That study, Retooling for an Aging America: Building the Health Care Workforce, stated that the number of older Americans will almost double between 2005 and 2030, as the baby boomers start to turn 65 in 2011. At the same time, the IOM report says, very few physicians or other caregivers are being trained with an expertise in geriatrics. The report concludes that we need to train our healthcare workforce better in geriatrics, improve recruitment into the field and explore new models of care.
The needs are so great that the residents, patients and their families and the community at large are really going to have to bone up and get very sophisticated about being able to help provide the care because there simply wont be the workforce to do it, says Sarah Greene Burger, a survey respondent, gerontological nurse, advocate for the elderly and former executive director of the National Citizens Coalition for Nursing Home Reform.
Penny Feldman, another respondent, is the vice president for research and evaluation at the Visiting Nurse Service of New York and director of its Center for Home Care Policy and Research. She calls the workforce training issue urgent and immediate.
The average age of a nurse in home care is about 46, she says, and many of these nurses did not receive training in geriatrics. The really critical issue is we need to retool our existing workforce and really give them the additional knowledge and skills and support to deal with this aging population, she says.
Financing the system is another enormous challenge, according to Feldman and other survey respondents, especially because the public has not, by and large, come to grips with the implications of the so-called gray tsunami.
Many, if not most, Americans wrongly assume Medicare will pay for their long-term care, and many are simply not aware of the high probability that they will need long-term care before they die.
In fact, Feldman cited AARP data showing that only 35% of people 65 or older think they will need long-term care in the future, while research shows that 69% of people who are 65 today will need some kind of support services at some point.
Len Fishman, a survey respondent and the president and chief executive officer of Hebrew SeniorLife, a senior housing and healthcare system based in Boston, says that the financing system should move away from the current welfare model, with Medicaid paying for long-term care for the indigent (in many instances people who have become impoverished by paying for long-term care) toward more of a disability model.
Adding a long-term-care benefit to Medicare would be less politically feasible, Fishman suggests, than other alternatives that might carry a lower price tag. Specifically, he favors a bill introduced a year ago in the Senate by Sens. Edward Kennedy (D-Mass.) and Tom Harkin (D-Iowa) and in the House by Reps. John Dingell (D-Mich.) and Frank Pallone (D-N.J.). Under the bill, workers would contribute $30 in monthly premiums through a payroll deduction for at least five years and would then be eligible for benefits under a two-tiered structure if they became disabled. People would be allowed to opt out of the program altogether, and the benefit levels would not cover the entire cost of nursing home care and therefore would split funding between public and private sources.
Maintaining such a public-private balance is in line with what survey respondents favored. Some 55% said individuals and the government should share long-term-care costs, while only 8% thought such costs should be paid mostly by the government.
By offering payment vouchers, the Kennedy legislation would allow disabled people to remain independent and receive care in their homes instead of forcing people prematurely into institutions, as the current system often does by sending dollars directly to nursing homes.
In the current system, there are more people going into nursing homes than would be the case if people had a cash benefit to make other arrangements, Fishman says. This kind of legislation might also unleash a great amount of incentive to offer care to even frail elders in their homes instead of nursing homes, he says.
Another organization that supports the Kennedy bill is the National Council on Aging. Howard Bedlin, the councils vice president for public policy and advocacy, says that in his 20 years of working on long-term-care policy in Washington for various organizations, this is the first time he has been encouraged about the possibility of forging a consensus around an approach to improving it.