Managing at the Intersection of Generational Change and Policy

Resources
“The Ecumen ‘Age Wave’ Study” http://www.ecumen.org/newspdfs/boomerreport.pdf
Lobbying and Advocacy Handbook for Nonprofit Organizations
The Nonprofit Board Member's Guide to Lobbying and Advocacy
Power in Policy: A Funder's Guide to Advocacy and Civic Participation
Generations: The Challenge of a Lifetime for Your Nonprofit Organization

Contents
The Ecumen Story—Rethink and Reinvent
    Rethink: As boomers age, business as usual is not an option
    Reinvent: Policy initiatives enable better service
What Can We Learn from Ecumen?

From Vince Hyman, former Publishing Director, Fieldstone Alliance:

The Ecumen Story—Rethink and Reinvent
In recent issues of Tools You Can Use, we’ve talked about the importance of policy change as a means of accomplishing mission goals. We’ve also addressed the importance of attention to generational change in planning.

This issue profiles one organization that—in planning for coming generational changes—saw the need for public policy changes in order to fulfill its mission.

Ecumen (www.ecumen.org), a consulting client of Fieldstone Alliance, is the Upper Midwest’s largest nonprofit senior housing and services company. Ecumen operates approximately 80 senior communities in Minnesota, Iowa, Wisconsin, and North Dakota. Housing services include independent living, assisted living, and nursing homes. Ecumen has 4,000 employees and serves 10,000 people annually through a mix of senior housing, community services, housing development, and consulting services. The following case study is used with the permission of Ecumen CEO Kathryn Roberts.

Rethink: As boomers age, business as usual is not an option
Ecumen’s mission is to build communities that support and enrich the lives of older adults and others it serves. It promises to create “home” for older adults wherever they choose to live. For many years, it has achieved this mission through a variety of senior care centers.

Because Ecumen deals with the aging population, it must consider what clients will need. And as the first Boomers hit retirement, Ecumen is preparing for their impact.

The baby boom generation has been the proverbial pig in the python for years. Soon it will challenge senior care. There are 78 million Boomers, the first of which are just entering retirement. Another Boomer turns 61 every seven seconds in this country. And Boomers don’t expect things to stay the same: Boomers claim “80 is the new 60” and they expect to feel 60 when they are 80. (Or perhaps—and here I speak as a Boomer—our sadly self-centered generation expects others to see us as 60 when we’re 80.)

The costs for care will be overwhelming IF we continue at the current pace with our current practice. In Minnesota alone, according to the Department of Human Services, senior care will cost $20 billion annually by the year 2050, when the oldest GenXers will be in their 80s, and the first Gen@s (another large cohort, born 1981 and later) will be hitting the retirement rolls. This is not a bright future—at least, for business as usual. Nor is it anything other than a cruel legacy for younger generations, who will pay the bill—through taxes, through steep limits on their own health care options, and through direct care of their parents and grandparents.

There is a problem in Minnesota, and much of the rest of the country. Government reimbursement systems for nursing home care are outdated and inadequate to the current challenge, let alone the future challenge. For many entities, financial viability is at risk. And no money means no mission, to paraphrase Peter Brinckerhoff.

The standard response to shortfalls is to lobby for more government funding. This business-as-usual tactic was described by Emmett D. Carson, now head of the Silicon Valley Community Foundation, in our book, Power in Policy:

Status quo mission statements often focus on providing direct human services and do not include a philosophy of social change. Such mission statements are an implicit endorsement that the current socioeconomic system of providing opportunity is essentially fair at allocating scarce resources. (p. 14)

For Ecumen, a status quo response would be to seek restoration and expansion of funds for its current senior care.
 
But Ecumen has taken an approach some might call radical—though others might call it realistic.

• It has conducted and is incorporating research on what its customers today and tomorrow desire.
• It is planning for current and future changes in technology that can alter and improve service.
• It is exploring the meaning of its mission in ways that are not bounded by its traditional programming.
• And finally, it recognizes that a number of its options are influenced by a complex policy system.

Research conducted by Ecumen revealed (not surprisingly) that Boomers do not want to live their lives in nursing homes and traditional senior care homes. Boomers expect to be more independent and want to remain in their own residences.

Thus, Ecumen is seeking to restructure how it delivers services for seniors. Moving away from traditional nursing homes, Ecumen is advocating for a much broader range of services designed to match how seniors want to live their lives. And this transition involves three unique public policy initiatives, not all of which are supported by others in the nursing home industry.

Reinvent: Policy initiatives enable better service
While many in the long-term care profession focus solely on seeking increased reimbursement rates from federal and state government, Ecumen is taking a different approach through three policy initiatives.

First, Ecumen is lobbying both the Congress and the Minnesota Legislature to enact tax credits for technology used in homes of senior citizens. For example, various sensory devices can tell a senior’s family and medical providers when the person needs help. With such devices, the person doesn’t have to be in a health care facility. Technology can take over a role that once made it necessary to put a person under constant care, and simultaneously help that person maintain independence and stay in his or her own home. But policy changes and funding changes are necessary to enable these technologies. (It’s worthwhile to note here that Brinckerhoff devotes significant text to helping nonprofits rethink mission delivery in the light of new technologies or, as he calls it, “meeting techspectations.”)

A second policy initiative is to encourage nongovernmental sources of financial assistance for senior care options. Ecumen is working with the Minnesota Department of Commerce to revise regulations on how long-term care insurance policies can be packaged with other insurance forms such as life and health. One idea that has been tried elsewhere is to package long-term care with life insurance so that if and when seniors needs special medical assistance later in their lives the cost of this care can be subtracted from what otherwise would be their life insurance proceeds at death. Funding options like this give seniors access to more funding resources. Such options also will ultimately reduce public expenditures for both Medicaid and Medicare.

A third thrust of Ecumen’s public policy innovation is to encourage the state’s Department of Human Services to expand and promote so-called waivered services. Such services allow a senior’s family members to be paid to help care for the individual.

All three of these policy options pursue Ecumen’s mission of giving seniors more choices than would be available through status-quo mission delivery. Many current practices simply can’t be financed by meager governmental resources.

What Can We Learn from Ecumen?
These examples of policy advocacy by a far-sighted nonprofit organization working at the confluence of mission, policy, and generational change suggest that the realm of policy advocacy is much broader than nonprofits traditionally think. But what kind of organization is prepared to face challenges with such energy? What can other organizations learn from Ecumen’s efforts? Stepping back from the story a bit, we see that the organization is:

• Community-driven: It researches what it constituents need and acts on the results.
• Mission-loyal: The organization looks beyond the bounds of its current programs to consider what the mission demands of the organization.
• Reality-based: It attends to the facts of its environment as shaped by demography, finance, and public policy.
• Creative: It innovates in response to the overlap of mission, community need, and environmental reality to generate new organizational patterns rather than reinforce static behavior.
• Bold: It accepts the risk it incurs when public actions put the organization up for public critique and when creative responses change current practice.
• Future-sensible: It thinks deeply about coming changes but works pragmatically in the present moment to capitalize on them.

Of course, these attributes add up to a strategic view of services and programs that will help the nonprofit sustain itself. But there is far more at stake than whether the organization continues. These attributes allow the nonprofit to better benefit the community it has promised to serve—its reason for existence.

Sincerely,

Vince Hyman
Publishing Director
Fieldstone Alliance

May 16, 2007

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