QUALITY: Taking Care of the Boomers

More bad news for those of us who plan on getting old some day. The Institute of Medicine just released Retooling for an Aging America: Building the Health Care Workforce which reminds us there are not going to be enough doctors and nurses to deal with the geriatric needs of the 78 million baby boomers who start reaching age 65 in 2011. The authors said Medicare, Medicaid, and other health plans should pay higher rates to encourage more docs to learn about geriatrics. It also recommended training for family members and other aides who do a lot of the heavy lifting (literally and metaphorically) for the elderly. In many parts of the country, it noted, dog groomers and manicurists are required to get more training than the people who take care of our seniors.

"We face an impending crisis as the growing number of older patients, who are living longer with more complex health needs, increasingly outpaces the number of health care providers with the knowledge and skills to care for them capably," said committee chair John Rowe, professor of health policy and management, Mailman School of Public Health, Columbia University, New York City.

This isn't the first report to remind us that geriatricians are underpaid relative to other specialties. A geriatrician earned $163,000 on average in 2005 compared with $175,000 for a general internist—even though the geriatrican has extra years of training. (Neither of them earn as much as many specialists.) Registered nurses who work in nursing homes or other long-term care facilities typically work more hours but earn less than nurses in other settings. Remember that the Boomers can be expected to age (and die) differently than earlier generations. They will live longer and many will live healthier, but they will also have multiple chronic diseases. Today, the report said, the typical 75-year-old has three chronic conditions and takes at least four prescription drugs. Someone has to coordinate their care.

The IOM recommended that ALL health care providers get some training in geriatrics as virtually all of them (OK, not the pediatricians) will treat at least some elderly people. The report considered too whether we need to rethink some of the roles and responsibilities of providers. Maybe we should allow a certified nursing assistant to administer some medications, freeing the R.N. to manage the more complicated needs of a chronically-ill elderly patient.

The report said Medicare needs to improve what it pays, and change its focus from short-term, acute crises to managing chronic and age-related conditions. Lawmakers are beginning to get that message. Last week, it was reported that Senate Finance Committee Chairman Max Baucus (D-MT) wants to beef up Medicare payments for primary care in the doctors' pay package he's working on. Whether the specialists go for that remains to be seen.