Report: Health Care Workforce Too Small, Needs Retooling

As the first of the nation's 78 million baby boomers begin reaching age 65 in 2011, they will face a health care work force that is too small and woefully unprepared to meet their specific health needs, says a new report from the Institute of Medicine. The report, "Retooling for an Aging America: Building the Health Care Workforce," calls for the immediate training of all health care providers in the basics of geriatric care and the preparation of family members and other informal caregivers, who currently receive little or no training, in how to tend to their aging loved ones. Medicare, Medicaid, and other health plans should pay higher rates to boost recruitment and retention of geriatric specialists and care aides, says the report.

Saying the country faces an 'impending crisis,' the report committee set a target date of 2030--the year by which all baby boomers will have turned 65 or older--for the necessary reforms to take place. "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," said committee chair John W. Rowe, professor of health policy and management at Columbia University's Mailman School of Public Health. "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."

Among other observations, the report notes that there is an overall shortage of health care workers in all fields but points out that the situation is worse in geriatric care because it attracts fewer specialists than other disciplines and experiences high turnover rates among direct-care workers such as nurse aides, home health aides, and personal care aides. For example, today there are just more than 7,100 physicians certified in geriatrics in the United States--one for every 2,500 older Americans. Turnover among nurse aides averages 71 percent annually, and up to 90 percent of home health aides leave their jobs within the first two years. The report concludes that higher pay in the specialty, more training, and changes in care delivery are mandatory for averting the crisis.

Older adults as a group are healthier and live longer today than previous generations, the report notes. Even so, individuals over 65 tend to have more complex conditions and health care needs than younger patients. The average 75-year-old American has three chronic conditions, such as diabetes or hypertension, and uses four or more prescription medications, the committee found. Dementia, osteoporosis, sensory impairment, and other age-related conditions present health care providers with challenges they do not often encounter when tending to younger patients.

Copies of the report are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242, or on the Internet at www.nap.edu. In addition, a podcast of the public briefing held to release this report is available at http://national-academies.org/podcast.

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