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The future will see the affluent elderly receiving the best care, while less affluent elderly will need to depend on public programs that must serve a broad demographic. Conflicting demands that must be balanced will include autonomy, choice, cultural competence, access, good jobs, and reasonable cost.

An insider-versus-outsider concept of advocacy captures the major differences in behavior between people working in a bureaucratic institution or agency and those working outside. Inside and outside advocates need to understand their different roles in the policy process where they may cooperate at one time and contest each other at another, but they should base their interaction on mutual respect.