Managing Aging Services in a Different World: Lessons of Change

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 perspective 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 characterize 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 delivered 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?