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As population ages, state faces health worker shortage

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California is facing a dire shortage of workers to care for its growing elderly population, state lawmakers said yesterday in a hearing to address the issue.

Elder care advocates, practitioners and educators spoke about the need to recruit, train and retain more geriatricians and other health care professionals.

The three-hour hearing was just the beginning of an ongoing conversation about caring for the state's aging population, said Assemblywoman Mariko Yamada, chair of the committee on aging and long-term care. Yamada, D-Davis, called the meeting with Assemblyman Sandre Swanson, D-Oakland, who chairs the committee on labor and employment.

"This is a serious challenge for us," Swanson said. "You can't export the industry of health care. It is something that has to remain in our state and in our country. We just would be smart if we do all we can to grow this industry."

More than 4.4 million Californians, or 11.3 percent of the state's population, are age 65 or older. By 2050, that number is expected to grow to more than 11.5 million – representing nearly one in five Californians, according to the state Department of Finance. 

But the state has far fewer caregivers for the elderly. California has only 534 certified geriatricians [PDF], according to the American Board of Internal Medicine. That translates to one geriatrician for every 8,262 seniors.

Nationwide, there are an estimated 3.6 geriatricians for every 10,000 seniors age 75 and older, according to the Geriatrics Workforce Policy Studies Center. At current training rates, the center projects that ratio will decline to 1.1 geriatricians for every 10,000 seniors [PDF] by 2050.

Still, geriatricians are only part of the elder care equation.

In 2008, California had 508,900 direct care workers [PDF] – certified nurse assistants, home health aides and personal care assistants – providing care to the elderly, according to the SCAN Foundation, a nonprofit senior advocacy group.

There are also millions of unpaid caregivers in the state. Eighty-five percent are family members, and most are women. The average age is 51, presenting another issue elder care: As more Californians age, so do their caretakers.

Aging also affects education: Nursing faculty on average are about 50 years old, Heather Young, dean and associate vice chancellor for nursing at the UC Davis Betty Irene Moore School of Nursing, said at the hearing.

"It's a national crisis," Young said. "It's the pipeline."

Many speakers at yesterday's hearing pointed to the need to recruit a younger elder care workforce. Some suggested incentives such as loan repayment programs, and others emphasized the need to support public education opportunities for elder care workers.

Simply growing the number of geriatricians – "an endangered species," Young said – will not be enough.

"It's impossible to convert people to become gerontological-focused," she said. "They have an identity as an oncologist or cardiologist. But the fact is they actually care for older people. It's not about converting – it's about gerontologizing, taking what they know and equipping them to serve the people they're serving better."



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RN4MERCY's picture
The Co-President of the California Nurses Association also provided testimony at the hearing, including the fact that there are over 362,000 actively licensed RNs in our state. Of those, over 116,000 became licensed since the enactment of minimum, safe nurse-to-patient ratio staffing standards. Studies have shown that the working conditions have improved as a result of these ratios validating reduced complications for patients, decreased RN turnover and burnout, and increased nurse and patient satisfaction. This is an important consideration, because testimony also included the fact that long term care facilities, which have no minimum staffing standards, have a 70% turnover of staff; the point being that there may not be so much of a "pipeline" problem, as a retention and working condition problem that's putting our seniors at risk. Also presented was testimony regarding cutbacks in beds, elimination of services, and a swelling population of aged and cognitively impaired adults with limited or no access to gero-psych units. This population has a high number of untreated chronic illnesses, mobility and sensory impairment, and debilitating self-care deficits; they are vulnerable and dependent. The few facilities that remain ARE NOT HIRING, and cutbacks in reimbursement will lead to further erosion of services and closures. The jobs are not there, as evidenced by the study just released by the CINHC reporting that 43% of new graduate nurses are not finding jobs. As a matter of healthcare justice, sound public health and social service policy, we need to reinvest in public service infrastructure. We need to eliminate the overhead and administrative waste of the for-profit healthcare, pharmaceutical, and insurance industry. We need to be fiscally responsible and push for an improved and expanded Medicare for All system of care, based on need, not on ability to pay at the point of service. This will lead to morally responsible budgeting, create jobs, and increase access to care.

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