Help Me if You Can: A Review of Research on the Approaching Care Gap

There’s no question: the aging population is growing nationwide and in the state of California is no different. And this increase in older population will come with an increase in need for services and supports. According to the “Senate Office on Research: Demographics and Workforce” appendix in the Senate Select Committee on Aging and Long-Term Care’s report, A Shattered System: Reforming Long-Term Care in California, 70 percent of Californians aged 85 or older have at least one disability. For 47.8 percent of these older Californians, their disability impacts their ability to live independently.

Care Gap NV-SpringIn addition, the appendix reports that, even though “early diagnosis and effective management of chronic conditions can enable older adults to enjoy their later years as functional, active, independent members of their communities,” older, more vulnerable Californians “receive about 50-60 percent of recommended care,” and care is particularly underused among certain ethnic groups.

Gaps in Health Care

The rising numbers of older adults and their growing need for long-term care becomes particularly urgent when it is considered that the number of geriatricians and nurses—especially those with a specialization in geriatrics—will not keep pace.

According to the Shattered System appendix report, geriatricians are specially trained to recognize “the unique needs of older adults transferring to or living in home or skilled nursing.” Yet, while this specialized knowledge will be needed for the growing older population, A Shattered System reports that there were only 739 geriatricians in California as of 2011, or about one geriatrician for every 5,968 older adults.

A 2008 report by the Institute of Medicine of the National Academies, Retooling for an Aging America, shares that in the next 15 years, some estimate the number of geriatricians “will have increased by less than 10 percent” while “others predict a net loss of these physicians because of a decreased interest in geriatric fellowships and the decreasing number of physicians who choose to recertify in geriatrics.”

The number of nurses, especially those specializing in geriatrics, is also projected to decline. The Eldercare Workforce Alliance issue brief, “Geriatrics Workforce Shortage,” reports that “by 2020, the nursing workforce is expected to drop 20 percent below projected requirements.” What’s more, Retooling for an Aging America notes that only one percent of all registered nurses are certified in geriatrics. As the overall number of nurses decreases, so too will that small percentage who have specialized geriatric training.

A main component of this drop in the number of registered nurses is the shortage of faculty in college nursing departments. According to the American Association of Colleges of Nursing’s 2014 “Nursing Faculty Shortage Fact Sheet,” nursing programs had to turn away almost 80,000 qualified applicants in 2013, mostly due to the fact that there weren’t enough faculty members to teach classes. The fact sheet notes that the reasons for nursing faculty vacancies, including “budget constraints, an aging faculty, and increasing job competition from clinical sites,” are not easily resolved.

Gaps at Home

The care gap even extends to family caregivers. According to AARP’s The Aging of the Baby Boom and the Growing Care Cap: A Look at Future Declines in the Availability of Family Caregivers, there were more than seven potential family caregivers for every person 80 years and older. But, as authors Donald Redfoot, Lynn Feinberg, and Ari Houser note, “as the population in this age group increases during the next 20 years, the number of people in the primary caregiving years (ages 45-64) is projected to remain flat.” The report notes that the ratio will fall to four to one in twenty years, and decline even further to three to one by 2050.

This change in the ratio of family caregivers to older adults is developing, the report notes, because of the aging of the boomer generation. Between 1990 and 2010, boomers were “aging into the prime caregiving years, with the result that the caregiver ratio was high and increasing.”

But that will no longer be the case as boomers age. “The departure of the boomers from the peak caregiving years,” say authors Redfoot, Feinberg, and Houser, will mean that the prime family caregiving population “is projected to increase by only 1 percent between 2010 and 2030.” And, the report adds, as “the availability of potential family caregivers…to arrange, coordinate, and provide LTSS is expected to decline dramatically…overall care burdens will likely intensify” leading to potential caregiver burnout.

Think Outside the Health Care Box

But, despite this growing care gap, there is hope, especially when looking at who is actually providing long-term care. For instance, while the number of geriatricians and registered nurses may be dropping, A Shattered System’s appendix report finds that “in California, direct-care workers provide an estimated 70 to 80 percent of the paid hands-on care for older adults or those living with disabilities or other chronic conditions.” And unlike the geriatrician and nursing populations, the direct care workforce—including personal care aides and nursing assistants—is growing. By 2018, direct care workers are projected to be the second largest occupational group in the U.S., outnumbering teachers, law enforcement, and nurses.

Coupled with the rise in direct care workers, studies note that the provision of variety in LTC can help fill the care gaps. For instance, A Shattered System warns against “miss[ing] the opportunity presented by health reform to think creatively about how services are arranged and provided.” And according to Retooling for an Aging America, “there is no single approach or best model that could be broadly adopted for all older patients. Older adults have diverse health care needs and a variety of models are necessary to meet those needs.” As a care model founded on individualized care and with a variety of living environments and service options, Assisted Living is one such solution.

This post was excerpted from an article first published in CALA News & Views Spring 2015: Teams Work.



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