LeadingAge Magazine · January-February 2020 • Volume 10 • Number 01

The end of 2019 brought the retirement of long-time LeadingAge employee Barbara Gay, vice president of public policy communications. LeadingAge members have been reading or hearing her words since 1994—in countless newsletters, online articles, education sessions, and speaking engagements. She specialized in making public policy, and the machinations of political actors, comprehensible.

LeadingAge spoke with Barbara in December for her memories of the last 25 years and why she loves our members.

Barbara Gay
Barbara Gay

LeadingAge: Take us back to the beginning. How did you get started at LeadingAge?

Barbara Gay: I was hired to get long-term care into President Clinton's health care reform proposal. Well, that didn't happen, but there's always been something to work on, especially with nursing homes, because there have been so many changes in the field.

When I started, in 1994, we had someone who had been working with us for some time, and her previous experience was in nursing homes. She remembered when the standard of care was physical restraints. You would get a catalog every year, and you would pick out which restraints you thought might be the most effective! Fortunately, we've seen the disappearance of that in the nursing home field, but in home care it's a different story. Ruth Katz [LeadingAge senior vice president, public policy/advocacy] went on Amazon and looked, and you can get all kinds of restraints to use on your relative that you're taking care of at home.

The same goes for antipsychotic drugs. There has been huge progress in eliminating the inappropriate use of those drugs in nursing homes, but there is a listserv I'm on, for aging parent family caregivers, where people ask, “What do I do about Mom or Dad's behavior?” They’ll say, “Get the doctor to prescribe something to calm them down.” So that's going to be another area I think is going to need some attention.

LeadingAge: What did you do before you came here?

Barbara Gay: Well, I have a law degree. And when I got out of law school, I went up to Capitol Hill. I went to the placement office, and took a typing test. I came to find out that everybody did their own typing on the Hill, so that wasn't a sexist thing. But I happened to get an interview with a congressman from New Jersey, Matthew Rinaldo, who needed somebody to be his assistant caseworker, so that's how I started.

We got all kinds of inquiries from people, but the most difficult ones were about “How can I get my mom or dad into the county nursing home?” People needed long-term care, and there was not very much in terms of home care available at that point, so once the family couldn't do everything that was necessary, there really needed to be a nursing home—and there wasn't much assisted living. And so that was a big part of my job.

This was in the late 1970s. I worked my way up to legislative director, and my boss was on what was then the House Aging Committee. He was very attuned to the needs of older constituents, especially because older people vote, and politicians are aware of this. They have a lot of free time to stay current on what's going on politically, and they have very definite opinions. So, my boss loved to go to senior housing organizations and talk to the residents. He retired in 1992. He was a Republican, and President Clinton had just taken office, so everything was switching over to the Democrats.

So, I had a year of underemployment, and I did a little spot of home care with my mom, and then I answered a blind newspaper ad in the Washington Post.

I found out they needed a lobbyist here, at what was then AAHA, the American Association of Homes for the Aging. And we used to say we're the only organization that laughs at ourselves!

I hadn't been here very long when they added “Services” in there too, in recognition of the way the field was beginning to diversify. But then of course you had to say the American Association of Homes and Services for the Aging, and by that time people's eyes were rolling back in their heads.

LeadingAge: Yes, it took me 3 years to get that right. What was your initial title?

Barbara Gay: I think I was director of congressional affairs. Congressional affairs was part of the whole policy shop for the first 6 or 7 years I was here, then they split congressional affairs off from policy, and that even affected the configuration of our office. That was about the time we were building [this] building, and the way the offices were set up on the 3rd floor was for congressional affairs to be at one end of the hall, and policy to be at the other end.

And then, Mike Rogers left—our senior VP for policy—and he had previously been with the Senate Aging Committee. So they glued congressional affairs back to policy, and Susan Weiss took over. She had started here in the 1980s, and she was an attorney. She had met or knew a lot of our members and our state executives. She was very familiar with the policy issues, and really a great human being.

After Susan left, we got Cheryl Phillips, who is a geriatrician and knows a lot about integrating services, and she had a lot of clinical expertise. A couple of years ago, she got interested in heading up a new organization for special needs plans.

And now we have Ruth, who has a strong agency background, and an academic background. So, we've had a range of expertise at the top of the policy shop, and it's made us very strong.

“I think what a lot of people forget—and don't give nursing homes credit for—are the improvements in the quality of care that have been made.”

LeadingAge: How did your job evolve?

Barbara Gay: I was lobbying, and then they brought in a second lobbyist, and there was a recognition that I really wrote better than I lobbied! So I moved into a position where I was doing more communications, working more closely with the communications team, developing messaging materials around the policies we were going to be advocating for, and then also keeping our members and our states current with what was going on here in Washington and how that was going to affect them.

LeadingAge: What have been the most interesting developments in the field while you’ve been with LeadingAge?

Barbara Gay: The continued quality efforts in nursing homes, and the way that we and our members have taken a leadership role in that. I think what a lot of people forget—and don't give nursing homes credit for—are the improvements in the quality of care that have been made. And this has been accomplished by nursing homes, not by think tanks, or advocacy groups, or trade associations, or legislators, or regulators. It's the nursing homes that have really done the tough work of figuring out, especially with dementia care, how to care for people who cannot understand what you're doing, or a lot of times can't communicate their wishes, or how they're feeling.

Our members have done very innovative things in figuring out how to provide essential services in the midst of a lot of challenges. In terms of housing, I'm kind of disappointed with the way public policy on housing has gone. In the 1990s and the early 2000s, HUD was getting over $1 billion for senior housing, and [then] that got cut in half, at a time when housing in many areas has become even less affordable, and when we have a growing population of older adults.

You look at the [number] of people now in their 60s, who have a lot fewer financial resources then sometimes their parents did. People got hit by the Great Recession when, like my own personal experience, you shovel money into the plan and nothing happens.

So, a lot of people are really not well-prepared for retirement. And it's the public programs that provide services that are going to become even more important. You look at something like the Older Americans Act. For years and years, it was funded at $1.7 billion in the face of an exploding elder population.

I was thinking just now about another example, regarding the geriatric health care workforce, people trained in the special health needs of this population. Who uses health care the most? Older people, and they do have specific health needs: A lot of times they are comorbidities, and doctors have to treat the entire person, they can't just treat a piece of a person.

There's a federal program that helps, in a train the trainer mode, to train people in the health care field across the continuum of services. And it was getting, I think, $43 million. We got it bumped up to $48 million, and now we're trying to get $51 million, and it's like charging at a brick wall. They’re saying we can't be increasing money for domestic programs in the current budget situation, but the reality is that the funding increase we're looking for is like budgetary lint, like dust on the surface of the budget, when you're talking about the trillions that we're spending. It's extremely disappointing that we still have such a long way to go to make Congress understand this.

LeadingAge: Do you have anything to say about, or to, the members?

Barbara Gay: Yes, it's been so great working with the members—that’s what makes it hard to leave. I've been to most of the states where we have state associations, and it's been eye-opening. I grew up in the Boston area, so then for me to be sent to South Dakota, Montana, Wyoming, or Kansas, and see a whole different aspect of long-term services and supports in rural and frontier areas. Those are areas where, again, policymakers in Washington don't really understand a lot of the challenges that people face when they're trying to provide services, especially home and community-based services, where you're paying people to drive for an hour or 2 just to get from client to client.

Our members have done such innovative work. And I think the Leadership Academy has been a good way for members to be able to share their expertise, just like the networking that happens at our conferences. I think the staff here at LeadingAge learn as much as the members do from the sessions and the networking that goes on at our conferences.

LeadingAge: What's next for you?

Barbara Gay: It feels kind of strange, but I do have a lot of travel coming up that I've planned. And you kind of hate to quit working while you're still able to keep contributing. On the other hand, a friend of mine last year emailed me and said, if we're going to go on all these hiking trips, we're going to have to do it while we can still get around! We're going to take a hiking trip in Spain, and we're going to go see the Silk Road in Uzbekistan, and my nuclear family now is on the West Coast, and I'd like to be able to see more of them.

I’ll do volunteer work. Meals on Wheels are delivered right across the street from me, where there are some senior apartments, so I can get involved in that.

I'm going to miss the staff, and my member friends, and my state executive friends, but it’s time to do something different.

Gene Mitchell is editor of LeadingAge magazine.