BY: FR. MICHAEL D. PLACE, STD
Fr. Place is president and chief executive officer, Catholic
Health Association, St. Louis. This article is adapted from his November 6,
2001, address to the annual meeting of the American Association of Homes and
Services for the Aging in San Diego.
November 2001 marked the 40th anniversary of the founding of the American
Association of Homes and Services for the Aging (AAHSA). During a four-day meeting
in 1961, 99 far-sighted women and men joined together to create a national organization
that would be guided by the highest ideals of care for the oldest members of
our society. What a foundation they laid! From a charter membership of 250,
AAHSA has grown to comprise more than 5,600 not-for-profit nursing homes, continuing
care facilities, retirement communities, assisted living and senior housing
facilities, and community service organizations. Each day AAHSA members serve
more than 1,000,000 older persons.
As I reflected recently on these 40 years of evolution, I was reminded of
my own experiences with institutions that serve the older members of our society.
I was raised in Evanston, IL, and have vivid memories of riding my bicycle around
the campuses of the Mather Home and the Presbyterian Home there. Both were imposing
structures surrounded by sweeping lawns. They conveyed such a strong sense of
tranquility that when one later heard adults whispering that Grandma Jones,
say, had "gone to the home," it did not seem such a bad thing.
In 1968, when my own grandmother was no longer able to care for my grandfather,
my mother and I began looking for a care facility for him. For the first time,
I experienced the smells and sounds of poor senior care. Thankfully,
we found a quite different place for my grandfather–that same Presbyterian Home
of my youth. Later, after I was ordained and began visiting parishioners in
various senior facilities, I often left them wondering: Why don't these homes
provide the kind of care my grandfather was fortunate enough to receive?
Although that question unfortunately remains appropriate for some long-term
care (LTC) institutions, this nation has been blessed to have AAHSA and its
members. AAHSA members remain committed to serving those whom many in society
would prefer to forget.
Rabbi Abraham Heschel, addressing the White House conference on aging in 1961,
remarked that old age should be regarded
not as the age of stagnation but as the age of opportunities for inner growth.
The years of old age may enable us to attain the high values we failed to
sense, the insights we have missed, and the wisdom we ignored. They are indeed
formative years, rich in possibilities to unlearn the follies of a lifetime,
to see through inbred self-deceptions, to deepen understanding and compassion,
to widen the horizon of honesty, to refine the sense of fairness. 1
Pope John Paul II has noted that "in all cultures old age is synonymous with
wisdom and common sense. By their very presence, older people remind everyone
. . . that life on earth is a 'parable' with its own beginning and end: to find
fulfillment, life must be based on values that are not transient and superficial,
but solid and profound."2
AAHSA members share the belief that old age is "an age of opportunity." As
I think about the organization, four of its qualities come to mind. I want to
say something about each of these qualities here.
AAHSA Has a Values-Based Tradition
The organization's founders spoke in terms of "the social components of care,"
by which they meant that care cannot be limited to health care alone; it must
address the whole person: body, mind, and spirit. Forty years later, this remains
a cornerstone AAHSA value, a tradition affirming that:
- Each person is unique and has inherent dignity.
- All, as members of society, have rights and responsibilities vis-à-vis
each other.
- Those with means have a responsibility to meet the needs of the poor.
- The helping process involves an exchange in which all participants benefit — because
in helping others, the helper is also served.
- Each of us has an obligation to be careful stewards of the resources entrusted
to us.
These affirmations, along with the other values and beliefs constituting AAHSA's
tradition, ring a universal chord in humankind and provide us with a foundation
and framework for the good work we do.
AAHSA Has a People-Attentive Perspective
As fee-for-service payment and cost-based reimbursement have been replaced
by arrangements that put providers at financial risk, the patient-first/people-
attentive ethic is increasingly challenged. This trend has recently been evident
in the transition to a prospective payment system for Medicare nursing home
patients. When the provider is at risk for a resident's care decisions, who
will be the advocate for the person in need? How, in circumstances sure to generate
pressure to minimize services or undertreat, can such pressures be balanced?
The best counterweight is a set of people-attentive values, such as those
of AASHA and its members. Indeed, AASHA institutions represent the "gold standard"
for person-centeredness, beautifully expressed in AAHSA's statement of values:
"We identify with the aspirations and concerns of those we serve and those with
whom we serve." This is one of the most difficult tasks we face: not to impose
our own ideas on those we serve, but to truly understand and help them realize
their own desires.
A moving example of this value involved a terminally ill resident at the Community
Parkview Care Center in Elwood, IN. The resident's wife visited him daily during
the eight months he was at the center. One evening, the resident became extremely
ill; he was clearly dying. But it was late in the evening and his wife could
not drive after dark. Recognizing the urgency of the situation, an employee
of the facility voluntarily drove to their home, picked up the resident's wife,
and brought her to the center so that she could be with her husband during his
last hours.
This recognition, that our own fulfillment and well being are inextricably
bound up in that of those we serve, is an extension of our not-for-profit character.
Our AAHSA institutions all have a mission central to their identity. Though
they may differ somewhat in the wording of their mission statements, all share
the understanding that service is their source, cause, and goal — that service
is both means and end.
This commitment to service involves service to the whole person, including
his or her spiritual needs — such as that provided at St. Anne Home in Greensburg,
PA. Every day St. Anne's women religious and resident chaplain welcome new residents,
conduct group and individual spiritual programs, and minister to all residents
and their families. They sit holding the hands of terminally ill residents.
They attend wake and funeral services, offering their support to family members.
Through religious services, group prayer and share gatherings, special holiday
programs, personal visits — and in countless other ways — St. Anne's pastoral care
staff are present for each resident's spiritual needs.
AAHSA Members Are Community-Grounded
AAHSA's person-centered ethic is complemented by its members' grounding in
their communities. We recognize that residents are part of a community and that
our institutions are a part as well. We recognize that every community has a
host of needs that are unlikely to be addressed by for-profit institutions.
We recognize that communities need stability and continuity of services, for
example; we know that we must be there for them, in good times and bad.
Doing so requires listening to the community. In Newton, KS, for example,
Friendly Acres conducted a utilization assessment and convened community focus
groups to determine whether to extensively renovate a number of nursing-home
beds and convert them to assisted living. When Friendly Acres told focus group
participants how much more the facility would have to charge to cover the renovations,
the groups urged it to go ahead with the assisted-living conversions but to
hold off on the renovations, so that the new units would be more affordable.
Friendly Acres took the groups' advice. The new service, now completed, is one
that local seniors both want and can afford.
Another example can be found at Elyria United Methodist Village in Elyria,
OH. When that organization found that it needed to move 12 cottages in order
to construct a new apartment building, it adopted two strategies aimed at improving
housing opportunities in its community. First, Methodist Village donated four
of the cottages to the Community Housing Cooperative, a local not-for-profit
organization that provides housing to low-income families. Methodist Village
then sold the remaining eight cottages for $1 each to anyone wanting the opportunity
to be a homeowner. Purchasers had only to provide their own lots and the cost
of moving a cottage. As a result, some Elyria families acquired homes that they
might not otherwise have been able to afford, the cooperative was able to serve
more community members in need, and Methodist Village saved the cost of demolishing
the cottages.
The participation of volunteers is another critical aspect of the community-based
ethic. As the management expert Peter Drucker has noted, volunteerism in not-for-profit
organizations can provide an important counterbalance to family dispersal and
dissolution and the fraying of community ties. Volunteers, whether board members
or bedside aides, can change lives — and in doing so, as Drucker says, "forge
new bonds to community, a new commitment to active citizenship, to social responsibility,
to values."3
In AAHSA facilities, volunteerism is a two-way street. For example, Jan Ostraner
originally came to the Brandel Care Center at Covenant Village of Northbrook,
in Northbrook, IL, to visit her mother, a resident there. After awhile, Ostraner
decided to become a volunteer at the facility; today she spends two or three
hours a day helping to lead residents' activities. Many other facilities are
involved in cooperative programs with local schools. Residents of John Knox
Village in Lee's Summit, MO, act as "adopted grandparents" and "lunch buddies"
for local schoolchildren who need good friends and good listeners.
AAHSA Facilities Have a Transformational Role
Because it is hard to put into words, we talk less often about an organization's
transformational role. But it is vital, in a time of challenge such we
are experiencing now, to emphasize that role. It has three aspects.
Transformation of the People Served The defining feature of a not-for-profit
organization, Peter Drucker says, is not that it is non-profit but rather that
it has a role in society different from that of either the for-profit or the
government organization. The product of a not-for-profit institution, in Drucker's
words, is "a changed human being. The non-profit institutions are human change
agents. Their 'product' is a cured patient, a child that learns, a young man
or woman grown into a self-respecting adult; a changed human life altogether."4
As AAHSA's values statement puts it, the organization's members "contribute
to people's ability to realize their full potential." AAHSA members recognize
that "a changed human life" is possible at every age, in every stage of life.
One such change occurred at the Boulevard Temple Retirement Community in Detroit,
where residents volunteer their time at the Great Grandchildren's Place, an
intergenerational day care program. Retirement community residents read to the
children and help them understand the world they live in. The retirement community's
director likes to talk about a resident named Dr. Wolfe, who did not do well
when he first came to Boulevard Temple. But Dr. Wolfe's spirit "blossomed" once
he became involved in helping children, the director says.
Something similar happened at Baptist Memorial Center in San Angelo, TX. When
the center was given two computers, its leaders saw that they had an opportunity
to try something new. They recruited a volunteer instructor from the community
to teach residents how to do e-mail. After some practice, the first three students
began showing their neighbors what they had learned. Today, two years and seven
computers later, 22 residents are actively involved in the center's Computer
Club and have published what they call a "Computer Manual for Senior Adults."
Florence Rose, an 86-year-old resident, says, "The use of computers has really
changed my life. I find myself eager to learn; feeling alive again!"
Transformation of the Institutions Themselves We AAHSA members are
also the agents of our own self-transformation, reinventing what we do and how
we do it.
A few years ago, I had an opportunity to observe at firsthand an AAHSA institution
engaged in just such a transformation.
I visited Providence Mount Saint Vincent in Seattle and found it in the process
of replacing a medical model of care with a resident-directed model. Over a
period of many years of planning that involved staff, residents, families, and
volunteers, the facility rewrote its vision and developed new set of goals.
The new resident-directed model is designed to maintain residents' independence,
privacy, sense of home, and dignity and to increase their interaction with staff
and with each other. Under this approach, residents choose their daily routines
and the services they wish to receive. In creating individual care plans for
residents, the staff seeks to understand their backgrounds and personal preferences
while, at the same time, educating them about concerns related to their well
being.
To facilitate maximum independence, Providence Mount Saint Vincent created
what it calls "neighborhoods," each of which has a large open kitchen/dining
area where residents and staff can congregate and help themselves to food from
steam tables any time of day. Each "neighborhood" has its own staff, cross-trained
in doing both household chores and delivering resident care. The new resident-directed
care model provides residents a home in which they have as much control and
independence as possible. This self-transformational process, intended to promote
individual transformations for those being cared for, is characteristic of AAHSA
members.
Transformation of Social Attitudes A prime motivation in the formation
of AAHSA was the fact that no national organization then existed to represent
not-for-profit providers of LTC services to the elderly. In 1958, Sen. John
Sparkman of Alabama sowed the seeds of AASHA when, during a hearing on nursing
homes, he asked, "Who speaks for the nonprofit and church home?"5
We lacked a single voice then, but AAHSA has since filled the void and become
the premier national representative for not-for-profit institutions and organizations
dedicated to housing and caring for the elderly.
AAHSA's effectiveness in this role can be seen in its success, year after
year, in preserving the Department of Housing and Urban Development's Section
202 senior housing program. Through AAHSA's efforts, this valuable program has
been maintained even though other housing programs have been cut back or eliminated.
Another feather in AAHSA's advocacy cap is the enactment of "return to home"
legislation ensuring that if an elderly person needs nursing care after a hospital
stay, the managed care company involved must make it available in the person's
own community. AAHSA's voice in national policy debates is strong, vibrant,
and effective.
A "Product" Always in Demand
What can we expect of AAHSA in the future?
First, we know we can feel confident about being not-for-profit in a for-profit
world. Forty years of growth and success tell us that mission can more than
hold its own in the marketplace. And, more important, we know that our "product" — a
changed life — will always be in demand.
Second, we can feel confident about being person-centered in an age that is
too often centered on material values. The process of improving the human condition
characterizes our services and sets us apart from business organizations whose
primary purpose is ensuring a reasonable return to stockholders. Instead of
evaluating options and strategies in terms of their impact on stockholders,
we ask what is best for residents, for the community, and for the continued
availability of services in the community.
NOTES
- Abraham J. Heschel, "The Older Person and the Family in the Perspective
of Jewish Tradition," in C. LeFevre and P. LeFevre, eds., Aging and the
Human Spirit: A Reader in Religion and Gerontology, Exploration Press,
Chicago, 1985, pp. 35-44.
- John Paul II, "Understanding
and Respect for the Elderly," July 25, 1999.
- Peter F. Drucker, Managing the Non-Profit Organization: Practices and
Principles, HarperCollins Publishers, New York City, 1990, p. xiv.
- Peter F. Drucker.
- Evelyn L. Haught, The First 25 Years, American Association of Homes
for the Aging, Washington, DC, 1986, p. 11.
Copyright © 2002 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.