Attachment A

Application: Emerging Aging and Disability Resource Center (ADRC) Partnership Designation

  1. Proposed name of ADRC partnership:
  1. Mutually agreed upon geographic boundaries of the proposed ADRC partnership (please provide map):
  1. Identify a primary and secondary person to serve as the key contact and point of communication with the Office of Services to the Aging:

Name: / Name:
Organization/Affiliation: / Organization/Affiliation:
Address: / Address:
City, State, Zip Code: / City, State, Zip Code:
Phone: / Phone:
Email: / Email:
  1. Describe the process used to identify and recruit ADRC partners. List each partner agency and provide the agency name, contact person's name, address, and phone number. Complete and submit the attached "Managing Partner Investment: Obtaining Buy-In" chart identifying the assets, self-interests, and strategic actions and responsibilities assumed by local ADRC partners (attached):
  1. Identify other potential ADRC partners invited to participate in the partnership but who chose not to participate and why:
  1. Submit a copy of the ADRC Partnership Readiness Assessment completed by the proposed ADRC partnership (Attachment D and E). Please attach a signature sheet of all partners with the readiness assessment, signifying their agreement with the assessment:
  1. Develop and submit an initial business plan for how the beginning work of the ADRC partnership will be accomplished and managed. The plan should include, at a minimum, the following:

·  Describe the business operations plan (I&A, resource database, etc.)

·  Describe partnership development process and ongoing relationships

·  Describe how partners effectively communicate within the partnership

·  Describe the community education and outreach plan

·  Describe plans to build capacity for Person-Centered Thinking/Person-Centered Planning

·  Describe how training will be provided to all partners

  1. Attach evidence of efforts made to seek public input on the proposed ADRC partnership plan for managing the work and operations (e.g. focus groups, public hearings, community forums, presentations, webinars, etc.):
  1. ADRC partnership agrees to (check one for each statement):

Yes / No
Participate in the development of evaluation activities
Participate in the development of statewide standards
Participate in the development of state-sponsored trainings
Participate in the development of quality indicators
Participate in the development of LTC resource database standards and criteria
Share data with the State
  1. Identify the communication points within the proposed ADRC partnership that will serve as call centers for Information and Assistance services (will take phone calls from the geo-routed phone number), and provide contact information as requested below (this is not limited to two agencies, please list as many agencies that will provide Information and Assistance services):

Name: / Name:
Organization/Affiliation: / Organization/Affiliation:
Address: / Address:
City, State, Zip Code: / City, State, Zip Code:
Phone: / Phone:
Email: / Email:
  1. Identify the communication points within the proposed ADRC partnership that will collect and maintain resources available in the ADRC partnership service area for inclusion on the MI LTC website, and provide contact information as requested below (this is not limited to two agencies, please list as many agencies that will serve as communication points):

Name: / Name:
Organization/Affiliation: / Organization/Affiliation:
Address: / Address:
City, State, Zip Code: / City, State, Zip Code:
Phone: / Phone:
Email: / Email:


Application Definitions

Aging and Disability Resource Center (ADRC) Partnerships: Michigan’s ADRC partnerships build on a “no wrong door” (decentralized) model that recognizes all stakeholders as equal partners. In an equal partnership, each member brings different assets to the table - all of which are valuable for the partnership to work, though some entities may have more resources to bring into the partnership than others. Decision making should be equal, even though for some the resources are not. ADRC partnerships are highly visible and trusted services in the community that empower persons of all ages and income levels to navigate the full range of long-term care support options according to their cultures, values, and preferences. ADRC partnerships provide person-centered planning; comprehensive and unbiased information and assistance; appropriate referrals; follow-up; and seamless access on available long-term support options. For more information on the Administration on Aging’s (AoA) ADRCs, please visit: http://www.adrc-tae.org/tiki-index.php?page=HomePage

Business Operations Plan: Business planning to ensure the development of a sustainable ADRC partnership model. The process of business planning benefits the partnerships by promoting a better understanding of the initiative; identifying strengths and weaknesses; encouraging innovation; communicating ideas and enhancing credibility. Development of a business operations plan demonstrates that the partnerships have mapped out the process required to deliver program services, and includes a budget, projection of costs and sustainability plan. It describes in detail, the specific operational policies and plans designed to achieve successful service delivery. Please visit: http://www.adrc-tae.org/tiki-download_file.php?fileId=2819

Community Education and Outreach: Effective, culturally diverse community education and outreach campaigns promote awareness of the ADRC partnerships as a trusted source for information and assistance. Education and outreach campaigns increase public awareness on the full array of public and private long term care options so that users of long-term care services can make informed decisions and plan for the future.

Emerging and Fully-Functional ADRCs: Emerging ADRC partnership is a definition specific to the State of Michigan. An Emerging ADRC Partnership is one that has shown evidence of initial partnership and business planning development. A Fully-Functional ADRC partnership is one that meets criteria based on the Administration on Aging's criteria in the ADRC Fully Functional Assessment. Please visit: http://www.adrc-tae.org/tiki-index.php?page=NewSite

Evaluation: A written plan for evaluating and monitoring services and sharing information with users and stakeholders. ADRC partnerships have performance goals and indicators related to visibility, ease of access, responsiveness, accuracy and timeliness (e.g., providing unbiased I&A and person-centered planning). The partnerships have policies and procedures in place for collecting and using feedback from the populations served. Users of long-term care services are informed of complaint and grievance practices to address problems and improve services.

Information and Assistance (I&A): Assistance to individuals in finding and working with appropriate human service providers that can meet their needs which may include; information-giving (e.g., listing the providers of a particular service category so an individual may make their own contact directly); group presentations; referral (making contact with a particular provider on behalf of an individual); advocacy intervention (negotiating with a service provider on behalf of a client); and follow-up contacts with clients to ensure services have been provided and have met the respective service need.

LTC Resource Database: An electronic directory available to and maintained by ADRC partnerships. The LTC Resource Database will have up-to-date, accurate information on the full array of long-term supports and services. Written policies and procedures will be available to ADRCs.

Partnerships: Relationships between organizations and individuals, characterized by mutual respect, cooperation and responsibility for the achievement of a specified goal. Partnerships are linkages formed for the purpose of investing resources to bring about mutually beneficial outcomes. ADRC partnerships must establish partnerships which meaningfully involve stakeholders (including users of long-term care supports and services) in planning, implementation and evaluation activities. ADRC partnership arrangements include: written agreements, written referral protocols, co-location, cross-training staff, joint marketing and outreach, service collaboration, sharing I&A resources and data.

Partner Training: A key aspect of ADRC partnerships is regular cross-training of staff to build the full range of competencies across the array of long-term care supports and services needed to effectively serve older persons, persons with disability and caregivers.

Person-Centered Planning: A process for planning and supporting the user of long-term care supports and services that builds on the individual’s capacity to engage in activities that promote community life and honor individual preferences, choices, and abilities. The person-centered planning process involves families, friends, and professionals as the user of long-term care services desires.

Quality Indicator: A quality indicator is a mutually agreed upon, measurable variable (or characteristic) that can be used to assess desired performance, adherence to a standard, or achievement of quality goals.