencies and informal service providers are identified and assessed.
The paper concludes with planning and policy recommendations for more effective use of ISN services. More effective use of the ISN by formal agencies may enable reduction of public expenditures while allowing elderly, physically handicapped and blind adults to remain in their homes, or the least restrictive setting, for as long as possible.


ABSTRACT
TITLE:
AUTHOR: DATE: SOURCE OF
NUMBER OF ABSTRACT:
PLANNING FOR SERVICES TO THE ELDERLY: A Study of Informal Support Networks Serving the Elderly, Physically Disabled and Blind Adults In Arapahoe and Douglas Counties, Colorado
Patricia A. Kolm
August 1983
COPIES: Public Affairs Office
DRCOG
2480 West 26th Avenue, Suite 200B Denver, Colorado 80211
(303) 435-1000
PAGES:
This study involves identification and analysis of the Informal Support Network in Arapahoe and Douglas Counties, Colorado, and includes an examination of interaction between formal and informal service providers in that region.


ACKNOWLEDGEMENTS
I would like to take this opportunity to thank Noah Midamba, Planner, Aging Services Division, Denver Regional Council of Governments (DRCOG) for suggesting the subject of research for this thesis, and for his excellent guidance in its development and completion. I would also like to express appreciation to DRCOG, Aging Services Division for technical and financial assistance in preparation of the final report.
I would like to thank Professor Herb Smith, School of Design and Planning, University of Colorado, Denver, for serving as my faculty advisor during this research. His guidance, encouragement, and reassurance were of great assistance.
My appreciation is also extended to Professor Dan Schler, School of Design and Planning, University of Colorado, Denver, who served on my thesis committee.
Patricia Kolm August 1983 Denver, Colorado


1
8
12
12
12
15
17
20
23
23
23
26
29
30
32
32
46
46
48
53
53
57
64
73
76
TABLE OF CONTENTS
EXECUTIVE SUMMARY ................... ,
INTRODUCTION.........................
BACKGROUND............................
Demographic Trends...................
Location of Study ...................
Legislation .........................
Case Management .....................
Informal Support Network.............
RESEARCH METHODS.....................
Conceptual Framework....................
Sample Selection.....................
Interview Design.....................
Interview ...........................
Data Analysis .......................
SURVEY RESULTS.......................
Major Findings.......................
CONCLUSIONS AND RECOMMENDATIONS .
Evaluation of Research Methods. Planning and Policy Implications. .
APPENDICES...........................
Appendix A. Sample Selection .... Appendix B. Formal Agency Interview. Appendix C. Tabulation of Survey Data
FOOTNOTES ...........................
BIBLIOGRAPHY


LIST OF TABLES
Table 1. Distribution of the Sample Selection Among the Thirteen Service Categories Presented in the Local Operational Plan for Case Management in Arapahoe and Douglas Counties, Colorado............................27
Table 2. Distribution of Formal Agency Interaction Among ISN Participant
Categories...........................................................33
Table 3> Distribution of Formal Agency Frequency of Interaction Among ISN
Participant Categories ............................................. 3^
Table 4. Distribution of Formal Agency Interaction with the ISN by Social
Support Service .................................................... 36
Table 5* Distribution of Formal Agency Interaction with the ISN by Problem
Centered Service.....................................................37
Table 6. Distribution of Formal Agency Reasons for Non-Interaction
with the ISN.........................................................^3


LIST OF FIGURES
Figure 1. Map of Arapahoe and Douglas Counties, Colorado..................13
Figure 2. Conceptual Framework for the Study..............................Zh


EXECUTIVE SUMMARY
A study of the Informal Support Networks serving the elderly, physically handicapped and blind adults in Arapahoe and Douglas Counties, Colorado was conducted during the spring of 1983 with the goal of assisting the Denver Regional Council of Governments (DRCOG) in the implementation of Senate Bill (S.B.) 138 Home and Community Based Services Program, Alternatives to Nursing Home Care, through the Local Operational Plan for Case Management in Arapahoe and Douglas Counties. This goal was accomplished through the development of a method to identify Informal Support Network (ISN) participants in the two counties, actual identification of ISN participants by using a Formal Agency Interview, identification and assessment of linkages between formal and informal service providers, and the development of policy and planning recommendations promoting the effective, efficient use of the ISN.
Data for the study were collected through the Formal Agency Interview.
A total of 41 formal agencies serving the target population in Arapahoe and Douglas Counties were randomly selected from the service categories presented in the DRCOG Local Operational Plan for Case Management in Arapahoe and Douglas Counties. These formal agencies were contacted by telephone and asked a series of comprehensive questions designed to identify ISN participants and illicit information regarding aspects of interaction between the formal and informal service providers.
Formal Agency and ISN Interaction
Of the 41 agency representatives interviewed, 90*2 percent reported that their agency interacts with ISN participants in provision of services


to the elderly, adult physically disabled and blind. The remaining 9-8 percent of the agencies reported no interaction with ISN participants in provision of services to the target population, and cited the primary reason for the non-interaction as agency structure as it relates to agency size, specifically lack of staff and financial resources. The response confirming major interaction with the ISN supports the assumption that Informal Support Networks currently exist in Arapahoe and Douglas Counties, and that formal and informal service providers interact with one another.
The survey found that agency personnel interact primarily with family and relatives of clients, followed by interaction with friends, volunteers, religious groups/churches, and neighbors. Interaction between agencies and group associations/service organizations, and youth groups occurs less frequently.
Agency interaction with the ISN in provision of Social Support Services such as reassurance, sharing information, sharing activities, and friendly visiting, is generally high, while the data indicate that there is less interaction between formal agencies and the ISN in provision of Problem Centered Services such as respite care, beauty/barber care, housework/yard-work, and cooking.
Through the survey, the formal agency representatives identified the strengths of their interaction with the ISN to be: l)commitment on the part of ISN participants who are viewed as dedicated and reliable in provision of services, 2) ability of ISN participants to improve the quality of care by meeting client needs that might otherwise not be addressed, and 3) the established ISN stability and effectiveness in providing services to the
target population.


Weaknesses in agency and ISN interaction as identified through the survey are: l) lack of information regarding the nature and function of the ISN as it relates to agency services, 2) lack of follow-through by both the ISN and formal agencies, 3) "the informality and lack of organization associated with the ISN which reduces agency control over provision of services, and 4) the need for improved recruitment and training of ISN participants by agencies.
All of the agencies indicating current interaction with the ISN report having staff who work directly with ISN participants on a regular basis.
It is likely that agency staff and ISN interaction will increase, since 64.9 percent of those interviewed reported intentions on the part of their agency to increase interaction with the ISN. Most agencies felt that they could use the ISN more effectively, and provided suggestions for improvement that addressed the weaknesses in interaction identified previously.
Responses to survey questions indicated that the majority of formal agency representatives believe that use of the ISN by their agency enables reduction of formal services required to maintain the target population in their homes, helps reduce expenditure of public funds for that purpose, and is a major factor in postponing or preventing institutionalization of the target population.
Identification of ISN Participants
Most of the specific information on ISN participants (i.e. name, address, telephone) provided by formal agency representatives is related to religious groups/churches, group associations/service clubs, informal support groups, private company service clubs, youth groups, schools, and volunteer


groups. Nearly all respondents declined to provide specific information on individuals, citing confidentiality as the primary reason for this action. However, agencies indicated willingness to provide information on individual ISN participants on a case-by-case basis in order to assist the case manager in development of a client "service package." Agencies reporting no current interaction with the ISN were able to provide general information on ISN services within their service area, but not specific information on ISN participants.
Recommendations
The following recommendations are suggested regarding the survey interview method:
(1) Remain within a 15 20 minute time frame if possible.
(2) Clarify any misunderstandings the respondent may have. The ISN concept must be continuously defined and clarified as the interviewer proceeds through the survey questions.
Based upon the research findings, the following recommendations are made for the better identification and utilization of ISN participants serving Arapahoe and Douglas Counties:
(1) The Case Manager should work closely with family, relatives, and friends of the client, and enlist the aid of those ISN participants identified through this survey whenever possible in order to expand and augment the ISN services to the client.
(2) As the Case Manager makes contact with formal agencies, he or she should inquire in greater detail regarding ISN participants.
DRCOG may encourage and assist agencies in the development and


maintenance of a data file of ISN participants serving their clients, and encourage exchange of this information among agencies.
A thorough assessment of data regarding linkages between formal and informal service providers resulted in the following recommendations to DRGOG:
(1) Encourage formal agency interaction with the ISN in the area of Problem Centered Services.
(2) Encourage formal agencies to maintain central records on the number of staff and their time spent interacting with ISN participants.
(3) Provide information to the agencies regarding the nature and functions of the ISN and services provided by ISN participants. Encourage formal agencies to share this information with one another.
(4) Provide technical assistance to formal agencies in their recruitment, training, and supervision of ISN participants.
(5) Encourage agencies to promote coordination and contact among ISN participants, thereby improving the continuity of service delivery in situations where a family member, friend, or volunteer may be ill, out-of-town, or unavailable.
(6) Encourage agencies to increase interaction with ISN participants other than family, relatives, friends, and neighbors whenever possible. This will provide relief to the personal ISN participants and expand ISN services for the client.


The study results will be utilized by DRCOG, Aging Services Division, and particularly by the Case Manager, in implementation of S.B. 138 through the Local Operational Plan for Case Management in Arapahoe and Douglas Counties. It is anticipated that the more effective identification and utilization of the ISN by formal agencies may enable reduction of public expenditures, while allowing elderly, physically disabled and blind adults to remain in their homes, or the least restrictive setting, for as long as
possible.


I. INTRODUCTION


I. INTRODUCTION
United States Census figures document that the elderly population in this country is expanding. This trend is also documented in the state of Colorado, and locally in Arapahoe and Douglas Counties. As a result of the increase in numbers of elderly people, planning for the development, implementation, and improvement of services to seniors has become a focus at all levels of government, and of increasing concern to agencies and individuals within local communities.
As the population ages, the need for formal and informal supportive services increases. This is particularly true for those classified as "frail elderly" (75 years and over), when institutionalization is more likely to be required. The cost of formal services, particularly nursing home care, has risen dramatically at a time when government funds for such services are no longer available in sufficient quantity.
During this period of dwindling financial resources, the state of Colorado is attempting to more efficiently and effectively provide services to the elderly, adult physically handicapped and blind through Senate Bill (S.B.) I38, Home and Community Based Services Program Alternatives to Nursing Home Care. The major goal of this research was to assist the Denver Regional Council of Governments (DRCOG) in the implementation of S.B. 138 through the Local Operational Plan for Case Management in Arapahoe and Douglas Counties.
A vital component of the Local Operational Plan for Case Management is the Informal Support Network (ISN) which includes, but is not limited to,
family units, friends and neighbors, religious organizations, community service
-8-


organizations, and volunteers. The effective use of the ISN, in conjunction with other necessary services, may enable clients to remain in their homes rather than be admitted to a long term care facility.
Since no coordinated base of information regarding the ISN and its linkages with formal agencies in Arapahoe and Douglas Counties existed prior to this study, the objectives of this research were the following:
(1) Development of a method for identifying existing ISN participants serving the target population in Arapahoe and Douglas Counties. This method may then be utilized by other Colorado counties involved in implementation of S.B. 138.
(2) Identification of ISN participants serving Arapahoe and Douglas Counties.
(3) Identification and assessment of linkages between formal agencies and the ISN.
(4) Development of policy and planning recommendations that will promote the effective, efficient use of the ISN, and its incorporation as a vital component into the total Case Management Plan.
The ultimate purpose of examining the ISN is to enable better use of existing resources, which will, in turn, contribute to a community's and/or county's ability to provide alternatives to nursing home placement. This will allow the target population to remain in the most desirable, least restrictive, and most cost-effective setting.
This report is presented in four parts. The first part describes the background for the study including demographic trends, legislation, case management, and the concept and functions of the ISN. The second part discusses in detail the research methods employed in the study. The third


section is an analysis of the survey data and presentation of major findings. The final part of the report presents an evaluation of the
research methods used, policy and planning implications for DRCOG, Aging Services Division, and recommendations for the effective use of the ISN and its incorporation into the total Case Management Plan.
-10-


II.
BACKGROUND


II. BACKGROUND
Demographic Trends
Nationally, the United States is an aging society. This trend is also
documented in the state of Colorado. According to information provided in
Colorado's Long Term Care Plan (March 1982), the elderly population age
65-plus in Colorado is expected to grow by approximately 19 percent to
296,000 by 1990. The over-75 age group is expected to grow by 25 percent to
123,000, and the over-85 age group is expected to grow by 22 percent to
slightly over 30,000 persons by that year.'*'
As Colorado's elderly population expands, it is also growing older as
is evidenced by the fact that between 1970 and 1980 Colorado's total 65-plus
population increased by 31*5 percent, and the over-85 population increased 2
by 50 percent. A substantial part of the State's elderly reside in the
Denver region. Nearly 21 percent of the older population in the Denver area
is 75 years or older, which represents 31 percent of the total population in
3
the region which is over 75* The State designates those age 75-plus as "frail elderly." This group is of particular concern to planners because these individuals are more prone to illness and disability, and thus, have a greater need for costly long term care services.
All of these figures indicate that planning for the development, implementation, and improvement of services to seniors has become, and will remain, a major focus at all levels of government, and of increasing concern to individuals and organizations within local communities.
Location of Study
This study examines the ISN, defined later in this section, in two
Colorado counties, Arapahoe and Douglas. Arapahoe County is located directly
(Figure 1.)
-12-


STATE PLANNING REGION III


east of Denver City/County and. shares boundaries with five additional Colorado counties including Adams, Washington, Elbert, Douglas, and Jefferson Counties. The area of Arapahoe County is slightly over 800 square miles. Arapahoe County is one of eight Colorado counties which are members of DRCOG.
The 1980 U. S. Census figures do not break down the population over age 65, but do so in groupings from 6O-69, 70-79, 80 and over. The total Arapahoe County population over age 60 in 1980 is 24,082 persons out of a total population of 293*621. These figures demonstrate an increase from 1970 when the population over age 60 equalled 12,265 out of a total population of
161,797. Those persons age 70 and over in 1980 equalled 9,242, totaling
4
3.1 percent of Arapahoe County's total population in 1980.
Clearly, the number of elderly persons living in Arapahoe County has increased dramatically within the last 10 years. The Local Operational Plan for Case Management prepared by DRCOG has estimated that 40 persons in Arapahoe County are eligible for community home based services under S.B.
138.
Douglas County is located directly south of Denver City/County and is bounded by Arapahoe County to the north, Elbert County to the east, Teller County to the south, and Jefferson County to the west. It is also one of eight counties belonging to DRCOG. The major portion of the county is classified as rural. Only 5 percent of the 540,000 acres (844 square miles) is developed, and this development is primarily in the northern portion of the county nearest Denver.^
The 1980 U. S. Census figures document that a total of 1,854 persons over age 60 reside in Douglas County out of a total population of 25*153* These figures demonstrate an increase from 1970 when the number of persons
-14-


over age 60 equalled. 87I out of a total population of 8,40?. Those persons age 70 and over (nearing and including the "frail elderly" classification)
equalled 732 in 1980, totaling 2.9 percent of Douglas County's 1980 popula-
. 6
tion.
As in Arapahoe County, the number of elderly persons, and total population, residing in Douglas County has increased dramatically between the years 1970 and 1980. The Local Operational Plan for Case Management, prepared by
DRCOG, has estimated that 20 clients in Douglas County are eligible for
n
community home based services under S.B. I38.
Legislation
As a result of the concern regarding provision of services to the growing number of elderly, legislation has been passed in Colorado with the intent of providing necessary services, and recently with the intent of enabling elderly, adult physically handicapped, and adult blind persons to remain in their homes, or a setting less restrictive than a nursing home, for as long as it is economically feasible.
S.B. 38, the Alternatives to Long Term Nursing Home Care Act, went into effect on January 1, 1981. The Act permitted expenditures for alternatives from existing nursing home care appropriations, and provided Medicaid coverage for additional types of home health care services, and reimburse-
g
ment for case management at the county level.
S.B. 38 provided for optional research pilot programs (Adult Day Care and Home Health Care). These pilot programs were implemented by many Colorado counties, including Arapahoe but not Douglas. It has been documented that many of the clients who received alternative services were much happier
-15-


than their counterparts in nursing homes, and that such community care can
9
be less costly than permanent institutional care.
Colorado's Long Term Care Plan (March 1982) identified a number of problems at both the state and local level. These problems include a multiplicity of services, eligibilities, programs, and policies which are uncoordinated, fragmented, duplicative, competitive, often in conflict, and designed around funding sources rather than the individual client's needs.^ As a result, the system is often ineffective and inefficient, and actually promotes institutionalization rather than maintenance of individuals in their homes or settings less restrictive than a nusring home.
Following S.B. 38, the next legislation to be introduced and passed by the Colorado legislature was S.B. I38, the Home and Community Based Services Program. On January 7> 1983 the State Board of Social Services passed rules for the implementation of this program, effective February 7, 1982.'*''*'
S.B. 138 supercedes S.B. 38, and defines additional services to be provided for Medicaid eligible persons as an alternative to long term nursing home care. Medicaid services are tightly controlled by state statute. Therefore, state statutory changes in the form of S.B. 138 were required to expand the range of services beyond those currently authorized. A Medicaid Waiver allows use of federal Medicaid funds currently budgeted for nursing homes (and limited alternatives under S.B. 38) for a wider array of alternatives. S.B. 138 expands eligibility for home health care and adult day care programs, and allows for provision of the following services:
Home Health Services Homemaker Services Adult Day Care Personal Care Respite Care
Transportation services
(including non-medical transportation)
Environmental Services
(home modification and electronic monitoring) Case Management Services (to coordinate all of the above services)
16-


For the purposes of this study, the target population is defined by S.B.
138 and the Medicaid Waiver to include the following:
(1) Elderly (age 65-plus with emphasis on age 75-plus "frail elderly"), physically handicapped adults, and blind adults (age 18-64) who meet a "level of care screen," i.e. would otherwise require a nursing home.
(2) Individuals who are eligible for Medicaid (or would be if in a nursing home under the "300% rule").
(3) Individuals who can be served with alternatives at a lower cost than nursing home care.
Case Management
S.B. 138 addresses the need for expanded alternatives to nursing home care for elderly, physically handicapped and blind adults through development and implementation of a Case Management Program. S.B. 138 also made participation in this process mandatory for all Colorado counties.
The County Commissioners of Arapahoe and Douglas Counties requested that DRCOG serve as the local case management agency. The County Commissioners contracted with DRCOG to develop and operate the Regional Case Management Program. DRCOG completed the Local Operational Plan for Case Management in Arapahoe and Douglas Counties and submitted the report to the Colorado Department of Social Services for review and approval.
According to the Local Operational Plan for Case Management, the purpose of S.B. 138 is "to authorize the use of Medicaid funds for the provision of home and community-based services for individuals who have
12
previously been placed in institutions or are about to enter an institution."
-17-


Case Management with the frail elderly is one of the first program approaches, other than the broad, but largely ineffective efforts to do
comprehensive planning for the aged. Past efforts to do broad planning for and with the aged have been characterized by categorical service planning and specific program development, rather than development of an integrated system.^
Case Management serves as a means to integrate and coordinate long term
care services. This approach addresses the fragmentation, duplication, and
gaps in service by establishing a single-entry point for dispersal of all
long term care services. The case manager receives referrals, assesses need,
develops a service plan and then a "service package," monitors client
14
progress, then reassesses and revises the service plan.
Case Management is a planning tool, particularly in its function of
resource finding and network developing. Effective Case Management identifies
service gaps, and other problems, and develops possible responses to those
dilemmas. Case Management interfaces with the service planning process in
its data collection and recording functions, and also interacts directly
15
with clients and potential clients.
Case Management employs the techniques of community organization
strategy through community assessment, development of new resources, and
promoting the use of old resources in new ways. Through Case Management
techniques, the interdependence and well-being of all citizens in a
community is affirmed, as are the mutual interests of all ages."^
In their text Community Development in America. Christenson and
Robinson state that "the idea of development stems from the vision of society
in terms of planned intervention, which stresses the utilization of knowledge
17
and technology to help solve the problems of individuals and groups."
-18-


Case Management relates to community development because it involves planned intervention, and stresses the use of existing knowledge to help solve problems. Nearly every definition in the Christenson and Robinson text stresses the involvement of community people and groups in the effort to better conditions and resolve community problems. The Case Management process supports this effort by including the client in service decisions, as well as seeking out additional resources.
Christenson and Robinson also state that one theme of community development is technical assistance or planning. The role of the planner in this instance "is to assess the situation in a community, county, or region, and based on the best technical information, suggest the most economically feasible and socially responsible appraoches for improving the situation.
As funding for new programs becomes increasingly unavailable and
additional restrictions are placed on existing funding, a priority of Case
Management will become maximizing the benefits of existing resources, and
19
increasing the efficienty and effectiveness of these services. The Local Operational Plan for Case Management in Arapahoe and Douglas Counties adheres to the principle of maximizing the efficiency and effectiveness of existing resources, and seeks to explore the ISN first, and purchase additional services only if necessary. The Regional Case Management Program will involve the ISN in the provision of services with the intent of providing clients with services and support necessary to enable them to remain at home at a reasonable cost.^
-19-


Informal Support Network
As Alice Collins and Diane L. Pancoast point out in their hook Natural
Helping Networks, A Strategy for Prevention, informal, spontaneous helping
activities occur so often all around us that they usually pass without 21
notice. However, informal services are becoming increasingly recognized as vital to the well-being of elderly and physically handicapped adults.
In his article "The Informal Support Network: A Description and Policy Perspectives," Gayle M. Boyle states that among the many factors related to nursing home utilization, there is evidence that a lack of informal support may be as important or more important than a change in the individual's health status.^
Boyle defines the ISN as including family, friends, neighbors, and others who can provide services and assistance to the elderly and'handicapped. He states that formal providers of care are distinguished from informal providers in that they are generally paid for their services and the basis
23
of their helping is related to employment by a formal agency or organization.
Collins and Pancoast point out in Natural Helping Networks, A Strategy
For Prevention that social agencies would be inundated were it not for the
informal services of helping networks. The ISN often carries the bulk of the
service load in many sectors and serves a preventative function. The services
24
provided by the ISN are accessible and individualized.
The most comprehensive explanation of the difference between informal and formal support is provided by Froland, Pancoast, Chapman, and Kimboko in their book Helping Networks and Human Services:
-20-


The formal world of organized professional services is largely composed of services that are publicly mandated or sponsored, whether they are state-administered or provided through chartered intermediaries such as private nonprofit organizations. As such, formal care also includes private practice, when controlled either by regulation or reimbursement, as well as services provided by voluntary organizations which receive governmental financial support either directly or indirectly through tax transfers. Formal services operate under a system of explicit categories for assessing need or eligibility, formal rules of procedure, specialization and formal coo coordination among helping roles, definitions and expectations associated with client or consumer status, consistency of standards for treating problems independent of personal characteristics of the client, and objectively stated criteria for what constitutes success or progress.^
Informal helping is defined as follows by these same authors:
Informal helping is voluntary and is relatively unorganized and spontaneous (Walfenden Report, 1973)* It is not a one-way activity, but a mutual flow which involves the receipt of help as well as giving.
The Local Operational Plan for Case Management includes the following
within the ISN: family units (including relatives), friends and neighbors,
religious and other group associations (including youth groups) and
volunteers. This network may engage in activities on a client's behalf in
a number of areas which include socialization and support, household
responsibilities, personal care, transportation, health maintenance, meal
preparation, and general assistance with problem-solving. The duration
27
and extent of ISN assistance varies.
-21-


Ill
RESEARCH METHODS


Ill. RESEARCH METHODS
Conceptual Framework
The conceptual framework for this study, as presented in Figure 1, defines the primary goal of the research, the objectives developed to reach this goal, the areas of focus within the study, and the target population. This framework assisted in the development of research methods and the survey interview.
Several assumptions were made in development of the conceptual framework of this study: l) An ISN currently exists within the two counties, and formal agencies that serve the target population presently interact to some degree with the existing ISN; 2) The more effective use of the ISN in providing services may reduce formal public services necessary to maintain the target population in their homes, and therefore, may decrease spending of public funds for that purpose; 3) The integration of knowledge regarding the functions and interactions of the ISN into the Case Management Plan will contribute to better coordination and comprehensiveness in the delivery of .services; and 4) Functionally impaired elderly and physically disabled and blind adults who are able to remain in their homes and community through the help of the ISN axe generally happier, and have maintained a higher level of social functioning than those who axe admitted to long term care facilities.
Sample Selection
The Local Operational Plan for Case Management in Arapahoe and Douglas Counties identified 65 formal agencies which serve the target population in these two counties. Of the total 65 agencies, 2? serve only Arapahoe County, five serve only Douglas County, and 33 serve both counties. Since the formal
-23-


FIGURE 2
CONCEPTUAL FRAMEWORK
Primary Goal
Assist in implementation of Senate Bill I38 (Home and Community Based Services Program Alternatives to Nursing Home Care) through the Local Operational Plan for Case Management in Arapahoe and Douglas Counties, Colorado
Objectives
Development of a method for identifying existing ISN participants serving Arapahoe and Douglas Counties which may then be utilized by other Colorado counties engaged in implementation of Senate Bill I38
Idntif ication of ISN participants serving Arapahoe and Douglas Counties
Identification and assessment of linkages between formal agencies and the ISN
Development of policy and planning recommendations that will promote the effective utilization of the ISN, and its incorporation as a vital component into the total Case Management Plan
Areas of Focus
Services provided by the ISN formal and informal interaction
Categories of ISN participants and frequency of interaction with formal agencies
Specific information on the ISN (i.e. names, addresses, telephone numbers)
Analysis of strengths and weaknesses of agency and ISN interaction
Future plans of agencies with regard to their interaction with the ISN
Data collection on the number of agency staff and their hours of contact with the ISN
Responses of agencies to assumptions that utilization of the ISN reduces required formal services, expenditure of public funds, and postpones or prevents institutionalization
Target Population
Functionally impaired elderly (age 65+ with emphasis on age 75+ -frail elderly)
Physically disabled or blind adults (age 18 64)
Individuals who would otherwise require nursing home care
Individuals who are eligible for Medicaid (or would be if in a nursing home under the "300% rule")
Individuals who can be served with alternatives at a lower cost than nursing home care
-24-


agencies had. previously been identified within the Local Operational Plan, an appropriate starting point for administration of the survey was with the formal agencies.
Given the time constraint, regional scale of the project, availability of only one interviewer, statistical requirements, and length of the interview, it was not feasible to contact one hundred percent of the formal agencies listed. The following factors were considered when determining the number and type of formal agencies to be contacted:
(1) Category of Service The 65 formal agencies identified with the Local Operational Plan are divided among thirteen categories of service, each of which was represented in the selected sample (Appendix A).
(2) Number of Potential Clients Arapahoe County projected 40 potential clients, while Douglas County projected a total of 20 potential clients. As a result of this difference, greater emphasis was placed on contacting formal agencies within Arapahoe County.
(3) Length of Survey Interview The approximate time anticipated for completion of a telephone interview was 15 20 minutes.
(4) Suggestions from Informed Professional Sources Contacts were made by telephone or personal visit with representatives of the following agencies:
Mile High United Way Information and Referral Service, Denver Colorado Office of Volunteerism, Denver
Douglas County Department of Social Services, Castle Rock Douglas County Senior Center, Castle Rock
Professionals from these agencies provided suggestions for determining which formal agencies might offer the most helpful information in identifying
-25-


the ISN. Due to the comprehensive nature of the services provided by these organizations, it was felt that they would be best able to provide such suggestions.
A total of 60 formal agencies listed in the Local Operational Plan serve Arapahoe County, and a total of 38 formal agencies serve Douglas County.
Many of these agencies serve both counties. Since Arapahoe County projects a greater number of potential clients, two-thirds (2/3) of the 60 agencies were contacted (60 x .667 = 40.2 or 40.0). Since Douglas County projects 20 potential clients, in comparison to Arapahoe County's 40, only one-half (l/2) of the 38 agencies were to be contacted (38 x .50 = 19)
Since many of the agencies serve both counties, contacts with Arapahoe County were determined first, with the expectation that the necessary nineteen contacts for Douglas County would be identified within those agencies that serve both counties. The required number of Douglas County contacts were selected through this process. Within each of the 13 service categories two-thirds (2/3) of those agencies serving Arapahoe County were randomly selected. If a service category had only one agency serving Arapahoe County, it was selected. Sample distributions among the 13 service categories are presented in Table 1. When an agency failed to respond to several telephone calls, a replacement agency was selected from within the same category of service.
Interview Design
The need identified in this research project is for direct, specific information regarding the ISN and linKages with formal agencies. The study was conducted within the time constraint of a four-month period (January -May 1983). Information on a regional scale was required, with only one
-26-


-LC
TABLE 1
DISTRIBUTION OF THE SAMPLE SELECTION AMONG THE THIRTEEN SERVICE CATEGORIES PRESENTED IN THE LOCAL OPERATIONAL PLAN FOR CASE MANAGEMENT IN ARAPAHOE AND DOUGLAS COUNTIES
Total Number of Total Number of Total Number of Total Number of Total
~*Unrepeated Agencies Agencies Serving Agencies Serving Both Unrepeated Agencies Sample
Service Category In Service Category Arapahoe County Arapahoe & Douglas Cos. Serving Only Douglas Co. Number
Home Health 20 19 16 1 13
Friendly Visiting 8 8 7 0 5
Respite Care 0 0 0 0
Homemaker Assistance/ Cnore Service ' 2 2 1 0 1
Environmental Services 1 0 0 1 0
Adult Day Care 3 3 2 0 2
Home Delivered Meals 2 2 2 0 1
Transportation 5 4 0 0 3
Health Materials, Equipment & Supplies 5 5 5 0 3
Nursing Home Facilities 12 11 0 1 7
Hospitals 3 3 0 0 2
Meal Sites 3 2 0 1 1
Recreation Programs 1 1 0 0 2
TOTALS 65 60 34 4 41
*An "unrepeated" agency is one which has been eliminated from all .other service categories where it'may also have appeared.
**This agency was selected as a replacement, and was not originally listed in the Local Operational Plan for Case Management in Arapahoe and Douglas Counties.
Source: Service Categories derived from the Local Operational Plan for Case Management in Arapahoe and Douglas Counties, DRCOG


interviewer to collect the data. It is intended that the method developed by this study will serve as a guide for other Colorado counties engaged in the same process under similar constraints. The development of an interview instrument which could be used by other counties was a major consideration. Given these factors, it was determined that a survey interview to be administered by telephone was the most appropriate method for efficiently gathering the required data.
The literature search failed to reveal a county-wide or regional survey conducted for the purpose of identifying ISN participants and their linkages with formal agencies. As a result, an independent survey was developed to specifically address both of these issues. Froland, Pancoast, Chapman, and Kimboko, the authors of Helping Networks and Human Services, conducted a research study with primary focus on the interaction between formal and informal support networks. Their study was not limited to agencies serving functionally impaired elderly, adult physically disabled and adult blind, but included interviews with agencies serving a variety of additional populations. Their primciple method of data collection included an in-depth personal interview with agency personnel conducted during the course of a one to three day visit to the agency. A ten page discussion guide was used and took a minimum of four hours to cover completely. Although the methods used by Froland, Pancoast, Chapman, and Kimboko are more in-depth and time consuming than the present interview, many of the survey questions were fashioned after information provided by these authors.
From the examples provided by the above mentioned authors, and information from additional sources (Planning for the Elderly, Alternative Community Analysis Techniques, 1979; Hispanic Natural Support Systems, 1980; and
-28-


An Aging Services Program Impact and Needs Assessment (DRCOG), 1981) a comprehensive list of items to he included on the interview schedule was compiled. The wording and order of the questions was then established with the goal of collecting data consistent with the previously established objectives of the study.
Interview
The survey was developed to gather data from formal agencies regarding their knowledge of and interactions with the ISN. If the agency contact person agreed to participate, there were 10 to 15 questions to be answered. If the agency indicated that it presently interacts with the ISN, then 15 questions were addressed. If the agency indicated that it presently is not working with the ISN, the contact person might still provide the reasons for this, and be able to elaborate on future possibilities, or perhaps identify informal service providers even though the agency does not directly work with them. If this was the case, a series of 10 questions was to be answered, several of which were the same as the 15 questions asked of agencies who report interaction with ISN participants.
Each survey was prepared in a standardized format and required agency identification in the form of name, address, telephone number, county served, and category of service as defined in the Local Operational Plan for Case Management. The contact person was identified by name and title. The date and time of the interview was also recorded.
As each contact was made by telephone, the interviewer offered an introductory statement providing personal and professional identification.
An agreement on the part of the contact person to participate was secured at
-29-


the end of the introductory statement. Upon completion of the interview, all respondents were thanked for their assistance. The interview is presented in Appendix B.
Data Analysis
The survey responses were tabulated and presented in the format of absolute frequency and adjusted frequency. Absolute frequency indicates the total number of responses received for each response category. The adjusted frequency is the percentage that each response represents of the total number of valid cases. Surveys which had "no response" to a question are regarded as missing cases, and are not included in the total count of valid cases.
The proportions under adjusted frequencies do not reflect "no responses."
For example, a total of 37 agencies participated in Part I of the survey (those agencies indicating interaction with the ISN). However, question Number Six, Parts A, B, and C*reports 15, 24, and 10 valid cases respectively, indicating that the difference between each of these numbers and 37 is the number of "no responses" to each of the questions three parts.


IV
SURVEY RESULTS


IV. SURVEY RESULTS
Summary of Major Findings
Of the 41 agency representatives interviewed, 90.2 percent reported that their agency interacts with ISN participants in provision of services to the elderly, adult physically disabled and blind. The remaining 9*8 percent of the agencies reported no interaction with ISN participants in provision of services to the target population. The response to this initial question supports the assumption that Informal Support Networks currently exist in most communities within Arapahoe and Douglas Counties, and that there is interaction between the formal and informal service providers. It is likely that this interaction will increase, since 64.9 percent of those interviewed reported intentions on the part of their agency to increase interaction with the ISN.
Agencies were verbally presented with a list of eight types of ISN participant categories and asked which of these they interact with. The agency contact person was then asked to rank by number the three ISN participant categories that their agency interacts with most frequently.
The categories of ISN participants were derived from the Local Operational Plan for Case Management in Arapahoe and Douglas Counties, and originally from the Miami Jewish Home and Hospital for the Aged. Table 2 presents the distribution of these responses by ISN participant category for general interaction. Table 3 presents the data in terms of frequency of interaction.
One hundred percent (100%) of the respondents indicate that they interact with family/relatives and do so more frequency than with any other ISN category. Respondents then reported their primary interactions to be with
-32-


TABLE 2
DISTRIBUTION OF FORMAL AGENCY INTERACTION AMONG ISN PARTICIPANT CATEGORIES
ISN Participant Category * of 3? Valid Cases Reporting Interaction * Of 37 Valid Cases Reporting No Interaction
Family/relatives 100.0% 0.0*
Friends 91.9* 8.1%
Volunteers 86.5* 13-5*
Neighbors 75-7* 24.3*
Religious Groups/ Churches 78.4* 21.6%
Group Associations/ Service Organizations 59.5* 40.5*
Youth Groups 45.9* 54.1%
Other lo.Q* 89.2*
Source: ISN Participant Categories were derived from the Miami Jewish Home and Hospital for the Aged


TABLE 3
DISTRIBUTION OF FORMAL AGENCY FREQUENCY OF INTERACTION AMONG ISN PARTICIPANT CATEGORIES
ISN
Participant
Category
% of 37 Valid. Cases Ranking Category as #1 in Frequency of Interaction
% of 37 Valid Cases Ranking Category as #2 in Frequency of Interaction
& of 37 Valid Cases Ranking Category as # 3 in Frequency of Interaction
% of 37 Valid Cases Giving Category No Rank
Family/Relatives 67.6% 10.8% 2.7% 18.9%
Friends 0.0% 29.7% 27.1% 43.2%
Volunteers 13. a* 13.5% 13.5% 59.5%
Neighbors o.o% 16.2% 18.9% 64.9%
Religious Groups/
Churches 2.7^ 8.1% 5-4% 83.8%
Group Assoc./ Service Organiza-
tions 0.0% 5.4% 8.1% 86.5%
Youth Groups o.o% 0.0% 8.1% 91.9%
Other 0.0% 0.0% 0.0% 100.0%
Source: ISN Participant Categories were derived from the Miami Jewish Home and Hospital for the Aged


friends, volunteers, religious groups/churches, and neighbors. Interaction with group associations/service clubs and youth groups occurs less frequently than with the above mentioned categories.
The interviewer proceeded with the respondent through a series of services, including those of a social nature and those of a problematic nature. The survey revealed whether or not the agency interacts with the ISN in provision of these services. The list of services was derived from the Local Operational Plan for Case Management in Arapahoe and Douglas Counties and originally from the Miami Jewish Home and Hospital for the Aged. Table 4 and Table 5 present the distribution of these responses by service type. Although all services are listed under one question, Number 3> each service is examined in terms of one hundred percent (100%) of the valid cases, and whether or not the response was Yes or No to interaction.
Agency interaction with the ISN in provision of Social Support Services is generally high, with over 80 percent of the agencies reporting interaction on over half of the twelve services. The greatest interaction occurs in provision of reassurance/support services, and the least interaction between formal and informal providers occurs with the services of life review and sharing food.
The data indicate there is generally less interaction between formal agencies and the ISN in provision of Problem Centered Services. The percentages of agencies reporting interaction with the ISN to provide such services as sharing information and activities, connection to community activities, and friendly visiting is far greater than interaction reported for services such as respite care, beauty/barber care, housework/yardwork, and cooking. Exceptions to this pattern in the Problem Centered category
-35-


TABLE 4
DISTRIBUTION OF FORMAL AGENCY INTERACTION WITH THE ISN BY SOCIAL SUPPORT SERVICE
$ of 37 Valid. Cases Reporting $ of 37 Valid Cases Reporting Agency/lSN Interaction No Agency/lSN Interaction
Social Support Services In Provision of
Friendly Visiting 86.5$
Telephone Contact 83.8$
Connection to Community Activities 91-9$
Escorting/Accompanying 89.2$
Sharing Food 45.9$
Sharing Activities 91.9$
Sharing Information 94.6$
Life Review 48.6$
Rememberance of Holidays 67.6$
Rememberance of Birthdays 67.6$
Reassurance/Support 97-3^
Spiritual Support 70.3$
Other 0.0$
Service In Provision of Service
13.3*
16.2$
8.1$ 10.8$ 54.1$ 8.1$ 5-4$ 51 Mo 32 Mo
32 Mo 2 Mo 29 Mo 0.0$
Source:
Social Support Services were derived from the Miami Jewish Home and Hospital for the Aged
-36-


TABLE 5
DISTRIBUTION OF FORMAL AGENCY INTERACTION WITH THE ISN BY PROBLEM CENTERED SERVICE
Problem Centered Services % of 3? Valid Cases Reporting Agency/lSN Interaction In Provision of Service % of 37 Valid Cases Reporting No Agency/lSN Interaction In Provision of Service
Housework/Yardwork 40 .5% 59.5%
Transportation 81.1% 18.9%
Beauty/Barber Care 37.8% 62.2%
Shopping 70.3$ 29.7%
Letter Writing 51.30 48.7%
Reading 62.2% 37.8%
Counseling 51.30 48.?%
Cooking 40.5% 59.5%
Errands 75.7% 24.3%
Taking Care of Finances 59.5% 40.5%
Information & Referral 83.8% 16.2%
Respite Care 37.8% 62.2%
Other 0.0% 0.0%
Source: Problem Centered Services were derived from the Miami Jewish Home and Hospital for the Aged
-37-


are the services of information and referral, and transportation, where over 80 percent of the agencies report interaction with the ISN.
The agency representatives were asked to provide the name, address, telephone number, and type of service provided by the ISN participants with which they interact. Although 83.8 percent of the respondents stated that they could specifically identify the informal individuals, groups, and organizations, only 62.2 percent actually agreed to provide this information to the interviewer.
Nearly all respondents declined to provide names, addresses, and telephone numbers of individuals, citing confidentiality as the primary reason for this action. As a result, most of the specific information provided is related to religious groups/ churches, groups associations/service clubs, and informal support groups, private company service clubs, youth groups, schools, and volunteer groups. Respondents frequently were unable to provide addresses of the ISN participant.
Response to previous questions indicates that formal agencies interact primarily with family/relatives, friends and neighbors. Thus, this survey does not effectively identify this segment of the ISN. However, most agencies indicated willingness to provide information on individual ISN participants on a case-by-case basis in order to assist the case manager in development of a client "service package."
In an open-ended question, agencies were asked to identify the strengths and weaknesses of their interaction with the ISN. The strengths most often cited can be combined into three major categories:
(1) Commitment. The ISN participants are committed to the provision
of services needed by the clients of the agency. They are dedicated, reliable, and have a motivation beyond monetary gain.
(2) Level of Care. The ISN participants help to meet client needs that might otherwise not be met. They help improve the quality of care by
-38-


reducing client isolation, providing individual attention, and providing a connection to the outside world, particularly for those who are institutionalized or homebound.
(3) Stability and Effectiveness. Agency respondents report that the established ISN with which they interact is both stable and effective in providing services to the target population.
The weaknesses most often cited by formal agencies in their interaction with the ISN can be combined into the following four major categories:
(1) Nature and Function of the ISN. Agencies report that there is a lack of information regarding the nature and functions of the ISN as it relates to their services. Agency respondents also note that Informal Support Networks often dissolve quickly, as do many human service agencies that work with them, and that resource information is outdated as soon as it is collected. Agencies are not aware of what ISN services are available, and as a result, feel that there are never enough ISN participants to assist in providing services.
(2) Follow-Through. Agencies report a lack of follow-through on their part, largely due to limited staff time available to supervise ISN participants. Agencies also report a lack of follow-through on the part of ISN participants. There may be no back-up for a family member or volunteer who is out-of-town or sick, for example. The ISN may not be providing the service effectively or appropriately.
(3) Lack of Organization. The informality and lack of organization associated with the ISN often creates frustration on the part of
a formal agency since ISN participants may be difficult to contact
-39-


or may be unavailable when needed. The formal agency lacks the degree of control over the ISN that it has with paid staff personnel.
(4) Recruitment and Training. Agencies report that the lack of ISN
participants indicates an immediate need for improved recruitment. Agencies also note a lack of effective initial and on-going training for ISN participants. The ISN participants are in need of training regarding the aging process, both physical and emotional problems of the elderly and handicapped, and appropriate methods of interaction with these clients.
When asked if their agency could more effectively use the ISN to provide services to the target population, 94.6 percent of those interviewed responded affirmatively. The suggestions most frequently stated were as follows: l) the availability of a resource directory providing information on the ISN is needed; 2) improved training for ISN participants in combination with development of recruitment techniques is needed; and 3) additional staff or staff time to recruit, train, and supervise the ISN participants is needed. An additional suggestion for increased effectiveness of the ISN was to provide the opportunity for coordination and contact among ISN participants. In response to a survey question regarding ISN participant interaction, 46.0 percent of the respondents reported no interaction among ISN members.
As is reflected in the decreased number of valid cases, agency representatives had difficulty answering question Number 6 regarding geographical distribution of the ISN within Arapahoe and Douglas Counties (Appendix B).
Many agency contacts stated that they had no idea of the geographical distribution of the ISN or areas of concentration. However, respondents did
-40-


identify the Informal Support Networks as primarily being urban and neighborhood-centered.
One hundred percent (100%) of the agencies indicating current interaction with the ISN report having staff who work directly with ISN participants on a regular basis. A total of 67.5 percent of the respondents reported that one through 10 staff members perform these functions; 32.5 percent indicated that over 10 employees serve in this capacity. For those reporting over 10 staff working directly with ISN participants, the actual numbers ranged from 15 through 200 staff members serving in that capacity. However, most responses were in the 15 through 60 range. The highest numbers of staff directly working with the ISN were reported by a home health agency and a nursing home facility.
In relationship to the number of staff, agencies were asked how much staff time per week (in hours) is spent working with the ISN. The majority, 64.3 percent, reported between 0 through 50 total staff hours per week were spent working with the ISN. The remaining 35*7 percent indicated over 50 total staff hours per week. The two highest agency estimates of 500 and 800 total staff hours per week were reported from a nursing home and a home health care agency. The reported number of staff working with the ISN and the staff time can best be compared by examining the tabulated survey data (Appendix C).
The last three survey questions addressed the issues of reducing formal services and public expenditures through use of Informal Support Networks, and the role of the ISN in postponing or preventing institutionalization of the target population. These three questions resulted in similar responses, with 67.6 percent of the respondents reporting that the use of the ISN by
-41-


their agency enables reduction of formal services required to maintain the target population in their homes; 62.2 percent of the respondents indicating that the use of the ISN by their agency helps to reduce expenditure of public funds necessary to maintain the target population in their homes; and ?0.3 percent of the respondents reporting that the use of the ISN is a major factor in postponing or preventing institutionalization of the elderly, adult physically disabled and adult blind. The response to these questions supports the assumption that use of the ISN in provision of services to the target population may reduce formal public services necessary to maintain this segment of the population in their homes, and decrease expenditure of public funds for that purpose.
The following paragraphs present responses of formal agencies that had indicated they have no interaction with the ISN. This section was incorporated as Part II of the interview for several reasons: l) it was undetermined how many respondents would report no interaction with the ISN; 2) responses of agencies reporting no interaction with an ISN may provide insight into the reasons for this lack of interaction; and 3) agencies reporting no direct interaction with an ISN may provide information on the ISN within their service area.
Of the total 41 completed interviews, only four respondents indicated no interaction with informal service providers. These four agencies were presented with a list of eight reasons for the lack of interaction and asked to select those that were applicable to their agency. Although these eight categories are combined under one question, Number 2, in Part II of the survey, each category is presented in terms of the percentage of valid cases. Table 6 presents the distribution of these responses by "Reasons for Non-Interaction." The primary reason for lack of agency interaction with the
-42-


TABLE 6
DISTRIBUTION OF FORMAL AGENCY REASONS FOR NON-INTERACTION WITH THE ISN
% of 4 Valid Cases Reporting Yes to Reason
Reasons ForNon-Interaction For Non-Interaction
% of 4 Valid Cases Reporting No to Reason For Non-Interaction
Agency Structure 75-0% 25.0%
Agency Size 25-0% 75.0%
Agency Leadership 0.0% 100.0%
Agency Stability 0.0% 100.0%
Personalities of staff or Informal Helpers 0.0% 100.0%
Stability of Neighborhood or Community in which Clients Live 0.0% 100.0%
Legal and Political Climate Encountered by Agency 25-0 % 75.0%
Other 0.0% 100.0$
Source:
Reasons for Non-Interaction derived from Helping Networks and Human Services, 1981, by Froland, Pancoast, Chapman, and Kimboko
-43-


ISN is agency structure as it relates to agency size, specifically lack of staff and financial resources.
The four respondents reported an inability to specifically identify ISN participants (i.e. name, address, telephone). However, all but one provided general information on ISN services. The total four respondents indicated that it would be beneficial to their agency's clients to develop connections with the ISN. However, none of the four agencies have plans to develop such connections.
The four respondents believed that use of the ISN by formal agencies enables reduction of formal services, and is a major factor in postponing or preventing institutionalization of the target population. However, the response was equally split when asked if use of the ISN by formal agencies enables reduction of public expenditures. Half of the agency representatives felt public expenditure was not reduced, stating that a client may require more skilled care, resulting in greater public expenditure, if institutionalization is postponed beyond the point when it can best prevent further deterioration. The remaining half of the agency representatives believed that formal agency interaction with the ISN reduces expenditure of public funds.
-44-


CONCLUSIONS AND RECOMMENDATIONS


V. CONCLUSIONS AND RECOMMENDATIONS
This portion of the report presents conclusions and recommendations derived from the survey data analysis. Conclusions and recommendations are presented in relation to objectives of the study.
Evaluation of Research Methods
A general method for identifying existing ISN participants in Arapahoe and Douglas counties was developed and can be summarized as follows:
(1) A comprehensive survey interview composed of 10 15 questions to be administered verbally by telephone among randomly selected formal agencies serving the target population in Arapahoe and Douglas Counties, Colorado.
(2) Tabulation of survey results by means of absolute frequency and adjusted frequency.
Strengths of the survey interview method are the following:
(1) Administered by Telephone. This method of administration allowed the maximum number of agencies to be contacted within the given time frame. Also, clarification of questions was easily provided.
(2) Sponsorship by DRCOG Aging Services Division. The interview was conducted under the auspices of a well-known and reputable agency. This encouraged contact people who worked for formal agencies to participate.
(3) Comprehensiveness of the Interview. The interview incorporated questions on types of ISN participants, services provided by the ISN, specific information on ISN participants (i.e. name, address, telephone), interaction among ISN participants, geographical
-46-


distribution of the ISN, staff time spent working with the ISN, recruitment, training, supervision, and reimbursement of the ISN participants, future plans of formal agencies for interaction with the ISN, participants suggestions for effective use of the ISN, analysis of strengths and weaknesses in formal and informal interaction, and finally, respondents opinions regarding the role the ISN plays in enabling reduction of formal services, reduction of public expenditures, and postponement or prevention of institutionalization. These categories were essential for a thorough analysis of the ISN.
(4) Inclusion of Part II in the Survey. Although the numbers of agencies reporting no interaction with the ISN were few, representative's responses provided insight into reasons for non-interaction, and also provided information on ISN participants.
(5) Utilization by Other Colorado Counties. With possibly a few minor additions and/or deletions, the interview can be used by other Colorado counties in implementation of S.B. 138.
Weaknesses of the survey interview method are the following:
(l) Length of Interview. Average time for administration of the
interview was 27 minutes. The potential respondent was initially told in the introductory statement that the survey would take 15 -20 minutes. However, many of the interviews took substantially more time. Over half of the 41 interviews (23) lasted from 30 75 minutes. The length may be partially attributed to the repetition of questions and categories which was often necessary since the survey was administered verbally by telephone. The length of the survey may also result because the ISN concept was unfamiliar to


many respondents. This required additional explanation by the interviewer, and additional consideration of questions by the respondents. However, the direct contact with respondents helped to avoid confusion in question response.
The following recommendations are suggested regarding the survey interview approach:
(1) Remain within a 15 20 minute time frame if possible.
(2) Clarify any misunderstandings that the respondent may have.
Following the brief introductory statement defining the ISN, the concept must be further clarified by the interviewer as he/she proceeds through the questions. Questions must be arranged to assist in this clarification. Respondents generally had difficulty separating services that their staff provided from services that staff enlisted the aid of the ISN to provide. This aspect must be repeatedly stressed while progressing through the survey, particularly with question Number 3*
Planning and Policy Implications
This survey has gathered specific information primarily on the following ISN participants: religious groups/churches, group associations/service organizations, informal support groups, private company service clubs, youth groups, schools, and volunteer groups. As previously stated, agencies indicate their most frequent contact is with family, relatives, and friends. Although specific information on a few individuals was gathered, most agencies declined to provide this information citing client confidentiality as the major reason. This indicates that in developing a "service package" for a
-48-


client, the Case Manager may refer to the specific information on ISN services provided by this survey and enlist their aid whenever possible. However, it remains essential to work closely with family, relatives, and friends of the client. It appears that identification of personal ISN participants can best be accomplished by one-to-one interaction with the client or agency representative, or both.
There are many more ISN participants in Arapahoe and Douglas counties than this survey has identified. The survey serves as an initial step in identification. Many agencies had no central record of ISN participants with which they interact. The information is often "in a staff person's head" and not readily available to other staff or an interviewer. Agencies often provided the interviewer with names of informal groups which "came to mind first."
Therefore, in order to provide better identification of ISN participants serving Arapahoe and Douglas Counties, the following recommendations are made:
(1) The Case Manager should work closely with family, relatives, and friends of the client, and enlist the aid of those ISN participants identified through this survey whenever possible to expand and augment the ISN services to the client.
(2) As the Case Manager makes contact with formal agencies he or she may inquire in greater detail regarding ISN participants. DRCOG
should encourage and assist agencies in the development and maintenance of a data file of ISN participants serving their clients, and encourage exchange of this information among agencies.
The survey successfully identified linkages between formal agencies and the ISN. With over 90 percent of the respondents indicating that their
-49-


agencies presently interact with the ISN, it can be assumed that an ISN does exist in both Arapahoe and Douglas Counties. The survey identified the categories of ISN participants which agencies interact with most frequently. The survey also revealed which services the ISN and formal agencies work together most frequently to deliver. The interview successfully gathered information on the total number of agency staff working directly with the ISN, and the total agency staff time spent working with the ISN, plus whether the agency recruits, trains, supervises, and reimburses ISN participants. Suggestions were gathered from agencies regarding more effective use of the ISN, as well as the agency's own evaluation of strengths and weaknesses of interaction. Finally, data was collected on future plans of agencies regarding interaction with the ISN.
A thorough examination of the data gathered regarding linkages between formal and informal service providers resulted in the following recommendations to DRGOG:
(1) Encourage formal agency interaction with the ISN in the area of Problem Centered Services.
(2) Encourage formal agencies to maintain central records on the number of staff and their time spent interacting with ISN participants.
(3) Provide information to the agencies regarding the nature and functions of the ISN and services provided by ISN participants. Encourage formal agencies to share this information with one another.
(4) Provide technical assistance to formal agencies in their recruitment, training, and supervision of ISN participants.
(5) Encourage agencies to promote coordination and contact among ISN
-50-


participants, thereby improving the continuity of service delivery in situations where a family member, friend, or volunteer may be ill, out-of-town, or unavailable.
(6) Encourage agencies to increase interaction with ISN participants other than family, relatives, friends, and neighbors whenever possible. This will provide relief to the personal ISN participants and expand ISN services for the client.
Interaction with the ISN is generally viewed positively by formal agencies. The majority of agencies feel that as a result of this interaction, formal services can be reduced or redirected, public expenditure can be reduced, and institutionalization of the target population can be postponed or prevented.
Although there are areas for improvement in the interaction between informal and formal service providers, the general expression of agency representatives is that the ISN is essential to the effective provision of services. Agency staff alone could not provide the individualized, ongoing, expanded services that the ISN makes possible.
-51-


APPENDICES


appendix a
SAMPLE SELECTION
HOME HEALTH Assigned Number Within
County Served Category Agency
A/D 18 Spalding Rehabilitation Center
a/d 3 Upjohn Healthcare Service
A 15 Arapahoe County Department of Social Services
a/d 20 Sewall Rehabilitation Center
A/D 6 Myer Care Health Service
a/d 4 Holistic Approaches to Independent Living
a/d 5 RX Home Health Agency
a/d 12 Tri-County District Health Department
a/d 7 Bodimetric Health Service
A/D 14 Kelly Health Care
A/D 2 Comcare, Inc.
a/d 11 Health Care at Home
a/d 16 Georgian House Hospice (replaced by Hospice of Metro Denver)
Total of Unrepeated Agencies Serving Arapahoe County: 19
Determination of Sample Size; 19 x .667 = 12.67 or 13
FRIENDLY VISITING
County Served Assigned Number Within Category Agency
A/D 7 American Red Cross
a/d 8 Washington Park Community Center
a/d 3 Arthritis Foundation
a/d 2 (5) Red Shield Senior Citizens Center
a/d 6 (replaced by JFCS) Salvation Army Corps Community Center
Total of Unrepeated Agencies Serving Arapahoe County: 8 Determination of Sample Size: 8 x .667 = 53 or
RESPITE CARE
Assigned Number Within
County Served Category Agency
A/D 1 Hospice of St. John
(same facility as Georgian House Hospice; replaced by Hospice of Metro Denver)
Total of Unrepeated Agencies Serving Arapahoe County: 1 Determination of Sample Size: 1 x .667 = .667 or 1
-53-


HOMEMAKER ASSISTANCE/CHORE SERVICE
Assigned Number Within
County Served Category Agency
A/D 1 A Helping Hand
Total of Unrepeated Agencies Serving Arapahoe County: 2 Determination of Sample Size; 2 x .667 = 1.33 or 1
ENVIRONMENTAL SERVICES
Assigned Number Within
County Served Category
Agency
Total of Unrepeated Agencies Serving Arapahoe County: 0
ADULT DAY CARE
Assigned Number Within
County Served Category Agency
A/D 1 Beth Israel Geriatric Center
A/D 3 Daybreak, Inc./Arvada Presbyterian Church
Total of Unrepeated Agencies Serving Arapahoe County: 3
Determination of Sample Size: 3 x *66? = 2
HOME DELIVERED MEALS
Assigned Number
County Served Within Category Agency
a/d 2 VOA Meals on Wheels
Total of Unrepeated Agencies Serving Arapahoe County: 2 Determination of Sample Size: 2 x .667 = 1.33 or 1
-54-


TRANSPORTATION
Assigned Number Within
County Served Category Agency
A 1 Inter-Faith Task Force
A 2 Senior Surrey
A 3 Tri-Valley Senior Citizens Association
Total of Unrepeated Agencies Serving Arapahoe County: 4
Determination of Sample Size: 4 x .66? = 2.66 or 3
HEALTH MATERIALS, EQUIPMENT & SUPPLIES
Assigned Number
Within
County Served Category Agency
a/d 1 (2) Center on Deafness/Avery Fund (replaced by American Cancer Society because
a/d Center on Deafness is currently involved in legal action with DRCOG)
3 National Kidney Foundation
a/d 5 Colorado Optometric Center
Total of Unrepeated Agencies Serving Arapahoe County: 5
Determination of Sample Size: 5 x .667 = 3-33 or 2
NURSING HOME FACILITIES
Assigned Number
Within
County Served Category Agency
A 3 Cherry Hills Nursing Home
A 8 Cherry Creek Nursing Center
A 7 Camellia Care Center
A 1 Beverly Manor
A 5 Julia Temple Center
A 9 Cherry Park Health Care Facility
A 11 Littleton Manor
Total of Unrepeated Agencies Serving Arapahoe County: 11
Determination of Sample Size : 11 x .667 = 7-33 or 7
-55-


HOSPITALS
County Served Assigned Number Within Category Agency
A 1 Aurora Community Hospital
A 3 Aurora Presbyterian Hospital
Total of Unrepeated Agencies Serving Arapahoe County: 3 Determination of Sample Size: 3 x .667 = 2
MEAL SITES
Assigned Number Within Within
County Served Category Agency
A 2 Englewood (Malley Senior Recreation Center)
Total Number of Unrepeated Agencies Serving Arapahoe County: 2 Determination of Sample Size: 2 x .667 = 1.33 or 1
RECREATION PROGRAMS
Assigned Number Within
County Served Category Agency
A 1 South Suburban Recreation Center
Total of Unrepeated Agencies Serving Arapahoe County; 1 Determination of Sample Size; 1 x .667 = .667 or 1
TOTAL NUMBER OF AGENCIES LISTED IN LOCAL OPERATIONAL PLAN = 83 TOTAL NUMBER OF REPEATED AGENCIES (all categories) = 18
51
TOTAL NUMBER OF AGENCIES SERVING A AND A/D TOTAL NUMBER OF AGENCIES SERVING D AND A/D TOTAL NUMBER OF AGENCIES SERVING A TO BE CONTACTED TOTAL NUMBER OF CROSSOVER AGENCIES ALSO SERVING D
= 60 x .667 = 40.2 or 4-0 = 38 x .50 =19 = 40 = 25
ADDITIONAL AGENCIES CONTACTED: Silver State Home (d)
Douglas County Senior Center (D)
(in conjunction with VOA Meals On Wheels) Aurora Senior Center (a)
-56-


APPENDIX B
FORMAL AGENCY INTERVIEW
Interview Introduction
Initial Call to Agency
My name is Trish Kolm. I'm a graduate student working with the Denver Regional Council of Governments (DRCOG) on my thesis project. My research involves identifying Informal Support Networks that agencies such as yours interact with in provision of services to elderly, disabled and blind adults. Will you refer me to the most appropriate person in your agency with whom I can discuss this subject?
When Appropriate Contact Person Is Located
1. Identification
Name: Trish Kolm
Position; graduate student, Master's thesis project, University of
Colorado, Department of Planning and Community Development
Agency Working With; Denver Regional Council of Governments (DRCOG) ,
Aging and Adult Services Division, Noah Midamba and Susan Gockings-Aldridge
2. Purpose of Study
To assist in the implementation of S.B. 138 through the Local Operational Plan for Case Management in Arapahoe and Douglas Counties by identifying Informal Support Networks (define) available to the frail elderly, physically disabled and blind adults in those two counties. The study will also assess the manner in which formal agencies interact with Informal Support Networks.
3. Procedure
Your agency has been listed as a resource for these two counties in the Local Operational Plan for Case Management prepared by DRCOG. Are you willing to take 15-20 minutes to answer 10-15 questions on this subject Your name will remain confidential.
If no, reasons for refusal: ______________________________________________
-57-


FORMAL AGENCY INTERVIEW
AGENCY NAME: _______
ADDRESS: __________
TELEPHONE: _________
COUNTY SERVED: ____
CATEGORY OF SERVICE:
CONTACT PERSON: ____
POSITION/TITLE: ____
DATE & TIME
1. Does your agency interact with Informal Support Networks in the provision of services to the elderly, adult disabled and blind? Yes ___________ No ______.
If the answer to # 1 is Yes: PART I
3. In what fashion does your agency interact with an Informal Support Network in the provision of services to the target population?
Social Support
friendly visiting telephone contact connection to community activities
escorting/accompanying sharing food sharing activities sharing information life review
rememberance of holidays rememberance of birthdays reassurance/support spiritual support
Other
Problem Centered
housework/yardwork
transportation
beauty/barber care
shopping
letter writing
reading
counseling
cooking
errands
taking care of finances information and referral respite care
2. With which types of Informal Support Networks does your agency interact? Rank by number the three ISN categories your agency interacts with most frequently?
family/relatives friends volunteers ne ighbors
religious groups/churches group associations/service organizations youth groups
Other
-58-


4. Can you specifically identify individuals, groups, organizations that serve
as part of an Informal Support Network? Yes ________ No _____. Will you provide
me with their name, address, and telephone? Yes ________ No ______.
(see attached sheet for additional information)
5. Do the Informal Support Networks that you have identified interact with each
other in the provision of services to the target population? Yes ________
No ______ Don't Know _______
If yes, in what ways do they interact? ______________________________________
6. How are the Informal Support Networks distributed within the geographical area that your agency serves? (Arapahoe and Douglas Counties)
'____ primarily urban '____ neighborhood centered
_____ primarily rural _____ community-wide
_____ other _____ other
G. Locations and concentrations within the two counties:
Arapahoe:
Douglas:
7. What is the number of staff in your agency who work directly with the Informal Support Network on a regular basis?
______ 0 _____ 1 _______ 2 ______ 3 _______ ^ _____ 5 _______ 6 ______ ? ______ 8
______ 9 _____10 _______ over 10
8. How much staff time per week is spent working with the Informal Support
Network? __________________(hours)
9. Does your agency recruit ______, train ____, supervise ______, reimburse ______
Informal Support Network participants?
If Yes: What is the type of recruitment? ___________________________________
What type of training is offered?
-59-


What type of supervision is provided?
What type of reimbursement is provided?
If No: Is your agency in favor of recruitment _______, training _____,
supervision ______, reimbursement _____ of Informal Support Network
participants?
Comments; ___________________________________________________________
10. Could your agency more effectively utilize Informal Support Networks in the
provision of services to the target population? Yes _______ No ______
Don't Know ______
If Yes; What are your suggestions for more effective use of the Informal Support Network?
11. What would you identify as strengths and weaknesses in the interaction between your agency and the Informal Support Network participants it deals with?
Strengths; __________________________________________________________________
Weaknesses:
12. Does your agency plan to increase ______, decrease ______, or maintain at the
current level ______ its interaction with Informal Support Network participants
If response is increase, what do these plans include? _______________________
If response is decrease, what are the reasons for reduction?


13. Do you feel that the use of Informal Support Networks hy your agency enables
the reduction of formal services that must be provided to maintain the target population in their homes? Yes _______ No _____ Don't Know _______
14. Do you feel that the use of Informal Support Network services by your agency
helps to reduce the amount of public money which must be spent to maintain the target population in their homes? Yes _______ No ______ Don't Know ______
15. Do you feel that the use of Informal Support Network services by your agency
is a major factor in postponing or preventing institutionalization of the target population? Yes _______ No _______ Don't Know ______
THANK YOU VERY MUCH FOR YOUR HELP
If the answer to # 1 is No: PART II
2. For what reasons does your agency not interact with or utilize Informal Support Network services in provision of services to the target population?
______ agency structure ______ stability of neighborhood or
______ agency size community in which clients live
_____ agency leadership ______ legal and political climate
______ agency stability encountered by agency
______ personalities of staff or ______ other
informal helpers
3. Even though your agency does not interact with or directly utilize Informal
Support Network services, are you aware of the existence of Informal Support Networks in your service area? Yes ______ No ________
4. Can you identify what services these Informal Support Networks provide?
Yes ______ No ______
If Yes, what are the services? ______________________________________________
5. Can you specifically identify individuals, groups, organizations that serve as
part of an Informal Support Network? Yes ______ No ________. Vill you provide
me with their name, address, and telephone? Yes ________ No ______
(see attached sheet for additional information)
6. Does your agency feel that it would be beneficial to its elderly, physically
disabled and blind adult clients to develop connections with an Informal Support Network in your service area? Yes _______ No ______ Don't Know _______
7. Does your agency or programs within have plans to develop connections with
Informal Support Network service providers? Yes ________ No ______ Don't Know __
If Yes, what do these plans include? _________________________________________
If No, what are the reasons?
-61-


8. Do you feel that the use of Informal Support Networks enables the reduction
of formal services that must be provided to maintain the target population in their homes? Yes _______ No ______ Don't Know ______
9. Do you feel that the use of Informal Support Network services helps to reduce
the amount of public money which must be spent to maintain the target population in their homes? Yes ______ No _______ Don't Know ______
10. Do you feel that the use of Informal Support Network services is a major
factor in postponing or preventing institutionalization of the target population? Yes No Don't Know
THANK YOU VERY MUCH FOR YOUR HELP
-62-



INFORMAL SUPPORT NETWORKS
NAME: ___________
ADDRESS: ______
PHONE: __________
TYPE OF SERVICE: COMMENTS: _______
NAME: ___________
ADDRESS: ________
PHONE: __________
TYPE OF SERVICE: COMMENTS: ______
NAME: ___________
ADDRESS: ________
PHONE: __________
TYPE OF SERVICE: COMMENTS: _______
NAME: ___________
ADDRESS: ______
PHONE: ________
TYPE OF SERVICE: COMMENTS: ______
NAME: ___________
ADERESS: ________
PHONE: __________
TYPE OF SERVICE: COMMENTS:
-63-


APPENDIX C
TABULATION OF SURVEY DATA
1. Does your agency interact with Informal Support Networks in the provision of services to the elderly, adult disabled and blind?
Absolute Frequency Adjusted Frequency
Yes 37 90.2
No 4 9.8
Valid Cases 41 100.0
PART I
3. In what fashion does your agency interact with an Informal Support Network in the provision of services to the target population?
Absolute Frequency Adjusted Frequency
Social Support Valid Cases YES NO YES NO
friendly Visiting 37 32 5 86.5 13.5
telephone Contact 37 31 6 83.8 16.2
connection to Community 37
Activities 37 34 3 91.9 8.1
escorting/accompanying 37 33 4 89.2 10.8
sharing food 37 17 20 45.9 54.1
sharing activities 37 34 3 91.9 8.1
Sharing information 37 35 2 94.6 5-4
life review 37 18 19 48.6 51.4
rememberance of holidays 37 25 12 6?.6 32.4
rememberance of birthdays 37 25 12 67.6 32.4
reassurance/support 37 36 1 97.3 2.7
spiritual support 37 26 11 70.3 29.7
other 0 0 0 0 0
Problem Centered Valid Cases
housework/yardwork 37
transportation 37
beauty/barber care 37
shopping 37
letter writing 37
reading 37
counseling 37
cooking 37
errands 37
taking care of finances 37
information & referral 37
respite care 37
other 0
Absolute Frequency Adjusted Frequency
YES NO YES NO
15 22 40.5 59.5
30 7 81.1 18.9
14 23 37.8 62.2
26 11 70.3 29.7
19 18 51.3 48.7
24 13 62.2 37.8
19 18 51.3 48.7
15 22 40.5 59-5
28 9 75.7 24.3
22 15 59.5 40.5
31 6 83.8 16.2
14 23 37.8 62.2
0 0 0 0
-64-


2. With which types of Informal Support Networks does your agency interact? Rank by number the three ISN categories your agency interacts with most frequently.
Absolute Frequency Adjusted Frequency
Valid Cases YES NO YES NO
family/relatives 37 37 0 100.0 0.0
friends 37 34 3 91.9 8.1
volunteers 37 32 5 86.5 13.5
neighbors religions groups/ 37 28 9 75-7 24.3
churches group associations/ 37 29 8 78.4 21.6
service organizations 37 22 15 59.5 40.5
youth groups 37 17 20 45.9 54.1
other 37 4 33 10.8 89.2
INTERACTIONS Top 3 Valid Cases ABSOLUTE FREQUENCY #1 #2 #3 No Rank
family/relatives 37 25 4 1 7
friends 37 0 11 10 16
volunteers 37 5 5 5 22
neighbors religious groups/ 37 0 6 7 24
churches group associations/ 37 1 3 2 31
service organizations 37 0 2 3 32
youth groups 37 0 0 3 34
other 37 0 0 0 4
INTERACTIONS Top 3 ADJUSTED FREQUENCY
No
f amily/relat ive s Valid Cases # 1 # 2 # 3 Rank
37 67.6 10.8 2.7 18.9
friends 37 0 29.7 27.1 43.2
volunteers 37 13.5 13.5 13.5 59.5
neighbors religious groups/ 37 0 16.2 18.9 64.9
churches 37 2.7 8.1 5.4 83.8
group associations/
service organizations 37 0 5.4 8.1 86.5
youth groups 37 0 0 8.1 91.9
other 37 0 0 0 100.0
-6 5-


4.
Can you specifically identify individuals, groups, organizations that serve as part of an Informal Support Network?
Absolute Frequency Adjusted Frequency
YES 31 83.8
NO 6 16.2
Valid Cases 37 100.0
Will you provide me with their name, address, and telephone? Absolute Frequency Adjusted Frequency
YES 23 62.2
NO 14 37.8
Valid Cases 37 100.0
Do the Informal Support Networks that you have identified interact with each
other in the provision of services to the target population?
Absolute Frequency Adjusted Frequency
YES 16 43.2
NO 17 46.0
DONT KNOW 4 10.8
Valid Cases 37 100.0
If Yes, in what ways do they interacts SEE COMMENTS
6. How are the Informal Support Networks distributed within the geographical area that your agency serves ? (Arapahoe and Douglas Counties)
PART A
Absolute Frequency Adjusted Frequency
primarily urban 11 73.3
primarily rural 3 20.0
both urban and rural l 6.7
Valid Cases 15 100.0
PART B
neighborhood-centered
community-wide
both neighborhood-centered & rcommunity-wide other (metro-wide 2)
(individualized
Absolute Frequency Adjusted Frequency
11 45.8
7 29.2
3 12.5
3 12.5
24 100.0
Valid Cases
-66-


6. (continued)
PART C Locations and Concentrations Within the Two Counties
Arapahoe County: Littleton, Englewood, Aurora (particularly in the older
neighborhoods, Deer Trail, Byers, Watkins Douglas County: Castle Rock (inner city), Parker
Valid Cases: 10
7.
8.
What is the number of staff in your agency who work directly with the Informal Support Network on a regular basis?
Number of Staff Absolute Frequency Adjusted Frequency
0 0 0.0
1 4 10.8
2 3 8.1
3 4 10.8
4 5 13.5
5 1 2.7
6 4 10.8
7 1 2.7
8 1 2.7
9 1 2.7
10 1 2.7
Over 10 12 32.5
Valid Cases 37 100.0
How much staff time per week is spent working with the Informal Support Network?
Hours Per Week Absolute Frequency Adjusted Frequency
0 5 2 7.1
6-10 4 14.3
11 20 5 17.9
21 30 3 10.7
31-40 3 10.7
41 50 0 0.0
Over 50 11 -39.3
Valid Cases 28 100.0
Does your agency recruit, train, supervise , reimburse Informal Support Network
participants? Valid Cases Absolute Frequency YES NO Adjusted Frequency YES NO
Recruit 37 25 12 67.6 32.4
Train 37 23 9 75-7 24.3
Supervise 37 26 11 70.3 29.7
Reimburse 37 10 27 27.0 73.0
-67-


9.
(continued.)
10.
If NO to all of the above, is your agency in favor of:
Absolute Frequency Adjusted Frequency
Valid Cases YES NO YES NO
recruitment 7 7 2 7778 22.2
training 7 7 2 77.8 22.2
supervision 7 7 2 77.8 22.2
re imbursement 7 3 6 33-3 66.7
Could your agency more effectively utilize Informal Support Networks in the
provision of services to the target population?
Absolute Frequency Adjusted Frequency
YES 35 94.6
NO 2 5-4
DON'T KNOW 0 0
Valid Cases 37 100.0
11. SEE NARRATIVE FOR DETAILS ON STRENGTHS AND WEAKNESSES OF INTERACTION
What would you identify as strengths and weaknesses in the interaction between your agency and the Informal Support Network participants it deals with?
12. Does your agency plan to increase, decrease, or maintain at the current level its interaction with Informal Support Network participants?
Absolute Frequency
Adjusted Frequency
Increase 24 64.9
Decrease 1 2.7
Maintain at Current Level 12 32.4
Valid Cases 37 100.0
-68-


13-
14.
15.
Do you feel that the use of Informal Support Networks by your agency enables the reduction of formal services that must be provided to maintain the target population in their homes?
Absolute Frequency Adjusted Frequency
YES 25 67.6
NO 9 24.3
DON'T KNOW 3 8.1
Valid Gases 37 100.0
Do you feel that the use of Informal Support Network services by your agency helps to reduce the amount of public money which must be spent to maintain the target population in their homes?
Absolute Frequency Adjusted Frequency
YES 23 62.2
NO 12 32.4
DONT KNOW 2 5.4
Valid Cases 37 100.0
Do you feel that the use of Informal Support Network services by your agency is a major factor in postponing or preventing institutionalization of the target population?
Absolute Frequency Adjusted Frequency
YES 26 70.3
NO 9 24.3
DONT KNOW 2 5-4
Valid Cases 37 100.0
-69-


PART II
RESULTS OF THOSE SURVEYS ANSWERING NO TO QUESTION NO. 1
2. For what reasons does your agency not interact with or utilize Informal
Support Network services in provision of services to the target population?
Reason Absolute Frequency Adjusted Frequency
Valid Cases YES NO YES NO
agency structure 4 3 1 75.0 25.0
agency size 4 1 3 25.0 75.0
agency leadership 4 0 4 0.0 100.0
agency stability 4 0 4 0.0 100.0
personalities of staff or informal helpers 4 0 4 0.0 100.0
stability of neighborhood or community in which clients live 4 0 4 0.0 100.0
legal and political climate encountered by agency 4 1 3 25.0 75.0
other 4 0 4 0.0 100.0
Even though your agency does not interact with or directly utilize Informal Support Network services, are you aware of the existence of Informal Support
Networks in your service area? Absolute Frequency Adjusted Frequency
YES 1 25.0
NO 3 75.0
Valid Cases 4 100.0
Can you identify what services these Informal Support Networks provide?
Absolute Frequency Adjusted Frequency
YES 1 25-0
NO 3 75.0
Valid Cases 4 100.0
5. Can you specifically identify individuals, groups, organizations that serve as part of an Informal Support Network?
YES
NO
Valid Cases
Absolute Frequency
0
4
4
Adjusted Frequency
-0.0
100.0
100.0
Will you provide me with their name, address, and telephone?
Absolute Frequency 0
Valid Cases
Adjusted Frequency 0
100
YES
NO
-70-


- 8 -
6. Does your agency feel that it would be beneficial to its elderly, physically disabled and blind adult clients to develop connections with an Informal Support Network in your service area?
Absolute Frequency Adjusted Frequency
YES 4 . 100
NO 0 0
DON'T KNOW 0 0
Valid Cases 4 100.0
Does your agency, or programs within, have plans to develop connections with
Informal Support Network service providers?
Absolute Frequency Adjusted Frequency
YES 0 0
NO 4 100
DON'T KNOW 0 0
Valid Cases 4 100.0
8.
Do you feel that the use of Informal Support Networks enables the reduction of formal services that must be provided to maintain the target population in their
Absolute Frequency Adjusted Frequency
YES 4 100
NO 0 0
DON'T KNOW 0 0
Valid Cases 4 100.0
9.
Do you feel that the use of Informal Support Network services helps to reduce the amount of public money which must be spent to maintain the target population in their homes?
YES
NO
DON'T KNOW
Valid Gases
Absolute Frequency Adjusted Frequency
2 50
2 50
0 0
4 ioao
10.
Do you feel that the use of Informal Support Network services is a major factor in postponing or preventing institutionalization of the target population?
Absolute Frequency Adjusted Frequency
YES 4
NO 0
DON'T KNOW 0
Valid Cases 4
100
0
0
100.0
-71-


FOOTNOTES


FOOTNOTES
Colorado Department of Social Services, Office of Program Development, Colorado's Long Term Care Plan, (March 1982, p. 8.
2Ibid., p. 5-
^Denver Regional Council of Governments, Local Operational Plan for Case Management in Arapahoe and Douglas Counties, (Denver, Colorado, 1983), p. 1.
4
U. S. Census Bureau, 1980 Census summary tape files 1 and 2; 1970 Census 1st and 2nd count tapes; Table prepared by DRCOG, October 1982, "1970-80 General Population and Housing Characteristics by County," p. 3*
^Denver Regional Council of Governments, Regional Growth and Development Plan for the Denver Region, Extension to Douglas County, (Denver, Colorado, October 1980), p. 9*
U. S. Census Bureau, op. cit., p. 4.
7
Denver Regional Council of Governments, Local Operational Plan for Case Management in Arapahoe and Douglas Counties, (Denver, Colorado, 1983), p. 10.
g
Colorado Department of Social Services, Office of Program Development, op. cit., p. A-5.1.
9
Denver Regional. Council of Governments, Local Operational Plan for Case Management in Arapahoe and Douglas Counties, (Denver, Colorado, 1983), p. 1.
^Colorado Department of Social Services, Office of Program Development, op. cit., p. iii.
^Colorado Department of Social Services, Division of Development and Review, Implementation of Home and Community Based Services (Senate Bill 138/ Waiver), Draft County Letter, no date given, p. 1.
'^TDenver Regional Council of Governments, Local Operational Plan for Case Management in Arapahoe and Douglas Counties, (Denver, Colorado, 1983),
P. 9-
13
Jack Strumpf and Norman Davidson, Case Management with the Frail Elderly: A Training Manual, Volume II, A Step by Step Analysis and Instructional Guide on the Practice of Case Management, (Senior Care Action Network, Los Angeles, California, 1981), p. 27
14
Dennis F. Beatrice, Case Management: A Policy Option for Long-Term Care, Department of Health, Education, and Welfare, Health Care Financing Administration, (Massachusetts: Brandeis University, 1979), p. 3
-73-



15IMd. p. 10-11.
^Jack Strumpf and Norman Davidson, op. cit., p. 28.
17
'James A. Christenson and Jerry W. Robinson, Jr. (editors), Community Development in America, (Ames, Iowa: Iowa State University Press, 1980),
p. 8.
l8Ibid., p. 45-
19
^Dennis F. Beatrice, £p. cit., p.4.
20
Denver Regional Council of Governments, Local Operational Plan for Case Management in Arapahoe and Douglas Counties, (Denver, Colorado, 1983),
P. 27.
21
Alice H. Collins and Diane L. Pancoast, Natural Helping Networks, A Strategy for Prevention, (Washington, D.C.: National Association of Social Workers, 1976), p. 24.
22
Gayle M. Boyle with Sharon K. Pattern, The Informal Support Network:
A Description and Policy Perspectives, Staff Paper No. 1, Task Force No. 4:
The Informal Support Network, Minnesota Long-Term Care System Development Project, Minnesota Department of Health, Office of Community Development, (Minnesota, April 1981), p. 1
23Ibid., p. 3.
24
Alice H. Collins and Diane L. Pancoast, op. cit., p. 25*
25
Charles Froland, Diane L. Pancoast, Nancy J. Chapman, and Priscilla J. Kimboko, Helping Networks and Human Services, Vol. 128, Sage Library of Social Research, (Beverly Hills and London:Sage Publications, 1981), pp. 23-25
Ibid., pp. 23-25 27
Denver Regional Council of Governments, Local Operational Plan for Case Management in Arapahoe and Douglas Counties, (Denver, Colorado, 1983) p. 27.
-74-


BIBLIOGRAPHY



BIBLIOGRAPHY
A Preliminary Proposal For A Regional Case Management Program (Denver Regional Council of Governments, Aging Services Division). Denver, Colorado, 1982.
Beatrice, Dennis F., Case Management: A Policy Option for Long-Term Care,
(Department of Health, Education, and Welfare, Health Care Financing Administration), Brandeis University, Massachusetts, 1979-
Boyle, Gayle M. with Sharon K. Pattern, The Informal Support Network: A Description and Policy Perspectives, Staff Paper No. 1, Task Force No. 4: The Informal Support Network, Minnesota Long-Term Care System Development Project, Minnesota Department of Health, Office of Community Development, Minnesota, April, 1981.
Case Management: State of the Art (U. S. Department of Commerce, National Conference on Social Welfare, Final Report), Washington, D.C., National Technical Information Service, 1981.
Christenson, James A. and Jerry W. Robinson, Jr. (editors), Community Development In America, Iowa State University Press, Ames, Iowa, 1980.
Collins, Alice H. and Diane L. Pancoast, Natural Helping Networks, A Strategy For Prevention, National Association of Social Workers, Washington, D.C., 1976.
Colorado's Long Term Care Plan, Colorado Department of Social Services, Office of Program Development, March, 1982.
Developing Long-Term Care: A Framework for the Los Angeles County Area Agency on Aging, Senior Care Action Center (SCAN), USC Andrus Gerontology Center, and UCLA/USC Long-Term Care Gerontology Center, Los Angeles, California, 1982
Evaluation Report (Phase II) Florida's Community Care for the Elderly Program: Management Study E-81-13 (Florida Department of Health and Rehabilitative Services, Office of Inspector General, Office of Evaluation), Florida, 1981.
Evaluation Report (Phase III) Florida's Community Care for the Elderly Program E-81-14 (Florida Department of Health and Rehabilitative Services, Office of Inspector General, Office of Evaluation), Florida, 1981.
Froland, Charles, Diane L. Pancoast, Nancy J. Chapman, Priscilla J. Kimboko,
Helping Networks and Human Services, Vol. 128 Sage Library of Social Research, Sage Publications, Beverly Hills and London, 1981.
Implementation of Home and Community Based Services Program (Senate Bill 138/Waiver), (Draft County Letter, Colorado Department of Social Services, Division of Program Development and Review), no date given.
Local Operational Plan for Case Management in Arapahoe and Douglas Counties (Denver Regional Council of Governments), Denver, Colorado, 1983.
-76-


i
i
O'Brien, John E. and Donna L. Wagner, "Help Seeking by the Frail Elderly: Problems in Network Analysis," Gerontologist, Vol. 20, February, 1980.
Regional Growth and Development Plan for the Denver Region, Extension to Douglas County, Denver Regional Council of Governments, Denver, Colorado, October, 1980.
Regnier, Victor (ed.). Planning for the Elderly, Alternative Community
Analysis Techniques. Los Angeles: The Ethel Percy Andrus Gerontology Center, University of Southern California Press, 1979-
Snow, David L., and Judith B. Gordon, "Social Network Analysis and Intervention with the Elderly," Gerontologist, Vol. 20, No. 4, August, 1980.
Strumpf, Jack and Norman Davidson, Case Management with the Frail Elderly:
A Training Manual, Volume II, A Step by Step Analysis and Instructional Guide on the Practice of Case Management, Senior Care Action Network (SCAN), Los Angeles, California, 1981.
U. S. Census Bureau. 1980 Census summary tape files 1 and 2; 1970 Census 1st and 2nd count tapes; Table prepared by Denver Regional Council of Governments, October, 1982 1970-80 General Population and Housing Characteristics by County.
Valle, Ramon and William Vega, Hispanic Natural Support Systems, State of California, Department of Mental Health, 1980.
Whiteneck, Gale G. and Carl E. Larson, An Aging Services Program Impact and Needs Assessment, prepared for the Denver Regional Council of Govern-Ments, Office on Aging, May 1981.
P
-77-