By Jennifer L. Boen
Independent journalist, Fort Wayne, Ind.
In the sea of America's diverse population, the rising tidewaters of baby boomers are creating a tsunami of health-care needs. The reverberations are already noticeable from too few specialty-trained physicians for diagnosing and treating complex problems of the elderly and growing shortages in the nurse workforce.
For every 10,000 people age 75 and older, just four geriatricians are available today, Herbert Sier, M.D., told attendees at the annual Association of Health Care Journalists' conference in Chicago. Sier is associate chief of geriatric medicine at Northwestern Memorial Hospital, part of the Feinberg School of Medicine at Chicago's Northwestern University.
"Five percent of the Medicare population consumes 50 percent of the Medicare dollars," he said. Yet "geriatrics is on the bottom of the totem pole in terms of reimbursement," offering little incentive for med students to consider geriatrics.
One in five Medicare beneficiaries has five or more medical conditions requiring specialty care, Sier said. Those with less complex needs can be served well through primary care physicians, but a shortage of those also exists, and geriatrics training is lacking. Just one in four med schools required a geriatric clerkship in 2005 and 2008, he said.
To fill the void more physician extenders such as nurse practitioners will be needed, said Linnea Windel, president/CEO of Visiting Nurse Association of Fox Valley in the Chicago area. Similarly, medical assistants and aides may have to assume some responsibilities registered nurses have now.
Speaker Valerie Gruss concurred, pointing out nurses comprise the largest health-care provider group, with nearly three million actively working. By 2020, a shortfall of 300,000 will be realized, said Gruss, clinical assistant professor with the University of Illinois-Chicago's School of Nursing.
Expanding the nurse workforce entails increasing faculty numbers and clinical sites in schools, empowering nurses as valued decision-makers and wooing more male nurses, she said. Lack of direct-caregivers such as nurse's aides and the nearly 75 percent turnover rate among them are additional barriers to quality care.
Confounding staffing issues is the reality that, although the U.S. lifespan is extended through better treatments and technologies, "We are living with more disability," said physiatrist Santiago Toledo, M.D., medical director of the orthopedic rehabilitation program at the Rehabilitation Institute of Chicago.
A paradigm shift in defining disability must occur, Toledo said, moving from disease to ability enhancement. It will be a "patient-centered focus on what the patient needs and wants to do. Boomers will change the paradigm of health care."
As care of the elderly is increasingly provided in the home, Windel said demonstration projects of novel community and home-based services are under way and are good fodder for journalists' stories.
Care coordination for older adults is essential, Sier said, noting, "EMR (electronic medical records) is going to be a large part of the 'cure' to see different systems involved in care from multi places." Yet much remains up in the air as the health-care system embarks on transformation. "If you're in a system that's fragmented," he said, "it's difficult to coordinate care."
