Academic journal article Generations

Caring for an Aging America in the Twenty-First Century

Academic journal article Generations

Caring for an Aging America in the Twenty-First Century

Article excerpt

Over the next twenty years, the population of people ages 85 and older may increase five-fold. This demographic will drive much of the resulting health and long-term-care demands-and it underscores the need for a quality workforce.

In January 2011, the first baby boomers turned age 65. Over the next twenty years, the number of adults who are ages 65 and older will double. The population of those ages 85 and older-the group most likely to need acute, primary, and long-term care-is expected to increase five-fold. One in five Americans will be of age 65 or older, compared with 12 percent today (Institute of Medicine, 2008).

While this demographic phenomenon is to be celebrated, it is also expected to place increasing demands on those who care for our elderly population-a group that uses considerably more services than younger people and whose health and long-term-care needs are often more complex. Elders are more likely to suffer from multiple chronic physical and mental illnesses, have higher levels of functional disability, use multiple medications, and have higher rates of dementia and other cognitive impairments (Medicare Payment Advisory Commission, 2007).

These demands require an educated, highly trained, competent workforce across all settings where people receive care-the hospital, a physician's office or clinic, a nursing home, assisted living (or other residential care setting), and private homes and apartments. The workforce ranges from the direct-care workers who provide hands-on care to a financially, racially, and ethnically diverse population, to the variety of clinicians who address the complex health and long-term-care needs of this population, to the managers and administrators who oversee the systems that deliver care.

This special issue of Generations recognizes the demographic reality that will be driving much of the health and long-term-care demand over the next twenty years and the need to develop a quality workforce to care for an aging America in the short and long term. The purpose of this special issue is to review the state of the art in the development of this workforce; to highlight the various policy and practice issues across professions and settings that are impeding or enhancing the development of this workforce; and to heighten awareness about the critical nature of these issues among the various stakeholders (policy makers, regulators, providers, professional organizations, educators, consumers, and families) who stand to benefit from the development of a quality eldercare workforce.

Why Workforce Matters

The development of a competent, committed workforce to care for our aging society is important and timely for two primary reasons. First, the supply of health and long-term-care workers does not currently meet demand and will certainly fall short of the increased demands expected in the future (Mather, 2007). Second, even if the numbers of workers were there, that is not sufficient: it is not possible to develop a quality and cost-effective delivery system without a well-trained, competent workforce that understands how to deliver care to older adults.

Concerns about supply

It has been estimated that the United States will need an additional 3.5 million healthcare workers by 2030 just to maintain the current ratio of healthcare workers to the population (Mather, 2007). And while the general need for professionals who care for older adults is high, the particular need for geriatric specialists is even greater. This trend is consistent across all professions including physicians (Association of Directors of Geriatric Academic Programs, 2007), nurses (Kovner, Mezey, and Harrington, 2002), social workers (Center for Health Workforce Studies, 2006), and other occupational categories. The current and projected lack of professionals and direct-care workers is particularly dramatic in the long-term-care sector (Harahan and Stone, 2009). …

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