Squaring to the Challenge: Who Will Be Tomorrow's Caregivers? (2016)

The caregiving workforce has been described as the critical link in the availability and quality of for our nation's elders (U.S. Senate Commission on Long-Term Care, 2013). We know that the demand for health and longterm- care services will expand inexorably as the population ages. What we do not know is who will ultimately care for the 10,000 people turning age 65 each day, and how can we ensure quality of life without a fundamental redesign of the way we deliver services?The challenge of identifying and developing the eldercare workforce of tomorrow is daunting in view of today's tangled system of care. No organized eldercare workforce exists currently. Instead, older adults are treated by a multitude of medical and social service professionals who are guided by mismatched incentives, payment mechanisms, and best practices, and who have little understanding of elders' and their families' unique needs and preferences-let alone formal training in geriatric or gerontological principles.The investments this workforce needs have been outlined on more than one occasion, most notably in a landmark report from the Institute of Medicine (IOM) (2008), Retooling for an Aging America: Building the Health Care Workforce. And yet, eight years later, very few of these recommendations have come to fruition. Why not? And what now?This article articulates the challenge to building a real and competent eldercare workforce, positing the reasons for our past failures, and imagining a better system where the unique needs of older adults are reflected in the capacity of the professionals and paraprofessionals who serve them-much as the system of pediatric specialty has responded to the unique needs of children and their families.Who Are America's Elders and What Do They Need?In 2010, 13 percent of the U.S. population was older than age 65; by 2050, this will be true of one in five people. Meanwhile, our healthcare system spends nearly twice as much per person on adults older than age 65 than it does on people ages 45 to 64-the impact of which will intensify with this changing population demographic (Kaiser Family Foundation, 2012). The biggest questions are: On what are we spending these dollars? Are they really going toward improving the quality of services people receive and the quality of life they experience? Unfortunately for most people, the answer to the latter question is no.There are 46 million adults older than age 65 living in the United States today (Baxter, 2015). Thanks to medical advances, lifestyle changes, and technology, life expectancy is greater than ever before in history (Centers for Disease Control and Prevention [CDC], 2014). Yet the gains in life expectancy and health have not been distributed equitably. The population of minority elders is significant and growing; by 2044, the United States will be a majority-minority nation (Colby and Ortman, 2014). And while the vast majority of older adults today are white non-Hispanic (79.3 percent), the proportion of older adults belonging to a minority ethnic group will double in the coming decades, encompassing nearly 40 percent of all elders by 2050 (Ortman, Velkoff, and Hogan, 2014). The number of elders of Hispanic origin will increase from 1.8 million in 2000 to more than 8 million in 2030; the older Asian cohort will increase from nearly 1 million to nearly 4 million over that same time period.Health and service access disparities on the riseSignificant health disparities exist between racial and ethnic groups in the United States and are exacerbated as people age. People of color are more likely to suffer from chronic illness such as diabetes, COPD, and heart disease (CDC, 2013). Only 25 percent of whites older than age 65 report functional limitations compared to 35 percent of minority elders (Congressional Budget Office [CBO], 2013). This is particularly true for older black and Hispanic people (U.S. Senate Commission on Long-Term Care, 2013). …