The next presidential administration will need to tackle dozens of pressing health care challenges. A panel of experts convened by the National Academy of Medicine (NAM) says caring for our older adults must be among the administration’s top priorities.
As part of NAM’s Vital Directions for Health and Health Care initiative, aging experts were asked to provide guidance on U.S. policy to improve the health of an aging population. The panel included John Rowe, M.D., professor of health policy and aging at Columbia University’s Mailman School of Public Health; Linda P. Fried, M.D., Mailman’s dean; and Terry Fulmer, Ph.D., R.N., of the John A. Hartford Foundation.
Their report describes four imperatives central to the health and well-being of older people:
- Develop new models of care delivery to address the clinical and financial challenges of frail patients with multiple impairments.
- Provide more social engagement and enhance work and volunteer opportunities to keep them engaged.
- Transform end of life care to coordinate care better and avoid fragmentation.
- Strengthen the eldercare workforce through research, specialized care and educational efforts to enhance the geriatric competence of all health care professionals.
“One of the most important challenges we face is the likely inadequacy of the elder care workforce in terms of numbers and competency,” said Rowe, who leads the MacArthur Foundation’s Network on an Aging Society, said in a phone interview. “The problem in a professional workforce, of course, is that we have far too few geriatricians and especially geriatric psychiatrists.”
There are also too few advanced-practice nurses who specialize in geriatrics, as well as a shortage of social workers and other healthcare and public health providers. “The fundamental thing that we have to do is to create less of a financial disincentive,” Rowe said.
Medicare does not recognize the added qualifications of geriatric experts and does not compensate providers accordingly. Reimbursement rates consider an hour with a geriatrician is the same as an hour with a general internist, although the former received additional training to manage better the more complex problems that older people can have. “So I’d tell the secretary of health that we need to fix that,” Rowe said.
He acknowledged that strategy could open up a new round of policy challenges, since other specialists also may insist on additional compensation each time they take a new training course or certification. In the meantime, Rowe and his colleagues recommend that all primary care providers, excepting those who only work with pediatric populations, get adequate training on the fundamentals of geriatrics to serve those patients better.
When it comes to the direct care workforce, “the number of hours of training that are required to get certification as a direct-care provider for older persons is less than a number of hours required to become a crossing guard or dog groomer,” Rowe noted. “Is that who you want taking care of your grandmother?”
Nursing assistants and home health care aides provide most of the paid care for older adults, and demand for these caregivers is projected to grow by nearly 50 percent between 2010 and 2020. Check out this edition of The Diane Rehm Show for more on the problem.
“The pressures on recruitment are aggravated by retention issues as annual turnover rates often exceed 50 percent,” Rowe said.
As this PBS article describes, low wages, inadequate training and supervision, and the perception that these are dead-end jobs must be addressed to improve care quality and meet projected need. “Without improving conditions and raising pay, which hovers at $10 an hour, it will be impossible to meet skyrocketing demand for skilled and devoted workers,” the story concludes.
In their report to the National Academy of Medicine, Rowe and colleagues also call for the establishment of state and the federal programs for loan forgiveness, scholarships, and direct financial incentives for professionals who become geriatric specialists.
A summary version of the report was published in the September 2016 online edition of the Journal of the American Medical Association (JAMA).