Vermont Long Term Care Forum
November 20, 2009

Convened by the Council of Vermont Elders

Meeting Design, Facilitation and Reporting:

Heidi Klein and Susan McCormack
Senior Associates

	
The Snelling Center for Government 
Fostering responsible and ethical civic leadership, encouraging public service by private citizens, and promoting informed citizen participation in shaping public policy in Vermont.

TABLE OF CONTENTS

MEETING SUMMMARY ……………………….……………..…... Page 3

SUPPORTING MATERIALS………………………………..…….. Page 7

	Meeting Agenda ……………………………….…….……. Page 8

	Participant List ..………………………………….……….. Page 10

	LTC Policy Forum Categories
	for Homework & Discussion Purposes .…….…...….. Page 11

	Homework Assignment and Template …………….... Page 12
	Homework Responses (sent separately) 

	Advance Readings ..……...………….………………….... Page 13

	Flip Chart Notes..……...………………………….…..…... Page 14

Meeting Summary

On November 20, 2009 the Community of Vermont Elders (COVE) convened individuals representing Vermont’s leading agencies, service providers and advocates for the long term care needs of older Vermonters for a day of discussion.  The goal of the meeting was to explore how to best serve the long term care needs of Vermonters and their families.  

Participants began the day noting the strains of the current financial, regulatory and policy environment and their continued steadfast commitment to serving Vermonters in need of long term care.  Many noted the “perfect storm” in the making given the: 
•	shrinking of capacity due to decreases in funding for vital medical and non-medical support programs;
•	increasing need presented by a growing population of older Vermonters; and
•	greater acuity of need given the shift to aging in community rather than in institutions.  

Many expressed grave concern about the future of their organizations as well as their collective ability to meet the needs of Vermont’s aging population.

The morning was spent sharing information from eleven distinct groups of long term care providers to create a shared understanding of the work of each entity or association as well as the impacts of the current landscape on programs, services and the people served.  The following is a brief summary of some of the themes from the presentations and participant reflections. (The full transcript can be found at the end of this report).

•	There is already a significant amount of collaboration and familiarity among the Vermont  LTC providers but discussions suggested there is need for additional creative and strategic thinking on how best to align partners to use existing resources to maximize impact

•	Participants support the intention of the Choices for Care program but many expressed continued concern about its implementation and some of the unintentional consequences given the concurrent decrease in overall funding. 

•	Existing care needs are not being met in the community and there is not adequate planning for the increasing demand that is coming soon with the aging of the “baby boomers” and others in need of care.  Future planning needs to take into account the continuum of health and financial means of all Vermonters.

•	There are abundant opportunities for collaboration among providers that are currently untapped either due to a lack of knowledge about each other’s work or due to barriers created through funding streams and regulations.  Some specific connections to explore include: elder care clinician program and home health agencies; VNA home care with VAHHA and VT Chapter of Private Duty; providers and disability support community; adult days and senior centers.

•	Organizations are exploring some interesting new models for care coordination which are linking programs and funding streams (e.g. SASH, PACE).  These new models show promise in placing the individual first (rather than the agency) and fostering improved health while aging in community.  Financial sustainability for these models remains an issue.

•	The Blueprint for Health will continue to provide the framework for health care in Vermont.  An opportunity may exist in linking long term care to the Vermont Blueprint for Health.  Participants at the forum noted that long term care providers and advocates have not participated fully in discussions about the Blueprint or in the existing pilot communities.  

•	There was varied understanding among participants about current national health care reform proposals and the potential impacts on the provision of long term care services in the state of Vermont.  Many believed that reform may offer new opportunities; others worried that the proposed “bundling” of funding and services may create new challenges.

•	Participants expressed interest in exploring the use of information technology to extend staff resources, assist in sharing information about initiatives that would benefit from more and deeper collaboration, and ideally drive down costs and improve outcomes.

•	Participants noted concern about the intense focus on a very small portion of the older population –those in greatest need for services and financial support – and the lack of planning for the broader population with a focus on prevention 

The clear message from those most familiar with state budgets is that funding will continue to decrease over the foreseeable future.  Improved efficiency and collaboration may not be sufficient; a significant change in our approach and programming may be needed.  Two critical questions that were posed by members of the group warrant further exploration:  

1)	What is the role of government?  There is a need to reconsider the essential roles, functions, and services to be provided by government as opposed to the private sector, the community and the family.

2)	Should all of the organizations, agencies and programs around the table continue or should we look at consolidation and restructuring?  If we prioritize the needs of the individual first and then design the supporting infrastructure of agencies/programs/services, how would it look and what we would do differently?  

In the afternoon, participants self-selected into one of two break-out sessions intended to identify opportunities and interest in working collectively.  In the session on short-term priorities, participants identified a range of potential ideas (see full list below).  Some of the themes included:

•	Broadening the discussion by bringing together advocates, elders, community members and people with disabilities to share experience and ideas with the forum participants 
•	Educating legislators and the incoming Governor and administration about long term care issues; the current system and remaining need
•	Exploring opportunities to address LTC issues in the Blueprint and through broader health care reform efforts – share information about the Blueprint, accountable care organizations and medical home with LTC providers
•	Exploring new ways of financing LTC through maximizing all funding streams (e.g. VA, LTC insurance), increased flexibility in Medicare, new state budget priorities

In the session that sought to explore a longer range vision for long term care the following ideas emerged:

•	Consider shifting some of the focus towards prevention and wellness.
•	Increase community planning/basic infrastructure development.  Work with partners such as the Health Department and regional planners.
•	Do an analysis of the population by age, income and health status as a way to figure out what the needs are [across a broad spectrum of need levels] and how to coordinate services.
•	Create new organizational structures that encourage collaboration among providers, while maintaining the integrity of each.

The day ended with a few moments to consider personal commitments to action based on new insights.  A few of the participants shared their ideas for continued collective action:

•	Explore how to maximize the Center on Aging as a resource to the this group and the Vermont organizations and agencies involved in LTC 
•	Further explore the issues related to broader community planning (e.g. Burlington Livable City Project) and the necessary policy changes and collaboration 
•	Conduct further analysis of total population across the wellness and financial spectrum to understand what is coming and how to prepare/plan – need to revisit assumptions in our planning
•	Advocate on behalf of this group could coalesce around the importance of the state having an adequate emergency response system and capacity to address elder abuse, neglect & exploitation
•	Convene a meeting/forum for this group to hear directly from consumers, advocates, and their organizations 
•	Engage in Blueprint discussions
•	Create materials to describe existing LTC system
•	Host a LTC briefing reception for new legislators and governor

Evaluation

In the meeting closing, participants reaffirmed their commitment to their work together and their belief in the ability to create positive change to address the long term care needs of Vermonters and their families. Respondents to a follow up survey gave the meeting high marks (94% rated the meeting as good or excellent) and expressed the idea that this gathering was a good beginning for additional work.

This meeting was a wonderful opportunity to reflect on the complexity of our work for elders, and the importance of a broad network, linked together in some way for the good of elders, and for efficient use of limited resources.

…really helped to paint a broader picture of the state of the state of LTC in Vermont.

An excellent beginning to a very important, complex topic

Given the multiple and sometimes competing interests, it was a great beginning.

Recommendations and Next Steps

•	Deepen the conversation about the changing role of government, organizations, communities and families

•	Broaden the conversation by including advocates and individuals with long-term care needs in order to improve understanding of needs, options and changes if started with the individual first 

•	Continue connections made through the meeting and encourage individual organizations and agencies to further explore opportunities to work with one another

•	Share materials about the Vermont Blueprint for Health, medical homes and accountable care organizations so LTC providers can knowledgably participate in state discussions about health care reform

•	Explore strategies to address long term care through community planning (such as the Burlington livable city project) to address demographic trends and improve livability         for all Vermonters

•	Learn more about collaborative models and multi-sector partnerships such as PACE & SASH and options for ensuring their sustainability 

•	Prepare a brief to share with legislators and policy makers based on the key themes and questions that arose at this meeting of leaders in the field, information about changing demographics, and key issues that need to be addressed in planning for future long term care needs  

SUPPORTING MATERIALS

Meeting Agenda

Participant List

LTC Policy Forum Categories for Homework & Discussion Purposes

Homework Assignment, Template for Overview, and Responses

Advance Readings

Flip Chart Notes

Long Term Care Forum
November 20, 2009 
Burlington, VT

Goal and Objectives 

Goal:  To explore how to best serve the long term care needs of Vermonters and their families

Objectives:
•	Create a shared understanding of the work we do
•	Create a shared understanding of the current landscape and its impacts on programs, services and the people we serve
•	Identify opportunities and interest in working collectively
o	Identify several short term priorities and assess whether there is broad support among forum participants for acting on these 
o	Begin to explore a big picture vision for long term care
Agenda 

9:00 	Welcome/Context	
•	Share hopes for the day – dyads, then share a few with large group 
•	Review objectives – invite participants to add to this
•	Establish agreements for the day’s work
•	Opening Exercise

9:30 	Share Overview of the Current Landscape
Purpose: Create a shared understanding of the current landscape in which we are each working to serve Vermonters who need long term care

•	State of the State
o	Overview of the current context (financial, regulatory, political) in which LTC discussions and decisions are being considered by state administrators and legislators

•	Category-based Sharing 
o	What is the essence of the work? What is truly important about it?
o	What are the opportunities and challenges you face given the current landscape? 
o	What is your newest, best thinking about what works well?

•	Chart Talk (intermixed with sharing by category)
o	What questions arise given your new understanding about the context in which others are operating?
o	What themes emerge (across categories) about opportunities and barriers to serving Vermonters who need long term care? 

11:30 	Explore Key Themes and Possibilities 
Purpose: Discussion and analysis of the morning’s presentations 
•	Small group discussion using appreciative inquiry followed by reports and large group discussion
o	What do the morning presentations tell us about what is important?
o	What are some of the opportunities given current realities?

12:15	Lunch

1:00	Discuss Opportunities for Change 
	Self-select into one of two work groups
Purpose: Identify interest in and opportunities for working collectively to better serve Vermonters who need long term care

•	Work Group A:Short-term Priorities (immediate needs and actions, possibly priorities)
•	Work Group B: Long-term Vision (vision for an integrated system of care) 

2:30	Share Results of Work Groups
Purpose: Identify interest in, opportunities and next steps for working collectively to better serve Vermonters in need of long term care

3:30 	Adjourn 

Participant List	
Bea Grause - President & CEO	Vt. Assoc. of Hospitals & Health Systems (VAHHS)	bea@vahhs.org	
Beth Rizzon	Howard Center for Human Services	bethri@howardcenter.org	
Betsy Davis - Consultant	Seniors Aging Safely at Home (SASH)	Delizabethjdavis@msn.com	
Brendan Hogan - Deputy Comm.	Vt. Dept. of Disabilities, Aging & Independent Living (DAIL)	brendan.hogan@ahs.state.vt.us	
Camille George - Director	State Unit on Aging, DAIL	camille.george@ahs.state.vt.us	
Catherine Hamilton - Vice President	Blue Cross Blue Shield of Vermont	hamiltonc@bcbsvt.com	
David Yacovone - Director of State Leg. Affairs	Vt. Assoc. of Hospitals & Health Systems (VAHHS)	david@vahhs.org	
Deborah Lisi-Baker - President	Vt. Coalition for Disability Rights - VCDR	dlisibaker@gmail.com	
Diane Novak - Executive Director	Vermont Assoc. of Area Agencies on Aging 	dianenovak@svcoa.org	
Dolly Fleming - Executive Director	Community of Vermont Elders - COVE	dolly@vermontelders.org	
Gail Moreau - Director	Heineberg Senior Center/Vermont Association of Senior Centers	gmmoreau@myfairpoint.net	
Jackie Majoros - State Director	Vt. Legal Aid (VLA) - Ombudsman Project	jmajoros@vtlegalaid.org	
Jeanne Hutchins - Program Mgr	Center on Aging - UVM - Elder Care Services - Fletcher Allen	jeanne.hutchins@uvm.edu	
Jim Leddy - Vermont President	AARP	jleddy@aarp.org	
Joan Senecal - Commissioner	Vt. Dept. of Disabilities, Aging & Independent Living (DAIL)	joan.senecal@ahs.state.vt.us	
Judy Peterson - CEO	Central Vermont Home Health & Hospice (CVHHH)	judy.peterson@hitchcock.org	
Ken Gordon - Exec. Director	Vermont Assoc. of Area Agencies on Aging 	kgordon@nevaaa.org	
Kevin Loso - Exec. Director	Rutland Housing Authority & Vt. Aging Collaborative	kloso@rhavt.org	
Kirt Sampson - Administrator	Equinox Village & VHCA	ksampson@equinoxvillage.com	
Laura Pelosi - Exec. Director	Vermont Health Care Association - VHCA	lpelosi@vhca.net	
Maureen Bertrand - Administrator	Woodridge Nursing Home & VHCA	maureen.bertrand@cvmc.org	
Dr. Mimi Reardon	Retired Physician	mimi.reardon@uvm.edu	
Nancy Eldridge - Exec. Director	Cathedral Square Corporation - CSC & Vt. Aging Collaborative	eldridge@cathedralsquare.org	
Patrice Thabault - President	Home Instead/Non-medical Home Care Agencies	pthabault@burlingtonvt.net	
Peter Cobb - Executive Director	Vt. Assembly of Home Health Agencies - VAHHA	vahha@comcast.net	
Rachel Lee Cummings - President	Armistead Caregivers/Non-medical Home Care Agencies	armisteadcare@comcast.net	
Sue Chase - member 	Vt. Assoc. of Adult Day Services - VAADS	sue@carepartnersvt.org	
Sue Watson - Executive Director	Program for All-inclusive Care for the Elderly (PACE)	watson@pacevermont.org	
Susan Besio - Director	Office of Vermont Health Access - OVHA	susan.besio@ahs.state.vt.us	
Invited but Unable to Attend	
Tom Davis - Board President	Community of Vermont Elders (COVE) 	winggame@myfairpoint.net	
Don George - CEO	Blue Cross Blue Shield of Vermont	georged@bcbsvt.com	

LTC Policy Forum Categories for Homework & Discussion Purposes
November20, 2009

1.	State of Vermont:  Joan Senecal (DAIL), Brendan Hogan (DAIL), Camille George (DAIL), Susan Besio (OVHA) [there will be an opening presentation from the state’s perspective, but they will not submit a template ahead of time]

2.	Hospitals & Physicians: Bea Grause (VAHHS), David Yacavone (VAHHS), Dr. Mimi Reardon

3.	Nursing Homes & Residential care: Laura Pelosi (VHCA), Maureen Bertrand (Woodridge), Kirt Sampson (Equinox Village)

4.	Home Health: Peter Cobb (VAHHA), Judy Peterson (CVHHH)

5.	Non Medical Homecare Providers: Rachel Lee Cummings (Armistead), Patrice Thabault (HomeInstead)

6.	Mental Health: Beth Rizzon (Howard Center for Human Services)

7.	Center on Aging & PACE: Jeanne Hutchins, Sue Watson

8.	Adult Day Programs: Sue Chase (Care Partners & VAADS)

9.	Senior Centers: Gail Moreau (Heineburg Center & VASC)

10.	Housing: Nancy Eldridge (CSC & VAC), Kevin Loso (Rutland Housing Authority& VAC) Betsy Davis (SASH)

11.	Area Agency on Aging: Ken Gordon & Diane Novak (NEKAAA & VAAAA) 

Others who will actively participate but will not submit a template or make a presentation.

12.	Advocacy & consumer organizations: Jim Leddy (AARP), Deb Lisi Baker (VCDR), Jackie Majoros (LTC Ombudsman), Tom Davis (COVE), Dolly Fleming (COVE)

13.	Insurance:  Catherine Hamilton (BCBS), Don George (BCBS)

Homework Assignment

Dear Participants – 

We are looking forward to seeing you all at the LTC Policy forum on November 20 at the AARP offices in Burlington.   

This is a reminder that we have some important homework we are asking most participants to send to us by November 11 so we can distribute the information to the other meeting participants.  Please see below for details.

For advance work and discussion purposes, participants have been grouped into 13 categories.  We are asking participants in most of the categories to work together to prepare two things in advance of the forum.  Please see attached list to see if your category requires the advanced work.  If so....

1. Using the attached template, write a short overview describing the current landscape in which your category is operating.  This overview is intended to help others understand your work and how the current financial and regulatory environment is affecting your ability to fulfill your mission.  The written overview is due by November 11 and will be shared in advance with all session participants.  Please send this to: heidi@snellingcenter.org

2. A representative from your category will be given 5 minutes during the forum to speak about the work you do and the context in which you are operating.  Your example should help others understand: 
•	the essence of the work-- what is truly important about it
•	the opportunities and challenges you face given the current landscape
•	your newest, best thinking about what works well

We encourage you to be creative (stories work well) and you may choose whatever format you think will best communicate your message.  Please let us know in advance if you have any special audiovisual needs.

Please don't hesitate to get in touch if you have questions or would like additional information.  

Best, Sue

Long Term Care November 20 Policy Forum
Template for Organization Overview

Organization Name: _________________________________

Background/synopsis of agency/organization

Change in demographics affecting operations/program/services

Current economic/financing environment, and corresponding implications for service, workforce, etc. 

Impact of regulatory environment on operations, service, other

Impact of Choices for Care

Current and emerging partnerships

Successes – What’s working now given current conditions

New or untapped opportunities

Advance Readings

The following papers have been identified as important “backgrounders” to ensure that all meeting participants share the same information base at the beginning of the meeting.  We therefore urge you to peruse the following before November 20th:
 
1.	VT Reimbursement White Paper, November 2006 (available through COVE)
2.	Summative Evaluation of MyCare   www.ddas.vermont.gov/ddas-archives/special-projects-initiatives-archives/mycare-vermont-archive/mycare-eval-fsa/ 
3.	Windham Summit on Mature Workers. www.windham-foundation.org/images/stories/pdfs/34tholderworkerreport.pdf   
4.	Nursing Home for the 21st Century  www.dail.vermont.gov/dail-publications/publications-legis-studies/nursing-facilities-for-21st-century-report-jan-2007 
5.	Shaping the Future www.dail.vermont.gov/dail-publications-annual-reports/shaping-the-future-2007 
6.	LTC Sustainability www.dail.vermont.gov/dail-publications/publications-legis-studies/ltc-system-sustainability-report-jan-2007 
7.	Direct Care Work Study www.dail.vermont.gov/dail-publications/publications-legis-studies/dcw-report-full

Additional reports shared by participants:

Supporting Alternative Integrated Models for Dual Eligibles: A Legal Analysis of Current and Future Options, Sara Rosenbaum, Jane Hyatt Thorpe, and Sara Schroth, George Washington University, November 2009

H. R. 3664 To direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program.

Flip Chart Notes

	(Note:	while not all discussion points or insights were recorded, these summary notes attempt to capture the key themes and ideas)

I.  Agreements

•	Share “Air Time”
•	Bring all of your experience and wisdom to group; go beyond your current affiliation
•	Reframe frustrations/challenges into suggestions for action
•	Articulate your thoughts with the group – don’t withhold important insights

II. Opportunities

•	Albany College of Pharmacy
•	Increase in grassroots aging in place groups
•	Promising new models to look at
•	Explore and create better alignment among multiple agencies
•	Support families caregivers

III. CHART TALK: REFLECTIONS ON SECTOR-BASED SHARING

What are you learning?

•	Tremendous opportunities for collaboration
o	So many organizations are focusing on the same challenges (discharge planning, etc), but not working together to our full potential
o	We are all dependent on each other to provide quality care that ultimately contributes to the quality of someone’s life!
o	There are evolving models to look at re: integration and collaboration
•	Some of the concerns/questions some have about potential impact of health care reform
o	There are places where we need to examine better integration, e.g. home health and the Blueprint for Health
o	National health care reform -  bundled payment concerns 
o	Outside forces impact systems 
•	New programs benefit some providers but negatively impact others
•	How complex everything is 
•	Vibrancy, vitality and importance of adult and senior centers

What new questions do you have?

•	What is the role of government? 
•	Curious about extent of influence administration leadership, governor (regardless of who occupies that seat) influences OVHA direction and LTC vision/direction
•	
Coordination with health care reform and Blueprint to include long term care
o	What is the role (or can be) of LTC in the Blueprint?
o	More understanding about the “bundled” implications
o	How can VT get rewarded by the federal government reform rather than penalized for our leadership?
•	What opportunities exist for greater collaboration? 
o	Ex: elder care clinician program and HHAs?
o	Dual membership of VNA home care with VAHHA and VT Chapter of Private Duty? 
o	Is there coordination among providers and disability support community?
o	Do adult days and senior centers work together?  How are they different?
•	How can we better use technology to extend staff resources and improve outcomes?
o	How can information technology assist in sharing information about initiatives that would benefit from more and deeper collaboration?
o	How can we better optimize technology to drive down costs and improve quality?
•	How to coordinate with all players
o	How to continue to do more with less
o	Its interesting to learn more about various providers – I’m eager to hear/learn more about collaboration possibilities, especially in a time of such challenges re: resources 
•	How do you make sure choices of participants drive design?
•	How do we make sure values autonomy honored – see person and not just the “client”
•	What is our contingency plan for 2011?
•	How can we take advantage of small numbers? Data?

What themes are you noticing?

•	Dedication, commitment: 
o	Dedicated/committed people serving vulnerable folks who too often have to navigate a maze of fragmented/partial services with insufficient assistance
o	Commitment to quality despite economic/other challenges
•	Desire to work together to solve challenges – interest in collaboration
o	Similar challenges
o	Mission driven
o	Focus on people
•	Case management across the continuum
o	Replacing the informal network of care
o	Primary care opportunity
o	Management of care likely to cross providers
o	Medical home: an elusive foal for “medical orphans”
o	Long term care = 24/7 system
•	All strapped for money
o	Erosion of capacity with escalating needs **
o	How do we all survive!
o	Constraints: funding and policy 
o	Payment system complexity and inadequacy
o	Recognition of the need to value and support caregivers
o	Medicare opportunities and challenges
o	Payment structure likely to change

•	Need to address both public and private sector funds and workforce issues
•	Workforce shortages
•	We are not sufficiently focused on the people’s needs as a whole and identifying collaborations that support those 200,000+
•	Housing is critical – more housing options

IV. Ideas for Short Term Action 

Broaden the conversation
•	Bring consumer advocates together to discuss collaboration with respect to LTC 
•	Consider how to include individuals — seniors and individuals with disabilities – in a listening sessions so provider and advocacy community can listen and learn
•	Convene broad discussion on role of state/government use of public funds 

Educate policy makers
•	Educate in-coming Governor (current candidates)
•	Clearly describe the roles of different LTC entities to alleviate confusion, identify overlap and gaps; include necessary redundancy if it exists and unmet needs

•	Key messages: 
o	formalize prior informal care-giving 
o	continued unmet need
o	start with the individual (rather than the provider or system)

New Funding and Collaborative Models
•	Fully maximize all payers – VA, LTC insurance
•	Increase flexibility in use of Medicare $
•	Integrate with pharmacy students w/waiver plan e.g. in Albany, NY
•	Separate medical vs. non-medical services as this influences cost, workforce, etc.
•	Advocate on behalf of need for adult protective services
•	Consider coalition of groups to prevent “Peter to pay Paul” decisions in the short-term and to ensure adequate funding for the long term care system
•	Build budget based on priorities – eliminate outdated programs, redundancy
•	Consider SASH model to integrate housing and integrate other providers
o	Talk about model re: collaboration/integration
o	Consider needs for funding and mechanism for program sustainability 

LTC and Health Care/Health Care Reform
•	Get LTC providers/organizations in discussions re: accountable care/medical home/Blueprint 
•	Create/share layman’s primer on accountable care to engage LTC advocates, consumers, etc.
•	Educate legislature re: connection between LTC and health care 
•	Need a strategy for evaluating and discussing Choices for Care – identify what needs to change as/if it continues

Other:
•	Transportation costs and lack of opportunity crosses all
o	Tap volunteer drivers
o	Residential care
o	Share Transporting the Public principles and support state legislation
•	Communications networks within communities supported at the state level (via associations)
•	Consider how best to use and support VT Center for Aging with respect to policy, research and coordination

V.  Ideas for Long Term Vision 

Vision Statement

Vermonters have more choices and control, are receiving what they need in their own communities, and are treated with dignity and respect.

Essential needs of older Vermonters and others in need of long term care

A place to live
Food
Non-medical caregivers
Medical caregivers
Access to health care
Transportation
Social support and activities
Education and employment opportunities/economic security
Environmental and safety supports
Coordination of services

Key Points
•	In 10 years there will be 250,000 Vermonters over age 55
•	Need to keep in mind full spectrum of services from prevention, community design and wellness issues to caring for those with the highest level of need

Ideas
•	Consider shifting some of the focus towards prevention and wellness.
•	Increase community planning/basic infrastructure development.  Work with partners such as the Health Department and regional planners.
•	Do an analysis of the population by age, income and health status as a way to figure out what the needs are [across a broad spectrum of need levels] and how to coordinate services.
•	Create new organizational structures that encourage collaboration among providers, while maintaining the integrity of each.

VI. Some Commitments and Next Steps 

•	Explore how to make the Center on Aging a resource to the organizations and agencies involved in LTC (Dolly Fleming)
•	Interest in coordinating re: community planning issues (e.g. Burlington Livable City Project) –
o	How to strengthen collaboration?
o	What is community?
o	What is needed at the policy level to change in this direction?
o	Consider consolidated plan (Deb Lisi-Baker)
•	Further analysis of total population across the wellness and financial spectrum to understand what is coming and how to prepare/plan – need to revisit assumptions in our planning
•	Need to identify concrete actions now:
o	Consumer advocates to meet (Dolly Fleming)
o	Engagement in Blueprint discussions
o	Create materials to describe existing LTC system
•	Bring consumers to this group – explore options (Dolly Fleming)
•	LTC reception for new legislators and governor