Unofficial aging week in the New York Times continues with a nice piece in yesterday’s Science section, “Preparing More Care of Elderly” by Milt Freudenheim.
Starting with a description of the demographic shifts our aging society is facing, the story more or less echoes the Institute of Medicine's Retooling the Health Care Workforce for an Aging America. It quotes Retooling committee members such as David Reuben, MD, on the low quality of care older adults with geriatric syndromes like depression and incontinence often receive. And it quotes another member, Terry Fulmer, RN, PhD, GNP, on the benefits of the NICHE program sponsored by JAFH 
and The Atlantic Philanthropies and led now by Elizabeth Capezuti. Plus, IOM deputy director Judy Salerno, MD, explains some of the financial barriers preventing an adequate research investment in geriatrics and hampering physicians in practice.
However, if you read the story carefully and have followed our reports in Health AGEnda you will also see the gigantic disconnect between what these geriatrics experts are saying and what the national leaders are saying. The American College of Physicians complains about low rates of Medicare and Medicaid payments (true), but doesn’t discuss the quality lapses in the care general internists provide or their insufficient training.
Kathleen Sebelius talks about the primary care training money and the medical home demonstrations going on without mentioning that to date these efforts have given little or no attention to geriatric issues in their design or implementation. Certainly the legislation makes no mention of the need to train primary care practitioners in geriatrics.
Yet the story quotes Dr. Sibelius as saying, “As we talk about needing more health care providers of all kinds, we are also retraining current providers to become better at geriatrics.”
I can only think that she is referring to the well-intentioned but woefully underfunded Geriatric Education Center program authorized by Title VII of the Public Health Act. The Patient Protection and Affordable Care Act expanded its mission and gave it a three-year, $10 million supplemental authorization (but not yet appropriation). That is a lot of money for you or me, but not a lot in terms of reaching a health care workforce that has millions of members.
In fact, none of our national leaders seem to have gotten the message: caring for complex, chronically ill older adults is a health challenge that is not "over the horizon somewhere," but upon us now. If, as the article states, "over 40 percent of hospital beds are occupied by older adults" (we say 48%), 20-30% of primary care visits are from older adults, and 70 and 90% of home health and long-term care beds are serving people over 65, what do you think will happen when older adults—now 14%--constitute 20% of the population? We already know that 70% of Medicare expenditures are on those beneficiaries with five or more chronic conditions. These are exactly the kind of people who require health care professionals with special geriatric skills to manage their complex physiological and social issues.
Thankfully, there is some good news in nursing described by Geraldine (Polly) Bednash of the American Association of Colleges of Nursing about the spread of geriatrics training in nursing through our GNEC project, as well as new required competencies in geriatrics for nurse practitioners. If we can get similar adoption of some basic competencies in geriatrics in medicine and other health professions and figure out how to help current and future practitioners meet them, we will have really made progress on our mission of improving the health of older Americans.
My favorite quote from the story is from Mary Naylor, RN, PhD, another Foundation grantee, commenting on the potential benefits of more skilled care for older adults: "Many of these people could be back on the golf course and enjoying their grandchildren if we did the right thing for them."