Below is my State of the Association speech from the 2009 AAHSA Annual Meeting and Exposition in Chicago:
Our members at Selfhelp in New York had a great theme a couple of years ago: “Our past propels us forward.” It conveys how four generations of values and mission are being transformed into contemporary programs to meet changing needs.
As we plan our golden anniversary in two years, I am reading and reflecting on our history. The more I read, the more I realize that our history propels us forward. It all began at Arden House in New York in 1961. Ninety-nine professionals met there to explore the prospect of creating this association. Based on a consultant report written by Dr. Robert Morris of Brandeis University, the Arden House founding mothers and fathers discussed history, values, and principles. Here are selected quotes and paraphrases from that report:
- “The not-for-profit home for the aged was once considered the basic social resource for the aged when individual and family resources failed.”
- That we all “have a sense of responsibility to the community.”
- The “strength of the winds of change” are so powerful that the existing institutions must change in the face of uncertainties with the admonition that “no firm outlines about the status of these institutions can be presented with assurance.”
- The elderly will have the economic power “to choose where and how they live in some independent form.”
- The elderly will be driven by a “search for privacy and a yearning to retain the familiar.”
- The report said we would serve more people in independent settings, yet increased numbers of people with disabilities, including the mentally ill, would require “great attention” from us. It said that we would need to pay special attention to the “flow between home and hospital” so that seniors would not be subject to “arbitrary eligibility processes” instead of “need.”
- The Arden House report predicted development of multi-purpose centers that include “all the various options with “added responsibility for many other services to the elderly outside of an institution.” It said that many homes would change their names.
The report predicted we would encounter competition from many directions, confusion about institutional versus non-institutional roles, anxiety about accreditations and licensing and the extent of government control, backward-looking boards and staffs who hope to recapture the past, skeptical health and welfare planners, reluctant contributors, and, not the least, “our own self doubt” that “we display a lack of confidence in the use of our own knowledge.”
The report said that “none of these problems are insurmountable,” that “boards do learn,” that each crisis is an opportunity, and that “the elderly present very great unmet needs for housing at low cost, for nursing and attendant care, for rehabilitation,” for “opportunities for constructive living.”
The author of the Arden House report asks our founders this basic question: “Can we be sufficiently flexible and imaginative to develop requisite programs and services?”
The report concludes that this body — now AAHSA — be created “to provide a significant medium through which these major issues of our society can be evaluated, solutions tested, and programs supported.”
Subsequently, our founding documents reflect the creation of “a national membership organization of non-profit voluntary and government homes for the aged. It provides its members with a means of identifying and solving problems of mutual concern and that protects and advances the interest of the people they serve.”
So, let our future propel us forward to today and project the next decade.
Today our mission is creating the future of aging services. How effective are we as a significant medium to evaluate the major issues of our society, test solutions, and support programs based on that mission statement?
Certainly, the creation of the Institute for the Future of Aging Services (IFAS) and the development of the Center for Aging Services Technologies (CAST) have created forums in which AAHSA members, in collaboration with businesses, academia, government and foundations, have tested culture change, housing with services models and technology applications.
Evaluation of major issues of our society has produced blue-ribbon thought-leadership bodies like the AAHSA Financing Cabinet, whose work is today at the center of health care reform. I hope you are proud that AAHSA is in a prominent leadership role in health reform.
We have become better-thinking partners with others to address quality. The Advancing Excellence in America’s Nursing Homes campaign is a child of Quality First in collaboration with consumers, providers, professionals, government, and the Commonwealth Fund. Advancing Excellence holds the best promise today for showing that we can create quality improvement in nursing homes.
Back in 2002, your board declared this the Era of Leadership. We concluded that we had no problem that leadership could not solve. We have brought you the best of leadership through the use of some of the best thought leadership concepts available anywhere.
We are overcoming our “lack of confidence in the use of our own knowledge” and “self-doubt” as leaders. Your commitment to shared learning is exemplary and well known. Leadership AAHSA and similar programs in our states are being embraced with enthusiasm and supported by you in so many ways. In fact, the key to leadership development is your personal commitment, colleagueship, mentoring, and shared learning with each other.
Our advocacy is focused on a fundamental advocacy agenda around 5 Big Ideas — most anticipated in the documents pondered by our founders. They are transformational ideas. Advocacy for the right policy for the right reasons is the number one priority we have together. What they called “constructive living” and “the quest for the familiar” we now call culture change.
The “confusion about institutional versus non-institutional roles” is being embraced by most of us. It is not an either-or, but a both-and. And it depends on the needs and preferences of the people we serve. It is a matter of balance and mix. Public policy is certainly beginning to bend toward that balance, though all services are still underfunded. The CCRC and comprehensive campuses abound, as a fulfillment of the vision of multi-purpose centers. In a decade, many of you will be centers for healthy aging, as the term “retirement” fades into the sunset.
The “search for privacy and a yearning to retain the familiar” got lost along the way as we created nursing homes as junior hospitals, with shared rooms and clinical environments in a regulation and reimbursement system not often friendly to our work. Our anxiety about that, as predicted by our founders, is well founded. We’ve learned that regulation doesn’t produce quality. It produces at best, compliance with regulation. People who have the time to understand needs, and help staff learn contemporary practice, produce quality.
We have given inadequate attention to what Arden House highlighted about the “flow between hospital and home.” Siloed business models, perverse reimbursement incentives and poor care coordination have created transfers based on the arbitrary instead of on real needs of seniors and their families.
Studies now show that the human and financial consequences are great because our fragmented system doesn’t handle transitions well. The hopes for improvement actually are found in PACE, hospice, CCRCs, and some Medicare Advantage programs, which start with need, not arbitrary eligibility. We will be cofounding shortly a quality initiative in collaboration with the Brookings Institution and chaired by a highly respected expert to address quality improvement in transitions to minimize the difficulty for consumers.
Even less attention has been paid to the mentally ill elderly, as the founders recognized. Too much loosely prescribed medication, too little geriatric psychiatry and therapeutic relationship training. With the knowledge that late-life depression is severe in the elderly, especially men, we still largely ignore the need. Mental illness is not a character flaw, and like many other illnesses, it does not cure itself.
The founders outline our “responsibility to the community.” We still have it! We enjoy public support — though donors and government can be skeptical and reluctant as the founders predicted — but many of you prove your motivations every single day and those good deeds are too often lights under a bushel.
Make no mistake, however, that the public eye is on us to justify the tax benefits, reputation, and philanthropy we enjoy. Stewardship is front and center. Our story about our responsibility must be made clear — and we need to tell it more boldly.
The founders were right about the strong winds of change and the uncertainty. None of us has a clear path and assurance of success. We never have. Yet, the history shows that we not only survive, but we change, transform, and thrive. You have served your communities on average 3-4 generations — some much longer. Yes, you have changed your names and business plans to reflect the changing need.
We need innovative sources of capital. We have formed a thought leadership group to make recommendation to policy makers about capital. We are a good risk. We use it well and pay our debts. We stand the test of time.
Yes, AAHSA’s founders dazzle us with their prophetic insights. By all measures, AAHSA has 48 years of success. Yet, we are more than homes and services. The founders said we are a medium for innovation to benefit the people we serve. So, what is that brand? What should we call ourselves as we look to the future? Many of you have gone through the exercise of branding and identity.
Your AAHSA board, staff, state leadership both lay and professional, are addressing our brand for the future. We’ve used surveys, discussion groups involving state associations and their leaders. Our brand is about values, innovation, advocacy for policies and programs that reinforce those values.
The values emanate from the voluntary, mission driven sector of every community: for the benefit of the people you serve through, as our founders said, “Opportunities for constructive living.” Next year we will announce our brand plan and promise and possible new name.
Our good friend and colleague Ken Durand, reflecting on the aging process and our missions, AAHSA’s role in our field, said to me recently, “You know, this old age is not only worthwhile, but it is meant to be. Therefore, it is our responsibility to help people get the most out of it.”
What an interesting way to conceptualize what you do for society — help people get the most out of the aging experience. Your brand.
Yes, our future propels us forward. So, I have 5 questions for us to ponder at this poignant time in our history.
- How do we stay focused on the best interest of the people we serve in the midst of today’s pressures?
- How do we communicate to the world that old age is not only worthwhile but meant to be in cultures of youth-oriented?
- How do we define our work together as mediums of innovation — flexible and imaginative — to help people get the most out of the aging experience — even when it is difficult?
- How do all of us create a value proposition with consumers and policy makers to demonstrate we are trusted providers of essential services that society must have and is will to pay for?
- Are you willing to advocated aggressively for transformational change?
The best evidence we can offer that answers each of these four questions positively is the extent to which we can show we are changing lives!
Your association is strong — yet we can be so much more. People expect that of us.
I have the greatest job in the field. I am honored to be your CEO. If there is anything we can do, call me.
