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What lies ahead, how to provide for it, and how to pay for it
“We are all aging and,
eventually, we all need aging services.” What we
advocate is no less than a revolution to reform the mindset of
those who provide aging services.
What do we seek and why is it necessary? A credible
aging services industry would be characterized by its
commitments and by the integrity with which resources are
deployed to meet those commitments.
This calls for financial
integrity. Let’s break
that down a bit. Commitments The core
commitment might be to address the growing dependence and
increasing frailty which makes the very old so needy.
There is a continuum of aging services from congregate
needs after employment ends through the support services to
accompany life’s closing transitions. Resources Meeting those
commitments requires money.
Money to pay people.
Money to provide buildings for gathering and housing.
Money to buy equipment. Stewardship The use of
money involves stewardship.
Where are we
now? Aging services
combine private business activity; nonprofit businesses and
nonprofit charities for the helpless or indigent; and government
business programs to deliver services on a universal platform.
Each form of organization has its strengths and its
weaknesses. Private
enterprise can respond quickly to creative concepts for quality
improvement or lower costs.
Nonprofits avoid tax obligations and need only be accountable
to mission. Government programs benefit from the coercive capacity of
government and from taxes as a funding source.
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Forms of Organizations Providing Aging Services As Jane Austen
might have written, “It is a truth universally acknowledged,
that a young person with good fortune will eventually confront
the challenges of age.” As our health
improves, we live longer and that has expanded the need for
aging services and the industry that provides them.
Now the demand for aging services is expected to increase
dramatically as the generation of post-World War II babies
passes the landmark ages of 60, 70 and beyond. Services are
provided by:
1.
Government,
principally
through Social Security, Medicare, Medicaid, and the Older
Americans Act;
2.
Nonprofit organizations,
principally
eldercare in hospitals, affordable housing, home and community
based services, programs of all-inclusive care for the elderly
(PACE), and Continuing Care Retirement Communities (CCRCs); and
3.
Private investor-funded
organizations,
principally for
insurance services; tax-credit financed affordable housing;
assisted living; skilled nursing; and other congregate housing.
These forms of
organization differ in their sources of financing:
Government has access to tax revenues and to the
borrowing capacity of the government; Nonprofits benefit from tax
exemption and can solicit tax advantaged donations; Private
organizations have access to equity investment capital. Government has
the least accountability, due to the doctrine of sovereign
immunity; nonprofits are subject to regulatory oversight and can
lose their tax exemption unless they operate within prescribed
limits; while private enterprise is subject to both regulatory
oversight and to accountability to its investors.
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