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Paul Willging Says...

May 1, 2006
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It All Comes Down to Education

It all comes down to education Having spent so much of my professional career in the public-policy arena, and now working in an academic environment, I'm often asked what the essential differences are between the two. (Actually, to be totally honest, I've never been asked that question-but it seemed like such a natural introduction to this column I thought I'd ask it myself.)

Truth be told, our perception of issues is, to a considerable extent, a function of our occupations. Representing long-term care as a lobbyist for nearly two decades certainly offered me a different perspective on issues facing the industry from that of my current avocation: preparing young men and women for careers in long-term care management, research, and public policy. That doesn't mean the issues themselves are different. From inside or outside the university, the dilemmas facing long-term care administrators are the same: declining census, marketplace competition, and extreme government scrutiny of quality and finance. These issues are on the radar screen no matter where we work in long-term care. But how one accommodates to them, how one prepares to confront them, how one adapts to them-that's how our perspectives might differ.

Certainly, education is the key, in both settings, to dealing with all the issues facing long-term care providers. The distinction lies in the audience. As an industry spokesperson in Washington, the focus of my educational efforts was on policy makers, both in Congress and the executive branch. As a professor, my focus is on students. Yet, although the purposes underlying the educational process in the two settings might differ, the essential function remains the same.

In lobbying, the purpose of education is to proselytize. To "proselytize" means to try to convert someone to a religious faith or political doctrine. We weren't much into religion (at least professionally), but we certainly were paid to talk politics. In the academic environment, the purpose of education is to enhance understanding for a different purpose; namely, improving functional capacity. Whether we academics are educating future policy analysts, researchers, or managers, our goal is to provide students the understanding and tools whereby they can perform those functions to the best of their innate abilities.

In dealing with the issues of census and marketplace competition, I devoted much of my energy as a lobbyist in Washington to the regulatory environment. We in the industry wanted to have an even playing field, with similar rules applicable to all providers along the long-term care continuum. In the reimbursement and financial arenas, the inadequacy of federal and state payments consumed most of our attention. With respect to quality, we wanted to show state and federal government the capricious and arbitrary nature of surveyors' quality measurement techniques.

Were we wrong to do this? Of course not. That was our profession, and there is nothing unethical or immoral about it. But were we successful? The answer to that question is more equivocal because, to some extent, the forces we were fighting were much more a product of larger social and fiscal questions that did not lend themselves to easy resolution, no matter our technical skills as lobbyists. Indeed, to successfully lobby, we had to at least understand those broader systemic concerns.

Problems with census and the marketplace are not a simple response to the government's inadequate regulatory oversight. Rather, they're the result of an increasing population of affluent seniors and their families who can now purchase products, including long-term care, more in tune with their individual preferences. Nor do state governments underpay providers (and they certainly do underpay) out of a sense of malevolence. No, it's because of the incredible burden that our current system of long-term care financing places on limited public funding sources. Moreover, increasing regulatory scrutiny could well be a result of legitimate public frustration over the (thankfully) small number of providers whose concern about quality is suspect.

What does all this say about the respective roles of lobbyists and educators? Well, for the lobbyist, it might suggest making an attempt to deal with larger social issues while simultaneously looking for immediate relief. And I commend today's trade associations for beginning, belatedly perhaps, to pay as much attention to the underlying issues of quality and long-term financing reform as they do to the regulatory burden and short-term reimbursement relief. In fact, neither perspective can be ignored, and neither can nor should be pursued to the detriment of the other. Both, within their own time frames, will make for a more secure industry, if dealt with successfully.

For the educator, however, I think it's equally important that we teach our students, even those oriented primarily toward a career in management, to distinguish between technical and systemic accommodation to the issues facing them as administrators, so that they might better understand their interplay and how they affect one another.