To advise policymakers and health leaders on the key healthcare challenges facing the next presidential administration, the National Academy of Medicine (NAM) launched the Vital Directions for Health and Health Care initiative. Columbia aging experts Dr. John Rowe, the Julius B. Richmond Professor of Health Policy and Aging at Columbia University’s Mailman School of Public Health and Mailman School of Public Health Dean Linda P. Fried and colleagues were asked to provide guidance to inform U.S. policy on better health for an aging population and recommend priority opportunities. A summary paper titled, “Viewpoint: Preparing for Better Health and Health Care for an Aging Population,” is published online in The Journal of the American Medical Association (JAMA).
[Photo: Dr. John Rowe]
Dr. Rowe highlights four vital directions central to the health and wellbeing of older persons:
“One of the most important challenges we face is the likely inadequacy of the elder care workforce—in terms of numbers and competency,” said Rowe, who also leads the MacArthur Foundation’s Network on an Aging Society. “Not only is there a shortage of board-certified geriatricians, but there are similar deficiencies in other components of the eldercare workforce, including nurses, social workers, and other healthcare and public health providers. Perhaps even more significant is the lack of sufficient training and demonstrated competence among all healthcare and public health providers who care for older people.”
Most paid care to older adults is delivered by nursing assistants and home healthcare aides, whose demand is projected to increase by nearly 50 percent between 2010 and 2020. “The pressures on recruitment are aggravated by retention issues as annual turnover rates often exceed 50 percent,” noted Rowe. Leading the list of actions driving the shortage are low wages, inadequate training and supervision, and the perception that these are “dead-end jobs.” He points out that in 2014 median hourly wages of certified nursing assistants were just slightly more than $12. For home healthcare aides, median wages were approximately $10.
Dr. Rowe also stresses that social factors are widely acknowledged to be major determinants of wellbeing yet inadequate attention has been paid to the importance of social engagement through participation in the labor force or volunteer activities. Existing programs such as the Retired and Senior Volunteer (RSVP) program and Experience Corps, co-founded by Dean Fried, have shown marked benefits but require private support and expansion.