by Frank James
The nation has had decades to prepare itself for the arrival of Baby Boomers into advanced middle age and senior citizenhood. But to probably no one’s surprise, in true American let’s-not-do-anything-until-the-crisis-is-on-us fashion, few preparations have been made for the inevitable healthcare needs of this aging wave.
In a new report, the Institutes of Medicine (IOM) spotlights the nation’s continued unreadiness for the higher healthcare burden to result from graying of the Baby Boomers whose leading edge turns 65 in 2011.
In 2011 the first baby boomers will turn 65, ushering in a new generation of older Americans. The 65-and-older population of the future will be markedly different from previous generations, with higher levels of education, lower levels of poverty, more racial and ethnic diversity, and fewer children. Their most striking characteristic, however, will be their numbers. The aging of the baby boom population, combined with an increase in life expectancy and a decrease in the relative number of younger persons, will create a situation where older adults make up a much larger percentage of the U.S. population than has ever before been the case. Between 2005 and 2030 the number of adults aged 65 and older will almost double, from 37 million to over 70 million, accounting for an increase from 12 percent of the U.S. population to almost 20 percent. While this population surge has been foreseen for decades, little has been done to prepare the health care workforce for its arrival…
…This year marks the 30th anniversary of the first report published by the Institute of Medicine (IOM) on the health care workforce for older patients, Aging and Medical Education. That report and others have called for an expansion of geriatric training, but so far the geriatric discipline has grown little in numbers or in stature… The report continues:
Besides being inadequately prepared in geriatrics, the current workforce is not large enough to meet older patients’ needs, and the scarcity of workers specializing in the care of older adults is even more pronounced. Among direct-care workers, nursing assistants provide 70 percent to 80 percent of the direct-care hours to those older adults who receive long-term care, but their shortage is well documented. Older adults account for about one-third of visits to physician assistants (PAs), but less than 1 percent of PAs specialize in geriatrics. Less than 1 percent of both pharmacists and registered nurses are certified in geriatrics. In 1987 the National Institute on Aging predicted a need for 60,000 to 70,000 geriatric social workers by 2020, yet today only about 4 percent of social workers—one-third of the needed number—specialize in geriatrics.
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These shortages will only be worse in the future. By 2030 the United States will need an
additional 3.5 million formal health care providers—a 35 percent increase from current levels—
just to maintain the current ratio of providers to the total population. The Bureau of Labor
Statistics predicts that personal and home-care aides and home health aides will represent the
second- and third-fastest growing occupations between 2006 and 2016, which will exacerbate
current shortages.
As of 2007, there were 7,128 physicians certified in geriatric medicine and 1,596 certified in geriatric psychiatry. According to one estimate, by 2030 these numbers will have increased by less than 10 percent; others predict a net loss of these physicians because of a decreased interest in geriatric fellowships and the decreasing number of physicians who choose to recertify in geriatrics. According to the Alliance for Aging Research, by 2030 the United States will need about 36,000 geriatricians. It may well not be possible to reach this goal, but the projection underscores the need for immediate and dramatic increases in the numbers of workers who care for older patients in order to close the gap between current supply and future demand.
Judging from the relative lack of attention this issue has received so far during the presidential campaign, it doesn’t look promising that this issue will get the kind of urgent attention the study says is required.