Partnership Models
Cross-sector partnerships are essential to align housing, health, and transportation to effectively address the needs of people with disabilities and older adults in rural communities. While many rural communities struggle with complex barriers that restrict access to housing and housing-related supports and services, cultivating the spirit of togetherness with focused collaboration among community organizations can lead to success in filling gaps and meeting individuals’ needs. Organizations and individuals alike must work to build trust amongst stakeholders through consistent engagement and continue to fund and support innovative solutions that build upon the strengths of a rural community and its unique partners.
The models highlighted below are examples of programs successfully improving access to housing and supportive services in rural communities through cross-sector partnerships.
- Northern Broome CARES
-
Categories Description Program Goal Assists older adults in rural environments support their continued independence.
Service Area Towns of Whitney Point, Barker, Lisle, Nanticoke, and Triangle in northern Broome County, New York.
Eligibility Requirements Adults age 60 years and older. Services Provided Assistance with shopping, clinical care management, telephone reassurance calls, emergency call buttons, health education, home safety assessments, home visits.
Funding Information Northern Broome CARES, in operation since 2020, also serves as a Naturally Occurring Retirement Community (NORC). A five-year grant from the state primarily funds the program.
Northern Broome CARES, a program of the Rural Health Network of South Central New York (RHNSCNY), helps older adults in rural areas of northern Broome County, NY. The program began in 2020 when RHNSCNY received a NORC grant from the New York State Office for the Aging (NYSOFA). Northern Broome CARES’ service area includes several towns in rural northern Broome County where many homes are older and in need of repair. Residents in this area have limited access to transportation, sparse health services, and are likely to experience social isolation.
The Broome County Office for Aging is a major partner and primary referral source for the program. Northern Broome CARES leases office space inside the local senior center operated by the Office for Aging. When applying for the NORC grant, Northern Broome CARES collaborated with the Office for Aging to design their program to effectively address community needs.
Northern Broome CARES collaborates with community partners to serve older adults in rural areas. The local primary care organization often refers older adults to the program. Gerould’s Professional Pharmacy, Inc. provides pharmacy services, home medical equipment, and home modification services to clients served by Northern Broome CARES. Gerould’s Pharmacy also subcontracts with Northern Broome CARES to provide a part-time Licensed Professional Nurse (LPN) to deliver clinical supports to the older adults served. During the academic year, Northern Broome CARES receives two or three Masters of Social Work (MSW) intern students through a partnership with Binghamton University’s MSW Program. The student interns support clients with weekly phone calls and home visits. Northern Broome CARES also partners with a local library and the local school district for outreach, education, and training opportunities such as digital literacy training for older adults.
The program includes two full-time and one part-time staff that assist around 120 people annually, with additional participants receiving assistance on an ad hoc basis. The most requested services include home visits by staff to assist with household chores (paying bills, doing laundry, etc.) or social connection through conversation or playing games. Program staff conduct weekly or bi-weekly home visits to 15-20 people each month.
Access to reliable and accessible transportation service options for older adults is a persistent challenge to the communities the Northern Broome CARES program serves. Previously, the program partnered with a local taxi company one day each week to provide rides for program participants. Members often planned doctors’ appointments, shopping trips, and other errands on taxi days. Unfortunately, the taxi company went out of business, and the program could not find another transportation service to fill this gap. As a temporary solution, Northern Broome CARES staff provide shopping assistance for participants once a week. Staff gather shopping lists and forms of payment, travel to the store(s) to purchase the items, and then deliver those goods to their members’ homes. Northern Broome CARES hopes to utilize a new volunteer driver program to fill in some of the additional transportation gaps for the older adults served.
“It's important that people see that you are in it for the long haul…There's no way around it. You just have to keep showing up.”
- Northern Broome CARES
- Garrett County Community Action Committee (GCCAC), Inc.
-
Categories Description Program Goal Provide supportive service information, make referrals to local community organizations to meet the needs of county residents Service Area Garrett County, Maryland
Eligibility Requirements Any county resident that needs assistance is eligible for service coordination
Services Provided Programs offered through the Service Coordination Department include emergency food, emergency shelter, energy assistance, workforce solutions, and homeless prevention services.
Funding Information As a Community Action Agency (CAA), GCCAC is primarily funded by federal Community Services Block Grants from the Administration for Children and Families.
The Garrett County Community Action Committee (GCCAC), Inc. administers programs and services to help individuals, families, and older adults achieve economic and social mobility in Garrett County, Maryland. In Garrett County, many live in housing passed down through family generations. As the dwellings age, individuals often lack the financial resources to repair, maintain, or modify the structures as needed. The county is also a popular resort destination, welcoming over 1.4 million tourists annually. While a boost to the local economy, the upscale resort environment inflates surrounding housing and building cost prices, which impacts residents’ ability to find and maintain accessible, affordable housing.
Established in 1965, GCCAC has since developed many innovative programs by engaging with residents and community-based organizations, as well as government entities, to learn about and respond to the needs of the community. GCCAC’s leadership values building and maintaining relationships with community stakeholders and credits these partnerships and cross-sector collaborations with their ability to grow into a trusted organization that meets the needs of their community. The organization also frequently hosts or participates in community meetings and has become a reliable, sought-out community leader for implementation of housing services and supports.
GCCAC currently offers the following programs and services:
- HeadStart
- Serving as the area agency on aging (AAA)
- Garrett Transit Service (GTS)
- Senior centers
- Emergency homeless shelter
- Housing Choice Voucher Program
- Continuum of Care (CoC) housing programs
- Homeless Solutions Program for local housing services
- Low Income Home Energy Assistance Program (LIHEAP)
- Emergency food assistance
As members of the National Community Action Partnership and the Maryland Community Action Partnership, GCCAC meets with legislative leaders on local, state and national levels. GCCAC leadership participates in monthly meetings led by the Garrett County Board of County Commissioners, which brings together the mayors of each municipality and other stakeholders for community planning. GCCAC also collaborates with state government agencies, including the Maryland Department of Housing and Community Development, to coordinate homeless services for the County. In partnership with the Garrett County Health Departmentand Maryland Physicians Care, GCCAC is developing a new food pantry and resource program called the 360 Access Hub. Another local partner of GCCAC is Garrett Cooperative Ministries, Inc., a local faith-based organization that operates a community thrift store and uses part of the store proceeds to provide ongoing donations to GCCAC to support their shared mission to improve the quality of life for those with limited income in the community.
GCCAC’s Service Coordination Department plays a key role in providing information, referrals, and support services to improve the quality of life for residents of Garrett County. GCCAC clients most frequently request energy assistance supports; of the approximately 13,000 households in the county, 2,500 households received energy assistance in 2024.
GCCAC leadership is working with their community partners to develop plans to address funding concerns around maintaining or increasing access to housing in the county. As the CoC lead, GCCAC has 650 units of public housing in Garrett County that are facing expiring Low-Income Housing Tax Credits (LIHTC)[ commitments to affordable housing. GCCAC plans to work with community partners in the housing sector to determine a strategy to ensure continued availability of the affordable units. The organization also identified the need for more transitional housing in the community as the small, non-time-limited, seven-bed shelter they operate maintains a consistent waitlist of approximately double its capacity.
“Have conversations with the local hospital, the health department…those people care about housing too. There's hardly anything that's going to have more of an impact on your health than whether or not you're housed.”
- GCCAC
- Atlantis Community Mobile Independent Living (IL) Unit
-
Categories Description Program Goal Assist consumers with overcoming any significant barriers that may be keeping them from living their lives independently in their communities
Service Area Catchment area includes Adams, Arapahoe, Clear Creek, Denver, Douglas, Elbert, and Jefferson counties in Colorado.
Eligibility Requirements Any person with a disability Services Provided Programs and services are based upon five core principles: advocacy, information and referral, peer support, independent living, and transition.
Funding Information The Mobile IL Unit, in operation since 2017, is a mobile office of the Atlantis Community Center for Independent Living (CIL) primarily funded by the Administration for Community through Part C of the Rehabilitation Act of 1973.
The Mobile IL Unit was created by purchasing a used paratransit vehicle (~$75k) that was modified as an accessible, mobile office space.
The Atlantis Community Mobile Independent Living (IL) Unit provides people with disabilities the assistance they need to overcome barriers to living independently in their communities. As one of the centers for independent living (CILs) in Colorado, Atlantis Community provides the five core services that all CILs provide for people with disabilities: advocacy, information and referral, peer support, independent living, and transition from institutional to independent living.
Atlantis Community’s Mobile IL Unit began in 2017 to support individuals experiencing barriers to supportive services, including those experiencing homelessness, in rural communities bordering the Denver metro area. Barriers to services include lack of public transportation, limited affordable housing, and access to health services. People with disabilities in the rural parts of the Denver metropolitan area also often have difficulty traveling to the Atlantis Community main office. The Mobile IL Unit is an effective model for reaching more rural community members by traveling to various locations throughout the day.
The Atlantis Community CIL partners with several community-based organizations to provide services and supports to the community. Atlantis maintains reciprocal relationships with local disability organizations, homeless shelters, and veterans’ organizations for outreach, referral, and information services. A local faith-based organization collaborates with Atlantis Community with funding to support housing set-up costs for individuals transitioning from homelessness. Atlantis Community also receives transition service referrals from social workers at local hospitals coordinating discharge for individuals without housing. The CIL participates as a community stakeholder with the Denver Support Team Assisted Response (STAR) program, providing wraparound behavioral health services to individuals referred from the crisis response team.
Atlantis Community operates the Mobile IL Unit four days a week, bringing their core services to people across the rural area. Approximately 70-75% of people served by Atlantis Community identified a goal to obtain permanent housing in their personalized service plans. Clients are either currently unhoused or transitioning from an institution with no housing to return to. The most recent data from Atlantis Community shows that between 2017 and 2019, Atlantis served 80 people across their main office and the mobile unit. Of those, Atlantis successfully supported 60in applying for and obtaining housing through U.S. Department of Housing and Urban Development’s (HUD) Section 8 voucher program.
An ongoing challenge faced by the Mobile IL Unit is continued contact with unhoused individuals that lack cell phones or access to email services. For example, the Mobile IL Unit will provide outreach to someone unhoused, but on the next visit to the same location, the person is no longer there and there is no way to contact them to follow up. Atlantis Community is exploring options to provide cell phones to unhoused individuals they assist so they can maintain contact after their initial encounter.