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"Retooling For An Aging America:
Building The Health Care Workforce,"
A Report From The Institute Of Medicine

Recent IOM News Coverage

FREE PDF of the IOM Workforce Report Now Available (5/09/08)

AGS President Advises Congress on Steps Nation Must Take to Address Growing Shortage of Healthcare Professionals Trained to Care for Aging Americans (4/21/08)

IOM Releases Report Addressing Growing Shortage of Healthcare Providers Trained to Care for Older Patients; AGS President To Testify At Senate Hearing on Workforce Issues Tomorrow (4/14/08)

AGS Comments on Questions IOM is Investigating in Study of Healthcare Workforce for Older Americans (9/11/07)

FREE PDF of the IOM Workforce Report Now Available
Due to overwhelming interest, a PDF of the prepublication copy of Retooling for an Aging America: Building the Health Care Workforce is now available for FREE downloading on the National Academies Press (NAP) website. Once you reach the NAP web page for this IOM report, you will need to scroll down, click on Sign In, and provide some general information about yourself before downloading your copy. Please note, the final report will also be available as a free PDF. Get a free PDF of Retooling for an Aging America.

AGS President Advises Congress on Steps Nation Must Take to Address Growing Shortage of Healthcare Professionals Trained to Care for Aging Americans
To prepare the nation's healthcare workforce to meet the needs of a population of older adults that will double by 2030, the US government must make sweeping changes both in the way it trains and compensates healthcare professionals and in the country's healthcare systems, AGS President Todd Semla, MS, Pharm.D., told Congress April 16.

Testifying before the Senate Special Committee on Aging on behalf of the AGS the day after the Institute of Medicine (IOM) released its long-awaited report on preparing the workforce to care for an aging society, Dr. Semla outlined steps the federal government must take to prepare the workforce for the coming Age Boom. The recommendations he outlined - and for which AGS has long advocated -- parallel many in the IOM report. The report was authored by a panel of experts that included several AGS members.

Because the Senate hearing focused on educational and training initiatives, these were the focus of Dr. Semla's testimony. To address the growing shortage of geriatrics healthcare professionals trained to care for the aging, the federal government should among other things, establish loan forgiveness programs for geriatrics healthcare professionals, Dr. Semla urged, noting the loan forgiveness bills now before the Senate and House. The federal government should also expand and fund Title VII Health Professions Programs, and support Title VII Nursing Workforce Development Programs. Washington must also expand and enhance support for the nation's Geriatric Research, Education and Clinical Centers (GRECCs), increase the number of Medicare GME slots, particularly in geriatrics, and collaborate with foundations and other organizations to train and prepare direct care workers and family and other informal caregivers, he advised.

Though the hearing focused primarily on training, Dr. Semla also urged Congress to reform Medicare and the nations' healthcare systems to realign reimbursement and incentives and provide adequate coverage for necessary and cost-effective services. "Changes like this to Medicare coverage are important incentives for geriatricians and other primary care providers," he noted.

IOM Releases Report Addressing Growing Shortage of Healthcare Providers Trained to Care for Older Patients; AGS President To Testify At Senate Hearing on Workforce Issues Tomorrow
The Institute of Medicine (IOM) released its long-awaited report concerning the readiness of the nation's healthcare workforce to meet the needs of an aging society today. The report, "Retooling for an Aging America: Building the Health Care Workforce," concludes that the future workforce "will be woefully inadequate in its capacity to meet the large demand for health services for older adults if current patterns of care and of the training of providers continue." The number of older Americans will nearly double to 70 million by 2030, the report notes, when youngest of the baby boomers will have reached retirement age.

AGS President Todd Semla, PharmD, will testify tomorrow on behalf of the AGS at a Senate Special Committee on Aging hearing focusing on preparing the nation's healthcare workforce to care for the rapidly growing number of older Americans.

The IOM report, which echoes and builds on findings from AGS' 2005 "Caring for Older Americans: The Future of Geriatric Medicine" report, notes the severe shortage of geriatrics healthcare professionals and calls for a wide range of sweeping initiatives to increase recruitment into geriatrics and ensure that all healthcare providers who care for older adults are adequately trained to meet their unique healthcare needs. Many of the recommendations parallel AGS' priorities.

Among other things, "Retooling for an Aging America" recommends that:

Medicare, Medicaid and private insurers offer higher compensation to healthcare providers caring for older adults and cover key services, such as care coordination, that are currently not covered
pubic and private payers offer a "specific enhancement of reimbursement " for healthcare services to older adults provided by practitioners with a "certification of special expertise in geriatrics."
Congress authorize and fund additional training programs for all healthcare professionals to better prepare them to care for older adults
state and federal governments offer loan forgiveness, scholarships and other financing incentives to professionals who specialize in geriatrics
Congress and foundations "significantly increase" support for research and demonstration programs that lead to development of new models of care in prevention, long-term and palliative care, and models of care that promote the effective uses of the workforce
public and private payers promote and reward new models of care for older adults that are shown to be effective and efficient
states and the federal government increase minimum training standards for all direct care workers
public private and community organizations provide funding and ensure adequate training for family and other informal caregivers
healthcare professionals and regulators consider expanding the roles and responsibilities of healthcare providers to better meet the needs of an aging population

AGS Comments on Questions IOM is Investigating in Study of Healthcare Workforce for Older Americans

In a letter to the Institute of Medicine (IOM) concerning the institute’s ongoing study examining the readiness of the nation’s healthcare workforce to meet the needs of an aging population, the American Geriatrics Society outlines strategies for meeting these needs.

The August letter, signed by AGS President-Elect and IOM Work Group Chair John B. Murphy, MD, addresses several key questions the IOM’s Future Health Care Work Force for Older Americans project is investigating.

In response to three related questions - “What is the best use of the healthcare workforce?” “What models of healthcare delivery hold promise to provide high quality and cost-effective care for older persons?” and “What new roles or new types of providers would be required under these models?” – [Murphy, John B. MD] among other recommendations the letter suggests adoption of a “medical home” model. In keeping with this interdisciplinary, collaborative team model, a primary care physician leads a team of healthcare professionals -- which may include nurses, nurse practitioners, certified nursing assistants, physician’s assistants, pharmacists, social workers, therapists and informal caregivers -- that provides older patients with coordinated care. A geriatrician serves as the organizational and educational leader for the team, notes the letter, which further describes the roles of each team member. It also notes that nurses’, social workers’, and informal caregivers’ roles would likely need to be expanded under this model and that a newly crated position, that of “certified care coordinator,” might be necessary as well.

The letter explains that while “all persons should have a ‘medical home’ there is a need for the selective use of more intensely interdisciplinary and collaborative care for target populations, conditions and settings.” Target populations include the frail elderly, those 85 and older, and low income and terminally ill patients, according to the letter. Target conditions include falls, hip fracture, dementia, depression, congestive heart failure, stroke and delirium. Citing examples of effective models for various settings, the letter mentions Evercare as a model for nursing homes; medical homes, care management plus, home-based primary care, PACE, GRACE, hospice and others as models for community settings; and ACE units as a model for hospital settings.

The letter goes on to offer suggestions regarding appropriate education and training for healthcare professionals caring for older adults; the financing of this training; and the best approaches to recruiting and retaining needed professionals. “Equitable earnings, relative to other healthcare workers, will facilitate recruitment and retention,” the letter notes. “Our current volume-based payment system that only considers team care and non-face-to-face services in a very limited manner has resulted in earnings that are not comparable to peer professionals. Addressing this will require different payment methodologies that will not make primary care less remunerative.”

Finally, the letter lists needed improvements in Medicare, Medicaid and other public programs. Among other things, it notes that the government must “seriously invest in health services research with a focus on effective models of care and comparative cost-effectiveness of treatments” and support better data collection. In addition, it should support the development and implementation of quality measures appropriate to older adults, especially the frail elderly.

The IOM report is expected out in March. The 15-member IOM committee conducting the study is headed by AGS member Jack W. Rowe, MD, and includes AGS members Marie A. Bernard, MD, Terry Fulmer, PhD, RN, Tamara B. Harris, MD, MS, David B. Reuben, MD, and Joseph E. Scherger, MD, MPH.

Those interested can subscribe to the IOM Future Health Care Workforce for Older Americans project’s mailing list and receive periodic updates on the projects’ progress.