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From April 2002 NASW NEWS The shortage of geriatric specialists is severe and is expected to worsen. By Katy O'Grady, Special to NASW NEWS NASW in February submitted written testimony to the U.S. Senate Special Committee on Aging that described the role of professional social work in caring for older Americans and outlined the actions NASW recommends for addressing the shortage of geriatric health care professionals. By 2030, the percentage of the United States population over the age of 65 is expected to nearly double, equaling roughly 70 million people. To accommodate this increase, the number of health care professionals trained to serve the specific needs of older patients must also grow significantly. The shortage of geriatric specialists in every branch of health care is severe and is expected to worsen. These issues led the Senate Special Committee on Aging to hold a hearing, "Patients in Peril: Critical Shortages in Geriatric Care," on Feb. 27. In his opening remarks, Committee Chair John Breaux (D-La.) included social workers as members of the multidisciplinary teams of health care professionals essential to the provision of good geriatric care. He emphasized the need for specific geriatric training of health care providers to help Americans "live not only longer lives, but better lives." In NASW's testimony, Executive Director Elizabeth J. Clark concurred that the need for trained geriatric specialists is increasing sharply and illustrated the integral role of professional social workers in the health care of elderly people. However, few social workers limit their practice to older clients, she wrote, and there is no uniform definition of the training necessary to be considered a specialist in geriatrics. Clark went on to identify the many obstacles facing social workers who do focus their practice on older Americans. The first is education. "Finding postgraduate training in geriatrics is a challenge—especially training that is comprehensive, useful and affordable," she stated. Medicare reimbursement presents the second obstacle. The 50 percent co-pay Medicare requires for mental health services, coupled with the complexity and inconsistency of the reimbursement process, discourages social workers from entering the geriatric field. Decreased public funding for community agencies, Clark said, creates two obstacles: smaller staff numbers, with the accompanying increase in caseload and stress for remaining staff, and reduced hiring of master's-level social workers who are more qualified to handle complicated cases and larger caseloads. Both situations can lead to potential compromises in quality of service to clients. Finally, said Clark, social workers are discouraged from working in geriatrics because of public misperceptions that working with older Americans is depressing, unrewarding and synonymous with working with sick and dying people. She proposed several strategies to begin to remove these obstacles: "Potential federal action may include the provision of funding for data collection and analysis, improvement of the societal value and respect accorded nonphysical health care providers, provision of funding for the development of geriatric curricula, and provision of adequate reimbursement rates for Medicare and Medicaid." To attract and retain social workers in geriatrics, she also recommended loan forgiveness, student and faculty stipends, and financial support for field placements in geriatrics. Witnesses at the hearing included, among others, Daniel Perry, executive director of the Alliance for Aging Research, which leads a coalition of advocates that NASW participates in. Following the testimony, discussion between the senators and the witnesses covered several issues of particular relevance to social workers, notably problems with Medicare reimbursement and the importance of treatment by multidisciplinary teams that include social workers. Sen. Breaux issued a press release immediately after the hearing, declaring the current shortage of geriatric-trained health care professionals "a crisis" and urging immediate action to remedy the shortfalls. In response to the hearing, NASW Senior Government Relations Associate Francesca Fierro O'Reilly said, "Fair Medicare reimbursement is extremely important to social workers. It was notable that the senators at the hearing seemed to be very interested in the fact that serving geriatric patients takes much more of a health care professional's time than serving other patients, but that Medicare does not distinguish for length of visits in its reimbursement schedule. Providers are essentially penalized by Medicare for seeing time-consuming clients." She warned that "if Congress is not willing to make serious, substantive Medicare reforms soon, there will be few to no providers left to care for older people." NASW Senior Staff Associate for Aging Lisa Yagoda noted, "The testimony from all of the professional disciplines involved in the hearing highlighted the fact that delivering care for older people requires a multidisciplinary approach that includes the services of professional social workers. It was a wonderful recognition that social work continues to play a vital role in addressing the needs of older Americans." For full NASW testimony: www.socialworkers.org/nasw/announcements/clark_aging.htm Back to NASW NEWS Contents
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