‘If We Do Not Act, We Are Writing Our Own Epitaph’ 

In my role as chair of the national board of LeadingAge, I made the following comments at LeadingAge’s PEAK Leadership Summit in Washington, D.C., on March 19.

Welcome to D.C., everyone! It’s great to see so many of you for the first time since we gathered for the annual meeting in New Orleans. In fact, for this year’s PEAK conference we have about 1000 registrants.

And I’m glad several hundred of us are planning to “take Capitol Hill” on Wednesday. This is important … critically important. As you know, a lot has happened since we were together in the Big Easy. These times in our field are definitely big, but certainly not easy.

Five months ago, we said that advocacy would be the Number One priority for our LeadingAge board. And that makes PEAK the most important meeting of our Association year. This PEAK is going to be different however, and it has to be. In the past, we were “one and done” when it came to work after our Capital Hill visits.

But not this year.

I’m calling PEAK 2018 our equivalent of the Daytona 500, the start of a Season of Advocacy. For those unfamiliar with the Daytona 500, it is a U.S. stock car race that marks the beginning of the racing season. But it’s not just any race, it’s the “Super Bowl” of races. Why have this super race at the beginning rather than the end of the season? The answer is momentum. The momentum for this big deal race is designed propel the sport all season long. So, Wednesday must be the same for LeadingAge. We must take the momentum from being on the Hill and use it as a motivating factor to keep advocating all year long.

As I stressed in New Orleans, it’s time to go on offense. And PEAK 2018 will mark the beginning of our offensive drive.

If there was ever any doubt, the last two months of 2017 reinforced the advocacy priority.

We found ourselves on the brink of near catastrophe with the Tax Reform Act of 2017. But in perhaps LeadingAge’s finest advocacy hour, we rallied with other like-minded associations and individuals to thwart the elimination of tax-exempt financing as we know it. Had this passed, it would have put an end to one of our only affordable means to access capital for needed refurbishment and growth.  As if this weren’t enough, we had the added worry of a possible elimination of the medical deduction.

We defended our position, worked with allies and fought for our proverbial lives. Ultimately – and thankfully – we prevailed.

In circumventing these ill-conceived propositions, we demonstrated what we can accomplish together through advocacy. Now we stand ready to push forward a new agenda. Our agenda.

Folks, we’re standing at the “tipping point” as it relates to our nation’s understanding of the care needs of older adults. If we do not act, we may well slide into the same abyss that has befallen the mental health field. But I believe we can right this ship and avoid the same icebergs. Yes, the winds of change are roaring like the March storms of the past few weeks. But while these changes will most likely not occur on my watch as your Chair, I am optimistic that I, along with many of you, will witness a nation demanding its government provide a payment mechanism for the chronic and long-term care needs of its citizens.

And this brings me to one of the most fundamental elements of our non-profit sustainability. We must get paid the full cost of providing care for the nation’s older adults. Without a fundamental public mechanism for paying for long-term services, we are destined to become an even more fragmented, less accessible system of care. Yes, something akin to the mental health field. If we do not act we are writing our own epitaph.

I know some of you may believe this is a dream – a far-off vision – especially when we have so many pressing issues before us. And, granted, this not as pressing as regulatory reform and workforce development. But if we do not get paid, we do not survive. Period. 

That said, let’s touch on regulatory reform. I’m entering my 33rd year as an administrator in the field of aging, and this has been our collective cry each and every year. Yet it never gets easier. Ask yourself: How can any of us, for-profit or non-profit, consistently improve quality if we don’t get paid the full cost of providing care? What an oxymoron when our legislators call for no increase in reimbursement – or worse yet, cuts to reimbursement – while championing the cleaning-up of America’s nursing homes.

Here’s a cold, hard fact – quality and reimbursement are positively correlated. You can’t have quality without investment. LeadingAge members have made lemonade out of lemons for decades as our nation has trolled along without a comprehensive system to pay for the care of those requiring chronic and long-term care services.

And, yet today, members are being forced to change. LeadingAge members – this nation’s best when it comes to providing care for older adults – are having to divest, curtail or in some cases completely dissolve programs designed to care for the nation’s poorest older adults.

Why? Because they have a fiduciary duty to stay in business. It’s simply called survival.

So, when you are visiting the Hill this week, and you or your group’s representative talks about regulatory relief, keep in mind we’ve been asking for this as a stand-alone for more than 30 years. It’s time to add in a demand to be paid, a demand that quality can only be had with investment. Our national leaders have the power to begin that investment with a funding vehicle that will ensure high quality and sustainable reimbursement.

We must only look to our acute care brethren as an example of what can be had once a funding mechanism is in place. Prior to the 1960s, hospitals in our country were full of bed wards and bed sores, and death rates from facility-acquired infections and surgical complications were at all-time highs. But once the country developed a public payment system – Medicare – to complement the growing private health insurance sector, we began seeing amazing advances in not just survivability, but also in innovative life-saving procedures.

And it all started with an investment – much like we need now.

I appreciate you giving me time today to focus on one fundamental component among many that are critical to our survivability as non-profit aging services providers. Yes, there are many others. And that’s why I’m thrilled that the board and staff of LeadingAge are entering a new era of public policy development.

Over the next year, we will hold a series of Town Hall meetings with each state affiliate and you, their members. We want to hear your thoughts, concerns and priorities when it comes to our national policy development. At each Town Hall, there will be a board member and staffer to record and report back all of the takeaways. LeadingAge’s new public policy committee, headed by Chair-Elect Carol Silver Elliot, will assimilate these thoughts, themes and ideas into a public policy agenda.

This bottom-up approach is a first for LeadingAge, and a real testament to the leadership of Katie Smith Sloan and her executive team.  But the process will fail miserably without the one ingredient LeadingAge cannot provide – you!  Please take the energy and inspiration you will discover at PEAK and parlay that into attendance at your state’s Town Hall meeting. Let your voice be heard and help shape your own future as a provider of aging services.

We can choose to see the funding challenges, the workforce challenges – and, yes, the regulatory challenges – as insurmountable obstacles and weights on our missions to serve. Or we can instead know that we are poised and eager to serve the largest number of older adults this country has ever witnessed. And do so with a resolve and determination that there is no provider better at meeting these challenges and providing their care than those sitting in this room.

Godspeed and blessings to each of you as we strive to fulfill our missions, sustain our organizations and change the way America ages! Thank you, and enjoy and make the most of your PEAK experience!

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