Vision
Pushing Beyond Our Comfort Zone: a Conversation With LeadingAge Chair Kathryn Roberts
by Gene MitchellKathryn Roberts, LeadingAge’s new chair, is president and CEO of Ecumen, Shoreview, MN. LeadingAge asked her to spell out her priorities and concerns as she begins her term.
Kathryn Roberts
Kathryn Roberts: First, I plan to do all I can to support Katie Sloan as she moves into the CEO role. A change at the top after 15 years likely will require some organizational attention we can’t anticipate. But Katie and I have been working together for years, so I expect a seamless transition.
Another priority will be continuing to work on long-term services and supports (LTSS). I’ve been a part of the LeadingAge LTSS task force for the past three years, and I remain strongly committed to this mission—because if we don’t do this, who will? LeadingAge has expertise and credibility in leading the way to workable long-term care financing. We’ve been nonpartisan in developing a full spectrum of options for lawmakers to work with—from highly reliant on private markets to highly reliant on public markets. We need to keep pushing to solve what is clearly one of the top issues facing an aging population.
And, in general, I plan to make it a priority to be heavily mired in the future. My view of a board chair’s role is to consistently push boundaries, recast conventional thinking and coax us out of our comfort zone.
LeadingAge: When you were sworn in as LeadingAge chair, you talked about the transformation of aging services. “Transformation” is a word we’re hearing more and more at LeadingAge. What does it mean to you?
Kathryn Roberts: Transformation is change on a grand scale that tends to be more abrupt than gradual. I’m not using the word casually or for dramatic effect. I truly believe the scope of change we face is enormous and coming at gale force. I’m certain there will be transformation. The question is whether we will transform ourselves or allow it to happen to us by the wear-and-tear of external forces.
“LeadingAge has expertise and credibility in leading the way to workable long-term care financing. We’ve been nonpartisan in developing a full spectrum of options for lawmakers to work with—from highly reliant on private markets to highly reliant on public markets.”
Kathryn Roberts: I’m oversimplifying, but I have four general categories of concern:
One is our relevance. We have a new breed of consumers who are consistently telling us the services we provide are not what they want. Just last month, a Harris Poll showed that two-thirds of 50-plus adults say they’d rather die than go to a nursing home. Now, that’s a clear message. Nor do they want to go into an assisted living community. What they want is to be assisted in living—at home. We’ve been de-institutionalizing our services for years, but baby boomers are asking us to go even further—to take our services to the streets. They want more than just home care services. They want their current communities to be age-friendly and dementia-friendly so they can live there as long as possible. They don’t want to be segregated in senior communities that we build for them on the edge of town.
Two is quality of care. The caregivers who serve the elderly, our employees, are in short supply. The number of older people needing care is growing much more rapidly than the ranks of younger people who want caregiving jobs. All our excellent recruiting work probably will not fully solve this fundamental demographic supply-and-demand issue. Fewer employees may be caring for more consumers. This is not just a recruiting issue. It’s a quality of care issue.
Three is competition. The type of work we do is a target for new opportunistic players. We bundle various services but are not necessary the most efficient providers of any one of those services. The profit-generating aspects of what we do are ripe for cherry-picking by companies without our mission-driven approach to elder care. Web-based services like Uber and Amazon are eyeing aspects of our markets. And, of course, hospitals and clinics are more aggressive than ever in competing for the short-stay rehab market.
And four is compensation. How we will get paid for what we do has never been more in flux. Medicare and Medicaid reimbursement is under constant downward pressure, and there is no reason to expect a change in the current political climate. Plus the vast majority of people just don’t have the private financial resources to cover their long-term care needs. Less than 5% have long-term care insurance, and about two-thirds of older adults can’t afford even a year in a nursing home.
LeadingAge: That sounds ominous. Are you pessimistic about the future?
Kathryn Roberts: Just the opposite. I’m energized by the challenge. This is all solvable, but not by tweaks here and there. We actually have more opportunity than ever before, given the number of people entering our market space. But we’re going to have to upend some of our most basic operational and cultural assumptions about how we deliver our services. The members of LeadingAge come from a rare and special history that puts mission ahead of money. Most of us do what we do because of the mission. And we’ve always found ways to fund our mission. But the unrelenting push for efficiency and affordability in health care is a game-changer.
The lines between profit and not-for-profit are much less relevant in this new world where the most efficient providers will ultimately prevail. If you want to help people, you have to be financially viable. And if you want to be viable, you have to be accountable and get measureable results. While many of us already have imposed these standards on ourselves, we all have to get ready for the standards to be externally imposed.
“We actually have more opportunity than ever before, given the number of people entering our market space. But we’re going to have to upend some of our most basic operational and cultural assumptions about how we deliver our services.”
Kathryn Roberts: Absolutely not. Our core values aren’t in question, but our traditional business models are. I’m saying to preserve our values and fund our missions, we have to accept that we now are on the same playing field as for-profit organizations. For the past 100 or so years, we had a segment of the health care market that other providers were willing to cede to us, and we all peacefully coexisted. We were mostly in the business of end-of-life care in brick-and-mortar care centers. That’s now a tiny sliver of the market, and it’s in decline. The older demographic segment is not only growing but also living heathier and longer. They want to age in place, and, more than ever before, that is possible. We have to think in terms of delivering service to them where they are, rather than waiting until they come to us when they have absolutely no other alternative. Not only is it more desirable to stay at home, it is generally more efficient.
Also, we have options to explore market segments outside our traditional scope. For example, we’re great at providing services for older disabled people. Why not expand our scope to all disabled people? My point is: we have plenty of opportunity. We expand our options by giving our consumers the options they want.