NYU dean warns of “perfect storm” brewing in healthcare

Dr. Fulmer was one of 14 members of an Institute of Medicine committee that compiled a report calling for fundamental changes in the U.S. healthcare system to address the aging population. A one-page summary of the report can be found atwww.iom.edu/agingamerica.
The committee recommends:

1. Training all healthcare providers in the basics of geriatric care.
   According to Dr. Fulmer, “Training all healthcare providers in the basics of geriatric care means that we must ensure that appropriate geriatric content is embedded in every healthcare professional and paraprofessional curriculum. Another recommendation is to look at loan forgiveness and create special programs regarding ways that geriatric academic career awards can be expanded. We need to use our current geriatric education centers to try to get as many people trained as possible. We should encourage training of all nursing students, all medical students, all social workers; all healthcare students should have appropriate content in their educational training concerning geriatrics and aging.”
    
2. Higher salaries and financial incentives to retain and recruit nurses.
   Dr. Fulmer says, “Pay structure is one important component in attracting and retaining people. Our committee wasn’t charged with determining where in the government or private sector those funds would come from. However, we do know that nursing assistants, for example, might make the same as a fast food restaurant worker. There has to be a salary differentiation so that geriatric care will be an attractive career path.”
    
3. Prepare family members and other informal caregivers, who currently receive little or no training, in how to care for their aging loved ones.
   “Most care for frail, elderly patients is provided by family members or friends. We have to use technology such as Web sites and television to get content out to individuals on how they can creatively care for their aging friends and relatives. Medication management, for example, is a very big challenge for families. We need to say to them, “Here are some ways found to be not only effective, but efficient for you to make sure medication management is handled correctly.” We need to get that kind of education out into the community. Currently, we have a lot of research (on the need for disseminating information), but we need to translate that research into useful information for lay caregivers of older friends and relatives."
    
4. Health plans need to pay higher rates to boost recruitment and retention of geriatric specialists and care aides.
   “This is just a fact,” Dr. Fulmer says. “How we do this has to be worked out by the big health plans.”

Dr. Fulmer has these suggestions for the long-term care industry: “Look for incentives to recruit and retain people into your workforce and think about what educational needs those colleagues will need in order to provide the best care for older adults. Continue to think about career ladders for older individuals. I know there are a lot of good ideas already happening among the assisted living industry. I would encourage you to think about ways technology can enhance work and how it can help you keep more experienced nurses and nursing assistants in the workforce. Ages ago we created something called a Hoyer lift to save nurses’ backs from lifting patients. We need a modern day “Hoyer lift” to support experienced nurses and nursing assistants as they age in the workforce to retain them. We need to find ways to make their work less physical. We need to use technology to the best of our ability and think about what we need to do to enhance their productivity―even something as simple as a flexible schedule.”