Annals of Long Term Care

To help ease the growing shortage of geriatrics healthcare providers in long-term care and other settings, Sen. Barbara Boxer (D-CA) recently introduced legislation that would create a geriatrics loan forgiveness program. Her “Caring for An Aging America Act” would not only extend loan forgiveness programs to professionals who complete training in geriatrics or gerontology and go on to care for older adults, it would also expand training and advancement opportunities for LTC workers. In addition, the legislation would create a health and LTC workforce advisory panel that would track and advise Congress and the departments of health and labor on manpower issues in elder care. All told, the bill would allocate $130 million in federal funds for the initiatives over five years.

The American Geriatrics Society was among the many healthcare and senior advocacy groups to endorse the legislation. As The Washington Post noted in a story about Sen. Boxer’s proposal, AGS has advocated “aggressively” for such measures. With good reason.

Although the Alliance for Aging research estimates that 14,000 geriatricians are needed in the United States now, and 36,000 by 2030, there are just 7000 or so currently in practice. There are shortfalls of other healthcare workers as well. The shortage of nursing assistants, home health aides, and personal care aides in LTC, for example, is increasingly challenging.

There are many contributors to these recruitment and retention problems. Inadequate compensation is a leading disincentive. Low pay makes the field especially uninviting to new graduates with increasingly large educational debt. Sen. Boxer’s legislation would help address this by making physicians, physician assistants, advance practice nurses, psychologists, and social workers who complete specialty training in geriatrics or gerontology—and who agree to care for older adults fulltime for at least two years—eligible for loan forgiveness. The “Caring for An Aging America Act” would also expand the Nursing Education Loan Repayment Program to include registered nurses who complete specialty training and work with older adults in LTC. In addition, the bill would expand career opportunities for nursing and direct care workers—who often must contend with inadequate training and limited opportunities for career advancement—by offering specialty training in LTC through the existing Career Ladders Grants Program. Finally, the bill would create the Health and Long-Term Care Workforce Advisory Panel for an Aging America, which would examine and advise the Secretary of Health and Human Services, the Secretary of Labor, and Congress on workforce issues related to elder healthcare. The legislation is similar to, but broader in scope than the legislation bill that Rep. Rosa DeLauro (D- CT) and Ileana Ros-Lehtinen (R-FL) proposed last year calling for geriatrics loan forgiveness for physicians.

Loan forgiveness programs can make a difference. A trail-blazing loan forgiveness program for geriatricians that South Carolina introduced in 2005 had boosted the number of geriatricians in that state by about a third by late 2007. But we need to do more. Investigating creative solutions—like the Vermont program that pays relatives and friends to care for older adults who’d otherwise be institutionalized, or the possibility of training and helping support retired physicians who agree to make house calls to homebound seniors (see our April AGS Viewpoint)—could pay off. Addressing the compensation gap, however, is absolutely imperative.