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A Call to Action

A Call for Leadership in Aging


The Institute of Medicine Calls for Fundamental Reform


rettikubg for an aging america

The Instititute of Medicine report, focused on the geriatrics workforce shortage, was released in April 2008.



As an expression of leadership in the field, the Hartford Foundation convened a group of funders who sponsored the 2008 book-length Institute of Medicine (IOM) report, Retooling for an Aging America: Building the Health Care Workforce. Alarmed by the looming health care crisis as the baby boom generation nears retirement age, experts in geriatric medicine, nursing, social work, and health policy analyzed the readiness of the health care workforce to meet the needs of older Americans. The resulting IOM report states that “the impending crisis, which has been foreseen for decades, is now upon us.”

The report issues an urgent call for fundamental reform: “Unless action is taken immediately, the health care workforce will lack the capacity (in both size and ability) to meet the needs of older patients in the future.”

To address the crisis, the IOM committee challenged the health care community to:

  • Enhance the competence of all individuals in the delivery of geriatric care,
  • Increase the recruitment and retention of geriatric specialists and caregivers, and
  • Redesign models of care and broaden provider and patient roles to achieve greater flexibility.
  • Education, training, and recruitment of geriatric-trained health professionals must be enhanced to improve care for the rapidly growing population of older adults. “Geriatric specialists are needed in all professions not only for their clinical expertise, but also because they will be responsible to train the entire health care workforce,” according to the IOM report.

    Because the health care system often fails to provide high quality care to older adults, the very systems of delivering care must also be transformed. The health care delivery and reimbursement systems in the United States are structured around acute care of single diseases. But most older adults require comprehensive, coordinated care of multiple chronic diseases and geriatric syndromes (such as incontinence and gait disorders).

    The IOM report calls for a shift in the way that health care services for older adults are organized, financed, and delivered. The committee noted that it is unlikely that a single approach could be broadly adopted for all older persons. Therefore, a variety of models will be needed to meet the diverse health care needs of older adults.

    Redesigning primary care to provide high quality chronic care, which will improve health care for patients of all ages, requires innovative and feasible strategies. Leaders must obtain funding and conduct research that will bring about the new models of care delivery. Resources will be allocated to such projects only if strong, well-connected, imaginative leaders advocate for them.

    New models of care can provide higher quality cost-efficient care, but only if the models are adopted into practice. Most health care settings—physician offices, hospitals, clinics, long-term care facilities—have well-entrenched systems in place. Those advocating for change are often met with resistance. Little will be accomplished unless leaders can inspire others to become active partners in the development of effective and efficient models of care.

    Finally, transformation of the entire health care system will occur only if policy makers understand the reforms that are needed, have the information to make a strong case, and have the political will to bring change. Nurses, social workers, and physicians have specialized knowledge and expertise. This will translate into public health policy only if they inform the nation’s health policy agenda. The notion of political activism may seem intimidating, but influencing public policy is essential to bring about reforms that ultimately will serve the interests of current and future generations of older adult patients.


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