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« Christa Monkhouse, Culture and Design | Main | Learning Circles »

April 17, 2008 |Permalink |Comments (2)

Geriatric Care Is Facing Crisis

This is conventional wisdom inside the field of aging but it is nice to see that it is getting attention from the Wall Street Journal. See article below with my comments bold...

Surge in Training
Called for to Meet
Exploding Demand
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 is a case of market failure. There is a large lead time in recruiting and training people who can work in this field. The need is great but current market incentives are pulling people into fields other than aging. Without action, the age boom will really hit and it will be impossible to meet the needs.

"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.

I agree with Dr. Rowe's view on this...

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."

The other big problem is that pushing "new recruits" into training programs which are nursing home-centric winds up giving people a false impression of the field. It is like scooping water with a sieve.

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.

This is what Eden at Home is all about...

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.

Not mentioned is the relatively low professional status NOT enjoyed by the field of geriatrics. This needs to change as well.

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.

Comments ( 2)

I think those who serve the elderly, like those who serve the poor, have low status (which also determines their income and the attractiveness of the professions to potential recruits) because the group they serve has low status. That in turn seems to stem from our society viewing the worth of every person in terms of their economic value. Even those who serve children, despite the children having economic value in the future, have lower status because economic value is judged more in terms of immediate profit-making than in terms of potential contributions. Those of us who are younger or wealthier keep this system going through psychological denial, imagining that we will never be old and needy, or that if we are we will have all our needs met through our money, and by keeping groups such as the elderly and the poor out of sight and out of mind. We also tend to turn lower status professions over to women, who in turn have lower status. Lower economic status also means less influence over the politicians who could help solve the problems.
I don't usually rely this much on the concepts of sociology or political theory in analyzing problems, but this is how it looks to me. That does not mean that problems are insurmountable. Raising awareness, through activities such as this blog is one way to promote change. Raising hell helps too.

Posted by DeanOR
April 17, 2008 11:56 AM

yes, we need more women raising hell! perhaps the boomers struggling to figure out how to care for aging parents will be the ones who can do it.

my own group, second wave feminists, has the limitation of being small--and a bit tired.

Posted by naomi dagen bloom
April 17, 2008 4:54 PM

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