Strengthening Eldercare Workforce Must Be a Priority for the Next President

By Sondra Forsyth

To advise policymakers and health leaders on the key healthcare challenges facing the next presidential administration, the National Academy of Medicine (NAM) launched the Vital Directions for Health and Health Care initiative. Aging experts John Rowe, MD, the Julius B. Richmond Professor of Health Policy and Aging at Columbia University’s Mailman School of Public Health; Terry Fulmer, PhD, RN, of the John A. Hartford Foundation; and Mailman School of Public Health Dean Linda P. Fried, MD, and colleagues were asked to provide guidance to inform U.S. policy on better health for an aging population and recommend priority opportunities. A summary paper titled, “Viewpoint: Preparing for Better Health and Health Care for an Aging Population,” is published online in The Journal of the American Medical Association (JAMA).

A release from the university notes that Dr. Rowe highlights four vital directions central to the health and wellbeing of older persons:

• Develop new models of care delivery to address the clinical and financial challenges presented by frail patients with multiple impairments.
• Strengthen the eldercare workforce to conduct research, provide specialized care as needed, and lead educational efforts to enhance the geriatric competence of all healthcare practitioners.
• Promote the social engagement of older persons and enhance efforts to support work and volunteer opportunities to reverse the decades-long trend toward disengagement of elders.
• Transform care for advanced illness at the end of life that is too often uncoordinated and fragmented. Improve system weaknesses through evidence-based approaches.

The release quotes Rowe, who also leads the MacArthur Foundation’s Network on an Aging Society, as saying, “One of the most important challenges we face is the likely inadequacy of the elder care workforce—in terms of numbers and competency. Not only is there a shortage of board-certified geriatricians, but there are similar deficiencies in other components of the eldercare workforce, including nurses, social workers, and other healthcare and public health providers. Perhaps even more significant is the lack of sufficient training and demonstrated competence among all healthcare and public health providers who care for older people.”

Most paid care to older adults is delivered by nursing assistants and home healthcare aides, whose demand is projected to increase by nearly 50 percent between 2010 and 2020. “The pressures on recruitment are aggravated by retention issues as annual turnover rates often exceed 50 percent,” noted Rowe. Leading the list of actions driving the shortage are low wages, inadequate training and supervision, and the perception that these are “dead-end jobs.” He points out that in 2014 median hourly wages of certified nursing assistants were just slightly more than $12. For home healthcare aides, median wages were approximately $10.

Rowe also stresses that social factors are widely acknowledged to be major determinants of wellbeing yet inadequate attention has been paid to the importance of social engagement through participation in the labor force or volunteer activities. Existing programs such as the Retired and Senior Volunteer (RSVP) program and Experience Corps, co-founded by Dean Fried, have shown marked benefits but require private support and expansion.

Co-authors in addition to Drs. Rowe, Fulmer and Fried are: Lisa Berkman, Harvard University; James Jackon, University of Michigan; Mary Naylor, University o fPennsylvania; William Novelli, Georgetown University; Jay Olshansky, University of Illinois; Robyn Stone, LeadingAge.