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As Baby Boomers Grow Older, the U.S. Healthcare System Will Face an Increasing Number of Critical Shortages

Apr 1, 2008


As “Baby Boomers” Grow Older, the U.S. Healthcare System Will Face an Increasing Number of Critical Shortages  

“Baby Boomers” have always created enormous social and economic changes in America. Numbering some 70 million, the post World War II generation has been referred to as the “age wage” since, whatever it needs at a particular time, it needs in magnitudes never experienced before or after.

In the late 1940s the diaper (real diapers, that is, not disposable ones) and baby food industries boomed. An enormous surge in school construction took place in the early and mid 1950s. The children’s clothing and toy industries grew substantially from 1945 through 1960. Boomers even created the demand for such fads as the “hoola hoop” and were responsible for the early and continued success of fast food and soft ice cream chains. The first great amusement parks like Disneyland (1955) and Freedomland (1960) (now the site of Co-op City in the Bronx, NY) were built and drive-in movies were at their peak.

As Boomers aged, the housing market expanded dramatically and the “suburbs” were born as parents needed more affordable space for their families. In the 1960s, Boomers became a potent political voice as they mounted massive anti-war protests during the Vietnam conflict. Colleges grew in size and number throughout the 1960s and 1970s as did all businesses associated with athletic equipment of any type. Sneakers and blue jeans (historically referred to as “dungarees”) became mega-industries.

When Boomers took to the highways, the automobile industry exploded as did the demand for gasoline and all types of leisure-related products. Quiet little vacation getaways like Cape Cod, for example, were turned into overpopulated and overpriced tourist traps.

Each phase of the “age wave” has produced major increases in employment in all areas of the economy; however, those increases, while long-term in many cases, are usually not permanent since, as the Boomers age, their needs and tastes change.

As Boomers reach their “golden years,” the spike in activity in certain (different) industries has been no less profound. This is a generation that is not going into old age quietly. Thus, any industry that gives even the slightest hope of looking or feeling younger is a potential growth-industry. These include: cosmetics (anti-aging creams, etc.); hair transplants; cosmetic surgery; Botox and related treatments for wrinkles; fitness equipment and exercise programs; diet drugs and weight-loss plans; painkillers, drugs for erectile dysfunction (Viva Viagra! and all of that). The construction of “retirement villages” and senior residences is at an all-time high. Hip and knee replacements are being done in record numbers as are cardiac pacemakers.  

Unfortunately, however, looking younger and feeling better do not stop the aging process itself and Boomers, like it or not, are now being referred to not as the “age wave” but, rather, as the “silver tsunami;” which threatens to swamp the healthcare system in a number of ways it never imagined.

Recently, MedPage Today published an article by Executive Editor Peggy Peck and reviewed by Robert Jasmer, Associate Clinical Professor of Medicine, University of California, San Francisco, which analyzed the impending crisis.

“The healthcare system and society at large are about to be inundated by what the American Geriatrics Society calls the silver tsunami -- a wave of Americans living into their eighth and ninth decades with few willing or able to care for them.”

Since 1978, the coming crisis in geriatric medicine has been reported on by the Institute of Medicine (IOM), which has projected critical shortages “in qualified physicians, nurses, nurse's aides, social workers, and even family members prepared to share the load.” In April of this year, the IOM issued a report titled "Retooling for an Aging America: Building the Health Care Workforce."
While this rapidly-approaching crisis has been talked about for years and is a coming reality few experts dispute, “little or nothing has been done for a generation to shore up what appears to be a steadily eroding healthcare edifice from a flood of aged patients.”

In 1982 the first independent department of geriatrics was created at the Mount Sinai School of Medicine in New York and six years later geriatrics was established as a recognized medical specialty. The goal of geriatric fellowship programs was to have more than 10,000 physicians certified in geriatrics by 2002.

Today, however, estimates of the number of certified geriatricians range from 5,800 to 7,100 “with much of the decline reflecting geriatricians who have neglected to complete the mandatory re-certification process required every six years.” While no clear explanation for the decline in re-certifications is evident, some experts believe the most likely reason was the lack of necessity, since there is little to be gained by doing so once a doctor receives his original certification.

Geriatricians also earn an average of $163,000 a year, or about half of what the average dermatologist earns. Thus, there have been a number of proposals suggested to encourage doctors to enter the field including paying bonuses to geriatricians who recertify and for medical education loan forgiveness.
While lower pay is a problem with professionals engaged in geriatric care in general, nurses and nurses’ aides experience even greater pay disparity than do geriatricians. For example, nurses’ aides working in a nursing home earns about $9.56 an hour or about what they could earn for far less stressful work at McDonald’s. They have a high incidence of injuries (especially back-related), few, if any, benefits and a turnover rate of over 70%.

Some 150 members of the American Geriatric Society (AGS) recently visited Capitol Hill where they met with 54 members of Congress to deliver the message that unless the "silver tsunami" is taken seriously, it promises to bring down the U.S. healthcare system. Unfortunately, Congress may not take the warning seriously since the AGS now sounds like “the boy who cried wolf” after sounding the alarm for 30 years.

It seems that the procrastinating may be coming to an end, however, since the full Senate Special Committee on Aging listened to important testimony. In addition, it’s not geriatricians alone who are pressing the issue. Joining them now are the John A. Hartford Foundation, Atlantic Philanthropies, Josiah Macy Jr. Foundation, Robert Wood Johnson Foundation, Retirement Research Foundation, California Endowment, Archstone Foundation, AARP, Fan Fox and Leslie R. Samuels Foundation, and Commonwealth Fund, all of which supported and funded the IOM report.

The IOM report contains this comprehensive list of things that should be done:

1.    “Medicare, Medicaid, and private insurers should offer higher compensation to healthcare providers caring for older adults and cover key services, such as care coordination, that are not now covered.

2.    Public and private payers should offer a "specific enhancement of reimbursement ‘for healthcare services to older adults provided by practitioners with a "certification of special expertise in geriatrics.’

3.    Congress shou¬ld authorize and fund additional training programs for all healthcare professionals to better prepare them to care for older adults.

4.    State and federal governments should offer loan forgiveness, scholarships and other financing incentives to professionals who specialize in geriatrics.

5.    Congress and foundations should ‘significantly increase’ support for research and demonstration programs that lead to development of new models of care in prevention, long-term and palliative care, and models of care that promote the effective uses of the workforce.

6.    Public and private payers should promote and reward new models of care for older adults that are shown to be effective and efficient.

7.    States and the federal government should increase minimum training standards for all direct care workers.

8.    Public private and community organizations should provide funding and ensure adequate training for family and other informal caregivers.

9.    Healthcare professionals and regulators should consider expanding the roles and responsibilities of healthcare providers to better meet the needs of an aging population.”

The IOM did not offer any plan or suggestions as to how these additional programs and benefits would be funded, although the report did make the observation that any additional monies spent now will result in savings later.
According to the MedPage article, the IOM report was intended “to analyze the problem and provide very clinical, evidence-based recommendations delivered not from the point-of-view of a single group of providers (physicians) but rather a big-picture approach that gave equal weight to issues of all groups of providers -- even family members who the IOM report said also need some training in the care of elderly relatives.”

A large-scale meeting of all interested groups is planned for June in Washington, DC. It is anticipated that the meeting will result in the selection of a leadership group will have the mandate of making the "silver tsunami" a key issue in this year's presidential election campaign. It is also expected that the AGS will stress the need for there to be a coalition of all geriatric caregivers, and not simply physicians, spearheading the drive to head off a healthcare catastrophe.

Parker Waichman LLP’s nursing home unit is devoted to protecting the rights of senior citizens living in nursing homes and senior residences and is highly knowledgeable in all aspects of eldercare and the federal and state laws applicable thereto. We have successfully represented many nursing home residents and their families with respect to a wide range of issues affecting the care and treatment provided in these facilities. If you or a loved one has been abused or received sub-standard care or treatment at a nursing home or other senior residence, do not hesitate to contact us at for a free consultation with one of our highly trained nursing home unit members.     

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