Annals of Long Term Care

These days, the biggest issue facing those of us who care for older adults is healthcare reform—and especially what’s in store for Medicare.

From a clinician’s point of view, it’s essential that reforms ensure that the growing number of older adults have access to high-quality, cost-effective care. To do so, reform provisions must do several things. They must address worsening nationwide shortages of geriatricians and other geriatrics healthcare providers. Given the growing numbers of older patients, reforms must expand training for geriatrics professionals and vigorously recruit and better prepare primary care physicians, as well as other professionals such as nurse practitioners and physicians assistants, to coordinate necessary care. Reforms should help better equip family caregivers to meet their loved ones’ unique care needs as well. It is also critical that there be appropriate Medicare reimbursement for essential elder healthcare—including services such as care coordination—in order to achieve quality care goals. In addition, reforms must adequately fund eldercare research and support the adoption of promising new models of care.

As of mid-October, the House reform bill and the two Senate reform proposals before Congress do include provisions that would help us make significant progress toward these goals. The American Geriatrics Society (AGS) has long advocated, and continues to advocate, for these provisions, both independently and in coalition with like-minded organizations. These reforms would both enhance Medicare coverage and make it more cost-effective, and, as a result, more sustainable.

This isn’t to say that current reform proposals do everything that needs to be done. While current proposals make some headway in addressing reimbursement problems, for example, they don’t solve them adequately. Given the breadth and complexity of healthcare reform, however, this and other unresolved issues will have to be taken up after lawmakers pass an initial omnibus reform bill.

The three reform plans now before Congress aren’t identical, and it’s still unclear which provisions will ultimately make it into final legislation. Here’s an overview of key reform proposals included in at least one plan:

Proposals designed to help recruit and train geriatrics healthcare professionals and primary care providers to meet the unique care needs of older adults, and better prepare direct-care workers and family caregivers to do the same, would:

• Provide grants to Geriatric Education Centers (GECs) to offer courses in geriatric care, chronic care management and long-term care, and to provide family caregiver training.

• Expand eligibility for Geriatric Academic Career Awards (GACAs) to a wide range of healthcare professionals.

• Fund Geriatric Career Incentive Awards to foster greater interest in eldercare among health professionals.

• Increase the number of Graduate Medical Education (GME) training positions in primary care.

• Establish federal traineeships for nurses pursuing advanced training in geriatrics.

• Fund training opportunities for direct-care workers.

• Establish either a Workforce Advisory Committee to develop a national healthcare workforce plan addressing the need for eldercare providers, or a national center charged with ensuring an adequate healthcare workforce.

• Establish loan forgiveness programs for physicians, physician assistants, pharmacists, advance practice nurses, psychologists, and social workers who complete training in geriatrics or gerontology.

• Create a graduate nurse education demonstration program to train advanced practice nurses to provide primary, preventive, and transitional care, and chronic care management for the elderly.

• Support the development of curricula and best practices in geriatrics.