Academic journal article Generations

Managing Aging Services in a Different World: Lessons of Change

Academic journal article Generations

Managing Aging Services in a Different World: Lessons of Change

Article excerpt

Although change is constant, all is not dire in the service delivery sector-as long as management bends with the winds.

The Older Americans Act (OAA) is about to qualify for an AARP membership card. Such a milestone demands reflection. Whether reviewing the past fifty years from the perspec- tive of a policy analyst, policy maker, regulator, direct-care provider, manager, or leader, what has changed within the aging services network, and what it likely will look like in the near and mid-term is affected by many factors. The OAA is a policy document and its intent is realized only after it has been filtered through all of these agencies and organizations, and the services delivered to individuals in their communities. The service is seldom a perfect reflection of the policy and programs.

Dominant cultural values, political will, personal and political philosophies, available technology, and economics all contribute to services and programs that impact or character- ize the changing aging network. These and other elements may shape, and be included in, the next version of the OAA, if it is reissued at all. Those of us who are responsible for service delivery are ultimately responsible to take into account all of the intentions, rules, regulations, and budget constraints, and ensure that the services deliv- ered mirror the initial intention closely enough to be accredited, audited, and supported by the various agencies and offices responsible for performing those functions.

At the risk of offending our colleagues and readers of Generations, and without being a reductionist, this article needs to ask and explore the following question: How will shifts in policy and reimbursement mechanisms affect the way we manage services and programs at every level?

Managing Aging Services in Different Times

From a management perspective, the factors with the greatest impact may or may not be intuitive to people working in the aging commu- nity. These influences may be in the goals of the provider agency, the objectives of the funding sources, the regulations of the major reimburse- ment sources, and in the standards of accredit- ing bodies. These agencies represent forces that have a direct impact on programs, and managers will manage them as implementers of policy. It is important to note that a shift in any one of these locations will ripple through the others and fall to the managers to assess, integrate, and deliver the services.

Any effort to attach oneself to a particular modality of treatment or caring, except on the highest conceptual level, has no place in the changing world of social service, healthcare, housing, or any other component of aging services management. There should be only consistency of purpose and commitment to the broadest objectives.

Consequently, what may have the most im- pact on the management team is the character of leadership, appreciation of the need to be flexible in the modality of care, and leadership's access to capital. Capital is required, facilitates flexibility, and allows management to assess and properly plan adjustments to changing circum- stances; including a decision to continue or discontinue the service in question.

At every point, to respond to structural or economic shifts, organizations need adequate resources. Shifts in policy or circumstances often include changing the location and ap- proach to services used by vulnerable aging populations. Making the required changes safely and with the level of support necessary to move from one set of circumstances (direct- service, regulatory environment, or even lo- cation) to another demands access to capital. Historically, many of these services have been publicly or charitably funded programs, and, either directly or through private nonprofit or for-profit agencies, are heavily dependent upon public and charitable support.

As budgets have been reduced and priorities changed, agencies need to adjust. …

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