The National Academies of Sciences, Engineering, and Medicine (NASEM) report Retooling for An Aging America: Building The Health Care Workforce celebrates its 10th anniversary on April 11th. EWA interviews Dr. Tracy Lustig of NASEM, Study Director for the report in this edition of Spotlight as a part of its year-long #TogetherWeCare campaign.
Tracy Lustig, D.P.M., M.P.H is a senior program officer with the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine)
Tell us about a little bit about the National Academies of Sciences, Engineering and Medicine.
The National Academies of Sciences, Engineering and Medicine operate under a congressional charter to the National Academy of Sciences, signed by President Lincoln in 1863. The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine.
How did you come to look at the eldercare workforce as an issue area?
The impetus for this specific project was directly due to the efforts of a coalition of private organizations who came together to sponsor the report, but the project also built on previous issues examined by the National Academies. In 1978, the National Academies released the report Aging and Medical Education, but that report focused on the role of physicians. The landmark 2001 study Crossing the Quality Chasm noted that the workforce plays a key role in transforming to a 21st century health system. Retooling for an Aging America in many ways represents a combination of these previous efforts by providing a comprehensive look at the health care workforce as a whole in the context of the issue of health care quality.
How did you settle on your recommendations in the report?
The committee conducted a thorough analysis of the forces that shape the health care workforce, including education, training, settings of care, models of care, and the financing of public and private programs. The committee also looked at the workforce broadly to include professionals, direct-care workers, family caregivers, and the patients themselves. This included examining the published literature, commissioning several papers, convening public workshops, and inviting testimony from a wide range of experts. Ultimately, the committee’s evidence-based recommendations represent a 3-pronged strategy to fundamentally change the way that care is delivered to older adults: enhance geriatric competence, increase recruitment and retention, and redesign models of care.
Were there any surprises you encountered while doing this report?
There were several areas which yielded surprising facts. Certainly the high turnover rate among direct-care workers – with up to 90 percent of home health aides leaving their jobs within the first two years, and many facilities having over 100 percent turnover – was alarming. Other findings that stand out include the proportionately low levels of training for direct-care workers as compared to other professions and the relative lack of training for family members who are often tasked with complex medical tasks such as wound care. Further, the committee found evidence that providing education and training leads these individuals to feel more confident in their skills and also to be less likely to leave their jobs. Therefore, the committee provided specific recommendations for improving the education and training of both direct-care workers and family caregivers.
As the report is now in its 10th year- what do you hope to see 10 years from now in the eldercare workforce?
Since the report came out, attention to the health care workforce for older adults has continued at the National Academies. A follow up report looked at the mental health and substance use workforce for older adults, and a 2016 report focused on the needs of family caregivers. We will continue to focus on the workforce, particularly in the Forum on Aging, Disability, and Independence. For the report itself, the committee set a target date for their recommendations of 2030; they noted that this date was chosen because it allowed enough time to achieve significant progress but not so far in the future that the medical landscape could change too greatly. The committee noted that “the preparation of a competent health care workforce and widespread diffusion of effective models of care will require many years of effort.” Ten years in, we have seen improvements toward achieving some of the recommendations in the report, and hopefully in the next ten years progress toward fully realizing the committee’s vision of care will be even more significant.
Tracy Lustig, D.P.M., M.P.H is a senior program officer with the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine). Dr. Lustig was trained in podiatric medicine and surgery and spent several years in private practice. In 1999, she was awarded a congressional fellowship with the American Association for the Advancement of Science and spent one year working in the office of Ron Wyden of the U.S. Senate.
Dr. Lustig joined the Academies in 2004. Much of her work has focused on the health care workforce and the aging of the U.S. population. She was the study director for consensus studies on the geriatrics workforce, oral health, and ovarian cancer research. She also directed workshops on the oral health workforce, the allied health workforce, telehealth, assistive technologies, home health care, hearing loss, and stereotypes in aging and disability. In 2009, she staffed an Academies-wide initiative on the “Grand Challenges of an Aging Society” and subsequently helped to launch the Forum on Aging, Disability, and Independence, which she currently directs.
Dr. Lustig has a doctor of podiatric medicine degree from Temple University and a master of public health degree with a concentration in health policy from the George Washington University.