Dick Ladd was a bulldog of a man. Stocky and firm of jaw as the bulldog trademark on a Mack truck, the former truck driver was recently described during a tribute to his memory as blunt-spoken, bold and steadfast. "Dick became an instant folk hero when the guy who was the head of [Oregon's] nursing home association called him a liar," said Charles Reed, who oversaw long-term care programs for the state of Washington. Reed recalled that Ladd, his Oregon counterpart, relished in telling how, after a brief dialogue regarding the meaning of the word liar, Ladd slugged the lobbyist.
Other words resounded at the memorial symposium during the 2004 Joint Conference of the American Society on Aging and the National Council on the Aging last spring: unique leader, creative force, humanistic visionary, superb analyst, fine teacher and master strategist. Few people who might have wandered into the small conference room during "The Making of a Revolution: Ladd's Legacy in Long-Term Care" would have known of this vigorous man of contrasts, but anyone familiar with the field of aging would have heard tributes to him from major-league players in American policy on aging.
"We take a lot of things for granted now that didn't exist," said Stephen McConnell, policy chief for the Alzheimer's Association in Washington, D.C. He continued, "I think we are forever indebted to Dick Ladd and the Oregon long-term care system; it has changed long-term care in this country, and we owe a huge debt to Dick. Ladd's legacy lives on, and we are all responsible for doing our part in making sure that it's carried out."
"Dick really is the guy who shifted the paradigm," said John Rother, director of policy and strategy for AARP in the nation's capital. He traces today's movement away from institutional care and to home-based and community-based services, particularly the development of assisted living, directly to the influence of Ladd, who died of cancer a year ago. Rother went on that Ladd's contributions will continue "to shape the entire future of this field."
Rother stressed that Ladd was "almost uniquely able to translate that vision into actual machinery of government and operations." His command of statistics and grasp of how political support and funding streams could be mustered made him a top consultant to state government across the United States. In the late 19808, he was hired away from the state of Oregon-where he built the national model for a flexible, public system of long-term care-to serve as the Texas commissioner of health and welfare under Gov. Ann Richards.
At the beginning of that decade, Ladd was appointed to head the new senior services division of the Oregon Department of Health and Human Services. Rother said, "He got people to believe in some pretty radical ideas that threatened the status quo and had strong opposition. Yet, he got the legislature to consolidate a very wide range of authority in the division of senior services, which was unusual at the time, very unusual." Under Ladd, Oregon become the first state to use one of the newly devised federal waivers allowing a state to wrap money from otherwise tightly controlled bundles of funding into a single package, so that service providers could coordinate a wide range of home-based and community-based care services. Ladd's efforts also persuaded federal authorities to expand the waiver approach.
Soon, Rother said, Oregon's program covered Medicaid, the Social Services Block Grant and the state's Project Independence. "It worked so well that he eventually also consolidated [long-term care] licensing, quality assurance, cash assistance and even food stamps in the program. Dick believed in making services understandable and accessible to the individual. We're still trying to accomplish a single point of entiy in long-term care around the country, and Oregon did it under his leadership."
Carol Austin, now of the University of Calgary School of Social Work in Canada and who once headed Ohio's long-term care program, remembered coming to Ladd as a graduate student in Oregon more than two decades ago. …