Services in aging are inherently multidisciplinary. The scope and complexity of chronic disease, impairment and other losses common in old age require the skills of a variety of health and social service workers trained in gerontology and geriatrics. Although the severe shortage of social workers in gerontological practice is beginning to be addressed (see the Aging Today "In Focus" section titled "Social Work: Building Its Role to Serve an Aging Society," March-April 2003), this workforce problem is only the tip of the iceberg. Across the spectrum of human-service workers, projections of the gap between the need for and the availability of professionals and paraprofessionals trained in gerontology are staggering.
A foreseeable consequence of the shortage is that care managers in this century will find their efforts to gain access to services on behalf of older clients challenging because trained providers simply will not be there. The idea of interdisciplinary teams of specialists in aging also flies in the face of projected shortages.
FEW DOCTORS, NURSES
As the ranks of boomers age 65 or older swell between 2011 and 2030, an estimated 36,000 geriatricians will be needed. Currently, about 9,000 medical doctors in the United States have a Certificate of Added Qualifications in geriatric medicine. Although all medical schools in England have a Department of Geriatrics, only four exist in the United States, and curriculum requirements in geriatric medicine are limited at the rest. Therefore, most of the needed geriatricians are not even in the pipeline.
The situation in nursing is equally or more grim, with the national shortage reaching crisis proportions. The practices of short-staffing and mandatory overtime in nursing homes are evidence of inadequacies in the size and training of the geriatric-nurse workforce. A pivotal concern in the debate over increasing the federally mandated nurse-to-patient ratios in nursing homes is that the United States doesn't have the nurses available to meet higher ratios.
Some steps have been taken to attract and retain a high-quality nursing workforce. For example, the American Nurses Association's Magnet Recognition Program confers "magnet" status on hospitals that exhibit sustained levels of excellence in patient care and nurse retention through workplace enhancements, such as greater involvement of nursing staff in decision making. Also, the Nurse Reinvestment Act, which became law in August 2002, provides scholarships, training grants, career-advancement programs and other incentives to enlarge the nursing workforce. Yet, in all likelihood, most of those entering the field will not choose to become geriatric nurse practitioners.
Generally, the reasons physicians, nurses, social workers, allied health and direct-care workers are not entering the field of aging can be traced to ageist attitudes, relatively low pay, poor working conditions, a negative public image of services for older people, and a belief that working with elders is not challenging or creative. Work needs to be conducted on many fronts to counteract the continuing and pervasive effects of ageism and to give students positive experiences with older adults. In particular, research shows that undergraduate students who are exposed to elderly people during their training are more likely to embark on a career in the field of aging. Efforts at lobbying Congress should be intensified to set specific goals for increasing the number of specialists in aging in all healthcare fields. Financial incentives, including stipends, loan forgiveness programs and funds for continuing education, should be in place to attract people to the field.
So where does this situation leave the care managers of tomorrow's elders? …