Diversity Assignment

Improving Quality of Life for Seniors: New Governance Tools

Yildirim Uryan & Jonathan Matusitz & Gerald-Mark Breen

Published online: 28 September 2010 # Springer Science+Business Media, LLC 2010

Abstract This analysis examines new governance tools that can be applied to security issues among the aging population in the United States, particularly in Central Florida. The authors explain the problem about the structure of law enforcement agencies today. Traditional bureaucratic organizations have a hierar- chical and centrally structured system, which operates with strict rules and regulations. The authors proceed to compare two models of governance: the traditional bureaucratic government and the new model governance. The latter is better in that it uses indirect methods and innovative tools. These tools are (1) grants, (2) needs assessments, (3) senior volunteers, (4) co-production, and (5) citizen participation.

Keywords eHealth . Florida . Governance tools . Law enforcement . Networks .

Seniors . United States

Introduction

This analysis examines new governance tools that can be applied to security issues among the aging population in the United States, particularly in Central Florida. Seniors are the fastest growing segment of the U.S. population. As of 2009, one in eight U.S. citizens is 65 or older. Approximately 25% of senior citizens live alone in the United States, which makes them the most vulnerable citizens in our communities (Harvard School of Public Health 2003). Because of the growing elderly population, many problems arise in different areas, from nursing home and health insurance issues to elderly abuse and dysfunctional elderly communities. According to the National Crime Victimization Survey (2004), not only is the number of elderly victims increasing across the country, but the number of elderly

Ageing Int (2012) 37:318–337 DOI 10.1007/s12126-010-9080-1

Y. Uryan: J. Matusitz (*) : G.-M. Breen Seminole State College, University of Central Florida, Partnership Center (#UP 3009), 100 Weldon Blvd., Sanford, FL 32773, USA e-mail: [email protected]

criminals is rising as well. The Central Florida region, more than any other area, is home to a growing number of elderly populations. Many elderly citizens have moved to Central Florida because they viewed the region as a retirement destination (Harvard School of Public Health 2003). It is estimated that, by the year 2025, one of four Central Florida residents will have turned 60 or over. Increased life expectancy also creates new issues for the public organizations and the criminal justice system because of the increasing number of elderly people in the community. Many elderly require help and social services to sustain their life. Before the percentage of seniors hits its highest point, it is necessary to develop effective policies by the government to address elderly issues. Reddel (2002) and Kamarc (2002) argue that organizations with a traditional bureaucratic structure cannot meet many of today’s problems because of a lack of flexibility. As an alternative to the traditional government model, new governance tools are more appropriate to deal with such community issues.

This analysis begins with a description of the problem about the current situation in the senior citizens population (e.g., the growing number of seniors, issues concerning elderly in Central Florida). The authors, then, explain the problem about the structure of law enforcement agencies today. As such, because of their current structure, they cannot respond to many issues. Their traditional bureaucratic organizations have a hierarchical and centrally structured system, which operates with strict rules and regulations. The authors proceed to compare two models of governance: the traditional bureaucratic government and the new model governance. The latter is better in that it uses indirect methods, comprising a number of innovative tools. These tools are (1) grants, (2) needs assessments, (3) senior volunteers, (4) co-production, and (5) citizen participation. The second tool, needs assessment, is particularly important because it identifies, in detail, four dimensions of needs: normative needs, perceived needs, expressed needs, and relative needs. What comes subsequently is a detailed description of partnerships and networks. Specifically, inter-organizational partnerships and networks are identified as important governance tools; they are likely to be effective and beneficial because, when partnerships and networks are well constructed, relationships among organizations facilitate coordination and governance. This analysis ends with a section on eHealth (i.e., an online service for helping nursing home practitioners deliver better care to seniors) and a discussion.

Description of the Problem

After World War II, several modern Western countries experienced an unusual spike in birth rates. Baby boomers from the post-World War II era are becoming the elderly population of today. They constitute the most rapidly growing segment of today’s population (Harvard School of Public Health 2003). About 77 million babies were born in the United States between 1946 and 1965. Beginning in 2006, those babies have begun to turn 60 years of age. For the next 19 years, every 7 seconds a baby boomer will turn 60; that means almost 8,000 new seniors a day. Because life expectancy is increasing, people could realistically live to the age of 95 (Knickman and Snell 2002).

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Figure 1 indicates elderly population growth in United States. Most communities in the United States experience a dramatic increase in the number of senior citizens and a transformation of the community structure (American Academy of AAM 2002).

As demonstrated in Figs. 2 and 3 (both on the next page), the Central Florida Region has confronted an elderly population denser than any other area across the country because of several reasons. For instance, many retired seniors (e.g., snowbirds from the Northeastern part of the country) desire to move and live in this area. Furthermore, many seniors who normally live in another area are frequently visiting and staying in Florida for a couple of months. The local government has no formal record of those citizens. By 2025, it is estimated that 25% of Orange County residents will be 60 and over. Today, of Orange County seniors age 65 and up, 25% live alone (Harvard School of Public Health 2003).

Elderly citizens need many public services including security. Many of them are not capable of sustaining their lives without help. Some have mental diseases such as dementia, Alzheimer, and sundowning syndrome (i.e., confusing their thought and reason). Many senior citizens become lost because of their mental illnesses.

For some of them, their intellectual and social abilities have been so severely lost that it interferes with their daily functioning (Harvard School of Public Health 2003). There are an increasing number of elderly victims and criminals in the community (NCVS 2004). Hence, before the number of problems related to senior citizens reaches its peak, law enforcement agencies should develop new policies to tackle these problems. It is important to note that law enforcement organizations having traditional bureaucratic structures cannot respond to these issues, partly because many of them are bigger than any single organization handling it alone (Martin 2006). The new governance model could possibly be an ideal alternative as it offers useful tools to manage elderly community problems and provide public services effectively.

Fig. 1 Elderly population growth in the U.S. (American Academy of AAM 2002)

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The New Governance Model

The changing nature of crime pushes law enforcement agencies to develop new ways to ensure community security. Kamarc (2002) states that many people have seen law enforcement bureaucracy as a major impediment in the crime prevention battle. Traditional bureaucratic organizations have a hierarchical and centrally structured system, which operates with strict rules and regulations. For this reason, emerging issues require more flexible and deliberative organizations. A bureaucratic government is a closed system with a one-way communication and information flow. It allows minimal citizen involvement into decision making process. A major difference from the new governance model is that the latter has an open system with multiple channels of communication and information flows. Citizens and organ- izations from public, private, and non-profit sectors can be included to produce better policies (Salamon 2002). Hence, a shift from bureaucratic organizations to new governance methods is necessary, which can enable governance tools to achieve public goals by circumventing direct governmental procedures (Kamarc 2002). In Table 1 (on the following page), Kettl (2000) describes the main differences between government and governance. One of the most important differences between the two models is service and good delivery system.

While a bureaucratic government directly provides service and good delivery (with a dominant role in the market), the governance model uses indirect methods, comprising tools such as contracting out with third parties, networks, interorgani-

Fig. 3 Florida population age distribution (State of Florida 2005)

Fig. 2 Age groups immigrating to Florida (Vogel 2006)

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zational pertnerships, volunteers, citizen involvement and collaboration with organizations from other sectors (Koschmann 2009).

Institutional Theory

Institutional theory rests on the premise that organizations have to adapt to their environment (their surroundings). As such, an institutional theorist would study how organizations can increase their ability to prosper in a given environment by satisfying their “populations” (e.g., stakeholders, customers, or simply citizens) (St. John 2009). Due to constant changes in demographics, organizations in various sectors need flexible management and the ability to produce different solutions to the problem of constant population “evolution.” For example, recently Nintendo, the famous software and game producer company, changed its products based on the current shift in demographic characteristics. Now, the company produces software and games for elderly people more than young and children (Kohlbacher and Hang 2007). Rapid changes in the technological and social areas and population structure have encouraged governments to adopt public services according to emerging needs and demands. According to Zhao et al. (2003), the driving force behind organizational change is the external environment, particularly the task environment with which an organization is confronted. Institutional theory can help us determine appropriate governance tools for handling elderly issues.

Institutional theory is a good theory to explain why organizations have to change or adapt to their environment. Pressures to modify existing services or bring in innovative methods may come from different sources. Nevertheless, organizational goals may remain the same: to retain their legitimacy and preserve the necessary elements (i.e., resources) required for the organization to adapt its environment (DiMaggio and Powell 1983). Increasingly, citizens’ expectations lead organizations to explore the best practices and adopt successful policies from different sectors. Inter-organizational networks and cross-sectoral partnerships are important for

Table 1 Main diffreneces between government and governance (Kettl 2000)

Government Governance

Program/Agency Tools

Hierarchy Networks

Public vs. private Public and private

Command and control Negotiation and persuasion

Management skills Enablement skills

Superstructure Functionality

Decisions Processes

Rules Goals

Roles Performance

Implementation Coordination

Outputs Outcomes

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developing innovative strategies (Nooteboom 2009). Besides, well-educated professionals within the organization and leaders can bring about “natural” changes in the organization. Organizations will not change by themselves; rather, normative factors can play an important role in the change of organizational policies and practices (DiMaggio and Powell 1983).

Governance Tools Proposed

Several tools of governance can be applied to the aging population problem that law enforcement agencies are currently facing in the Central Florida region. In order to identify appropriate governance tools, it is necessary to categorize issues that elderly citizens care for. Laura Long, a program manager at Orange County Sheriff’s Office (in Orlando), can be a good leader in identifying elderly issues relating to security. Likewise, Senior and Law Enforcement Together (SALT) is an existing program working to locate elderly citizens’ issues and, by the same token, to educate street level officers. Yin (1980) states that both crime and fear of crime severely affect elderly citizens. SALT manager contends that fear of crime among elderly citizens should be thoroughly examined because it reduces their overall quality of life. Law enforcement agencies should also develop policies and programs to reduce senior victimization. Another important issue is to enhance a sense of security among seniors which will improve overall quality of elderly citizens’ life. The growing elderly population not only changes the structure of the community but also affects the functioning of the community. As stated previously, it is a problem affecting the whole country. Now that readers are more aware of the circumstances of the senior citizen problem of the Central Florida region the authors will provide proposed tools of governance in the following subsections. These tools are (1) grants, (2) needs assessments, (3) senior volunteers, (4) co-production, and (5) citizen participation.

Grants

Grants can be obtained to encourage law enforcement agencies to recruit new personnel or to assign existing personnel to work on those issues. When govern- ments attempt to promote a specific action, service, or activity, a qualified individual or an organization can be supported by federal funding. Governments can support different organizations from public, private, or non-profit sectors on the specific conditions. One important characteristic is that grants are generally offered on a competitive basis. The purpose of grants is to stimulate third-party organizations to provide specific services for citizens or specific population strata. Governments can guarantee to address community needs by supporting third-party organizations without having to accept the direct service responsibility and costs (Beam and Conlan 2002).

According to Beam and Conlan (2002), grants are the most prominent governance tools of the United States Federal Government. An examples of a grant offered in the community security area is the grant offered by President Clinton, during his first term, to a group of 100,000 community police officers in order to protect U.S. communities. In the following years, the award amount (building up on the same

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grant) reached $8.8 billion. The money was used to recruit new police officers—and replace existing ones—for new community policing programs. It was one of the largest grants that the United States Federal Government awarded to states and local governments for communities throughout the country (Beam and Conlan 2002).

Another federal grant award was given by the United States Department of Justice to the Office of Community Oriented Policing Services between 2003 and 2006. The funds were used to promote police and community partnership. Throughout the nation, 65 law enforcement agencies were awarded more than $250 million to develop policies relating to community policing programs. One of the most populated regions of Central Florida is the Orange County area. Up to 2006 in Orange County, sheriff officers have already been awarded more than $20 million to support community policing programs, to recruit new community police officers, and to reassign existing officers to other community policing programs (COPS 2006).

Because the growing elderly population is a national problem of United States, President George W. Bush stated that the aging population was more than a crisis. This put extraordinary strains on both the federal and local governments. President Bush proposed that elderly citizens’ cost to federal budget be capped at 60% by the year 2030 (White House 2006). The full impact of the aging population on Social Security, Medicare, and Medicaid will affect the entire U.S. population. For these reasons, it is crucial to develop new policies to mitigate the effects of the aging population. With respect to the State of Florida, former Florida Attorney General Bob Butterworth also calls attention on the elderly issues. He emphasizes Florida’s explosive increase of the elderly population and criminal behavior targeted against these vulnerable citizens. He also highlights the increasing fear of crime among elderly citizens. The psychological and emotional impact of crime on elderly citizens is more important than the raw numbers of committed crimes. The necessity of educating public and social service officers needs to be underscored. Mr. Butterworth states that both federal and local governments—especially law enforcement agencies, social, and public service providers—have to educate its citizens (particularly elderly citizens), as well as the judiciary system and other branches of the public service system (Ravenna 2006).

Grants offered by both the federal and local governments can be the first tool to encourage law enforcement organizations to develop effective policies and programs (Beam and Conlan 2002). Since each law enforcement organization has to allocate a certain amount of money from the budget to develop programs, grants are essential when the policy is not observable in the regular budget process. Grants can induce public organizations to change their routine services and status quo, which is difficult to modify. Perhaps, this is the most important reason why grants are among the most widely used governance tools.

Needs Assessments

Needs are statements that identify people at risk and challenges they face. In determining the current conditions of the problem, the first step should be to identify senior citizens’ emergent issues and existing problems. Effective human service design and implementation requires a needs-based strategy. Hence, a needs assessment can be an appropriate tool to translate problems identified into needs

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and measurable objectives which, in turn, will be analyzed to design effective policies and programs (Kettner et al. 2008). Once needs are determined thoroughly and sensitively, law enforcement organizations can clearly select a course of action.

According to Kettner et al. (2008), it is difficult to define and measure a needs assessment. Ponsioen and Maslow, both theorists on needs, offer two different insights, which can help us better understand the concept of need. The two theorists differ on the interpretation of the concept. While Ponsioen (1962) defines the need in terms of a level below which no one should fall, Maslow (1954) explains the need in terms of a hierarchy in which higher-level considerations become “needs” only after lower-level needs are satisfied. From these two vantage points, needs assessments have both qualitative and quantitative dimensions. Situations can be labeled as a specific problem; similar individuals or groups can be aggregated to categorize problems. The “need” can be identified with different approaches. Organizations can establish basic standards or ask people’s perceptions regarding their needs. While an expressed need aims at investigating people who have sought a specific service, a relative need indicates the difference of existing service level among similar communities

Given the importance of the concept of need, senior citizens’ needs assessments can be adequately measured by using four dimensions of needs: normative needs, perceived needs, expressed needs, and relative needs. Relying on existing standards established by governments (usually called normative needs) can determine the level of needs for senior citizens because existing standards can be improved according to the current or new future conditions (Kettner et al. 2008). Since normative needs are established as measurable targets, law enforcement agencies can generate objective targets. Laura Long, the program manager at Orange County Sheriff’s Office (in Orlando), states that the number of help desks and street officers dealing with elderly citizens should be increased because of dense work load. Adjusting normative needs according to social indicators can be an example of a needs assessment.

Perceived needs represent the second dimension. A perceived need considers people’s thoughts and feelings about their needs. Perceived needs are not visible because they have not been formally expressed yet (Netting et al. 2008). It is important to ensure the balance between citizens’ perceived needs and professional program designers’ judgment of needs (Kettner et al. 2008). The balance can be achieved by frequent interviews with citizens facing problems in their lives or within their communities. Volunteer elderly citizens, non-profit organizations dealing with elderly issues, and citizens concerned can be utilized to identify perceived needs. Exploring perceived needs has many benefits beside needs assessment because it allows a couple of governance tools such as citizen participation, senior volunteers, and co-production, which will be identified later in this section.

Expressed needs, sometimes called demand needs, are the third dimension. By and large, expressed needs are reflected in service statistics for individuals served and in waiting lists of people who looked for services but for whom services were poor or unavailable (Netting et al. 2008). Indeed, many senior citizens in need apply for government services (e.g., welfare). Statistics constantly report how many citizens could be successful—or how many of them could not—if their needs were met and explain what the reasons are. Unmet needs and demands can lead program designers’ to create better planned services for the elderly (Kettner et al. 2008).

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Providing information on unmet needs may require contacting a couple of public organizations that provide public services for elderly citizens. As explained, in the next large section, inter-organizational partnerships and networks can be utilized for information sharing among related organizations to explore expressed needs.

Lastly, relative needs are ones that compare a set of needs with another set of needs (Netting et al. 2008). A needs assessment adopting such perspective would enable a comparison of existing service gaps among similar communities or geographic regions to determine the level of service for a specific government. This can be used by controlling basic differences in population characteristics and structure (Kettner et al. 2008). Using four dimensions of need assessment ensures program designers to analyze the current situation and to plan a course of action addressing community’s problems. Since the risk population is elderly citizens affecting crime and fear of crime, volunteer elderly citizens, co-production and citizens concerned can help to reach the most vulnerable elders.

Senior Volunteers

Senior volunteers can provide a great deal of information on the prominent issues affecting elderly citizens’ lives. These volunteers can be useful not only for providing information but also for program implementation. They work for the benefit of community members without receiving a compensation for their services. The scope of volunteer involvement in local government organizations has an impressive level, which is regularly increasing. More than 25% of all citizens are voluntarily working in governments and 85 percent of volunteers are serving local governments. Between 1990 and 1999, the proportion of volunteers serving local governments has increased from 79% to 85% (Gazley and Brudney 2005). Volunteer elderly citizens can be interviewed by program designers to identify elderly people’s emergent issues and existing problems. Even though utilizing volunteers in organizational processes may include additional expenses (e.g., training and supervising senior volunteers), the overall benefit of using volunteers can, by far, outweigh these costs, especially in social welfare services (Gazley and Brudney 2005). Volunteer’s perceived needs can be investigated thoroughly and sensitively to design a course of action.

For instance, Orange County Sheriff Office has a program named Senior and Law Enforcement Together (SALT). SALT manager Laura Long states that the rationale of the program is to identify elderly citizens’ issues by using volunteer elders. Senior volunteers are working with law enforcement to reduce senior victimization of Orange County region. The goals of the SALT program are to enhance a sense of security among seniors and improve overall quality of life for seniors. Many volunteer elderly citizens frequently visit SALT departments to identify issues within the senior community. These volunteers serve as mediators of elderly population’s matters; some of them have even worked with SALT for more than 10 years. According to Laura Long, they are utilizing elderly volunteers as “decoders” of elderly citizens. As such, decoding implies “reading” people. Senior volunteers have grown and lived in a peer environment, which is different from the environments of the lower-age brackets. Elderly people may not understand today’s organizational process and policy implementations of law enforcement agencies because of rapid

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changes in culture and social life, but they certainly are able to understand (i.e., “decode,” read) their peers. Furthermore, SALT managers admit that program designers have experienced difficulties in understanding elderly citizens without using volunteers’ help. Senior volunteers can express elderly community’s needs, their own perceived needs, and influence law enforcement agencies in shaping policies via deliberations with SALT manager.

Co-production

Co-production, a concept that aims at allocating volunteer seniors’ time to other seniors in need, can be used as another tool in the programs developed by services. The rationale behind co-production is to engage end-users or citizens actively into service production and delivery of services to achieve better outcomes. Social welfare services are the most appropriate targets for co-production, which citizens become partners and participants in building successful results. This tool enables citizens to contribute to government programs and create an atmosphere for professionals and citizens to understand each other (Pestoff 2006).

Senior citizens, and their relatives, can be used for programs developed by law enforcement agencies. SALT manager Laura Long has developed and practiced many programs aiming at preventing crimes against the elderly and facilitating their lives. One of the programs for senior citizens consists of visiting their homes frequently. The goal of the program is to help elders conquer their fears of crime even though they are living alone in their homes. Relatives and friends of elders targeted by the program can be utilized as an implementation of co-production. The benefits of co-production are plentiful. For example, the number of elderly people accessed throughout these projects can be increased. Law enforcement organizations can compensate for their scarce resources through the help of citizens. Participating citizens can contribute a great deal to law enforcement programs and help improve seniors’ quality of life. Since a certain number of senior citizens are considered populations at risk, developed programs can reach a large number of elderly citizens by constantly interacting with them. Both citizens and professionals understand each other and produce better outcomes.

Nevertheless, it is important to note that measuring the effectiveness of co- production programs is a difficult task. To begin, no large-scale measure or assessment of co-production among senior citizens has been provided in the literature so far. SALT managers insist on the success of the partnership and assert the number of developed and practiced programs have been successful up to now. Even though it cannot be exactly known whether these programs are effective or not, feedbacks of the senior citizens working in co-production implementations can be considered as a measurement model. Their feedbacks can be useful in designing new programs or modifying existing ones.

Citizen Participation

Citizen participation can (1) provide information to public administrators and program designers, (2) enhance the legitimacy of organizations’ actions, and (3) improve the quality of policies. With the rise of democratic governance, there is a

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shift from information sharing to information processing models of citizen participation, a shift from consumer-type citizens to shapers of government policies and projects, and a shift from citizen involvement to citizen empowerment in policymaking process (Lukensmeyer and Torres 2006). One of the most important differences between bureaucratic government and new governance is the concept of citizen participation. While bureaucratic governments resist the participation of citizens in decision-making processes, new governance utilizes the concept as a governance tool.

The rationale for using the citizen participation is to promote communities’ quality of life by actively having citizens participate into decision-making processes. In this manner, governance becomes more democaratic and effective than the typical “passive citizen” system (Irvin and Stansbury 2004). Cooper (2004) proposes four reasons for citizen participation: (1) to uphold the rights of citizens in a democratic society, (2) to maintain the stability of the political and administrative system, (3) to achieve better policies and programs, and (4) to educate and develop citizens (Cooper 2004).

When addressing different forms of participation, Arnstein (1969) created a participation ladder consisting of eight steps of participation ranked in order from most government power (nonparticipation of citizens) to most citizen power (citizen empowerment). These eight steps are manipulation, therapy, information, consulta- tion, placation, partnership, delegated power, and citizen control. These are steps of the ladder from government power to citizen power. Likewise, Lukensmeyer and Brigham (2005) point out five different form of participation: informing, consulting, engaging/involving, collaborating, and empowering.

In a similar fashion, Fung (2006) indicates three important dimensions forming citizen participation: participants characteristics (the “who”), forms of involvement in decision-making (the “how”), and the linkage between public will and decision- making, also called “discussion” (the link between the “who” and the “how”). Cooper et al. (2006) identify five dimensions of citizen engagement: size, scope, purpose, location, and process. Cooper and colleagues also mention that citizen participation may break law enforcement agencies’ confidentiality and consume more time and resources throughout the decision-making process. For these reasons, administrators and executives criticize citizen participation for consuming time and management, but also for having relatively higher costs.

Nevertheless, citizen participation has many potential benefits. So, it is necessary to capitalize on the benefits offered by citizen participation in order to avoid the disadvantages aformentioned. The cost of citizen participation is an important consideration for partnerships and stakeholders in terms of “who is concerned” in the decision-making process. This translates into costs incurred when citizens participate, such as transportation costs and production costs. Production costs, for instance, refer to the costs incurred by organizations for coordinating the citizens’ participation process (e.g., allocated personnel, resource investment, and time). Lukensmeyer and Torres (2006) present a number of techniques for deliberation, which should be effectively considered to mitigate participation costs. For Lukensmeyer and Torres, citizen juries, deliberative pollings, issue forums, study circles, 21st-century town meetings, and citizen assemblies can be effective deliberation techniques involving citizens in decision-making processes. And, of course, they are also cheaper.

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One disadvantage about citizen participation is that, in its attempt to increase transparency for the public, some specific information about senior citizens needs to remain close and confidential, such as senior citizens’ specific diseases or other confidential information. Only the government or proper officials should possess that information, not the citizens in general. In addition, certain issues may require specific professional skills and knowledge that citizens do not have (Lukensmeyer and Torres 2006). In some situations, consensus cannot be provided or a final decision may not make each party happy. And a deliberation process may become competitive and, therefore, foster a distrustful atmosphere among citizens, stake- holders, and government (Cooper et al. 2006). Nevertheless, those negative points can be mitigated—to a certain extent—by properly designed participation methods.

Since one of the purposes of citizen participation is to inform citizens, programs intended to help elderly citizens can be demonstrated to citizens. Along with SALT programs, Older Persons Referral Card and Vehicle Emergency Information Card are other programs that help elderly citizens who are frequently lost because of specific illnesses or conditions. SALT managers have specifically designed identity cards describing their illness, home address, contact numbers of their relatives, and other directives. The more citizens get familiar with these identity cards, the more help can be obtained for senior citizens. Moreover, this process will cultivate mutual understanding and foster bonds of trust among community members, decision makers, and governing institutions. When citizens learn more about programs, they may affect political behaviors and attitudes and support government policies (Lukensmeyer and Torres 2006).

The following section which, in and of itself, is too lengthy to be a subsection of the tools of governance section, will give a detailed description of partnerships and networks. Specifically, inter-organizational partnerships and networks are identified as important governance tools; they are likely to be effective and beneficial because, when partnerships and networks are well constructed, relationships among organizations facilitate coordination and governance.

Partnerships and Networks

Without a doubt, problems related to senior citizens extend across different organizations and sectors. Consequently, inter-organizational partnerships or networks between related agencies can contribute a lot to existing public organizations that deal with those problems. Difficulties of managing conflict among members can be surpassed when appropriate structures and models are designed for public purposes (Provan and Milward 1995).

Inter-organizational Partnerships

Since no organizations can handle most of the current social problems alone (Martin 2006), partnership is an important tool for law enforcement organizations. Partnership is defined as two or more entities joined together to accomplish a specific task, which would be more difficult to accomplish if each entity were to do it alone (Cheney et al. 2010). Partnerships generate resources of stakeholders in a pool, which can be useful

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when solving problems. When comparing top-down bureaucratic governments with partnerships, Klitgaard and Treverton (2003) use a nice metaphor. For the two authors, there is a shift from the layer cake governance model (in which different organizations are separately assigned different tasks) to the marble cake governance model (in which new partnerships form among organizations across sectors).

Community, partners, and responsibility, are three main dimensions of partnerships. While community refers to geography (i.e., the partnership targets a neighborhood or town), partners stand for all individuals and organizations interested in sharing responsibility for a specific problem (Mann et al. 2007). Two different approaches of partnerships have been considered by law enforcement agencies. According to Terpstra (2004), many law enforcement agencies appreciate partnerships as a community policing concept but also consider the community security as a task of police organizations. According to some other law enforcement agencies, community security is not a task, which police should handle alone, but a shared responsibility of different agencies and parties.

There also exist different partnership models for law enforcement organizations throughout the country, mostly in the areas of school security, health, and social welfare. School programs aim to reduce students’ criminal activities by working together with parents, school administration, teachers, and local law enforcement agencies. In such programs, community members observe their streets and report important security issues or concerns to local law enforcement agencies. Direct information-sharing with law enforcement agencies is another predominant partnership model, which aims to provide better service to citizens. Likewise, the American Association of Retired Persons (AARP), the National Sheriffs Association (NSA), and the International Association of Chiefs of Police (IACP), are organizations that have signed a partnership agreement in 1988 to work together when dealing with security issues for senior citizens. The aim of the partnership agreement is to reduce criminal victimization and enhance the delivery of social and security services for elderly citizens (TRIAD Council 2003). Figure 4 (below)

Fig. 4 The national information exchange model (Kurlander 2006)

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illustrates the National Information Exchange Model’s Domain Data Core Concept as an example of information-sharing partnerships (Kurlander 2006).

Along with the partnership agreement, TRIAD partnership was coordinated for Orange County (see Fig. 5 on the next page). TRIAD is constituted of three public organizations; the Orange County Sheriff’s Office, the State Attorney, and the Commission on Aging of Orange County Health Department. Each organization has assigned a unit to work on this project. At the Orange County Sheriff’s Office, Senior and Law Enforcement Together (SALT) managers work as conveyers and coordinators of the partnership. The State Attorney has a project named “second pair hands” for TRIAD. The Senior Resource Alliance of Commission on Aging is assigned from the Orange County Health and Family Department for TRIAD (TRIAD Council 2003).

The improvement of the overall quality of life among seniors is the main objective of the partnership. The reduction of senior victimization and the enhancement of a sense of security among seniors are other objectives that determine the success or failure of the partnership. The effectiveness of the partnership measure the extent to which the organization attains pre-determined outcomes. Hence, the success of TRIAD can be evaluated by looking at objective goals. The Orange County TRIAD and SALT Council declare the partnership’s pre- determined main goals as the design of improved methods for the reduction of crimes against the elderly and the improvement of law enforcement and social services delivery to seniors (TRIAD Council 2003). The council does not directly measure the delivery of law enforcement and social services to senior citizens or the satisfaction of the elderly population who participate in the activities of the partnership. However, the success of the partnership can be evaluated by looking at the number of projects developed and implemented by the council and the number of elderly people accessed throuhout these projects.

The reassurance programs developed and practiced by TRIAD comprise various activities including the prevention of crimes against elderly population and the improvement of their lives. TRIAD managers point out more than 20 different programs including “9-1-1 Cell Phones,” “File of Life,” “Vehicle Emergency Information cards,” “Older Persons Referral Card” and “Senior Academies.” However, TRIAD does not have a measurement system to determine the number of elderly people accessed throughout these projects but it estimates that developed programs reach a large number of senior citizens like a snowball sampling method. SALT managers insist on the success of the partnership and stress the higher number of such developed and practiced programs.

Networks

Networks are formal or informal structures composed of members from public, private, and non-profit organizations working together to achieve specific goals

Fig. 5 TRIAD partnership members (TRIAD Council 2003)

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(Silverman 2008). Agranoff (2003) claims that “changing the nature of work from labor-based production and services to the integration of knowledge-based symbolic- analytic work” (p. 8) has placed greater importance on human capital. Public managers possess only some part of the knowledge to solve community problems. This is the reason why networks has a greater importance in today’s world. According to McGuire (2002), networks are multiple linkages among multiple organizations. Jackson (2008) emphasizes the likely benefits of networks. As such, organizations can provide practical connections with other public, private, and non- profit agencies, even if it means sharing management or authority with other stakeholders. Moynihan (2008) describes networks as different aspects of the world that share the characteristic of interconnectedness. Network members can join and leave as they wish (e.g., due to overlapping goals). Nevertheless, each member has incentives to use the network to their benefit.

Networks might not be beneficial when there is disagreement on how the network should be run or how matters in the network should be acceptable or unacceptable. Lack of initial agreement on specific issues is considered as one of the main reasons for network failures. It is important to keep all relevant stakeholders in the loop and inform them all the way. In addition, when the roles and responsibilities of the network members are not clearly defined, it is difficult for the network to sustain its functions and achieve its goals (Goldsmith and Eggers 2004). Furthermore, holding the members accountable becomes more difficult, particularly in some public service networks. One of the major questions for networks is who takes responsibility in the program implementation. As one can see, networking might not be a good idea for every problem and in every environment (Simo and Bies 2007).

Strengths of networks include the leverage of expertise, the response to complex service demand, and the reduction of risks and costs. On the other hand, network weaknesses include the difficulty and cost to coordinate routine procedures and relations between agents. Additionally, networks are time-consuming and can be a challenging method for reaching a consensus in solving problems, especially in issues related to public interests. It is also difficult to figure-out to what extend the network is self-organized (Milward and Provan 2006).

Since the focus of this analysis is on the senior population of the Central Florida region, it is necessary to consider a regional network that includes law enforcement agencies, social work and health departments, citizens, volunteers, business and philanthropic communities, and local jurisdictions with the support of state and federal governments. Moynihan (2008) can guide us in creating a network for the Central Florida region. He states that it is necessary to identify problem or information needs and possible network members. Each possible network member will be evaluated in terms of their skills, resources, relationships, and information. Existing relationships and necessary linkages should be clearly mapped or established. Specific environmental conditions that can affect the network or senior citizens themselves, unanticipated events, and uncertainties about tasks should be identified. Lastly, network management structure should be specified among self- governance, lead-organization, and network administrative organization models (Moynihan 2008).

The network, which TRIAD partnership wants to create, can be a good example for creating an appropriate network type and management structure.

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Relating to the network management structure, TRIAD is acting as a network administrative organization because SALT manager Laura Long works as a full time staff setting up to manage the network (Milward and Provan 2006). Additionally, elderly problems are identified by SALT manager and presented to the advisory board of TRIAD. Core group members always attend these meetings. These characteristics resemble the network administrative organization type, which has “efficiency of day-to-day management, strategic involvement by key members and sustainable” structure (Milward and Provan 2006, p. 22). SALT manager Laura Long states that the last step they want to achieve is to connect elderly citizens with assistance providing by partnership organizations. Since the TRIAD board has an agenda for policy issues focusing on problems elderly citizen have, it seems that the board is planning to create a problem solving network type. Indeed, Milward and Provan (2006) define the problem solving network that “focus is on solving existing complex problems rather than building relationships for future problems” (p.11).

eHealth Services as Quality Care

It might prove interesting to determine whether the use of technologies in elderly communities can provide additional help. Technology is a facilitator in healthcare interactions and interventions within long-term care populations and nursing home settings in particular (Matusitz et al. 2010). For example, e-health—the use of distant technologies (e.g., the Internet) to provide medical or health services—has increasingly been used in nursing homes and hospitals (Breen and Matusitz 2007; Breen et al. 2008; Matusitz and Breen 2007b). Web sites such as WebMD.com can aid and provide senior citizens as well as healthcare practitioners and the general public with access to a limitless medical database (e.g., to make diagnostic and treatment decisions) (Matusitz and Breen 2007a). By the same token, the inclusion of technology-based tools would be suitable to inter-organizational relationships or networks. The Internet has enabled the general public to obtain more information about a wide range of topics. Incorporating Internet-based strategies in the new governance model would not only be cheap for tackling issues related to senior citizens; it would also be fast, effective, and easily manageable.

As Matusitz and Breen (2007a, b) assert, eHealth consists of telecommunications technologies or Internet-based services (e.g., WebMD.com and Medlineplus.gov) that provide or share medical information. According to estimates, there are about 100,000,000 eHealth users each day (Breen and Matusitz 2007, 2010). However, it is surprising that few studies have looked into nursing homes’ (practitioners: MDs, RNs, LPNs, NAs, etc.) perceptions or opinions of eHealth services and their immediate efficacy in treatment and care administration for residents (Matusitz et al. 2010). eHealth services offer an encyclopedia of medical and pharmaceutical information easily accessible thanks to the Internet. These services provide answers to questions about diagnosis, treatment, prescription drug protocols, and side effects (Breen and Matusitz, 2007, 2010; Breen et al. 2010; Matusitz et al. 2010). Breen and Zhang (2008) published a theoretically-driven article explaining how eHealth services are able to offer considerable assistance to nursing home practitioners

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when determining clinical decisions vis-à-vis seniors, ranging from analysis of symptoms, to diagnoses and treatment options (Martin et al. 2002; Wan et al. 2010).

Nursing staff cannot perform medical care delivery at the best possible level when their knowledge base of physiology and abstruse medical topics are minimal or insufficient (Breen and Zhang 2008). eHealth constitutes an knowledge source beyond compare, which nursing home practitioners can rapidly access so that they can get the information they need for firm decisions when directing care plans and delivery for senior residents (Matusitz et al. 2010). eHealth services such as WebMD.com and Medlineplus.gov also represent a continuous educational reserve that nursing home practitioners can regularly use to refresh or gain knowledge of new diagnostic, treatment, or assessment procedures that will boost the inclusive quality of care and service delivery to seniors (Wan et al. 2010).

Discussion

The growing elderly population in U.S. communities will present a number of problems in public administration area in the near future. It seems that several issues will emerge for law enforcement agencies. Their managers have to develop proactive policies before serious problems emerge. As of 2009, one in eight U.S. citizens is 65 or older. Approximately 25% of senior citizens live alone in the United States, which makes them the most vulnerable citizens in our communities (Harvard School of Public Health 2003). This is the same percentage of residents of age 65 and up living alone in Orange County, Central Florida. Many of them are not capable to sustain their lives without help. For some of them, their illnesses, intellectual disabilities, or social disabilities are so enough that they interfere with their daily functioning. It is clear that seniors are the most vulnerable citizens in U.S. communities. As this analysis has demonstrated, it is difficult for traditional bureaucratic governments to handle, by themselves, this emerging social problem. Indeed, the Copenhagen Center claims that “no single actor, public or private, has the all-encompassing knowledge, overview, information or resources to solve complex and diversified problems” (Martin 2006, p. 48).

For all these reasons, the authors of this analysis have provided a series of governance tools that have proved to transform the range and level of government actions. These tools are (1) grants, (2) needs assessments, (3) senior volunteers, (4) co-production, and (5) citizen participation. And let us not forget the value of inter- organizational partnerships and networks. The issue that senior citizens are facing is a public problem that can be indirectly addressed and solved by those various strategies. Because each of these tools has its own specific mechanism, skill requirement, operating process, and, ultimately, a different effect on the community, using each governance tool appropriately, with the right people, is of utmost importance. While traditional bureaucratic government are not as effective due, for instance, to their close structure in delivering public services, the new governance model tends to use a number of tools to increase public service quality and efficiency. Law enforcement organizations, because of their current structure, cannot respond to these issues. Their traditional bureaucratic organizations have a hierarchical and centrally structured system, which operates with strict rules and

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regulations. The governance model uses indirect methods, comprising a number of innovations.

As we have also seen, eHealth services constitute web sites that offer an encyclopedia of medical information for nursing home practitioners. The immediate access to eHealth may help remedy some of the current issues in nursing homes and, ultimately, improve the quality of life for seniors by offering them better care and faster treatment. No matter what strategy is adopted, allowing more flexibility, whether through informal networks or other innovative methods, is no longer an option; it is a necessity. For the past 50 years, the United States has changed tremendously. So has the U.S. population. New demographics require new changes. Viable methods have to be created to solve the problems that seniors are facing. It is the authors’ hope that the tools identified in this analysis have provided readers with a better understanding of how better our lives can be when we become senior citizens.

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Yildirim Uryan, M.A. a Major in the Turkish National Police, is presently a doctoral student in the Department of Public Affairs at the University of Central Florida. His research interests include aviation security, public administration, and policing. He can be reached via email at [email protected].

Jonathan Matusitz, Ph.D. is an Assistant Professor in the Nicholson School of Communication at the University of Central Florida. His academic interests are organizational communication, communication & technology, and health communication.

Gerald-Mark Breen, Ph.D. is a research associate in the Department of Public Affairs at the University of Central Florida. His research interests include public policy and analysis, communication, and service improvement. He can be reached via email at [email protected].

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