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Panel Predicts Shortfall in Care for the Aged
By: Mike Mitka
JAMA, October, 11 2000
Chicago-Some pieces of good news may produce bad results
for health care delivery in the upcoming decades.
The good news is that people are living longer and women have increased
professional job opportunities. That combination means, however, that
planners are projecting a shortage of health care workers particularly of
registered nurses, a field traditionally filled by women by 2020, when the
majority of baby boomers reach the age when most medical attention is
needed.
Consequently, policy analysts are beginning to warn government, education,
and business leaders about the coming problem. They are also trying to
find solutions.
The latest to join the growing chorus is a panel convened by the Nursing
Institute at the University of Illinois at Chicago (UIC) College of
Nursing. The panel, which met here a month ago to discuss "The Future
of the Health Care Labor Force in a Graying Society," is chaired by
Lynn Martin, former US secretary of labor.
"How can we meet the challenges of an aging society? How do we face
an aging health care labor force? How can we increase a declining pool of
potential health care workers? How will market forces affect the quality
and size of the necessary labor pool?" Martin asked, setting the
framework for the panel's task.
The panel, which will meet twice more before spring 2000, hopes to address
these questions and issue a report by April. The panel members include
business executives, policymakers, academics, and professional association
leaders. Among them are former senator Bill Bradley; Kweisi Mfume,
executive director of the NAACP; Louis Sullivan, MD, president of
Morehouse School of Medicine and former secretary of the US Department of
Health and Human Services; and Richard Corlin, MD, president-elect of the
American Medical Association.
Corlin said he was pleased with the first meeting and was impressed that
turf protection by the various members was nonexistent.
"This very pragmatic group wants to clarify the workforce needs
particualrly at the level of RNs, LPNs, and nurses aides, and how our
aging population is going to impact those needs and what will be the
economic consequences," Corlin said. "We are especially
interested in the effects of increased home health care and long-term care
as our population ages."
SOBERING STATISTICSStatistics presented to the panel by Noreen M. Sugrue,
DrPH, senior research specialist at the University of Illinois Nursing
Institute in Urbana show that: · In 2000, about 35 million people, or 13%
of the US population, are aged 65 or older. By 2030, about 70 million, or
20%, will be aged 65 or older.
· Between 1995 and 2010, the number of people in the United States aged
65 to 84 is expected to grow 13%. For those aged 85 or older, the growth
rate is 56%. This means that while people aged 85 or older make up 2% of
the population in 2000, by 2050 they will make up 5% of the population.
· Until about 2040, the labor supply will grow more slowly than the
population. Between 1995 and 2005, there will be a 10% decrease in the
number of people aged 25 to 34 in the labor force.
It is predicted that by 2020 there will be 20% fewer RNs than needed (JAMA.
2000;283:2948-2954). Many reasons are posited for this projected
shortfall. Panel members stressed as one cause perhaps a bit belatedly the
increasing job opportunities for women whotraditionally had been offered
only two professional occupations: teaching and nursing. This lack of
opportunity created an overstocked skilled, educated labor pool whose
wages were suppressed because of their numbers. The panel noted that women
now have opportunities in all professions.
"Because of the revolution in the women's labor market, nursing isn't
their only option," said Jim Smith, PhD, a panel member and senior
economist at RAND Corp. "And because the wages and working conditions
for nurses are not all that great, you can't find women willing to join
this labor force like you did. They're gone."
The potential for combating this emerging shortage is not good. The UIC
researchers said that 92% of RNs are women and that percentage is not
expected to change. They also predict there will not be an increase in the
percentage of minority members who become RNs, which is troubling since
minorities will be a growing percentage of the overall labor force.
ROLE OF ECONOMICSSmith expects classic economics to play a part in the
nursing situation. He said that wages for RNs should increase and attract
more candidates but that these people will be paid for their advanced
skills, while employers hire less expensive nurses' aides to perform
certain traditional aspects of RN work.
Because an aging population means an increase in people with chronic
conditions who must be cared for in long-term care facilities or at home,
some members of the panel also expressed concern about the nursing home
industry. Their concern is valid considering that at a September 5 hearing
before the Senate Special Committee on Aging it was noted that five of the
10 largest nursing home chains in the past few years have been in
bankruptcy, and that about 1600 nursing homes are now operating under
Chapter 11 bankruptcy protection.
Also, testimony before that committee on July 27 by Nancy-Ann DeParle,
administrator of the Health Care Financing Administration, revealed that
54% of nursing homes were below suggested minimum staffing levels for
nurses' aides and 31% were below the suggested minimum staffing level for
RNs. The suggested minimums are such that there are enough aides for each
to spend 2 hours a day with each resident and enough RNs for each to spend
12 minutes a day per resident.
The situation can be equally grim when family members care for someone at
home, said other panel members. Personal wages may be lost and economic
productivity may decline as workers are forced to stay at a family
member's bedside.
The panel heard that the supply of physicians should be adequate in the
foreseeable future, although that workforce will be aging just as patients
will be. Between 1998 and 2020, the percentage of active physicians over
age 65 will increase by approximately 114%, while during the same period,
the percentage of physicians under age 46 will drop 29% (Physician
Characteristics and Distribution in the US: 2000-2001 Edition. Chicago,
Ill: American Medical Association;2000).
NEED COMMUNITY CONSCIOUSNESS: Len Nichols, PhD, a panel member who is
principal research associate at the Urban Institute, Washington, DC, said
he hopes the panel's work will reach the consciousness of the research and
policy communities.
"We're not going to come up with '14 Ways to Solve the
Problem,'" Nichols said. "We're here to lay out the problem and
say this is what policymakers and society should think about before it
gets to a crisis level."
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