The American healthcare workforce is not geared up to meet the needs of the aging baby boomer generation that turns 65 in 2011 says a new report from the Institute of Medicine, titled Retooling for an Aging America: Building the Health Care Workforce.

The number of older Americans is set to double between 2005 and 2030. This poses a serious challenge for the health care system. For example, older adults suffer from at least one chronic illness and require more sustained, long term care than other groups.

America’s 78 million baby boomers are also better educated and more racially and ethnically diverse than previous generations, presenting a new pattern of demand on health services for older people.

The challenge is further heightened by the shortage of people and skills in the healthcare services, particularly in long term care.

The Institute of Medicine, a not-for-profit, nongovernment organization set up in 1970 as part of the National Academy of Sciences, asked the ad hoc Committee on the Future Health Care Workforce for Older Americans to assess the health care needs of older Americans in terms of the people who will have the job of looking after them: the nation’s health care workers.

The report concludes that there is an urgent need for root and branch reform of how the health care workforce is trained and deployed in looking after older patients.

The committee recommended that the term “health care” workforce should be expanded to include everyone who plays a part in looking after patients, not just professionals and direct-care workers, but also informal carers like family members and friends, and even patients themselves.

In order to equip all these groups of healthcare workers, the committee suggested the nation adopt a three point strategy:

  • Develop everyone’s knowledge and skill about geriatrics.
  • Recruit and retain more geriatric specialists and carers.
  • Improve care delivery.

Education and training in geriatric care is generally inadequate, so health care workers don’t have the requisite knowledge and skill to deliver the best health services possible to older people, said the report.

One way to enhance quality of care is to require professionals to show competence in geriatric care in order to get a license or certificate to practice.

The competence of workers who are paid to deliver hands-on care, such as home health aides, personal care aides, and nurse aides needs significant enhancement too, said the committee. This could be achieved by significant improvement in their education and training, and stronger standards, such as those at federal and state level.

There should be better integration of patients and informal caregivers in the health care team, said the report. Patients can be taught self management as a way to reduce their need for formal care, and informal carers can be given a greater role in the delivery of health care to older patients.

In order to achieve this integration of informal care, patient self care and professional care, more funds should be forthcoming from public, private and community organizations, and these should also provide training opportunities for informal carers.

The committee suggests that low pay and the high cost and duration of training accounts for the lower percentage of specialists in geriatrics compared to other fields. To address this they suggest financial incentives be offered to health professionals prepared to specialize in geriatrics.

Such incentives should include pay increases, special awards, and programmes such as bursaries, scholarships, and more direct cash incentives.

Low pay, poor working conditions, few promotion opportunities and high rates of injury are given as reasons for the high turnover and low job satisfaction among direct care workers. These problems could be alleviated by redesigning jobs to make them more desirable, for example by providing clearer and more accessible career progression and improving line management relationships.

The low pay problems in the direct care workforce could be resolved by making state Medicaid increase pay and fringe benefits for this group.

To increase the quality of care delivery to older patients, the report suggests there should be more joined up services that:

  • Provide comprehensive care.
  • Make for efficient delivery.
  • Encourage older patients to be active in their own care.

The report said there are many promising new models of care that espouse these principles, for instance in palliative and preventive care, yet there is little evidence of them being put into practice, probably because the money is not there to educate, co-ordinate, and create more interdisciplinary working.

The committee suggest more work is needed to make more people aware of these new models of care, and that Congress, public and private funding be made available to promote and develop them.

Committee chair John W Rowe, who is professor of health policy and management at the Mailman School of Public Health, Columbia University, New York City, said:

“We face an impending crisis as the growing number of older patients, who are living longer with more complex health needs, increasingly outpaces the number of health care providers with the knowledge and skills to care for them capably.”

“The sheer number of older patients in the coming years will require trying new models for delivering health care and the commitment of greater financial resources,” he added.

“If our aging family members and friends are to live as robustly as they can and in the best health possible, we must have a work force of adequate size and competency to take care of them,” said Rowe.

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Source: Institute of Medicine brief.

Written by: Catharine Paddock, PhD