America’s ageing boomers face health care system crisis

As the first of USA’s 78 million baby boomers reach age 65 in 2011, they will face a health care work force that is too small and woefully unprepared to meet their specific health needs, according to a new report from the Institute of Medicine.

The report calls for “bold initiatives” to train all health care providers in the basics of geriatric care and to prepare family members and other informal caregivers, who currently receive little or no training in how to tend to their ageing loved ones.

Government and private health plans should pay higher rates to boost recruitment and retention of geriatric specialists and professional elder-caregivers, said the Institute.

The committee set a target date of 2030 – the year by which all baby boomers will have turned 65 or older – for the necessary reforms to take place.

“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 committee chair John W Rowe, professor of health policy and management at the Mailman School of Public Health at Columbia University in New York City.

“The sheer number of older patients in the coming years will require trying new models for delivering health care and the commitment of greater financial resources,” he added. “If our aging family members and friends are to live as robustly as they can and in the best health possible, we must have a work force of adequate size and competency to take care of them.”

The US  has an overall shortage of health care workers in all fields, but the situation is worse in geriatric care because it attracts fewer specialists than other disciplines and experiences high turnover rates among direct-care workers, including nurse aides, home health aides, and personal care aides.

Older adults as a group are healthier and live longer today than previous generations, the report notes. Even so, individuals over 65 tend to have more complex conditions and health care needs than younger patients. The average 75-year-old American has three chronic conditions, such as diabetes or hypertension, and uses four or more prescription medications, the committee found. Dementia, osteoporosis, sensory impairment, and other age-related conditions present health care providers with challenges they do not often encounter when tending to younger patients.

Virtually all health care providers treat older patients to some extent during their careers – and likely will do so even more frequently given that one in five Americans will be 65 or older by 2030 – so they need a minimal level of competence in geriatric care, the committee concluded.

The report calls for health care facilities, community organisations, and other public and private groups to offer training programs to help family members, friends, and other informal caregivers provide proper assistance to their loved ones and to alleviate the stress they may feel in coping with an older friend’s or relative’s needs.
Health professionals should regard patients and their family caregivers as an integral part of the health care team, the committee added.

Federal agencies should support the advancement of assistive technologies that can help older patients manage their conditions and handle the basic activities of daily life and also can help family caregivers take care of their loved ones.