To develop and guide the study, the Secretary of Health and Human Services appointed a Committee on Personnel for Health Needs of the Elderly. The Committee includes representation from 12 offices and agencies of the Department, plus members from the Department of Defense and the Veterans Administration and a consultant from the Bureau of Labor statistics. The co-chairs are the Directors of the National Institute on Aging, National Institutes of Health, and the Bureau of Health Professions, Health Resources and Services Administration.

Findings

Concerning the Population

1. The population 65 years of age and over will increase about 2 percent a year between now and 2020 (compared to an increase of less than 1 percent for younger persons). The oldest old (85-plus) segment of the population will experience the most rapid growth before 2000. The youngest old (65-74) segment will increase fastest between 2000 and 2020.

2. The older population will require expansion of a wide range of health services, including preventive, primary, long-term, hospice, and rehabilitation care.

3. Effective services can help many older persons to maintain functional independence and remain at home for longer periods.

Concerninq Personnel Needs

4. Expansion of knowledge and practices in geriatrics presents significant opportunities for improving the quality of care and the utilization of resources; further gains from research are likely. Both current and future personnel must be equipped with the knowledge and skills to apply these advances.

5. If recent rates of chronic disability and health care utilization are maintained, consumer demands for more and a greater variety of health services will more than double by 2020. However, in light of the many uncertainties concerning the future health status of older persons, advances in technologies, changes in health care delivery and financing, and other factors, long-range projections should be considered as general indicators rather than as specific estimates.

6. A wide range of well-educated health personnel, ranging from aides to medical specialists, will be required to respond to the diverse needs of older people. Under any conditions, requirements for personnel specifically prepared to serve older people will greatly exceed the current supply.

7. Health care practitioners will routinely serve older persons in the future as part of their regular practices. The care of older person may typically comprise one-third to two-thirds of the future workload of most physicians and other types of health personnel.

8. Anticipated growth in the supply of health care practitioners during the next several decades will provide substantial resources to strengthen primary care and other needed health services for older persons.

9. Family members and friends will continue to have key roles in providing support to older persons. They must be assisted to maintain these critical responsibilities. Such support can substantially reduce demands for formal health care.

Concerning Education and Training Needs

10. Although attention to aging and geriatrics has expanded in recent years, most health professions education programs give relatively little emphasis to these issues; elective, as opposed to required, courses predominate.

11. Shortages of faculty members and other leaders with adequate preparation in aging and geriatrics are a serious constraint on the development of further activities in undergraduate, graduate, continuing education, and in-service training programs. The current number of prepared teaching faculty and investigators ranges from only 5 to 25 percent (depending on the field) of the total number estimated to be needed for the development of such activities.

12. The capacities of education and training programs to better prepare personnel to provide services in homes, other community programs, and nursing homes must be greatly expanded to meet increased demands.

13. Collaborative arrangements among providers and academic institutions have proved to be the most effective use of scarce educational resources and the best way of furthering multidisciplinary approaches. These include the regionally distributed Area Health Education Centers and Geriatric Education Centers aided by the Health Resources and Services Administration, the Long-term Care Gerontology Centers assisted by the Administration on Aging, and the VA Geriatric Research, Education, and Clinical Centers.

Concerning Financing

14. Financing of geriatric education and training activities has come from multiple sources, including State and local public funds, private funds, and federal programs; nationwide data on the full extent of such funding are not available.

15. Medicare and other health care financing programs have supported education and training activities for current staffs and new personnel in aging and geriatrics in the same manner as for other health personnel. Special problems have been experienced in the development of these programs due to such factors as the increasing emphasis on preventive and ambulatory care, the multiple and complex conditions of many older patients, and the need to involve a wide variety of settings and disciplines in these education and training activities.

16. Various alternative approaches to the support of education and training by Medicare and other health care financing programs are possible. These might include greater emphases on in-service training and continuing education, targeting more current support to geriatric education, and allocating limited additional funds or specific grants for geriatric education and training specifically focused on improving the care of older persons.

Recommendations

1. Personnel needs to ensure adequacy and availability of healthcare for o1der persons shou1d be continuously monitored to analyze the impact of changes in the health status of older persons, gains in knowledge and technologies, modifications in healthcare delivery and financing arrangements, and other factors.

While it is clear that many more health personnel must be better prepared to serve the increasing number of older persons, the specific nature and scope of future requirements cannot be determined many years in advance. Illustrative projections cited in the report indicate a need for substantial increases in the number of health personnel specifically prepared in these areas. The dynamic nature of the U.S. society and health care system requires ongoing assessments of the direction and scope of future needs. Estimates of the numbers and types of personnel needed must also be adjusted in the light of new developments in knowledge and practices if they are to be realistic and useful.

2. In light of the documented needs for many more adequately trained personnel to provide responsive care to older persons, training needs should be addressed in the following ways:

a. Essentially all health and human services personnel should be educated specifically about the special conditions and needs of older persons and have up-to-date knowledge concerning the most effective means of preventing and managing diseases and disabilities experienced by older persons.

Almost all primary care physicians, other physicians, dentists, nurses, and other health and related personnel will be serving a substantial number of older persons in the future. If they are to be adequately prepared for these responsibilities, there must be greater emphasis on these issues in basic and advanced education programs.

b. Continuing education and in-service training activities for health and human services personnel of all types should give greater emphasis to advances in knowledge and practices concerning the most effective care of older persons.

Existing professionals and supporting personnel will be the majority of caregivers for many years. They must be prepared to apply effectively advances in knowledge and technologies that are resulting from important research gains. These efforts should involve the entire spectrum of caregivers--from family members, volunteers, and aides, to various medical specialists.

c. The number of faculty members and other leaders adequately prepared to plan and guide education and training programs in aging and geriatrics and to provide consultation should be greatly expanded as a first priority.

Faculty members who are well-prepared are essential for the planning and guidance of all types of education and training efforts as well as research. The current critical shortages in all health and related disciplines must be overcome if meaningful progress is to be achieved in strengthening capacities to provide high-quality care to older persons.

3. Education and service programs should give special attention to high-priority services and high-risk groups within the elderly population as well as to cultural and other important differences.

Examples of high-priority services are home and community-based care, services in nursing homes, health promotion and disease prevention, and rehabilitation. Examples of high-risk groups include lifelong handicapped and disabled persons, Alzheimer disease patients, and especially frail older individuals and their families. Further, all caregivers should be sensitive and responsive to the cultural, social, and other differences among older persons.

4. Financinq of qeriatric education and training activities should be derived from multiple sources and should be targeted to strengthen proven approaches for all types of health and human services personnel.

Various sources--including State and local public funds, private funds, and federal programs--must continue to provide critical support if the identified needs are to be met. The future roles of Medicare and other health care financing programs should be clarified as a result of current studies and debate concerning the responsibilities of these programs in funding the education of new health professionals. Potential approaches to the modification of such policies include a) increasing emphasis on or adding requirements with respect to in-service training and continuing education, b) targeting funds to devote resources to geriatric education, and c) allocating additional funds for educational efforts specifically focused on care of older persons.

5. Ongoing studies and analyses of the adequacy and availability of health services for older persons and related education and training activities should be undertaken.

This study found significant gaps in timely information in many areas. Cooperative efforts of private, professional, and public agencies should be aimed at developing and sharing complete and current information.