Better Know a Network: Agewell Pittsburgh

In 2004 in Pittsburgh, Pennsylvania, the Jewish Association on Aging, Jewish Community Center of Greater Pittsburgh, and Jewish Family and Community Services were brought together by the Jewish Community Foundation to form Agewell Pittsburgh. The partnership was convened initially around a Nationally Occurring Retirement Communities  (NORC) grant.

The funds made it possible to create the first version of their network. They created care teams across the participating organizations. Social workers or program coordinators went into seniors’ homes and assessed the community-based services that they needed to maintain their independence. Then the care team worked together to create a joint plan for each senior. This type of collaboration was only possible because of the funding available. However, after the NORC grant restructured, they found that the model to be too expensive.

Next, they eliminated the duplication of services among their agencies and collaboratively became a one-stop-shop for seniors. Through collaboration, they help seniors stay in their homes and independent in the community for a long as possible. Although the initial restructuring was painful, now the collaboration boasts a more efficient and effective service than before.

What sets the network apart is the frequency of their interactions and their commitment to continuous quality improvement. When we interviewed the team, they said: “We found that we have to continue to communicate and function as a virtual organization.” The directors from each organization communicate daily, and the 30 service coordinators who provide discrete services on the ground meet every other month “to talk about gaps in service, best practices, service delivery, outcomes, and to make sure they are in constant communication.”

This level of communication, Alexis Mancuso of Jewish Community Center of Greater Pittsburgh explains, makes AgeWell function. “If you don’t do business this way, you lose everything you’ve created. Listen, this is not different than being a family. If you stop talking and you don’t see each other, it’s going to fracture the family. We are the AgeWellians, and we are proud of it. And yes, it takes a lot of time, but there you have it.”

More than just communication, AgeWell has also developed a robust evaluation system, which has helped them to continue to learn across agencies. The agencies have agreed upon 20 protective factors that help to ensure elder independence and wellbeing. However, each agency does not collect data on all 20 protective factors. Instead, they only collect data on the ones that their agency influences. Collaboratively, they examine those outcomes to determine ways that they can continue to improve.

The results have been impressive. Here are just a few of their client outcomes:

  • 97% of their clients maintained or improved functions.
  • 93% remain at home.
  • 86% avoid emergency departments.

As these figures attest, AgeWell Pittsburgh clients do better than Medicare recipients nationwide. No wonder they were the winner of the 2017 Lodestar Collaborative Prize.

When asked about what advice they would offer other social-impact networks, Dana Gold from Jewish Family and Community Services offered this insight: “Get to know each other and trust each other. Without the ability to fight like brothers and sisters, laugh like best friends, and trust one another’s expertise, commitment, and insight, I don’t think the collaboration would work.”


Better Know a Network is a series focusing on the most innovative social impact networks in the country. Do you know of an innovative network we should feature? Drop us a note at We’d love to have a conversation.