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• What is COLLAGE, The Art & Science of Healthy Aging^®?
• How does COLLAGE work? What does it do?
• What is special about the membership consortium?
• How does the COLLAGE program help individuals?
• Who developed the program?
• How were the COLLAGE assessment tools developed?
• What does the assessment process look like?
• We hear many stories coming from aging services organizations about quality wellness programs that they’ve developed – isn’t that enough?
• How do the principles of LeadingAge’s Quality First and COLLAGE intersect?
• How would you make the business case for COLLAGE?
• Where will COLLAGE be in 2 years, 5 years, and 10 years?
• What is the COLLAGE national data repository?
• How is training handled? What level of support will staff get as we implement the tool?
• Is there software available to automate COLLAGE data collection?
• If we ever decide to discontinue our relationship with COLLAGE, will we be able to get our data in a usable format?
• What functions does the Web-based software support?
• What level of computer equipment is needed for COLLAGE users?
• Can laptop computers be used to record assessments in private residences?
• Is COLLAGE data encrypted when transmitted over the Internet?
• How is security handled in COLLAGE?
• What are your security standards to protect the data?
• What is your disaster recovery process for the data?
• Are there back-up policies and availability if the single server fails?
• How are ongoing operating costs managed? If a server needs replacement, or the operating system needs upgrading, how will that be managed financially?
• What are the steps to join the COLLAGE consortium?

COLLAGE is a consortium of aging services organizations working to advance healthy aging and improve outcomes of older adults living independently. Members of the consortium – continuing care communities, moderate-income and federally subsidized housing programs, and home care and community-based agencies – use a unique, holistic, evidence-based assessment tool and person-centered process to improve quality of life and successful aging. As of January, 2011, there are over 60 non-profit sites in 22 states that participate in the membership consortium and use the COLLAGE Web-based software.

COLLAGE gives organizations the tools to partner with older people in their quest to age successfully. Through the COLLAGE assessment system, organizations have the opportunity to measure, track and improve healthy aging outcomes. Valid and reliable assessment data leads to: 1) the development of personalized healthy aging plans for individuals, and 2) a methodology to target the right programs and services to best match needs for a campus or community. This two level approach enables individuals to take charge of their own healthy aging and allows organizations to focus aging support resources appropriately for their community.

Measuring outcomes is critical; without them, communities don’t know whether their programs are having the intended impact on residents and community. COLLAGE health and wellness data is the engine that drives all wellness program operations to help maintain and promote independence among older adults.

COLLAGE offers consortium members the opportunity to use a tested, high-quality assessment system and to develop a data infrastructure, together. That doesn’t happen very often and it’s difficult for organizations to do it on their own. Taking part in COLLAGE provides members the opportunity to share data and learn from one another -- something that is in sync with LeadingAge (formerly AAHSA) and the mission of sharing information so the whole field can improve.

A designated staff person, often called the wellness or health coach, meets with a resident (or client) for a one-on-one conversation about the person’s interests, needs, experiences, preferences and challenges. Together the coach and resident create a meaningful, person-centered Healthy Aging Wellness Plan aimed at improving the person’s health and quality of life.

The COLLAGE conversation helps identify resources, both within and outside the community, that will enrich residents’ lives. The COLLAGE-based conversations may address a wide range of issues affecting health, including preventive health maintenance; yoga, balance or exercise training; nutrition; chronic fatigue; shower/bathing assistance; social connections, volunteerism, etc. Armed with a deeper knowledge of resident needs and interests, a COLLAGE community is in a better position to develop programs, services and interventions that will improve quality of life.

Initiated in 2003, COLLAGE is a joint venture between Kendal Outreach, LLC (www.kendaloutreach.org), a subsidiary of The Kendal Corporation, a system of communities and services for older adults, and the Institute for Aging Research at Hebrew SeniorLife (www.hebrewseniorlife.org), in Massachusetts. Both organizations collaborate with interRAI (www.interrai.org), an international group committed to improving health care for older people and people with disabilities.

Members of the COLLAGE consortium use a suite of evidence-based, scientifically grounded assessment instruments developed by interRAI (interrai.org), a collaborative network of clinicians, researchers, and policy makers in over 30 countries. interRAI’s core organizational goal is the promotion of evidence-based clinical practice and policy decisions.

A new streamlined assessment system was released in July 2012. It starts with the COLLAGE Wellness Assessment that covers nine areas including: exercise and physical fitness, nutrition, social relationships, emotional, spiritual, practices affecting health/well-being, recreation, sleep, and goals for wellness service planning. The Wellness Assessment is typically initiated and completed by the resident without the need for a coach to be present.

The COLLAGE Core Assessment tool is a short health-focused evaluation that gathers key information and when used with the Wellness Assessment provides a well-rounded view of independent persons. Data coming from the Core Assessment informs organizations about their resident’s health and wellness needs and potential risks to independence, and allows them to better target programs and resources to enhance healthy aging. It also is used to indicate when a resident would benefit from a more in-depth assessment.

Built into the new system is the capacity for the Core Assessment to “trigger,” through a color-coded display, the need for staff to administer a longer health-focused evaluation called the Comprehensive Assessment. Preliminary analysis suggests that about 10% of independent residents (depending on the setting) that have had a Core Assessment will trigger for the additional in-depth assessment.

Several states have mandated the use of the interRAI assessments as agencies are encouraged to redesign Medicaid-related services, streamline operations, improve healthy aging outcomes and save money. The Community Health Assessment system and its utility in tracking and measuring health and wellness is becoming known to a growing national pool of professionals in the long term care industry.

Give or take some tweaking that individual organizations may make, the process map looks like this:

• Resident handed a blank Wellness Assessment (WA) form to complete on his/her own.
• Assessment coach meets with resident to go over completed WA.
• Coach completes the Core Assessment with resident.
• Data from the WA and Core Assessment is coded in software (during assessment conversation or after).
• Personal Wellness Profile (PWP) report is given to resident.
• WA and Core Assessment outcomes, both found in the Indicators Report and PWP, are discussed with interdisciplinary team (IDT).
• If the Core Assessment triggers a Comprehensive Assessment, the Comprehensive is initiated by coach.
• At another meeting with resident, the coach and resident collaboratively create a Healthy Aging Plan (HAP) based on assessment outcomes.
• The coach follows up with resident to assess HAP progress with IDT support.

For many years providers have used stories or anecdotes to demonstrate the need for funding older adult projects or to prove organizational viability. Stories certainly can make a compelling case for programmatic merit, but they don’t demonstrate quality. To show that something really works, a provider must have solid outcomes-based program measures. Without this, communities will never know whether anecdotes really represent what’s going on across their entire membership.

COLLAGE embraces all of the principles of Quality First that LeadingAge (formerly AAHSA) has promoted over the past several years. It focuses on using scientifically-derived, standardized instruments to collect information so that informed, evidence-based decisions can be made by individual organizations, and accurate comparisons can be shared across organizations. Comparing data over time allows organizations to really understand where they are improving and where they need to dedicate additional resources. There is no way to get to quality without engaging in the kind of analysis that COLLAGE data enables organizations to do.

Making the business case for COLLAGE can be challenging, particularly in times of economic downturn when the question of where to spend limited resources is high on everyone’s priority list. The clear trend in the health sector is a tremendous focus on data to improve outcomes in hospitals, in primary care, and in all of the various acute care settings. Likewise, aging services organizations need to understand key characteristics of the people they serve, particularly their health needs, and to find ways to intervene to improve their current health conditions and potentially mitigate problem areas that may be more costly down the line. The most important thing for a Chief Financial Officer or Executive Director to think about is the return on investment. COLLAGE will facilitate better wellness practices, deliver better information to clients and their families, demonstrate how an organization is doing over time, and illustrate how an organization compares to peer organizations in your field.

We believe COLLAGE will be well positioned in five to seven years with over 200 sites nationally using our robust assessment system. We are committed to continuous improvement efforts to expand on the current capabilities of the system to meet emerging member needs, as evidenced by several innovative initiatives that are currently underway.

The national data repository, housed at the Institute for Aging Research at Hebrew Se­niorLife in Boston, currently stores over 25,000 assessment records representing over 10,000 clients (as of June 2012). The reposi­tory was established to inform public policy, benchmark quality healthy aging programs around the country, and enable the develop­ment of model practices to improve healthy aging outcomes.

Training is entirely web-based. We offer about four to five interactive webinars a month (each between one and two hours) and for the most part repeat them every month. Our plans include recording most of the software training so that is available to registered users on an on-demand basis. Staff has access to the Center for Information Management software helpdesk, either by phone or e-mail, during regular business hours. In addition, members can contact COLLAGE/Kendal Outreach staff with expertise in coaching dynamics, assessment coding, the interview process, operations and organizational development.

Yes. Access to a common software program for an unlimited number of coaches (users) is available as part of the consortium membership. It is a Web- or browser-based application with all data for all COLLAGE members stored on a single server. The COLLAGE software was developed and is supported by our technology vendor, the Center for Information Management, Inc., in Ann Arbor, Michigan.

Yes, you are guaranteed a full export of all of your data, in any of several common formats (such as, text files with comma-separated value format (CSV)), combined with a data dictionary and delivered in a secure fashion.

The software allows staff to maintain profiles of older adults, record all COLLAGE assessments, and create Healthy Aging Plans linked to assessment information. It includes, options to track member-specific levels of care, participation in programs, and service used. A wide range of standard reports are included, both for individuals and as group profiles, as well as a robust ad hoc query and report generation tool for customized reports.

Users of web application need a computer capable of running Windows XP, Windows Vista, or Windows 7, with the current version of the browser, preferably, Mozilla’s “Firefox”. However, users of the optional Mobile Edition (for off-line assessments using laptop computers) must meet additional requirements. To read or download our equipment recommendations, click HERE.

Assessments can be entered on any computer with Internet access at any time using the standard software. However, when Internet access in not available, there is a mobile edition of the COLLAGE software that allows coaches to download resident information and complete assessments and plans in an “off-line” mode. When they return to the office, they can easily synchronize their laptop with the central server and consolidate their off-line information with all other information for the person interviewed.

All connections to the COLLAGE data server use 128-bit SSL encryption enforced by a VeriSign certificate.

Each COLLAGE coach is assigned a unique user account and password on the COLLAGE server that is linked to their specific member organization. These accounts strictly control access so users can only see data for residents belonging to their organization. User accounts are also assigned specific privileges by administrators at the member organization that can, when desired, appropriately limit access to data in the COLLAGE system based on work responsibilities. Transactions are logged by the COLLAGE system by user account for audit purposes.

This is best described in our Business Associate Agreement document – contact COLLAGE to request a copy.

We have implemented industry standard disaster recovery practices, including nightly exports, weekly cold back-ups of entire system, and unattended offsite storage of back-up files, all in a fully automated environment.

In additional to using high availability server equipment housed at a newly HIPAA-compliant commercial data center with redundant gigabit-connected networks and power supplies, we have a failover server available in the same rack as the COLLAGE server.

Our fees to consortium members cover ongoing infrastructure and operation expenses, such as the need to replace or upgrade a server.

The following steps will help you get started with COLLAGE. The order is not critical and each organization may wish to develop its own evaluation process with an emphasis on one area over another.

• Early on involve key management, execu­tives and front line staff as well as your residents early in evaluating whether COL­LAGE will add value to your organization. Ensure this is the right time to integrate and launch the program.
• Participate in at least one free, one-hour introductory COLLAGE introductory webi­nar. Go to http://tiny.cc/COLLAGEwebinars for more information.
• Review the Wellness Assessment, Core Assessment and Comprehensive Assess­ment forms.
• Speak with consortium members to bet­ter understand program logistics, chal­lenges, resource requirements, and op­erational strategies for success.
• Review and complete the Trial Period Op­erating Agreement and enclose a $500 non-refundable deposit.
• Once COLLAGE has a signed copy of the Trial Period Operating Agreement on file, COLLAGE staff will work with you on sev­eral key areas, including:
  • selecting assessment coaches and pro­jecting staffing patterns;
  • creating a deployment plan, including how to communicate to the commu­nity about COLLAGE;
  • designing a process to recruit residents;
  • preparing for software implementa­tion;
  • managing and overseeing the program;
  • using assessment data for program and service development, and improv­ing healthy aging outcomes.
• Participate in up to five, one-two hour we­binar training sessions on use of assess­ment tools and software.
• Complete the Consortium and Business Associate Agreements.
• Within 45 days of completion of the three training sessions, forward balance of first year fee.