New York is home to 3.4 million individuals aged 60 and older, ranking New York third in the nation in the number of older adults. Like the rest of the country and the world, New York's aging baby boomer cohort will further swell the ranks of the State's older population in the coming years.
New York's demographic structure reflects some of the same major demographic forces that have formed the nation's population; however, the State's population characteristics are also unique in many ways: New York's population size, distribution, and composition have been driven by very dynamic demographic events both internal and external to the State. Such forces as foreign immigration, high levels of domestic in- and out-migration, and the high fertility rates of the State's large and expanding ethnic populations have shaped New York's population, and will continue to do so in the future.
The dynamics of population change provide us with challenges as well as tremendous resources and opportunities to make our communities the best places to live, work, play, and grow old. One of those challenges is how to assure that there is a trained and ready workforce to provide appropriate services to help meet the needs of our older adult population - and, in order to successfully meet the challenges we face in delivering quality services to older adults, part of the response needs to include both having the right set of professionals and paraprofessionals to work with our older adult population, and also providing appropriate education and training for that workforce.
The topic of workforce training and education for individuals working with older adults is large and complex. It challenges us to consider all aspects involved in preparing the workforce: current pre-professional, in-service and paraprofessional and professional training and educational needs and opportunities; training credentials, certifications, and/or other requirements; issues of cultural competency; issues of funding; and career ladder opportunities.
In a recent study conducted by the University at Albany's Center for Health Workforce Studies, it was found that the United States as a whole is unprepared to meet the care challenges posed by an aging population. According to the study, people are living longer and are more aware of available services, the older adult population will be larger, more ethnically diverse, and have a higher education level than previous generations. As demand for care services grows, large numbers of workers providing care will be retiring at the same time, making shortages likely.2
The need for a workforce that is knowledgeable about older adults is growing and increasingly important due to the demographic forces that are shaping our communities. In 2006, the Association of Gerontology in Higher Education (AGHE) conducted an environmental scan of employers and employees to gain perspectives about the topic of certification in gerontology.3 The survey included employees and employers working in fields associated with older adults. The results from the AGHE environmental scan about certification in gerontology showed that certification would enhance employment opportunities, clarify expectations, ensure individuals are better prepared for jobs, and add value to one's professional standing.
The impact of certification on clients and community was explored, which found that certification could demonstrate employees' public accountability by showing that they had met the minimum standards required of the field. Furthermore, certification may increase the quality of care for older adults. One comment summed up the issue: "If employers buy in, then certification will be important, otherwise not."4
Another topic area covered in the AGHE survey was the impact of certification on practice. The results found that the drive for certification could potentially raise the bar for a minimum entry-level standard, provide opportunity for career ladders, clarify expectations of clients and the community, and increase the quality of services for older adults.
The AGHE scan also looked into the impact of certification on academia. Results showed that respondents overall believed that certification would compel the standardization of core competencies, encourage enhancement of specialty areas, delineate levels of education, and increase demand for online courses by students.
In New York, we need to take a close look at how we are preparing the workforce for an older and more diverse population. We know that future successful older adult care service delivery is dependent upon a well-prepared workforce to provide aging services in our state. The State and our communities do not yet have the health and long-term care service delivery or workforce systems in place to meet future - let alone current - demands. This situation is occurring precisely at a time when the population most reliant upon these systems, those aged 85 and over, is growing at the fastest rate.
According to the New York State Department of Health, 11 percent of the population aged 65 and older is currently in need of help with routine or personal care activities, and it is projected that this trend will increase significantly over the coming years, with the entry of the baby boomers into the elder cohort.5
The Center for Health Workforce Studies reported that nationally, we experienced a 6 percent nursing shortage in 2005, and that is projected to fall 29 percent below predicted requirements by 2020.6 New York also lacks enough people trained as geriatric specialists in health and human service disciplines to meet the needs of the growing cohort of older adults; despite a rapidly growing elderly population, the number of certified geriatricians fell by a third between 1998 and 2004.7
In addition to shortages in nursing and geriatric medicine, one of the major gaps facing New York is a lack of social workers trained in gerontology and geriatrics. The demand and opportunity for social workers in the field of gerontology is clear. According to the New York Academy of Medicine's Social Work Leadership Institute (NYAM/SWLI), social work is a profession that has developed and continued to provide expertise in navigating multifaceted systems of service.
While nursing and geriatric medicine shortages are well recognized, significant shortages also exist in rehabilitation therapies, specifically occupational therapy, speech therapy, and physical therapy; at the same time, demand is anticipated to continue.8 Workforce shortages and high vacancy rates are reported for occupational therapists, physical therapists, and speech therapists in hospitals, rehabilitation centers, and public schools.9 Competition for therapists exists between geographic areas and employment settings - particularly among hospital, geriatric rehabilitation, home health, and long-term care settings, who then advertise the benefits of working for their organizations. With this range of employment options, therapists can select positions that best address their interests and needs, such that therapists working with older adults often choose these practice areas. Positive educational experiences, including clinical educational experiences in geriatric practice, coupled with professional opportunities and competitive salaries, increase the likelihood that therapists will choose to work with older adults.10 In addition, demographics and health care demands are such that rehabilitation programs provide care for large numbers of older patients.
Geropsychologists also are in high demand but in short supply. Geropsychologists are clinical psychologists with specialized expertise to work with older adults. They are trained to conduct competency examinations and to provide evidence-based treatment regimens for depression, sleep problems, stress experienced by caregivers of older adults, and non-pharmacological techniques to treat behavioral problems among adults with dementia. Alarmingly, Heath Gordon (Personal Communication, January 11, 2008) found in his dissertation research based on a national web-based survey that 88 percent of psychology trainees had completed only one course or less in aging. Lamentably, in part because of this lack of training among psychologists (as well as psychiatrists), Bartels11 noted, "older people with mental disorders are significantly more likely to receive inappropriate and inadequate treatments compared to younger adults." Moreover, psychology doctoral students who want to serve the older population are challenged to find pre-doctoral internships in aging due to a critical lack of geriatrics training infrastructure. Yet, the demand for geropsychological services - which has never been higher - will continue to increase in the near future because the baby boomers are more prone to experiencing depression, anxiety disorders, and substance abuse than is the current generation of older adults. 12
Furthermore, we continue to need well-qualified paraprofessional and professional front-line workers, including home care workers, certified nursing assistants, social adult day services providers, and case managers, including individuals trained in geriatric care management. Finding ways to recruit and retain frontline long-term care workers has become a priority for many states, including New York. Major issues include pay and benefits, transportation costs, childcare resources, the work environment, training and preparation, career ladder opportunities, and 'competition' from other employers such as fast food operations, malls, etc. For paraprofessional and professional workers who are engaged in delivering care to older adults, such efforts include improving wages and benefits, developing additional training and opportunities for career advancement, and creating additional employee supports.
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