SeniorJournal.com

INDEX

FRONT PAGE

PAGE TWO
More Headlines

 • General Features

 • Find Help

 • SENIOR ALERTS

 • Baby Boomers

 • Odds & Ends

Health-Fitness

 • Fitness

 • Health/Medicine

 • Medical Research

 • Nutrition/Vitamin

Government

 • Politics

 • Medicare

 • Medicare Drug Program

 • Medicare Q&A - Dear Marci

 • Medicaid

 • Social Security

 • Social Security, Medicare Q&A

Enjoying Life

 • Books

 • Entertainment

 • Features

 • Grandparents

 • Senior Statistics

 • Senior Stars

 • Sex & Seniors

 • Sports

 • Travel

 • Senior Volunteers

On The Web

 • Links - Senior

 • Senior Friendly Business Links

 • Sites We Like

Elderly Issues

 • Elder Care

 • Assistance for Elderly

 • Housing

Money 

Thinking

 • Opinions

Get Instant Supplemental Medicare Insurance Quotes.

E-mail this page to a friend!

Senior Citizen Politics

Martha Stewart Testifies at Senate Aging Hearing for Effort to Add More Healthcare Workers for Senior Citizens

Sen. Kohl promises legislation to expand, train, and support all sectors of the health care workforce, including doctors, nurses, direct care workers, and family caregivers

	Martha Stewart with her mother at the Center for Living’s ground-breaking ceremony in 2007. Photo by Martha Stewart Living Omnimedia

April 17, 2008 – Martha Stewart headlined a hearing of the Senate's Special Committee on Aging yesterday that may set the wheels in motion to expand the recruitment and training of healthcare workers to meet the needs of the 78 million baby boomers about to join the Medicare ranks, and to help relieve the 44 million Americans serving as the sole source of care for an older family member or loved one.

The hearing was the first in which Congress reviewed the Institute of Medicine’s (IOM) major recommendations for improving and expanding the skills and preparedness of the health care workforce in their report, “Retooling for an Aging America:  Building the Healthcare Workforce,” released Monday.  

Committee Chair Herb Kohl (D-WI) announced at the opening of the hearing that he plans to incorporate lessons from today’s hearing into "legislation to expand, train, and support all sectors of the health care workforce, including doctors, nurses, direct care workers, and family caregivers."

The healthcare challenge was presented by Dr. John Rowe, Chairman of the IOM’s Committee on the Future Health Care Workforce for Older Americans, who said, "This combination of aging baby boomers and increased longevity will lead to a near doubling of the number of adults aged 65 and older, from 37 million to over 70 million, accounting for an increase from 12 percent of the U.S. population to almost 20 percent."

On the healthcare side of the ledger, however, the report finds:

  ● Today there are only a little more than 7,000 certified geriatricians, a 22 percent decrease from the year 2000. Some expect this number will continue to decline.

  ● Today, there is only about 1 geriatric psychiatrist for every 11,000 older adults; at current rates of growth, in 2030 there will only be one for every 20,000.

  ● Less than one percent of nurses, pharmacists, and physician assistants are specialists in geriatrics; less than 4 percent of social workers specialize in aging.

  ● Health care professionals, including doctors, nurses, social workers, and others receive very little training in caring for the common problems of older adults such as confusion, incontinence, and falls.

Rowe is also a Professor in the Department of Health Policy and Management, Columbia University Mailman School of Public Health.

Stewart focused on the challenges of the family caregiver saying, "I understand the challenges family caregivers face. My mother, Martha Kostyra, passed away last year at the age of 93."

She said she and her siblings "came to know first hand the number of issues that needed to be managed" by caregivers to senior citizens.

She said much of what she has learned is from work at the  Martha Stewart Center for Living, a model clinic for coordinated outpatient geriatric services at Mount Sinai in New York, which she established in honor of her mother.

"Our aging relatives and the families who care for them yearn for basic information and resources," she said.

"We all know this is a significant sector of our society: more than 75 percent of Americans receiving long-term care rely solely on family and friends to provide assistance. The majority of these caregivers are women, many of whom are also raising children. Often, these women are working outside the home as well."

She had three specific recommendations for the committee:

● We must make an effort to coordinate care. Most older Americans have several doctors. It’s important for these doctors to cooperate with one another and work closely with caregivers.

 ● It is important that we, as a society, recognize the stresses and challenges that caregivers face and support them as best we can. We want to ensure that their health isn’t undermined by the demands of eldercare.

 ● We must encourage families to open up a dialogue now. Even if your older relatives are in good health, it’s important to plan for a day when they might not be.

Other witnesses at the hearing included:

  > Dr. Robyn Stone, Executive Director of the Institute for the Future of Aging Services at the American Association of Homes and Services for the Aging.  Dr. Stone’s testimony highlighted the weaknesses and limitations of the current health care system in meeting the needs of aging boomers.

  > Dr. Todd Semla, President of the American Geriatrics Society, made the case for using existing law to increase the number of trained geriatricians practicing in the U.S.

  > Mary McDermott, a family caregiver herself and a member of the Wisconsin Quality Home Care Commission Board of Directors, discussed the challenges faced by direct care workers in acquiring the skills they need to assist frail elders and individuals with disabilities who wish to remain in their own homes.

  > Dr. Sally Bowman, an Associate Professor at Oregon State University, who provided an overview of recent research on issues affecting family caregivers and suggested innovative ways in which health professionals, direct care workers and family caregivers can receive training and education in a variety of settings.

Editor's Notes: Sponsorship for the IOM project was provided by The John A. Hartford Foundation, The Atlantic Philanthropies, The Josiah Macy, Jr. Foundation, The Robert Wood Johnson Foundation, The Retirement Research Foundation, The California Endowment, The Archstone Foundation, The American Association of Retired Persons (AARP), The Fan Fox and Leslie R. Samuels Foundation, and The Commonwealth Fund.

Information on the IOM report can be found online at http://www.iom.edu/agingamerica.

Testimony by Martha Stewart
U.S. Senate Special Committee on Aging
April 16, 2008

Chairman Kohl, Ranking Member Smith and members of the Committee: I appreciate the invitation to testify before you today and am honored to be here.

You have chosen a subject that is increasingly critical to our quality of life—not only for older Americans but for family members who care for them. I look forward to learning from the work of the Committee as it continues to examine this issue. The experience of the distinguished professionals on your panel today will be important as well.

I respond to your invitation today as a member of a family whose eyes were opened by personal experience—and to share what we have been learning at the Martha Stewart Center for Living at Mount Sinai Medical Center in New York City.

My professional life has been centered on the home, the well-being of the family and everything that these subjects encompass. When I began working in this area more than 25 years ago, the subject of homemaking as it relates to families was largely overlooked, though the interest was clearly broad and the desire for information strong.

My colleagues and I soon discovered we were satisfying a deeply felt unmet need. Today I see a similarly unmet need. Our aging relatives and the families who care for them yearn for basic information and resources. We all know this is a significant sector of our society: more than 75 percent of Americans receiving long-term care rely solely on family and friends to provide assistance. The majority of these caregivers are women, many of whom are also raising children. Often, these women are working outside the home as well.

I understand the challenges family caregivers face. My mother, Martha Kostyra, passed away last year at the age of 93. My siblings and I were fortunate that she was in good health almost until she died. Still, we came to know first hand the number of issues that needed to be managed.

First, it’s difficult, especially in smaller cities and rural locations, to find doctors experienced in the specific needs that arise with age. Think of all that this includes: the effect of medications on elderly patients; how various medicines interact with each other; warning signs for depression and onsets of other conditions increasingly common in the elderly.

How do we ensure that they take their medications?

How do we help structure our parents’ lives so they can live independently for as long as possible?

And how do we support the generation of caregivers who devote so much of themselves to their parents’ aging process?

This only touches on the myriad of issues, of course. Worry is the backdrop for everything these families do: What if the parent falls? What if she leaves the burners on? What if he takes his medications twice—or forgets to take them at all?

Now I am learning even more about the physical, emotional and financial toll that the experience can exact. Caring for an aging parent or loved one can be another full-time job. In fact, 43 percent of baby boomers have taken time off from work and 17 percent have reduced hours to help care for an aging parent.

They do this at a time when their expenses are rising. One recent study found that half of those caring for a family member or friend 50 years or older are spending, on average, more than 10 percent of their annual income on caregiving expenses. Many dip into savings and cut back on their own health care spending to cover the bill. Is it any wonder that family caregivers are at increased risk of developing depression, anxiety, insomnia and chronic illnesses?

In the Kostyra family, we were grateful to be there for my mother, who had given so much to us and was a well-loved presence in our lives and in the lives of her 13 grandchildren. Our experience in her final years and my resulting awareness of the issues Americans face is one of the reasons for the creation of the Center for Living. The goal of the Center, which is dedicated to my mother, is to help people to live longer, healthier, productive lives even as they age.

We have set a goal at the Center to use research and the practice of geriatric medicine to try to elevate the level of eldercare and its importance in our society. Did you know that there is currently one geriatrician to every 8,500 baby boomers? That’s clearly not adequate.

We are also working to develop new tools and resources for caregivers. We are collaborating with a large number of organizations and motivated, experienced individuals, many of whom have been studying these issues for years. There are numerous devoted and knowledgeable people in this arena, and we hope we can all learn from each other.

This is a field that eventually impacts most families in emotional and encompassing ways. Yet sometimes it’s the simple solution that holds an answer.

Not so long ago at the Center, a woman brought in her father, who had suffered a stroke two years earlier. After the stroke, he had been told he could never eat again and was placed on a feeding tube. He was devastated and depressed. He had spent his life as someone with a passion for good food, and his future looked bleak to him. At the Center, a doctor experienced in geriatric care asked the man to drink a glass of water. He did, without a problem.

“If he can do this,” the doctor said, “he can eat.” This simple exchange improved the man’s quality of life immeasurably. And I’m sure it improved the quality of his daughter’s life, too, knowing that her father was happier.

I want to share with you three things I’ve learned from our work at the Center and that others may find useful:

 ● We must make an effort to coordinate care. Most older Americans have several doctors. It’s important for these doctors to cooperate with one another and work closely with caregivers.

 ● It is important that we, as a society, recognize the stresses and challenges that caregivers face and support them as best we can. We want to ensure that their health isn’t undermined by the demands of eldercare.

 ● We must encourage families to open up a dialogue now. Even if your older relatives are in good health, it’s important to plan for a day when they might not be.

I have always been a firm believer in the role of preparation and organization in progressing toward a goal. My concern today is whether our country and our overstretched medical system can possibly meet the demands of 76 million baby boomers who will start turning 65 in the next two years.

Statement of John W. Rowe, M.D.
Professor, Department of Health Policy and Management, Columbia University Mailman School of Public Health and Chair, Committee on the Future Health Care Workforce for Older Americans, Institute of Medicine, The National Academies

 Before the Special Committee on Aging U.S. Senate
 April 16, 2008

Good afternoon Chairman Kohl, Ranking Member Smith, and distinguished members of the Committee. Thank you for the opportunity to testify before you on the critical health care needs of older Americans and the need for reform. I applaud the Committee for its diligent work on issues affecting older Americans and commend you, Mr. Chairman, for holding this hearing.

 My name is John Rowe. Currently, I am a Professor in the Department of Health Policy and Management at the Columbia University Mailman School of Public Health. I am an academic geriatrician and in one of my prior positions was the founding Director of the Division on Aging at the Harvard Medical School.

Today, I come before the Committee in my capacity as the Chair of the Institute of Medicine’s Committee on the Future Health Care Workforce for Older Americans. The Institute of Medicine serves as advisers to the nation to improve health. Established in 1970, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector and the public.

I will be discussing the results and recommendations of a report my committee colleagues and I released on Monday, Retooling for an Aging America, which examines our aging population and its effect on the health care workforce.

Our nation faces significant challenges when it comes to ensuring all Americans have access to needed health care services. Specifically, I am here today to call your attention to a looming crisis that is quickly approaching: the considerable shortfall in the quality and organization of the health care workforce to care for tomorrow’s older Americans.

Factors driving the future demand for geriatric care include the following:

   ● Americans are living longer than ever before, and older adults accumulate disease and disabilities as they age.

  ● In just 3 years, the first of the 78 million baby boomers will turn 65.

  ● This combination of aging baby boomers and increased longevity will lead to a near doubling of the number of adults aged 65 and older, from 37 million to over 70 million, accounting for an increase from 12 percent of the U.S. population to almost 20 percent.

  ● Older adults account for a disproportionate share of health care services. The 12 percent of older Americans today account for 26 percent of all physician office visits, 35 percent of all hospital stays, 34 percent of all prescriptions, 38 percent of all emergency medical responses, and 90 percent of all nursing home use.

  ● About 80 percent of older adults require care for chronic conditions such as hypertension, arthritis, and heart disease. Almost all Medicare spending and 83 percent of Medicaid spending is for the care of individuals with chronic conditions.

In hearing this daunting list, the question arises: how adequate is our health care workforce supply to meet these impending needs? The answer is quite simple: we are woefully unprepared. The U.S. health care system is in denial about the impending demands. Little has been done to prepare the health care workforce for the aging of our nation and the current supply and organization of the health care workforce will simply be inadequate to meet the needs of the older adults of the future.

For example,

   ● Today there are only a little more than 7,000 certified geriatricians, a 22 percent decrease from the year 2000. Some expect this number will continue to decline.

  ● Today, there is only about 1 geriatric psychiatrist for every 11,000 older adults; at current rates of growth, in 2030 there will only be one for every 20,000.

  ● Less than one percent of nurses, pharmacists, and physician assistants are specialists in geriatrics; less than 4 percent of social workers specialize in aging.

  ● Health care professionals, including doctors, nurses, social workers, and others receive very little training in caring for the common problems of older adults such as confusion, incontinence, and falls.

  ● The federal standards for the training of nurse aides and home health aides have not changed since they were mandated over 20 years ago. The state of California, for example, requires more hours than the federal minimum, but has even higher standards for dog groomers, crossing guards, and cosmetologists.

  ● Informal caregivers, the family and friends of older adults, are also ill-prepared for their significant roles in the care of older patients.

  ● Innovative new approaches to delivering care to older adults have been shown to be effective and efficient, but most are not implemented widely and instead left to die on the shelf.

In January 2007, the Institute of Medicine charged the Committee on the Future Health Care Workforce for Older Americans with developing a consensus report determining the health care needs of Americans over 65 years of age and to assess those needs through an analysis of the forces that shape the health care workforce, including models of care, education and training, and recruitment and retention.

After examining all relevant factors, hearing testimony from a wide range of experts, and meeting with a variety of stakeholders and interested parties, the committee came to the strong conclusion that steps need to be taken immediately along a three-pronged approach. First, we need to increase the competence of virtually all members of the health care workforce in the basic care of older adults. Second, we need to increase the number of geriatric specialists both to provide care for those older adults with the most complex needs as well as to train the rest of the workforce in basic geriatric principles.

Finally, we need to change the way that care is organized and delivered, using each person to his or her highest level of ability, including family, friends, and patients themselves.

There is a great “myth” that effectively addressing the threats of solvency and sustainability of the Medicare Trust Fund will assure older adults access to high-quality care. In fact, funding is only half of the problem: we first need to ensure that our health care workforce has the capacity, both in size and ability, to deliver the health care services that a new generation of older adults will soon need. Having funds available does not guarantee that there will be someone available to provide the quality care our oldest Americans deserve.

While I encourage all to review the full report of the committee, I will summarize the key recommendations.

Enhancing Geriatric Competence Virtually all health care workers should be able to provide care for the basic health care needs of older adults. There are a number of challenges to the geriatric education and training of health care workers, including the scarcity of faculty, non-standardized curricula, and a lack of training opportunities.

While the exposure to geriatrics in professional schools has improved, much more formal training is needed. Currently, training is highly variable, ranging from guest lecturers to elective courses to discrete courses in geriatrics. More than half of surveyed medical students and one-quarter of dental students perceive inadequate coverage of geriatric issues in their undergraduate courses.

One notable way in which training is inadequate is the lack of exposure to settings of care outside of the hospital. Since much care of older patients occurs in nursing homes, home settings, and assisted-living facilities, the committee concluded that preparation for the comprehensive care of older patients needs to include training in non-hospital settings. In addition, the committee recommends that virtually all types of health care professionals should be required to demonstrate competency in care of older adults as a criterion for licensure and certification.

Similar standards are needed for direct-care workers, the nurse aides, home health aides, and personal care aides who are the primary providers of paid hands-on care to older adults. Currently, the federal minimum number of hours of training for most types of direct-care workers is 75 hours, a minimum that has not changed in over 20 years. The committee recommends that states and the federal government should increase minimum training standards for direct-care workers. The federal minimum training for nurse aides and home health aides should be increased to at least 120 hours (the number required by at least the top quartile of states) and their certification should require demonstration of competence in the care of older adults. In addition, states should also establish minimum training requirements for personal care aides.

Finally, both patients and informal caregivers need to be better integrated into the health care team. By learning self-management skills, patients can improve their health and reduce their needs for formal care. In addition, informal caregivers play a large role in the delivery of increasingly complex health care services to older adults. The committee recommends that public, private, and community organizations provide funding and ensure that training opportunities are available for informal caregivers.

Increasing Recruitment and Retention of Geriatric Specialists and Caregivers

 Geriatric specialists are needed in all professions for three significant reasons: they have the clinical expertise needed to care for those older patients with the most complex health care needs, they will be responsible for training the entire workforce in the geriatric principles related to the common health care conditions of older adults, and they will be conducting research on the models of care that are more effective and efficient in delivering these needed services.

Unfortunately, the effort, time, and costs associated with extra years of geriatric training do not translate into additional income. In 2005, a geriatrician earned $163,000 on average compared to $175,000 for a general internist despite the extra training required to become a certified geriatrician. Physicians who select another specialty, such as dermatology, can earn over $300,000 a year. This may be seen as evidence that our society places little value on the expertise needed to care for our vulnerable population of frail older adults.

This discrepancy is due in part to the fact that a geriatric specialist derives less income from private payers than from public payers. Medicare and Medicaid payments, which represent almost all sources of payment to geriatricians, fail to fully account for the fact that the care of the most frail older patients with more complex health care needs is especially time-consuming, leading to fewer patient encounters and fewer billings.

The committee recommends that public and private payers should provide financial incentives to increase the number of geriatric specialists in all health professions. All payers should include a specific increased reimbursement for clinical services provided by geriatric specialists.

Programs such as the Geriatric Academic Career Awards administered by HRSA’s Bureau of Health Professions have been successful in the development of academic geriatricians but similar opportunities are rare or not available for faculty in other professions. In the nursing profession, the lack of available faculty is a significant barrier to training more nurses. One estimate shows that about 32,000 qualified applicants to nursing programs are denied admission primarily due to the lack of available faculty needed to expand programs. The committee recommends that Congress fund and expand the scope of these awards to support faculty in other health professions.

The committee recommends the establishment of programs that would provide loan forgiveness, scholarships, and direct financial incentives for professionals who become geriatric specialists. The committee found that programs linking financial support to service, such as the National Health Service Corps (also administered by the Bureau of Health Professions), have been very effective in increasing the number of health care professionals who care for underserved populations and should be used as a model for creating a National Geriatric Service Corps to recruit geriatric specialists in all professions.

In addition to professionals, the need for direct-care workers is dire. These workers often have high levels of turnover and job dissatisfaction. They often receive low wages (averaging less than $10 per hour) and have few benefits – many are more likely to lack health insurance and use food stamps than workers in other fields. In addition, they are at significant risk for on-the-job injuries. To help improve the quality of these jobs, more needs to be done to improve job desirability, including greater opportunities for career growth. To overcome huge financial disincentives, the committee recommends that state Medicaid programs should increase pay for direct care-workers and provide access to fringe benefits.

Improving Models of Care The committee created a vision for the future that follows three principles:

   ● The health needs of the older population need to be addressed comprehensively;

   ● Services need to be provided efficiently; and

   ● Older persons need to be encouraged to be active partners in their own care.

The committee conducted extensive research to identify innovative approaches in both the private and public sectors that are getting strong results. A number of new models of care show great promise to improve the quality of care delivered to older adults and reduce costs. Examples include CMS’ Program of All-Inclusive Care for the Elderly (PACE) and the Improving Mood: Promoting Access to Collaborative Treatment for Late Life Depression (IMPACT), which resulted from efforts initiated by the John A. Hartford Foundation. However, the diffusion of these models has been minimal, often due to the fact that current financing systems do not provide payment for features such as patient education, care coordination, and interdisciplinary team care.

The committee recommends that more be done to improve the dissemination of models of care that have been shown to be effective and efficient for older adults. Since no single model of care will be sufficient to meet the needs of all older adults, the committee also recommends that Congress and foundations significantly increase support for research and programs that promote the development of new models of care in areas where few models are currently being tested, such as preventive and palliative care.

In order to deliver care more effectively and efficiently, one workforce adaptation that needs extensive development is the expansion of the roles many members of the health care workforce (including technicians, direct-care workers, informal caregivers, and the patients themselves) to include the delivery of more complex services. Job delegation involves the shifting of specific tasks from more specialized workers to less specialized workers or even families, friends, and patients themselves (along with the necessary training to assume these responsibilities). Job delegation has worked in other populations in need. For example, in Africa, the significant shortage of health care workers to care for persons with HIV/AIDS was successfully ameliorated through delegation of tasks to individuals at the community level. Other examples of expanding roles has been seen in our own country through the development of the nurse practitioner and physician assistant professions, as well as the development of specialized skills among many direct care workers. More research is needed on how we can best maximize the use of all of individuals in caring for older adults.

As part of this ideal of maximizing the efficient use of workers, the committee recommends that federal agencies provide support for the development of technological advancements that could enhance individuals’ capacity to provide care for older patients.

This includes the use of assistive technologies which may both reduce the need for formal care and improve the safety of care and care-giving as well as health information technologies, including remote technologies, that improve both the communication among all caregivers and the efficient use of professionals.

Finally, in order to maintain focus on this problem, the committee recommends that the Bureau of Health Professions deliver an annual report on the progress made in addressing the crisis in supply of the health care workforce for older Americans.

Conclusion

 Mr. Chairman, my fellow committee members and I hope that this report will serve as a catalyst for systematic change in the structure of our health care system and workforce. It is our profound belief that immediate and substantial action is necessary by both public and private organizations to close the gap between the status quo and the impending needs of future older Americans. Again, I want to thank the Committee for allowing me to testify and I look forward to answering any questions you may have.

Search for more about this topic on SeniorJournal.com
		Web	SeniorJournal.com

Click to More Senior News on the Front Page

Copyright: SeniorJournal.com