An Interview with Rebecca May-Cole
Executive Director at the Pennsylvania Association of Area Agencies on Aging (P4A)

How providers of human services across Pennsylvania are learning to work together to respond to an increasingly challenging environment

Providing human services is an increasingly complex challenge. Coordinating with health care, public health and other human service providers has always been difficult. But shifting policy environments and increased competition, including from health care, are making the task even harder. Add in the increased demand as a consequence of aging and the ongoing impact of the pandemic, and you’re left with a sense of perpetual crisis. Since December 2019 Collaborative Consulting has been working with the Pennsylvania Association of Area Agencies on Aging (P4A) to respond to this challenge. In this post, we speak with Rebecca May-Cole, the Executive Director of P4A, on the work we’ve done together, including how they have started to shift from a collection of organizations fighting individual fires to a coordinated, state-wide network operating to a shared strategic vision.

Collaborative Consulting (CC): Hi Rebecca. Perhaps you can start by saying a little more about P4A.

Rebecca May-Cole (RMC): P4A is an association made up of all 52 Area Agencies on Aging (AAAs) in Pennsylvania, serving all 67 counties. The AAAs pay annual dues to the association, and the P4A Board of Directors are all directors of member AAAs.

CC: Tell us what kind of services your members provide.

RMC: The AAAs provide information about resources and services available to Pennsylvanians age 60 and over. They assess the individual’s needs for services, make referrals to case managers, and link individuals to services. These include legal services, home-delivered meals, transportation, counseling on what public benefits may be available, senior centers, and in-home services amongst others. Services provided by AAAs are focused on older adults but can also include their caregivers.

CC: There were quite a few challenges in Pennsylvania, some due to shifts in policy and some due to increased competition; can you describe one of them?

RMC: AAAs were first designed to be an all-inclusive, ‘one-stop shop’ to support older adults and help keep them in their communities. They were the original managers of care for older adults. Over time, the concept of managed care gained popularity, and Pennsylvania’s Department of Human Services implemented managed care for individuals in the Medical Assistance long term care system. The AAAs then had to contract with the managed care organizations (MCOs) to continue providing services to Medical Assistance recipients. The addition of managed care in Pennsylvania resulted in an added layer of administrative expense for Pennsylvania, and the results for older adults and people with disabilities have been mixed.

CC: Tell us more about the response from the AAAs.

RMC: The AAAs tried to establish contracts with the MCOs but they did so individually or in small groups, not on a state-wide basis. Some were successful, others not, and over time the MCOs hired many of the AAA staff to do what the AAAs had been doing. Part of this was because the MCOs were trying to control the cost of services and some AAAs were struggling to sustain services on the funds provided. Some AAAs tried to collaborate with others in order to respond but their efforts were only partially successful. I believe the fact that the AAAs were not united in their response was an issue – they could be ‘divided and conquered’.

CC: Interesting observation. The idea of being united made you think of having a ‘network-wide strategy’; tell us what you meant by that.

RMC: The 52 AAAs have to create a plan for their area and submit it to the Pennsylvania Department of Aging. The Department then creates a state plan. In this process, the network of AAAs across the state never come together to plan statewide. Obviously, there are differences between AAAs, some based on the needs of the communities they serve, but I believe they can come together, both regionally and statewide, to allow for more effective and efficient use of resources while remaining sensitive to the unique needs of the communities they each serve. That’s what I meant by a ‘network-wide strategy’.

CC: Give us an example of that.

RMC: I’ll give you a regional example. Each AAA is required to provide ombudsman services. Ombudsmen are people who investigate complaints and advocate for individuals receiving long term care. Some of the smaller AAAs don’t have the funding to support a full-time ombudsman, so several can join together to pay for one who then provides the service across all their areas. I believe we can do more of these kinds of collaborations, while still allowing autonomy for each AAA.

CC: In the strategy work, we did a lot of external and internal research, including an external market assessment; why was that important?

RMC: On the external stuff, there were two parts – what’s happening outside of Pennsylvania and how are the AAAs perceived by others within Pennsylvania. On the former, aging services are changing across the country so we wanted to understand what we can learn from that. On the latter, we have to remember that ‘perception is reality’, so we need to understand how we’re viewed and, if it’s not acceptable to us, work out how to change that view. On the internal stuff, again, there were two parts – how do the AAAs view themselves and what direction do we, as a network, want to move in. On the former, we need to understand whether there is a difference to how we view ourselves and how we’re viewed, and, if so, why? And on the latter, we as a network (and we as the association serving the network), must be clear on what goal or goals we want to move towards.

CC: You were also intentional about how you got people from the AAAs involved in the strategy process; why was that important to you?

RMC: I am an outsider. I have never worked for a AAA. I have never provided direct services. How can I pretend to know what the AAAs need? That is why I wanted to have leaders within our network participate in the process. I felt strongly that the scope of work needed to be shaped by the AAAs, not me. We brought in members of our Board of Directors. We brought in tenured AAA Directors and newer Directors. We had people from a variety of backgrounds: rural, urban, non-profit and county. Together, they developed the plan. I saw my role – the role of P4A – as supporting, not leading, that work.

CC: Another thing you had in mind was the idea of the network having the capacity to keep thinking strategically; again, why was that important to you?

RMC: The AAAs are always facing crises. This is true across all human services – there is great need but inadequate resources. Policies are always changing. Funding allocations grow and shrink. It’s like being in a forest fire. It’s easy to focus on the flames in front of you but we need to look up. Where is the fire coming from? What is causing it? Can we put it out at the source? As a network, we have great ideas about what we could or should be doing but are constantly sidetracked by the next fire. We needed the capacity to take a break from fire-fighting and look up. Having that enables the network to have a direction, to be strategic. There will never be a time when there are no fires but we need to carve out the resources needed to be strategic while fighting the fires.

CC: What resulted from the external and internal research was a profile of the network, including the identification of five strategic priorities. The network selected one to focus on for now; which was it, and why?

RMC: The AAAs overwhelmingly chose to focus on the strategic priority to improve the quality and consistency of the work they do. To me, this is the underpinning of all of the other priorities. If the work of the AAAs is high quality we can more easily enhance our relationships and partnerships (within and outside of the network), expand our capacities as a network, and strengthen our efforts in advocacy, whether it’s strengthening our advocacy for older adults or strengthening the advocacy for the AAAs. These are the other four strategic priorities, but the AAAs are largely aligned in the idea that improving quality and consistency of the work they do is the building block that underpins them. A high-quality AAA system, for instance, draws in organizations that want to partner in the good work. It also gives credence to what we’re advocating for.

CC: That’s great. Do you have a final thought for us?

RMC: This entire experience has been a multi-year process. I first came to Collaborative Consulting (CC) with the desire to be more strategic, which was not well formulated or detailed. You helped me bring that desire to fruition in a way that I couldn’t have done by myself. The CC team enabled us to develop a full-fledged strategic plan and with extensive buy-in from the AAAs. Not only was CC critical to that process, it was also critical to ensuring that we kept moving forward. My biggest fear was that we would have a great plan but be sidetracked because of the ongoing crises. And CC continues to help us stay focused on our goal, and to make strategic thinking part of the fabric of our organizations.

CC: Thank you for saying that.

We enjoyed working with Rebecca, P4A, and the member AAAs. What they’re doing – to carve out the time to strategize as a network – is incredibly difficult amongst the many fires raging around them. But what we were most impressed with was the way in which P4A and its members did not want strategy setting to be a one-time activity, destined to become a polished document forgotten in a drawer. We particularly liked the focus on understanding how the AAAs were perceived, what goals they, as a network, wanted to move towards, and the desire to build strategic capacities and alignment as part of the process.

Further Reading

  • External Market Assessment: This external market assessment by Collaborative Consulting offered P4A a series of strategic insights and considerations for planning and orienting services and activities to current, emerging, and future social, public policy, and market-based trends.
  • Pennsylvania AAA Network Profile: This profile was the culmination of primary research conducted with key informants and stakeholders within and peripheral to the network, including over 90% of constituent AAAs.