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

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Index A All Payer Graduate Medical Education Act, 170 Access to care Allied and Auxiliary Health Care geographic distribution of health Workforce Project, 163 care professionals, 126–128 Allied health care workers, 152 insurance coverage for direct-care Alzheimer’s disease workers, 210–211 mortality, 44 mental health services, 46 prevalence, 21, 44 oral health care, 144 prevalence trends, 55 Activities of daily living Ambulance utilization, 47 assistance needs of older adults, 43 Ambulatory care, 3, 46 mental health problems and, 45 American Association of Colleges of tasks and responsibilities of Nursing, 141 informal caregivers, 251–252 American Board of Family Medicine, technological support, 14, 115, 164, 137–138 244–246 American Board of Internal Medicine, trends in health status of older 137–138 adults, 40, 55 American Dietetic Association, 158 Advanced Illness Management Plan, American Geriatrics Society, 158 83–84 American Physical Therapy Advanced medical homes, 100–101 Association, 158 Advanced practice registered nurses, American Society of Hospital 143–144 Pharmacists, 146–147 African Americans. See Race/ethnicity Apprenticeships, 224 Aging and Medical Education, 2, Arizona, 90–91 28–29 Arthritis, 42, 45–46, 55 Alcohol and substance abuse, 45 Asian Americans. See Race/ethnicity 285 

286 INDEX Assistive technologies, 14, 115, 164, Collaborative for Ethnogeriatric 244–246 Education, 155–156 Association of American Medical Committee on the Future Health Care Colleges, 129 Workforce for Older Americans, Atlantic Philanthropies, 141–142, 150, 25–28 154 Community-Based Jobs Training Grants, 164, 230 Community-based services B demand for direct-care workers and, Balanced Budget Amendment, 137 200 Beacon Hill Village, 229 long-term care provision, 48 Better Jobs Better Care, 230 shortcomings of Medicaid policies, Boston University Medical Center, 155 23 Bureau of Health Professions, 6, 30 volunteer workers for, 229 Community colleges, 163–164 Compensation for health care workers C direct-care workers, 11, 209, 210–211, 220–222 California Endowment, 163 financial incentives for geriatric California HealthCare Foundation, 163 training, 10, 171 Cancer, 44, 45–46, 57 geriatric medicine professionals, 171 Capitated payment, 97–98 supply and demand estimates and, Care coordinator. See Geriatric care 28 managers wage pass-throughs, 11, 221, 222 Rosalynn Carter Institute for Complementary and alternative Caregiving, 258 medicine, 49 Cash and counseling program, 92–93 Comprehensive care, 76–77 Centers for Medicare and Medicaid Comprehensive Geriatric Education Programs, 231–232 Program, 142 Centers of excellence in geriatric Congress, recommendations for, 6, 11, medicine, 29, 141, 154 13, 30, 108, 175 Cerebrovascular disease, 44 Continuum of care, 157–159 Certified nursing assistants. See Nurse informal caregivers in, 242 aides Cooperative Home Care Association, Chiropractic services, 49 222 Cholesterol control drugs, 49 Coordination of care Chronic conditions current shortcomings, 114 definition of long-term care, 27 goals of health system reform, 77 fee-for-service payment system, 96 in Medicare Advantage, 97 future challenges for health care in MedPAC, 99 system, 16 model of end-of-life care, 83–84 health care utilization for, 42–43, in new models of care, 114 45–46 significance of, in health care Medicare spending, 3, 16, 42–43 outcomes, 47–48, 113–114 mortality, 16 Cost of care prevalence, 16, 21, 42 assistive technologies, 246 City College of San Francisco, 163 

INDEX 287 chronic condition spending, 3, 16, Dentists and oral-health care workers 42–43 aging of population of, 168 cost of geriatric training, 171 board certification, 145 economic value of informal emerging supply problems, 19, 20 caregiving, 18, 247–248 geographic distribution, 126–127 efficiency of care and, 56 supply and demand projections, 144 financial assistance for informal training, 144–146, 154 caregivers, 261–263 Department of Health and Human financing mechanisms for new Services, recommendations for, models of care, 98–101 14, 246 future challenges, 24–25 Department of Labor, hospice care, 48 recommendations, 14, 246 IMPACT model of care for Depression depression, 104 physical health and, 45 implications for health care system prevalence, 45 reform, 28 treatment models, 79–80, 103–104 in last years of life, 44 Diabetes, 45–46, 55 long-term care spending, 48, 62 Diet and nutrition outcomes of Medicare feeding assistants, 225 demonstration projects, 88 geriatric content of medical training, per beneficiary, 24, 65 157, 158 projected Medicare spending, 58 provider training in health Council for Adult and Experiential promotion, 157 Learning, 224 Dietary supplements, 49 Council on Social Work Education, Dietetics, 152, 158 149, 150 Direct-care worker recruitment and Crossing the Quality Chasm, 2, 29, 48, retention 76, 256 causes of turnover, 209–210 Cultural sensitivity challenges, 11, 209–210, 232 principles of delivery system reform, current turnover, 209 77 financial factors, 210–211, 220–222 training for work with special labor pool expansion, 227–229 populations, 155–157 model programs for, 229–232 quality of care and, 213–214 recommendations for, 11 D reform of roles and responsibilities, Deficit Reduction Act, 86 226 Definitions, 27 strategies for improving, 214–215, Delirium 233 definition, 105 work environment factors, 211– HELP model of care, 105–106 213, 222 prevalence, 105 Direct-care workers, 32 Dementia career lattices, 224 physical health and, 45 compensation, 11, 200, 210–211, prevalence, 44 220–222 See also Alzheimer’s disease employment settings, 201 

288 INDEX on-the-job injury risk, 212–213 E professional recognition, 223 projected demand, 200 Education and training of health care quality of patient care, 213–214 workers recommendations for compensation, adaptation to new models of care, 11, 222 112 recommendations for training and advanced practice registered nurses, certification, 9, 218–220 143–144 recruitment and retention. See continuing education, 161 Direct-care worker recruitment in continuum of care, 157–159 and retention costs to providers, 10, 171 reform of roles and responsibilities, current shortcomings, 4, 5, 21–22, 225 124, 128, 160, 204 role of, in older adult health care, dentists and oral-health care 199, 203, 232 workers, 144–146 strategies for workforce direct-care workers, 9, 204–205, improvement, 201, 217–220 215–220, 232–233 supply, 20–21, 199–200 in disease prevention, 157–158 training costs, 209 emergence of new medical training requirements, 204–208, professions and, 165 217–220, 232–233 enrollment patterns, 19 training shortcomings, 22, 204, exposure to geriatric patients, 169 215–218, 232 faculty recruitment and retention, types of, 27, 201 10–11, 152, 153–155, 175–176 work environment, 11, 21, 199, financial aid for geriatric training in 200–201, 209, 211–213, 214, exchange for service, 176–181 222–226 financial incentives for health care workforce demographics, 203– professionals, 10, 11, 171, 181 204 future prospects, 162 See also Home health aides; Nurse health care outcomes and, 21 aides; Personal- and home-care in health promotion, 157 aides home health aides, 207, 215 Direct Service Workforce informal caregivers, 9–10, 242, Demonstration, 231 254–256, 260–261 Disabilities, older adults with for interdisciplinary team work, demographic differences, 50 159–160 long-term care utilization, Internet-based, 162–163 4, 44 leadership, 153–155 mental health problems and, 45 licensed practical nurses, 141 prevalence, 43 licensure and certification trends, 54–55, 63 requirements and, 8–9, 161–162 Disease prevalence, 40–42 in non-hospital settings, 6–8, 23, projections, 59 136–137 Distance education, 162–163 nurse aides, 206–207, 215 Diuretic drugs, 49 obstacles to improving, 6, 123, 128, 160–161 

INDEX 289 obstacles to recruitment of health Evercare program, 85–86 care professionals, 169, 170 Evidence-based care, 79–80 palliative care, 158–159 patient self-management interventions, 243–244 F pharmacists, 146–147 Family caregivers. See Informal physician assistants, 148 caregivers of physicians, 128–138 Feeding assistants, 225 quality of care and, 21, 216 Fee-for-service reimbursement system, recommendations for, 6–10, 137, 22, 96–97 161–162, 175, 218–220 Fellowships, 134, 147, 167, 171, 172 recruitment and retention linkage, Florida, 127 216 Future of Disability in America, The, registered nurses, 141–143 244, 245 role of community colleges in, 163–164 social workers, 149, 150 G for use of new medical technologies, Gay, lesbian, bisexual, and transgender 164 persons, 152, 156–157 for work with special populations, diversity considerations in new 152, 155–157 models of care, 109 Educational attainments of older Geographic variation adults, 53, 54–55 distribution of health care Efficiency of care, 13, 56, 77 professionals, 126–128 Electronic health records, 14, 114, 257 population age distribution, 51 Emergency Health Personnel Act, 179 Geriatric Academic Career Awards, Emergency medicine 10–11, 136, 154, 175 geriatric training, 151 Geriatric care managers, 165 older adult utilization, 3, 46–47 Geriatric Education Centers, 129 utilization projections, 57–58 Geriatric Resource Nurse, 154 Employment and Training Geriatric Resources for Assessment and Administration, 230–231 Care of Elders (GRACE), 80–81 End-of-life care Geriatric specialists AIM model, 83–84 board certification, 137–138 cost of, 44 career satisfaction, 167 diversity of needs, 44 centers of excellence, 29 goals for new models of care, 109 current workforce, 4, 5, 21, training for health care professional, 124–125 158–159 dentists and oral-health care Epidemiology workers, 144–146 chronic conditions, 16, 21, 42 emergency medicine, 151 demographic variations in health emerging supply problems, 19, 167 care utilization, 49–52 federal training programs, 134–136 geriatric syndromes, 43 fellowships, 134 mental health conditions, 44–45 financial incentives for, 10, 11, projected morbidity, 55 171–175 

290 INDEX geographic distribution, 127 Health care needs of older adults interdisciplinary team training, conceptualization of, 27–28 159–160 demographic trends and, 52–55, licensure and certification, 8–9, 66–67 161–162 gender differences, 49–50 negative stereotypes, 169 inpatient diagnoses, 47 obstacles to professional training, last years of life, 44 123, 128 limitations of projections, 64–65 older adult utilization patterns, 46 in nursing homes, 44 optometry, 152 oral health, 144 pay disparities for health care principles of delivery system reform, professionals, 10 76–78 physical therapists, 151 reasons for physician office visits, physician assistants, 148 45–46 podiatry, 152 scope of, 3, 17 previous efforts to improve supply technology development and, 14, of, 28–29, 30 55–56 professional leadership, 153–155 See also Chronic conditions; projected need, 5, 19, 20, 125–126 Utilization projected supply, 5, 125 Health Insurance Portability and recent growth, 2 Accountability Act, 257 recommendations for education and Health Resources and Services training, 6–10, 161–162, 175, Administration, 57, 129, 218–220 134–136, 145, 154, 155, 159, recommendations for recruitment 160, 176 and retention, 10–11, 171–172 Health status of older adults registered nurse training, 141–143 average, 21 roles for retired professionals, 169 current self-reports, 40, 42 shortcomings of federal disease prevalence, 40–42, 59 reimbursement system, 23 diversity of, 40 social workers, 5, 21, 125, 148– geriatric syndromes, 43 149, 150 in long-term care facilities, 44 Geriatric syndromes, 43 mental health conditions, 44–45 Geriatric Training for Physicians, racial/ethnic differences, 50–51 Dentists, and Behavioral/Mental in rural areas, 127 Health Professions Program, socioeconomic status and, 50–51 136, 154 trends, 2–3, 40, 54–55 Geriatrician Loan Forgiveness Act, 180 See also Health care needs of older GRACE. See Geriatric Resources for adults Assessment and Care of Elders Healthcare Effectiveness Data and Green House, 81–83, 111, 225 Information Sets, 99 Hearing problems, 43 Heart disease H epidemiology, 42 John A. Hartford Foundation, 29, medication use, 49 79–80, 129, 134, 141, 143, 150, mortality, 44 153–154, 155, 159, 170 office visits related to, 45–46 

INDEX 291 HELP. See Hospital Elder Life Program I Help-seeking behaviors mental health services, 46 Immigrant population preventive care utilization, 50, 51 in health care workforce, 227–228 sexual orientation and, 156–157 language proficiency and health care High Growth Job Training Initiative, utilization, 51 230–231 use of interpreters in health care, Hispanic population. See Race/ethnicity 253 HIV/AIDS, 156 IMPACT. See Improving Mood: Home health aides Promoting Access to recommendations for training, 9, Collaborative Treatment for Late 218 Life Depression recruitment and retention Improving Mood: Promoting Access challenges, 209 to Collaborative Treatment for services, 202 Late Life Depression (IMPACT), supply and demand trends, 17–18 79–80, 103–104, 111–112 training requirements, 9, 22, 207, Incarcerated population, 54, 155 215, 218 Incontinence, 43 workforce characteristics, 203 Indian Health Service, 178 See also Direct-care workers Indiana University, 80–81 Home health care Informal caregivers, 32 demand for direct-care workers and, caregiver characteristics, 248–250 200 definition, 18, 247, 249 direct-care worker employment in, demand projections, 64 201 economic value, 18, 247–248 Medicare coverage, 47, 99–100 financial assistance, 261–263 projected demand, 58, 200 frequency and intensity of help technology development for, 14, 56 from, 247 utilization patterns, 47 influence on health care outcomes, Hospice 253–254 AIM model of care, 83–84 integration with medical team, federal program spending, 48 256–258 utilization park, 44 long-term care provision, 48 Hospital Elder Life Program (HELP), new models of care, 113 105–106 numbers of, 248, 249 Hospitals quality of care, 247 direct-care worker employment in, recommendations for training, 201 9–10, 255 discharge patterns, 47 respite, 261 post-acute care, 47, 254 role of, in continuum of care, 242, utilization patterns, 45, 46, 47 247, 263 utilization projections, 57–58, 59 spouses as, 250 Hypertension stress for, 258 epidemiology, 42 supply concerns, 18, 242, 249–251, medication use, 49 263 physician office visits for, 45–46 support programs, 258–263 tasks and responsibilities, 251–253 

292 INDEX training models, 255–256 nurse aides, 296 training needs, 4, 9, 242, 260–261 pharmacists, 147 Information technology recommendations for, 8–9, 161– electronic health records, 14, 114, 162, 218 257 Life expectancy goals of health system reform, 77 gender differences, 49–50 for new models of care, 114–115 population trends, 16 recommendations for, 14 socioeconomic status and, 51 Infrastructure development and Lifespan Respite Care Bill, 259, 261 maintenance Long-term care recommendations for, 12 barriers to recruitment of health See also Information technology care professionals for, 167–168 Institute for Geriatric Nursing, 141 current utilization, 43, 48 Intensive care, 57 definition, 27, 48 International medical graduates, 134, demand projections, 61–62, 63–64 155 demographic trends and, 54 Internet-based education, 162–163 nurse aides in, 201–202 Interpreters, language, 253 spending, 48 See also Chronic conditions; Nursing homes J Jewish Vocational Services, 163 M Maine, 90 K Manchester Community College, 164 Kaiser Permanente, 97 Marital status, 51 Kansas, 126–127 Medicaid compensation for direct-care workers, 11, 220, 221–222 L coordination with Medicare benefits, 23 Learning organizations, 107 demonstration projects, 88–93 Lewin Group, 61–62 financial challenges, 15, 24–25 Licensed practical nurses future of health care system, 30, 31, nursing home needs, 167 56 scope of practice, 140–141 informal caregiver support, supervisory role, 141 258–259 training, 141 long-term care spending, 48 Licensure and certification nurse aide training requirements, board certification for physicians, 206 137–138, 145 nursing home bias, 23 continuing education requirements, projected service utilization, 4 161 recommendations for, 10, 11, 171, geriatric care managers, 165 222 geriatric competency requirements, shortcomings of current payment 161 system, 22, 23, 174–175 goals, 161 

INDEX 293 spending on non-institutional nurse aide training requirements, service delivery, 200 206 spending per beneficiary, 65 obstacles to new models of care, spending trends, 24, 65–66 107 strategies for enhancing recruitment original purpose, 22 of geriatric specialists, 171, population projections, 53 174–175 post-acute care service coverage, 47 See also Reimbursement projected service utilization, 4, Medical Home demonstration projects, 58–61 101. See also Advanced medical recommendations for, 10, 11, 171 homes research budget, 88 Medical technologies shortcomings of current payment future demand for health services system, 22–23, 174–175 and, 14, 55–56 special needs plans, 98–99 new models of care, 114–115 spending per beneficiary, 24, 65 provider training for, 164 strategies for enhancing recruitment to support activities of daily living, of geriatric specialists, 171, 14, 115, 164, 244–246 174–175 See also Information technology total budget, 88 Medicare utilization patterns of consumers, additional benefits to support new 46 models of care, 99–100 See also Reimbursement Advantage plan, 97–98 Medicare Modernization Act, 86, 98 chronic care spending, 3, 16, 42–43 Medications coordination of patient care in, 114 average consumption among older coordination with Medicaid adults, 21, 49 benefits, 23 older adult utilization, 3, 45, 48–49 copayment disparities, 12, 108, role of informal caregivers in 174–175 administration of, 257 demonstration projects, 84–88 scope of practice reforms in end-of-life spending, 44 administration of, 166–167, 225 fee-for-service system, 96–97 utilization by type of medication, 49 financial challenges, 15, 24–25, 66 MedPAC, 99 future of health care system, 30, 31, Mental health, 44–45 56 geriatric education and training for graduate medical education, 23, physicians, 133 136, 137 geropsychiatric nursing, 143 hospice care, 44, 48 help-seeking behaviors, 46 Hospital Insurance Trust Fund, 24, older adult utilization patterns, 46 66 physical health and, 45 informal caregiver support, 258, reimbursement reforms to enhance 260, 261 recruitment of geriatrics long-term care spending, 48 professionals, 174–175 Medication Regimen Review, 146 supply of geriatric specialists, 125 medication use by enrollees, 49 training requirements for geriatric mental health coverage, 12, 46, 108 psychiatry, 138 

294 INDEX Minnesota, 91 Mortality Models of care delivery, 31 among older adults, 44 additional Medicare benefits to chronic condition-related, 16 support new models, 99–100 circumstances of last years of life, advanced medical homes, 100–101 44 collaborations for dissemination, socioeconomic status and, 50–51 107 Mt. San Antonio College, 163 common features of innovative models, 93–95, 115 coordination of care in, 113–114 N current shortcomings, 6, 11–12, 14 National Advisory Council on Nurse dissemination experiences, 103–106 Education and Practice, 155 financing mechanisms, 98–101 National Association of Social goals for improving, 12 Workers, 150 interdisciplinary care teams, 113 National Caregiver Support Program, international models, 27, 110–111 259 Medicaid demonstration projects, National Citizen’s Coalition for 88–93 Nursing Home Reform, 217 Medicare research and National Clearinghouse on the Direct- demonstration projects, 84–88 Care Workforce, 232 for middle class consumers, 109 National Council of State Boards of new approaches, 78–79 Nursing, 141 obstacles to diffusion, 103, 107–108 National Direct Service Workforce palliative care in, 109 Resource Center, 231 performance evaluations of, 78, 93 National Family Caregiver Support population diversity considerations, Program, 261 109 National Geriatric Service Corps, 11, preventive interventions in, 109 181 principles, 76–78 National Health Service Corps, 11, private sector models, 79–84 176, 179–181 recommendations for, 6, 12–14, 108 National Institutes of Health, 178–179 reforms in workforce roles and Native Americans. See Race/ethnicity responsibilities, 13, 111–113, New Hampshire, 126–127 115 Northern Michigan University, 155 reimbursement reform for, 12 Nurse Aide Training and Competency requirements for successful Evaluation Program, 206 implementation, 12, 75, 101–102 Nurse aides research needs, 12–13, 108–110 career lattices, 224 workforce adaptation to, 13, 111 current supply, 5 workforce considerations in new demand projections, 58 designs, 109–110 employment settings, 201 Monitoring health care workforce feeding assistance role, 225 supply medication administration goals, 30 responsibility, 166, 225 rationale, 5 quality of care, workload and, recommendations for, 6, 30 213–214 

INDEX 295 recommendations for training, 9, older adult utilization, 3–4, 45, 48 218 oral-health care in, 144 role of, in older adult care, 201–202 per capita spending, 65 supply challenges, 21 projected demand, 58 training requirements, 9, 22, 206– quality of care, staffing levels and, 207, 215, 217, 218, 232–233 213–214 See also Direct-care workers racial/ethnic differences in Nurse Competence in Aging, 141–142 utilization, 50 Nurse Education, Expansion, and screening guidelines, 157–158 Development Act, 142–143, 170 shortcomings of Medicaid policies, Nurse practitioners, 3, 143 23 Nurse Reinvestment Act, 141–142 workforce turnover, 209–210 Nurses See also Long-term care emerging supply problems, 19 Nursing Reinvestment Act, 155 medication administration role, 166 obstacles to increasing supply, 140 projected demand, 58 O projected supply, 140 Obesity scope of practice and job delegation prevalence projections, 59 reforms, 165–166 service utilization projections and, support for doctorate level faculty, 61 175–176 Omnibus Budget Reconciliation Act, See also Licensed practical nurses; 86, 206 Nurse aides; Nurse practitioners; Oncology, 57 Registered nurses Optometrists, 58, 152 Nurses Improving Care for Health Oregon, 90 System Elders, 154 Osteopathic medicine, 11, 138, 175 Nursing Demand Model, 57 Nursing homes age distribution of residents, 43–44 P current utilization, 43–44 PACE. See Programs of All-Inclusive direct-care worker employment in, Care for the Elderly 201 Palliative care. See End-of-life care emerging workforce supply PAS Workforce Project, 232 challenges, 21 Patient-centered care, 76 Evercare program model of care, Patient role in health care 85–86 goals, 77–78 Green House model of care, 81–83 new models of care, 113 health status of residents, 44 professional workforce needs and, informal caregiver effects on entry, 4–5 254 scope of, 241–243 Medication Regimen Review, 146 self-management, 243–244 mental health problems among Personal- and home-care aides residents, 45 income, 209 nursing staff, 141 monitoring performance of, 203 occupational injury risk, 212 on-the-job injury risk, 212 

296 INDEX recommendations, 9, 218 Podiatrists, 58, 152 recruitment and retention Polk Community College, 164 challenges, 209 Population trends and patterns role of, in older adult care, 202–203 aging, 1, 15, 16, 45, 52–53 training, 9, 207–208, 215, 218 demographic features, 1, 4, 15–16, workforce development programs, 52–55 232 demographic variations in health See also Direct-care workers care utilization, 49–52 Pharmacists geographic variation, 51 current certification in geriatrics, 5, health care workforce aging, 20, 21, 125 168–169 education and training, 146–147 health status, 2–3 emerging supply problems, 19, 146 informal caregivers, 248–251 licensure, 147 population diversity considerations in older adult health care, 146 in new models of care, 109 reform of medication administration potential sources for direct-care roles, 166–167 worker labor pool, 227–229 reimbursement for advanced projections for elderly population, services, 174 52–55 PHI, 224, 232 training for work with special Physical therapy, 58, 151 populations, 155–157 Physician Aggregate Requirements Practicing Physician Education Project, Model, 57 154 Physician assistants Practicum Partnership Program, 150 current supply, 5, 21, 125, 148 Prayer, 49 education and training, 148 Preventive care income, 171 goals for new models of care, 109 in older adult health care, 147–148 language proficiency and utilization older adult utilization, 5, 147 of, 51 practice settings, 147, 148 Medication Regimen Review, 146 scope of work, 147 principles of delivery system reform, Physicians 76 aging of population of, 20, 168 provider training in, 157–158 board certification, 137–138, 161 racial/ethnic differences in career satisfaction, 167 utilization, 50 cost of geriatric training, 171 shortcomings of current health care current medical school training, delivery, 109 129–133 socioeconomic status and utilization current supply of geriatric of, 51 specialists, 124–125, 128–129 Primary care emerging supply problems, 19 definition, 27 income, 171, 172 Medicare reimbursement policies, postdoctoral training in geriatrics, 23 133–136 Prisons, 54, 155 See also Physician assistants; Private sector, new models of care, Professionals, health care; 79–84 Resident physicians 

INDEX 297 Professionals, health care, 31–32 diversity considerations in new current supply, 124 models of care, 109 definition and scope, 27 health care professionals, 126 educational enrollment patterns, 19 health status and utilization emerging supply problems, 19–20 patterns, 50–51 financial aid for geriatric training in population projections, 52–54 exchange for service, 176–181 principles of delivery system reform, geographic distribution, 126–128 77 incomes, 171 provider–patient relationship, 126 National Institutes of Health workforce diversity, 126 research grants to, 179 RAND Future Elderly Model, obstacles to geriatric training, 123 58–61 projected need, 58, 124 Real Choice Systems Change Grants, racial/ethnic diversity, 126 231 recommendations for recruitment Recruitment and retention, 31–32 and retention, 10–11, 171–176 aging of workforce and, 168–169 resident training in non-hospital direct-care workers. See Direct-care settings, 6–8, 23 worker recruitment and retention See also Geriatric specialists; education and training as factor in, Nurses; Physicians 216 Programs of All-Inclusive Care for the financial aid for geriatric training in Elderly (PACE), 84–85, 104–105 exchange for service, 176–181 financial incentives, 10, 171–181, 182 Q geriatric specialists, 10, 123 Quality of care geriatrics faculty, 10–11, 153–155, current shortcomings, 14, 16, 75–76 175–176 direct-care workers, 213–214 goals for new models of care, efficiency of care, 56, 77 109–110 informal caregivers, 247 negative stereotypes of geriatric principles of delivery system reform, work, 169 12, 76–78 nursing home workforce, 209–210 provider training and, 21, 216 obstacles to, 123, 167–170, recruitment and retention issues, 181–182 213–214 quality of care and, 213–214 shortcomings of federal recommendations for improving, reimbursement system, 22–23 10–11, 171–176 transitions between care settings, in rural areas, 127, 128 47–48 Regenstrief Institute, 80–81 workplace environment and, 214 Registered nurses advanced practice training, 143–144 aging of population of, 20, 168 R current certification in geriatrics, 5, 125 Race/ethnicity income, 171 direct-care workforce, 203, 204 job delegation skills, 165–166 

298 INDEX nursing home needs, 167 Respiratory disorders recruitment and retention, 168 mortality, 44 training, 141–143 Rewarding Provider Performance, 114 Reimbursement Donald W. Reynolds Foundation, 129, billing code modifiers, 173 154 capitated payment systems, 97–98 Risk adjusted payments, 97, 100 coordination within federal system, RTI International, 62–64 23 Rural population fee-for-service system, 96–97 diversity considerations in new mental health services, 46 models of care, 109 for new models of care, 12, 98–101, health care professionals, 127–128 108 health status of older adults, 51, for patient self-management 127 interventions, 244 recruitment and retention of health policy changes affecting demand care workers, 127, 128 and utilization, 56 recommendations for, 10, 12, 108, 171–172 S risk adjustment, 97, 100 Settings for care shortcoming of current system, demographic trends and, 54 22–23 direct-care workers, 201, 203 strategies for enhancing recruitment recommendations for training of of health care professionals, 10, professionals in, 6–8, 137 171–175 transitions between settings, 47–48, for team care, 13 77 Remote monitoring technologies, 14, Skilled nursing facilities, 47 77, 114–115, 245 Smoking, service utilization projections Research and, 61 financial aid for geriatrics Social HMOs, 86–87 researchers, 178–179 Social workers recommendations for new models of aging of population of, 168 care, 12–13, 108–110 competencies for work with older Resident physicians adults, 149–150 in dentistry, 145 current supply of geriatric geriatric training, 133–134, 155 specialists, 5, 21, 125, 148–149 Medicare graduate medical education and training, 149, 150 education programs, 23, 136, practice settings, 149 137 Practicum Partnership Program, 150 pharmacists, 147 projected needs, 5, 148 racial/ethnic diversity, 126 roles for retired professionals, 169 recommendations for training, 8, Society of General Internal Medicine, 137 155 training in non-hospital settings, Socioeconomic status 6–8, 23, 136–137 care delivery models for low-income Resources for Enhancing Alzheimer’s older adults, 80–81 Caregiver Health, 256 goals for new models of care, 109 

INDEX 299 health care utilization and, 51 V health status and, 50–51 preventive care utilization and, 51 Veterans, 52, 54 South Carolina, 178 Veterans Administration, 134, 145, Special needs plans, 98–99 159, 257 State governments Veterans Health Administration, 48, 54 financial aid for geriatric training in Volunteer workers, 229 exchange for service, 176–178 recommendations for, 11, 218 W scope of practice reforms, 166 Suicide, 44–45, 52 Weill Cornell Medical College, 137 Sutter Visiting Nurse Association, 83 Wellspring nursing home, 223 Wisconsin, 91–92 Women’s health T insurance coverage for direct-care Team care workers, 210–211 HELP delirium management model, utilization patterns, 49–50 106 Workforce, health care informal caregivers in, 256–258 adaptation to new models of care, new models of care, 7, 13, 113 13, 111 PACE model of disability care, 85 aging of, 20, 168–169 patient role in, 4–5, 77–78, 113 barriers to recruitment and training of medical professionals for, retention, 5 159–160 coordination of care, 114 current capacity, 4–5 definition and scope, 27 U demand for non-institutional services, 200 United Health Care Corporation, future challenges, 1–2, 14, 15–17, 85–86 29–30 Urban Institute, 62–64 goals for improving, 2, 75–76 Utilization goals for new models of care, chronic care-related, 42–43 109–110 consumer expectations for care and, job delegation reform, 110–111, 56 165–166 current patterns, 43–44, 45–49 new professions, 165 demographic patterns, 49–52 new provider designations, 13, 112 determinants of, 4 older workers, 228–229 models for projecting demand and, reform rationale, 67 57, 58–59, 61–62, 64–65 roles and responsibilities in new older adults, 3–4, 17, 39, 53 models of care, 111–113, 115 physician visits, 42, 45–46 roles for retired professionals, 169 projected demand, 4, 15, 17, 39, salient issues, 2, 25, 26–28, 29, 55–56, 57–61, 62, 63–64, 123–124 66–67 scope of practice reforms, 13, 77, reimbursement policies and, 56 112, 165–167 

300 INDEX supply monitoring, 5, 6, 30 Workload timely implementation of reforms, efficiency improvement, 77 2, 26, 31 quality of nursing care and, volunteer workers, 229 213–214 See also Compensation for health care workers; Education and training of health care workers; Professionals, health care