LeadingAge Magazine · March/April 2013 • Volume 03 • Number 02

Closing Gaps Between Seniors’ Needs And Providers’ Offerings: Academy Fellows Begin the Conversation

March 14, 2013 | by Pamela Sarsfield Fox, Diane Burfeindt, Christopher Ichien, David Urso, D. Bruce Jones and Brian Lawrence

A group of LeadingAge Leadership Academy fellows used “study circle” methodology to begin examining where services for the aging fall short.

“One may lead perhaps with no more than a question in hand.”
– Ron Heifetz, Leadership Without Easy Answers

The LeadingAge Leadership Academy uses a learning method called a “study circle” to collectively examine a timely issue relevant to not-for-profit aging services providers. These highly participatory discussions are enriched by the Fellows’ diverse backgrounds and perspectives.

Study circle discussions provide a vehicle for ongoing dialogue, deliberation and shared problem-solving. Fellows work together to generate ideas for action and/or areas for further exploration and gain confidence in affecting change and advancing person-centered approaches in aging services.

Over the course of a year, the 2012 Leadership Academy Fellows engaged in study circle work both as a mechanism for leadership development and as a means to contribute to thinking around specific, timely issues affecting aging services. The question the Fellows considered this year is:

“For whom and what are the gaps in services and programs that we see and how do we think not-for-profit aging services organizations should meet these needs?”

In other words, what aging services needs are we, as providers, not currently meeting, and in what new ways could we do so? What and where are the gaps between what people need and what providers are offering?

The Fellows’ study circle efforts will culminate in an education session at the upcoming PEAK Leadership Summit that will bring providers together to share the ways they and their organizations are and should be addressing the opportunities identified. As our goal is to promote ongoing and expanded dialogue about these important themes, attendees will receive a discussion guide to help providers engage in generative conversations within their communities similar to those we had in the Academy.

While we identified many needs in services and programs, we found that certain themes emerge from our work:

  • A culture of fear
  • A system of silos
  • The perception of aging as a disease
  • A lack of communication between seniors and service providers
  • A lack of affordable care options
  • A limited pipeline of future leaders in our field

Identifying these needs generated opportunities for action to effect change. We challenge our readers to consider these opportunities as they examine their own work and the impact on those we serve.

Opportunity: How do we move beyond risk aversion to boldly address immediate challenges facing aging services?

Fear plays a part in aging services from the standpoint of both the consumer and the service provider. Consumers fear the prospect of aging and of entering care communities. Providers fear the regulatory maelstrom in which they must operate; they fear competitors, and they fear change to their reimbursement sources. These fears are not unfounded, but they are fears that are often founded in ignorance, and they often prevent growth and change in our field.

Our challenge as aging services providers is to educate our senior population and our peers and to engage with both groups in open dialogue. Can we find ways to educate our seniors about their rights, the scope of services available to them, and the funding mechanisms in place to support them? Can we as providers overcome our fear of our competitors to join with them so that we can share best practices and collaborate in closing persistent gaps? Can seniors and providers unite to share a common voice in seeking regulatory change that will close gaps?

Opportunity: How can we cooperate and collaborate to serve our elders better?

Many older adults receive care from multiple physicians and other care providers, each of whom provides care in a vacuum, without interaction or even awareness of the other providers. The result often is overmedication, multiple trips to the hospital, and reduced health outcomes for the patient. It is time for a shift from this paradigm of “silos” of care to collaborative care.

The term “silo effect” is metaphorically used to refer to the tendency to store and hoard things, including information, best practices, health care services and payment for services within one organization or within a department inside an organization. In a recent article, Eleanor Feldman Barbera, Ph.D., notes that, “Silos operate at various levels of long-term care. They can be found in the silent acquiescence of department head meetings, hospital transfers without complete documentation, care plan meetings where key players are missing, and nursing home admissions that neglect to provide residents and families with the information they need to become proactive members of the team.”

In addition to the silos identified by Barbera, consider that the organizations involved in a senior’s care can include regulatory agencies, long-term care providers, home health care agencies, Medicare, Medicaid and hospitals, so the complexity of care and services expands dramatically. In many cases, these organizations and individuals are working independently of each other, resulting in a disconnected and inconsistent quality of care.

Can not-for-profit senior living and long-term care organizations advocate for seniors by promoting sharing of best practices, integration of information, and client-focused care? Can LeadingAge be the voice for seniors by promoting meaningful healthy aging in society in a coordinated and collaborative way?

Opportunity: How can we restore the value and showcase the potential of elders in our youth-focused society?

In our society, aging is often associated with deterioration and impairment. Negative stereotypes of the elderly persist, and in a study cited in The Gerontologist (Vol. 41, No. 5), 80% of adults over age 60 reported experiences of ageism. Ageism has many forms, including negative stereotypes, age discrimination in the workplace, financial abuse and physical neglect and abuse. The costs associated with ageism are myriad and difficult to quantify. They range from impact on self-esteem, to the cost of lost wages, and negative health outcomes. Perhaps most insidiously, the negative mind-set provides a quiet rationale for a lack of emphasis on funding and support for the elderly in our society. They are perceived as a burden, and so they are ignored.

The problem is pervasive, and not subject to easy answers or quick fixes. We must consider equally pervasive solutions that include marketing campaigns, media images that counter negative stereotypes, educational campaigns that begin in early school years before negative stereotypes become fixed in the minds of young people, and increased legislation and funding for enforcement of legislation aimed at reducing the incidence of elder abuse.

What are you doing in your community to refute negative stereotypes of the elderly? What can LeadingAge do to promote positive images of the elderly in marketing, entertainment and news media?

See the following articles for examples of how negative stereotypes of the elderly can be combatted:


Opportunity: How do we include the older adults, their expertise and their wisdom as we seek to address their needs?

Our communities are staffed by highly trained professionals who are given the latest in education and resources to do what is best for the people we serve. But, do we truly know what they want or need? Aging services providers can address this gap by seeking the wisdom, input and engagement from the people we serve. In our communication, we need to be aware of how we interact with older adults to ensure we are seeking their wisdom as experienced individuals rather than offering to listen to them in a placating way.

Today’s retirees are yesterday’s leaders, and they have vast experience and knowledge. When the elders you serve offer input on an opportunity for improvement in your organization, do you give them a voice, or do you dismiss them, with the reminder that you have hired professionals to manage such matters?

Aging service providers must dismiss their own egos and consider that perhaps we don’t have all the answers! You are challenged to encourage your staff to see older adults as people with many years of wisdom and experience and not just as customers or people in need of help. We certainly need to see the people we serve as experts regarding their own lives and ask them where we can partner with them to provide the best services to all residents.

As we move forward, let’s ask the following questions of ourselves and our colleagues.

1. Are we willing to give older adults a voice in the management and long-term direction of the organizations that serve them?
2. Are all older adults given the primary voice in determining the care and services they receive?
3. Do we know the history and expertise of the older adults we serve, and do we leverage that experience?

Opportunity: How can we broaden the socioeconomic spectrum we serve?

A dominant worry looming across our country is the affordability of aging services. It is becoming more urgent as a wave of new seniors moves into retirement—many of whom have not adequately planned or saved for their retirement. While our society maintains some services for the very poor, and the wealthy can self-fund their needs, the middle class is increasingly unable to pay for necessary services.

One of the stark realities of this affordability gap is that we’re no longer talking about nameless individuals on the lowest economic spectrum; we’re talking about our parents—and even ourselves—not being able to afford the care we provide.

However, it is this realization that enables us to see clearly how we want our parents to receive care. We must translate that vision into immediate changes in how we provide services for them … and for ourselves, as providers and clients. We need to look outside our walls and look for opportunities to meet the needs of a wider range of economic levels.

Ask your loved ones what their concerns are for the future, what they like and don’t like about our system, and what would they like if they had a choice? And then ask how you can begin to transform your practices so that all of us have a more secure, high-quality future of care and services.

There’s no better time to act. The gap is only widening.

Opportunity: How can we leverage education and leadership development to attract talent to the field and nurture rising stars?

Everyone should already be aware of the dramatic increase in demand for senior services on the horizon. We are in great need of talented, passionate and dedicated individuals who will take the lead in ensuring these services are available to our seniors. As the greying of our nation continues, so does the workforce that provides these critical services.

Individuals in aging services must create programs that educate youth about our field. We must look to other fields that have experienced a greying workforce for examples of increasing interest in our field. By increasing education and opening up opportunity in this challenging economy, the hope is to reduce the stigma that is so often attached to such a career. Early education and exposure may encourage more individuals to pursue a career in the field. Education and interaction can begin as young as pre-school and continue through high school and college. We must seek creative partnerships with other specialties like arts, recreation and theatre to involve young adults in our field.

As current leaders and pioneers in the field retire, there must be a plan for succession and development for new leaders to become champions for this field. Development of leadership programs like the LeadingAge Leadership Academy will be essential to having effective organizations and innovative solutions in the future.

We must ask how we can leverage education and leadership development to attract talent to the field. How can we nurture rising stars to retain them? What can each of us do to make a difference today with the people that interact with our community?

Conclusion: We welcome your ideas and feedback and we invite you to join the Study Circle conversation at the PEAK Leadership Summit (Session 15-D) so that we can explore tangible solutions to these gaps and continue to move this conversation into our communities.

Applications to the 2014 Leadership Academy will be available in late March, 2013. To learn more about the LeadingAge Leadership Academy, click here.