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Retooling for an Aging America: Building the Health Care Workforce
Index
A
Access to care
geographic distribution of health care professionals, 126–128
insurance coverage for direct-care workers, 210–211
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Retooling for an Aging America: Building the Health Care Workforce
Index
A
Access to care
geographic distribution of health care professionals, 126–128
insurance coverage for direct-care workers, 210–211
mental health services, 46
oral health care, 144
Activities of daily living
assistance needs of older adults, 43
mental health problems and, 45
tasks and responsibilities of informal caregivers, 251–252
technological support, 14, 115, 164, 244–246
trends in health status of older adults, 40, 55
Advanced Illness Management Plan, 83–84
Advanced medical homes, 100–101
Advanced practice registered nurses, 143–144
African Americans. See Race/ethnicity
Aging and Medical Education, 2, 28–29
Alcohol and substance abuse, 45
All Payer Graduate Medical Education Act, 170
Allied and Auxiliary Health Care Workforce Project, 163
Allied health care workers, 152
Alzheimer’s disease
mortality, 44
prevalence, 21, 44
prevalence trends, 55
Ambulance utilization, 47
Ambulatory care, 3, 46
American Association of Colleges of Nursing, 141
American Board of Family Medicine, 137–138
American Board of Internal Medicine, 137–138
American Dietetic Association, 158
American Geriatrics Society, 158
American Physical Therapy Association, 158
American Society of Hospital Pharmacists, 146–147
Apprenticeships, 224
Arizona, 90–91
Arthritis, 42, 45–46, 55
Asian Americans. See Race/ethnicity
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Assistive technologies, 14, 115, 164, 244–246
Association of American Medical Colleges, 129
Atlantic Philanthropies, 141–142, 150, 154
B
Balanced Budget Amendment, 137
Beacon Hill Village, 229
Better Jobs Better Care, 230
Boston University Medical Center, 155
Bureau of Health Professions, 6, 30
C
California Endowment, 163
California HealthCare Foundation, 163
Cancer, 44, 45–46, 57
Capitated payment, 97–98
Care coordinator. See Geriatric care managers
Rosalynn Carter Institute for Caregiving, 258
Cash and counseling program, 92–93
Centers for Medicare and Medicaid Programs, 231–232
Centers of excellence in geriatric medicine, 29, 141, 154
Cerebrovascular disease, 44
Certified nursing assistants. See Nurse aides
Chiropractic services, 49
Cholesterol control drugs, 49
Chronic conditions
definition of long-term care, 27
fee-for-service payment system, 96
future challenges for health care system, 16
health care utilization for, 42–43, 45–46
Medicare spending, 3, 16, 42–43
mortality, 16
prevalence, 16, 21, 42
City College of San Francisco, 163
Collaborative for Ethnogeriatric Education, 155–156
Committee on the Future Health Care Workforce for Older Americans, 25–28
Community-Based Jobs Training Grants, 164, 230
Community-based services
demand for direct-care workers and, 200
long-term care provision, 48
shortcomings of Medicaid policies, 23
volunteer workers for, 229
Community colleges, 163–164
Compensation for health care workers
direct-care workers, 11, 209, 210–211, 220–222
financial incentives for geriatric training, 10, 171
geriatric medicine professionals, 171
supply and demand estimates and, 28
wage pass-throughs, 11, 221, 222
Complementary and alternative medicine, 49
Comprehensive care, 76–77
Comprehensive Geriatric Education Program, 142
Congress, recommendations for, 6, 11, 13, 30, 108, 175
Continuum of care, 157–159
informal caregivers in, 242
Cooperative Home Care Association, 222
Coordination of care
current shortcomings, 114
goals of health system reform, 77
in Medicare Advantage, 97
in MedPAC, 99
model of end-of-life care, 83–84
in new models of care, 114
significance of, in health care outcomes, 47–48, 113–114
Cost of care
assistive technologies, 246
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chronic condition spending, 3, 16, 42–43
cost of geriatric training, 171
economic value of informal caregiving, 18, 247–248
efficiency of care and, 56
financial assistance for informal caregivers, 261–263
financing mechanisms for new models of care, 98–101
future challenges, 24–25
hospice care, 48
IMPACT model of care for depression, 104
implications for health care system reform, 28
in last years of life, 44
long-term care spending, 48, 62
outcomes of Medicare demonstration projects, 88
per beneficiary, 24, 65
projected Medicare spending, 58
Council for Adult and Experiential Learning, 224
Council on Social Work Education, 149, 150
Crossing the Quality Chasm, 2, 29, 48, 76, 256
Cultural sensitivity
principles of delivery system reform, 77
training for work with special populations, 155–157
D
Deficit Reduction Act, 86
Definitions, 27
Delirium
definition, 105
HELP model of care, 105–106
prevalence, 105
Dementia
physical health and, 45
prevalence, 44
See also Alzheimer’s disease
Dentists and oral-health care workers
aging of population of, 168
board certification, 145
emerging supply problems, 19, 20
geographic distribution, 126–127
supply and demand projections, 144
training, 144–146, 154
Department of Health and Human Services, recommendations for, 14, 246
Department of Labor, recommendations, 14, 246
Depression
physical health and, 45
prevalence, 45
treatment models, 79–80, 103–104
Diabetes, 45–46, 55
Diet and nutrition
feeding assistants, 225
geriatric content of medical training, 157, 158
provider training in health promotion, 157
Dietary supplements, 49
Dietetics, 152, 158
Direct-care worker recruitment and retention
causes of turnover, 209–210
challenges, 11, 209–210, 232
current turnover, 209
financial factors, 210–211, 220–222
labor pool expansion, 227–229
model programs for, 229–232
quality of care and, 213–214
recommendations for, 11
reform of roles and responsibilities, 226
strategies for improving, 214–215, 233
work environment factors, 211–213, 222
Direct-care workers, 32
career lattices, 224
compensation, 11, 200, 210–211, 220–222
employment settings, 201
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on-the-job injury risk, 212–213
professional recognition, 223
projected demand, 200
quality of patient care, 213–214
recommendations for compensation, 11, 222
recommendations for training and certification, 9, 218–220
recruitment and retention. See Direct-care worker recruitment and retention
reform of roles and responsibilities, 225
role of, in older adult health care, 199, 203, 232
strategies for workforce improvement, 201, 217–220
supply, 20–21, 199–200
training costs, 209
training requirements, 204–208, 217–220, 232–233
training shortcomings, 22, 204, 215–218, 232
types of, 27, 201
work environment, 11, 21, 199, 200–201, 209, 211–213, 214, 222–226
workforce demographics, 203–204
See also Home health aides;
Nurse aides:
Personal- and home-care aides
Direct Service Workforce Demonstration, 231
Disabilities, older adults with
demographic differences, 50
long-term care utilization, 4, 44
mental health problems and, 45
prevalence, 43
trends, 54–55, 63
Disease prevalence, 40–42
projections, 59
Distance education, 162–163
Diuretic drugs, 49
E
Education and training of health care workers
adaptation to new models of care, 112
advanced practice registered nurses, 143–144
continuing education, 161
in continuum of care, 157–159
costs to providers, 10, 171
current shortcomings, 4, 5, 21–22, 124, 128, 160, 204
dentists and oral-health care workers, 144–146
direct-care workers, 9, 204–205, 215–220, 232–233
in disease prevention, 157–158
emergence of new medical professions and, 165
enrollment patterns, 19
exposure to geriatric patients, 169
faculty recruitment and retention, 10–11, 152, 153–155, 175–176
financial aid for geriatric training in exchange for service, 176–181
financial incentives for health care professionals, 10, 11, 171, 181
future prospects, 162
health care outcomes and, 21
in health promotion, 157
home health aides, 207, 215
informal caregivers, 9–10, 242, 254–256, 260–261
for interdisciplinary team work, 159–160
Internet-based, 162–163
leadership, 153–155
licensed practical nurses, 141
licensure and certification requirements and, 8–9, 161–162
in non-hospital settings, 6–8, 23, 136–137
nurse aides, 206–207, 215
obstacles to improving, 6, 123, 128, 160–161
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obstacles to recruitment of health care professionals, 169, 170
palliative care, 158–159
patient self-management interventions, 243–244
pharmacists, 146–147
physician assistants, 148
of physicians, 128–138
quality of care and, 21, 216
recommendations for, 6–10, 137, 161–162, 175, 218–220
recruitment and retention linkage, 216
registered nurses, 141–143
role of community colleges in, 163–164
social workers, 149, 150
for use of new medical technologies, 164
for work with special populations, 152, 155–157
Educational attainments of older adults, 53, 54–55
Efficiency of care, 13, 56, 77
Electronic health records, 14, 114, 257
Emergency Health Personnel Act, 179
Emergency medicine
geriatric training, 151
older adult utilization, 3, 46–47
utilization projections, 57–58
Employment and Training Administration, 230–231
End-of-life care
AIM model, 83–84
cost of, 44
diversity of needs, 44
goals for new models of care, 109
training for health care professional, 158–159
Epidemiology
chronic conditions, 16, 21, 42
demographic variations in health care utilization, 49–52
geriatric syndromes, 43
mental health conditions, 44–45
projected morbidity, 55
Evercare program, 85–86
Evidence-based care, 79–80
F
Family caregivers. See Informal caregivers
Feeding assistants, 225
Fee-for-service reimbursement system, 22, 96–97
Fellowships, 134, 147, 167, 171, 172
Florida, 127
Future of Disability in America, The, 244, 245
G
Gay, lesbian, bisexual, and transgender persons, 152, 156–157
diversity considerations in new models of care, 109
Geographic variation
distribution of health care professionals, 126–128
population age distribution, 51
Geriatric Academic Career Awards, 10–11, 136, 154, 175
Geriatric care managers, 165
Geriatric Education Centers, 129
Geriatric Resource Nurse, 154
Geriatric Resources for Assessment and Care of Elders (GRACE), 80–81
Geriatric specialists
board certification, 137–138
career satisfaction, 167
centers of excellence, 29
current workforce, 4, 5, 21, 124–125
dentists and oral-health care workers, 144–146
emergency medicine, 151
emerging supply problems, 19, 167
federal training programs, 134–136
fellowships, 134
financial incentives for, 10, 11, 171–175
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geographic distribution, 127
interdisciplinary team training, 159–160
licensure and certification, 8–9, 161–162
negative stereotypes, 169
obstacles to professional training, 123, 128
older adult utilization patterns, 46
optometry, 152
pay disparities for health care professionals, 10
physical therapists, 151
physician assistants, 148
podiatry, 152
previous efforts to improve supply of, 28–29, 30
professional leadership, 153–155
projected need, 5, 19, 20, 125–126
projected supply, 5, 125
recent growth, 2
recommendations for education and training, 6–10, 161–162, 175, 218–220
recommendations for recruitment and retention, 10–11, 171–172
registered nurse training, 141–143
roles for retired professionals, 169
shortcomings of federal reimbursement system, 23
social workers, 5, 21, 125, 148–149, 150
Geriatric syndromes, 43
Geriatric Training for Physicians, Dentists, and Behavioral/Mental Health Professions Program, 136, 154
Geriatrician Loan Forgiveness Act, 180
GRACE. See Geriatric Resources for Assessment and Care of Elders
Green House, 81–83, 111, 225
H
John A. Hartford Foundation, 29, 79–80, 129, 134, 141, 143, 150, 153–154, 155, 159, 170
Health care needs of older adults
conceptualization of, 27–28
demographic trends and, 52–55, 66–67
gender differences, 49–50
inpatient diagnoses, 47
last years of life, 44
limitations of projections, 64–65
in nursing homes, 44
oral health, 144
principles of delivery system reform, 76–78
reasons for physician office visits, 45–46
scope of, 3, 17
technology development and, 14, 55–56
See also Chronic conditions;
Utilization
Health Insurance Portability and Accountability Act, 257
Health Resources and Services Administration, 57, 129, 134–136, 145, 154, 155, 159, 160, 176
Health status of older adults
average, 21
current self-reports, 40, 42
disease prevalence, 40–42, 59
diversity of, 40
geriatric syndromes, 43
in long-term care facilities, 44
mental health conditions, 44–45
racial/ethnic differences, 50–51
in rural areas, 127
socioeconomic status and, 50–51
trends, 2–3, 40, 54–55
See also Health care needs of older adults
Healthcare Effectiveness Data and Information Sets, 99
Hearing problems, 43
Heart disease
epidemiology, 42
medication use, 49
mortality, 44
office visits related to, 45–46
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HELP. See Hospital Elder Life Program
Help-seeking behaviors
mental health services, 46
preventive care utilization, 50, 51
sexual orientation and, 156–157
High Growth Job Training Initiative, 230–231
Hispanic population. See Race/ethnicity
HIV/AIDS, 156
Home health aides
recommendations for training, 9, 218
recruitment and retention challenges, 209
services, 202
supply and demand trends, 17–18
training requirements, 9, 22, 207, 215, 218
workforce characteristics, 203
See also Direct-care workers
Home health care
demand for direct-care workers and, 200
direct-care worker employment in, 201
Medicare coverage, 47, 99–100
projected demand, 58, 200
technology development for, 14, 56
utilization patterns, 47
Hospice
AIM model of care, 83–84
federal program spending, 48
utilization park, 44
Hospital Elder Life Program (HELP), 105–106
Hospitals
direct-care worker employment in, 201
discharge patterns, 47
post-acute care, 47, 254
utilization patterns, 45, 46, 47
utilization projections, 57–58, 59
Hypertension
epidemiology, 42
medication use, 49
physician office visits for, 45–46
I
Immigrant population
in health care workforce, 227–228
language proficiency and health care utilization, 51
use of interpreters in health care, 253
IMPACT. See Improving Mood: Promoting Access to Collaborative Treatment for Late Life Depression
Improving Mood: Promoting Access to Collaborative Treatment for Late Life Depression (IMPACT), 79–80, 103–104, 111–112
Incarcerated population, 54, 155
Incontinence, 43
Indian Health Service, 178
Indiana University, 80–81
Informal caregivers, 32
caregiver characteristics, 248–250
definition, 18, 247, 249
demand projections, 64
economic value, 18, 247–248
financial assistance, 261–263
frequency and intensity of help from, 247
influence on health care outcomes, 253–254
integration with medical team, 256–258
long-term care provision, 48
new models of care, 113
numbers of, 248, 249
quality of care, 247
recommendations for training, 9–10, 255
respite, 261
role of, in continuum of care, 242, 247, 263
spouses as, 250
stress for, 258
supply concerns, 18, 242, 249–251, 263
support programs, 258–263
tasks and responsibilities, 251–253
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training models, 255–256
training needs, 4, 9, 242, 260–261
Information technology
electronic health records, 14, 114, 257
goals of health system reform, 77
for new models of care, 114–115
recommendations for, 14
Infrastructure development and maintenance
recommendations for, 12
See also Information technology
Institute for Geriatric Nursing, 141
Intensive care, 57
International medical graduates, 134, 155
Internet-based education, 162–163
Interpreters, language, 253
J
Jewish Vocational Services, 163
K
Kaiser Permanente, 97
Kansas, 126–127
L
Learning organizations, 107
Lewin Group, 61–62
Licensed practical nurses
nursing home needs, 167
scope of practice, 140–141
supervisory role, 141
training, 141
Licensure and certification
board certification for physicians, 137–138, 145
continuing education requirements, 161
geriatric care managers, 165
geriatric competency requirements, 161
goals, 161
nurse aides, 296
pharmacists, 147
recommendations for, 8–9, 161–162, 218
Life expectancy
gender differences, 49–50
population trends, 16
socioeconomic status and, 51
Lifespan Respite Care Bill, 259, 261
Long-term care
barriers to recruitment of health care professionals for, 167–168
current utilization, 43, 48
definition, 27, 48
demand projections, 61–62, 63–64
demographic trends and, 54
nurse aides in, 201–202
spending, 48
See also Chronic conditions;
Nursing homes
M
Maine, 90
Manchester Community College, 164
Marital status, 51
Medicaid
compensation for direct-care workers, 11, 220, 221–222
coordination with Medicare benefits, 23
demonstration projects, 88–93
financial challenges, 15, 24–25
future of health care system, 30, 31, 56
informal caregiver support, 258–259
long-term care spending, 48
nurse aide training requirements, 206
nursing home bias, 23
projected service utilization, 4
recommendations for, 10, 11, 171, 222
shortcomings of current payment system, 22, 23, 174–175
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spending on non-institutional service delivery, 200
spending per beneficiary, 65
spending trends, 24, 65–66
strategies for enhancing recruitment of geriatric specialists, 171, 174–175
See also Reimbursement
Medical Home demonstration projects, 101.
See also Advanced medical homes
Medical technologies
future demand for health services and, 14, 55–56
new models of care, 114–115
provider training for, 164
to support activities of daily living, 14, 115, 164, 244–246
See also Information technology
Medicare
additional benefits to support new models of care, 99–100
Advantage plan, 97–98
chronic care spending, 3, 16, 42–43
coordination of patient care in, 114
coordination with Medicaid benefits, 23
copayment disparities, 12, 108, 174–175
demonstration projects, 84–88
end-of-life spending, 44
fee-for-service system, 96–97
financial challenges, 15, 24–25, 66
future of health care system, 30, 31, 56
graduate medical education, 23, 136, 137
hospice care, 44, 48
Hospital Insurance Trust Fund, 24, 66
informal caregiver support, 258, 260, 261
long-term care spending, 48
Medication Regimen Review, 146
medication use by enrollees, 49
mental health coverage, 12, 46, 108
nurse aide training requirements, 206
obstacles to new models of care, 107
original purpose, 22
population projections, 53
post-acute care service coverage, 47
projected service utilization, 4, 58–61
recommendations for, 10, 11, 171
research budget, 88
shortcomings of current payment system, 22–23, 174–175
special needs plans, 98–99
spending per beneficiary, 24, 65
strategies for enhancing recruitment of geriatric specialists, 171, 174–175
total budget, 88
utilization patterns of consumers, 46
See also Reimbursement
Medicare Modernization Act, 86, 98
Medications
average consumption among older adults, 21, 49
older adult utilization, 3, 45, 48–49
role of informal caregivers in administration of, 257
scope of practice reforms in administration of, 166–167, 225
utilization by type of medication, 49
MedPAC, 99
Mental health, 44–45
geriatric education and training for physicians, 133
geropsychiatric nursing, 143
help-seeking behaviors, 46
older adult utilization patterns, 46
physical health and, 45
reimbursement reforms to enhance recruitment of geriatrics professionals, 174–175
supply of geriatric specialists, 125
training requirements for geriatric psychiatry, 138
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Minnesota, 91
Models of care delivery, 31
additional Medicare benefits to support new models, 99–100
advanced medical homes, 100–101
collaborations for dissemination, 107
common features of innovative models, 93–95, 115
coordination of care in, 113–114
current shortcomings, 6, 11–12, 14
dissemination experiences, 103–106
financing mechanisms, 98–101
goals for improving, 12
interdisciplinary care teams, 113
international models, 27, 110–111
Medicaid demonstration projects, 88–93
Medicare research and demonstration projects, 84–88
for middle class consumers, 109
new approaches, 78–79
obstacles to diffusion, 103, 107–108
palliative care in, 109
performance evaluations of, 78, 93
population diversity considerations, 109
preventive interventions in, 109
principles, 76–78
private sector models, 79–84
recommendations for, 6, 12–14, 108
reforms in workforce roles and responsibilities, 13, 111–113, 115
reimbursement reform for, 12
requirements for successful implementation, 12, 75, 101–102
research needs, 12–13, 108–110
workforce adaptation to, 13, 111
workforce considerations in new designs, 109–110
Monitoring health care workforce supply
goals, 30
rationale, 5
recommendations for, 6, 30
Mortality
among older adults, 44
chronic condition-related, 16
circumstances of last years of life, 44
socioeconomic status and, 50–51
Mt. San Antonio College, 163
N
National Advisory Council on Nurse Education and Practice, 155
National Association of Social Workers, 150
National Caregiver Support Program, 259
National Citizen’s Coalition for Nursing Home Reform, 217
National Clearinghouse on the Direct-Care Workforce, 232
National Council of State Boards of Nursing, 141
National Direct Service Workforce Resource Center, 231
National Family Caregiver Support Program, 261
National Geriatric Service Corps, 11, 181
National Health Service Corps, 11, 176, 179–181
National Institutes of Health, 178–179
Native Americans. See Race/ethnicity
New Hampshire, 126–127
Northern Michigan University, 155
Nurse Aide Training and Competency Evaluation Program, 206
Nurse aides
career lattices, 224
current supply, 5
demand projections, 58
employment settings, 201
feeding assistance role, 225
medication administration responsibility, 166, 225
quality of care, workload and, 213–214
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recommendations for training, 9, 218
role of, in older adult care, 201–202
supply challenges, 21
training requirements, 9, 22, 206–207, 215, 217, 218, 232–233
See also Direct-care workers
Nurse Competence in Aging, 141–142
Nurse Education, Expansion, and Development Act, 142–143, 170
Nurse practitioners, 3, 143
Nurse Reinvestment Act, 141–142
Nurses
emerging supply problems, 19
medication administration role, 166
obstacles to increasing supply, 140
projected demand, 58
projected supply, 140
scope of practice and job delegation reforms, 165–166
support for doctorate level faculty, 175–176
See also Licensed practical nurses;
Nurse aides;
Nurse practitioners;
Registered nurses
Nurses Improving Care for Health System Elders, 154
Nursing Demand Model, 57
Nursing homes
age distribution of residents, 43–44
current utilization, 43–44
direct-care worker employment in, 201
emerging workforce supply challenges, 21
Evercare program model of care, 85–86
Green House model of care, 81–83
health status of residents, 44
informal caregiver effects on entry, 254
Medication Regimen Review, 146
mental health problems among residents, 45
nursing staff, 141
occupational injury risk, 212
older adult utilization, 3–4, 45, 48
oral-health care in, 144
per capita spending, 65
projected demand, 58
quality of care, staffing levels and, 213–214
racial/ethnic differences in utilization, 50
screening guidelines, 157–158
shortcomings of Medicaid policies, 23
workforce turnover, 209–210
See also Long-term care
Nursing Reinvestment Act, 155
O
Obesity
prevalence projections, 59
service utilization projections and, 61
Omnibus Budget Reconciliation Act, 86, 206
Oncology, 57
Optometrists, 58, 152
Oregon, 90
Osteopathic medicine, 11, 138, 175
P
PACE. See Programs of All-Inclusive Care for the Elderly
Palliative care. See End-of-life care
PAS Workforce Project, 232
Patient-centered care, 76
Patient role in health care
goals, 77–78
new models of care, 113
professional workforce needs and, 4–5
scope of, 241–243
self-management, 243–244
Personal- and home-care aides
income, 209
monitoring performance of, 203
on-the-job injury risk, 212
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recommendations, 9, 218
recruitment and retention challenges, 209
role of, in older adult care, 202–203
training, 9, 207–208, 215, 218
workforce development programs, 232
See also Direct-care workers
Pharmacists
current certification in geriatrics, 5, 21, 125
education and training, 146–147
emerging supply problems, 19, 146
licensure, 147
in older adult health care, 146
reform of medication administration roles, 166–167
reimbursement for advanced services, 174
PHI, 224, 232
Physical therapy, 58, 151
Physician Aggregate Requirements Model, 57
Physician assistants
current supply, 5, 21, 125, 148
education and training, 148
income, 171
in older adult health care, 147–148
older adult utilization, 5, 147
practice settings, 147, 148
scope of work, 147
Physicians
aging of population of, 20, 168
board certification, 137–138, 161
career satisfaction, 167
cost of geriatric training, 171
current medical school training, 129–133
current supply of geriatric specialists, 124–125, 128–129
emerging supply problems, 19
income, 171, 172
postdoctoral training in geriatrics, 133–136
See also Physician assistants;
Professionals, health care;
Resident physicians
Podiatrists, 58, 152
Polk Community College, 164
Population trends and patterns
aging, 1, 15, 16, 45, 52–53
demographic features, 1, 4, 15–16, 52–55
demographic variations in health care utilization, 49–52
geographic variation, 51
health care workforce aging, 20, 168–169
health status, 2–3
informal caregivers, 248–251
population diversity considerations in new models of care, 109
potential sources for direct-care worker labor pool, 227–229
projections for elderly population, 52–55
training for work with special populations, 155–157
Practicing Physician Education Project, 154
Practicum Partnership Program, 150
Prayer, 49
Preventive care
goals for new models of care, 109
language proficiency and utilization of, 51
Medication Regimen Review, 146
principles of delivery system reform, 76
provider training in, 157–158
racial/ethnic differences in utilization, 50
shortcomings of current health care delivery, 109
socioeconomic status and utilization of, 51
Primary care
definition, 27
Medicare reimbursement policies, 23
Prisons, 54, 155
Private sector, new models of care, 79–84
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Professionals, health care, 31–32
current supply, 124
definition and scope, 27
educational enrollment patterns, 19
emerging supply problems, 19–20
financial aid for geriatric training in exchange for service, 176–181
geographic distribution, 126–128
incomes, 171
National Institutes of Health research grants to, 179
obstacles to geriatric training, 123
projected need, 58, 124
racial/ethnic diversity, 126
recommendations for recruitment and retention, 10–11, 171–176
resident training in non-hospital settings, 6–8, 23
See also Geriatric specialists;
Nurses;
Physicians
Programs of All-Inclusive Care for the Elderly (PACE), 84–85, 104–105
Q
Quality of care
current shortcomings, 14, 16, 75–76
direct-care workers, 213–214
efficiency of care, 56, 77
informal caregivers, 247
principles of delivery system reform, 12, 76–78
provider training and, 21, 216
recruitment and retention issues, 213–214
shortcomings of federal reimbursement system, 22–23
transitions between care settings, 47–48
workplace environment and, 214
R
Race/ethnicity
direct-care workforce, 203, 204
diversity considerations in new models of care, 109
health care professionals, 126
health status and utilization patterns, 50–51
population projections, 52–54
principles of delivery system reform, 77
provider–patient relationship, 126
workforce diversity, 126
RAND Future Elderly Model, 58–61
Real Choice Systems Change Grants, 231
Recruitment and retention, 31–32
aging of workforce and, 168–169
direct-care workers. See Direct-care worker recruitment and retention
education and training as factor in, 216
financial aid for geriatric training in exchange for service, 176–181
financial incentives, 10, 171–181, 182
geriatric specialists, 10, 123
geriatrics faculty, 10–11, 153–155, 175–176
goals for new models of care, 109–110
negative stereotypes of geriatric work, 169
nursing home workforce, 209–210
obstacles to, 123, 167–170, 181–182
quality of care and, 213–214
recommendations for improving, 10–11, 171–176
in rural areas, 127, 128
Regenstrief Institute, 80–81
Registered nurses
advanced practice training, 143–144
aging of population of, 20, 168
current certification in geriatrics, 5, 125
income, 171
job delegation skills, 165–166
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nursing home needs, 167
recruitment and retention, 168
training, 141–143
Reimbursement
billing code modifiers, 173
capitated payment systems, 97–98
coordination within federal system, 23
fee-for-service system, 96–97
mental health services, 46
for new models of care, 12, 98–101, 108
for patient self-management interventions, 244
policy changes affecting demand and utilization, 56
recommendations for, 10, 12, 108, 171–172
risk adjustment, 97, 100
shortcoming of current system, 22–23
strategies for enhancing recruitment of health care professionals, 10, 171–175
for team care, 13
Remote monitoring technologies, 14, 77, 114–115, 245
Research
financial aid for geriatrics researchers, 178–179
recommendations for new models of care, 12–13, 108–110
Resident physicians
in dentistry, 145
geriatric training, 133–134, 155
Medicare graduate medical education programs, 23, 136, 137
pharmacists, 147
racial/ethnic diversity, 126
recommendations for training, 8, 137
training in non-hospital settings, 6–8, 23, 136–137
Resources for Enhancing Alzheimer’s Caregiver Health, 256
Respiratory disorders mortality, 44
Rewarding Provider Performance, 114
Donald W. Reynolds Foundation, 129, 154
Risk adjusted payments, 97, 100
RTI International, 62–64
Rural population
diversity considerations in new models of care, 109
health care professionals, 127–128
health status of older adults, 51, 127
recruitment and retention of health care workers, 127, 128
S
Settings for care
demographic trends and, 54
direct-care workers, 201, 203
recommendations for training of professionals in, 6–8, 137
transitions between settings, 47–48, 77
Skilled nursing facilities, 47
Smoking, service utilization projections and, 61
Social HMOs, 86–87
Social workers
aging of population of, 168
competencies for work with older adults, 149–150
current supply of geriatric specialists, 5, 21, 125, 148–149
education and training, 149, 150
practice settings, 149
Practicum Partnership Program, 150
projected needs, 5, 148
roles for retired professionals, 169
Society of General Internal Medicine, 155
Socioeconomic status
care delivery models for low-income older adults, 80–81
goals for new models of care, 109
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health care utilization and, 51
health status and, 50–51
preventive care utilization and, 51
South Carolina, 178
Special needs plans, 98–99
State governments
financial aid for geriatric training in exchange for service, 176–178
recommendations for, 11, 218
scope of practice reforms, 166
Suicide, 44–45, 52
Sutter Visiting Nurse Association, 83
T
Team care
HELP delirium management model, 106
informal caregivers in, 256–258
new models of care, 7, 13, 113
PACE model of disability care, 85
patient role in, 4–5, 77–78, 113
training of medical professionals for, 159–160
U
United Health Care Corporation, 85–86
Urban Institute, 62–64
Utilization
chronic care-related, 42–43
consumer expectations for care and, 56
current patterns, 43–44, 45–49
demographic patterns, 49–52
determinants of, 4
models for projecting demand and, 57, 58–59, 61–62, 64–65
older adults, 3–4, 17, 39, 53
physician visits, 42, 45–46
projected demand, 4, 15, 17, 39, 55–56, 57–61, 62, 63–64, 66–67
reimbursement policies and, 56
V
Veterans, 52, 54
Veterans Administration, 134, 145, 159, 257
Veterans Health Administration, 48, 54
Volunteer workers, 229
W
Weill Cornell Medical College, 137
Wellspring nursing home, 223
Wisconsin, 91–92
Women’s health
insurance coverage for direct-care workers, 210–211
utilization patterns, 49–50
Workforce, health care
adaptation to new models of care, 13, 111
aging of, 20, 168–169
barriers to recruitment and retention, 5
coordination of care, 114
current capacity, 4–5
definition and scope, 27
demand for non-institutional services, 200
future challenges, 1–2, 14, 15–17, 29–30
goals for improving, 2, 75–76
goals for new models of care, 109–110
job delegation reform, 110–111, 165–166
new professions, 165
new provider designations, 13, 112
older workers, 228–229
reform rationale, 67
roles and responsibilities in new models of care, 111–113, 115
roles for retired professionals, 169
salient issues, 2, 25, 26–28, 29, 123–124
scope of practice reforms, 13, 77, 112, 165–167
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supply monitoring, 5, 6, 30
timely implementation of reforms, 2, 26, 31
volunteer workers, 229
See also Compensation for health care workers;
Education and training of health care workers;
Professionals, health care
Workload
efficiency improvement, 77
quality of nursing care and, 213–214
