Monthly Archive

Jan. 26, 2007

Dear Mr. President:

Your State of the Union message surely highlighted fundamental and enduring American ideals reflected in our “commitment of conscience,” so eloquently stated. Our members, mission-driven care and services providers who serve the elderly and disabled, support your assertion that a “future of hope and opportunity requires that all our citizens have affordable and available health care,”… and that “government has an obligation to care for the elderly, the disabled, and poor children.” Well said, sir!

You then mentioned the challenge of “entitlements.” Please understand that remarks like that have become code for cutting Medicaid, social programs and senior housing for the very same populations that commitments of conscience should be faithful to. So, lest we all talk of commitments in one breath and cuts in another, perhaps this is the time for you and Congress to clarify what you believe all Americans are entitled to.

America’s early historical principles say we are entitled to life, liberty and the pursuit of happiness. Noble, universal, enduring umbrella ideals forged in the crucible of the great American experiment of self-governance, freedom and promotion of the general welfare. Our existing entitlements did not come easy. A century after the Civil War, it took major national unrest to assure equal access to the ballot box for all Americans.

Over time, other apparent entitlements have evolved. For example, we now require all children to attend school and receive immunizations, and we afford them universal protections from abuse, neglect and exploitation. It is safe to say that we as Americans believe they are entitled to be educated and protected, as we decided that seniors are entitled to prescription medication two years ago — a long overdue benefit.

But we quickly reach the limits of entitlements for children because not all of them have health care. Are not our children entitled to health care? You made that a priority in your speech. I suspect virtually every American would support that as an entitlement. Mr. President, you and Congress, as the elected representatives of our commitments of conscience must make it so.

What of other vulnerable populations? Are they not entitled to basic health care as part of Americans commitment of conscience? As a matter of practice, do we turn them away at our emergency rooms and public health clinics? No, usually not, but we often don’t make it easy for them. In fact, we often channel them through a two-tiered great divide system of inner-city mega-facilities and the blue chip insurance hospitals. The former is chronically under-funded and take in our difficult, uninsured and Medicaid populations. Then, some politicians complain that the tax burden to support them is too great, so we cut their funding. Yet, no major city or rural community can survive without these large and small oases of health for all citizens. Are these services an optional commodity or a basic entitlement? Our collective conscience would say the latter, I would wager.

So, why not recognize what we, in our hearts, already know and believe — that all Americans are entitled to basic health care as a right? It took 400 years for people of different races in America to agree that we all are entitled to vote, socialize, shop, worship, dine, ride and be educated. So, is not the time long overdue that we should all finance, support and have equal access to the considerable, miraculous and advanced health resources of America? Let’s do it in two years—not another 400.

Mr. President, do you, your family, members of Congress and federal employees have immediate access to excellent health care? Of course—and you deserve it. The American people have a moral obligation to see that you have it. But, how then do you differ in status from a convenience store worker, a nursing assistant, a domestic worker, a teacher’s aide, a new graduate looking for job, a homeless person or a family down on its luck? I’d bet your upbringing would say we are all equal in the eyes of the Almighty. If so, isn’t it time to declare that all Americans are entitled to health care?

Health care feasible as an entitlement, pundits might ask? The money to cover the cost might be found in a surprising place: the restructuring of long-term care financing. Many American families face the cost of practical obligations of a family or friend chronically impaired. The demographics say that the majority of this growing group of American citizens are elderly, but one third are younger. They all need care and support.

The conventional wisdom is that Medicaid’s problem is greedy families wanting to hide assets and the solution is tax breaks to buy long-term care insurance. Neither conclusion reflects but a minuscule amount of truth. Yet, there are existing long-term care financing models in Europe and successful experiments in the United States that could create a sound and viable long-term care financing model that could save Medicaid and help us fund health care as an entitlement. Mr. President, there are solutions to financing of health care beyond the current, and narrow, scope of inquiry and the protection of special interests health care businesses. Yes, health care in general, and long-term care in particular, can be affordable entitlements!

Mr. President, you made no mention of Katrina and Rita recovery. A surprise for many who listened to you. Are the people of the Gulf Coast region entitled to funds and support to restart their lives? We made them a promise to rebuild their community, and money was committed. Yet, efforts are slow and priority of national interest seems weak. While your attention is focused on unimaginably complex issues, surely there must be a surge plan to catalyze the Gulf Coast recovery. Are not all Americans entitled to the opportunity to recover from great tragedies? Surely we are.

And, Mr. President, you made no mention of housing policy. Not surprising with the press of other issues. Isn’t housing, either rented or owned, a basic entitlement for all Americans? Certainly your leadership has made it easier for more people to own their homes, and the economic climate you have created has made it easier to obtain affordable loans. Both great achievements. But what about low-income elderly people unable by personal circumstances of health or pocket book to live alone in a home? Two generations ago, the U.S. Department of Housing and Urban Development created subsidized housing to address this emerging need for senior housing assistance and low interest capital to stimulate construction. A very successful program. Now, there are 10 low-income seniors on a waiting list for every unit that becomes available. Yet, funds are continually squeezed, the bureaucratic barriers to new construction and renovation daunting and the mechanisms to coordinate housing with services to keep older people out of nursing homes and emergency rooms are limited — all of which have negative impact on health and the cost of health care. The loop circles back to health care.

So, Mr. President, isn’t it time we decided that all Americans are entitled to health care, housing and recovery from catastrophe as the new era manifestations of enduring and hard-earned, assured American ideals of life, liberty and the pursuit of happiness? None of us can feel secure at home without these essentials. To deny them sears our souls and masks the real costs of inevitable conditions and untreated sickness. A moral failure and bad business. Not what makes America great.

We’d support your leadership on these matters the last two years of your Administration. That would be quite a legacy. You could be remembered for your “commitments of conscience.” I like that phrase a lot.

Thank you, Mr. President. AAHSA will help you fulfill these commitments. We believe that Americans are entitled to them.

Sincerely,

William L. Minnix

President & CEO
The American Association of Homes and Services for the Aging

Jan. 23, 2007

You need to know the AAHSA Plan for 2007-2008 and what you can do to advance it. The plan is based on the unprecedented confluence of the following information.

Scenario Planning Process — All AAHSA members are receiving by mail an outstanding publication about the future called the “Long and Winding Road,” our updated 10 year scenario planning report. It identifies “consumer behavior” and “talent and workforce availability” as the biggest uncertainties we face in the next decade. I ask you to read it, download supporting information from our Web site and make it a source of strategic discussions throughout your organization.

Member and Employee Satisfaction Surveys — The 2006 AAHSA Member Value Survey pointed out member diversification and overall satisfaction with AAHSA. More than 75 percent of our members are providing some kind of home-oriented services. Approximately 75 percent conduct a resident/client satisfaction survey, but only 25 percent conduct staff satisfaction surveys. I ask you to keep transforming your organization with an eye toward helping older people stay in a place they call home. And, conduct regular client and employee satisfaction surveys. Those who know most about the people they serve and work with will be tomorrow’s successful organizations.

Quality First — Quality First is our multi-year quality improvement plan to achieve excellence and earn the public trust. At its core are “Tell Your Story” and “Live Your Story.” It is based on a continuous quality improvement management and governance culture. It is for all members. Quality First has begun to change the national discussion from punishing nursing homes to transforming aging services for all Americans.

The National Commission for Quality Long-term Care published an excellent booklet called “Out of Isolation: A Vision for Long-term Care in America.” It is clear, simple and outlines the six major area of systems change that challenge America’s aging services continuum. It is a “must read” for your board and other constituents.

I ask you to advance Quality First and report your results. Our Web site is full of tools, examples and case studies that you can use to be successful.

If you are a nursing home, sign up for the new Nursing Home Quality Campaign, a supplement to Quality First. More than 1,200 nursing homes have signed on to measure new and existing quality measures. This voluntary campaign is an unprecedented collaboration on the part of providers, consumers, professionals and government. The campaign reinforces existing quality measures and it introduces process measures related to resident and employee satisfaction.

With these core priorities outlined, below is a summary of our 2007-2008 business goals to advance our mission of creating the future of aging services.

1. To Tell Our Story More Boldly
Our 2006 Annual Meeting & Exposition in San Francisco was a phenomenal experience of storytelling. We all need to get really good at it through annual reports, media relations, resident life history programs and policy maker visits to your organization. The popular media is still focused on negative stories of personal experiences. Our 2007 Annual Meeting in Orlando, Fla., will follow-up on that storytelling journey. The theme is “Live Your Story.” It will remind us again that storytelling changes lives, reinforces fundamental values and underscores enduring truths. It is up to us to change the perception of our work. Perception is reality until we change it.

2. To Strengthen Our Leadership Position
We must continue to position AAHSA members as transformational leaders. We need to be advocate leaders, thought leaders, innovation leaders and statesperson leaders. We will continue to convene leadership groups like CAST, our Long-term Care Financing Cabinet, our Affordable Housing Cabinet and our Faith-Based Cabinet as national models to be emulated locally. We will continue to offer tailored leadership development programs for you and your team. To paraphrase Jim Collins, greatness is a matter of conscious choice and leadership is the key. Leadership matters.

3. To Develop Innovative Models of Care and Services
Some of our members have organizational histories dating back to post Civil War. Yesterday, they were leaders of widows and orphans homes. Today, they are leaders in comprehensive gerontological centers, non-traditional housing models, geriatric rehabilitation, hospice and much more. These same organizations and newer ones like them will lead us into the future. We have led innovation for two centuries — where human need has arisen, our member ancestors have met it. It requires courage, hard work, vision and commitment. We all need to be innovators, and we all need to learn more from each other. I have not found a problem yet that one member faces that another hasn’t addressed successfully, nor have I seen a need that a great not-for-profit hasn’t figured out how to meet.

4. To Advance Advocacy Activism
We know all too well that if we don’t actively advocate for the right policies for the right reasons, bad things will happen through ill-conceived law, regulation or litigation. All of us — including residents, families, staff and boards — must tell our story to policy makers. They listen to somebody’s story every waking hour of every day. That’s how bridges to nowhere get funded and housing and Medicaid don’t. Activism. You must personally and organizationally get involved in advocacy. AAHSA makes it easy for each of you to “Contact Congress” through our Web site. You can express an opinion in less than a minute. You no doubt remember “minute men” from American history class. Today we need “minute people” to get Congress’ attention on key issues.

5. To Reinforce Membership Value
You value AAHSA membership. Thank you. Those who use our Group Purchasing program have collectively saved more than the amount AAHSA receives in dues from all members. Many of you who use our affinity insurance program have similar results. But more important, as one of our members leaders put it, “Every major innovative idea my organization has implemented has come by way of AAHSA.” Our member survey reflects that those who get involved feel more value. It’s called the Power of Community.

6. To Strengthen Relationships with State Associations
Gone are the days when there were clear lines between state and national issues — and between states themselves. We are all in this era of transformation together. While each state has its local dynamics, character, economy and demographics, one thing binds all of us: our aging parents and friends deserve consistent, secure and competent care and services through policies that make quality an automatic public expectation.

Therefore, AAHSA—which is you, our members—is a state and national team. “Think global, act local” and “standing alone together” are two guideposts I use to describe the great relationship we have with state partners. It is incumbent on members and professional staff to see that we synergize and energize our advocacy, shared and storytelling. Together.

7. To Advance a Culture of Discipline
Jim Collins’ Good to Great paradigm includes developing a Culture of Discipline. Like each of you, AAHSA needs to continuously improve our planning and management processes to help you do your job more effectively. Simply put, our job is to help you help the people you serve and those who care for them. To lead you requires that we be the best we can be based on your ever-changing needs. To help us continuously improve, we want your feedback and participation at state and national levels.

A new era is emerging. AAHSA has a responsibility to lead and serve through the Power of Community.

That’s the plan. Let us know how we’re doing — and how you’re doing.

LarryWilliam L. Minnix, Jr., D.Min.
AAHSA President and CEO