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Crisis Ahead for Elderly Health Care?

Experts warned Monday that the United States faces a massive health care shortage that threatens to leave millions of seniors without proper health care within the next three decades.

A report issued by the Institute of Medicine says that medical and nursing schools are training far too few doctors and nurses on how to care for the elderly. At the same time, other workers, such as nurses' aides and home health workers, remain undertrained and underpaid, the experts say.

"We really feel that this is a crisis," said John W. Rowe, MD, who chaired the panel issuing the report.

The number of Americans over 65 years of age is expected to nearly double by 2030. At the same time, the number of doctors specializing in geriatrics has been falling and rests around 7,000 now, according to the report.

Rowe said most policy makers focus on Medicare's financial condition without paying attention to a looming lack of care.

"Even if there is enough money, there isn't going to be anybody there to provide the care," said Rowe, a professor of health policy and management at the Mailman School of Public Health at Columbia University. "We've been in denial up until now about the second half."

The report says the country will need to triple its ranks of health care workers qualified to care for older persons by 2030. It calls for loan forgiveness and incentive plans to entice more doctors and nurses into geriatric specialties.

An internist who specializes in managing the multiple chronic diseases of old age earns an average of $163,000 per year, compared with $175,000 for the average internist with only general training, the report says.

Salaries, Training

But the report also calls for higher salaries and more training for nursing aides and home health workers who shoulder much of the care for the elderly. Rowe warned that many of those workers don't make "a living wage" today.

In California, "there are higher training standards for dog groomers, crossing guards, and cosmetologists" than for home health workers, he said.

The workforce shortage has already led many home care agencies to rely on workers from developing countries. Susan A. Chapman, PhD, another of the report's authors, said stop-gap measures won't be enough to fill needed slots in the coming years.

"It's not going to be a viable solution. Even with more immigration we would not solve the crisis in the numbers of providers we are going to need," said Chapman, the director of the Allied Health Care Workforce Program at the University of California, San Francisco.

In a statement, American Medical Association Board member Cecil B. Wilson, MD, said Medicare's financial health and doctor training were both concerns.

"With approximately 7,000 geriatricians currently in the United States, all physicians caring for aging patients need to become proficient in geriatric care to help meet the increasing health care needs of seniors," the statement said.

By Todd Zwillich
Reviewed by Louise Chang
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