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The Aging Workforce Revisited

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I’ve written about workforce issues in a previous post and have had it on the docket for more posts for awhile now.  Workforce development is an important – dare I say the most important? – challenge we face in providing quality care for older adults globally.

This infographic from Nursing School Hub is a lovely depiction of the issue. (My thanks to reader Deyanara Riddix for sharing it with me).

Did you know, for example, that the average American reaching age 65 today is expected to live another 19.3 years?

And that the number of older adults aged 85 and over will triple by 2040 from 6 to 14.6 million?

That’s a lot of people who will need care and, at least for medical care, nurses will be doing most of the work.  The expected growth in nurses will not be enough to meet this demand even though the job growth in this area will be higher than the overall average.

Plus nurses, like most health care and social service professionals, are aging too.  In 2008, just 30% of nurses were under the age of 40.  That means a wave of retirements just when a growing workforce with bachelor’s degrees or higher is most needed.

Not only is there a need for more nurses (and doctors and pharmacists and social workers and physical therapists), but they need to have training specifically in geriatrics – if not a specialty focus, at least geriatrics infused throughout the curriculum.

A 2012 article by researchers from the University of Kentucky looks at geriatric content in the curriculum of seven health care related fields (social work not included I’m sad to say).  Here are some things I found most interesting.

All of the programs mentioned integrating geriatric content throughout the coursework at some level.  This included content on age-related sensory and cognitive deficits and communication strategies to accommodate them, recognition of diseases common with aging, problems associated with taking multiple medications, prejudicial attitudes toward older adults, Medicare reimbursement, and the need for interdisciplinary perspectives and collaboration.

Only three offered stand-alone geriatric courses and five programs included experiential assignments.  The assumption (probably a correct one) was that students interact with older adults in clinical settings and learn some of this content there, but there is a different skill set that needs to be taught in the classroom as well.

Everybody interviewed valued the inclusion of geriatric content.  They talked about the growing older adult population, the disproportionate use of health care services by older adults, and the fact that no matter where students end up working they will interact with older adults at some point.

But valuing the content is not always enough.  One of the biggest barriers to adding geriatric content is simply time.  Students have only so many credit hours and if you add something you have to take away from somewhere else. I’m all too familiar with that in my own curricular efforts. There also aren’t that many educators with specialized geriatric training.  And a big concern (from my point of view) is lack of student interest.  Many students haven’t spent time with healthy older adults and then they are sent to work in a nursing home.  They walk away with a negative stereotype about older adults and the type of work that is involved.

All of these are barriers that can be overcome with some energy, resources (money and people power), and a bit of ingenuity.  But we’d better not wait too long.

Health care workers – how do we love thee

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In the Sunday, Feb 8 issue of the New York Times there was an article about the impact of the economic crisis and extreme austerity measures in Greece on health care.  This NYT article looks in particular at the shortage of nurses forcing hospital patients to hire private nursing care. Enter the entrepreneurs and a burgeoning business of selling illegal nursing care. Not surprisingly, the “nurses” (mostly or entirely women I assume) who provide this care are untrained which is leading to a variety of noticeable consequences. Besides substandard care for individuals (an important issue in and of itself), there has been an increased spread of illnesses in hospitals because the illegal nurses are not following basic hygiene protocols like wearing gloves.

Given that I’m thinking about health care workforce issues a lot right now, this article caught my attention and made me wonder what data is available related to health resources (particularly workforce) and health outcomes. No one is expecting such extreme problems in the countries I’m looking at (the U.S., Finland, and Estonia), but they are anticipating a shortage of health and social services workers adequately trained to work with our aging populations. Beyond the substitution of unqualified and untrained workers, what impact might a worker shortage have? It’s easy to imagine the impact on an individual’s health through delays in care, not getting care at all, or getting inadequate care. But what about a population’s health? Does a shortage of health care workers, make us, as a country, less healthy?

The short answer seems to be yes. A variety of studies both between and within countries have found that the density of health care workers (i.e., the number of workers divided by the number of people in the population), particularly doctors and nurses, is associated with health outcomes ranging from maternal and infant health and mortality to mortality, hospitalization, and spending among Medicare beneficiaries in the U.S.  Of course, it’s probably more complicated than density alone. Geography, race, and FTEs (i.e., the amount of care provided vs. the number of workers) are important too.

There’s not as much data on other types of health workers such as community health workers, social workers, and complementary and alternative medicine practitioners. Nor is there as much focused specifically on outcomes among the older population as there is about mothers and children. (At least I haven’t found it yet – if you know of some, please share!). Given that geriatricians, geriatric nurses, and geriatric social workers are where health care worker shortages are predicted to grow over the coming years, some understanding of what counts as a shortage and what impact that may have is worth thinking about.