JUST THE FACTS.

Who: American Association of Homes and Services for the Aging

What: 1999 Annual Meeting and Exposition

Where: Chicago's Navy Pier

When: October 25-28

Attendees: 4.985

Exhibiting companies: 400

THE PROSPECTIVE PAYMENT SYSTEM cast a shadow over AHCA's Honolulu show, and thunderbolts from Wall Street had investors running for cover at NIC's shmoozefest in Washington. But on Chicago's Navy Pier, the site of AAHSA's 38th annual meeting and exposition, it was blue skies and smooth sailing. With attendees and exhibitors numbering nearly 7,000--the organization's largest show ever--it was clear that the not-for-profit side of the long term care business is in ascendance. One reason may be, as spokesman Robert Greenwood, put it, "reimbursement changes have taken the profit motive out of long term care." Another reason: Everyone was talking expansion as providers reaffirm their historic mission of offering a continuum of care.

The big bopper: Len Fishman deserves no small amount of credit for the conference's buoyant mood. A great cheerleader for the industry, AAHSA's new president and CEO said at the opening ceremonies that senior housing and care is at the forefront of America's concerns. Pointing to a recent cover story in Time titled "Taking Care of our Parents," Fishman said, "We have an unprecedented opportunity to address the public."

Noting that the story was directed not at seniors but at their baby boomer children, a group that will take its "sense of entitlement into old age," Fishman sounded a clarion call for consumer-driven care. "Providers will have to shape long term care around the needs and preferences of customers," not themselves.

AAHSA also should be "drivers of a system that serves all economic groups," he said. And who better than not-for-profits to lead the charge, he said, citing a recent New York Times editorial--a "love letter to AAHSA," he called it--that lavished praise on four faith-based facilities--then zinged for-profits as "the homes with the worst financial troubles--and the most consistent patterns of resident abuse."

At a press breakfast following the opening session. Fishman said he was most excited by the growth of "housing with support services," a.k.a assisted living and CCRCs. "Why has it taken us so long to figure this out?," he asked, saying we need to rethink financing, be it "Medicare, Medicaid, private insurance, or out-of- pocket," to embrace these models.

On AAHSA's strategy for addressing the hot-button issue of recruitment and retention of frontline workers, Fishman sounded less optimistic, what with unemployment as low as 1.5 percent, the "sensationalizing of bad care driving people out of the field," and government reimbursement failing to take staffing needs into account. One solution: "You need to find ways of empowering frontline workers."

The buzz: AAHSA had better come up with some answers because staffing issues seemed to preoccupy attendees. "The work ethic has degenerated to the point where you can pay staff better wages but that doesn't mean you'll get quality performance," said John Strickland, executive director of Kettering Medical Center, a Miamisburg, Ohio, CCRC.

Echoed John Kaduce, president of Life Care Retirement Communities in Des Moine, "Everyone's running short-staffed. All the survey penalties are a result of short-staffing."

Keynote speaker and Eden Alternative founder William Thomas won some converts. "One of our caregivers is attending breakout sessions on it," said Roderic Shirk, CFO of Lutheran Homes Societies, in Holland Ohio.

The government was a frequent whipping boy at the show. Panelist Steve Volza said he sees a parallel between the Chicago marathon, which overlapped the conference, and obtaining funding for assisted living in New York: Both require working through a "pain barrier."

The bills: The health care policy forum highlighted the latest federal regulatory and legislative activities and AAHSA's initiatives and responses. Fiddling with his microphone, HCFA's Tom Hagen quipped, "It's easier to amplify my voice then to find something useful to say." But he had no trouble finding something flattering to say. "There's a way to lobby HCFA, then there's a nice way--and you guys do it the nice way," Hagen commented.

Or sounding compassionate. "It doesn't bother me a lot to publish a reg people don't like--but it does bother me to make a mistake that hurts people."

But the star of the panel was Barbara Gay, AAHSA's director of congressional affairs, who boasted of recent legislative action on bills amending the Balanced Budget Act, including add-ons in underpaid RUG categories, carve-outs for low-volume business, and a two-year moratorium on therapy caps. In the next session of Congress, she said, look for activity in "prescription drug financing," and count on the Senate Special Committee on Aging "continuing to come up with things for HCFA to enforce and investigate."

The box lunches: On the first day the exposition hail was open, someone forgot the tables so attendees ate their sandwiches picnic-style. By day two, the situation had been corrected and conversation was easier. At one table, Ramesh Chandra Sethi of Senior Citizens Home and Services in Bombay--AAHSA's first member from India--said he "came to learn about facilities, trends, design, and care--and then figure out how to Indianize it. In India there has always been a lot of family bonding, but that's breaking down."

At the same table, a group from Samsung Life Insurance Company, which is building South Korea's first CCRC, said their country also has some catching up to do. "The aging population is growing faster than any other country," noted Nameun Lee.

Brian McLennon, administrator of corporate development for Pacific Retirement Services in Medford, Oregon, said he came to shop for "software to integrate all our seven CCRCs and 20 HUD-202 buildings" and "to scout out executive talent."

AAHSA Chair Stephen Proctor strolled the aisles like a proud father. Expressing astonishment at the turnout, he cited Fishman for "upping the organization's profile," not-for-profit providers' sense of commitment, Chicago's central location, a whopping 160 educational sessions, and an exhibit hall so full, "we had to turn exhibitors away."