New Professions

The health care workforce has a history of creating new professions in response to need, often as a result of the emergence of new technologies or the development of new models of care. At other times, new professions arise because of a serious shortage of providers. The profession of physician assistants, for example, was created in the 1960s to meet the urgent need for providers of primary care. In the same way, new professions may arise in response to the demand for services from older populations.

One type of new worker that has recently emerged in the care of older adults is the geriatric care manager. This new role stems from the development of a formal title for a care coordinator, a job which currently is often undertaken by a variety of providers without formal recognition. In most states, anyone can use this title without any requirement of training or certification (Stone et al., 2002), although many geriatric care managers are certified in other professions, most often in either social work or nursing. Recently, however, the number of certification programs for care managers has surged; one survey found more than 40 different certification designations that might be appropriate for care managers, such as “certified family life educator” and “certified case manager” (Reinhardt, 2003). As more people become aware of the importance of care coordination, especially for the older, frail elderly population, it can be expected that there will be increased need for health care workers who can fill this role. At the same time, the competencies needed to be an effective care manager will need to be developed, a task that will be made more difficult by the fact that no one profession “owns” this position.

Expanding Roles

To compensate for the serious shortages of providers that will characterize the coming decades, workers will need to be used more efficiently. More specifically, health care providers of all levels of education and training will need to assume additional responsibilities—or relinquish some responsibilities that they already have—to help ensure that all members of the health care workforce are used at their highest level of competence. Some professionals will likely need to increase their skills in order to be competent in more areas of care, while higher-level professionals may need to delegate some duties in order to be able to devote more of their time to providing the complex services that only they can provide. (See Chapters 3 and 5 for more on job delegation.) However, professionals are often not prepared for the role of delegator. For example, while RNs are increasingly responsible for supervision and delegation of care tasks to assistive personnel, they often are not taught the necessary decision-making skills

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