adults if current patterns of care and of the training of providers continue.

  1. In all of the health professions where efforts to promote geriatric specialization have been undertaken, these efforts have been mostly insufficient to produce a larger number of geriatric leaders.

  2. Informal caregivers provide a large amount of long-term care services to families and friends, and will continue to be a significant part of the health care workforce.

  3. The structure of public programs precludes both the effective delivery of care to many older adults and the development of an appropriate workforce.

  4. Immediate and substantial action is necessary by both public and private organizations to close the gap between the status quo and the impending needs of future older Americans.

The nation is responsible for ensuring that older adults will be cared for by a health care workforce prepared to provide high-quality care. If current Medicare and Medicaid policies and workforce trends continue, the nation will fail to meet this responsibility. This report is not simply a call for more Medicare and Medicaid spending. Throwing more money into a system that is not designed to deliver high-quality, cost-effective care or to facilitate the development of an appropriate workforce would be a largely wasted effort. Rather, this report serves as a call for fundamental reform. If such reform is to occur, it will require both timely information and ongoing reexamination.

The committee concluded that more needs to be done to ensure that bold and appropriate actions are set in motion.

An important first step is to provide a reliable evidentiary basis to help focus attention.

Recommendation 1-1: The committee recommends that Congress should require an annual report from the Bureau of Health Professions to monitor the progress made in addressing the crisis in supply of the health care workforce for older adults.

This report needs to include regular reexamination of the health care needs of older Americans so that workforce redesign strategies may be properly adjusted. This report may also include monitoring of accomplishments toward national goals and milestones and needs to be inclusive of the entire workforce with consideration for the interaction between the informal and formal workforces.

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