Updates on Health Policy Activities: Geriatric Nursing Input and Involvement

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• The National Eldercare Workforce Alliance
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• Dr. Barbara Resnick

There is no question but that nursing has responded to the issues and queries around health care reform and has been proactive in getting policy statements out to the appropriate individuals in a timely manner. Examples of this abound such as the development of the Commitment to Quality Health Reform: A Consensus Statement by the Nursing Community signed and supported by the follow organizations:

Nursing has responded to support such things as Title VIII Nursing Workforce Development training programs and on supporting nursing-specific issues such as ensuring that advanced practice nurses are able to practice to the full scope of their abilities in all states across the country. In addition to nursing-specific issues, nurses have joined forces in geriatrics to address issues that affect the care of older adults. One major area of focus has been within the development and ongoing work of the National Eldercare Workforce Alliance. I have introduced the work of this group in prior editorials and felt inclined to give an update so that among all the exciting, ongoing national health policy initiatives, this work does get lost. It is only by addressing the entire workforce needs focused on care of older adults that we can truly address how our country will handle the increasing number of older adults and best manage their care needs.

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The National Eldercare Workforce Alliance 

In November of 2009, the American Geriatrics Society (AGS), serving as a co-convener, initiated the work of the National Eldercare Workforce Alliance (EWA). Nancy Lundebjerg from AGS and Steven Dawson from Paraprofessional Healthcare Institute (PHI), a national nonprofit organization working to improve the quality of eldercare and disability services by supporting quality jobs for direct-care workers, were named co-conveners of the EWA. AGS and PHI are among the 28 national organizations that comprise the alliance, which is supported by grants from the Atlantic Philanthropies, the John A. Hartford Foundation, and member contributions.

The focus of the EWA is to address growing shortages of health care professionals, direct-care workers, and family caregivers who are adequately prepared to care for older adults. Among the 28 member organizations, many of these are nursing groups such as those within the Coalition of Geriatric Nursing Organizations (CGNO) and the American Nurses Association. The Alliance's member organizations include those comprising individuals with policy expertise, health care professionals, direct-care workers, and older adults themselves.

The alliance was formed in direct response to the Institute of Medicine's 2008 report, “Retooling for an Aging America.” In this report, it was noted that the nation's eldercare workforce is dangerously understaffed and unprepared to care for the rapidly growing number of older adults anticipated in the coming years. Developing the alliance has expanded the opportunities and abilities of any one group alone to advance issues around funding initiatives that will help create a workforce that is better prepared to care for our nation's aging population. A large, interdisciplinary group such as this that supports programs such as Title VII and Title VIII has a stronger and louder voice than would be heard by any one organization. The critical importance of this was reinforced in comments made to the group at their Fall 2009 meeting by current Health Resources and Services Administration administrator Nancy Wakefield, PhD, RN.

In immediate response to the eldercare workforce crisis, the Alliance's goals are to:

The alliance has already endorsed proposed legislation that would expand geriatrics training for medical school and other health professions faculty, physicians, nurses, social workers, clinical psychologists, and other allied health professionals, as well as for nurses' aides, home health aides, and other direct-care workers and family caregivers. Senators Herb Kohl (D-WI), Blanche Lincoln (D-AR), Bob Casey (D-PA), and Representative Jan Schakowsky (D-IL) introduced the legislation, “The Retooling the Healthcare Workforce for An Aging America Act,” in the House and Senate in early 2009.

In a March 27 letter to Labor Secretary Hilda Solis and Health and Human Services Secretary Kathleen Sebelius, 25 members of the EWA urged a reevaluation of Labor's controversial “companionship exemption” policy and asked to meet with the administrators to explore the issue. Under the policy, which dates to 1975, home- and community-based care workers can be classified as “companions,” thereby exempting their employers from federal minimum wage and overtime standards. Since 1975, however, the nature of the work that many home-care aides perform has changed dramatically, with these workers providing far more than companionship to the many seniors for whom they care. As the New York Times noted in a recent editorial, exempting home-care workers from minimum wage and overtime protections is unwise.

EWA members voted to support the Caring for an Aging America Act of 2009 and the Geriatrics Loan Forgiveness Act. Introduced by Senators Barbara Boxer (D-CA) and Susan Collins (R-ME), the Caring for an Aging America Act of 2009 proposes to allocate $130 million over 5 years to fund educational loan forgiveness and training and career advancement opportunities for health care professionals and direct-care workers who make a commitment to caring for older adults. The Geriatrics Loan Forgiveness Act, proposed by Representatives Rosa DeLauro (D-CT) and Ileana Ros-Lehtinen (R-FL), will enable health care professionals pursuing advanced training in geriatrics to participate in the National Health Service Corps Loan Repayment Program. This program currently forgives up to $25,000 dollars on behalf of an individual for the first 2 years of obligated service.

The EWA has also finalized its positions on potential reauthorization and expansion of Title VII Geriatrics Health Professions and Title VIII Nursing Workforce Development training programs. Title VII Geriatrics Health Professions Programs include geriatric faculty fellowships for physicians, dentists, and behavioral and mental health professionals; the Geriatric Academic Career Awards (GACA) program; and the nation's Geriatric Education Centers (GECs). Title VIII Nursing Workforce Development Programs support training and continuing education for nurses who care for the elderly and the development and dissemination of curricula concerning geriatric care. Congress last reauthorized Title VII programs, for 5 years, in 1998, and the reauthorization process would provide an opportunity to expand and refine the programs. In addition to advocating for reauthorization, we have been advocating for increased Title VII and VIII funding. In an encouraging development in early May, President Obama requested $42 million for Title VII geriatrics programs in his 2010 budget proposal—a 35.5% increase over 2009 funding. The president's budget plan also requests $263 million for Title VIII nursing education programs, including an $88 million (237%) increase for the Nursing Education Loan Repayment Program and an increase for the Nursing Faculty Loan Program.

Members of the EWA have already spent several days on Capitol Hill to advocate for aging workforce–related issues in an organized and strategic manner. Some of you may have already responded to requests and participated in these events. The success of these visits has far exceeded the expectations of the EWA, which is increasingly being recognized as a strong and single voice for workforce issues in aging. I urge you all to keep abreast of these activities because you are likely involved by virtue of your membership in any of the nursing organizations taking part in the alliance. Please respond to queries for input on particular issues as appropriate or join in to requests to respond to issues through letters to your appropriate senators and representatives at the state level. Many of us went into geriatrics at a time when we defended our interests and hung our heads in shame for our choice to work in long-term care facilities versus other “more exciting” sites where “real nursing” happened. Who knew that at some point in our careers, we would need to share what we have learned and step up to the plate to ensure that all older adults receive the type of care that comes with knowledge of aging and aging issues and a love, respect, and true appreciate of those for whom we care.

Make a point to check out the updates on the EWA Web site (www.eldercareworkforce.org) and join in to make the voice of the EWA as loud as it can be.