Interview with Bruce Lederman , J.D., Long Term Service and Support Industry Thought Leader

Bruce Lederman, J.D., has been leading the discussion surrounding the changing environment in Long Term Service and Support (LTSS) for over 25 years. His experience in the senior care field and passion for improving the ways in which older adults receive access to care drives his involvement in the North Shore and beyond. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area.
We sat down with Bruce to discuss the LTSS industry, and his expertise on the trends, growth, and challenges those in the field are currently facing.
What led you into the senior care industry, and what do you like most about the field?
I’ve always been passionate about serving older adults. After law school, I became a nursing home administrator. I am very interested in the development of the LTSS network for older adults, and in making an impact for older adults to live in an environment they choose that maximizes their independence and dignity.
What common challenges do you see long term service and support providers facing today, and where are the biggest areas for improvement?
The industry is facing numerous challenges. With 74 million baby boomers entering the LTSS ecosystem, we need to start planning for their care in an efficient manner. From changing consumer expectations, to a lack of funding, to uncertainty about how to deliver healthcare in the most efficient manner, these factors will have an impact on LTSS. They will shape the ways in which we are able to sustain people in the least institutionalized manner. New technology is creating opportunities to engage with older adults and caregivers, which can be both positive and negative.
We’re not looking for a killer app to come in as a one-size-fits-all solution. Instead, we’re looking for an array of solutions that baby boomers will be able to select from that will allow them to live in the least institutional, yet healthful environment.
Can you discuss your proudest moments in your career, or some of your biggest achievements?
I enjoyed serving as a nursing home administrator because of the special opportunity to lead a team and to improve peoples’ lives in a very real way. It is always rewarding to be present at a time in an older adult’s life when they need it most. I am very proud of the work I did as nursing home administrator, and have very fond memories of working with my dedicated team members. I also spent 10 years as a board member for 18,000 older adults, and served for 2 years as board chair with CJE SeniorLife. Around 3 years ago I started my blog,, because I thought maybe other people out there are also interested in LTSS and how it’s being shaped by a number of factors—from consumer expectation, to technology, to financial resources, any beyond.
What’s the best advice you’ve received in your career?
Transparency. Your team members need to understand where you’re coming from and you need to understand where they’re coming from. Transparency is also paramount for consumers to be able trust your services. They need to experience your firm authentically, and know that you are who you say you are. To quote Maya Angelo, “When someone shows you who they are, believe them the first time.”  This applies to both the good and the bad. Transparency and authenticity are key elements of success in this industry, and across the board.
What advice would you give to someone just entering into the senior care field?
I would say they need to ask a lot of questions. LTSS is a very complicated ecosystem, partially because payment drives the delivery and availability of care. Understanding how all of the pieces fit together helps an individual understand where they want to fit in as a professional. Some people may prefer to work in home health care or with meal assistance over geriatric care management, or post-acute care. There are so many different parts to the LTSS field, and it is easy to become silent and lose sight of the grand picture, which is: how do we serve the older adult in a setting that makes them the most comfortable?
What are some of the biggest changes / advances you’ve experienced in the senior care industry over your 25+ years of experience?
There are so many more housing options today. It used to be that older adults were living either independently in a community, or in an assisted living facility. Now, there are many more options for them to find a living environment that meets their needs. Technology has advanced to the point where we now have remote monitoring, alongside new communication platforms for families and care providers to share and exchange data. The evolution of the Medicare Advantage Act and Affordable Care Act will also create big changes across the board for LTSS. Everyone is now looking for efficiency and ways to improve the quality of care while maintaining that efficiency, which is the driving force behind LTSS.
You recently wrote about the shrinking supply of caregivers—can you talk more about this trend, and why it’s going in this direction?
I think that in relation to the number of people who will need care, the number of caregivers is shrinking. With 74 million baby boomers entering the long term service and support ecosystem, there will be some big challenges. The truth is—there will be sufficient caregivers, but what the care becomes may be something else 26 years from now. The changing expectations, technology, and payment sources will alter how that care is delivered.
What makes a great LTSS provider, and how does Freedom Home Care align with this?
I have had relatives who’ve had care with Freedom Home Care, and they definitely represent the authenticity that I was talking about early on. Freedom Home Care shows up as they claim to be. That’s who they are—who they claim to be, a genuine, trustworthy care giving firm. In general, having the flexibility of private caregivers really allows the family members of an older adult needing care to have time for themselves. Caregiver burnout is a real dynamic. In fact, one-third of American households are currently giving assistance to an older adult. I think that’s why you see the role that private duty health care can play when it comes to maintaining an older adult in the most independent setting that is also the most helpful to the family.