By Vincent Antenucci

Center for Applied Research in Dementia

March 2019


In 1979 President Carter delivered a speech titled, “A Crisis of Confidence,” which was later called his “Malaise Speech.” The word “malaise” didn’t come up in the speech, but this unofficial title accurately reflected the national mood. I was about to turn 17 when President Carter essentially called on the nation to snap out of it and get with the program. It wasn’t the message that I or most Americans wanted to hear at the time, as demonstrated in the 1980 election.

Sometimes we don’t like to hear about ideas for change, especially if it requires us to modify our behaviors or ways of thinking. We seem to take comfort in the status quo, and so we tell ourselves that “it’s just the way it is” and “nothing ever changes.” Although Carter specifically was speaking about the energy crisis, his words are remarkably relevant to the present state of long-term care in America.

As a researcher/trainer/consultant in the long-term care industry over the past 25 years, I have only recently begun to see real change at the margins of our care culture as it relates to persons with Alzheimer’s disease and other types of dementia. I have had the privilege of witnessing true communities emerging in memory care in the United States, but we still have a long way to go. There clearly is a crisis of confidence when it comes to belief in our ability as a society to improve our culture of care. Having seen firsthand what is possible when all staff and all residents of a care community are treated with respect, dignity and equality, I have very little tolerance for intransigent attitudes among professionals.

In 1979 Carter challenged Americans to take a proactive stance on energy to overcome economic and social “malaise.” But instead we chose consumption over conservation. Vehicles have grown larger and we have become complacent and reckless on energy. As a result of decades of unrestrained fossil fuel consumption, we are facing increasingly catastrophic impacts on the global climate and economy. Are we now prepared to do what is necessary to avoid catastrophe?

What does this have to do with the long-term care industry? Here’s the reality: Change is coming. The question is, will the industry be prepared? Will society be prepared? We’ve heard so much about the numbers of baby boomers who will require care in the coming years. However, very little thought, it seems, is given to the qualitative differences between Boomers and the two preceding generations, which the industry has grown accustomed to serving. Boomers will be far less tolerant of the status quo. They will not tolerate stifling boredom, being ordered around, being treated like children, or being treated like unfortunate sufferers. Boomers will demand change, and change will come.

President Carter stated that he “listened to the voices of America.” In fact, he met with several citizens who represented different backgrounds and points of view over a 10-day period at Camp David. Their comments and viewpoints were used to shape Carter’s policy initiatives to address the nation’s energy and economic challenges. Likewise, effective, proactive leadership in the long-term care industry must begin with listening to the public it now serves—and will serve. It also requires a willingness to change and a willingness to act.

For years we have been hearing about “culture change” and “person-centered care.” So where is it? We remain stuck in an old paradigm that either reflects a hospital (medical model) on the one hand or a hotel (service industry) on the other. Neither of these models resembles a community.  Every company or organization in the industry wants to stand out as providing “communities of caring” or some permutation of that sentiment. Yet evidence of true community is scarce. Why is this? The answer is, we don’t like change. We hold onto our professional training as if it were bestowed from the almighty. It is not comfortable for us to have our thinking or beliefs challenged—but it is necessary. We must learn to take a fresh look at how we treat people of all ages in our society, regardless of their diagnoses. Instead of being perceived as places where skilled professionals shoulder the burden of our aging, disabled and sick, care communities can and should become indistinguishable from the broader communities in which we all live. Only when this happens will the industry be ready for 78 million Boomers. So let us all snap out of it and get with the program.




Vincent M. Antenucci is Research & Training Manager / COO at the Center for Applied Research in Dementia, where he develops therapeutic dementia and memory disorder interventions, activity products, books, and Montessori training programs to benefit persons with dementia. As an experienced speaker and trainer, he has given testimony for the Ohio Speaker’s Task Force on Alzheimer’s and Dementia, and enabled hundreds of caregivers to empower people with dementia to live more fulfilling lives.

Contact him by email at for more information on bringing the revolution to your care community.