Building the Health Care Workforce within an Aging Society

By Theresa Sangram, PREPARE Staff Writer

The Institute on Medicine (IOM) first issued a report on the health care workforce for older patients 30 years ago. This new report builds upon that tradition as well as on IOM’s broader mission to improve the quality of health care. It also provides a benchmarking plan designed to guide development of a highly skilled geriatric health care workforce.

The study sought to determine the health care needs of the rapidly growing and increasingly diverse older adult population, and presents a plan on how to address those needs by analyzing the state of the health care workforce. This involved assessing the future health status and health care utilization of this segment of the U.S. population. The research committee then set out to determine the best use of both the health care workforce and informal caregivers in order to meet the future demands of older Americans. They considered promising models of health care delivery, what new roles that health care workers would need to play under these models, the types of education that would be needed to support workforce development, and best practices in recruiting and retaining high quality geriatric health care workers.

In the near future, the older adult population will be quite different. The older adult population will be more ethnically diverse, geographically mobile, and living under considerably different economic conditions. The current health care workforce is inadequately trained and too small to meet the future needs of a growing older adult population. Among direct care workers, nursing assistants provide 70 to 80% of the direct care to older adults in long-term care environments. Furthermore, older adults account for one-third of visits to physician assistants, and yet less than 1% of physician assistants specialize in geriatrics. These numbers are similar for both registered nurses and pharmacy professionals.
CNA
Shortages in the geriatric health care workforce will only get worse in the future should the recruitment, training, and retention patterns within the health care workforce remain unchanged. Furthermore, the inefficiencies associated with staff shortages will become more acute if quality-of-care reforms are not made. In order to meet the health care needs of the aging population, the geriatric competence of the entire workforce needs to be enhanced, the number of geriatric specialists and caregivers needs to be increased, and innovative health care delivery models need to be implemented.

To supplement professional training, the IOM expert panel recommends: (1) training of all staff in all settings where older adults receive care; (2) that competency in the care of older adults becomes a part of all health care professional licensure and certification processes; (3) that states and the federal government increase minimum training standards for all direct care workers, including CNAs and home health aides; and (4) that public and private organizations provide funding for training opportunities for informal caregivers.

In order to increase retention and recruitment of geriatric health care workers, the panel suggests that financial incentives be provided to increase the number of geriatric health professionals. Furthermore, they recommend loan forgiveness, scholarships, and direct financial incentives be provided to professionals who become geriatric specialists. Finally, Medicaid should increase pay and fringe benefits for direct-care workers by setting wage floors, establishing minimum percentage service rates, and so forth.

Finally, the panel offers recommendations for reforming the health care models currently in use. They propose that payers should reward the dissemination of models of care shown to be effective for geriatric care, that Congress and foundations significantly increase their support for demonstration programs, and that service providers expand the roles of those who care for older adults beyond the traditional scope of practice, e.g., by providing opportunities for greater professional recognition, development, and compensation.

For more information, access the full report here http://www.nap.edu.