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Developing a long-range plan

August 1, 2007
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For a distinguished organization with a long track record in elder services, long-range planning for the 21st century was a challenge

ong-range planning for an organization is never an easy task. It can be especially demanding when the organization has a historic track record of pioneering service. This was the challenge we faced not long ago at the Jewish Home and Hospital Lifecare System (JHHLS) in the New York metropolitan area.

For more than 155 years, the JHHLS mission has been to provide health, housing, and supportive services for frail elders. Today, the Jewish Home's scope includes three nursing homes/rehabilitation centers (in Manhattan, the Bronx, and Westchester County), low- and moderate-income se-nior housing, a long-term home healthcare program serving more than 1,000 clients, a home health aide agency, medical and social adult day programs, telemedicine, and a transportation program serving the system's elders by bringing them daily to day centers and outside medical appointments. Its governance structure consists of a sys-tems board and four divisional boards, one for each nursing home and the Community Services Division.

As a leader in aging services, JHHLS has provided many of these services before they were mandated or even the norm. It had the first nursing home in the country to have a full-time social worker (1938), subsidized apartments for self-reliant elderly (1939), home healthcare services (1940), full-time physician services (1942), a department of rehabilitation (1956), and medical-student training in geriatrics (1984). Our emphasis, as a not-for-profit direct service center serving 10,000 seniors annually, is on dignity, quality, innovation, research, and education.

To maintain 21st century leadership, the board of trustees wanted a long-range plan that would prioritize and wisely guide its initiatives and decision-making process for the next 15 years. The issues needing consideration included future demographic imperatives; potential government initiatives; the challenge of meeting the needs of an increasingly diverse population of seniors aged 85+; evolving consumer aspirations, including the desire to remain at home through changing circumstances; aging and inadequate physical plants; the desire for culture change; the impact of managed care; nursing shortages; unstable revenue and reimbursement streams; and increasing government regulation.

Thus, for the third planning process in our 155-year history, the chairman of the system's board of trustees formed a committee of board members and executive management. The committee conducted field trips to facilities identified as innovators. Guest speakers discussed demographics and healthcare delivery trends, end-of-life care, community planning, governmental regulations, and political outlooks. The committee also held focus groups; conducted individual and group interviews with staff, residents, families, administrators, and department heads; and organized a retreat for the system's board, the board of trustees of each nursing home, and the Community Services Division.

The resulting long-range plan recognizes that the future will focus on service delivery in individuals' own homes; it identifies the caregiver as a member of the “service family,” for whom supports are a part of our mission; it notes that wellness is an organizational priority; and it focuses on diversifying revenue streams. Although the process culminated with a renewed passionate commitment to care for the elderly, it fundamentally shifted the organization's focus to lifetime care, with an emphasis on wellness, care for caregivers, and providing community services regardless of recipients' income. Our new mission statement reflects this: “We are passionate about the quality of aging. The services we provide support health, individuality, and dignity. Our mission is Lifecare.”

Our mission is guided by six “pillars” to support and guide the strategic plan for 2020: (1) empowering the workforce with concepts of leadership and customer-focused service; (2) conducting research, education, and advocacy for innovative methods of caring, sharing best practices, and promoting quality aging through prevention and technology; (3) addressing the needs of individuals and caregivers to achieve person-centered care and anticipate as well as satisfy their needs; (4) welcoming the Jewish community to ensure a Jewish environment that is respectful of all religions; (5) creating communities of caring in and outside existing and future facilities; and (6) promoting wellness to support healthy aging and a more holistic approach, striving for preventive, wellness-oriented care at home or in other settings.

The long-range planning process behind these developments taught us several lessons about what to do and not do in conducting such an effort:

It is important to anticipate and manage planners' expectations. Managing expectations is important to every significant process within the not-for-profit sector. For long-range planning, specifically, it is important that all internal and external publics understand the realities of the process, including the required time frame, the required commitment by committee members, the costs, the opportunities for staff and other input, and the format and content of the final product.