pressures to control costs will surely increase while spending continues to rise faster than economic growth. The Congressional Budget Office reports that if health care costs continue growing at the current rate, federal spending on Medicare and Medicaid will rise to 20 percent of the GDP by 2050, roughly the same share of GDP that the entire U.S. federal budget accounts for today (CBO, 2007b; Orszag and Ellis, 2007). It is unlikely that there will be adequate funds to support all desirable models of care for the future older population, and changes in benefits and taxes are likely to occur. Retirees are experiencing reductions in Medicare supplemental benefits provided by their prior employers, a trend that will likely continue (AHRQ, 2004; Zabinski, 2007). Moreover, many older adults in the future may not have the coverage or resources needed to pay out of pocket for some clinically indicated services.

In coming years the health care system as a whole will be faced with a number of pressing concerns, including children’s health, obesity, emerging infections, HIV/AIDS, and other challenges that will compete for scarce public resources. While the committee recognizes the tensions that are likely to arise as policymakers are forced to prioritize among multiple need areas, it maintains that workforce shortages in the care of older adults (in terms of both size and competence) is a looming crisis that demands significant attention.


The Institute of Medicine (IOM) formed the Committee on the Future Health Care Workforce for Older Americans in January 2007 to determine the best use of the health care workforce to meet the needs of the growing number of adults 65 and older (Box 1-2). To address this charge, the committee sought to describe promising models of health care delivery and the workforce that will be necessary in the future to serve the medically indicated, culturally conditioned, and satisfiable health care needs of the population of older adults, recognizing that any or all of these needs may be modified.

The committee met four times during the course of the 15-month study. It commissioned six technical papers (see Appendix B) and heard testimony from a wide range of experts (see Appendix C) during two public workshops. Staff and committee members also met with and received information from a variety of stakeholders and interested individuals. Support for the study was provided by 10 organizations: AARP, the Archstone Foundation, the Atlantic Philanthropies, the California Endowment, the Commonwealth Fund, the Fan Fox and Leslie R. Samuels Foundation, the John A. Hartford Foundation, the Josiah Macy, Jr. Foundation, the Retirement Research Foundation, and the Robert Wood Johnson Foundation.

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