Geriatric Care Is Facing Crisis
Surge in training called for to meet exploding demand
April 15, 2008
The Wall Street Journal
By THEO FRANCIS and VANESSA FUHRMANS
Health-care institutions must rapidly increase training in geriatric care to ward off an "impending crisis" as 78 million baby boomers head toward old age, according to a report by the federal Institute of Medicine.
Calling the U.S. health-care work force "too small and woefully unprepared" for the growing elderly population, the 242-page report lays out a stark picture of increased demand for health-care workers -- unmet by a stagnant or even dwindling supply of those trained to treat the elderly.
"This could be seen as evidence that our society places little value on the expertise needed to care for vulnerable, frail older Americans," said John W. Rowe, chairman of the committee that wrote the report and former chairman and chief executive of health-insurance giant Aetna Inc.
In addition to training specialists, the report recommends weaving more geriatrics training into general medical education for doctors, nurses and others. "We're not saying every [old] person needs a geriatrician any more than every person who has a heart needs a
cardiologist, but we need to enhance the care they do receive," Dr. Rowe said.
Some nursing homes and other institutions are already pairing with medical, dental and nursing schools to provide hands-on geriatric training. Hebrew SeniorLife, a nonprofit nursing-home and senior-housing group in Boston, helps train about 750 medical, dental, nursing and other students from more than a half-dozen local schools; second-year Harvard Medical School students spend two weeks treating its elderly residents. Next month, Brandeis University plans to announce a program with Hebrew SeniorLife to train health-care administrators interested in focusing on the elderly.
But such efforts are rare, due to the time and expense of implementing them. Another Hebrew SeniorLife program -- giving nurse aides a day off a week to work toward becoming a licensed practical nurse -- costs some $450,000 a year, funded by a state grant and donations.
"The first thing you need are patients, and the second thing you need are health-care professionals who have a spare moment to be providing high-quality teaching," said Len Fishman, the nonprofit group's chief executive and a former New Jersey Commissioner of Health and Senior Services. "Most long-term-care facilities are small; they don't have medical staffs."
Monday's report also recommends training for those taking care of elderly people, noting that 90% of those receiving care at home get help from family and friends, and 80% rely solely on them.
By 2030, one American in five will be over 65, and in coming years more than half of all medical care in the U.S. will go to that group, the report notes. Those over 65 currently make up about 12% of the population and account for a quarter of doctors' office visits and at least a third of hospital stays, prescriptions and ambulance trips. Patients over 75 average three chronic conditions and may take four or more medications.
Currently, just one doctor specializes in geriatrics for every 2,500 Americans over age 65, and similar shortfalls exist among other geriatric specialists, including psychiatrists and social workers, the report said. Between 2000 and 2006, the number of certified geriatricians actually fell, by 22% -- and to maintain existing ratios of medical professionals, the U.S. would need to increase its health-care work force by 35%, or 3.5 million people, the report said.
The report blamed misplaced financial incentives for much of the shortfall. Doctors specializing in geriatrics averaged income of $163,000 a year in 2005, compared with internists who earned $175,000 with no specialty training. Other specialists, from surgeons to radiologists and dermatologists, can earn more than twice as much.
Meanwhile, half of those workers caring directly for the elderly -- helping them dress, bathe and eat, for example -- are paid less than $9.56 an hour, the report notes.
Write to Theo Francis at email@example.com and Vanessa Fuhrmans at firstname.lastname@example.org