Looming Funding Cuts to Geriatrics Health Professions Training Programs Threaten Eldercare

Elizabeth Foy White-Chu, MD, is a geriatrician and wound care specialist at Hebrew Senior Life, a multisite affiliate of Harvard Medical School that provides older adults in the Boston area with comprehensive care, including acute care, rehabilitation services, and long-term care. Dr. White-Chu works as a primary care physician at one of the Senior Life’s sites, and travels from site to site to care for patients with chronic wounds. Although she is busy, for the last year and a half she has been able to take on yet another important role in providing quality healthcare to older adults—that of teacher. Thanks to the federal Geriatric Academic Career Award (GACA) she won in 2010, Dr. White-Chu has been able to make time to teach trainees at Hebrew Senior Life, students at Boston-based allied health schools, and staff affiliated with local visiting nurse associations how to better prevent and treat wounds in older patients.

“The GACA protects some of my time so I can teach,” explains Dr. White-Chu, who emphasizes the importance of an interdisciplinary approach to care in her teaching, which is an approach central to geriatrics. “Because wound care is so complex, this care can’t rest on one individual; we have to involve all of the members of the team, including staff at nursing homes and long-term care units. The GACA has allowed me to develop an innovative, interdisciplinary curriculum for physicians, nurses, nursing assistants, social workers, rehabilitation therapists, and dieticians. I’m teaching everyone—200 at any given time.”

The GACAs, which are one of several important programs that comprise the federal Title VII Geriatrics Health Professions Programs, are 5-year awards. Even so, Dr. White-Chu is concerned about funding next year, as President Obama’s recently proposed budget for fiscal year 2013 calls for a 1% cut in funding for all Title VII geriatrics programs. This cut would come in the wake of the 7% cut in funding that the programs sustained this fiscal year. The Title VII programs, which are designed to increase the number of academics in various disciplines with geriatrics expertise and to provide healthcare professionals with training that improves the quality of elder healthcare, are not the only key geriatrics initiatives that face cuts. The president’s budget also calls for a 1% cut in funding for Title VIII Geriatrics Nursing Workforce Development Programs.

All of these cuts are being made at a time when the population of older adults in the United States is growing dramatically. In response, American Geriatrics Society (AGS) Chief Operating Officer and Eldercare Workforce Alliance (EWA) Co-convener Nancy Lundebjerg met with law-makers in Washington mid-March to highlight the importance of Titles VII and VIII geriatrics health professions funding. Ms. Lundebjerg and EWA Policy Advisor Gail MacInnes met with staff in nine Congressional offices, from both sides of the aisle, explaining the need to support and expand the number of faculty and educators who provide geriatrics training.

“Title VII Geriatrics Health Professions Programs are the only federal programs that seek to increase the number of faculty with geriatrics expertise who can then train members of the multidisciplinary team,” Ms. Lundebjerg explained. “These programs are the surest way for us to build a healthcare workforce that is competent to care for older adults, thus improving access to quality care for older adults.”

Both the AGS and the EWA have sent letters to key members of the appropriations committees calling for more—not less—funding for Titles VII and VIII geriatrics training programs. Instead of a cut in funding, the AGS and EWA are requesting the following:

•  A total of $37.6 million for Title VII Geriatrics Health Professions Programs, which is an increase from the current $30.9 million. This total would include $5.5 million for the GACA program, which received $5.47 million this fiscal year. In addition to the GACAs, Title VII programs include the nation’s Geriatric Education Centers, which provide quality interdisciplinary geriatric education and training for geriatrics specialists and nonspecialists and oversee the Geriatric Training Program for Physicians, Dentists, and Behavioral and Mental Health Professions. The total also includes funds to implement the new Geriatric Career Incentive Awards Program, which was authorized under healthcare
reform.

• A total of $5 million for Title VIII Geriatrics Nursing Workforce Development Programs, an increase from $4.48 million this fiscal year. Title VIII programs are the primary source of federal funding for initiatives that provide nursing students, direct care workers, allied health professionals, vocational nurses, registered nurses, and advanced practice nurses with training that enhances the care they provide to older patients. 

In its letter to Congress, the AGS recognizes the fiscal constraints lawmakers face, but notes that the eldercare workforce is too small and unprepared to meet the needs of the rapidly growing aging population, a concern also outlined by the Institute of Medicine in a seminal report in 2008. The AGS’ letter outlines the cost-effectiveness of the Titles VII and VIII programs.  For example, the letter notes that over the course of the 2010-2011 academic year, the GACA program funded 68 full-time awardees, who collectively provided interdisciplinary training to more than 45,000 healthcare professionals and clinical staff in geriatrics who administered services to more than 57,000 underserved, uninsured older adults in a wide range of settings. It also notes that the Title VIII Comprehensive Geriatric Education Program’s 27 grantees provided education and training to more than 3600 registered nurses, more than 1200 registered nursing students, nearly 900 direct care workers, more than 550 licensed practical and vocational nurses, more than 250 faculty members, and more than 300 allied health professionals. These are impressive returns on investment.

The AGS plans to launch the first of several public policy advocacy campaigns on behalf of adequate funding for Titles VII and VIII geriatrics programs in the coming months. We urge you to join these campaigns. If you have not already registered with the society’s online Health in Aging Advocacy Center, which is accessible at https://capwiz.com/geriatrics/home, please register today to help ensure that these essential programs get the support they need now and in the future.

“If I could talk to members of Congress, I’d remind them of the aging demographic in America, and that we need more geriatricians and other staff trained in geriatrics,” said Dr. White-Chu. “It’s clear that we need to be investing more, not less, in this training.” U