Preparation is underway for the 2015 White House Conference on Aging. Now is the time to make our voices heard. The planning committee is inviting input from the public about what issues related to aging are most important. Common themes that are emerging are retirement security, healthy aging, long-term services and supports, and elder justice. In addition to a variety of listening sessions and webinars being held around the country to discuss these themes, you can share your thoughts and experiences at the conference website: http://whitehouseconferenceonaging.gov through the “Get Involved” button.
Below are some of my thoughts related to long-term services and supports that I have shared with the conference planners. What issues do you think are most important?
I hope that the 2015 White House Conference on Aging will discuss ways to address expected workforce shortages in physical health, behavioral health, and social services for older adults. We know there will be greater need. Even though more people live healthier lives for longer, the sheer number of older adults moving forward will require more health care providers just to maintain the current ratio of providers to the total population. The work force itself is growing older – a wave of retirements in all sectors of health and social services are expected by 2020 leaving an additional gap in providers. This does not even address the need of service providers trained to work specifically with older adults. There are already very few physician assistants, pharmacists, registered nurses, social workers, and doctors who specialize in geriatrics.
Because more people are surviving into old age, health and social service providers are having to deal with more chronic illness for both physical and behavioral health conditions. And yet, the focus remains oriented toward responding to time-limited, acute care problems. As older adults experience this disjuncture between the available care and their need to manage chronic health problems, they become increasingly skeptical of the effectiveness of the health care system to meet their needs. At the same time, proper management of chronic problems is important for preventing more difficult problems down the road.
Despite this need there is a decreasing interest in geriatric work among all health professionals. While students generally agree that geriatric care is an important part of health and social services, they also do not believe that geriatrics offers good career opportunities. Barriers to recruitment and retention include negative perceptions about working with older adults, concerns about physically and emotionally demanding working conditions, and concern about the financial disadvantages of this work.
There are things that we can do to address these concerns, many of which have been highlighted in a 2008 Institute of Medicine report (http://www.iom.edu/Reports/2008/Retooling-for-an-Aging-America-Building-the-Health-Care-Workforce.aspx) as well as by scholars and practitioners across a variety of fields. These include:
- Providing incentives such as loan forgiveness, scholarships, and fellowships for those committing to practice with older adults for a significant period of time.
- Restructuring reimbursements from all payers to provide 1) enhanced reimbursement for services delivered to older adults by practitioners with specific geriatric expertise; 2) reimbursement for medical care management which is a crucial part of dealing with chronic conditions; and 3) Medicare reimbursement for social workers and nurses who work as care managers in many evidence-supported geriatric care models.
- Providing funding for rigorous interdisciplinary training programs.
- Infusing gerontology content throughout curricula and requiring criteria related to working with older adults as part of licensure, certification, and recertification.
- Supporting the development and dissemination of technological advancements as well as the training to integrate these advances into care.
These efforts will address a number of issues. They will offset educational costs for those who specialize in working with older adults. Students often accumulate additional debt for a field that tends to pay less. Similar models have been successful in increasing professionals working with underserved populations in a number of contexts. At the same time, restructuring reimbursements will help address some of this income disparity in geriatric services. Education and licensure reforms will improve professionals’ ability to work in interdisciplinary teams – something that is particularly important for addressing the complex needs of frail older adults – as well as providing all providers some level of training in geriatrics and gerontology. Finally, technology is increasing the effectiveness and efficiency of health care delivery in a variety of ways, but the dissemination of these technologies more broadly and making sure that providers are trained to use them is lagging.
It is imperative that we move forward with work force development now so that we are not scrambling to fill these gaps in the future.