LeadingAge Magazine · March/April 2015 • Volume 05 • Number 02

Exposing Gaps: Four Challenges for Our Field

March 01, 2015 | by Roque’ Christensen, Alla Rubinstein, Pegeen Sullivan and Dana Weaver

The 2014 LeadingAge Leadership Academy Fellows found four ways our field must better serve seniors—and its own workers.

A “study circle” is a simple, unstructured type of group learning that allows participants to examine important issues. Each year, the LeadingAge Leadership Academy engages in this process in order to discuss the following question:

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?

The study circle process enables Fellows to think on a grand scale and not limit possibilities. The goal is not to problem-solve, but to grow as leaders through the high-level conversations around the gaps in aging services. We began this process during our first meeting together, at the 2013 Annual Meeting in Dallas, TX, and the list of issues the 2014 Fellows identified was long. Through much discussion and healthy debate, each team was asked to focus on one gap—between what people need and what is made available to them by providers in our field—that it felt needed to be uncovered for the aging services field.

Fellows enjoyed the opportunity to be creative and not be limited by the scope of the issues. Additionally, each team had to do a presentation on the gap it addressed. It is interesting that there was no duplication of topics among the groups.

The gaps identified were:

  • Friendly foods for relief of pain and inflammation
  • Who will take care of the caregivers serving our residents today?
  • How to feel valued as we age
  • Creating inclusivity: eradicating ageism, ableism and creating more integrated communities


The nine Fellows whose group name was “It’s All About U” were led by Leadership Academy coach Dennis Russell, senior VP of MHS Alliance and president/CEO of MHS Consulting. The team found inspiration for its name from one of the Academy’s assigned readings: Presence by Peter Senge and three co-authors. In Presence, the authors found that people remain stuck in old patterns of seeing and acting. By encouraging deeper levels of learning, we create an awareness of the larger whole, leading to actions that can help to shape an evolution and our future. The group found this premise to be true, both in experiencing group dynamics and in the evolution of its group project. After soliciting ideas from each group member as to which service gaps they felt passionate about, and some lively debates about the merits of each, the group settled on the impact of food choices on wellness, specifically how food can prevent or reduce the impact of chronic disease.

It’s All About U initially chose to research the top nine chronic diseases affecting seniors. The idea was to focus on educating providers on the natural healing properties of various foods and how those choices can potentially help people reduce reliance on medications and minimize the impact of the diseases’ symptoms in their daily lives. The group quickly determined that the original idea was too broad and that many resources were already directed at each individual disease by large organizations such as the American Diabetes Association or the American Heart Association.

The group decided to narrow the scope of its work. It determined that pain and inflammation were a commonality across all nine diseases. As many as 116 million American adults suffer from chronic pain. According to the National Institutes of Health, chronic pain is devastating to quality of life and can lead to increased fall risk, less socialization, depression, decreased mobility and socialization, and poor sleep quality. The group also found that there was a void in information and education relating to using food choices to help control, minimize or relieve these symptoms, and that Mother Nature is really great at providing us with foods that help our bodies heal naturally.

The group reached out to industry partners, requesting support in developing nutritionally-sound, science-based menu plans that use friendly foods for pain and inflammation relief. In their final project presentation, the group proposed providing member organizations with resources to educate and empower their residents to use friendly food as a method of pain and inflammation control. The group also established a menu identifier, “Captain IF,” a blueberry antioxidant superhero, to delineate friendly food options, and proposed that LeadingAge member organizations sign pledges to provide them.

It’s All About U’s service gap concept came from group member Jon Schilling, who neatly summed up the great aspects of the process: “The power of discussion and listening, the freedom to learn about yourself in an environment that is judgment-free, a place to share thoughts, ideas, problems, and solutions away from ‘politics’ at work. Mistakes should be celebrated (at work) because we learn the most from mistakes, and job titles should not make a difference when looking for leaders within your organization.”

The group of eight Fellows known as “Traveling Transformers,” led by Leadership Academy coach Barbara Thomas, CEO of Kendal at Oberlin, Oberlin, OH, narrowed its focus from 24 possible gaps to five. The group’s discussions concerning livable wages for aging-services staff quickly become a shocking conversation about a workforce unprepared and underfunded for retirement. The majority of hardworking staff serving in elder care today will not be able to afford the care and services they may need during their own retirement years. Who will care for them?

According to the Bureau of Labor Statistics (2009), long-term care workers such as certified nursing assistants, dietary aides and those in housekeeping services had an annual wage below the overall median of $33,190. In 2012, BLS reports the median pay for a nursing assistant was $11.73 per hour. Long-term care office workers earned approximately $31,870 per year, which is close to the average salary of all workers in the nursing home field, who earned around $31,640 per year. The pay of office staff was lower than the average U.S. salary of $45,230 per year. Such workers also earned less than other office workers across the country, who earned around $34,120 per year.

Seventy-four percent of baby boomers believe they will have to rely heavily on Social Security in retirement. The average social security check is $1,230 a month. Considering these facts and seeing the steady rise of workers age 65-plus who need the money and cannot afford to retire, the following questions must be asked of the LeadingAge membership:

  • Where does this leave your staff?
  • How will your staff be able to save for retirement?
  • When will your staff be able to afford to retire?
  • Who will take care of those caregivers serving our residents today?

Fellows Gretchen Wagner and Emily Hoshida both wrote poetry during the group process, capturing the emotions surrounding this gap, written from the perspective of an aging-services professional working in our organizations today. The following poem was chosen by the Traveling Transformers to be shared as part of the group’s final project presentation to the Academy. The presentation consisted of Fellows from the group reading lines of poetry, photographs of caregiving staff and residents working together, information about the gap, and live guitar music from Emily Hoshida, who sang “Will You Remember Me?” by Sarah McLachlan.

Today I care for someone precious, who needs my help to carry on.
Today I make the difference, by easing someone’s load.
Today I care for people, while learning each one’s story.
Today I comfort one who’s dying, and grieve the loss of one I love.

Tomorrow I am weary, but must continue on
not only for the people, but my work is never done.
Tomorrow I will dream about a place I can’t imagine
Where I will be the one who needs another to help me carry on.

Tomorrow I will wonder who, when and how,
 How will I get the care I’ve given?
When will my work be done?

Who will provide a way for me, to have what I’ve given to so many?

- Gretchen Wagner

As we move through the chapters of our lives, our real and perceived value in this world is uncertain. The group known as the “Quaked Outers,” led by Leadership Academy coach Aline Russotto, executive director at Orchard Cove, Canton, MA, identified feeling valued as we age as an important missing piece in the work of aging-services professionals. The group asked elders from a number of LeadingAge members to help raise awareness about the roles of aging adults in society. Elders were asked to send the group objects and voice recordings that describe their roles and purposes.

The objects received ranged from a toy car to a beautiful porcelain tea set. Each object was accompanied by a voice recording that explained how that object represented the individual’s value. A group of seniors from Luther Manor in Wauwatosa, WI, helped attach those objects to a bust sculpture, appropriately named Val, formed by group member Ellie Nocun. The image of Val was amazing and when she was given a voice through the recordings, the entire project was powerful.

The plan was for Val to travel to each of the communities that contributed to her creation and be displayed for a period of time. Her journey across the country would raise awareness about the value of elders and end at the 2015 PEAK Leadership Summit in Washington, DC.

The group presented Val to the entire Academy in July. Val gave a voice to elders and the group was eager to have the message spread across the country. Val was left in a meeting room overnight to introduce her to Academy guests at the Leaders in Residence breakfast the next morning.

Sometime during the night, Val disappeared. She could have been thrown out with the old linens, taken by one of the hotel staff, or accidentally dropped and shattered—one will never know. The Fellows were heartbroken when it became evident that Val was gone for good.

S.A. Sachs said, “Hope rises like the phoenix from the ashes of a shattered dream.” Like the phoenix, Val began to emerge from the ashes as a metaphor of the lack of value the greater society places on elders. This field, and society in general, has a great challenge to help elders view themselves as valuable no matter what their age and to help others see the beauty and purpose within them.

Today’s elders were pioneers who paved the way for all of the successes enjoyed today. Their value is immeasurable and their mark on history is profound. The greater challenge is to honor each and every one by assuring that they maintain their purpose in this world and are valued by the greater society. Those societies who value their elders have a greater societal connection than those who don’t.

The “Change Agents,” led by Leadership Academy coach Tama Carey, COO and executive VP of operations for Presby’s Inspired Life, Lafayette Hill, PA, were from diverse backgrounds across the professional spectrum, though the group almost instantly found itself collaborating quite naturally. Each member had unique strengths, which proved valuable when building its project.

When the team first started to consider its theme, ageism and segregation in senior communities, it struggled with addressing such a seemingly intractable issue that overwhelmed members’ thinking. The group at first thought it unimaginable that it could tangibly fill a need in senior care. Finding a single focus or angle seemed almost impossible. As conversations were steered toward examples of blatant ageism the group members had experienced in their own environments, the group quickly realized how much discrimination happens right under providers’ noses.

The deliberation process for the group’s effort to “create inclusivity” included ongoing encouragement of honest, open discourse without attempts to restrict the brainstorming process. The method wasn’t forced and the group found an easy rhythm in taking turns expressing ideas. While continuing regular discourse on monthly calls, each member of the team conducted interviews of residents and staff within their respective communities and talked to peers in other countries to gather data.

As a result of these interviews, the group asked itself painful questions:

  • Are we really honoring older adults when we focus on and celebrate only those who are well?
  • Where else in society would it be acceptable to segregate and marginalize people who are deemed “undesirable” by their peers?
  • Why is this happening?
  • And most importantly, what can we do about it?

The group became determined to find bright spots and use these as tools to set good examples, rather than getting bogged down in reinforcing negative models. It was important for the team to have a finished product that aging-services leaders and practitioners could use and adapt within their own communities and not feel as overwhelmed by the dilemma.

The group likened its bright spots to other points in history when issues seemed to be intractable but were overcome. The civil rights movement, women’s suffrage and the rights of persons with disabilities all came to mind.

Team member Jill Vitale-Aussem was inspired by the group’s reading assignment, Switch, and put together a document shaping the group’s thinking. The team reviewed and revised her draft, ensuring that every perspective was included.

The outcome was an article titled “Creating Inclusivity,” disseminated among LeadingAge members and published in LeadingAge magazine. The group hopes its efforts help change the mindset of a deeply rooted culture and encourages leaders in senior care to realize a new culture free of ageism, ableism and segregation—a culture that embodies the true meaning of the word “community.”

For Thrive questions and resources related to this article, follow the links below. Thrive is a LeadingAge member benefit, and access is limited to members. Use the MyLeadingAge login page to log in or create an account.

Visit the Thrive main page

* Thrive is a new initiative that provides resources to help organizations achieve a successful future in meeting the needs of the people and communities they serve. There are seven major topic areas in Thrive. For each, Thrive offers questions designed to stimulate discussion among your leadership team and board of directors. Most questions include resources that link to white papers, articles, tools, presentations and business intelligence. New resources will be continually added.

The LeadingAge Academy’s use of study circles as a mechanism for leadership development, as well as the opportunity for Fellows to contribute important thinking about specific, timely issues affecting the field of aging services, is very valuable for Fellows.

2014 Fellow Ken Young describes it best when he says, “The project provided an excellent experience of team-building. Valuable lessons were gained in that, although some team members had much greater subject-matter expertise related to the specific project topic … each team member was empowered by all others to share his or her unique skills and gifts and contribute equally to the project.”

Each group of the Fellows had a vision for how their work could be shared beyond their discussions. U Choose can be duplicated by LeadingAge members as an educational program or an addition to dining services. The presentation that posed tough questions about workers in our field and their struggles to afford decent retirements could be turned into a voice-over video with music, to raise awareness and spark conversation about the need to better support these hard-working individuals. Val was to travel across the nation inspiring people—care workers, senior adults, everyone—to be aware of aging roles in our society and how to ensure elders never feel undervalued. The “Creating Inclusivity” article was published in LeadingAge magazine and received recognition when it won an Honorable Mention from the 2014 MARCOM Awards. (See the sidebar in this article for more on the award.)

In order to ensure that the conversations around the gaps in aging services continue, LeadingAge Leadership Academy Fellows from 2012, 2013 and 2014 will host an education session during the upcoming 2015 PEAK Leadership Summit in Washington, DC. The session will discuss the trends coming out of the study circle process and explore how LeadingAge-member organizations can address those gaps through services and programming.