U.S. Health Care System Unprepared For Millions Of Baby Boomers Who Are About To Become Eligible For Medicare

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 16 Apr 2008 - 9:00 PDT

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The U.S. health care work force is "too small and woefully unprepared" to meet the geriatric care needs of the 78 million aging baby boomers, according to a report released on Monday by the Institute of Medicine, the Wall Street Journal reports (Francis/Fuhrmans, Wall Street Journal, 4/15). The report, titled "Retooling for an Aging America: Building the Health Care Workforce," estimates that currently there is one certified geriatrician for every 2,500 seniors. In three years, the first of the baby boomers will turn 65 years old, and by 2030, all 78 million will have reached that age -- nearly double the number of people older than age 65 in 2005, according to the report. The U.S. would need 36,000 geriatricians by 2030 to meet the need, according to the report. The report says there are 7,128 certified geriatricians today (La Ganga, Los Angeles Times, 4/15).

IOM attributes much of the shortfall to misplaced financial incentives. The average pay in 2005 for a physician specializing in geriatrics was $163,000, compared with $175,000 for a general internist with no specialty training. Other specialists can earn more than twice as much (Wall Street Journal, 4/15). The report also says that Medicare's low reimbursement rates; focus on treating short-term problems, rather than managing chronic conditions; and lack of coverage for preventive care may exacerbate the problem (Schmid, AP/San Francisco Chronicle, 4/15).

The report also cites a high rate of turnover among direct-care workers, such as nurse's aides and home health aides, and lack of knowledge by "informal caregivers," such as family members, friends and others who provide care for seniors in their homes. According to the report, 71% of nurse's aides change their jobs annually, and as many as 90% of home health aides find a new job within two years (Reichard, CQ HealthBeat, 4/14). The report says that 90% of seniors receiving care at home get help from family and friends and 80% rely solely on them.

Recommendations
Although the report calls for increasing the number of geriatricians, it also recommends that physicians, nurses and others receive more geriatric training during their general medical education (Wall Street Journal, 4/15). In addition, the report recommends that Medicare, Medicaid and private insurers increase payment for geriatric care to attract workers. The report says that creating initiatives at local hospitals and community groups to help train informal caregivers could help the situation. It also recommends that state attorneys general recognize such training at hospitals as justification for their tax-exempt status (CQ HealthBeat, 4/14). In addition, IOM recommends that states and the federal government create programs that would forgive student loans for people caring for older adults (Los Angeles Times, 4/15).

"This could be seen as evidence that our society places little value on the expertise needed to care for vulnerable, frail older Americans," John Rowe, chair of the committee that wrote the report and a former chair and CEO of Aetna, said. He added, "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" (Wall Street Journal, 4/15).

Senate Finance Committee Chair Max Baucus (D-Mont.) on Friday said that he wants to increase Medicare payments to primary care physicians, which include geriatricians, as part of a Medicare package due on the Senate floor in mid-May. AARP said it is lobbying for a bill (S 2708), co-sponsored by Sens. Barbara Boxer (D-Calif.) and Susan Collins (R-Maine), that would bolster geriatric and long-term care training. The legislation also would create a panel that would track geriatric and long-term care and issue recommendations for improving the fields (CQ HealthBeat, 4/14).

A summary of the report is available online.

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