Date: July 1st, 2008
In April the prestigious Institute of Medicine (IOM) released its latest report and recommendations about what needs to be done to build the health care workforce to care for an aging population. The report, Retooling for an Aging America: Building the Health Care Workforce, provides a snapshot of the health care challenges posed by elderly patients living with multiple chronic conditions, and highlights the increasingly complex health needs of this rapidly aging population and the inability of the nation’s current health care workforce to meet these needs.
Older Americans use more health care services than their younger counterparts and their health care needs are often more complex. The sheer size of the baby boom generation, coupled with increased longevity, will propel the number of people age 65+ to double, reaching 70 million by 2030. As a result, this age group will represent almost 20 percent of the total population.
Yet despite this demographic trend, our health care workforce is ill-prepared to address this ‘silver tsunami.’ Many of the health professions are already experiencing shortages, and employers find it difficult to recruit and retain all types of health care workers. These shortages will grow given that many health care workers are approaching retirement age themselves and not enough young people are entering the field to fill their ranks and meet the increased demand for services.
The situation is worse in geriatric care because it attracts fewer specialists than other disciplines and experiences high turnover rates among direct-care workers — nurse aides, home health aides, and personal care aides. For example, there are just over 7,100 physicians certified in geriatrics in the United States today — one per every 2,500 older Americans. Turnover among nurse aides averages 71 percent annually, and up to 90 percent of home health aides leave their jobs within the first two years. Furthermore, the education and training of the health care workforce fails to adequately address the complex needs of older adults.
According to the report, in order to avert a health care crisis, the health care workforce needs to be expanded to include any person involved in care delivery—not only health care professionals, but also family (informal) caregivers and individual patients themselves. Specific recommendations include:
- Boosting recruitment and retention of geriatric specialists and health care aides;
- Widening the duties and responsibilities of workers at various levels of training;
- Better preparing informal caregivers to tend to the needs of aging family and friends; and
- Developing new models of care delivery and payment where federal programs fall short.
In addition, the report notes several ways that the Medicare program hinders the provision of quality care to older adults, including its low reimbursement rates, its focus on treating short-term health problems rather than managing chronic conditions or age-related syndromes, and its lack of coverage for preventive services or for health care providers' time spent collaborating with a patient's other providers.
The Alliance for Aging Research is a strong proponent of federal policies to meet the vast needs of the nation’s geriatrics workforce. Over the past twenty years, the Alliance has provided leadership by convening advocates, drafting legislation and speaking before multiple audiences to address the dearth of training of geriatric health care professionals. The Alliance has been a consistent and early advocate calling for improved financial incentives to compensate those who care for our aging population. The most recent IOM report is the latest of many calling for attention and action to address this looming problem. The report outlines a number of important action steps that have the potential to vastly improve the quality of health care for older Americans. If we hope to prevent a crisis in the near future, we must move from study to action. The IOM’s recommendations deserve serious attention from the public, the health care professions, advocacy groups, members of Congress and other policymakers.