“Look Away, Look Away”: Training a Geriatric Workforce

With California on the precipice of an older adult population explosion – part of the greatest demographic shift in the history of planet Earth — there must be a comprehensive state plan to train workers to support all of these aging people. Right?

Wrong.

There’s a huge demand for a prepared workforce and there’s no traction from any of the systems in any of the national or local models,” says Janet Frank, a national expert on workforce development and past president of the California Council on Gerontology and Geriatrics.

People are afraid of (aging),” agrees June Simmons, who heads the San Fernando-based Partners in Care Foundation. “There is such a thing as ageism.”

The state is awash in indifference and uncertainty about training an elder workforce. As a result, the approaching “silver tsunami” could wreak havoc on a state that is lacking a comprehensive training plan and suffers from a lack of vision, disincentives for critical jobs like geriatricians, and pervasive ageism.

While the state’s overall population will grow 10% by 2024, the older adult population will jump a whopping 50% according to a 2014 report from the Public Policy Institute of California, or PPIC. By 2030, nearly one in five Californians will be over 65 — 8.4 million older adults.

California faces a severe shortage of geriatric-trained professionals and paraprofessionals,” says last year’s critical aging report, A Shattered System: Reforming Long-Term Care in California. “In 2011, the state had only 739 geriatricians – or one for every 5,968 older adults. In addition, less than one percent of all Registered Nurses are certified in gerontology.”

California will need a vast new cadre of trained workers to care for its rapidly aging population. Besides the most important — geriatricians, caregivers, nurses, dementia specialists, and geriatric mental health experts — a wide swath of other workers will be needed to address the specific needs of older adults.

Yet even one of the nation’s staunchest aging allies is shifting its focus.

The Hartford Foundation has spent half a billion dollars for geriatric training and education over the past three decades, since it first began funding dozens of Geriatric Centers of Excellence nationwide, including three now in California: UCLA, UC San Francisco and UC San Diego (the last focusing on geriatric psychiatry).

The centers have faithfully trained physicians, faculty and fellows — a big picture approach to aging — but the inititiave’s funding will end in 2019 after Hartford trustees decided to focus instead on more practical applications in local clinical settings.

We were building up the supply and thought people, including government, would wake up by now to understand the need for (workforce education),” says Hartford’s Nora OBrien-Suric. “It’s not happening and I don’t know why.”

Dr. David Reuben, who co-directs the UCLA / Hartford Center of Excellence, says not only is the center losing its Hartford funding, but also support from Atlantic Philanthropies (this year) and The Reynolds Foundation (in 2017).

Geriatrics academic health centers have taken a big hit with the loss of Reynolds and Atlantic philanthropies funding and the changes in focus of Hartford,” says Reuben. “These are all occurring within a couple year time frame, making the blow particularly hard.”

Other funding has arrived, but in a vastly different form.

UCLA is one of four California universities to receive federal dollars for workforce education under the Geriatric Workforce Enhancement Project, or GWEP.

Yet these grants have a much smaller, more targeted scope within local communities. To some, they seem like a drop in the bucket.

So where will these workers trained in older adult skills come from?

Some point to the unique ability of community colleges to cheaply train workers like caregivers in lower-skilled positions.

California’s community college system is poised to play a major role in training the nearly 200,000 workers needed by 2020 to fill occupations in the health care sector likely to require some college education below a bachelor’s degree,” according to the PPIC.

Yet even there, the system lacks a comprehensive plan for training workers for the state’s rapidly aging populous.

Linda Zorn, who directs the health workforce initiative for the state’s 113 community colleges and 2.1 million students, says there is no overarching plan to guide local colleges through this growth spurt.

It doesn’t quite work that way in the community college system,” says Zorn. “Each college is individually controlled.”

Zorn says her office helps the local colleges respond to the needs of the local job market but doesn’t discuss major demographics shifts to prepare them for long-term trends.

While American River College has a long-established geriatric specialty program, Santa Barbara City College recently developed its own program for dementia caregivers, and The College of the Canyons has a three-year grant to train nursing faculty in geriatrics, does Zorn know of similar aging programs within the community college system?

I would have to go to each college’s website to know what each college is offering,” she says.

Education technology and workforce preparedness are not in sync,” says Frank, noting that community colleges are typically reimbursed according to enrollment. Smaller classes aimed at future growth trends or “the social good” are often not highly prized.

There are a lot of disincentives in our educational system,” says Frank.

By 2020, the United States will need more caregivers than either teachers or law enforcement professionals.

At the same time, caregivers are disenfranchised by poverty wages normally hovering around $10. Turnover rate exceeds 50%. A national Fight for $15 movement hopes to raise the minimum wage to $15.

A lot of people don’t like that they aren’t high-paying jobs, livable wages,” says Cheryl Brown, who heads the state Assembly Committee on Aging and Long-Term Care.

What is the state doing to support a trained elder workforce?

Hopefully, we can write some legislation that will make it,” laments Brown. “They say my ideas cost too much.”

Still, all is not lost.

California has in the past successfully addressed similar problems.

A decade ago, the Nurse Education Initiative was launched to counter a severe shortage of California nurses. Between 2005 — when the state launched the initiative — and 2009 the number of nursing students jumped 75% as 35 new nursing programs were established.

It is clear that strong state action, including financial investment, can help improve health workforce supply over a relatively short period of time,” reports PPIC.

A similar success occurred between 2010 and 2013 with the Personal and Home Care Aid State Training Program. Jump-started by the Affordable Care Act, California was one of six states to receive federal funding to train home caregivers.

Yet for every isolated success – the L.A. Net Community Health Resource Network is training physicians in geriatric medicine – California has experienced a sustained legacy of failure, apathy and short-sightedness.

We’ve had a marketing crisis in attracting people into this field,” admits Frank.

And so the crisis is real.

And in the words of singer Aimee Mann “It’s not going to stop, until you wise up.”

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