adult will be much different from the 85-year-old adult). A necessary step is the development of a health care workforce (including health care professionals, direct-care workers and informal caregivers) sufficient in size and skill to serve this growing number of older adults.

Health services provided to older adults today are not as effective as they could or should be. The quality of care provided to older adults often falls short of acceptable levels for a variety of conditions (Wenger et al., 2003), and the proportion of recommended care that patients actually receive declines with age (Asch et al., 2006). One of the greatest challenges will be reorganizing the health care system and its workforce so that older adults have access to quality services at a cost that the country can afford. Care coordination and other health-management practices that may facilitate this have not been widely adopted. These practices involve restructuring how the health care workforce operates, but they provide an opportunity to reform service delivery so that the next generation of older adults will receive more effective health care services than their parents.

In addition to having a higher prevalence of chronic disease, older adults have greater vulnerability to injury (e.g., falls) and to acute illness (e.g., pneumonia) and have more limitations on their activities of daily living (ADLs).¹ As a result, older adults use health services at far higher rates than the rest of the population. These high rates of health service utilization coupled with the large rise in the number of older adults can be expected to result in a dramatic increase in the demand for health and long-term care services in the coming decades. This escalation in demand for health care services will in turn create a number of challenges that will need to be addressed, including inadequate numbers of health care workers, the limited training of those workers in geriatric skills, the misalignment of the payment system, and scarce financial resources.

The rising demand for services places increasing pressure on the health care workforce to expand its capacity. The Bureau of Labor Statistics (BLS) reports that the aging of the population will make the health care industry a major source of overall projected employment growth in the United States between 2006 and 2016 (BLS, 2007b). Employment in the home health and the residential-care industries is rising particularly quickly (Table 1-1).