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AGS/ADGAP Resources
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What does the report, "Retooling for an Aging America," address?
On April 14, 2008, 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. 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 the youngest of the baby boomers will have reached retirement age.
"Retooling for an Aging America" echoes and builds on findings from AGS' 2005 "Caring for Older Americans: The Future of Geriatric Medicine" report. It documents the severe and growing shortage of geriatrics healthcare professionals, and calls for a wide range of sweeping initiatives to increase recruitment into and retention in 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.
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Why is the IOM report important?
AGS has long warned that the nation is facing an impending health care crisis as the number of older patients with complex health needs increasingly outpaces the number of health care providers with the knowledge and training to adequately care for them.
With the eldest of the nation's 78 million baby boomers reaching retirement age in just three years, fundamental changes in the nation's health care delivery system need to be made, and greater financial resources need to be committed to ensure that they receive high-quality, patient centered care. The nation is not prepared to meet the unique health care needs of the aging population. The Alliance for Aging Research estimates that we will need 36,000 geriatricians to care for the 70 million adults who will be over 65 in 2030, for example. That's a ratio of 1 geriatrician to every 1,945. Today, we have just 1 geriatrician for every 2,546 Americans and the number of professionals entering careers caring for older adults is declining.
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What are the IOM's recommendations?
The committee responsible for the IOM report concluded that the definition of the health care workforce must be expanded to include anyone involved in a patient's care: health care professionals, direct-care workers, informal caregivers (usually family and friends) and patients themselves. Their IOM report recommends that all of these individuals have the essential data, knowledge, and tools to provide high quality health care. The committee proposes a concurrent three-pronged approach:
- Enhance the geriatric competencies of the entire workforce;
- Increase the recruitment and retention of geriatric specialists and caregivers
- Improve the way that care is delivered.
"Retooling for an Aging America" offers specific recommendations in a number of areas:
Providing an Evidentiary Base
- Recommendation 1.1: Congress should require an annual report from the Bureau of Health Professions to monitor the progress made in addressing the crisis in supply of the health care workforce for older adults.
Enhancing Geriatric Competence
- Recommendation 4.1: Hospitals should encourage the training of residents in all
settings where older adults receive care, including nursing homes, assisted-living
facilities, and patients homes.
- Recommendation 4.2: All licensure, certification, and maintenance of certification for health care professionals should include demonstration of competence in the care of older adults as a criterion.
- Recommendation 5.1: States and the federal government should increase minimum training standards for all direct-care workers. Federal requirements for the minimum training of CNAs and home health aides should be raised to at least 120 hours and should include demonstration of competence in the care of older adults as a criterion for certification. States should also establish minimum training requirements for personal care aides.
- Recommendation 6.2: Public, private, and community organizations should provide
funding and ensure that adequate training opportunities are available in the community for informal caregivers.
Increasing Recruitment and Retention
- Recommendation 4.3: Public and private payers should provide financial incentives to increase the number of geriatric specialists in all health professions (4.3).
- Recommendation 4.3a: All payers should include a specific enhancement of reimbursement for clinical services delivered to older adults by practitioners with a certification of special expertise in geriatrics.
- Recommendation 4.3b: Congress should authorize and fund an enhancement of the Geriatric Academic Career Award (GACA) program to support junior geriatrics faculty in other health professions in addition to allopathic and osteopathic medicine.
- Recommendation 4.3c: States and the federal government should institute programs for loan forgiveness, scholarships, and direct financial incentives for professionals who become geriatric specialists. One such mechanism should include the development of a National Geriatric Service Corps, modeled after the National Health Service Corps.
- Recommendation 5.2: State Medicaid programs should increase pay and fringe benefits for direct-care workers through such measures as wage pass-throughs, setting wage floors, establishing minimum percentages of service rates directed to direct-care labor costs, and other means.
Redesigning Models of Care
- Recommendation 3.1: Payers should promote and reward the dissemination of those models of care for older adults that have been shown to be effective and efficient.
- Recommendation 3.2: Congress and foundations should significantly increase support for research and demonstration programs that:
- promote the development of new models of care for older adults in areas where few models are currently being tested, such as prevention, long-term care, and palliative care; and
- promote the effective use of the workforce to care for older adults.
- Recommendation 3.3: Health care disciplines, state regulators, and employers should look to expand the roles of individuals who care for older adults with complex clinical needs at different levels of the health care system beyond the traditional scope of practice. Critical elements of this include:
- development of an evidence base that informs the establishment of new provider
- designations reflecting rising levels of responsibility and improved efficiency;
- measurement of additional competence to attain these designations; and
- greater professional recognition and salary commensurate with these responsibilities.
- Recommendation 6.1: Federal agencies (including the Department of Labor and the Department of Health and Human Services) should provide support for the development and promulgation of technological advancements that could enhance an individual's capacity to provide care for older adults. This includes the use of ADL technologies and health information technologies, including remote technologies that increase the efficiency and safety of care and caregiving.
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