Rosalie A. Kane had a broad and sustained impact on the field of gerontology. She brought a fierce creativity and independence of thought to every question she attacked. Her unexpected death on May 5, 2020, leaves a hole in the hearts of her many students, friends, family, and colleagues around the world. Along with her late husband Robert Kane, she worked tirelessly to change policy and healthcare delivery for older adults and people with disabilities, at local, state, national, and international levels. She will be sorely missed.
Rosalie and Robert (Bob) Kane came to the University of Minnesota in 1985 after careers at the RAND Corporation, the University of Utah, and the Indian Health Service. Rosalie held faculty appointments in both the School of Social Work and the School of Public Health. She served as Editor-in-Chief of The Gerontologist (1989–1992), and was guest editor of three issues of Generations. Among many prestigious awards, Rosalie received the Kent Award from the Gerontological Society of America, and was inducted as a Fellow into the American Academy of Social Work and Social Welfare. As an indication of their long professional collaboration, Rosalie and Bob jointly received the President’s Award of the American Society on Aging.
A central theme of Rosalie’s scholarly contributions was her focus on the personal needs, preferences, and interactions of people who use long-term services and supports (LTSS). She turned her gaze to a wide range of topics: interprofessional teams, residential facilities, home care, and comprehensive assessment. Most importantly, she never ceased to press for improvement of both the quality of care and quality of life across settings. Her work formed the basis for a generation of research and policy for case management in home- and community-based service (HCBS); assisted living as an alternative residential setting; quality of care in nursing homes and in home care; rebalancing of state funds to community-based services and away from funding nursing homes; and efforts to change the culture of nursing homes, including formative research on the Greenhouse/Small House movement. Her work on defining and measuring quality of life in nursing homes has had lasting impact on the field; key concepts have been adopted in a number of state and federal programs.
All of this article’s authors had personal and professional relationships with Rosalie, and we offer these remembrances.
Howard B. Degenholtz
I came to the University of Minnesota as a doctoral student 1991, fresh out of college and filled with questions about how to bring bioethics and health policy together into an empirical research program. I was assigned to Rosalie because of her connection to the Center for Bioethics, then under the leadership of Art Caplan.
In 1991, Rosalie had just published Everyday Ethics (Kane and Caplan, 1990), and was working on Ethical Conflicts in the Management of Home Care (Kane and Caplan 1993). As a graduate student interested in bioethics, this was the perfect place to be. Her office was like a “salon” for these ideas; the culture change movement was picking up steam, and we debated the challenge of expanding the definition of quality to include “quality of life.”
‘Not only is it morally important to prioritize resident voices, but also it is technically possible to capture that information.’
As a student, I had the unique opportunity to serve as the project coordinator for an intervention—training case managers to assess the values and preferences of HCBS clients and incorporate those preferences into their care plans. I gained a life lesson that I have carried with me, now as a teacher and lead investigator: We learn by doing.
Later, I had the chance to collaborate with Rosalie on a Centers for Medicare & Medicaid Services (CMS)–funded project to define and measure quality of life (QOL) for people living in nursing homes. At the core of the QOL measurement was the notion that care should be preference-based—that activities should be meaningful to the person; that interactions with staff and others should be respectful; that seemingly mundane decisions about the minutiae of everyday life should have the highest priority. Most importantly, this work established that not only is it morally important to prioritize resident voices, but also it is technically possible to capture that information reliably and validly through self-report interviews.
There are many days when I get caught up in the details of study design, academic administration, or teaching responsibilities. Often when analyzing data, or poring through interview transcripts, the larger purpose can be obscured by myriad details. In graduate school I put up a sign above my desk, inspired by Rosalie, that read, “It’s the Autonomy, Stupid!”
Rosalie’s legacy, for me, is embodied in that notion—that the focus and priority must always be on the people who use LTSS.
Keren Brown Wilson
Rosalie was a mentor, colleague, and most of all, a friend. I knew Rosalie for more than 40 years. And yet I can’t tell you exactly how our friendship came to be more important than her being a mentor and a colleague. Perhaps it is because she always remained someone who kept teaching me, and with whom I enjoyed an ongoing professional relationship. Undoubtedly, there are many who can speak more eloquently to her status as someone who was, and who will continue to be, an icon in the field of gerontology. They can and should note her influence on scholars, a daunting list of publications written, and her insatiable appetite for discovery. These characteristics made her a force in our field.
‘Just as she was passionate about data, she could seem to be as oblivious to circumstances around her, including people.’
But I want to speak about her as a person and friend. No doubt about it Rosalie was a bit quirky. Just as she was passionate about data, she could seem to be as oblivious to circumstances around her, including people in that space. Even in one-on-one conversations her mind jumped around, heading this way and that. It was hard work talking with her. You often had to sort out several themes in the buzz-saw like conversation—comments about findings of a recent study, complaints about a faulty garage door opener, observations about lack of social justice, and sharp questions about your life, your work, your feelings.
You had to pick one or two themes to focus on first and treat the others like white noise. It didn’t matter, eventually the most important information would be covered. And, although I never knew how she did it, she would hear what I said as well. She often surprised me in subsequent conversations by saying “I have been thinking about what we talked about …”
Like many people, Rosalie struggled to balance her life. She was always working. But also, she was thinking about her family. She called her husband, geriatrician Robert Kane, “Robbie,” and he called her “Rosie.” When he died suddenly, she was bereft. She fretted and beamed when she talked about her “girls” and her grandchildren. She struggled, like many, to stay on top of the needs of her parents as their health declined and was a passionate advocate for their person-centered care. Her brothers and their families were important to her. So, it was easy to share both my own joys and sorrows with my friend when things happened in my family.
I have so many memories—funny, happy, sad. Imagine being in China’s Forbidden City with Rosalie dithering over which chopsticks she preferred. Think of her emerging from her battle with cancer fussing about her hair, which she admitted had never been great. Recall her wondering if she could have done anything more when her husband became fatally ill. And you will see, that when all was said and done, she was still human. I was lucky she called me friend.
I first met Rosalie in 1989 in Tallahassee, where I was serving as the state director of the Aging and Disabled Adults State Unit. Rosalie was conducting research on case-management policies and practices in multiple states. I’d heard of Rosalie and her work but wasn’t yet very familiar with it. After that very first conversation I immediately began to look up and read her research, much of it done in collaboration with her husband Bob Kane.
I read everything I could find as fast and as thoroughly as I could get my hands on it. She taught me more about case management in aging services in our first long conversation than I had learned in dealing with aging issues for almost a decade as a policy and budget adviser in the Florida Governor’s Office. That conversation and the follow-up engagement with her academic and policy work led to a 31-year-long conversation with Rosalie about everything under the sun regarding LTSS and a wide range of mutual interests from politics to good fiction and films, religion, moral philosophy, and virtually everything under the sun!
‘I never knew anybody else like her, nor learned more from anyone else about LTSS and many other important matters.’
In our continuous conversation about LTSS research, policy, and politics, she introduced me not only to the realities of case management, but also many other LTSS issues, including assisted living and group foster care for older people (the Oregon and Washington models). I learned that there are effective and more livable alternatives to nursing home care for many people. I learned that there is a practical value of putting a far greater priority on quality of life than quality of care in nursing homes and other LTSS programs, and that we need methods for measuring it. I learned about the Green House/Small House model as an alternative to the traditional, large nursing home model of residential care. Finally, I learned of her concerns about the impact of the for-profit managed LTSS approach to funding and administering LTSS services, concerns I came to share.
I will miss Rosalie enormously. I never knew anybody else like her, nor learned more from anyone else about LTSS and many other important matters. I’ve long felt very lucky that I met her when I did and had the opportunity to learn from her for decades.
Susan C. Reinhard
I keep wanting to call Rosalie for her guidance now, as I was able to do for a quarter of a century. I knew her work well before then, but the first time I called her was in 1995, when I became responsible for policy development and oversight of all Senior Services in New Jersey. I wanted to advance HCBS and balance our public funding of long-term care, which at that time stood at 93 percent going to nursing home care.
We needed more HCBS options, and we wanted those options to be covered by Medicaid as well as private pay. From her publications and presentations, I knew Rosalie was studying all the issues I needed to understand. So, I called her. She offered substantial guidance. But the most important advice she gave me was to make sure people on Medicaid could have a lockable private room and to get that in the regulations right from the start. We did.
Ten years later, my father was able to move from a nursing home to assisted living under a Medicaid HCBS waiver. He had global aphasia so could not verbally express his gratitude when he was given the key to his room. He just smiled and cried. Rosalie made that happen. For my father and for so many others.
Rosalie also profoundly affected my work on nurse delegation, which continues to this day. That is the policy that permits registered nurses to delegate to unlicensed assistive personnel tasks like medication administration, tube feedings, and other daily activities that people with chronic stable conditions need routinely to be able to live in their homes rather than in a nursing home. She studied the laws and regulations in twenty states and offered her analysis that we needed policy, but we also needed adoption in actual practice. I still have the hard copy of that report. And it is still so relevant.
‘I truly wish I could tap into that brain and energy right now.’
We conducted research together on nurse delegation, convened nurses, consumers, policy makers and other stakeholders, and made good progress over the years. We even got a nurse delegation indicator in the LTSS State Scorecard series that I continue to lead at the AARP Public Policy Institute. With the help of strong advocacy, states have made enormous progress in this policy area.
Rosalie was an esteemed member of the National Advisory Panel for the Scorecard. I last saw her in person at our December 2019 meeting, though I talked to her subsequently. She was going to work with me more on transforming long-term care, particularly her work on the small nursing home models she studied. I truly wish I could tap into that brain and energy right now.
Rosalie brought so much to the table. She was brilliant, creative, passionate, generous, and steadfast in her scholarship. We shared a bias toward action. Listen to others, stimulate new solutions. Stick to a vision of dignity and choice for people who need help to live their lives to fullest extent possible. Then do all you can to galvanize others to advance evidenced-based solutions. To me, that is her legacy. I am forever grateful for her mentorship and friendship.
A Profound Impact
Each of us in our own way learned a tremendous amount from Rosalie. Her work and her life stood as lessons to everyone she encountered. Most importantly, she had a profound impact on LTSS policy. With her life, she left each of us, and the world, better off. With her passing, she leaves us to continue in her memory and recommit to the values and ideals she ceaselessly endeavored to reach.
Howard B. Degenholtz, PhD, is an associate professor in Health Policy and Management, and faculty at the Center for Bioethics and Health Law, at the University of Pittsburgh Graduate School of Public Health in Pittsburgh, Pennsylvania. Keren Brown Wilson, PhD, is founder and CEO of the Jesse F. Richardson Foundation in Clackamas, Oregon. Larry Polivka, PhD, is the executive director of the Claude Pepper Center and scholar-in-residence with the Claude Pepper Foundation, at Florida State University in Tallahassee, Florida. Susan C. Reinhard RN, PhD, FAAN, is senior vice president and director of the AARP Public Policy Institute and chief strategist at the Center to Champion Nursing in America and Family Caregiving Initiatives in Washington, DC.
Kane, R. A., and Caplan, A. L., eds. 1990. Everyday Ethics: Resolving Dilemmas in Nursing Home Life. New York: Springer Publishing Company.
Kane, R. A., and Caplan, A. L., eds. 1993. Ethical Conflicts in the Management of Home Care: The Case Manager's Dilemma. New York: Springer Publishing Company.