Aging Baby Boomers May Face Health Care Crisis

A recently released report by the Institute of Medicine calls the U.S. health-care work force “too small and woefully unprepared” for the impending flood of aging baby boomers. The report warns that, without changes, the health care system will be unable to fill the needs of the 78 million heading toward age 65. The situation is further compounded by the fact that many of the physicians and nurses who practice today are baby boomers themselves and will be in the position of requiring care rather than providing it.

People born during the big baby boom between 1946 and 1964 make up about 29 percent of the nation’s population. By 2030, one in five Americans will be over 65. In the coming years, more than half of all medical care in the U.S. will go to that group that often have more complex conditions and healthcare needs than do younger patients. “We face an impending crisis as the growing number of older patients outpaces the number of health care providers with the knowledge and skills to care for them,” said committee chair John W. Rowe, professor of health policy at Columbia University.

Currently, those over 65 make up approximately 12 percent of the population. This group accounts for one-fourth of doctors’ office visits and at least one-third of hospital stays, ambulance trips, and prescriptions. The report, titled “Retooling for an Aging America: Building the Health Care Workforce,” estimates that currently there is one physician certified in geriatrics for every 2,500 Americans over age 65, with similar shortfalls among geriatric specialists such as psychiatrists and social workers.

The situation in California is even worse. A state legislative report estimates there to be one geriatrician for every 4,000 Californians 65 and older. The Census Bureau showed there were close to 4 million residents who were 65 and older in 2006, and that number is expected to more than double by 2030. In addition, only 3% of social work students specialize in gerontology, only 5% have taken a course on aging, and the state faces a shortfall of 30,000 certified nursing assistants who care for the frail elderly in convalescent homes, according to the California Strategic Plan on Aging Advisory Committee. John Pynoos, professor of gerontology at the University of Southern California’s Andrus Gerontology Center calls it a “crisis,” noting that California is already behind the curve.

The report levied the blame for much of the shortfall on misplaced financial incentives. For example, doctors specializing in geriatrics in 2005 had an average income of $163,000, compared to internists without specialty training earning $175,000. Other specialists, such as surgeons, radiologists, and dermatologists can earn more than twice as much. The report notes the fact that half of the workers providing direct care for the elderly by helping them dress, eat, and bathe are paid less than $9.56 per hour. "Many of these workers live in poverty themselves, without benefits or health insurance," said Susan Chapman, director of the Allied Health Workforce Program at UC San Francisco and a contributor to the report. "Turnover can be up to 90 percent a year. That impacts on the quality of care, when we can't rely on a consistent person to care for your mother-in-law or my mother."

The report said that in order to maintain existing ratios, the U.S. would need to increase its healthcare force by 35 percent, or 3.5 million. The report’s authors recommend that all health care providers as well as the millions of family members, friends and others who are taking care of the elderly be trained in geriatric medicine. The institute also called for “financial incentives to increase the number of geriatric specialists in all health professions”, contending that Medicare, Medicaid and other health plans should pay higher rates to boost recruitment and retain geriatric specialists and care aides.