By 2034, the number of adults 65 and older is expected to grow 40%, yet today, the geriatric care field is already short-staffed.
The shortcomings of geriatric care were first brought to light in the 1970s and 1980s by Robert Butler, MD, who noticed gaps in his education when caring for older adults, the complex needs of this patient group and the lack of training physicians received. However, little progress has been made since then.
There are fewer than 7,300 physicians who are board-certified geriatricians. This means there is about 1 geriatrician for every 10,000 older adults in the U.S., and few residents are entering geriatric care. In 2023, fewer than 42% of geriatric medicine fellowship positions were filled.
"The vast majority of older people are getting care from people who have little to no training in the care of older adults," Louise Aronson, MD, professor of geriatric medicine at the University of California at San Francisco, told The Washington Post.
The supply and demand mismatch means a growing proportion of older adults will not have access to physicians who specialize in their care.
"When the older population is growing by about 10,000 a day, and the population of children is declining, you have this massive imbalance, which is not just a healthcare issue. It's a huge economic issue," Michael Dowling, president and CEO of New York City-based Northwell Health, told Becker's.
What's driving the gap
At the current rate, physicians trained in geriatric medicine are not keeping up with the needs of patients. This is driven by a few issues:
- Geriatrics is relatively new and became officially recognized in 1988.
- Many accredited medical schools do not teach geriatrics because it's not a requirement.
- Primary care shortages exacerbate the shortfall of geriatricians because many primary care physicians move into geriatrics later in their careers.
- Fellowship-trained geriatricians have more training than general internalists but earn about $20,000 less.
- Most older adults are on Medicare and reimbursements lag behind private insurers.
Nursing home care lags behind too
Nursing homes are also grappling with barriers to providing proper care to older adults.
The demand for direct care workers is expected to grow by 42%, or nearly 800,000 jobs, by 2032, but most nursing homes see their employees leave within a year. The average salary for direct care workers is $33,380 and nearly half of workers rely on public assistance.
Some fear the demand for nursing home care could grow worse after CMS updated its new minimum staffing standards. The new mandate, issued April 22, requires all nursing homes that receive Medicare and Medicaid to provide a total of at least 3.48 hours of nursing care per resident per day, including a defined number for registered nurses (0.55 hours per resident per day) and nurse aides (2.45 per resident per day). A KFF estimate found only 19% of nursing facilities met the new standards.
The nursing home industry also has to grapple with for-profit groups that tend to have worse patient outcomes. Another KFF report found 72% of nursing homes were owned by for-profit groups. These groups are often owned by private equity, real estate investment trusts or complicated ownership structures. To boost profiles, many for-profit operators set up networks of related companies to provide fee-based services to nursing homes they own, including management, physical therapy, staffing and renting real estate. As of 2022, the latest data, 1.3 million residents lived in a nursing home owned by a for-profit group.
Systems trying to change to norm of geriatric care
Many healthcare systems have recognized the growing need for geriatric care and have led the way to improving it in their service area.
Biddeford, Maine-based University of New England received nearly $5 million to educate and train Maine's healthcare workforce in geriatric care. The program will develop the direct care workforce, enhance rural education and create more dementia-inclusive communities. It is the only federally funded program dedicated to education and training healthcare professionals in geriatrics.
Northwell Health has adopted the Institute for Healthcare Improvement and The John A. Hartford Foundation's framework that rests on four M's: What Matters Most, Medication, Mentation and Mobility. The system uses the framework in all adult acute care settings, primary care ambulatory sites, and post-acute care locations. The effort requires staff training, evidence-based assessment tools and metrics, governance and partnerships with outside institutions.
Nationwide, more than 4,000 sites of care have been recognized as age-friendly organizations.