AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING (AAHSA).

Celebrating Four Decades of Service Innovation

In November 26, 1961, a group of dedicated long-term care professionals met for four days on the banks of the Hudson River to discuss the role and mission of nonprofit providers in long-term care. Out of those discussions was born the American Association of Homes for the Aging (AAHA). Their initial planning and foresight led to the association's becoming an acknowledged leader in aging services, a cutting-edge organization that prides itself on providing wide-ranging services for its members in addition to ongoing advocacy, information and education.

The 1960s

While the for-profit nursing home industry had its own representative organization in Washington, not-for-profits did not. Certainly, some of the leading denominational groups had representation in the nation's capital, but there was no unified voice for the "third sector." Ollie Randall, a founder and vice-president of the National Council of the Aging (NCOA), set about planning to do just that.

At the meeting at Arden House, the American Association of Homes for the Aged (the name of the original California association of not-for-profits) graciously allowed the use of its name. Its first headquarters was at the NCOA offices in New York City. The first board of directors meeting was in January 1962. The first annual meeting attracted 300 registrants, and there were 250 members by the end of the first year.

Lester Davis was the first executive director. He directed the development of the association's early publications such as the "Social Components of Care," educational efforts and important policy initiatives. Early on, the association attempted to seek widespread accreditation of nursing homes. AAHA was instrumental in early legislative efforts on behalf of older Americans, such as the creation of the Older Americans Act, Medicare and Medicaid, and long-term-care-related sections of the Hill-Burton Act.

There was much debate in this era on whether housing for the elderly should be interpreted as a church-related activity. The association advocated for rent subsidies for elderly in need of housing. Throughout this turbulent decade, AAHA leaders served on a variety of presidential advisory boards and task forces, and had a profound impact on the nation's aging policy.

The 1970s

In 1971, the association moved to Washington, DC. There was tremendous growth of state associations during the 1970s, and state and national association relationships were the subject of many leadership meetings. In 1973, the State Executives Forum began and the association held its first spring legislative conference.

In 1975, David Crowley was appointed executive director. The bywords of the late 1970s were corporate self-assessment and resident decision making. Throughout this period, it was recognized that AAHA's constituents included not only the facility but the resident. The "social components of care" philosophy evolved into the first Resident's Bill of Rights.

During this time, there was also much emphasis on promoting the "home without walls" concept; AAHA members branched out into home-and community-based services. Early efforts at regulating nursing homes and funding for the Older Americans Act were the main legislative priorities. There were also perpetual threats to the Section 202 subsidized housing program, and AAHA joined forces with other aging groups to keep it alive. In 1978, AAHA and 19 other organizations founded the Leadership Council of Aging Organizations (LCAO). AAHSA remains an active participant in the LCAO and the aging network in general.

The latter part of the decade was marked by great introspection by the AAHA board as the heterogeneous nature of nonprofits in aging services grew. In its first-ever membership survey, AAHA discovered that 85% of its members offered some type of outreach services to the community at large.

The 1980s

A retreat of the House of Delegates in 1980 set forth a blueprint for much of the decade. It predicted a growing scarcity of public dollars and manpower, and an increasing amount of government interference and bureaucracy, coupled with ongoing competition from the for-profit sector. The delegates were right.

AAHA participated in Institute of Medicine hearings on nursing home quality of care and participated in the development of the nursing home reform law of 1987 (OBRA). AAHA staff worked hard to have its members' interests well represented in the development of the regulations that followed its passage, but had significant problems with their implementation. This led, for example, to the association participating in a lawsuit that delayed implementation of the mental illness/retardation provisions.

Each of President Reagan's budgets called for axing funds for subsidized housing for the elderly. This led to AAHA initiating successful press and coalition efforts to preserve the Section 202 program throughout the decade. Staff also helped guide reform efforts at HUD, where there were some programmatic problems in the early part of the decade.

Staff leadership reins passed to Sheldon Goldberg in 1986. Under the board's direction, he and staff initiated a number of new services for members, such as the first association-sponsored long-term care insurance. AAHA also celebrated its 25th anniversary that year, and The Continuing Care Accreditation Commission (CCAC)--founded by member CCRCs in the Delaware Valley who asked AAHA to expand it nationally--accredited its first facility. As the decade ended, there were 3,300 AAHA members, and the organization had just added its Western and Mid-Atlantic regional offices to the existing Midwestern office in order to expand on its member and state relations activities.

The 1990s

The decade began with hope that AAHA could help the federal government achieve a solution to the nation's long-term care financing problem. By 1993, the board approved a comprehensive national plan that was shared with members of Congress, the White House and other policymakers. It emphasized a public/private partnership and ways to grow private insurance; many of those ideas were passed by Congress as part of a Limited health reform package.

AAHA also took a leadership role, under the aegis of its Commission on Ethics in Long-term Care, to reduce the use of restraints in nursing homes through stepped-up training and communications. The effort worked, as did the commission's encouragement of members to form ethics committees or other ways of "doing ethics." The association adopted a credo in 1991 that codified the "not-for-profit" view of care and services for the aged. Similarly, the association worked with the Catholic Health Association on the development of the Social Accountability Program training program for long-term care organizations.

The association changed its name in 1993 to the American Association of Homes and Services for the Aging (AAHSA) to reflect the fact that more than 90% of members offer some form of community service. There are now, in addition to healthcare and housing, continuing care, assisted living and home- and community-based services staff--representing, in sum, the full continuum of care.

In 1999, Len Fishman became AAHSA's CEO. Under his leadership, the association has reasserted itself in the national debate on long-term care and has increased its efforts to educate policymakers and the public on the vital role that not-for-profits representing the continuum of care will have in the next century. Today, AAHSA consists of more than 5,300 not-for-profit nursing homes, CCRCs, assisted living and senior housing facilities, and community service organizations. More than half of AAHSA's members are religiously sponsored. Every day, AAHSA's members serve more than one million older persons across the country.