By Robert A. Applebaum
As a researcher studying aging services and long-term care for the past thirty-five years, I continue to be amazed at how the world I study and thought I knew has changed. I often say to audiences when presenting data from our two-decade longitudinal study of Ohio’s longterm services system, “If you would have shown me these data twenty years ago and said this will happen, I would have said, ‘No way.’ ”
In 1993, nine out of ten older people on Medicaid in Ohio who needed long-term care were in nursing homes, and the industry had been quite successful in protecting its funding base and discouraging the expansion of homeand community-based services (HCBS). Today, the state is approaching a fifty-fifty balance between institutional and HCBS use by older people (Mehdizadeh et al., 2013).
But stories of dramatic change are not unique to long-term services and supports (LTSS). In recent years, conversations with colleagues from all types of fields, including healthcare, law, education, manufacturing, politics, journalism, architecture, retail, financial services, and, of course, technology have revealed a similar phenomenon. While the specifics differ, the common theme is that change, whether from demographic, technological, and social trends, or environmental, political, and economic shifts, means that a large number of us and our organizations operate in a considerably different world than that of just five or ten years ago.
This issue of Generations is featured in the Generations Web Seminar Series
Companies That Didn’t Evolve
The pace and nature of today’s changes make organizational success that much more difficult to achieve. In the past, businesses or products that failed did so primarily because the product was based on a bad idea or proved to be of poor quality. Who can forget such ill-fated product ideas as Cosmopolitan magazine’s foray into the yogurt business, Clairol’s attempt to market a Touch of Yogurt shampoo, Colgate toothpaste’s development of Kitchen Entrees, Thirsty Dog’s flavored bottled water for pets, or Harley Davidson’s perfume line? Companies have gone out of business because of bad products: think of White Star Lines (builder of the Titanic); the early computer maker, Commodore, which chose to make its second-generation product incompatible with its first; or the high-end gadget store The Sharper Image, which went bankrupt in part when their Ionic Breeze air-purifying machine was found to release ozone into the home.
In today’s environment there is a second phenomenon: companies with a high-quality product or service based on a good idea are failing because they have not kept pace with the changing world. Most notable of these was Eastman Kodak, founded in 1881 and not only profitable, but very much a part of American culture (with its own song, the 1975 hit “Times of Your Life”). For many, the little yellow box of Kodak film was a trusted companion at important life events—birthdays, graduations, vacations. Today Kodak is in bankruptcy. Its core business of manufacturing photographic film products has practically disappeared. The slide projector, another famous Kodak moment, is now displayed in New York City’s Museum of Modern Art.
Other well-known companies are also finding their quality products not doing well in a changing world. Blockbuster video ran a great store filled with high-demand movies, then Netflix made videos available through the mail and online, and today Blockbuster retail operations have ceased. Motorola in 2003 made the biggest selling mobile phone ever, but failed to get into the smart phone business and in April sold its mobile business unit. And, of course, the Palm and the Blackberry PDAs soon will be relegated to museum status.
Why, despite making good products, did these companies fail? Because the world changed, and they did not. It is important to provide a good product or service, but it is essential to continually evolve in a dynamic world. The reason this issue of Generations is so important is that the aging services network’s system changes of today are no less dramatic than those faced by Kodak, Motorola, or Blockbuster.
As the aging network approaches age 50, born of the 1965 Older Americans Act, it, too, is at a critical juncture. I would argue that the aging network was a good idea and has delivered a quality product over these past five decades. With the incredible growth of the older population one might have thought these would be boom years for those with vast experience delivering aging services. Instead the traditional aging network is facing major challenges, and in many states long-standing providers are fighting for their survival.
How and why has this happened, and what are the implications of these changes for delivering services to older people in the United States? What current and future changes face the existing delivery system serving older people? Do these changes represent natural progress and efficiency as the United States strives to serve an ever-growing aging population—or do they represent proprietary businesses capitalizing on a growing market with limited commitment to serving frail and vulnerable elders?
Will these changes improve the service delivery system? Or will they accentuate societal inequality, which has been mitigated to some degree through an array of programs and services steadily developed in the United States? This issue of Generations addresses these important and timely questions.
Will We Be Prepared?
Two phenomena are facts of modern life: Change is happening pretty much everywhere and at a breathtaking rate; and—despite an ongoing series of apocalyptic predictions—odds are we will be around to face these new conditions. The $64,000 question for us as individuals and for our organizations is will we be prepared? Will the aging network and its long-standing providers be able to adapt to the changes of today to continue their legacy as a caring industry?
Heraclitus said, “The only thing that is constant is change.” A significant barrier faced by organizations in responding to current challenges is the paradox of change. While change is an organizational constant and a source of organizational and individual energy, significant, sudden, or rapid change may be experienced as a threat and met with paralyzing bewilderment at best or, at worst, resistance grounded in skepticism or cynicism. Preparing ourselves and our organizations for change is extremely difficult and can be overwhelming.
The pressures of the work we have to do today, when combined with other life responsibilities of family and friends, means that taking a deep breath to think about the future feels like a luxury. How do we worry about tomorrow’s issues and challenges when we are treading water today? Yet in today’s environment,
preparing for change is more important than ever. Because, whether we are ready for change, are prepared for change, or embrace change—it is going to happen.
A second aspect of the paradox of change is that while change is necessary, the change implemented has to be the right strategy. Just as I described the new venture failures of existing businesses—Cosmo yogurt and Harley Davidson perfume are among my favorites—aging network organizations will have to weigh those same choices. Several articles in this issue raise questions about aging network approaches under consideration or already implemented, such as the decision to have a greater role in healthcare. Members of the network and their organizations need to respond to a changing world with limited time and resources, coupled with growing pressure to make the right strategy decisions. And, it should be emphasized that organizations also have the ability to help shape the changes they will experience. Area agencies in Ohio and Massachusetts were able to convince state policy makers to include their case management expertise as part of the states’ new integrated care demonstrations.
For those of us who are American Society on Aging members or others working to serve older people, the ability to respond to the changes and challenges of today will not only shape our future work lives, but more profoundly will change the lives of elders and their families. The growth of the older population will be so dramatic over the next twenty-five years that if we get this wrong, generations of people will feel the impact. One of the exciting and scary parts of our efforts to respond to these challenges is that there is no script or road map to follow. But if we can ask the right questions, are clear about where we have been and what we are now doing, understand the issues before us, innovate, and lead, the aging network will be in a stronger position to address the future.
Our goal for this issue is to contribute to this dialog by bringing together experts in the field to address these critical questions about the future of aging services. I have been interested in these questions for a number of years and I believe they represent the biggest challenges that we have faced in the fifty-year history of the aging network.
To have the opportunity to choose the writers to address these questions has been great fun. I hope you find their ideas as interesting and thought-provoking as I did. If you do, then we as a network will be one step further away from being talked about in the same way as that yellow box of film—a good memory, but no longer relevant. In the end, change will happen when we think about things differently. Yes, changing technology is a part of the formula, but it is people that will make or break future strategies and outcomes.
Robert A. Applebaum, Ph.D., is a professor of gerontology and director of the Ohio Long-Term Care Research Project of Scripps Gerontology Center, Miami University, Oxford, Ohio.
Editor’s Note: This article is taken from the Summer 2014 issue of ASA’s quarterly journal, Generations, an issue devoted to the topic “The Future of Aging Services.” ASA members receive Generations as a membership benefit; non-members may purchase subscriptions or single copies of issues at our online store. Full digital access to current and back issues of Generations is also available to ASA members and Generations subscribers at Ingenta Connect. For details, click here.
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Mehdizadeh, S., et al. 2013. “Maybe Elephants Can Dance: Two Decades of Progress in Delivering Long-Term Services and Supports in Ohio.” Oxford, OH: Scripps Gerontology Center, Miami University.
Very excited to read the complete edition of Generations. I agree the longevity of humankind has exceeded the evolution of available aging services. As a humble supplement to the ASA journal, please consider reviewing my perspective and proposed solutions to this concern in the article titled "Are Aging-Services Providers Strategic Planning in Past Tense?" on the McKnight's website (www.mcknights.com)