As we come to the end of another Older American’s Month, it is a good time to assess the progress we are making in the development of our eldercare workforce.
It has been eight years since the Institute of Medicine released its groundbreaking report, Retooling for an Aging America: Building a Health Care Workforce. Policymakers and professionals continue to recognize that we must address this issue. In 2013, the U.S. Senate Commission on Long Term Care described the workforce as the “critical link in the availability and quality of services for our nation’s elders.”
Unfortunately, we are a long way from a well-developed, quality eldercare workforce. Resolving the workforce crisis requires addressing recruitment, retention, training, and compensation issues across the direct-care and professional health care workforce-which is essential to improve the quality of care and quality of life for older adults.
- Increase pay and job quality. They are critical to ensuring adequate recruitment and retention. Half the direct care workforce turns over every year and the average wage in 2013 was $9.61 an hour. In less than two years, by 2018, more than one million direct care workers will be needed.
- Training the entire workforce, especially primary care providers, in the unique needs of older adults is critical. Many older adults will not have access to geriatricians. Currently, there are only 7,029 geriatricians practicing in the U.S., roughly half the number needed. It is therefore critical that the primary care workforce is trained in geriatrics and gerontology.
- Expand the Geriatrics Workforce Enhancement Program (GWEP). The GWEP is the only federally funded geriatric training program. The innovative program is training the entire workforce, family caregivers and consumers in the care of older adults. However, the $38.7 million program is only in 44 communities and 29 states. There are large geographic areas, especially rural areas, that have no programs. Yet, rural populations are growing increasingly older.
- Develop additional incentives to go into geriatrics and gerontology. Right now, there are many disincentives to go into the geriatrics specialty. For example, geriatricians make less than half as much as a number of other specialties. A majority of medical students carry thousands of dollars of debt coming out of medical school. When it comes time to choose a specialty, salary is an important component. Providing incentives, such as loan forgiveness and increased salaries, are essential.
- Support and train all unpaid caregivers – including family, friends and other caregivers. Much of the 37 billion hours of care in the U.S. is provided by the more than 40 million unpaid family caregivers. If they were paid, it would cost an estimated $470 billion.
- An essential step in addressing our fragmented health and long-term care system is to adopt care models that provide well-coordinated, person-directed and family-focused services across settings.
- Team based geriatric care is critical to providing high-quality care for older adults, many of whom have multiple complex chronic conditions. This requires a provider team with a diverse range of skills for addressing this population’s physical, mental, cognitive, and behavioral needs.
Ultimately, it is about transformational change in the workplace. AND the workplace where the bulk of care takes place is the patient’s home within a community. The system in place was not set up to provide extensive care in the home or community. As such, our current workforce provides care in a patch work manner.
We know how to do this. We have dozens of models of care that can work. However, we are moving too slowly. The number of older baby boomers is increasing at the same time the workforce and family caregivers providing care are decreasing.
As the daughter of a baby boomer, I worry about this from a personal perspective. How long will my parents be able to live in their log cabin in the woods? With several diagnosed chronic conditions already, are there professionals in their area adequately trained in the care of older adults? What if they need round the clock care? We have known about these issues for many years, yet we shy away from asking these questions until we reach a crisis. Well we are here, baby boomers are already turning 70. We have very little time to make this systematic change. We must reprioritize the care of our parents, grandparents, and ultimately us. We must demand it of our elected officials and communities.
Abby Marquand, PHI, and I explore these issues at greater length in the latest issue of Generations.
Amy York is the Executive Director of the Eldercare Workforce Alliance.