Recommendation 4-3b: Congress should authorize and fund an enhancement of the Geriatric Academic Career Award (GACA) program to support junior geriatrics faculty in other health professions in addition to allopathic and osteopathic medicine.

Many efforts to recruit and retain health professionals seek to relieve at least part of the financial burden associated with the personal cost of their education and training. The committee concluded that programs linking financial support to service have been effective in increasing the numbers of health care professionals who care for underserved populations and that they would serve as a good model for the development of similar programs to address the shortages of professionals in geriatrics.

Recommendation 4-3c: States and the federal government should institute programs for loan forgiveness, scholarships, and direct financial incentives for professionals who become geriatric specialists. One such mechanism should include the development of a National Geriatric Service Corps, modeled after the National Health Service Corps.

Direct-Care Workers

Recruitment and retention is especially dire among direct-care workers. They receive low wages and few benefits, they have high physical and emotional demands placed on them, and they are at significant risk for on-the-job injuries. These workers report high levels of job dissatisfaction resulting from poor supervision, a lower level of respect among colleagues, and few opportunities for advancement. Not surprisingly, then, there are high levels of turnover among these workers. Overall, the successful recruitment and retention of direct-care workers depends on a significant culture change to increase the quality of these jobs through improvements in the job environment and adequate financial compensation for their current and expanding roles.

Recommendation 5-2: State Medicaid programs should increase pay and fringe benefits for direct-care workers through such measures as wage pass-throughs, setting wage floors, establishing minimum percentages of service rates directed to direct-care labor costs, and other means.

Redesigning Models of Care

The U.S. health care system suffers from deficiencies in quality, and the health and long-term care services provided to older patients are no



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