creating a centennial vision : four possible scenarios the american occupational therapy association
TRANSCRIPT
Creating a Creating a Centennial VisionCentennial Vision::
Four Possible ScenariosFour Possible Scenarios
The American Occupational Therapy The American Occupational Therapy AssociationAssociation
Apple’s Vision of the “Knowledge Navigator” in 1987
A VISIONARY EXAMPLE
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Apple’s Vision Fostered the Apple’s Vision Fostered the Development of:Development of:
Portable, wireless flat screen computersPortable, wireless flat screen computers Multiple input devices (voice, touch)Multiple input devices (voice, touch) Simultaneous applications Simultaneous applications Agents (AI)Agents (AI) Integrated IT (phone, data, network)Integrated IT (phone, data, network) Personal data managers (calendar, tasks)Personal data managers (calendar, tasks) VideoconferencingVideoconferencing Data mining and retrievalData mining and retrieval
(Sculley, 1989)
When When we imagine future worldswe imagine future worlds
and create visions,and create visions,by acting on those visions by acting on those visions
we set in motion we set in motion circumstances that circumstances that
enable our imagination enable our imagination to become reality.to become reality.
Mahatma Gandhi (1869–1948)
“Be the change you want to see in the world.”1
1ThinkExist.com, 2005a.
Imagine a world differentImagine a world differentthan the one you now inhabit...than the one you now inhabit...
© Sonia Coleman. Used with permission.
What must What must the the profession of profession of occupational occupational therapy do therapy do during the during the next twelve next twelve years to best years to best position position itself for the itself for the world of world of 2017 and 2017 and beyond?beyond?
Shaping the Centennial VisionShaping the Centennial Vision
© Sonia Coleman. Used with permission.
Looking to the Future:Looking to the Future:Some Common MistakesSome Common Mistakes
Making predictions rather than attaching Making predictions rather than attaching probabilities to possibilitiesprobabilities to possibilities
Simply extrapolating current trendsSimply extrapolating current trends Overestimating the influence of short- Overestimating the influence of short-
term changeterm change Underestimating the influence of long- Underestimating the influence of long-
term changeterm change Thinking of only one futureThinking of only one future
Planning for ChangePlanning for Change
Change is constantChange is constant
In the present age, change is not In the present age, change is not incremental, it is exponentialincremental, it is exponential
No one can exactly predict the future, but No one can exactly predict the future, but we can anticipate the course of known we can anticipate the course of known trendstrends
Unexpected or “wildcard” events are key Unexpected or “wildcard” events are key reasons why known trends are not reasons why known trends are not foolproof in predicting the futurefoolproof in predicting the future
Examples of WildcardsExamples of Wildcards The stock market crash The stock market crash
of 1929of 1929 The attack on Pearl The attack on Pearl
HarborHarbor Shooting of Martin Shooting of Martin
Luther King, Jr.Luther King, Jr. The advent of HIV-AIDSThe advent of HIV-AIDS The fall of the Soviet The fall of the Soviet
UnionUnion The 9-11 attacksThe 9-11 attacks
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Consider where the profession is nowConsider where the profession is now
Anticipate what the public’s needs are Anticipate what the public’s needs are likely to be as the country moves into the likely to be as the country moves into the third decade of this century and beyondthird decade of this century and beyond
Identify the services that must be Identify the services that must be provided at that point to meet those provided at that point to meet those needsneeds
Take steps to prepare the profession to Take steps to prepare the profession to provide those servicesprovide those services
Therapeutic Positioning in the Therapeutic Positioning in the Strategic SenseStrategic Sense
““Skate to where the puck is Skate to where the puck is going to be.” going to be.” ——Wayne GretzkyWayne Gretzky11
““Skate to where the puck is Skate to where the puck is going to be.” going to be.” ——Wayne GretzkyWayne Gretzky11
• Identify and understand important trends
• Take steps to shape events
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1ThinkExist.com, 2005b.
The point The point is not to is not to predict the predict the future, future, but to but to prepare for prepare for it and to it and to shape it.shape it.
© Health Canada, www.hc-sc.gc.ca. Used with permission of the Minister of Public Works and
Government Services, Canada, 2005.
Occupational TherapyOccupational Therapy
Current profile and emerging areas of practiceCurrent profile and emerging areas of practice
© Health Canada, www.hc-sc.gc.ca. Used with permission of the Minister of Public Works and
Government Services, Canada, 2005.
T o t a l P r a c t i t io n e r s : 1 1 2 , 6 5 3
O T s 8 2 , 9 9 0
O T A s 1 9 , 9 9 0
Occupational Therapy Occupational Therapy Workforce Workforce
(AOTA, 2005)
Workforce Trends Workforce Trends 1968–20031968–2003
20,000
40,000
60,000
80,000
100,000
120,000
1968 1978 1988 1998 2003Year
OTAs
OTs
(AOTA, 2005)
Practice SettingsPractice SettingsHospital
13%
College/ Academics
10%
Rehab6%
Other10%
Skilled Nursing/ Residential
Care13%
School System31% Outpatient
6% Private Practice5%
Community-Based
6%
(AOTA, 2005)
Today’s Emerging Areas of Today’s Emerging Areas of Occupational Therapy PracticeOccupational Therapy Practice
Ergonomics consulting Design and accessibility consulting and home
modification Older driver assessment and training Consulting to assisted-living facilities Technology and assistive-device development and
consulting Health and wellness consulting Low vision rehabilitation Addressing Alzheimer's disease and caregiver training Addressing the needs of children and youth Community services
Important Drivers of ChangeImportant Drivers of Change
Aging and longevityAging and longevity
Universal design Universal design
Internet and the Information AgeInternet and the Information Age
Prospective and preventive Prospective and preventive medicinemedicine
Changing world of workChanging world of work
Information accessInformation access
Drivers of Change (cont.)Drivers of Change (cont.)
Diversity of population Diversity of population
Stress and depressionStress and depression
Developments in assistive Developments in assistive technologies technologies
Changes in lifestyle values and Changes in lifestyle values and choiceschoices
Health care costs, reimbursement Health care costs, reimbursement issues, and the efficacy of careissues, and the efficacy of care
10% 14%
(9%)5%
75%
54%
(U.S. Census Bureau, 2002)
Under 15
15–34 35–44 45–54 55–64 65+
Total U.S. Population Growth:18%
Change in PopulationChange in Population20002000––20202020
Age (years)
UNIVERSAL DESIGNUNIVERSAL DESIGNRecognizes that people are different
Equitable useEquitable use Flexibility in use Flexibility in use Simple and intuitive Simple and intuitive
useuse Perceptible Perceptible
informationinformation Tolerance for errorTolerance for error Low physical effortLow physical effort Size and space for Size and space for
approach and useapproach and use
Copyright Copyright © 1997 NC State University, The Center for © 1997 NC State University, The Center for Universal DesignUniversal Design
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Information AgeInformation Age
• Rise of the personal computer
• The Internet
• Wireless connectivity
• Personalization
• Privacy/identity concerns
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Changing World of WorkChanging World of Work• Growth in the service sector, Growth in the service sector, more specific risksmore specific risks
• New forms of work (e.g., New forms of work (e.g., telework, job sharing, contracting)telework, job sharing, contracting)
• Growing interest in autonomous Growing interest in autonomous work (entrepreneurism)work (entrepreneurism)
• Changing management Changing management structures (flatter, smaller, leaner)structures (flatter, smaller, leaner)
• Increasing work pace and Increasing work pace and workloadworkload
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About 25 million About 25 million (10%)(10%) of of current U.S. residents current U.S. residents were not born in the U.S.were not born in the U.S.
The Hispanic population The Hispanic population will increase from 37 will increase from 37 million today to 55 million million today to 55 million by 2020 (49% increase).by 2020 (49% increase).
By 2020, the median age By 2020, the median age of Hispanics will be 28.8 of Hispanics will be 28.8 versus 37.6 for the total versus 37.6 for the total population.population.
Cultural Diversity in 2020Cultural Diversity in 2020
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Stress-Related DisordersStress-Related Disorders There is growing There is growing
evidence of a clear evidence of a clear connection between connection between stress and chronic stress and chronic disease through the disease through the immune system.immune system.
The term The term “allostasis” refers to “allostasis” refers to the body’s response the body’s response to the stress of life to the stress of life over time.over time. F
rom
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Chronic StressChronic Stress“Provides a hormonal milieu conducive to “Provides a hormonal milieu conducive to
the development” ofthe development” of
Visceral obesityVisceral obesity Insulin resistance/dyslipidemia syndromeInsulin resistance/dyslipidemia syndrome HypertensionHypertension AtherosclerosisAtherosclerosis OsteoporosisOsteoporosis Immune dysfunctionImmune dysfunction DepressionDepression Irritable colonIrritable colon Peptic ulcerPeptic ulcer Substance abuseSubstance abuse
(VanItallie, 2002, pp. 40–45)
Specific Measures: Specific Measures: Allostatic LoadAllostatic Load
Blood Blood pressurepressure
Cortisol Cortisol excretionexcretion
C-reactive C-reactive proteinprotein
LDL, HDLLDL, HDL Total Total
cholesterolcholesterol
Body mass indexBody mass index Waist-to-hip ratioWaist-to-hip ratio Noradrenalin Noradrenalin EpinephrineEpinephrine DHEADHEA
Robert M. Sapolsky
Why Zebras Don’t Get Ulcers A readable and
useful overview of the
relationship among stress, disease, and
coping
DepressionDepression The inability to cope with the demands of The inability to cope with the demands of
everyday life can lead to depression.everyday life can lead to depression.
About 26% of Americans had a mental About 26% of Americans had a mental health disorder in 2002.health disorder in 2002.
Two thirds (66%) of these cases were Two thirds (66%) of these cases were moderate or severe.moderate or severe.
Only 52% of the severe cases, 34% of the Only 52% of the severe cases, 34% of the moderate cases, and 23% of the mild moderate cases, and 23% of the mild cases were treated by professionals.cases were treated by professionals.
(Narrow, 1999)
Assistive TechnologiesAssistive Technologies
Smart home monitoringSmart home monitoring RoboticsRobotics Programmed electrical stimulation of Programmed electrical stimulation of
muscles to enable movementmuscles to enable movement Cochlear implantsCochlear implants Biosensors and biomonitoringBiosensors and biomonitoring New uses of telemetryNew uses of telemetry
Technological AdvancesTechnological Advances Nanotechnology:Nanotechnology:
Molecular-scale Molecular-scale machines to deliver machines to deliver drugs, repair cells, or drugs, repair cells, or produce needed produce needed proteins or enzymes proteins or enzymes
Use of genetic markersUse of genetic markers
Regenerative Regenerative medicine/stem cell medicine/stem cell breakthroughsbreakthroughs
Wearable Wearable diagnostics/monitoring/ diagnostics/monitoring/ imagingimaging Fro
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Continued debate on the meaning of family
Greater emphasis on balancing work and family
Less interest in lifelong careers
Growing acceptance of end-of-life options
Growing recognition of the importance of social factors influencing health (e.g., ICF)
Greater appreciation for quality-of-life issues
Lifestyle Values & ChoicesLifestyle Values & Choices
DALYs(thousands)
Percent of total
All causes 160,944
1. Ischaemic heart disease 15,950 9.9
2. Unipolar major depression 9,780 6.1
3. Cerebrovascular disease 9,425 5.9
4. Road traffic accidents 7,064 4.4
5. Alcohol use 6,446 4.0
6. Osteoarthritis 4,681 2.9
7. Trachea, bronchus, and lung cancers 4,587 2.9
8. Dementia & other degenerative CNS disorders 3,816 2.4
9. Self-inflicted injuries 3,768 2.3
10. Congenital abnormalities 3,480 2.3
DALYS*DALYS*
100.0
*Disability Adjusted Life Years (a measure of disease burden)(Murray & Lopez, 1996)
DALYs(thousands)
Percent of total
All causes 160,944
1. Ischaemic heart disease 15,950 9.9
2. Unipolar major depression 9,780 6.1
3. Cerebrovascular disease 9,425 5.9
4. Road traffic accidents 7,064 4.4
5. Alcohol use 6,446 4.0
6. Osteoarthritis 4,681 2.9
7. Trachea, bronchus, and lung cancers 4,587 2.9
8. Dementia & other degenerative CNS disorders 3,816 2.4
9. Self-inflicted injuries 3,768 2.3
10. Congenital abnormalities 3,480 2.3
DALYS*DALYS*
100.0
*Disability Adjusted Life Years (a measure of disease burden)(Murray & Lopez, 1996)
Number of Medicare BeneficiariesNumber of Medicare Beneficiaries
25.531.0 34.1 38.6
52.2
68.2
20.4
8.6
8.7
7.35.4
3.33.0
0
10
20
30
40
50
60
70
80
1970 1980 1990 2000 2010 2020 2030
Calendar Year
Disabled & ESRD
Elderly
* Estimated. Numbers may not sum due to rounding.
Source: CMS, 2004.
The number of people Medicare serves will nearly double by 2030.
20.4
28.4
34.3
39.6
45.9*
61.0*
76.8*
Me
dic
are
En
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me
nt
(mil
lio
ns
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Percent of Individuals Percent of Individuals Limited in Activities Because of Limited in Activities Because of
Chronic Conditions (By Age)Chronic Conditions (By Age)
0
5
10
15
20
25
30
35
40
45
%
< 18 18Ğ44 45Ğ64 65Ğ74 75 +
Age(Robert Wood Johnson
Foundation, 1996)
U.S. Health Care CostsU.S. Health Care Costs Medical care at end of life consumes 10%–12% of
total health care budget and 27% of Medicare budget.
At least one third of all Medicare expenditures provide care for eventually fatal illnesses.
About 27%–30% of the total Medicare budget is spent in the final year of life.
Of total amount spent in final year of life, nearly 40% is spent in the last 30 days.
Hospice care can save 25%–40% of health care costs during the last month of life.
(Trupin, Rice, & Max, 1995)
One view of what we need to design a One view of what we need to design a successful health care system for the successful health care system for the
futurefuture
Crossing the Quality Chasm:Crossing the Quality Chasm:A New Health System for the A New Health System for the
21st century21st century
——Institute of Medicine (IOM), Institute of Medicine (IOM), 20012001
IOM Report: IssuesIOM Report: Issues
Between the health care we have and the Between the health care we have and the care we could have lies not just a gap, but care we could have lies not just a gap, but a chasm.a chasm.
A system full of under use, inappropriate A system full of under use, inappropriate use, and overuse of careuse, and overuse of care
A system unable to deliver today’s A system unable to deliver today’s science and technology; will be worse science and technology; will be worse with innovations in the pipelinewith innovations in the pipeline
IOM Report: Issues IOM Report: Issues (cont.)(cont.)
A fragmented system characterized by A fragmented system characterized by unnecessary duplication, long waits, and unnecessary duplication, long waits, and delaysdelays
Poor information systems and disorganized Poor information systems and disorganized knowledgeknowledge
““Brownian motion” rather than Brownian motion” rather than organizational redesignorganizational redesign
A system designed for episodic care when A system designed for episodic care when most disease is chronicmost disease is chronic
Health care providers operate in silosHealth care providers operate in silos
IOM Report: IOM Report: RecommendationsRecommendations
Commit to a national statement of purpose for Commit to a national statement of purpose for the health care systemthe health care system
Six aimsSix aims– Safety: Avoid injuriesSafety: Avoid injuries– Effective, evidence-based practiceEffective, evidence-based practice– Patient-centered: Patient values guide decisionsPatient-centered: Patient values guide decisions– Timely: Reduce waiting and delayTimely: Reduce waiting and delay– Efficient: Avoid wasteEfficient: Avoid waste– Equitable: Care doesn’t vary by gender, ethnicity, Equitable: Care doesn’t vary by gender, ethnicity,
etc.etc.(IOM, 2001, pp. 5–6, 9–12)(IOM, 2001, pp. 5–6, 9–12)
IOM Report: Getting Evidence IOM Report: Getting Evidence Into Health Care DeliveryInto Health Care Delivery
Ongoing analysis and synthesis of medical Ongoing analysis and synthesis of medical evidenceevidence
Delineation of guidelinesDelineation of guidelines
Identification of best practices in design of care Identification of best practices in design of care processesprocesses
Better dissemination to professionals and publicBetter dissemination to professionals and public
Decision support toolsDecision support tools
Goals for improvementGoals for improvement
Measures of quality for priority conditionsMeasures of quality for priority conditions(IOM, 2001, pp. 19–20)(IOM, 2001, pp. 19–20)
Question:Question:Are today’s emergingAre today’s emerging
areas of practiceareas of practicealigned with the needsaligned with the needs
that will be presentthat will be present
in the year 2020?in the year 2020?
Answer:Answer:We can’t know with We can’t know with
certainty. But one approach certainty. But one approach that will help answer that that will help answer that
question and guide planning question and guide planning in an informed way involves in an informed way involves
the creation of scenarios.the creation of scenarios.
How to Best Think About the Future?How to Best Think About the Future?
No absolute answer to the question, but No absolute answer to the question, but tarot cards and crystal balls are not the tarot cards and crystal balls are not the answer.answer.
Think of the drivers of change.Think of the drivers of change.
Use the drivers of change to imagine Use the drivers of change to imagine different scenarios of the future.different scenarios of the future.
Imagine at least three scenarios; each Imagine at least three scenarios; each should be plausible but different.should be plausible but different.
Step backward from future scenarios to Step backward from future scenarios to think about what to do now to prepare.think about what to do now to prepare.
What is Scenario PlanningWhat is Scenario Planning??
A way of analyzing known trends in A way of analyzing known trends in order to imagine conditions that order to imagine conditions that define views of possible worldsdefine views of possible worlds
These possible worlds are used as These possible worlds are used as planning structures to guide thinking planning structures to guide thinking about potential courses of actionabout potential courses of action
Four ScenariosFour ScenariosA.A. Familiar Territory (Expected)Familiar Territory (Expected)
B.B. Scare City (Feared)Scare City (Feared)
C.C. Bold New Frontier (Aspirational)Bold New Frontier (Aspirational)
D.D. Shining City on the Hill (Visionary)Shining City on the Hill (Visionary)
Scenario Profile CategoriesScenario Profile Categories
DemographicsDemographics
Health careHealth care
Mental and physical well-beingMental and physical well-being
Design and technologies for quality livingDesign and technologies for quality living
EducationEducation
Occupational therapy practice Occupational therapy practice environmentenvironment
OT ScenariosOT Scenarios
Familiar TerritoryFamiliar Territory Scare CityScare City
Bold New FrontierBold New Frontier Shining City on the HillShining City on the Hill
Describes a feared Describes a feared future where current future where current challenges cascade into challenges cascade into an era of limited an era of limited opportunities for opportunities for occupational therapyoccupational therapy
Describes an expected Describes an expected future with enough future with enough opportunity for the opportunity for the profession to progress profession to progress steadily alongsteadily along
Describes an aspired future Describes an aspired future shaped by scientific and shaped by scientific and technological advances technological advances that could alter the that could alter the practice of occupational practice of occupational therapytherapy
Describes a visionary Describes a visionary future where a more future where a more holistic view of health holistic view of health transforms occupational transforms occupational therapy and its role in therapy and its role in societysociety
Familiar Territory Familiar Territory Expected Future OverviewExpected Future Overview
Increasing numbers of elderly Increasing numbers of elderly people benefit from early people benefit from early interventions, living longer and interventions, living longer and with less disabilitywith less disability
Community design aids mobilityCommunity design aids mobility
Health care services become Health care services become more client-centered for clients more client-centered for clients who have insurance or can who have insurance or can afford to payafford to pay
Schools diversify in their ability Schools diversify in their ability to meet student needsto meet student needs
© Health Canada. Used with permission of the
Minister of Public Works and Government Services, Canada, 2005.
Scare CityScare CityFeared Future OverviewFeared Future Overview
The lucky few buy their way up to the services they need
Increases in disability overwhelm health care and school systems
Promising alternatives exist, but they elude the majority
As resources for quality of life grow scarce, mental and physical well-being decreases
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Bold New FrontierBold New Frontier Aspirational Future OverviewAspirational Future Overview
Advanced science and technology transforms health care and learning
Buildings and communities are rationally designed for mobility and independence
Traditional institutions are yielding to distributed venues for health, education, and social services
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Shining City on a HillShining City on a HillVisionary Future OverviewVisionary Future Overview
The values of holistic The values of holistic approach to health lead to approach to health lead to longer, more meaningful longer, more meaningful lives for everyonelives for everyone
Prevention is reinforced Prevention is reinforced by caring relationshipsby caring relationships
People of all ages interact People of all ages interact in livable environmentsin livable environments
Disabilities have lost their Disabilities have lost their stigma as people openly stigma as people openly pursue their full potentialpursue their full potential
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Connecting the DotsConnecting the DotsCurrent Current
StateStateFutureFuture
ScenarioScenarioPossiblePossible
ImplicationsImplicationsFewer thanFewer than1% of OTs work1% of OTs workin mental health.in mental health.
Mental illness is Mental illness is becoming a major becoming a major health burden.health burden.
Continuing Continuing education, education, education, licensureeducation, licensure
Much content inMuch content ineducational educational programs is aboutprograms is aboutbody structure and body structure and function.function.
Developments in Developments in stem cells, assistive stem cells, assistive technologies, etc.,technologies, etc.,may restore may restore functional ability.functional ability.
Educational Educational programs may need programs may need to shift focus to to shift focus to lifestyle and QOL lifestyle and QOL strategies.strategies.
What Will Be Likely, Regardless of What Will Be Likely, Regardless of Which Scenario is Closest to Which Scenario is Closest to
Predicting the Future?Predicting the Future?
Demonstrating value/efficiencyDemonstrating value/efficiency
Being clear about our mission Being clear about our mission (scope of practice)(scope of practice)
Putting patients firstPutting patients first
Constantly trying to improveConstantly trying to improve
Basing what we do on evidenceBasing what we do on evidence
Addressing needs of elderlyAddressing needs of elderly
Group AssignmentsGroup Assignments Rank importance of drivers for the Rank importance of drivers for the professionprofession Consider current conditionsConsider current conditions Discuss scenariosDiscuss scenarios Identify population needs for OT in the Identify population needs for OT in the imagined world (scenario)imagined world (scenario) Identify changes needed to get there Identify changes needed to get there in policy, education, practice, researchin policy, education, practice, research
““The future belongs to The future belongs to the unreasonable ones, the unreasonable ones, the ones who look the ones who look forward not backward, forward not backward, who are certain only of who are certain only of uncertainty, and who uncertainty, and who have the ability and the have the ability and the confidence to think confidence to think completely differently.”completely differently.”1
- - George Bernard ShawGeorge Bernard Shaw
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1Handy, p. 16.
Task Group DeliverablesTask Group Deliverables
•Group rank of importance of drivers•Specific ideas about needed change in practice, education, research, policy•Summary of recommendations in written form•Demographic forms completed by each group member
National DialogueNational Dialogue
Conference focus groups, RA, Conference focus groups, RA, ASAP, ASDASAP, ASD Collate, digest informationCollate, digest information Encourage state area dialogues Encourage state area dialogues with members and nonmemberswith members and nonmembers Interactive Web siteInteractive Web site Planning council to digest Planning council to digest feedback and propose vision and feedback and propose vision and 10-year plan (by 2007)10-year plan (by 2007)
ReferencesReferences American Occupational Therapy Association. (2005). [Membership survey]. Unpublished raw data.American Occupational Therapy Association. (2005). [Membership survey]. Unpublished raw data. Centers for Medicare and Medicaid Services. (2005). Public programs: Medicare, Medicaid, SCHIP. In Health Centers for Medicare and Medicaid Services. (2005). Public programs: Medicare, Medicaid, SCHIP. In Health
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Handy, C. B. (1996). Handy, C. B. (1996). Beyond certainty: The changing worlds of organizations. Beyond certainty: The changing worlds of organizations. Boston: Harvard Business Boston: Harvard Business School Press.School Press.
Institute of Medicine. (2001). Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21Crossing the quality chasm: A new health system for the 21stst century. century. Washington, DC: National Academy Press.Washington, DC: National Academy Press.
Murray, C. J. L., & Lopez, A. D. (Eds.) (1996). Murray, C. J. L., & Lopez, A. D. (Eds.) (1996). Summary: The global burden of disease: A comprehensive Summary: The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard School of Public Health on behalf of the World Health Organization and the World Cambridge, MA: Harvard School of Public Health on behalf of the World Health Organization and the World Bank.Bank.
Narrow, W. E. (1999). Narrow, W. E. (1999). One-year prevalence of mental disorders, excluding substance use disorders, in the One-year prevalence of mental disorders, excluding substance use disorders, in the United States. United States. Unpublished.Unpublished.
National Institute on Aging. (2002). National Institute on Aging. (2002). Aging in the United States: Past, present, and futureAging in the United States: Past, present, and future (NIH Publication No. (NIH Publication No. 95 4009). Washington, DC: U.S. Government Printing Office.95 4009). Washington, DC: U.S. Government Printing Office.
Robert Wood Johnson Foundation. (1996, August). Robert Wood Johnson Foundation. (1996, August). Chronic care in America: A 21st century challenge.Chronic care in America: A 21st century challenge. San San Francisco: Institute for Health & Aging: University of California.Francisco: Institute for Health & Aging: University of California.
Sculley, J. (1989). The relationship between business and higher education: A perspective on the 21Sculley, J. (1989). The relationship between business and higher education: A perspective on the 21 stst century. century. Communications of the Association of Computing Machinery, 32,Communications of the Association of Computing Machinery, 32, 1056–1061. 1056–1061.
The Center for Universal Design. (1997). The Center for Universal Design. (1997). The Principles of Universal DesignThe Principles of Universal Design, Version 2.0 Raleigh, NC: North , Version 2.0 Raleigh, NC: North Carolina State University.Carolina State University.
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AcknowledgmentsAcknowledgments
This slide presentation was This slide presentation was developed by the AOTA Vice-developed by the AOTA Vice-
President pursuant to his President pursuant to his responsibilities for Strategic responsibilities for Strategic
Planning. Appreciation is extended to Planning. Appreciation is extended to Carolyn Baum, PhD, Leti Ford, Judy Carolyn Baum, PhD, Leti Ford, Judy Wolf, Maureen Peterson, Cynthia Wolf, Maureen Peterson, Cynthia
Johansson, and Barbara Dickson for Johansson, and Barbara Dickson for their assistance in its preparation.their assistance in its preparation.
© 2005 by the American Occupational Therapy Association, Inc. All rights © 2005 by the American Occupational Therapy Association, Inc. All rights reserved.reserved.