Citizens League
Report date
August 2019
What has been most instrumental to your progress?
We were able to tap into a broad range of expertise and experience as we investigated, analyzed and crafted solutions. In addition to the contributions of Task Force members (half of whom were solos themselves) and speakers, the input from solos from various walks of life was invaluable. The personal interviews and focus groups with diverse solos helped Task Force members to expand their understanding of the overall solo population. Such input helped to transform the conversations from the theoretical to the real.
The effective planning and management of the Task Force and follow up pilot projects was critical to the overall success of the project. We used our resources well and were able to accomplish our project goals. We used a proven Citizens League process--discovery--analysis--idea generation--recommendations--which helped the Task Force to work through a complicated issue. Each agenda included time for members to check-in and debrief, which helped everyone to process information and connect it with their own experience. Our two co-chairs worked well together and handled their role well. All of these 'administrative' elements allowed the group to work together effectively and ultimately come to agreement around the solos framework and recommendations.
As noted in the interim report, the timeliness of the subject definitely added fuel to the project. During the Task Force process and pilot projects, we found people who were receptive to the issues raised and eager to learn more. They were also eager to share their own perspectives and experiences. Solos and professionals who work with older adults alike, expressed their appreciation for this initiative. Some were impatient—wanting specific answers/solutions right now; others developed ideas about steps they could take (and lead to three of the pilot projects plus requests for presentations) Thus, need and interest informed our work and has begun to spark even more thinking and action.
Key lessons learned
The project demonstrated the value of both zooming in and zooming out when dealing with a complex topic. There are many elements in the larger health decision making system—legal, medical, social, among others. And, it is important to investigate each of these individual systems to get a complete picture. At the same time, it is essential to step back and see the whole—how the elements function together and where one element may work against another. There wasn’t time to do justice to each of the individual elements, and sometimes it was difficult for Task Force members not to get 'stuck' on one detail at the expense of others. Periodically we had to review our purpose, process and remind them of how far they had come--that even small steps forward had value. This helped because, at one point a Task Force member commented 'I'm just beginning to realize how big this issue is. All of this underscores the value of both patience and perseverance.
It was clear there was much more to be discovered about solos and solo-ness in the various diverse communities and in greater Minnesota. Though we gained important insights from the focus groups and from our Advisory Group, we barely scratched the surface. This project was viewed as the 'starter dough' for work on solos--a mechanism for building momentum and stimulating further action. And to that end, the project was successful.
The foundation would have been even richer had we been able to bring on solos of color and solos from ethnic communities. Though we actively recruited to get solos of color and solos from ethnic communities to be on the Task Force, the time commitment and language barriers proved difficult for them to participate. Given this, we consulted with community leaders who serve solos of color and solos from ethnic communities throughout the project. Moving forward, we know we will need to spend more time identifying strategic partners from diverse communities and greater Minnesota into the Executive Team.
The foundation would have been even richer had we been able to bring on solos of color and solos from ethnic communities. Though we actively recruited to get solos of color and solos from ethnic communities to be on the Task Force, the time commitment and language barriers proved difficult for them to participate. Given this, we consulted with community leaders who serve solos of color and solos from ethnic communities throughout the project. Moving forward, we know we will need to spend more time identifying strategic partners from diverse communities and greater Minnesota into the Executive Team.
Reflections on the community innovation process
It is difficult to single out any one element of the community innovation process as a driver of progress. Inclusiveness was essential to rich dialogue among Task Force members and the information gathered from solos helped to keep the focus on the 'real' rather than the 'theoretical.' Task Force members collaborated well with one another and in a short time became a cohesive group. We'd underscore what we said in the interim report-- that resourcefulness was especially important. We were able to tap into personal and professional connections of the Executive Team and Task Force members to generate new data and to inform discussions. Resourcefulness also allowed us to rethink the way we used our available grant money. By having the opportunity to extend the grant period, we were able to test several of the Task Force recommendations and to share information more widely than originally anticipated. Informational sessions with the MN Board on Aging and MN Department of Human Services stimulated interest in solos by two key stakeholders. Both are now considering follow up activities. Distribution of the Phase 1 report has lead to discussions on the national level.
Progress toward an innovation
This was a foundational project where defining and reframing were innovations. The Task Force and Executive Team adopted definitions for solos and solo-ness to avoid ageist and stereotypical beliefs that the target audience consisted primarily of individuals without children or partners and the frail elderly. Enunciating the concept that anyone can be 'functionally solo' (lacking effective health decision support temporarily or ongoing) was a breakthrough; it provided kind of short hand for multiple intersecting themes. We saw managing health and well being as a central issue for most people in the second half of life and that decisional elements are an often overlooked element of care. And , finally, we saw that people need health decision support--and sometimes decision proxies--throughout that second half, not just at the end of life. This broader reframing will help to put an important public policy issue in the spotlight and better develop solutions for a broad spectrum of older adults.
What it will take to reach an innovation?
The challenge that lies ahead will be to ensure that key stakeholders understand and embrace the framework (described in our Phase 1 project report). This is not a one-time task; the message must be packaged in different ways and reinforced. We will need many ambassadors to carry the ideas forward and generate long-term solutions.
What's next?
The next step will be to identify a few strategic partners who are in a position to build upon the initial foundation and continue the momentum. For example, conversations are continuing with MN Department of Human Services staff to see what, if any role, the State might play in better supporting solos. Discussions are also underway with Minnesota's Center for Excellence in Supported Decision Making to see if this organization might play a role in training volunteers to help solos with health decisions. The nonprofit, Massachusetts Health Decisions, has developed relevant training materials and has expressed an interest in testing them in Minnesota. We continue to distribute the Phase 1 Final Report, the Wilder Data Analysis, and the Phase 2 report on the pilot projects in Minnesota and across the country. The materials have been well received and appear to be helping to fill the information gap around solos and health decision making.
If you could do it all over again...
It took several months of concentrated activity to educate the Task Force members about the purpose and scope of the project and help them 'gel' as a group. The two project coordinators didn't have a lot of time to implement focus groups or gather other new 'raw material' to provide background. Though Wilder Research staff presented some data about older adults during the initial orientation, we didn't tap into their research skills until the second phase of the project. In hindsight, it would have been helpful to have that research earlier in the process. Having the hard data would have helped Task Force members to understand the solo population in more 'concrete' terms rather than as an abstract topic. While in this kind of foundational work it is useful to let people struggle a bit, our time line was limited and so it was also important to be efficient and give Task Force members a sense of mastery and progress. A few more 'facts' up front would have helped. As mentioned earlier, we would have devoted more time at the front end to recruit a more diverse Task Force members or find more accommodating ways for solos of color and solos from ethnic communities to participate.
One last thought
We are grateful to the Bush Foundation for supporting this initiative. It has allowed Minnesota to get a running start on a challenge that will be with the state and the country for a long time to come. The feedback we have received thus far has been largely positive; solos and organizations alike have expressed their appreciation for this effort.