- The Washington Times - Tuesday, April 15, 2008

Millions of baby boomers are approaching a point in their lives when they will need geriatric care, but the U.S. health care system is “woefully unprepared,” won’t have enough workers to meet the impending crush and may actually discourage the best care, according to a new report.

The first of America’s 78 million baby boomers begin to turn 65 years old in less than three years, and by 2030, one in five Americans will be 65 or older, according to the report by the Institute of Medicine (IOM), an arm of the National Academy of Sciences.

“We face an impending crisis as the growing number of older patients, who are living longer with more complex health needs, increasingly outpaces the number of health care providers with the knowledge and skills to care for them capably,” said Dr. John W. Rowe, professor of health policy and management at Columbia University and chairman of the committee that wrote the report.

He added, “It’s our profound belief that immediate and substantial action is necessary.”

The report — funded by several private groups including AARP, the John A. Hartford Foundation and the Robert Wood Johnson Foundation — shows it takes specific skills and knowledge to treat older patients, and the U.S. is unlikely to have enough geriatricians to meet the coming needs.

There are about 7,100 physicians certified in geriatrics in the U.S. — one for every 2,500 older Americans, the report found. The report noted that according to the Alliance for Aging Research about 36,000 geriatricians will be needed by 2030, but the talent pool will fall short, at fewer than 15,000.

Turnover among nurse aides is about 71 percent annually and up to 90 percent of home health aides leave their jobs within the first two years.

Americans are living longer, but the average 75-year-old has three chronic conditions and uses four or more prescription medicines, the committee found. Dr. Rowe said general health care practitioners receive “very little training” in the specific needs of the elderly.

The report also found that the salaries of those who specialize in geriatric care lag behind other health care professionals. A geriatrician earned an average salary of $163,000 in 2005, and a general internist earned $175,000, even though geriatricians must complete extra years of testing and training.

The committee also noted several ways that Medicare hinders quality care for older Americans, with its low reimbursement rates for doctors, its focus on short-term health problems rather than managing chronic conditions, and its lack of coverage for preventive services or for the time health care providers spend collaborating with a patient’s other providers.

Dr. Katalin Roth, director of geriatric and palliative care at the George Washington Medical Center, said geriatricians are trained to know the special needs of the elderly, generally view their jobs as “very rewarding” and are among the few modern doctors who often travel to their patients in assisted living facilities or nursing homes.

Among other problems, Medicare reimbursement rates are higher for procedures than they are for time spent with patients, and geriatricians are usually heavy on the latter, she said.

The report comes as the Senate Special Committee on Aging tomorrow holds a hearing, “Caring For Our Seniors: How Can We Support Those On The Frontlines?”

Sens. Barbara Boxer, California Democrat, and Susan Collins, Maine Republican, have crafted a bill that aims to generate more geriatric specialists and long-term care workers, and also creates an advisory panel to make recommendations.

The IOM report recommends several changes, including requiring health care workers to demonstrate competence in basic geriatric care in order to maintain their licenses and certifications; providing more courses and training in how to care for the elderly, in all professional schools and health care training programs; and increasing pay for geriatric specialists and direct-care workers.

Specifically, Medicare should increase its reimbursement rates for services delivered by geriatric specialists and states should allocate funds to be added to the Medicaid payments that cover the majority of services provided by direct-care workers, the report states.

The reforms should take place by 2030, the committee suggested.

The report noted that between 29 million and 52 million family members, friends and others tend to aging parents or other individuals.

Like many other baby boomers, Carol Casserly, 58, and her husband Tad, 59, of Hampton Township, N.J., are caring for both of their elderly mothers. Mr. Casserly’s mother, Marion, 88, is at an assisted-living facility, and Mrs. Casserly’s mother, Betty, 86, is in a nursing home.

“It’s such a balancing act,” said Mrs. Casserly, who plans to retire from her job this spring, mostly to spend more time with her mother.

The Casserlys are starting to think about their future living arrangements. Mrs. Casserly said there are waiting lists now at assisted-living facilities, and her mother’s nursing home at times has been short-staffed.

“If they’re short-handed now, what are we going to do when this baby boom generation hits?” she asked.

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