Education & Training: Meeting the Needs of Older Adults

The Best Prescription for Healthier Older Adults: Quality Coordinated Care

Geriatrics Workforce Training Shortfall Virtually all health care workers care for older adults to some degree. Older adults require a health care workforce with the expertise to meet their unique needs. The supply of qualified health professionals and direct-care workers with adequate training to serve the needs of aging adults is declining precisely at a time when demand, due to burgeoning numbers of older adults, is increasing at an unprecedented rate. The Institute of Medicine’s (IOM) landmark report, Retooling for an Aging America: Building the Health Care Workforce, concludes that “the education and training of the entire health care workforce with respect to the range of needs of older adults remains woefully inadequate.”

THE CHALLENGE:

Expanding Geriatrics Education for Health Care Professionals

The breadth and depth of geriatrics education and training for health care professionals remains inadequate to prepare them for the health care needs of the future. In order to provide specialized, quality care for older adults, health professionals need education and training in geriatrics and gerontology. Despite some improvements, geriatrics principles are still too often insufficiently represented in health care training curricula and clinical experiences focused on gerontology are not robust.

• Less than 3 percent of students in medical schools choose to take geriatrics electives. [1]
• Although 75 percent of social workers report working with older adults, social work training and competency requirements lack focus on this population. Only four percent of social workers report receiving geriatrics training and only 24 percent of Bachelor’s of Social Work programs offer a certificate in aging or gerontology.[2]
• Less than one percent of all registered nurses are certified as gerontological and the vast majority of schools of nursing had no faculty members who were certified in gerontological nursing by the American Nurses Credentialing Center.[3]
• Less than one percent of pharmacists are certified in geriatrics.[iii]
• Although 69 percent of all practicing psychologists provide some services to older adults, only three percent view geriatric patients as their primary professional target. Only one quarter of psychologists are exposed to geropsychology in graduate coursework.[4]
• Although 87 percent of physical therapists report working with older adults, less than one percent  of practicing phyisical therapists are certified as geriatric clinical specialists. [ii]
• Less than half of pharmacy schools have a distinct course in geriatrics despite the fact that per capita prescription drug use by people 65 and older is triple that of younger individuals.[5]
• Less than one-fifth of schools training oral-health workers, including dentists and dental hygienists, offer a course in geriatrics practice.[6]

The IOM report cites “lack of faculty, lack of funding, lack of time in already-busy curricula, and the lack of recognition of the importance of geriatrics training” as the main barriers to the appropriate levels of training.

Training for Direct-Care Workers 

Due to the expanding population of older adults, and the growing desire to live independently and remain at home, the demand for the direct-care workforce is projected to reach 4.3 million by 2018.[7] The challenge for training the direct-care eldercare workforce – including nurse aides, home health aides, and personal and home-care assistants – is every bit as great. While direct-care workers are responsible for providing 70 to 80 percent of the paid hands-on long-term care for older adults, their preparation and training is underfunded and inconsistent.[8]Poor training and insufficient training systems undermine worker confidence, inadequately address the needs of consumers, and increase turnover.

• The minimum federal requirement for nurse aide training is only 75 hours. Although some states require additional training, 20 states require only this bare minimum, which has not been adjusted in over 20 years. The IOM report recommends that minimum federal requirements be increased to at least 120 hours.[9]
• Training requirements vary from state to state and often fail to give direct-care workers the skills and knowledge they need to care for the complex needs of today’s older and frailer consumers.[10]
• Inadequate training systems, which limit opportunities for certification and higher wages, make it difficult for direct-care workers to advance without leaving the direct-care workforce.[11]

Training and Support for Consumers and Caregivers

An estimated 43.5 million unpaid caregivers provide care to someone 50 years or older annually.[12] Family caregivers can face physical, emotional, mental, and financial challenges in their caregiving role. Opportunities for training and access to supportive services are an imperative to this backbone of long-term care.

• More than three-quarters of caregivers feel they need more help or information related to caregiving.[13]
• Nearly one in five informal caregivers who assisted with medication management and one in three who assisted with changing dressings or bandages received no instruction or training in performing these tasks.[14]
• Specific caregiver interventions which appear to be most beneficial include those that work with both the caregiver and the care recipient, those that emphasize behavioral skills training, and those that are both multi-component and tailored to caregivers’ specific needs.[15]

People with moderate dementia have been able to defer institutionalization by nearly a year when their family members receive caregiver support services, including counseling, information and ongoing support.[16]

RECOMMENDATIONS:

Recognizing the Unique Needs of Older Adults
High-quality care for older adults, many of whom have multiple complex chronic conditions, requires a diverse range of skills for addressing their physical, mental, cognitive and behavioral needs. The lack of training requirements for both health professionals and the direct-care workforce results in part from a lack of recognition that older adults have distinct health care needs.

Investing in Health Care Professionals
Exposure to geriatrics principles and practices will be essential for training the health professionals serving older adults. A much needed commitment, given that by 2030, America’s 65 and over population will mushroom from 12 percent to 20 percent of the total population.

Investing in the Training of Direct-Care Workers
A significant investment in training standards, curricula, and infrastructure is crucial to prepare greater numbers of workers for direct-care jobs. The growing demand for home-based care and direct-care services presents an opportunity to provide the recognition and respect the direct-care workforce deserves, by increasing funding for new educational opportunities and eldercare training.

Supporting Consumers and Caregivers
Funding should be made available to ensure adequate training opportunities are available in the community for informal caregivers. Existing and new models offer programs that assist caregivers in making decisions and solving problems.

TAKING ACTION
To meet the unique needs of older adults, the Eldercare Workforce Alliance is calling for increased funding for the geriatrics health professions, direct-care workforce, and consumer and caregiver training and support. As the IOM concluded, investing in education and training is vital to meeting our nation’s responsibility to provide high-quality care to our aging population.

PDF of Issue Brief.

[1] IOM report Retooling for an Aging America: Building the Health Care Workforce, page 133.

[2] Council on Social Work Education, http://www.cswe.org/File.aspx?id=31797

[3] Hartford Institute for Geriatric Nursing, http://www.hartfordign.org/About

[4] American Psychological Association, http://www.apa.org/practice/guidelines/older-adults.pdf

[5] IOM report Retooling for an Aging America: Building the Health Care Workforce, page 130.

[6] IOM report Retooling for an Aging America: Building the Health Care Workforce, page 130.

[7] PHI Facts, http://www.directcareclearinghouse.org/download/NCDCW%20Fact%20Sheet-1.pdf

[8] PHI Facts, http://www.directcareclearinghouse.org/download/NCDCW%20Fact%20Sheet-1.pdf

[9] IOM report Retooling for an Aging America: Building the Health Care Workforce, page 219; PHI http://www.directcareclearinghouse.org/download/state-nurse-aide-training-requirements-2009.pdf

[10] PHI, http://phinational.org/policy/recommendations/training-support

[11] PHI, http://phinational.org/policy/recommendations/training-support

[12] National Alliance for Caregiving and AARP, http://www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf

[13] Family Caregiver Alliance, http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439

[14] Family Caregiver Alliance, http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=691

[15] Family Caregiver Alliance, http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439

[16] Family Caregiver Alliance, http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439

[ii] American Physical Therapy Association Research Department. From: 2010 Practice Profile Survey. Alexandria, VA: American Physical Therapy Association; 2011. Unpublished data.

[iii] IOM report Retooling for an Aging America: Building the Health Care Workforce, page 125.

Originally published on February 16, 2011.

Fast Facts