The White House Conference on Aging: a positive view; The report issued this September was born of a conference of controversy. One professional's perspective on what it means.

Editor's Note: In mid-September, the Bush administration released the final report of the 2005 White House Conference on Aging. Some 2,500 delegates--consumers, providers, academics, advocates, association representatives, etc., selected by their respective state governments--had spent several December days in Washington deciding on their "top 50 recommendations" for dealing with the aging of America and strategies for implementation. During the proceedings, though, some attendees tangled with conference organizers over its rules and regulations. And for the first time in the 40-plus-year history of the conference, the President did not appear. In the end some delegates wondered out loud whether it had all been worth it and proposed abolishing the event altogether. What does this signify for the September report? A positive perspective is offered by an experienced healthcare academic and administrator who attended the conference as an observer and commentator. In his view, the conference succeeded in creating a convincing and compelling portrait of America's future.

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THIS SEPTEMBER, THE WHITE HOUSE CONFERENCE ON AGING RELEASED ITS FINAL REPORT. NO DOUBT THE REPORT'S FINDINGS AND RECOMMENDATIONS WILL BE DISCUSSED FOR MONTHS AND EVEN YEARS TO COME. OF IMMEDIATE INTEREST, THOUGH, WAS THE GENESIS OF THIS REPORT. IT IS THE PRODUCT OF A CONTROVERSIAL EVENT.

Not long ago an article in a long-term care industry publication piqued my interest. The author was reporting on one delegate's appraisal of the White House Conference on Aging that occurred last December. I had been there, too, and wondered, initially, if we had attended the same event. Upon reflection I realized that our differences do not so much concern the actual events that took place as the symbolic significance of the occasion.

From the critical delegate's perspective, given its lack of achievements, the White House Conference on Aging ought to be retired forthwith and never convened again. For my part, in covering the conference firsthand for a regional long-term care publication, I was not so much impressed by what it actually accomplished as by the potential it showed for developing the national aging agenda and defining for the next 10 years the relevant issues in aging and healthcare.

Whether we like it or not and whether we agree or not, an aging agenda is out there in public now, thanks to the conference, and it will deeply influence the course of our important debate about aging in America.

Last year's conference occurred just as the baby boomers began to turn 60. The conference was unequivocal: This generation's numbers will profoundly impact aging services and change the way we think about aging in this country. Fittingly enough, boomers (born from 1946 to 1964) were well represented both as conference stakeholders and in many of the forums that occurred before the conference. They acknowledged that these issues touched them personally.

While the conference did not purport to present an aging policy blueprint, or even a plan, as much as a listing or accounting of issues, it represented a beginning. Maybe many actions it took were more symbolic than actual, but they were nonetheless real.

As most readers know, the White House Conference on Aging has occurred approximately every 10 years since 1961. The conference brings together many of the relevant stakeholders associated with aging, including policy makers, political leaders, advocacy groups, service providers, public interest groups, academics, aging constituents, and the press. Many of the aging policy initiatives introduced by the federal government over the past 50 years have been initiated, discussed, and/or recommended by this conference. This year the conference added implementation strategies to its recommendations.

While six major areas of aging were addressed, the most pressing and significant of them were healthcare services and the health status of the aging population. As is becoming increasingly clear, healthcare is becoming the "third rail" of politics and is looming as the single most critical issue in aging.

It did not come as a surprise to me, however, that following the conference there were doubts as to its usefulness and value. For example, before the conference AARP published an article generally favorable to it. However, Eden Alternative/Green House pioneer Bill Thomas commented in the AARP Bulletin following the conference that it had produced "more smoke than fire," and he questioned the value of a gathering that occurs only every 10 years. (And he wasn't the only one.)

There was controversy as well over whether resolutions coming from the floor should be debated--White House organizers had ruled that they could not be--and there were complaints about the lack of input allowed from delegates. However, as noted, the conference's Policy Committee added implementation strategies to the recommendations developed by the delegates, which affirmed, to me at least, that the real work of a conference like this is not so much identifying issues as addressing them.

This conference did not seem much different from the others in action-directed orientation--and we do have the positive example of the 1961 conference, which spawned Medicare and other significant aging programs. It is interesting that one of my graduate advisers, Charles Schottland (former Social Security Administration Commissioner, dean of the Heller School for Social Policy and Management, and president of Brandeis University), used the 1961 conference in his seminars as an example of just how such gatherings and events can result in significant policy changes even when confronted by well-organized and-financed opposition. The 1961 conference recommended the program we now know as Medicare, for example, over the opposition of the American Medical Association and the insurance industry--the first time that a resolution recommending government medical insurance for aging Americans had ever been passed in a public forum. Four years later, Medicare was enacted (with Schottland observing, ironically, that those who opposed it most strongly eventually gained the most from it).

As is widely known now, this most recent conference was the first one that a sitting President did not address. However, Policy Committee members noted that while the President had not been able to fit the conference into his schedule, he had sent more senior representatives of the administration than had previous administrations. Nevertheless, a good many delegates felt that President Bush's absence was, in the words of one delegate, a "snub." One senior delegate from Ohio suggested that the President was afraid to speak in anything but a controlled environment. It was further noted that this administration has presented little in the way of an aging agenda.

It could be argued that, given the President's current standing and public support, his presence would have added only marginal value to the conference. Indeed, some felt that his absence worked to the benefit of those who favor more substantial reforms and a more progressive aging agenda that looks beyond the current presidential administration and into the future.

Despite the well-managed, controlled, and often orchestrated environment, I thought the conference presented well and passionately the concerns of many who contend that the administration is not concerned about issues related to aging. Many delegates represented governors, whose interest and stake in these issues will generate the real political energy and financing to carry them forward into the future. In speaking with many delegations from red states as well as blue states, I found that all had significant concerns about the evident lack of concern at the federal level about aging and the impending challenges that will most certainly have an impact on the states. While national politics seems primarily preoccupied with scandals, Iraq, and the war on terror, aging (as the expression goes) has political "long legs" and will most certainly affect the 2008 elections and beyond.

Unlike previous conferences, and more in line with administration thinking, a good number of the speakers, Policy Committee members and Advisory Committee members were from the commercial sector. Yet their impact was not significant. Even though these administration representatives were in full force and on message, many of their positions failed to make it to the final voting. For example, Social Security privatization did not make the "top 10" recommendations. Indeed, many resolutions favored by the administration and commercial sector were not high on the delegates' agenda, despite the push by administration representatives. If the conference was a "trade show," as some have alleged, the "sponsors" may well wonder what return they received for their investment.

At the end of the conference, to no one's surprise, the top 10 resolutions included many that dealt with healthcare and the Older Americans Act (reenactment of which was recommendation No. 1). The resolution that received the second most votes addressed the need for a more coordinated and comprehensive long-term care strategy. This, too, was no surprise, as many of the delegates expressed concern about the nation's obvious lack of such a strategy. The overall concern about long-term care quality and access was underscored by the popularity of resolutions to strengthen and improve older Americans' access to transportation (No. 3) and to improve Medicaid (No. 4), as well as the need to promote innovative models of noninstitutional long-term care (No. 7) and attain an adequate number of trained and culturally competent workers in geriatrics (No. 9).

The top 10 did include two surprises. The first was the very specific reference to transportation alluded to in No. 3--not often seen in such discussions--and the second was the strong support for improved recognition, assessment, and treatment of mental illness and depression among older Americans (No. 8). This marks the first time that mental health was recognized as an issue at a White House Conference on Aging, and it marked a clear success for the various constituencies that lobbied for it.

No one said, though, that developing and implementing a national aging agenda will be easy. For example, as the conference voted its "top 10," the House of Representatives followed a Bush administration recommendation and voted to virtually eliminate all support for geriatrics-related education. So much for No. 9. Dr. Robert Butler, president and CEO of the International Longevity Center-USA and first administrator of the National Institute of Aging, speaking at the closing session, decried the cut and detailed its dire consequences for baby boomers and aging programs in general if geriatric education is not supported. Even for a get-together as carefully orchestrated as the conference, the dissonance created by this one issue was strongly evident.

Despite the apparent lack of wholehearted support by the Bush administration and the perceived trade show atmosphere, I believe that the priorities set by the conference and its recommended implementation strategies will provide a road map for future political efforts to improve the health and independence of older and aging Americans. Rarely do we have such a national agenda articulated by a cross section of thinkers, providers, and activists. If we look to other social areas, such as education and children's services, there are few similar examples of gatherings held on a regular basis with the potential for generating a national policy agenda.

So, before we prematurely "retire" the White House Conference on Aging, let us acknowledge its true importance. There is something very valuable about such an event, even if it is initially judged to be symbolic.

There were 2,500 people involved in this conference. Their impact on the future will be pronounced, given the fact that many of these delegates attended because they are, in the words of trends authority Malcolm Gladwell, "connectors." Their connections with each other and with the future of aging will be a force, as the national aging agenda evolves and works it way into the public consciousness.

James A. Lomastro, PhD, brings more than 35 years' experience to the field of aging research and policy. With a doctorate from the Heller School for Social Policy and Management at Brandeis University, he has performed clinical research at the Boston University School of Medicine, taught full time and consulted at Northeastern University, and worked for 25 years as a practicing administrator, director, and executive, primarily in aging, human services, and healthcare in public, nonprofit, and profit-making enterprises. He continues to practice as a licensed long-term care administrator and is currently contributing editor to the Healthcare Ledger, a publication reaching 30,000 healthcare professionals in New England, for which he covered the 2005 White House Conference on Aging as a reporter and commentator. For further information, phone [phone] or e-mail [e-mail]. To 0send your comments to the author and editors, please e-mail [e-mail].

BY JAMES A. LOMASTRO, PHD