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Milliken: Cost, regulation burden aging services; nonprofits carry out their mission

As I prepare to retire this month and reflect on my 45 years in senior living, I am amazed at how much change there has been yet how much must still occur to meet the need that lies ahead. Consumer demand, recruiting and retaining staff, working within Maryland’s regulatory environment, and managing the cost of care will continue to be challenges.

Today’s seniors want to live well and be well longer, but also want to know that quality care is available when needed. Residents at Carroll Lutheran Village live independently about eight years longer before needing long-term care versus those who move to our Health Care Center directly from the greater community. Why? Continuing care retirement communities, as they are called in Maryland, create environments where residents thrive in an active, social and supportive environment. They are attractive for the lifestyle and the availability of assisted living and short and long-term skilled care when needed. Providers must recognize changing consumer preferences and offer services that will improve quality of life while offering some security for future care.

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A skilled workforce is paramount to meet the needs and desires of seniors as many will transition from independence to living with some assistance. Long-term care providers particularly are stereotyped as institutional and often conjure up images that are degrading to both seniors and those who care for them. As a result, young people don’t often consider aging services as a career path. In my experience, however, those who do are incredible people who work for more than a paycheck — they make a difference to the people they care for and the organizations they serve. Yet recruiting and retaining the best talent is a challenge given the regulatory environment in Maryland and the continual decline in care reimbursements. Fortunately, Carroll Lutheran Village has been blessed with many caring and compassionate team members.

Aging services in Maryland are highly regulated compared to other states making it difficult to start or expand services. Existing providers find that compliance in the current regulatory environment is costly — and even more costly if they fail to comply. In reacting to a few poor performers in senior living, Maryland has made regulatory compliance a priority over caring for people. In skilled care, for example, nurses spend an inordinate amount of time documenting the care they provide to avoid fines and citations. This does little to improve the quality of services or add value to the consumer. I agree that providers should be regulated and held accountable. However, when compliance takes priority over providing hands-on care, the regulations have become a detriment to the people they are meant to protect. These regulations also come with costs not fully reimbursed by Medicare or Medicaid.

As the cost of health care in general increases, Medicare and Medicaid reimbursements continue to decline. The cost of uncompensated care is passed to the consumer or absorbed by the organization caring for them. It is understandable that many people prefer to stay in their homes for as long as possible. For those who need some support, in-home care services may be an affordable option. But when 24-hour support is needed, in-home care is typically more expensive than an assisted living or skilled nursing center. The need for assisted living and skilled nursing centers will always exist. Providers must change their service models to offer an experience that seniors will value while managing increasing costs. For many for-profit providers the answer is higher rates and other tactics to protect their profit margins. Nonprofits, however, operate differently.

The nonprofit difference has been a mantra for my entire career. Nonprofits face the same challenges and opportunities as for-profits. The difference is mission. Nonprofits serve people and their communities first and fundraise to help underwrite the cost. Nonprofits rely on the communities they serve to support them as they carry out their mission of service. Carroll Lutheran Village is been fortunate to have the support of the greater community as we continue to serve our residents and our community.

I leave next month knowing that the 40-year legacy of Carroll Lutheran Village is in capable hands. Thank you for the honor and privilege of serving this community for the past 25 years.

Carroll Lutheran Village President/CEO Geary K. Milliken is retiring after 25 years on June 21.

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