Eldercare Professionals Require More Training, Better Pay

Researchers from a recent opinion article published in JAMA believe certified nursing assistants (CNAs) caring for seniors should be required to have 120 hours of training, and their compensation should reflect the skills and knowledge required to perform high-quality work (doi:10.1001/jama.2016.12335).

John W Rowe, MD, Columbia University, New York, NY, and colleagues looked at challenges to senior care and found that care worker compensation was a crucial factor in workforce shortages. The combination of low wages, inadequate training and supervision, and perceptions that the positions are “dead-end” jobs resulted in recruitment and retention issues, according to authors.

They also noted that compensation issues extend to social workers, nurses, geriatricians, and other health care works as well. “For instance, the income of geriatricians is well below that of general internists or family physicians, despite the additional training required to become certified in geriatrics,” authors wrote. “Nursing also has a shortage in geriatrics; less than 1% of registered nurses and less than 3% of advanced practice registered nurses are certified in geriatrics.”
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The article is one of several articles resulting from the efforts of 19 workgroups who met earlier this year as part of the National Academy of Medicine’s “Vital Directions” initiative, which seeks to develop a health policy agenda that may be able to gain bipartisan support.

In order to strengthen the eldercare workforce, Dr Rowe and colleagues make the following suggestions:

• health care professionals should be required to demonstrate competence in eldercare;
• Reimbursement for clinical services should be enhanced for those who have certified expertise in geriatrics;
• Graduate medical education payments should be extended to apply to training of public health physicians and nurses studying geriatric care and health promotion;
• And state and federal programs should be established for loan forgiveness, scholarships, and financial incentives for geriatric specialists.

Other areas that “require immediate attention and will yield significant benefits” include: coordination of care for older adults with multiple chronic conditions, social engagement for older adults, and advanced illness and end-of-life care.

According to the authors, “These realistic and affordable recommendations blend greater dissemination of existing proven strategies with development of targeted new approaches.” With the growing older adult population in the United States, they believe “the nation cannot afford to fail.”—Amanda Del Signore