In “Retooling for an Aging America: Building the Health Care Workforce,” a new report released last month, the Institute of Medicine prioritizes a need for the U.S. health care workforce to receive increased training and higher pay as a prerequisite for meeting the needs of 78 million baby boomers who turn 65 between 2011 and 2030.
Three years from now, if the status quo remains, the aging baby boomers will comprise 20 percent of the U.S. population and be met by a health care workforce that is too small and very unprepared for the necessary geriatric care of aging adults.
The IOM charged its ad hoc taskforce, the Committee on the Future Health Care Workforce for Older Americans, to determine the health care needs of Americans over 65 years of age and to assess those needs through an analysis of the forces that shape the health care workforce, including education and training, models of care, and public and private programs.
The committee determined three steps must be taken immediately before 2030:
First, we need to increase the competence of virtually all members of the health care workforce in the basic care of older adults.
Second, we need to increase the number of geriatric specialists both to provide care for those older adults with the most complex needs as well as to train the rest of the workforce in basic geriatric principles.
Finally, we need to change the way that care is organized and delivered, using each person to his or her highest level of ability, including family, friends, and patients themselves.
Today’s older Americans comprise 12 percent of the total population but 26 percent of all physician office visits, 35 percent of all hospital stays, 34 percent of all prescriptions, 38 percent of all emergency medical responses, and 90 percent of all nursing home use.
The health care workforce, though, comprises a mere 7,000 certified geriatricians which sounds lofty until you realize this is a 22 percent decrease from eight years ago.
And mental health? There is one geriatric psychiatrist in today’s industry for every 11,000 older adults; and if growth rates remain consistent, there would be one for every 20,000 in 2030.
Despite the disproportionate health care numbers, “the U.S. health care system is in denial about the impending demands,” said committee chairman Jack Rowe in this testimony last month to the U.S. Senate Special Committee on Aging.
Rowe argues that our society places little value on the expertise needed to care for our vulnerable population of frail older adults, considering that a geriatrician earned an average salary of $163,000 in 2005, compared to a general internist salary of $175,000 despite extra training for the former. The disconnect is further seen in a dermatologist salary of over $300,000 a year.
More alarming (though not surprising to me) is that federal standards for nurse aide and home health aide training has not changed in 20 years from its current level of 75 hours. California, Rowe says, requires more training hours than the federal minimum, but has even higher standards for dog groomers, crossing guards, and cosmetologists.
The next issue of my American Society of Public Administration journal is expected to have a larger story about this, and its impact on municipal workers.