Aging and Disability Resource Consortium of Northeastern Massachusetts

2006 ADRC Evaluation Report: Executive Summary
A Comprehensive Analysis of Goals and Objectives
for the Third Project Year

Conducted by:

The Commonwealth of Massachusetts
Massachusetts Rehabilitation Commission
Research, Development and Evaluation Department

October, 2006

Table of Contents:

ADRC Reference Guide to Project Committees, Stakeholders and Terminology………….2        	 	

Description of Project……………………………………………………………………….4	

Method of Evaluation………………………………………………………………………..5	

Executive Summary of Findings…………………………………………………………….6	

		

Conclusions and Policy Recommendations…………………………………………………70	

	 	

Attachments………………………………………………………………………………….75	

		

	

ADRC Reference Guide to Project Committees, Stakeholders and Terminology
Administration on Aging (AoA): One of the federal agencies funding Aging and Disability Resource Center grants throughout the country.
Aging and Disability Resource Consortium of the Merrimack Valley and the Aging and Disability Resource Consortium of the North Shore, Cape Ann and Greater Lynn Regions (ADRC): A Consortium of Aging Service Access Points and Independent Living Centers within the Commonwealth of Massachusetts in the northeast region of the state dedicated to providing streamlined access to services assisting elders and individuals with disabilities with living independently in the community.
Centers for Medicare and Medicaid Services (CMS): One of the federal agencies funding Aging and Disability Resource Center grants throughout the country.
Community Partners Advisory Board (CPAB): An advisory board in the Merrimack Valley comprised of leadership staff from local agencies and providers serving elders and individuals with disabilities. The Community Partners Advisory Board provides guidance to the overall direction of the grant and on a variety of project objectives, including, but not limited to: outreach and marketing, streamlined access and serving private pay consumers. 
Connect the Dots Initiative: A statewide initiative designed to bring together the key stakeholders of all systems change grantees in the Commonwealth of Massachusetts.
Consultation Form: The tool utilized by Intake and Referral staff at the partner agencies to track consumer service needs and the mechanism used to refer consumers to partner agencies for assistance.
Consumer Board (CB): An advisory committee in the Merrimack Valley comprised of elders, individuals with disabilities, caregivers and support persons. The Consumer Board provides input on how the ADRC can best serve the target population. 
Coordinating Committee (CC): The primary project management team for the Aging and Disability Resource Consortium of the Merrimack Valley. This committee is comprised of project staff, partner agency staff and evaluators. The primary function of the Coordinating Committee is to manage the completion of project goals and objectives. 
Elder Services of the Merrimack Valley (ESMV): The Aging Services Access Point  and the Area Agency on Aging in the Merrimack Valley of Massachusetts, serving 23 cities and towns, and an original member of the ADRC.
Green Book: The name of the resource manual for elders developed by Elder Services of Merrimack Valley. In the second project year, ADRC of the Merrimack Valley staff expanded the Green Book to include resource information for individuals with disabilities. 
Massachusetts Rehabilitation Commission (MRC): The Massachusetts Rehabilitation Commission is the public vocational rehabilitation program in the Commonwealth of Massachusetts. Staff from the Research, Development and Evaluation Department are responsible for conducting all program evaluation activities for the ADRC project.  A representative from the MRC Community Services Division is also a member of the Coordinating Committee.

No Wrong Door Approach: This approach was adopted in the second project year to accommodate the needs of the partner agencies while also providing streamlined access to services for consumers. Utilizing this approach, a consumer or service professional can call any Consortium member and receive information on an array of services for both elders and individuals with disabilities. This process streamlines access by eliminating the need for multiple referrals. 
Northeast Independent Living Program (NILP): The Independent Living Center serving the Merrimack Valley region and original member of the ADRC.
Aging and Disability Resource Consortium of the North Shore, Cape Ann and Greater Lynn Regions: The Aging and Disability Resource Consortium expanded in the third year of the grant to the North Shore, Cape Ann and Greater Lynn Regions.  This Consortium is comprised of five partner agencies:  North Shore Elder Services (ASAP); Greater Lynn Senior Services (ASAP); SeniorCare, Inc. (ASAP); the Independent Living Center of the North Shore and Cape Ann (ILC); and Elder Service Plan of the North Shore (PACE program).
Outreach and Marketing Subcommittee: This committee is comprised of project staff, as well as staff from the partner agencies and members of the Consumer Board and Community Partners Advisory Board of the Merrimack Valley. The primary objectives of this committee are providing suggestions and recommendations regarding the development of ADRC print materials, how to increase awareness of the ADRC in the community, how to brand the ADRC and how to conduct outreach to un- and under-served populations.
Service Planning Team (SPT): This team is comprised of project staff and intake staff from both partner agencies of the Merrimack Valley. The Service Planning Team is charged with developing the tools to accommodate the streamlined information and referral process, comprehensive assessment, eligibility determination and service planning. 
Virtual Gateway:  The Virtual Gateway is the Commonwealth of Massachusetts’ web-based system to provide entry to all state social service programs. 

Aging and Disability Resource Consortium of Northeast Massachusetts
Year 3 Final Evaluation

Heather Johnson-Lamarche, Project Director
Funded by:  Administration on Aging and Centers for Medicare and Medicaid Services
AoA Project Officer:  Greg Case         Grant # 90AM2760
CMS Grant Manager:  Judy Norris 
Grant # 11-C-91939/1-01

Description of Project

The Aging and Disability Resource Consortium (ADRC) of the Merrimack Valley and the Aging and Disability Resource Consortium of the North Shore, Cape Ann and Great Lynn regions are funded by a three-year federal grant from the U.S. Administration on Aging (AoA) and Centers for Medicare and Medicaid Services (CMS) awarded to the Massachusetts Executive Office of Elder Affairs.  The ADRC is designed to serve elders and individuals with disabilities in their efforts to live independently in the Massachusetts communities identified in this project Consortium. The project has completed the three year grant term. 

The strategy adopted by the Consortia is a “No Wrong Door” approach to ensure that consumers, caregivers and social service professionals obtain the resource information required to access an array of long term support services that promote the independence of elders and individuals with disabilities in the community.  The principle community partners in the first two years of this Consortium are Elder Services of Merrimack Valley (ESMV) and the Northeast Independent Living Program (NILP). In the third year, the project was expanded to the North Shore Region, where 3 ASAPs, 1 IL center and 1 PACE program (North Shore Elder Services, Greater Lynn Senior Services, SeniorCare, Inc., the Independent Living Center of the North Shore and Cape Ann, and Elder Service Plan of the North Shore) are collaborating to ensure the same seamless access to aging and disability services in their region.  

The third year of the grant was devoted to further refining the No Wrong Door approach in the pilot area, as well as expanding the project to include the North Shore region.  Project leadership adopted the “No Wrong Door” approach in Year 2 to further streamline intake and referral services. In the past, consumers who required services from both member agencies would have to make two separate phone calls and complete duplicate intakes. Under this new approach, consumers and social service professionals may call any Consortium organization for information on the entire array of services offered by the partnering agencies, as well as services available in the community. Intake and referral staff are trained to address issues related to both aging and disability, and intake information is shared between the agencies. In the North Shore region, the partner agencies installed a One Touch phone system that allows them to quickly refer consumers who could benefit from assistance from partner agencies. Each of these refinements in Intake and Referral results in a single point of access for the wide array of services offered by the Consortium members.  Thus, regardless of which agency is contacted first, there is now “No Wrong Door”. 

Method of Evaluation
Massachusetts Rehabilitation Commission, Department of Research, Development and Evaluation, Evaluators

The evaluation of this project is conducted by the Massachusetts Rehabilitation Commission (MRC), the public vocational rehabilitation provider in Massachusetts. MRC manages over $4 million in grant funds and its Research, Development and Evaluation Department is responsible for conducting independent evaluations for several grants related to serving individuals with disabilities. 

MRC evaluators utilized multiple approaches to collect information and evaluate the ADRC project in Year 2, including interviews with key stakeholders, MIS data collection and analysis, observations from attending meetings, analysis of work product and stakeholder satisfaction surveys. MRC utilized a continuous quality improvement approach in the evaluation of this project. Evaluators worked closely with the Project Director to monitor the completion of work plan objectives, which were tracked in a project management Gantt chart.  The MRC team led evaluation meetings in which objectives were reviewed for completion, and the accomplishments of the team as well as the challenges they faced were documented.  These meetings provided an opportunity for the evaluators to interview project staff about the progress of the grant, and to elicit their input on the lessons learned and what solutions were developed. In addition to the evaluation meetings, MRC evaluators also attended Coordinating Committee and Advisory Board meetings to observe the decision making process and completion of work plan objectives. These meetings also provided opportunities for the evaluators to collect work product throughout the year.

In addition to the qualitative methods described above, MRC evaluators also monitored the quantitative measures defined by the Lewin Group, the Washington consulting firm engaged in coordinating the evaluation activities of all ADRC grantees. Evaluators compared the baseline data to the following three years to analyze the impact of the ADRC on intake and referral calls for both agencies. MRC also conducted a separate evaluation of Stakeholder Satisfaction, which is discussed later in this document. 

Executive Summary of Findings

The Massachusetts Aging and Disability Resource Consortium is a successful partnership between Aging Service Access Points (ASAP) and Independent Living Centers in the Merrimack Valley and North Shore regions. This three year project has resulted in the successful development of a streamlined information and referral process serving consumers regardless of age, disability status or income. The Massachusetts ADRC model utilizes systems change within existing program infrastructures to better serve consumers. Although the grant has formally come to an end, the partner agencies are committed to the continued utilization and improvement of the ADRC model. The Executive Office of Elder Affairs was also awarded a two-year replication grant in September, 2006, which will focus on expanding the ADRC model throughout the Commonwealth.

Successful outcomes of the ADRC pilot project include:
•	Successful Development of the Consortium Concept
While other states chose to develop separate Aging and Disability Resource Centers, which involved large investments in infrastructure, the Massachusetts approach was built on the utilization of existing social service infrastructure. The resulting model is a Consortium of existing agencies who are committed to working together to serve both target populations, as opposed to a separate Center. The resulting partnerships benefit both consumers and agency staff. Teamwork between social service agencies is the central idea of the Consortium model, and it is clear that when agencies work together, the consumer experiences improved results.
•	Outreach to Consumers and Community Organizations
Project staff in the Merrimack Valley area have made a significant impact in raising awareness about the ADRC partnership throughout Lawrence and the surrounding communities.  Brochures explaining the partnership between ESMV and NILP were developed early in the process in both English and Spanish language versions. Project staff developed ADRC information cards that can be used as a networking tool among consumers. The Program Coordinator also wrote a monthly newsletter directed toward social service professionals, highlighting project outcomes and other recent news related to elder affairs and disability issues. In addition, the Outreach and Training Coordinator conducted over 60 community presentations on the ADRC for local social service agencies, hospitals and civic/community groups.
•	Successful Development of a Consumer Resource Manual
ESMV’s resource manual, entitled “The Green Book” is very well known in the Merrimack Valley community. This manual is published every two years, and is utilized by consumers, caregivers and social service professionals in the area. Last year, the Green Book was revised to include disability resources, in cooperation with NILP.  This change was very well received in the community. ESMV and NILP remain committed to including disability resources in future editions of the Green Book.
•	Ongoing Cross Training between Agencies
Agency staff in both the Merrimack Valley and North Shore region participated in several formal cross-trainings over the past three years related to the ADRC concept, each organization’s philosophy of serving consumers, and specific intake and referral forms and tools that were developed throughout this collaboration. In Year 3, agencies in the Merrimack Valley sponsored a Brown Bag Lunch training series, which covered several topics related to serving elders and people with disabilities. Some topics covered include working with individuals with psychiatric disabilities, legal issues and services, and evacuation planning in nursing homes. This luncheon training series was well received by staff, and ESMV and NILP expect to continue with this series.
•	Exploration of Service Models for Private Pay Consumers
Project staff conducted outreach to private pay individuals and interviewed several in a focus group format to determine their specific needs. Agency staff provide information and referral services for private pay consumers who exceed the income limits of their programs. 
•	Development and Expansion of Community Transition Team
Nursing home transition and diversion was a primary focus of this project in the Merrimack Valley. Project staff developed an interdisciplinary team of professionals from state agencies (MRC, DMR, DMH), local community service agencies, hospitals and nursing homes to work collaboratively with staff at ESMV/NILP on this issue. This team approach developed a tracking process to identify barriers to transition, as well as a method to track progress towards transition.  A total of 17 individual cases have been brought before the Community Transition Team for discussion and deliberation.  Five individuals have received enhanced services in the nursing home as a result of the team model.  One individual has successfully transitioned out of a nursing home to a group home setting.  Perhaps most importantly, this team approach to nursing home transition  implemented a process for tracking barriers to transition.  Housing is the greatest barrier to transition to the community, whether it be affordable housing, accessible housing or housing with adequate support services.  These data will be used to advocate for continued systems change, and will be useful information to share with the MA Systems Transformation Grant Diversion Subcommittee.   The Community Transition Team will continue to work together, and the model will be expanded to the North Shore Consortium.
•	Utilization of Virtual Gateway
Agency staff from both ESMV and NILP completed training in the on-line MassHealth application, and have utilized this tool to assist consumers in applying for MassHealth and other programs such as food stamps. 
•	Implementation of Data Management Protocols
Consortium agencies have built reporting mechanisms into their data systems to quantify outcomes related to the ADRC. The Executive Office of Elder Affairs is in the process of converting all ASAP/AAA agencies to a new data system that will include the necessary data elements to continue to generate outcome reports. Currently work is unfolding to develop an electronic consultation form which will allow for the electronic transmission of consumer referral information across agency partners.  The work that results from this effort will be made available to all ASAPs and ILCs who participate in the expansion of the ADRC model across the Commonwealth.
•	Outreach to State Policymakers and Agency Heads
Project staff have invested a great deal of time in increasing awareness of the ADRC pilot project, including the ADRC philosophy, program model and project outcomes. The Project Director worked closely with State contacts to ensure their awareness of the project and its impact on consumers. The ADRC concept was written into the Systems Transformation Grant, which is a testament to the work of project staff in increasing awareness of the ADRC model at the State level. Additionally, a State-level sustainability team was formed in late 2005 to initiate important discussions across the Executive Leadership and pilot sites regarding the future of the ADRC model and how it can be sustained.  This team framed the concept for the ADRC expansion proposal which was recently funded, and will continue to meet on a regular basis to guide the expansion of the ADRC model across the Commonwealth.
•	Development of the ADRC Toolkit
This project was about systems change, rather than the addition of a new program or agency. The result was an extremely detailed work plan that addressed the key steps each Consortium member will need to take to incorporate the key components of the ADRC. In completing each of these objectives, project staff developed several reports, tools and marketing materials that could be helpful to others wishing to establish an ADRC in their area. Project Staff pulled all of these documents and resources together in a lessons learned document entitled: “ADRC Toolkit: Building on Success”. This document will be a key resource for agencies within Massachusetts, as well as those in other states who are interested in developing an ADRC utilizing existing program infrastructure.
•	Successful Expansion to the North Shore Area
One of the major successes of the third year of the project was the expansion of the ADRC model to the North Shore/Cape Ann/Greater Lynn region. This new partnership, consisting of 3 ASAPs, 1 ILC and 1 PACE program is currently developing their own model for the ADRC in their community. While they are incorporating all the key components of the ADRC, they are choosing methods for doing so that work in their local area, as opposed to simply replicating the Merrimack Valley pilot. This has been one of the primary lessons learned: the ADRC concept can be effectively expanded to other areas while still allowing for differences at the local level. The North Shore partnership is extremely energized, active and committed to the Consortium. While they are still in the process of developing their individual model, they have established solid relationships among the partner agencies and have momentum in moving the project forward. 
•	Award of Replication Grant
In September, 2006, the Massachusetts Executive Office of Elder Affairs was awarded a replication grant from AoA and CMS to continue to expand the ADRC model throughout the Commonwealth. The Project Director from the pilot grant, along with a Program Coordinator, will work with agency staff of AAA/ASAPs and ILCs throughout Massachusetts to develop their own local ADRC models. The first step in this process is to conduct a readiness assessment to prioritize which areas are most ready to begin immediate work on the project. These grant activities will be conducted over a two year period. By October, 2008, the ADRC model should be fully integrated throughout Massachusetts. 
•	Establishment of Formal MOU between Pilot Agencies
Although the formal grant has come to an end for the pilot agencies, they have pledged to continue the work of the ADRC in their community. In doing so, they have developed a formal MOU outlining the roles and responsibilities of each agency as they continue to serve consumers utilizing this collaborative model. Agencies in the Merrimack Valley have adopted transition plans to absorb the functions of staff provided by the grant. These agencies have demonstrated the level of commitment necessary to ensure enduring systems change in the Merrimack Valley.  Partnering agencies in the North Shore, Cape Ann and Greater Lynn regions have also drafted formalized MOUs among each other and are committed to continuing the development of the ADRC in their region.

The ADRC model provides significant benefit to elders and individuals with disabilities in respect to their efforts to live independently in their communities in the Commonwealth of Massachusetts. The Massachusetts ADRC model has developed into a “best practice” model that is very portable and can be expanded or replicated throughout the Commonwealth of Massachusetts.  

The remainder of this document outlines each project objective in detail, showing the progress made toward each goal and the lessons learned. The document concludes with a discussion of recommendations for project staff as well as policymakers as they pursue the ADRC and other systems change initiatives to further streamline access to services for elders and individuals with disabilities. 

Conclusions and Policy Recommendations

The Aging and Disability Resource Consortium of Northeastern Massachusetts is a three year federal grant awarded to the Massachusetts Executive Office of Elder Affairs from the Centers for Medicare and Medicaid Services (CMS) and Administration on Aging (AoA).  This systems change initiative is designed to streamline access to community-based services for elders and individuals with disabilities, with the goal of helping these target populations live successfully in the community.  The Consortium currently consists of a partnership between Elder Services of Merrimack Valley (ESMV) and the Northeast Independent Living Program (NILP), and will expand to the North Shore region in the third year of the project.

The third project year was marked by several successes, including the expansion of the project to the North Shore region, the implementation of the Brown Bag Lunch training series, the expanded role of the Community Transition Team, the development of the Toolkit resource, and the grant award for additional funding for the expansion of the ADRC.  Project staff, in concert with agency leadership and state contacts solidified the pilot ADRC model, and collaborated with the North Shore agency leadership to develop a successful ADRC in that region. This three year grant provided the opportunity and framework for Massachusetts to develop their ADRC model.  The task currently at hand is to utilize the replication grant to institutionalize this model as a business practice throughout the 27 ASAPs and 11 ILCs in Massachusetts. 

The evaluators of this project, along with project leadership have embraced a Continuous Quality Improvement approach to evaluate the effectiveness and efficiency of the ADRC efforts.  MRC makes the following recommendations based on the results of this comprehensive evaluation of the project thus far:

•	Comprehensive Needs Analysis  
The evaluators recommend that project staff conduct a comprehensive analysis of the social service needs of elders and individuals with disabilities, with particular emphasis on people with disabilities who are aging into the elder service system.  This analysis will quantify the current benefits and programs that the target population is receiving, and will identify any additional gaps in services that need to be addressed.  In addition, this analysis will provide detailed information on unmet needs among these target groups, as well as an indication of how accessible services are to these populations. Quantifying the needs of the target population and demonstrating how the ADRC model addresses those needs are critical questions that will need to be addressed to effectively advocate to state policymakers for continued sustainability of the project.

•	Develop Effective and Efficient Advisory Boards for Expansion Activities
If there was one area that was a consistent stumbling block for the pilot project, it was the effective use of the Advisory Boards. The project staff learned several lessons from that experience that should be taken into consideration as staff proceed with the expansion process. First, staff must consider the appropriate membership of the Coordinating Committee/Management Team for each local area. The principals of the agencies need to be involved on a consistent basis, and the membership should include at least one consumer and one professional advisory board member. In addition, it is important to realize that the expansion proposal does not include funding for staff in each expansion area. Therefore, care must be taken to develop productive boards without miring agency staff in meetings. It is recommended that each project area develop its own advisory board that is inclusive of both consumers and professionals. However, providing stipends to consumers is not recommended based on the experience of consumers on the Lawrence Consumer Board who had difficulties with Social Security because of the extra income the stipend provided.  Roles and responsibilities of all board members must be clearly articulated from the start, and board activities should not begin until the project leadership can effectively communicate the vision and goals of the project along with the roles of all parties involved. Finally, the advisory board must offer members a real opportunity to participate in the work of the ADRC. This can be accomplished by establishing formal working committees, or by utilizing the expertise of members on an ad hoc basis.  The success of this advisory board model in the North Shore illustrates how this structure keeps people actively engaged and committed to the process. 

•	Establish Coordinated Marketing Activities for Expansion Sites
Once the expansion process is underway, each regional Consortium will be responsible for conducting outreach and marketing activities. This will be a struggle for some, as the grant does not provide additional resources for agencies to conduct these activities. As a result, agencies should focus their marketing efforts on activities that were determined to be most effective in the pilot project. For example, the use of the consumer information cards was an effective, low cost strategy. Better use of local newspapers through public service announcements and human interest stories is an effective strategy for increasing awareness about the tangible benefits of these partnerships. Web sites and listserves are other relatively low cost marketing methodologies. Finally, the expansion project staff should invest time in conducting marketing and outreach to legislators and policymakers at the state level. 

•	Virtual Gateway Efforts and Implementation of Web-based Strategy
It is recommended that the project proceed with developing a web page for the expansion project on the Mass.gov web site, and continue to collaborate with the Virtual Gateway efforts.  In addition, each expansion area should have its own ADRC web page with an accompanying listserv for consumers, board members and policy makers. The web page would serve as a clearing house of information and resources for all stakeholder groups. In addition to providing information to the general public and other stakeholders, implementation of a web-based strategy will boost recognition of the project goals and, more importantly, project outcomes.

•	Continue Staff Training & Develop I&R Standards Training for ILCs
While agency leadership can develop policies around streamlining access to service for consumers, it is the staff that will carry out these mandates. As a result, particular attention must be given to training all staff in the ADRC philosophy, as well as the implementation of new forms, I&R tools, or reporting activities. Again, expansion projects will not have significant training funds, which results in the need to streamline training activities so that they are manageable. The Brown Bag lunch series was an effective, low cost model for training, as is incorporating ADRC training into regularly scheduled staff meetings. In addition, it is important to remember that ILCs may require additional training on how to do Intake and Referral, as these organizations do not have I&R standards such as AIRS. The project manager may wish to work with the ILCs to develop their own I&R standards in concert with other expansion activities. 

•	Develop All Forms and Staff Tools in Accessible Formats
The Consultation Form that was utilized by the pilot agencies was designed as a paper form. Some staff at the Independent Living Center of the North Shore could not use the paper version. The project is addressing this issue by developing an electronic equivalent of the consultation form, which could be completed using voice activation software such as Dragon or Jaws. As other agencies develop their forms and I&R tools through the expansion project, it is essential that these documents are completed in a format that is accessible for all staff. 

•	Allow Each Expansion Area to Determine their own ADRC Model 
One of the primary strengths of the Massachusetts ADRC model is that it builds systems change into the existing social service infrastructure, thereby reducing overhead and operating costs for the project. While the strategy of utilizing existing agencies to implement the ADRC promotes efficiency, it is also important to recognize that each of these agencies has its own culture, philosophy and relationships with other local agencies that will influence how agency leadership will choose to implement the ADRC model. Therefore what works in one region, may not work in another for a host of reasons. This was one of the lessons learned in the North Shore expansion that occurred in Year 3. As the project moves from demonstration to expansion, it is essential that project staff recognize the unique differences between the various partner agencies and allow them maximum flexibility to determine the ADRC model that works best for them. Obviously there will be key components that all sites will have to adopt, but their methods for doing so will be as diverse as the communities they reside in. By maintaining some local control over the decision making process, project staff will empower and motivate the individuals who will eventually carry on the work of the ADRC to develop the best possible collaborative model for their community.

•	Develop Journal Articles for Publication  
This project has learned a great deal about how to get established organizations to collaborate in ways that benefit consumers and organizations alike. There have been many lessons learned that others in government, community-based and faith-based agencies could learn from. One method of disseminating the lessons learned is through academic and professional journals. Project staff should not overlook these resources in their dissemination plan.

•	Development of a PowerPoint Presentation for National/State Conferences
 The ADRC model developed in Massachusetts is unique in that it involves coordinating the intake and referral practices of two distinct, established organizations. Many other ADRC projects have been designed as a “Center” where a new organization has been developed to integrate the information and referral needs of elders and people with disabilities. Because of the unique approach used in Massachusetts, there is great value in sharing the lessons learned with others. One method of doing so is to present at national and statewide conferences on the successes, struggles and solutions achieved so far in this project. Project staff should develop a PowerPoint template that can be modified for each presentation to ensure that they will be ready when presentation opportunities arise. The Project Director has already begun this process by presenting at a national conference for Systems Change grantees.

•	Conduct a Cost/Benefit Analysis and Develop a Sustainability Proposal for State Policymakers
ADRC staff have invested considerable time and energy into increasing awareness of the ADRC concept among policymakers. Now is the time to take the next step and quantify the results of the project, and then articulate those results in a proposal for sustainability at the State level.  The Executive Office of Elder Affairs has received two additional years of federal funding to expand the ADRC model throughout Massachusetts. This endeavor presents a perfect opportunity to measure the impact of the ADRC in these new areas.  Impact measures could include I&R calls to agencies, the number of cross-referrals between agencies, consumer needs data, consumer satisfaction data, the number of consumers diverted from nursing homes or transitioned from nursing facilities to the community, and actual case studies of how the Consortium agencies work together to the benefit of consumers. The second critical piece of any sustainability proposal is the detailed cost analysis. Project staff must quantify the expected cost to the State, while making a cogent argument that the benefits or outcomes are worth the cost. On a philosophical level, there appears to be agreement among state policymakers that the ADRC model is efficient, effective and the right thing to do. Yet, given the projections of extremely tight state budgets over the next several years, along with more and more interest groups competing for fewer state resources, project staff will need to make a very strong case for state funding of this program. 

The three year, pilot ADRC project has resulted in the successful development of a program model to increase collaboration between the elder and disability agencies, while providing seamless entry into the service delivery system for elders and persons with disabilities.  Since the start of the project, the concept of the ADRC has evolved from rather vague idea about how agencies can work together to a solid program model that can be replicated in other areas.  The lessons learned throughout this process will now guide project staff in their endeavor to expand the ADRC throughout Massachusetts, and to advocate for sustained funding from the Commonwealth.