From Darkness Into Light

This theme calls on us to think about what it means to grow old in America today. I believe it also calls on us – as providers, consumers, employers, and advocates – to consider our role in ensuring a meaningful life for those in their later years.

One of the biggest challenges we face in achieving the objective of a meaningful life is an acute shortage of workers – at all levels – to provide services and supports to people as they age. While workforce challenges often come in cycles, our current challenges are here to stay for a while.

It’s a numbers issue.

In a recently released LeadingAge survey on workforce issues, 83.5% of LeadingAge members reported that an insufficient number of qualified applicants for vacancies is the number 1 of top 3 challenges facing providers. Well behind that number, at 65% and 63% respectively, are competitive wages and staff turnover. LeadingAge members also reported that the most difficult staff to recruit were registered nurses.

This should come as no surprise when we look closely at the numbers, as LeadingAge members are not immune from national – even international – trends.

In 2010, the ratio of caregivers to people needing care was 7:1; in 2030, it will be 4:1. While the population age 80 and older will increase by 44% between 2030 and 2040, the number of caregivers will only increase by 10%. The gap grows wider.

For the next 25 years, we will need to be intentional about attracting younger people to our field, redesigning jobs to accommodate phased retirement for older workers, and entering the immigration debate to ensure a steady supply of qualified workers. It is first and foremost about numbers and then about training and retraining, excellence in workplace cultures, and creating career ladders and lattices. Once recruited, retention is key.

We know that the time and attention required to cobble together creative solutions to these workforce challenges draws precious resources away from other priorities. While many of the barriers are specific to the characteristics of local markets, we believe that there is a critical role for LeadingAge to play in sharing what works: tools, strategies, partnerships, and promising ideas.

The LeadingAge Center for Workforce Solutions, launching in June, will be our platform for learning and exchange. It is my expectation that it will grow exponentially over the coming months as we hear from you and identify new resources. We are focusing heavily on recruitment and retention strategies.

To “Age Out Loud” we need the services, supports, and infrastructure to ensure all can age with choice and dignity. To that end, a quality workforce that is compassionate and caring is essential.

Join LeadingAge in promoting Older Americans Month. And let me know, how do you plan to Age Out Loud?

Intro:

The theme of this years’ Older Americans Month is “Age Out Loud.” It is a clarion call to listen carefully to the voices of those who are in their later years.

Associated Blog:

Conversations with Katie

Pagan Kennedy, author of "Inventology: How we dream up things that change the world," wrote an opinion piece in the New York Times recently. In it, she asserted that "we assume that creativity and innovation belong to the young. We're wrong." She went on to report about the number of patents in information technology, materials science, and the life sciences granted to people in the second half of life. They tower above those in their younger years. Why should this surprise us? The 94-year old scientist she wrote about, Dr John Goodenough, shared the observation that "you have to draw on a fair amount of experience in order to be able to put ideas together."

It sounds so logical and yet, our society continues to cast aside the wisdom of the ages with assumptions that are ageist. While we all won't invent something deserving of a patent, wisdom and experience produce invaluable insights. Among these are lessons we share with our children, decisions that draw on experiences, perspective that comes with having witnessed past events, and the "intellectual freedom" Dr. Goodenough describes, that expands our thinking.

Examples of disregarding people because of assumptions associated with their age are rampant. We see examples in advertising, the workplace, and in policy debates, particularly relevant today as Congress considers replacements to the ACA, which would significantly impact Medicaid.

Our priority in the Medicaid debate is to protect the structure and financing of this critical program. It will remain a priority for us as changes to the program are likely to reemerge in the coming weeks and months. LeadingAge is proud to stand with other Medicaid advocates in our shared commitment to older adults, children, people with disabilities, and those in financial need. Age is not a differentiator; Medicaid, as a critical program that touches all ages, is a tie that binds.

In the end, it comes down to a deep belief in the worth of all people, regardless of age. As we advocate for a more rational regulatory system for nursing homes, an increase in the supply of affordable housing, and the preservation of Medicaid, we are mindful of the needs of individuals, their families, providers, and communities. There is little that LeadingAge members do that doesn't have a ripple effect on each of these stakeholders.

We must continue to be vigilant about drawing on that “fair amount of experience” that Dr. Goodenough talks about as we advocate for what is right. In our policy work and in our to day interactions, Carol Silver Elliott, president and CEO of The Jewish Home Family, reminds us that, “We are all individuals, regardless of age and ability. We need to remember that and to help others remember it as well."

Associated Blog:

Conversations with Katie

Imagine 3,500 people in a line that snakes around an affordable housing apartment building in downtown Manhattan having heard the announcement that the building is opening up its waiting list. Of the 3,500 individuals desperate for an affordable place to live, 200 will be placed on the waiting list and only 50 will ultimately move into an apartment when a vacancy occurs over the course of the next six years.

This leaves 3,450 people still seeking a clean, suitable and affordable place to live. And, that's just 1 day and 1 building in 1 city in America.

It is crystal clear that we are facing a severe shortage of affordable housing for older adults. Congress has not funded new housing through the Section 202 Housing for the Elderly program for the last 5 years, creating a devastating lag in new construction.

The President's recently released "skinny budget" request does nothing to remedy this situation. In fact, it reverses it, taking more than $6 billion away from HUD.

Leaked documents from what will become the President’s program-by-program level request for funds paint a dire picture. These documents show the White House is contemplating underfunding Section 202 rental assistance by $105 million and service coordinators by $18 million. The impact: thousands of older adults would no longer have the benefit of a critical link to needed services and supports by virtue of remaining in their affordable apartments safely.

If such dramatic cuts were ever enacted, existing Section 202 programs may need to close their doors and their nonprofit sponsors may be asked to accept significantly less for rental costs. The future stability of 202 programs would surely be at stake.

To make matters worse, it appears that the Section 202 program is one of many targets for cuts. Public housing, vouchers, and the HOME program are all understood to be on the chopping block.

The "skinny budget" is not yet law so cuts of this magnitude are, at this stage, a signal not a decision. But even a portion of those cuts would exacerbate the crisis we are already facing. We MUST reverse this damaging direction.

The right to adequate housing is recognized in the Universal Declaration of Human Rights. Adequate housing is a prerequisite for security, safety, and quality of life. It is an integral part of a community's infrastructure. It is a platform for health care. But to be all these things, it needs to start with a place to live.

We need to ACT NOW to get the attention of lawmakers. They need to understand that, without adequate and expanded resources, this already dire crisis will get worse. For many, this will mean homelessness.

We need to talk about the people on waiting lists, lists whose waits are more often than not, endless.

We need voices from all states and communities.

We need to be relentless in our pursuit of public policies that recognize that adequate housing is a moral imperative and a human right.

Join us in this fight for affordable housing for older adults.

Intro:

Lawmakers need to understand that, without adequate and expanded resources, the affordable senior housing crisis will get worse.

Associated Blog:

Conversations with Katie

The policy challenges confronting LeadingAge members in a new Administration are daunting. It is truly a new day in Washington and we must re-frame our advocacy messages to reflect this new reality. We have listened to our members and state partners about their concerns and we are focusing on 3 primary issues:

Preserving the financing and structure of Medicaid
Funding more affordable housing
Delaying implementation of Requirements of Participation for Nursing Homes

There are certainly other issues we are working on—such as the CNA training lock-out and protecting against cuts to non-defense discretionary spending. However, when the stakes are high, priority and focus are essential.

Medicaid

The threat to Medicaid is serious. The proposals under consideration include turning Medicaid into a block grant for states or providing states with a per capita cap on beneficiaries. While both proposals include more flexibility for states, they come with a price: deep cuts to federal funding, which would undoubtedly result in reduced benefits and provider payments and cuts in eligibility.

As we know from experience, once a program’s structure is changed to a block grant, there is no turning back. Medicaid affects the people you serve, the services you provide, and your workforce and their families. The impact of these proposals would be significant. And guaranteed coverage could be a thing of the past.

Affordable Senior Housing

There is simply not enough affordable housing today. Funding for programs we have used in the past has dried up and we are left with the Low Income Housing Tax Credit program (LIHTC), which is complex and requires rent subsidies to ensure that it remains affordable. This vehicle is insufficient and we need to do more.

We need to use every argument we can muster to bring attention to this issue, including the risk of a rapidly increasing senior homeless population and the need to invest in community infrastructures.

Nursing Home Requirements of Participation

As our members who manage nursing homes know, complying with the new Requirements of Participation (ROPs) is a huge undertaking. The ROPs are hundreds of pages long and lack the kind of clarity that is necessary to ensure an organization is in full compliance.

We are urging the Administration to delay implementation until CMS can provide sufficient guidance to allow nursing homes to comply. The time and effort to sort out what is expected is taking precious time away from resident care and services. This is unacceptable. While delay is a decision that is within the purview of CMS, we are encouraging members of Congress to put pressure on CMS as well.

On each of these 3 priority issues, we have asked members to write or call their members of Congress, visit district offices, and take advantage of the President’s Day recess to invite policymakers to their communities.

I am thrilled that our combined advocacy efforts in the past 2 months on these priority issues has resulted in more than 10,000 calls and letters.

I attended a breakfast meeting recently with a member of the United States Senate. She acknowledged the groundswell from citizens who are reaching out to policymakers, telling their personal stories, and describing the impact of proposed policies on people, programs, and communities. And, it’s not just one story that gets their attention; it’s the collective impact of hearing thousands of them.

We will continue to ask for your support because we need to be as loud as possible on Capitol Hill and in state capitals across the country. Look for more Action Alerts as we continue to raise our voices on these issues.

So much of what we believe in and have come to depend on is at risk. Those who are ultimately harmed are those we serve, those who serve them and those who we will serve in the years to come. Thank you for being our echo. We will be yours.

Associated Blog:

Conversations with Katie

This past weekend, I took a long walk through American history. It started near the Marine Corps Barracks where a flag with but 15 stars has flown since 1801. The stars signified the number of states that existed when Thomas Jefferson took his oath of office.

My path then took me past the United States Capitol with its temporary staging, risers, and fencing. Workers were setting up security tents for the nation’s 58th Inauguration. The flagpoles above the Senate and the House of Representatives flew no flags, signifying that neither chamber was in session.

Continuing along Independence Avenue, the Department of Health and Human Service, Voice of America, Departments of Education and Agriculture—all massive structures and equally massive institutions—reminded me of the political challenges that American citizens have endured and, eventually, faced head on with courage and wisdom.

Across the broad avenue designed by L’Enfant stands the Native American Museum, the Air and Space Museum, and museums dedicated to modern, African, and Asian art. Their displays tell stories about the most exciting moments and most dire moments in our history, the times when our high ideals clashed with harsh realities, the times when courage and wisdom led us to make heart searing choices.

But my walk had an objective—the monuments to Martin Luther King, Jr., Franklin Delano Roosevelt, and Thomas Jefferson. It was not their statues I sought out but their quotes, timeless quotes for unsettling times, words of courage and wisdom engraved in stone. I felt the need to be reassured, inspired, and prepared for the challenges we face in aging services in the coming months and years.

What I found were these enduring words of courage and wisdom:

"The ultimate measure of a man is not where he stands in moments of convenience and comfort, but where he stands at times of challenge and controversy."

Martin Luther King, Jr.— Strength to Love, 1963.

"I see one-third of a nation ill-housed, ill-clad, ill-nourished. The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little."

Franklin Delano Roosevelt — January 20, 1937

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights, among these are life, liberty, and the pursuit of happiness, that to secure these rights governments are instituted among men. We...solemnly publish and declare, that these colonies are and of a right ought to be free and independent states...and for the support of this declaration, with a firm reliance on the protection of divine providence, we mutually pledge our lives, our fortunes, and our sacred honour."

Thomas Jefferson — Excerpt from the Declaration of Independence, 1776.

So, as the United States of America prepares to conduct its 58th Inauguration—a peaceful transfer of power that no other people on earth has been so fortunate to experience—I found my walk to be remarkably comforting. For in each instance, my heroes’ words pointed to their deep faith in the citizens of this country to meet every challenge, to find the strength to unite against the common enemies of mankind, to secure their own and their fellow citizens’ freedoms.

From 1789 when George Washington took the oath of office until Donald Trump repeats those same words, words written into the Constitution by our Founders, we have grown from thirteen states with 3.8 million citizens to fifty states plus the District of Columbia with 324.4 million citizens. It is, if you think about it, a remarkable journey, one that is only in midcourse, one that all of us are taking together.

With the courage to overcome challenges we face and the wisdom to pursue a path inclusive of all, surely we can pledge “our lives, our fortunes, and our sacred honour” to those self-evident truths that have guided us since 1776.

Associated Blog:

Conversations with Katie

Last week, I spent 5 days in Indianapolis for the LeadingAge Annual Meeting and EXPO with more than 6,500 members, partners, sponsors, and friends. It was another tremendous event where aging services professionals from all corners of the country - and world - came together to celebrate the journey that unites us all: aging. Being in Indianapolis with so many people who are passionate about caring for aging adults reminds me how vitally important our work is, now more than ever.

Our next President, Donald Trump, has been largely silent on the issues that we care about most deeply. And yet, I believe the new Administration will be unable to ignore the implications of the dramatic demographic shifts that are underway.

Throughout this long election cycle, LeadingAge has remained nonpartisan while being extremely vocal about the needs of all older adults, regardless of political affiliation or socioeconomic status.

We reached out to presidential candidates to talk about the priorities we believe are the most critical to our aging population: the need for more affordable senior housing to address a severe housing crisis; the burden of paying for long-term services and supports on our families and healthcare system; the rapidly changing - and often confusing - landscape of payment reform; and workforce challenges that haunt us, impede our success, and divert precious resources.

With a new Administration and Congress set to take the stage in early 2017, we will remain as focused and determined as ever. As a community of aging services professionals, we will be stewards for the well-being of the people whose lives we touch. We will stand up for what is right so we can permanently erase the stigmas around aging. And we will amplify all of our voices so that the issues that matter most to us are heard LOUD AND CLEAR.

Progress on these issues will only happen if we, as a nation, can repair the glaring gap in trust among voters and policymakers that has become so evident in this election cycle. We can do our small part by forging relationships that will lead to trust so we can develop policies that address the most essential issues for our aging society.

As Socrates famously said, “The secret of change is to focus all of your energy, not on fighting the old, but on building the new.”

Intro:

There is little doubt that significant change is in the air. From the cool fall air that now breezes through my window in Washington, DC after a hot, humid summer to the headline that covered every newspaper around the world this morning, change is what we will face in the coming days and months.

Associated Blog:

Conversations with Katie

I recently heard a member remark "we need to write the book we want to read," which made me reflect on the power of the collective LeadingAge narrative.

As mission-driven, dynamic, aging services organizations, you have the ability to influence the social fabric of your communities and the well-being of individuals and families.

As your national association, we have the determination to influence public policies that impact your daily operations. And, we have the ambition to think beyond today's needs to shape a better tomorrow for older adults and their families.

Our policy team pursues both tracks relentlessly - fighting for our members in their local communities and for national policies that affect us all. We are fighting for:

Older Americans Act funds.
Sensible Medicare policy with respect to the 3-day stay.
Funding for capital to increase the supply of and preserve existing affordable senior housing.
Demonstration projects to prove the efficacy of aging services technology.

We believe in sound arguments, solid analysis, and persistent advocacy. Yet, we are in an era of incremental change, of a propensity for inaction over action, and a seemingly pervasive belief that older adults’ needs have already been met. An uphill battle for sure - but we march on.

In the context of our broader social impact agenda, we are pursuing policies that will shape the future we believe in. A future where aging adults have access to quality services and supports. One that has solved the seemingly intractable problem of how individuals pay for the services and supports they need. One which elevates the workforce in aging services so that quality is ensured and services are expanded. And one that acknowledges that our society is aging and we are ill-prepared.

Are we punching above our weight? Perhaps. What gives us the moral authority to be so bold is the deep experience of our member organizations, the unwavering commitment to doing better for those we serve, and our mission to be the trusted voice for aging - today and for many tomorrows to come.

We can't achieve the policy impact without you - your voices and your experiences. Tell your stories to your policy makers. Join us in Washington whenever you can for visits to the Hill. Invite your residents, staff, and families to join the Seniors Action Network to be the clear, strong voice for policies that truly make a difference.

The only certainty with the coming election is that there will be change. We are planning for a number of possible scenarios, tossing around the "what ifs", and trying to draw attention to the issues we care about. Whatever the outcome, it will change our world and set new directional signals to advance our agenda.

Within the parameters of our nonprofit, nonpartisan status, we are far from idle bystanders, and we are just as anxious as you to have the election behind us so we can doggedly pursue our agenda with whatever results it brings.

Thank you for your continued effort to pursue an advocacy agenda that is absolutely critical to the future of our field and the older adults and their families that depend on us.

Intro:

Associated Blog:

Conversations with Katie

I recently read about a vacation resort hotel that is closing before the end of the season because they simply can’t attract an adequate amount of staff to operate. I cringed at a story about public health nurses working at half their staff capacity against increased needs. And, I read still more about small towns, schools, and businesses that are relying on foreign workers and students to fill their workforce and classroom gaps.

These challenges mirror closely the ones that keep LeadingAge members up at night in every corner of the country.

Recruiting and retaining quality staff at all levels is EVERYTHING in aging services. Workforce challenges are driven by local market conditions and national policies. They are influenced by demographics, wage competition, and a wholly unfair stigma about working in our field.

LeadingAge, in partnership with our states, is taking on the tall order of finding solutions to overcome these challenges as outlined in our new strategic plan.

Here are a few of the activities already underway:

The Center for Applied Research at LeadingAge has uncovered truths about our workforce through analysis of major data sets and the development of tools to clarify the competencies needed for middle managers and frontline workers.

Our Leadership Academies tap into innate leadership potential, fostering opportunities for career and professional growth while deepening a commitment to our field. To date, thousands have completed the program and are serving as leaders in a variety of diverse settings nationwide, contributing to strengthening our workforce.

We have advocated for mandatory reporting of staffing in nursing homes as a key indicator – for consumers and regulators – of quality. We have evaluated the overwhelmingly positive role that a wellness nurse can have in improving quality of life for low-income residents of affordable housing while saving healthcare dollars. And, we have supported legislative efforts to incentivize clinicians to practice in geriatrics.

And, yet we have only scratched the surface.

In the coming months and years, we will double down on these initiatives and more. This is a “put a man on the moon” challenge for our field over the next decade and it won’t be met without our concerted and collective effort.

In early October, we will send LeadingAge members a survey so we can understand more deeply how workforce challenges impact your organization and what you are doing to face them head first. We hope you will take a few minutes to respond so we can target our strategies to most closely align with your needs.

I promise to review the results closely and read every answer to open-ended questions so I can learn from you and report back to you on our plans. Together, we can be the trusted voice on workforce solutions

This weekend, I encourage you all to take a moment to reflect on the reason why Labor Day was created in the first place: to recognize the contributions workers have made to the strength, prosperity, and well-being of our country.

There are no workers more deserving of this accolade than those who serve our older adults every day.

Intro:

As the Labor Day holiday weekend approaches, 3 stories have captured my attention from towns and cities across the country about our field’s most pressing challenge: workforce.

Associated Blog:

Conversations with Katie

Every summer, I spend time in a remote area of Maine, with few of the creature comforts I’m used to at home. And I love every second of it.

The peace and serenity provides me with a time to reflect on the year in progress and an opportunity to plan for the months ahead.

This year was no different. I’ve had a lot to think about since starting as President and CEO of LeadingAge a little more than 6 months ago. The aging services field is changing and I am committed to making sure LeadingAge is in lock step with those changes, if not a step ahead.

David Brooks, a columnist for the New York Times, suggested that there are 4 big forces of change coursing through modern societies.

Global migration, leading to demographic diversity.
Economic globalization, creating wider opportunities (but also inequality).
Internet access, giving people more choices over what to buy and pay attention to.
Culture of autonomy, valuing individual choice and self-determination.

If that’s not enough, the pace of change is getting faster and faster, giving us a shorter time to adapt.

These changes are transformative and, therefore, bring with them opportunity and a great deal of uncertainty. Each one touches our aging services work in significant ways: increased diversity of our workforce and those we serve; the challenges of distinguishing our services in the marketplace for an increasingly discerning consumer; the growing population of poor elderly; and changing consumer expectations.

Since we are far from immune from these changes, our task is to embrace them, fold them into our organizations, and do so rapidly.

If this isn’t already enough, we have change and uncertainty in our political arena. What will the next Congress, administrations at the federal and state levels, and state legislatures look like? Where will we find a friendly ear? What will it take to advance our legislative agendas?

LeadingAge recently adopted a strategic plan that calls on us to be bold, proactive and innovative. It demands that we seize opportunities, form strategic partnerships, and provide unparalleled value to our members. Our work will be informed by these "big forces of change coursing through (our) society."

We will use the tools and resources at our disposal to tackle these challenges and know that each of you will do so as well. It is in times like these that associations are more essential than ever. Key to our future success requires pooling our collective resources, expertise, and passion for what we do.

The fellowship within the LeadingAge community is unparalleled in aging services. Our big hearts, working together, will make us stronger and better at turning changes into opportunities.

Intro:

Every summer, I spend time in a remote area of Maine, with few of the creature comforts I’m used to at home. And I love every second of it.

Associated Blog:

Conversations with Katie

Recent tragic events in this country have caused me to stop and wonder about how far we have strayed in our basic respect for humanity and how we view and treat one another. It is hard to fathom the degree of hatred one must feel to kill another human being. It is even harder to fathom the extent to which this has happened in this country in recent months and of all of the innocent lives lost.

Before he was assassinated, Martin Luther King, Jr. said, "Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that." Those words are as true today as they were when spoken, but over the last several weeks, our country has been distracted by more darkness than light and more hate than love.

How, then, do we move forward to regain the light and love that we have strayed from?

I think I know what the answer is - or at least where to start: LeadingAge.

As I have seen before during times of tragedy - 9/11 and Hurricanes Katrina and Sandy come to mind - LeadingAge members have an amazing capacity for taking care of one another and the communities they are a part of. They have the ability to rise above darkness and hate, and to offer comfort to those in need.

What I admire most about LeadingAge members are your big hearts - hearts that are filled with compassion for helping people live the best life possible as they age. Hearts committed to making their communities vibrant and safe. Hearts filled with a deep desire to always do better and to do what is right, even if it is hard. Hearts that believe in the fundamental worth of each person, regardless of their stage in life or where they come from.

Hearts that believe in light. Hearts that believe in love.

Your big hearts give me hope for the future. Continue to shine your light. Be beacons for an uplifting view of humanity, justice for all, and peace for those who need it most.

Thank you from the bottom of my heart, which is made bigger because of you.

Intro:

Recent tragic events in this country have caused me to stop and wonder about how far we have strayed in our basic respect for humanity and how we view and treat one another.

Associated Blog:

Conversations with Katie

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