Will There Be Enough Care for the Elderly?

The elderly-care industry is facing a human resources problem. As the number of aging Americans grows, the ranks of elderly-care professionals -- from registered nurses to paraprofessionals who make home visits -- remains stagnant, and is even shrinking in many areas.

Low wages and hard working conditions make it difficult for nursing homes and home-care providers to recruit and retain qualified employees. With the baby boomer generation approaching 60 and life spans expected to grow, some fear the industry is not prepared to handle the influx of aging patients.

"We all know the boomer demographic is aging and that life spans are lengthening, and I think there is a crisis coming," said Ann Marie Cook, chief executive officer of Lifespan, a nonprofit agency in Rochester, N.Y., that helps older adults and families find elderly care. "The crisis might not happen immediately, but it would be ill-advised to not address the problem now."

Many hope that aggressive recruiting and incentive programs will attract a new generation of professionals into elderly care. And the introduction of home-care technology, including caring for patients through teleconferencing, could allow nurses to see more patients and relieve some of the industry's staffing problems.

Americans are Living Longer

In 1900, the average American life span was about 47 years, according to Jeanette Takamura, dean of Columbia University's School of Social Work and former assistant secretary for aging in the U.S. Department of Health and Human Resources. The average life span is 78 today; by 2030, there will be double the number of Americans over the age of 65, pushing today's number to 72 million. With better medicine and technology, Americans are expected to continue living longer, healthier lives.

That's a daunting concept for a traditionally cash-strapped industry. Long-term elderly care, particularly for nurses, has historically been a low-paying field. Providers often are unable to compete with the salaries offered by hospitals or other health care organizations.

Some companies are aggressively recruiting nurses and paraprofessionals, offering small bonus incentives, educational benefits or ladder programs that eventually move nurses into management positions. One home-care nursing company, Visiting Nurse Service, also in Rochester, instituted a program in which one year of paraprofessional service earns workers full tuition to a college program that trains them to become Licensed Practicing Nurses.

"We're telling people who are interested that this can be a career rather than just a job," said Victoria Hines, CEO of Visiting Nurse Services. "It's become a recruiting tool."

But financial constrictions along with the negative stigma of working with frail elderly patients have made it difficult to recruit and retain staff. Hines noted that even with increased enrollment this year, the new paraprofessionals in the program only replaced the ones who dropped out in early 2005. The annual turnover rate for paraprofessionals in the elderly-care industry is about 40 percent to 50 percent nationwide, Hines said, and the nursing turnover is about 15 percent.

"Paraprofessionals still only make about $8 an hour, and that's for visiting five homes a day doing hard, physical labor. They could make the same amount of money working at a retail store," she said.

Nursing Homes Changing Focus

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.

Working With Technology

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."