Commentary on the Geriatric Healthcare Workforce: Leveraging the Potential of Interprofessional Teams

Flaherty and Bartels, 1 published in this issue, have examined the current state of the healthcare workforce and have shown that the primary care workforce needs to be better prepared to care for older adults. They propose several approaches to address this concern. They include increasing geriatrics training across the health professions educational continuum, implementing evidence-based models of collaborative, team-based care, and expanding the role of nurses and caregivers in the delivery of care to older adults. Despite the fact that, 10 years ago, the Institute of Medicine outlined the necessary steps to ensure adequate geriatrics preparation of the healthcare workforce, the health sector continues to experience shortages of all types of healthcare workers. The education and training for healthcare professionals, the direct care workforce, and lay and family caregivers in geriatrics is often limited in scope. It needs to be expanded to account for the diversity of the healthcare workforce and the need to align with both teamand value-based care. More must be done to ensure that all who care for older adults have competence in geriatrics principles appropriate to their scope of practice, professional discipline, occupation, and/or role in the delivery of healthcare. The recruitment and retention of providers with an interest in interprofessional geriatrics care are hampered by several factors, including the stigma of aging, age discrimination, stereotypes of older populations, the aging of the workforce itself, and financial disincentives. In summary, the professional, paraprofessional, and formal and informal caregiver geriatrics workforce continues to have insufficient education in geriatrics. Flaherty and Bartels make a compelling argument for expanding the role of caregivers. In the current healthcare climate, caregivers have been increasingly meeting patient care needs at home. They often provide complex healthcare services formerly delivered only by licensed healthcare personnel in a hospital or other institutional setting. Of caregivers for persons living with dementia, 51% are providing medical/nursing tasks without prior preparation. In addition, caregivers provide a range of services, from assistance with daily activities and providing direct care to navigating complex healthcare and social services systems. Caregivers are integral members of the interprofessional team and require training to fully function in this role. Registered nurses are uniquely positioned to help caregivers navigate the healthcare system, and support and educate caregivers in their expanded roles. Flaherty and Bartels also make a compelling argument for expanding the role of nurses. The escalating problem of multiple chronic conditions in older adults is another public health challenge that registered nurses are embracing. One in four Americans has multiple chronic conditions that require ongoing medical attention or limit activities of daily living, and that number increases to three in four Americans aged 65 years and older. Expanded roles for registered nurses include working as healthcare coaches to promote health and wellness in patients and caregivers. They play a central role in the management of chronic diseases, including educating patients and caregivers on self-care management. By coordinating care for patients with complex multiple chronic conditions, facilitating care transitions, and leading and participating on interprofessional teams, nurses are taking on greater responsibilities in the delivery of complex care to high-need patients. Nurse practitioners can lead efforts in primary care to address quality improvement and provide value-based care. They are opening nurse-led primary care clinics and providing care independently in a growing number of states and new settings. With an increasing aging population and the opportunity for registered nurses and nurse practitioners to taken on expanded roles, a critical need exists for education and training in geriatrics for these providers to provide high-quality, value-based care to older adults. The federal government supports several programs to educate and train the healthcare workforce. The following is a brief description of some of the geriatrics trainings programs that are currently being provided to health professions students, faculty, practitioners, direct care workers, caregivers, and patients. The Health Resources and Services Administration’s (HRSA’s) Geriatrics Workforce Enhancement Program (GWEP) is an interprofessional education and From the Division of Medicine and Dentistry, Bureau of Health Workforce, Health Resources and Services Administration, Rockville, Maryland.