Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 1
Summary1
The aging of America has and will continue to have profound conse -
quences for the nation’s economy and society for years to come. The U.S.
Census Bureau projects that the number of adults age 65 and older will
increase from 40.3 million to 72.1 million between 2010 and 2030. Service
providers, health care researchers, workforce experts, demographers, and
others have long warned policy makers that with the aging of the baby
boomer population, the nation faces a “silver tsunami” with the potential
to overwhelm the nation’s health care system. Similar calls have been
made to address the nation’s inadequate training and shortages of per-
sonnel for mental health and substance use (MH/SU) care. A health care
workforce that is not prepared to address either MH/SU problems or the
special needs of an aging population is a compelling public health burden.
In 2008, the Institute of Medicine (IOM) issued a report, Retooling for
an Aging America: Building the Health Care Workforce, which highlighted
the urgency of expanding and strengthening the geriatric health care
workforce to meet the demands of our rapidly aging and changing popu -
lation. The following year, Congress mandated that the IOM undertake a
complementary study focusing on the geriatric MH/SU workforce needs
of the nation. Thus, the IOM entered into a contract with the Office of the
Assistant Secretary for Planning and Evaluation in the U.S. Department
of Health and Human Services (HHS). The IOM Committee on the Mental
1 This summary does not include references. Citations for the findings presented in the
Summary appear in subsequent chapters.
1
OCR for page 2
2 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS
Health Workforce for Geriatric Populations was appointed in early 2011 to
carry out the charge. The 16-member committee included experts in geri-
atric psychiatry, substance use, social work, psychology, nursing, direct
care, epidemiology, workforce development, labor economics, long-term
care, health care delivery and financing, and health care disparities.
The committee’s core charge was to assess the MH/SU needs of
adults age 65 and older and to recommend how the nation should pre-
pare the MH/SU workforce to meet these needs (Box S-1). The committee
focused on the full spectrum of workers who are engaged in the detection,
diagnosis, treatment, care, and management of MH/SU conditions in
older adults—ranging from personnel who may have minimal education
to specialty professionals with the most advanced psychiatric and neuro-
logical training. This includes
• MH/SU specialists such as general psychiatrists, psychologists,
social workers, psychiatric nurses, and substance use counselors
who may provide services to patients of any age;
• primary care providers, such as general internists, family medi-
cine practitioners, advanced practice registered nurses, and physi-
cian assistants who may provide services to patients of any age
(but may have daily contact with older adults who have MH/SU
conditions);
• primary care providers with specialized training in the care of
older adults, such as geriatricians and geriatric nurses;
• MH/SU providers with specialized training in the care of older
adults, such as geriatric psychiatrists, gerontological nurses, gero -
psychologists, and gerontological social workers;
• direct care workers (DCWs) who, with minimal training, are
employed to provide supportive services either in facilities or in
the home;
• peer support providers who, with special training, teach peers the
skills and behaviors to self-manage their mental illness; and
• informal caregivers such as family members, friends, and volun-
teer community members with the potential to identify and sup-
port older adults who may need MH/SU services.
The committee limited its scope in accordance with the sponsor’s
suggestions. The study’s target population was older adults who have a
prevalent MH/SU condition for which there were sufficient data for study
(including the behavioral and psychiatric symptoms of dementia). The
principal diagnoses of Alzheimer’s disease and other dementias, intel -
lectual disability, and autism spectrum disorder were excluded. Also out
of scope were the effectiveness of individual therapeutic interventions,
OCR for page 3
3
SUMMARY
BOX S-1
Charge to the IOM Committee on the Mental Health Workforce
for Geriatric Populations
At the request of the U.S. Department of Health and Human
Services’ Office of the Assistant Secretary for Planning and
Evaluation, the Institute of Medicine (IOM) will convene an ad
hoc committee to determine the mental and behavioral health
care needs of the target population—the population of Ameri-
cans who are age 65 years and older—and then make policy and
research recommendations for meeting those needs through a
competent and well-trained mental health workforce, especial-
ly in light of the projected doubling of the aged population by
2030.
The committee will
• Provide a systematic and trend analysis of the current and
projected mental and behavioral health care needs of the
target population.
• Within the target population, consider the special needs of
growing ethnic populations, of veterans with posttraumatic
stress disorder, and of persons with chronic disease.
• Weigh the impact of improved diagnostic techniques, of ad-
dressing mental health issues as part of effective chronic dis-
ease management, and of the implementation of the federal
mental health parity law on meeting the mental health needs
of the target population.
When making recommendations, the committee will consider
forces that shape the health care workforce, such as education,
training, modes of practice, and the financing of public and pri-
vate programs.
tobacco use (as a substance use condition), and workforce issues related
to caregivers’ needs.
A VULNERABLE AND UNDERSERVED POPULATION
Current and Future Prevalence of MH/SU
Conditions Among Older Adults
MH/SU conditions in older people are associated with a wide range
of negative effects, including emotional distress, functional disability,
OCR for page 4
4 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS
reduced physical health, increased mortality, suicide, high rates of hospi-
talization and nursing home placement, and high costs. The committee
identified 27 MH/SU conditions that can have substantial negative effects
on a person’s emotional well-being, functional and self-care abilities, and
quality of life (Box S-2). Although available data do not support definitive
prevalence estimates, the committee concluded that at least 5.6 million
to 8 million older adults have one or more of these conditions—about
14 to 20 percent of the overall elderly population. Depressive disorders
and dementia-related behavioral and psychiatric symptoms are the most
prevalent. Serious mental illness—including schizophrenia and bipolar
disorder—is less common, but has significant implications for the work -
force and care delivery.
Many older adults who have MH/SU conditions also have acute
and chronic physical health conditions, and some have cognitive and
functional impairments. The interaction of physical health conditions,
cognitive and functional impairments, and MH/SU conditions is a defin-
ing feature of the geriatric mental health and substance use fields and
has critical implications for the workforce. The interaction of these condi -
tions also results in difficult caregiving situations for families, physicians,
and other health care professionals, and residential care and home- and
community-based service providers. For example:
• Age-related changes in the metabolism of alcohol and drugs,
including prescription drugs, can cause or exacerbate alcohol and
drug use conditions and increase an older person’s risk of danger-
ous overdoses, even for people who have used alcohol and drugs
at the same dose and frequency for many years without serious
negative effects.
• Loss and grief are common in old age. The death of a spouse, part-
ner, close relative, or friend can trigger or exacerbate depression
and lead to severe, debilitating symptoms. Providers may find it
difficult to distinguish major depression and grief when a patient
is in the midst of a significant loss.
• Medications to treat common acute and chronic physical health
conditions in older people can cause and exacerbate MH/SU con-
ditions and, conversely, medications to treat MH/SU conditions
can cause or worsen their physical health conditions.
• Cognitive and functional impairments can complicate the detection
and diagnosis of MH/SU conditions. Cognitive impairment can
also reduce an older person’s ability to comply with treatment rec-
ommendations, including medications prescribed for the person’s
MH/SU and physical health conditions.
OCR for page 5
5
SUMMARY
BOX S-2
Geriatric Mental Health and Substance Use Conditions
Addressed in This Report
DSM-IV-TR Mental Disorders Other Conditions
• Adjustment disorder • Anxiety symptoms
• Anxiety disorders (includ- • At-risk drinking or drug use
• Behavioral and psychiatric
ing posttraumatic stress
disorder) symptoms of dementia
• Bipolar disorder • Complicated grief
• Depressive disorders • Fear of falling
• Personality disorders • Hoarding
• Schizophrenia • Minor depression (depressive
• Substance-related disorders symptoms)
• Severe domestic squalor
(including alcohol depen-
• Severe self-neglect
dence and abuse, drug de-
• Suicidal ideation, plans, or
pendence and abuse)
attempts
NOTE: DSM-IV-TR mental disorders are defined by explicit criteria in the Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision.
These unique characteristics of geriatric MH/SU create important
requirements for workforce competencies, including the ability to detect
possible MH/SU conditions in older people with coexisting physical
health conditions and cognitive and functional impairments; ability to
diagnose the conditions or knowledge about how to refer the person
for a diagnostic evaluation; and ability to adapt treatments and ongoing
management to accommodate the coexisting conditions.
Several demographic trends—growing population diversity, change
in the makeup of the older population and characteristics of the baby
boomer cohort—are likely to affect the prevalence of MH/SU conditions
and the need for services in the coming decades. The U.S. Census Bureau
projects that, from 2010 to 2030, the proportion of whites in the older
population will decrease from about 80 to about 71 percent, reflecting siz-
able increases in the black and Hispanic/Latino older population. During
the same period, the black older adult population is expected to increase
by about 115 percent, and the Hispanic/Latino older adult population by
more than 200 percent. By 2030, blacks will constitute about 10 percent of
the older population, and Hispanic/Latinos about 12 percent.
OCR for page 6
6 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS
Although there are only limited prevalence data for subgroups of
older adults with MH/SU conditions, some analyses suggest important
differences among racial and ethnic groups. The proportions of different
age cohorts within the 65-and-older age group are also changing and
are likely to have implications for the types of MH/SU services that are
needed. For example, as the group ages 75-84 grows, dementia and associ-
ated psychiatric symptoms will become more prevalent.
As the baby boomers age, the rates of use of illicit drugs appear likely
to increase. One recent report by the Substance Abuse and Mental Health
Services Administration (SAMHSA), for example, found that illicit drug
use nearly doubled among people ages 50-59 between 2002 and 2007,
increasing from 5.1 percent in 2002 to 9.4 percent in 2007. This included
an increase in marijuana use from 3.1 to 5.7 percent and nonmedical use
of prescription drugs from 2.2 to 4 percent.
Adverse drug reactions may also be on the rise. According to
SAMHSA, 61 percent of the 1.1 million emergency department visits for
adverse drug reactions involved a person age 65 or older in 2008, and
nearly a fourth of these emergency visits involved central nervous system
drugs, including narcotic and nonnarcotic pain relievers.
Use of MH/SU Services
Older adults have been less likely to use MH/SU services compared
with younger people with similar conditions. Older adults have also been
less likely to use services provided in specialty settings, such as psychiat -
ric hospitals, mental health clinics, and substance use treatment centers,
and more likely to use MH/SU services provided in general medical care,
residential care, and community-based service settings. In comparison
with the current generation of older people, the baby boom generation
has had higher average rates of mental health service use throughout
their lives, and it is possible they will continue this pattern of service use
as they grow older.
THE GERIATRIC MH/SU WORKFORCE:
TOO FEW AND NOT PREPARED
Questions about the relationship between the demand for services
and the supply emerge naturally in any discussion of workforce issues.
It might seem straightforward to translate data on illness prevalence
into estimates of service need and then, in turn, to estimates of required
workforce supply. However, such efforts have always been fraught with
methodological challenges and serious questions about the validity of the
estimates that have been generated.
OCR for page 7
7
SUMMARY
Data on the geriatric MH/SU workforce are even more elusive because
the majority of workers who provide services to the geriatric population
do not have recognized credentials in this specialty, and are thus more
difficult to count, track, and analyze. Nevertheless, the committee finds
that the sheer number of providers entering, working in, and remaining
in the fields of primary care, geriatrics, mental health, substance use, and
geriatric MH/SU is disconcertingly small.
Geriatric MH/SU specialists are an essential part of the interdisciplin-
ary team because they are the most experienced and best equipped to con-
sult and provide care for serious mental illnesses. With shifting models
of care and the changing roles of different professions, it is not possible
to estimate with great precision how many geriatric MH/SU specialists
will be necessary to serve the geriatric population. However, the rate of
specialized providers entering the workforce is dwarfed by the pace at
which the population is growing. For example, the number of available
fellowships in geriatric psychiatry has remained relatively stagnant since
the 1990s, while the number of geriatric psychiatry fellows filling avail -
able slots decreased by half. This decline, juxtaposed with the predicted
doubling of the geriatric population in the next 20 years, will make it
increasingly difficult to rely solely on highly trained specialists to meet
the MH/SU needs of older adults.
Training
General providers at all levels should be aware of the signs and
symptoms of MH/SU conditions, and be able to respond appropriately
within their level of training and scope of practice. However, few profes -
sions have mandated curricular standards related to MH/SU in geriatric
patients. Where there is curriculum, it is unclear how and to what extent
the concepts are applied in the classroom or in practical training. The
prevalence of co-occurring conditions in the elderly and the shift toward
collaborative models of care make interprofessional training essential to
overall training in geriatric MH/SU care. The increasing racial, ethnic,
and linguistic diversity of the geriatric population also makes cultural
competence imperative. To what extent these aspects of care are being
integrated into training and education is also unclear.
Barriers to Growing the Workforce
The barriers to growing and strengthening the geriatric MH/SU
workforce are fundamental and entrenched in the systems and programs
of numerous public and private entities—including multiple HHS and
other federal agencies, professional organizations, medical and profes -
OCR for page 8
8 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS
sional training institutions, credentialing and accreditation organiza -
tions, licensing bodies, service systems, payers, and research institu-
tions (Box S-3). Recent efforts to augment training show that even when
provided opportunities to specialize in geriatric MH/SU, students often
do not choose to pursue it. This underscores the importance of simulta-
neously providing more training opportunities, guidance, mentorship,
positive experiences, and financial incentives. Building up one of these
BOX S-3
Key Barriers and Issues Related to and
Strengthening the Geriatric MH/SU Workforce
Defining the Geriatric MH/SU Workforce
• The geriatric MH/SU workforce is made up of many types of pro-
viders. Workforce roles are often poorly defined and overlapping.
Estimating Workforce Supply and Demand
• The standardized workforce data trended over time that are re-
quired to make accurate predictions of workforce supply and de-
mand are not available.
Shortage of Geriatric MH/SU Providers
• The workforce prepared to care for geriatric MH/SU is inadequate
in sheer numbers, with the growth of the population threatening
to exacerbate this.
Recruiting Geriatric MH/SU Providers
• Across all health professions, relatively few opportunities for spe-
cialization in geriatric MH/SU exist. There is little support or men-
torship available for those who do pursue specialization.
• Financial incentives are not in place to encourage geriatric MH/SU
providers to enter and stay in this field.
Inadequate Preparation of the Geriatric MH/SU Workforce
• Professional training in geriatric MH/SU is inconsistent and not
well documented because national standards and requirements
in these areas are minimal and vague. MH/SU specialists have
little required training in geriatrics; geriatric specialists have little
OCR for page 9
9
SUMMARY
components without considering the others will not solve the workforce
crisis at hand.
Training general health care professionals and DCWs is pivotal to
improving the workforce because they are the most likely personnel to
come into contact with older adults with MH/SU conditions. The extent
to which training and education are provided for these groups is not well
documented. Relatively few standards are in place to ensure that formal
required training in MH/SU; and most general providers do not
have extensive requirements in either area.
Training the Geriatric MH/SU Workforce
• Many professions have made progress on geriatric MH/SU com-
petency development and workforce development, though these
efforts are often done in silos where their dissemination and im-
pact are not easily measured.
• Innovations in geriatric MH/SU workforce development are of-
ten vulnerable to grant cuts, and many promising programs end
without adequate documentation or evaluation to assist future
development.
Strengthening the Role of Direct Care Workers (DCWs) in Geriatric
MH/SU Care
• Complex factors, including poor working conditions, low wages,
lack of training, and limited opportunities for advancement, deter
the development of a stable DCW workforce.
• DCWs have the most contact with older adult patients, yet do not
have adequate training in geriatrics or MH/SU, and virtually never
receive training in both.
Empowering Older Adults and Their Families
• There is a growing emphasis on peer support and self-care, in-
cluding for older adult populations.
• Family members play a major role as caregivers, but receive little
support and training for caring for older adults with any medical
conditions, including MH/SU conditions.
OCR for page 10
10 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS
training programs include competencies in addressing MH/SU condi-
tions in older adults. Also essential to training are skills in cultural com -
petence and interprofessional collaboration to meet the complex needs
of older adults. However, the evidence base to determine what modes
of training are most effective in geriatric MH/SU is largely insufficient.
WORKFORCE IMPLICATIONS OF MODELS
OF GERIATRIC MH/SU CARE
U.S. health care delivery remains in a mode of care with origins in the
early 20th century, when health care problems were typically acute and
life expectancy was significantly shorter than today. However, an acute
care orientation is not appropriate for much of geriatric care. For the older
adult, chronic illness is the norm, not the exception—for both mental and
physical health conditions.
A persuasive body of evidence, drawn from two decades of research,
indicates that two common MH/SU disorders among older adults—
depression and at-risk drinking—are most effectively addressed when
care is organized to include these essential ingredients: (1) systematic
outreach and diagnosis; (2) patient education and self-management sup-
port; (3) provider accountability for outcomes; and (4) close follow-up and
monitoring to prevent relapse. Moreover, these elements are best obtained
when care is patient centered, in a location easily accessed by patients
(e.g., in primary care, senior centers, or patients’ homes), and coordinated
by trained personnel with access to specialty consultation. This is not
likely to be achieved, however, without practice redesign and change in
Medicare payment rules. There is a fundamental mismatch between older
adults’ need for coordinated care and Medicare fee-for-service reimburse-
ment, which precludes payment of trained care managers and psychiatry
consultation.
The committee concluded, as have many other studies, that the deliv-
ery of and payment for health care services to older adults must be reor-
ganized to reflect the chronic nature of MH/SU and other health condi -
tions prevalent in the 21st-century geriatric population. The workforce
implications are daunting. Registered nurses are particularly well suited
to coordinate MH/SU and physical health care, but they need additional
training to serve in this capacity. Primary care providers, such as physi-
cians, advanced practice registered nurses, and physician assistants have
not been trained in collaborative care and do not work in a practice or
system supportive of comanagement, colocation, screening, and outcome
monitoring required by these models.
Frontline workers within the aging provider network agencies may
be a potential source of care managers. However, they will require inten-
OCR for page 11
11
SUMMARY
sive training in evidence-based program treatment as they are likely to
have limited knowledge of MH/SU. Moreover, training alone will not
ensure the intended outcome of effectively meeting the MH/SU needs
of older adults. Adequate supervision and coaching support of staff are
also essential.
Finally, research on effective delivery of MH/SU care for certain older
populations is urgently needed, especially for individuals residing in
nursing homes and other residential settings, prisoners, rurally isolated
elders, and older adults with serious mental illnesses.
RECOMMENDATIONS
There is a conspicuous lack of national attention either to prepar-
ing the health care workforce to care for older adults who have MH/SU
conditions or to ensuring sufficient numbers of personnel for the rapidly
growing elderly population. Many federal agencies, particularly within
HHS, influence the makeup, competence, and capacity of the health
care workforce to deliver MH/SU services to older adults. Yet, federal
responsibility appears to be diffused across various agencies, bureaus,
and departments. Moreover, the efforts of these agencies are minimal,
lack specific focus on geriatric MH/SU, and, in some cases, are being
discontinued. The Agency for Healthcare Research and Quality (AHRQ),
for example, has initiated a noteworthy interagency effort—the Academy
for Integrating Mental Health and Primary Care—to coordinate the col-
lection, analysis, synthesis, and dissemination of research on integrating
MH/SU services in primary care. But the program is underfunded.
The Centers for Medicare & Medicaid Services (CMS) has substantial
potential to influence the delivery of geriatric MH/SU services. At pres-
ent, Medicare and Medicaid reimbursement rules act to deter rather than
to facilitate access to effective and efficient geriatric MH/SU services. The
agency has numerous projects under way to evaluate new approaches—
including payment reform—to improving the quality and effectiveness of
services provided to Medicare and Medicaid beneficiaries. These innova-
tion efforts may lead to MH/SU workforce improvements if eventually
implemented on a wide scale.
The Health Resources and Services Administration (HRSA) is the
central HHS agency tasked with promoting the production and training
of key health personnel, but none of its geriatric training programs require
exposure to MH/SU conditions.
Several institutes at the National Institutes of Health have missions
related to aging and mental health or substance use, but none focus on
geriatric MH/SU. The National Institute of Mental Health (NIMH), for
example, has funded important research to inform the effective delivery
OCR for page 12
12 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS
of MH/SU services to older adults, but NIMH is scaling back support for
interventions and services research in favor of research in basic transla-
tional neuroscience.
SAMHSA is the federal government’s lead agency charged with
directing services and resources to people with MH/SU conditions, yet it
has consistently devoted only a small fraction of its budget to older adults.
It is particularly disconcerting that the agency is reducing its activities
related to geriatric MH/SU, including the elimination of the Older Adults
Targeted Capacity Expansion grants program.
BOX S-4
Recommendations
RECOMMENDATION 1: Congress should direct the Secretary of
Health and Human Services (HHS) to designate a responsible entity
for coordinating federal efforts to develop and strengthen the na-
tion’s geriatric mental health and substance use (MH/SU) workforce.
• The committee urges Congress to fund the already authorized
National Health Care Workforce Commission to serve in this ca-
pacity. In the absence of congressional action, the Secretary of
HHS should act as soon as possible to designate an alternative
body.
• The coordinating body should have the following priorities with
respect to the geriatric MH/SU workforce:
Identification, development, and refinement of methods for
improving recruitment and retention of geriatric MH/SU per-
sonnel, including ways to build a workforce that reflects the
increasingly diverse older adult population.
Promotion and support of widescale implementation of
evidence-based models of geriatric MH/SU care that effective-
ly deploy personnel.
Identification, development, and refinement of model curricula
and curriculum development tools in geriatric MH/SU, includ-
ing effective models of training for integrated rehabilitation,
health promotion, health care, and social services for older
adults with serious mental illness.
Identification, development, and refinement of core compe-
tencies in geriatric MH/SU for the entire spectrum of person-
nel who care for older adults, including direct care workers,
OCR for page 13
13
SUMMARY
Box S-4 presents the committee’s recommendations. Congress and
the HHS Secretary must act to establish a locus of responsibility for geri -
atric MH/SU, to invigorate investment in the human capital that is the
geriatric MH/SU workforce, to catalyze basic system redesign to allow
for effective deployment of geriatric MH/SU personnel, and to stimulate
essential research to inform the education and training of personnel and
workforce planning itself.
peer support specialists, primary care physicians, nurses (at all
levels), physician assistants, substance use counselors, social
workers, psychologists, rehabilitation counselors, and marriage
and family therapists.
Evaluation and dissemination of all of the above.
RECOMMENDATION 2: The Secretary of HHS should ensure that its
agencies—including the Administration on Aging (AoA), Agency for
Healthcare Research and Quality (AHRQ), Centers for Medicare &
Medicaid Services (CMS), Health Resources and Services Adminis-
tration (HRSA), National Institute of Mental Health (NIMH), National
Institute on Drug Abuse (NIDA), and Substance Abuse and Mental
Health Services Administration (SAMHSA)—assume responsibil-
ity for building the capacity and facilitating the deployment of the
MH/SU workforce for older Americans:
• CMS
CMS should evaluate alternative methods for funding primary
care and other personnel who provide evidence-based mod-
els of care to older adults with MH/SU conditions. This should
include reimbursing care managers as well as the psychiatrists
and other mental health specialists providing supervision of
their work.
CMS should evaluate alternative payment methods to encour-
age effective deployment of the workforce to provide integrat-
ed primary care, chronic disease self-management, and health
promotion for older adults receiving care in community mental
health centers and other specialty mental health settings.
CMS should explore approaches and strategies for improving
care delivery to older adults with MH/SU conditions through its
contracts with quality-improvement organizations.
continued
OCR for page 14
14 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS
BOX S-4 Continued
CMS should enforce and monitor implementation of the Pre-
Admission Screening and Resident Review (PASRR) and Mini-
mum Data Set (MDS) nursing home requirements regarding
residents’ mental health. The agency should also ensure that
PASRR and MDS mental health assessments inform residents’
care plans and that nursing home personnel implement the
care plans accordingly.
• HRSA
The HRSA Administrator should ensure that the National Center
for Health Care Workforce Analysis devotes sufficient attention
to geriatric MH/SU with guidance from the national coordinat-
ing body described below.
The HRSA Administrator should ensure that the Geriatric Ac-
ademic Career Awards career development grants include
awards to geriatric MH/SU specialists if they commit to work-
ing with older adults in acute or long-term care settings.
The HRSA Administrator should ensure that the Geriatric Ed-
ucation Centers and the Comprehensive Geriatric Education
Program institutional awards fund programs that train individu-
als in geriatric MH/SU care.
• NIMH
The Director of NIMH should ensure that the institute conducts
research on methods for increasing the capacity of the mental
health workforce to provide competent and effective care for
older adults who reside in the community or in nursing homes
or other congregate residential settings.
• SAMHSA
The SAMHSA Administrator should ensure that the agency
devotes sufficient attention to the capacity of the behavioral
health workforce to provide both geriatric mental health and
geriatric substance use services.
The SAMHSA Administrator should ensure that the agency re-
stores funding of the Older Adult Mental Health Targeted Ca-
pacity Expansion Grant program.
The SAMHSA Administrator should require states that receive
MH/SU block grants to document and to report how the funds
are used to support local capacity to serve older adults.
RECOMMENDATION 3: Organizations responsible for accreditation,
certification, and professional examination, as well as state licens-
ing boards, should modify their standards, curriculum requirements,
and credentialing procedures to require professional competence
OCR for page 15
15
SUMMARY
in geriatric MH/SU for all levels of personnel that care for the diver-
sity of older adults.
• These efforts should include requirements for recredentialing
and professional development for already licensed and certified
personnel.
RECOMMENDATION 4: Congress should appropriate funds for the
Patient Protection and Affordable Care Act (ACA) workforce pro-
visions that authorize training, scholarship, and loan forgiveness
for individuals who work with or are preparing to work with older
adults who have MH/SU conditions. This funding should be targeted
to programs with curricula in geriatric MH/SU and directed specifi-
cally to the following types of workers who make a commitment to
caring for older adults who have MH/SU conditions:
• Psychiatrists, psychologists, psychiatric nurses, social workers,
MH/SU counselors, and other specialists who require skills and
knowledge of both geriatrics and MH/SU.
• Primary care providers, including geriatricians and other physi-
cians, registered nurses (RNs), advance practice registered nurs-
es (APRNs), and physician assistants.
• Potential care managers for older adults who have MH/SU condi-
tions, including RNs, APRNs, social workers, physician assistants,
and others.
• Faculty in medicine, nursing, social work, psychology, substance
use counseling, and other specialties.
• Direct care workers and other frontline employees in home health
agencies, nursing homes, and assisted living facilities (including
personal care attendants not employed by an agency).
• Family caregivers of older adults with MH/SU conditions.
RECOMMENDATION 5: HHS should direct a responsible entity (as
described above) to develop and coordinate implementation of a
data collection and reporting strategy for geriatric MH/SU work-
force planning. Data collection and reporting should include the
following:
• Prevalence data for Diagnostic and Statistical Manual of Mental
Disorders (DSM)-defined disorders and other MH/SU conditions,
including data on comorbidity of these conditions. Representa-
tive data on the following subgroups are essential:
Age within the 65+ population (65-74, 75-84, and 85 and older)
continued
OCR for page 16
16 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS
BOX S-4 Continued
Gender
Race and ethnicity (including non–English speakers)
Veteran status
Living situation (private household, public housing or se-
nior housing facility, group home, assisted living or other
residential care facility, and nursing home)
Coexisting physical health conditions
Coexisting cognitive and functional impairments
Geographic area
• Use of MH/SU services for the above subgroups.
• Comprehensive and comparable information on the full range
of geriatric MH/SU personnel with sufficient detail to assess
the workforce supply by race and ethnicity; language skills;
geographic location and distribution; qualifications, training,
and certification; areas of practice; and hours spent in the
care of older adults.
