In addition to personnel shortages, elderly-care businesses are adjusting some long-standing practices. The construct of the traditional nursing home has changed considerably in the past decade. The focus during the previous 40 years had been on creating modern, hospital-like settings for aging patients to live in and receive care.
But aging Americans are less and less willing to move into nursing homes, believing they feel too institutional. More often, today's elderly want the freedom to live in their own homes or to live with family members, so the number of long-term nursing home inhabitants has declined. Columbia's Takamura said only about 4 percent to 5 percent of the country's elderly population now lives in nursing homes.
"There's been a market shift. Consumers want choice," said Bruce Yarwood, president and CEO of the American Healthcare Association, who worked in the nursing home industry for more than 30 years.
But living longer lives means many people are living with chronic conditions that require professional care. Family members are not always able to take time off work or to offer the kind of specialized treatment that health care workers are trained to provide. So house calls may once again become commonplace.
"Looking forward, the biggest growth area is going to be in home care," Yarwood said.
This shift and the impending boomer retirements pose several challenges. Elderly-care facilities are searching for methods to balance their personnel shortages with the need to serve off-site patients. And some current nursing staffers need to be retrained to perform care services in patients' homes.
Some have found that installing technology like video conferencing, known as telemedicine, allows their staff to reach a greater number of patients.
"A nurse capable of managing people outside of a hospital or home can see maybe six or seven patients in the course of a day. But that number could jump to two dozen or more if they're using video conferencing," said Larry Minnix, CEO of the American Association of Homes and Services for the Aging. "That's one way to address the personnel shortage without being impersonal with the patients."
Hines agreed. But she pointed out that Medicare and Medicaid have been slow to embrace telemedicine. The government insurance programs often don't reimburse patients for telemedicine treatment, making such treatment difficult for many patients to use.
But as patient loads increase and health care staffing is stretched thin in coming years, Hines said that telemedicine is the logical next step.
"You're going to eventually reduce the need for nursing intervention by setting up telemedicine capabilities," she said. "It's all about efficiency -- sending one person to one home is just not an effective use of time when that one person could be serving several people." Using technology to streamline filing systems could help cut down expenses and avoid costly liability lawsuits. Minnix said 50 percent of all liability cases stem from faulty or insufficient filing. Moving to wireless, paperless systems, though costly at the outset, could prevent bigger financial losses in the future, he said.
"The next wave is really creating the technology that allows people to stay at home and allows the health care industry to treat them," Minnix said. ""Our business has to be smart about how they understand the technical capabilities of their investments, but in the long run it could save them money and help them treat more people."