Advocate for Quality Healthcare for Older Adults
The Institute of Medicine’s (IOM’s) recent report, Retooling for an Aging America: Building the Health Care Workforce, is a much needed wake-up call. If there was any lingering doubt that our aging nation was facing a serious healthcare crisis, the April report dispels it.
The report spotlights key population, recruitment, and training trends that, together, will converge to create this crisis—unless our healthcare system undergoes significant reform. By 2030, it notes that 70 million Americans, or 20% of the population, will be age 65 years or older. Thanks to medical advances, including advances in the treatment of cardiovascular disease and cancer, more older Americans will be living longer with chronic disease. Unfortunately, recruitment into the field of Geriatrics and efforts to train generalists to meet the unique healthcare needs of older patients aren’t keeping pace. Not by a long shot. In short, the nation’s healthcare workforce will be too small and too ill prepared “to meet the large demand for health services for older adults if current patterns of care and of the training of providers continue,” the IOM report warns.
To prevent this looming crisis, Retooling for an Aging America calls for a three-pronged approach designed to:
1. Enhance the geriatric competencies of the entire workforce (appropriately, the report defines the healthcare workforce to mean everyone responsible for the patient’s well-being, including healthcare professionals, direct-care workers, informal caregivers such as family and friends, and patients themselves);
2. Increase the recruitment and retention of geriatric specialists and caregivers; and
3. Improve the way that care is delivered.
The report also recommends a wide range of initiatives to increase recruitment into Geriatrics, to ensure that all healthcare providers who care for older adults are adequately trained to meet their unique healthcare needs, and to revamp and improve the way elder healthcare is delivered to improve outcomes and cost-effectiveness.
Now, there’s a good chance that you’re well aware of all of this, and that you’re familiar with the IOM report. But what about your state and federal legislators? Are they familiar with the report, and do they understand how failure to act on its recommendations will affect their older constituents? While legislators are fully aware that a higher percentage of older than younger Americans vote, and understand the need to be responsive to older Americans, they’re also bombarded at any given time by multiple and competing vested interests and, in many cases, by financially powerful lobbies.
That’s why every single one of us who cares about quality elder healthcare needs to raise awareness of and advocate for the kinds of changes the IOM report recommends. Here’s how:
First: Visit the American Geriatrics Society’s (AGS) website at www.americangeriatrics.org, and become a member of the AGS if you aren’t already one. (Membership is open to all.) Many of the findings in the IOM report echo and build on findings in AGS’ 2005 report, Caring for Older Americans: The Future of Geriatric Medicine. And many of the recommended initiatives in Retooling for an Aging America—which was authored by a panel of experts that included several AGS members—parallel those for which the AGS has long advocated. The AGS has a history of advocating for public policy aimed at ensuring older adults access to quality healthcare, including policy that supports recruitment and training of, and adequate Medicare reimbursement for, geriatrics healthcare professionals. It also has a membership that’s active in advocacy work. Consider this: During the AGS’ 2008 Annual Scientific Meeting in Washington, DC, this past May, more than 150 AGS members met with nearly 80 legislators to raise awareness of the IOM report’s findings and to urge support for pending legislation that could help avert a senior healthcare crisis in the United States. The AGS website, which includes a regularly updated Public Policy News Page, offers a wealth of continually updated information about legislation affecting elder healthcare. A bonus for becoming a member is that AGS members also have access to the AGS’ Advocacy Toolkit, which offers great advice on corresponding with, scheduling, and preparing for meetings with legislators.
Second: Visit and register with AGS’ “Health in Aging Advocacy Center,” at www.healthinaging.org/advocacy/, and urge like-minded friends and colleagues to do the same. (You don’t need to be an AGS member to join.) Once you’re registered, AGS staff will e-mail you each time the Center launches an advocacy campaign on behalf of legislation central to ensuring older Americans access to quality healthcare. The Center’s e-mails include links you can click to read about the legislation at hand, and to access easily customized letters to your legislators urging them to take appropriate action. Joining these advocacy campaigns only takes a couple of minutes and a couple of key strokes, but the benefits are lasting.
Third: Advocate for the seniors and healthcare professionals in your state and region. Most AGS advocacy campaigns focus on federal legislation. You can expand your involvement and reach by raising state and local awareness of and advocating for state and local policies that support geriatrics healthcare professionals and older patients in your area. How? Stay in touch with local and state leaders via e-mail and phone, and encourage sponsorship and endorsement of policies and programs that improve healthcare for your older patients. Become active in your state or regional geriatrics society. AGS has interdisciplinary state and regional affiliates throughout the nation. If you don’t have one in your area, contact AGS, and learn more about starting an interdisciplinary affiliate where you live.
Fourth: If you’re a member of both the AGS and the American Medical Association (AMA), designate AGS as your representative to the AMA’s House of Delegates. Among other things, the AMA recommends Medicare coding and reimbursement changes to the Centers for Medicare & Medicaid Services. AGS’ ability to influence decisions regarding such changes is contingent on AGS having a seat on the AMA House of Delegates. To do that, AGS needs to have at least 1000 of its members join the AMA as well.
Public policy advocacy requires five essentials: patience, perseverance, creativity, time, and a basic knowledge of the key issues at hand. Patience means waiting for the right moment when the timing is right. Persevering means trying, trying, and trying again to get your point across to your elected officials. Creativity means looking for new ways to raise awareness and advocate, for example, by developing public forums on elder healthcare with the help of your state geriatric healthcare organization (whether that’s an AGS chapter, a chapter of the American Medical Directors Association, or the National Conference of Gerontological Nurse Practitioners). Making the most of your time means maximizing your opportunities for effective advocacy by taking advantage of last-minute, unexpected appearances that your legislators or their staff make at town meetings or other local public events. (If you can’t go, check whether colleagues can.)
When it’s time for audience participation in these events, speak up for initiatives that support quality elder healthcare, or pull your legislator aside and ask for a couple of minutes of his or her time so that you can share information about the IOM report, the looming healthcare crisis, and ways of preventing it. Utilize the “talking points” and other information concerning policy and legislation that AGS provides in the policy sections of its website to point out problems and, more important, to suggest solutions. Policymakers are also busy, so keep it short, and offer to send more detailed information in writing. Then follow up by sending it. Sending or e-mailing a “Thank You” when a policymaker supports measures that enhance healthcare for older Americans is also important.
How effective is Grassroots Advocacy? Within hours of the visits that AGS members made to legislators during the AGS’ recent annual meeting, 13 additional congressmen endorsed three key bills—The Geriatric Assessment and Chronic Care Coordination Act, the Caring for an Aging America Act of 2008, and the Geriatricians Loan Forgiveness Act—designed to boost geriatrics recruitment and training, and improve access to quality elder care. (For information about these bills that you can share with others, visit www.americangeriatrics.org/policy/.)
The IOM report made headlines nationwide and abroad. Its release has created a golden opportunity for everyone who supports quality healthcare for older adults to advocate for changes in our healthcare system that can avert what could be a dire crisis in eldercare. We can’t afford to miss this opportunity. Help us get the word out.
Charles A. Cefalu, MD, MS
Public Policy Advisory Committee
Former Public Policy Fellow
The American Geriatrics Society
A free PDF of the prepublication copy of “Retooling for an Aging America: Building the Health Care Workforce” is now available on the National Academies Press (NAP) website, http://books.nap.edu/catalog.php?record_id=12089. On the webpage for the IOM report, scroll down, click “Sign In,” answer the prompts, and then download. The final report will also be available as a free PDF.