Population Aging
As population demographics shift, policy changes are needed to support this shift. Change is particularly needed in the areas of retirement, education for health professionals, and staffing and reimbursement patterns in health care. Mandatory retirement policies specify the age at which a person must leave a position. These policies originated in the early 20th century with the introduction of pensions after the Civil War and were solidified when Social Security began in 1940. Since they provided a guaranteed stream of income and relieved employers of the duty of evaluating aging workers for ongoing fitness to perform the job, they were widely embraced. In 1986 Congress struck down these laws in a bundle of civil rights acts.
However, today almost 80% of men and an even higher proportion of women are out of the workforce by age 65. As pension funds whither and unemployment rates are high, it becomes increasingly more important to examine how older Americans can continue employment. Without careful planning, older adults will outlive their financial resources and become a societal burden, thereby risking a rise in ageist beliefs. Thoughtful innovation, such as a retirement corps modeled after other government programs (AmeriCorps, VISTA), would be an ideal way for older adults to continue to remain vital and earn income.
Since older adults are the most frequent users of all health services, a mandated increase in didactic and clinical geriatric exposure for all health profession programs is needed. The National Council of State Boards of Nursing must be instrumental in driving this change in nursing. Similar changes need to occur in medicine, dentistry, and allied health programs.
Complex, multimorbid patients require more time for care and service coordination. Yet reimbursement for seeing Medicare patients has been declining, and there have been many attempts to decrease reimbursement further, an approach that is likely to deter providers from entering into care of older adults and will strain the pool of existing providers. Clear recognition of the complexity of older adult care via improved reimbursement is desirable. Improved reimbursement must then be translated into staffing patterns. Regulations pertaining to staffing of hospitals, skilled nursing facilities (SNFs), and rehabilitation centers deserve thorough review.
Hospitalized patients have high acuity that requires increased nursing time. As length of stay has decreased, these patients with ongoing, complex needs are discharged to SNFs, home health agencies, and community care. Staffing patterns and time allotted for scheduled visits, however, have not changed to reflect this higher acuity. Regulatory changes in staffing and reimbursement are needed to improve care of older adults.
Implications for Policy
As population demographics shift, policy changes are needed to support this shift. Change is particularly needed in the areas of retirement, education for health professionals, and staffing and reimbursement patterns in health care. Mandatory retirement policies specify the age at which a person must leave a position. These policies originated in the early 20th century with the introduction of pensions after the Civil War and were solidified when Social Security began in 1940. Since they provided a guaranteed stream of income and relieved employers of the duty of evaluating aging workers for ongoing fitness to perform the job, they were widely embraced. In 1986 Congress struck down these laws in a bundle of civil rights acts.
However, today almost 80% of men and an even higher proportion of women are out of the workforce by age 65. As pension funds whither and unemployment rates are high, it becomes increasingly more important to examine how older Americans can continue employment. Without careful planning, older adults will outlive their financial resources and become a societal burden, thereby risking a rise in ageist beliefs. Thoughtful innovation, such as a retirement corps modeled after other government programs (AmeriCorps, VISTA), would be an ideal way for older adults to continue to remain vital and earn income.
Since older adults are the most frequent users of all health services, a mandated increase in didactic and clinical geriatric exposure for all health profession programs is needed. The National Council of State Boards of Nursing must be instrumental in driving this change in nursing. Similar changes need to occur in medicine, dentistry, and allied health programs.
Complex, multimorbid patients require more time for care and service coordination. Yet reimbursement for seeing Medicare patients has been declining, and there have been many attempts to decrease reimbursement further, an approach that is likely to deter providers from entering into care of older adults and will strain the pool of existing providers. Clear recognition of the complexity of older adult care via improved reimbursement is desirable. Improved reimbursement must then be translated into staffing patterns. Regulations pertaining to staffing of hospitals, skilled nursing facilities (SNFs), and rehabilitation centers deserve thorough review.
Hospitalized patients have high acuity that requires increased nursing time. As length of stay has decreased, these patients with ongoing, complex needs are discharged to SNFs, home health agencies, and community care. Staffing patterns and time allotted for scheduled visits, however, have not changed to reflect this higher acuity. Regulatory changes in staffing and reimbursement are needed to improve care of older adults.
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