|
E-mail this page to a friend!
Senior Citizen Politics
Who Will Care for the Elderly and Disabled?
In 2008, there were barely 7,000 geriatricians to
treat 38 million seniors; in 2006-2007 just 253 physicians were enrolled
in geriatric medicine fellowships
By
Howard Gleckman, Senior Research Associate at the Urban Institute
 July 20, 2009 - Advocates of including long-term
care services in health reform usually focus on two issues: How many
Medicaid dollars should be spent on home care and whether to create a
national long-term care insurance program, such as Sen. Edward Kennedy,
D-Mass., has proposed in his CLASS Act. But neither of those reforms
would mean much without more and better-qualified health care workers
and medical professionals to deliver care.
Both long-term assistance and chronic care
management often require specially trained doctors, nurses, nurses’ and
physicians’ assistants, social workers, or health aides. Yet, we already
face desperate shortages of qualified medical professionals and para-professionals
who can meet the highly specialized needs of the frail elderly and other
disabled adults. As 77 million baby boomers age, this shortage threatens
to become a major public health crisis.
We actually are facing two separate, though
related, problems. The first is the need for medical practitioners who
are trained in geriatric care. You might think that treating aging
boomers would be a growth industry. Yet, physician specialists in
geriatric medicine are retiring faster than their replacements are being
trained.
In 2008, there were barely 7,000 geriatricians to
treat 38 million seniors. And, according to an eye-opening study by the
Institute of Medicine, in 2006-2007 just 253 physicians were enrolled in
geriatric medicine fellowships. Oddly, while the opportunities for
specialty geriatric training are increasing, the number of doctorss
enrolled in these programs has been shrinking. The story is the same for
geriatric psychiatry fellowships—more opportunities but fewer takers.
The consequences of this lack of training are
potentially deadly because the needs of the frail elderly are very
different from those of other patients. They often suffer from multiple
diseases—20 percent of those 75 and older have five or more chronic
illnesses.
They take many more medications, and they often react to
those drugs in unpredictable ways. Surveys show that many doctors feel
ill-prepared to care for these patients.
Why don’t medical students want to study
geriatrics? When I was researching my recent book, Caring for Our
Parents, I had the chance to ask Dr. David Greer, the retired dean of
the Brown University Medical School and a former geriatrician himself.
Greer pointed to three reasons: Low pay, low status among other docs
and, perhaps most important, “physicians don’t like to treat patients
who don’t get better.”
Medicare and private insurers can address the
first, perhaps as part of the push in health reform to create “medical
homes”—practices that, for an extra fee, will manage a patient’s overall
care. It will, sadly, be much harder to change physician attitudes
towards elderly and disabled patients.
The second problem is with those front-line workers
who provide the day-to-day physical care for long-term patients. It is
tough work for low pay, and it is no surprise that few are willing to do
it.
According to the Labor Department, the average wage
for a home health worker is just $9.50 an hour, about what we pay the
guy who works at the local car wash.
Consumers who hire aides through agencies may pay
twice that, but those staffing firms may take half to handle paperwork,
training, pay worker’s compensation, and for overhead.
Many home aides have no health insurance, sick
days, vacation pay, or retirement benefits. The Labor Department reports
they are more likely to be injured on the job than coal miners. Nursing
home aides may get some benefits, but they have little opportunity for
advancement and often work in a stifling, top-down, highly structured
environment. It is no wonder that in many facilities up to 80 percent of
workers quit each year.
What can be done to attract more people to these
essential jobs? To start, aides could be paid more. But long-term care
is already prohibitively expensive for many and higher wages will drive
costs beyond the reach of still-more families. Better training and more
opportunities for advancement will help. And some nursing homes, in the
vanguard of what’s become known as the “culture change movement” are
giving aides more autonomy and responsibility. Not surprisingly, they
report higher morale and lower turnover.
Both the House leadership health reform bill and
the Senate Health, Education, Labor and Pensions Committee measure
include modest provisions to encourage better training for elder care
workers and medical professionals. It is at least a start. But the
growing demand for more home care will mean nothing if there are not
enough workers to provide that assistance.
Howard Gleckman, a senior research associate at
the Urban Institute, is author of Caring For Our Parents and a frequent
writer and speaker on long-term care issues.
View all previous columns by Gleckman »
|
This
information was reprinted from
kaiserhealthnews.org with permission from the Henry J.
Kaiser Family Foundation. You can view the entire Kaiser
Daily Health Policy Report, search the archives and sign up
for email delivery. © Henry J. Kaiser Family Foundation. All
rights reserved. |
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
Debate involving Medicare taking on new urgency amid
doubts if the health overhaul will meet Obama's goal of slowing health
care costs