As the U.S. healthcare system braces for a flood of aging Baby Boomers, the Institute of Medicine (Washington) this week sounded a siren alarm: There simply won't be enough resources or healthcare workers to cover this geriatric boom without immediate action.
The country is woefully unprepared in geriatric care skills, and the current healthcare workforce is not large enough to meet older patients' needs, according to the IOM. So, the agency has crafted a blueprint to confront the looming crisis with release of a report, "Retooling for an Aging America: Building the Health Care Workforce."
"We can't wait any longer. Given the demographic shift, virtually all healthcare providers need to be prepared to manage the common medical problems of old age," Carol Raphael, president/CEO of Visiting Nurses Services (New York) and a report co-author, told Medical Device Daily. "We don't believe we'll be able to produce sufficient geriatric specialists by 2030, so it's essential that all healthcare providers be prepared to manage aging people's needs. We do need to increase the number of geriatric care specialists for those with the most complex issues and then they should train everyone else."
Raphael is a member of the IOM 15-member Committee on the Future Health Care Workforce for Older Americans charged with developing an action plan to confront the Boomer healthcare flood. Her reference to the year 2030 is tied to the fact that the largest-ever proportion of older adults will increase from 12% of the U.S. population in 2005 to almost 20% by 2030. But the influx begins sooner, in just three more years, when the first of these 78-million-member Boomers, born between 1946 and 1964, begins to turn 65.
The report calls for major initiatives starting immediately to train all healthcare workers in the basics of geriatric care and to prepare family members and other informal caregivers who currently receive little or no training, in how to tend to their aging loved ones.
The committee also calls on Medicare, Medicaid and other health plans to pay higher rates to boost recruitment and retention of geriatric specialists and care aides. The group targets the year 2030 for the necessary reforms to take hold.
Today's adults may be healthier and live longer, but they also tend to have more complex conditions and healthcare needs than younger patients, the report notes.
The average 75-year-old American has chronic conditions, such as diabetes or hypertension, using four or more prescription medications. The committee found that dementia, osteoporosis, sensory impairment and other age-related conditions present provider challenges that aren't often encountered when tending to younger patients.
The IOM's work in the area of geriatrics isn't new — this is the 30th anniversary of its first report on the workforce for geriatric patients, titled "Aging and Medical Education ."
The current committee is calling for a three-pronged approach to a solution:
• enhance the competence of all individuals in the delivery of geriatric care;
• increase the recruitment and retention of geriatric specialists and caregivers;
• and redesign models of care and broaden provider and patient roles to achieve greater flexibility.
Following are other recommendations from the report:
• Healthcare professionals and regulators should consider expanding the roles and responsibilities at various levels of training. For example, if a certified nursing assistant is able to administer certain medications, a professional nurse would have more time to concentrate on more complex patient needs.
• Because much of their income comes from the government program, Medicare should increase its reimbursement rates for services delivered by geriatric specialists. Medicare's low reimbursement for geriatric primary care is the foremost reason that geriatric specialists earn lower salaries (average $163,000 compared to a dermatologist, earning $300,000), the report says.
• Direct-care workers' wages must be increased. The median wage for direct-care workers in 2005 was $9.56 an hour, and many do not have health insurance.
• Health professionals should regard patients and informal caregivers as an integral part of the healthcare team. State attorneys general should recognize training programs for unpaid caregivers as a way that non-profit hospitals could meet the requirement to provide benefits to their local communities in exchange for their tax-exempt status.
"We are enlarging how we define the healthcare workforce," Raphael said. "In addition to including professionals and para-professionals, we're including informal caregivers [relatives, friends and networks]; we are also including the patients themselves because they will have a much different role and a partnership with providers."
Importantly, future elderly patients will be far different from the seniors we know today, according to the report: "The demographic characteristics of older Americans will differ from previous generations in terms of their race, family structure, socioeconomic status, education, geographic distribution, and openness regarding their sexual orientation. All of these factors can affect health status and utilization of services."
• Medicare and other public and private insurance plans need to remove disincentives that prevent healthcare providers from adopting new models of care delivery such as interdisciplinary team care that could improve patients' health and lower costs.
Raphael said the first step in making all of these changes happen is information dissemination.
"We're working to share the results of this report," she said. "John Rowe has met with a number of committees in Congress. We're working on the action plan. We have to educate people that the solutions are doable and that, incrementally, we can begin to tackle this."
Committee chair John Rowe, professor of health policy and management at the Mailman School of Public Health, Columbia University (New York), said, "The sheer number of older patients in the coming years will require trying new models for delivering healthcare and the commitment of greater financial resources. If our aging family members and friends are to live as robustly as they can and in the best health possible, we must have a work force of adequate size and competency to take care of them."
IOM reports a shortage of healthcare workers in all fields, but the situation is worse in geriatrics because it attracts fewer specialists than other disciplines and experiences high turnover rates among direct-care workers such as nurse aides, home health aides, and personal care aides. Today, there are about 7,100 physicians certified in geriatrics in the U.S. Turnover among nurse aides averages 71% annually, and up to 90% of home health aides leave their jobs within the first two years.