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The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? (2012)

Chapter: Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)

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Suggested Citation:"Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Appendix D

IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)

Recommendation 1-1: 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.

Enhancing Geriatric Competence

Recommendation 4-1: Hospitals should encourage the training of residents in all settings where older adults receive care, including nursing homes, assisted-living facilities, and patients’ homes.

Recommendation 4-2: All licensure, certification, and maintenance of certification for health care professionals should include demonstration of competence in the care of older adults as a criterion.

Recommendation 5-1: States and the federal government should increase minimum training standards for all direct-care workers. Federal requirements for the minimum training of certified nursing assistants (CNAs) and home health aides should be raised to at least 120 hours and should include demonstration of competence in the care of older adults as a criterion for certification. States should also establish minimum training requirements for personal-care aides.

Suggested Citation:"Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Recommendation 6-2: Public, private, and community organizations should provide funding and ensure that adequate training opportunities are available in the community for informal caregivers.

Increasing Recruitment and Retention

Recommendation 4-3: Public and private payers should provide financial incentives to increase the number of geriatric specialists in all health professions.

Recommendation 4-3a: All payers should include a specific enhancement of reimbursement for clinical services delivered to older adults by practitioners with a certification of special expertise in geriatrics.

Recommendation 4-3b: Congress should authorize and fund an enhancement of the Geriatric Academic Career Award (GACA) program to support junior geriatrics faculty in other health professions in addition to allopathic and osteopathic medicine.

Recommendation 4-3c: States and the federal government should institute programs for loan forgiveness, scholarships, and direct financial incentives for professionals who become geriatric specialists. One such mechanism should include the development of a National Geriatric Service Corps, modeled after the National Health Service Corps.

Recommendation 5-2: State Medicaid programs should increase pay and fringe benefits for direct-care workers through such measures as wage pass-throughs, setting wage floors, establishing minimum percentages of service rates directed to direct-care labor costs, and other means.

Redesigning Models of Care

Recommendation 3-1: Payers should promote and reward the dissemination of those models of care for older adults that have been shown to be effective and efficient.

Recommendation 3-2: Congress and foundations should significantly increase support for research and demonstration programs that

•   promote the development of new models of care for older adults in areas where few models are currently being tested, such as prevention, long-term care, and palliative care; and

•   promote the effective use of the workforce to care for older adults.

Suggested Citation:"Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×

Recommendation 3-3: Health care disciplines, state regulators, and employers should look to expand the roles of individuals who care for older adults with complex clinical needs at different levels of the health care system beyond the traditional scope of practice. Critical elements of this include

•   development of an evidence base that informs the establishment of new provider designations reflecting rising levels of responsibility and improved efficiency;

•   measurement of additional competence to attain these designations; and

•   greater professional recognition and salary commensurate with these responsibilities.

Recommendation 6-1: Federal agencies (including the Department of Labor and the Department of Health and Human Services) should provide support for the development and promulgation of technological advancements that could enhance an individual’s capacity to provide care for older adults. This includes the use of activity-of-daily-living (ADL) technologies and health information technologies, including remote technologies, that increase the efficiency and safety of care and caregiving.

Suggested Citation:"Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×

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Suggested Citation:"Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
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Suggested Citation:"Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
Page 360
Suggested Citation:"Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
Page 361
Suggested Citation:"Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
Page 362
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At least 5.6 million to 8 million--nearly one in five--older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care. With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation.

For decades, policymakers have been warned that the nation's health care workforce is ill-equipped to care for a rapidly growing and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity, and lack of basic competence and core knowledge in key areas.

Following its 2008 report highlighting the urgency of expanding and strengthening the geriatric health care workforce, the IOM was asked by the Department of Health and Human Services to undertake a complementary study on the geriatric mental health and substance use workforce. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? assesses the needs of this population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach, nor a few isolated changes in disparate federal agencies or programs, can adequately address the issue. Overcoming these challenges will require focused and coordinated action by all.

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