In PA 741: Emerging Trends in Public Service with Dr. Al Hyde, we were tasked with writing a seminar paper that explores a public issue that will need to meet challenges of a changing world. Prior to beginning the MPA program, I had been a director of two adult day care programs. In response to the potential opportunities offered by the Affordable Care Act (ACA), I had been charged with reinvigorating the programs and positioning them as viable, affordable and legitimate alternatives to institutionalization. This paper was informed by my own professional struggles with meeting the challenges of a changing world from the perspective of a nonprofit administrator who neither had time or resources to develop a well-conceived strategic plan.

With the 65 and older demographic expected to double to 88.5 million by 2050, this Silver Tsunami is expected to have tremendous impacts on long-term care. With the cost of nursing home care expected to double in cost and the government expenditures for long term care expected to triple, re-charting the territory of long-term care will be necessary to meet the needs of Silver Tsunami. The paper analyzes who makes up the Silver Tsunami, the structural gaps in the spectrum of long term care, and the implications on seniors, families, and the players in the long-term care market. The paper then focuses on adult day care programs that has long been overlooked by government and often called the “best kept secret” in long-term care. Recommendations include a suggestion to policymakers to recognize the role of adult day care programs as an effective and affordable provider of care and suggestions to nonprofit providers to redesign and innovate care to stay competitive with for-profit organizations.


"Silver Tsunami" image from MacKay MacKay