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The 5 Big Ideas were developed in 2005 to encapsulate AAHSA's major policy agenda in simplified format. These ideas were based on accumulated beliefs, experiences and successes of members who are developing innovative programs that have broad policy implications. They were designed to advance Quality First.

The original ideas have been revised based on discussion in a variety of venues. They wear well! Now, based on the general acceptance of those messages, following modifications are offered.

1. Personal Care Management.
Whatever the setting, regardless of the size of the community or complexity of family or caregiver dynamics, and irrespective of the various payment sources involved, older and disabled people with complex problems need consumer centered care management. It is essential in helping people navigate a fractured health and human services delivery system. Whether care management means be transitions through the health system in times of acute crisis, effective disease management to forestall decline, or planned interventions to enhance quality of life, learning how to manage care is an essential consumer need, and, therefore an essential competence for tomorrow's successful providers. There are several brands of effective care management, including many developed by our own members over the years, but personal care management is imperative! It leverages and organizes the power of community.

2. Culture Transformation.
Staffing is the best known proxy for quality, and a healthy culture is the key to staff competence and retention. There are numerous successful examples of culture transformation development. They are based on respect for caregivers, team building and management, continuous quality improvement, and resident centered care.

Beyond the positive human resources psychology and the business case that can be made for healthy cultures, AAHSA's Ethics Commission believes that we have a moral imperative to foster corporate cultures committed to social justice. Programs consistent with social justice would include health and retirement benefits, livable compensation, and personal development opportunities.

In addition, our Scenario Planning process has identified consumer activism and talent availability as the two biggest uncertainties facing our field. Those organizations that create healthy cultures for the work force will be those that will meet or exceed consumer expectations. We are in the people business. Culture Transformation is essential to the health and viability of future providers—and more importantly should have a major impact on the health of society.

3. Home Centered Care.
All signs for the future of aging services point to the home as the center of care and services delivery—whether that home is a multi-unit affordable housing site, a continuing care retirement community, a nursing home, or a single family dwelling. Home becomes the center stage of the continuum in every community. Home-centered care will be accompanied by a revolution in financing and regulation to complete the transformation to the future service delivery paradigm.

Home centered service means the creation of tailored environments through better facility design. Smart and flexible architecture and construction will need much attention, because physical environment can undoubtedly delay institutionalization, provide safer living accommodations, help monitor and treat chronic health conditions, and reinforce health promotion.

Applied research around the efficacy of innovative models is essential to provide data for responsible policy, which is the essential mission of the Institute for the Future of Aging Services. Consumers want to live in a place they call home.

4. Technology.
Through the Center for Aging Services Technologies (CAST), it is clear from our members, technology companies and universities, and government that technology is not just an accelerator for aging services transformation but may well be a leader of it. This is because the consumers we serve—and every sector of the world to which they relate—are using technology to acquire knowledge and manage their lives. A lynchpin of life technology will be the life span planning record.

Emerging technology advances in aging services are growing exponentially. The issue for AAHSA members is whether or not we strategically plan for it expeditiously. The issue for government is whether or not consumer behavior will make certain policy decisions around technology irrelevant.

One thing is clear: Technology will make a tremendous difference in quality and cost. The technology phenomenon must be understood, anticipated, and incorporated into the aging services agenda. Providers must play a crucial leadership role in technology development and application for an aging society. High touch, high tech becomes a theme song.

5. Financing Long Term Care.
Myriad studies, trends, and prognostications support the conclusion that the current system of financing long term care through Medicaid, with a smattering of long term care insurance, is inadequate and unsustainable for the country. A new, rational approach is needed that infuses sufficient funds into a national plan. A new national plan should be fair and equitable for all who will have long term care needs, ensure choice to allow people to responsibly remain at home, support the natural care-giving network, be fiscally sound, and be overseen by a governance structure immune from conflicts of interest.

In short: a public insurance model is called for. In such a plan everyone pays a modest premium. There are uniform standards of eligibility and care management. The dollars follow the eligible consumer. And, the money is managed in a sound actuarial and independent structure. This plan could resolve the pending Medicaid financial crisis, and there are precedents for it in other countries challenged by the same demography.

These 5 Big Ideas frame the AAHSA policy and advocacy agenda. They are integrally interrelated. They are aligned in principle. They anticipate a wave of inevitable dynamics facing our country. They reinforce AAHSA's position as thought leaders. They are consistent with AAHSA's long standing ideals as framed years ago at an AAHSA Annual Meeting: "Homes Without Walls..." and all 5 Big Ideas leverage the key ingredient that catalyzes past, present, and future aging care services: The Power of Community. Yes, we all know that responsible communities take care of their own! Our job is to advocate for the national local policy framework that makes serving the elderly and those who care for them much easier to do.