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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 demonstra- tion 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. 359

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360 MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER ADULTS Recommendation 6-2: Public, private, and community organizations should provide funding and ensure that adequate training opportuni- ties 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 enhance- ment 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) pro- gram 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 finan- cial incentives for professionals who become geriatric specialists. One such mechanism should include the development of a National Geri- atric 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 dis- semination 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 • romote the development of new models of care for older adults in p areas where few models are currently being tested, such as preven- tion, long-term care, and palliative care; and • romote the effective use of the workforce to care for older adults. p

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361 APPENDIX D 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 designa- tions; 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 techno- logical 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.

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