hygienist or dental aide therapist) to solve overwhelming oral-health workforce shortages (Kravitz and Treasure, 2007).


As discussed previously, changing the way that health care services are delivered to older Americans will require an overall culture change by all segments of the workforce and delivery organizations, including changes in ideas about who needs to provide specific services and how those individuals need to interact with each other. Adopting new models of care will require the care teams to be flexible so that the workforce will be sufficient in both size and skill to meet the needs of older adults. While it is not possible to discuss in detail the implications of each individual model for the health care workforce for older adults, the committee determined that the models have certain common themes that demonstrate the need for the different segments of the health care workforce to adapt to changes in the way that care is delivered to older adults.

The models that have the strongest bases of evidence typically require providers of different disciplines to work together to improve the coordination of care. In addition, several of the models require providers to take on new roles and assume greater levels of responsibility. As more models depend on patients and informal caregivers being part of the health care team, these individuals will need to be given more education and training so that they can be more effective members of the team. Finally, as is true for the health care workforce as a whole, the development and use of new technologies will have implications for the health care workforce for older adults; the implications will arise not only from the need to train individuals in the use of these new technologies but also from their potential ability to assist existing health care workers in performing tasks and their potential for reducing the number of workers needed. These types of adaptations are discussed in general terms below and then in greater detail in subsequent chapters where their implications for different parts of the health care workforce are considered.

New Roles and Responsibilities

Many of the new models of care require the workforce to change its practices in various ways. For example, as discussed previously, the shahbazim from the Green House model take on far more responsibility and are more involved in residents’ lives than are traditional CNAs. They interact regularly with the residents’ health care providers and alert them to changes in residents’ status. Under the IMPACT program, depression-care managers

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