February 2014
The Center
for Health Affairs
Issue Brief
Bracing for the Boomers:
Addressing the Healthcare and
Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
The Leading Advocate for Northeast Ohio Hospitals
In this Issue Brief
Acknowledgements...................................................................................................2
Establishing the Safety Net for Seniors......................................................................5
Ensuring the Solvency of the Medicare Program......................................................7
The Affordable Care Act......................................................................................8
Potential Policy Solutions....................................................................................8
Medicaid..................................................................................................................10
Long-Term Care in Ohio.....................................................................................11
Workforce................................................................................................................12
National Workforce...........................................................................................12
Healthcare Workforce of the Future: Who will Deliver Care?..........................13
Conclusion................................................................................................................16
Suggestions for Stakeholders...................................................................................17
Issue Brief
1
The Center
for Health Affairs
Acknowledgements
This issue brief was written by Tony Gutowski, manager, public policy
development, and Deanna Moore, vice president, corporate communications.
Bill Ryan, president and CEO, provided invaluable insight and comments.
We would also like to thank Dan Lewis, chief of staff, The MetroHealth System,
whose contributions helped shaped the focus of this brief.
Special thanks are extended to the staff of The Center for Health Affairs:
Julie Cox, director, marketing; Luisa Barone Gantt, specialist, digital marketing;
Earnest Law, assistant manager, facilities; Chris Nortz, director facilities;
and Beverly Cash, receptionist.
2
Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
Bracing for the Boomers:
Addressing the Healthcare and
Workforce Challenges of a Generation
The first baby boomer turned 65 in 2011, which marked the beginning of what will
be the largest group of older Americans the country has ever seen at one time. In
total, boomers – born between 1946 and 1964 – comprise a quarter of the total
U.S. population, and represent 77 million individuals.1 As the boomer generation
has grown up, the nation has eagerly watched as they challenged existing norms
– ranging from the level of education obtained to the amount of time spent in
the workforce. Today the boomers continue to challenge the nation, albeit in a
much different way.
The nation’s ability to adequately meet the healthcare needs of the elderly, rising
costs of government-sponsored health insurance and the mass retirement of
trained healthcare workers are all significant worries. And, while their tremendous
influence on the country is nothing new, baby boomer’s impact during their golden
years will present a host of new challenges, all necessitating adjustments in how
our nation cares for the elderly.
Perhaps the single greatest question arising from these changes is how to maintain
a viable safety net for retirement for all generations. For nearly five decades
workers have paid into government programs which guarantee access to health
insurance and retirement income; however, because of the size of the baby
boom generation, these programs now face unprecedented financial challenges.
Americans today – regardless of their age – are left to question whether safety net
programs like Medicare and Social Security will be available for their retirement.
This Issue Brief examines some of the most pressing questions raised by the aging of
the baby boom generation as well as some of the changes already being employed
to mitigate those challenges. To be sure, there is much work to be done and there
are no easy answers. The trickle of baby boomers that have reached retirement
age today will tomorrow be a flood. The steps we take now have the potential to
influence our country for generations to come, yet, just how our nation will adapt
to this change is, in many ways, still uncertain.
Issue Brief
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The Center
for Health Affairs
Baby Boomers at a Glance
Within the next two decades, the proportion of people 85 and
Age
older is expected to grow – increasing from 14 percent in 2010
to 21 percent by 2050.2
Today’s population of those 85 years and older is considerably
less racially diverse than the 65 years and older population,
which means racial diversity among the elderly will increase
as the baby boom generation ages.3 Looking forward, the
Ethnicity
proportion of minority persons ages 65 years and older is
expected to double during the years 2010 to 2050 – from 20
percent to 42 percent of the total population – with the largest
growing minority group being Hispanic.4
Median shared lifetime earnings, as well as median per capita
Income
family income increased for those born during the two decade
boom period.5
Population 65 Years and Older by Size and
Percent of Total Population: 1900 to 2000
14
12.6% 12.4% 12.6%
45,000,000
11.3%
12
40,000,000
9.9%
35,000,000
9.2%
10
Millions
30,000,000
8.1%
8
25,000,000
6.8%
20,000,000
5.4%
6
15,000,000
4.7%
4.1%
4.3%
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2010
1
2
3
4
5
6
7
8
9
10
11
12
10,000,0004
5,000,000
2
0
0
Sources: U.S. Census Bureau, decennial census of population, 1900 to 2000; 2010 Census Summary File 1
4
Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
Establishing the Safety Net for Seniors
Protecting the nation’s seniors has been a national priority for nearly a century.
During the 1930s, the Great Depression and resulting poverty left many looking to
the government for help. The first step was taken by President Franklin Roosevelt
in 1935 by creating the Social Security Board to provide basic social welfare and
insurance programs to Americans in order to prevent a recurrence of the severe
poverty which persisted during the Great Depression.6
Income During Retirement
Social Security benefits, which about 1 in 4 households rely on, are a primary
source of income for many retired families.7 Started in 1935 in an effort to provide
disability, survivor, or retirement
Security is a fund in which
matching contributions.
insurance to individuals, Social
workers and employers pay
8
With nearly 90 percent of
Americans 65 and older
receiving Social Security,
and two-thirds relying on
the benefit payment for at
least half of their income,
ensuring that the program
important to the U.S. economy
remains solvent is vitally
and the ability for patients to
pay for their care.9 That’s because, beyond ensuring a comfortable retirement
for the elderly, Social Security will comprise 6.1 percent of the total U.S.
economy by 2030.10
It wasn’t until three decades later in 1965 that the authorizing board, now called
the Social Security Administration, expanded to include Medicare under Title
XVIII.11 That expansion marked the first time a federal program relied on federal
income taxes to subsidize Old-Age, Survivors, and Disability Insurance, referred
to as OASDI.12 The program and taxing system remain in place today, although
numerous amendments have been made since its initial implementation.
Issue Brief
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The Center
for Health Affairs
What Does Medicare Cover?
Part A
Hospital visits, home health following hospital stays, skilled
nursing facility stays, and hospice care for the aged and disabled
Physician visits, outpatient hospital visits, home health, and
Part B
other services for the aged and disabled who have voluntarily
enrolled
Part C
Similar to Parts A and B, however, covered by private health
insurance plans through “Medicare Advantage” program
Subsidized access to drug insurance coverage on a voluntary
Part D
basis for all beneficiaries and premium assistance for lowincome enrollees
Source: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal
Supplementary Medical Insurance Trust Funds.” May 31, 2013. http://downloads.cms.gov/files/TR2013.pdf
Prior to Medicare, in the early 1960s, more than
half of Americans age 65 and older — 56 percent —
did not have health insurance.14 This historic piece
of legislation guaranteed seniors’ access to health
insurance for the first time in American history,
creating a sense of security previously unknown
for the elderly. Older Americans no longer had to
worry that illness or disability would wipe out their
life savings or that their families would go bankrupt
trying to pay for their care.
Inpatient hospital
services represent the
largest segment of
Medicare spending,
accounting for 26
percent of benefit
payments in 2012.13
Since then, Americans have come to rely on
both of these programs, which are now considered a normal and expected part
of retirement. However, now — nearly half a century after their creation —
concerns about the long-term financial stability of Social Security and Medicare
have garnered an increasing amount of national attention. After years of paying
Medicare and Social Security taxes, baby boomers and younger generations have
begun to question whether these programs will be there when they retire.
6
Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
Ensuring the Solvency of the Medicare Program
Though the subject is often the focus of heated national debate, there is plenty of
evidence to suggest concern about the long-term financial stability of Medicare
is warranted. Medicare spending has been on the rise in recent decades and
the Social Security Trust Fund is evaporating faster than it can be replenished.15
With total expenditures reaching $574 billion in 2012, Medicare spending already
comprises 3.6 percent of total Gross Domestic Product (GDP) and under current
law, spending on the program is projected to increase to 5.6 percent of total
GDP by 2035.16
Medicare Total Expenditures as a
Percentage of the Gross Domestic Product
Calendar Year
Source: “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance
and Federal Supplementary Medical Insurance Trust Funds.” May 31, 2013.
The Medicare Boards of Trustees — the small group charged with governing the
fund — publish yearly reports on the health of the fund and have repeatedly
corroborated these findings. In their latest report the Trustees look at the reasons
behind the rise in Medicare spending seen over the last three decades and
conclude that there are several reasons behind the trend, most notably: growth in
the number of beneficiaries, increases in the prices paid per service, increases in
the average number of services per beneficiary (utilization) and increased average
complexity of services (intensity).17
Issue Brief
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The Center
for Health Affairs
To be sure, growing Medicare spending is a challenge to the long-term financial
stability of the Medicare program, but that’s not the only factor impacting the
program’s solvency. With a shrinking contribution base and a growing beneficiary
pool – also known as the number of workers per beneficiary – there are fewer
dollars going into the program while more are flowing out. From 2010 to 2030,
the number of beneficiaries will increase from 47 million to 79 million, driving
down the ratio of workers per beneficiary from 3.7 to 2.4.18 In addition, despite
efforts to curtail expenditure growth, the Boards of Trustees project that Medicare
expenditures will grow at a faster rate than workers’ earnings or the economy
overall because of the growth in the number of beneficiaries.19
Together, Medicare spending growth and the decreasing number of workers per
beneficiary, have led analysts to wonder how long will there be adequate funds
to pay out full Medicare benefits? And the question is a valid one. Medicare Part
A is estimated to cover only 87 percent of expenditures by 2026, and only 71
percent by 2050 if the program remains on the same course.20 In light of these
concerns, policymakers have begun examining ways to improve the fiscal health
of the program.
The Affordable Care Act
The Affordable Care Act (ACA) included several measures to rein in rising Medicare
spending without substantially reducing care to beneficiaries. All told, Medicare
stands to reduce per capita and overall spending by $716 billion from 2013 to
2022 due to the policy changes in the law.21 Though Medicare beneficiaries
will not see these changes directly, providers will see a number of reductions
in reimbursement. Payments to providers will be reduced, for instance, when
patients are readmitted for avoidable conditions or have contracted infections in
their facilities. In addition, overall payments to Medicare Advantage plans will also
be reduced so that their reimbursement is more comparable to the traditional
fee-for-service program.22
The ACA also aims to: enhance preventive services,
close the gap in Part D prescription coverage,
known as the donut hole, and coordinate care
in a way that reduces cost and improves health.
Lastly, and most notable for the baby boomers, the
upfront reductions made to Medicare spending
will protect the program until at least 2029, which
extends by 12 years the solvency of the fund.23
8
The upfront reductions
made to Medicare
spending will protect the
program until at least
2029, which extends
by 12 years the
solvency of the fund.
Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
Potential Policy Solutions
Despite changes within the ACA, many experts have warned that the law falls
short in its efforts to protect the Medicare program for future generations. In
response to the intense debate and heightened national attention to this issue,
several proposals have been brought before congress; however, beyond minor
adjustments, no substantial programmatic changes have been made.24 Despite
this, there are a number of policy ideas that seem to keep resurfacing when the
national conversation turns to Medicare solvency. A few of the most common
include raising the eligibility age from 65 to 67, increasing the Part B deductible
and increasing the Medicare payroll tax.
Increased life expectancy is one justification many cite for raising the eligibility
age from 65 to 67. That’s because the average senior lived about 14.3 years past
65 when the program was created, whereas today’s 65 year olds live about 19.2
additional years.25 Extending the age of eligibility to 67 would also align Medicare
and Social Security programs so that beneficiaries would become eligible at
the same time. Should such efforts succeed in congress, the Congressional
Budget Office (CBO) has estimated that it would reduce Federal spending by
$113 billion by 2021.26
Another policy option to improve the fund
solvency is to increase the Part B deductible,
which covers medically necessary services and
preventive services for beneficiaries. While
current law allows the Part B deductible to
Medicare patients paid
rise along with per capita expenses, Medicare
just $147 in 2013 for
patients paid just $147 in 2013 for services such
services such as doctor’s
as doctor’s visits or examinations.27 Since per
visits or examinations.
capita expenses are expected to rise during
the next decade, many have proposed increasing the deductible by $75 for
beneficiaries.28 If the option were applied incrementally to new beneficiaries,
the CBO estimates a $2.3 billion reduction by 2022; alternatively, if the increase
were applied to all current and new enrollees federal savings are expected to
reach $32 billion.29
Spending restraint efforts such as raising the eligibility age or increasing premium
contributions ultimately impact the beneficiary; however, proposals such as
increasing the payroll tax have an effect on the entire society. Under the current
structure, employees and employers split the payroll tax – 1.45 percent each –
which pays for roughly 36 percent of program income.30 One option to extend
Medicare solvency is to remove the additional 0.9 percent payroll tax paid by highwage earners and replace it with a 1 percent increase for all workers.31 If the tax
code were adjusted to apply this increase to all workers, the Medicare payroll tax
would generate $651 billion by 2021.32
Issue Brief
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The Center
for Health Affairs
Medicaid
Medicare isn’t the only safety net program that will be impacted by the aging baby
boom generation. Medicaid, which today pays for the majority of long-term care,
faces significant changes in the years to come.33
As the baby boom generation grows older, one of the
biggest challenges facing the Medicaid program is the
anticipated increase in demand for long-term care
and the price tag associated with it. While traditional
hospital-based care is expected to rise modestly over
the next four decades, home and community-based
long-term care is expected to grow at a much faster
rate – more than doubling from 12 million in 2010 to
27 million by 2050.34
Medicaid spending
for long-term services
and supports has
grown from $54
billion in 1995 to
$123 billion in 2011.35
Financed through the state and federal government,
growth in Medicaid spending associated with the increased demand for longterm care has implications for both Ohio and the United States. While there is no
disagreement that increased demand for long-term care will impact state budgets,
estimates for just how much vary. Lower estimates project that Medicaid costs will
grow from the current 20 percent to 35 percent of the state budget in some states,
while higher estimates project costs will rise by 50 percent.36 Regardless, it’s clear
that something must be done to slow the spending.
While there are no easy answers and no one solution that can solve the growth in
Medicaid spending, states have begun to put an emphasis on shifting long-term
care out of nursing facilities into community-based settings. One of the primary
reasons for this shift is because community and home-based care is often more
cost-effective in the long run.37 This emphasis on community-based care is having
an impact. In 1995 only 20 cents of each Medicaid dollar spent on long-term
services and support was dedicated to home and community-based care; whereas
in 2011 nearly 45 cents of each dollar spent was designated for that type of care.38
Community-Based Care for Everyone:
On June 22, 1999, the United States Supreme Court held that community-based services must be
provided to persons with disabilities by public entities when (1) such services are appropriate; (2) the
affected persons do not oppose community-based treatment; and (3) community-based services can
be reasonably accommodated after taking into account the resources of both the public entity and
the patient.39 Olmstead v. L.C. was brought before the court because of two women, Lois Curtis and
Elaine Wilson, who were denied access to a community-based program because of mental illnesses
and developmental disabilities.40 The court ruled that forcing individuals who have a mental illness or
developmental disability into an institution when they clearly qualified for community-based care was
in clear violation of Title II of the Americans with Disabilities Act.41
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Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
In addition to states’ efforts to lower Medicaid spending for long-term care by
shifting away from nursing facilities, the Affordable Care Act bolsters states’
Medicaid programs by enhancing federal funding and making available new
waivers for home and community-based services.42 Moving forward, ensuring
these services are adequately financed to provide the baby boomer generation
with the best possible care in the best setting will be of great importance to public
and private insurers, as well as those providing healthcare services.
Long-Term Care in Ohio
Ohio has identified several ways to cut healthcare costs and deliver care more
efficiently by delivering long-term care in the most efficient setting. One area of
success in its efforts to “rebalance long-term care,” has been Ohio’s participation
in the federal Money Follows the Person (MFP) demonstration project. From
2008 through 2012, the HOME choice program – funded by the MFP project
– transitioned 2,999 Medicaid beneficiaries from institutions to home and
community based settings.43 These are Medicaid beneficiaries who wanted to
move from long-term care facilities into alternative settings, according to Ohio’s
Office of Health Transformation.
In addition, Ohio has been investing heavily in rebalancing investment in longterm care by providing more resources to home and community and home-based
services, and less to institution-based providers. With over $200 million allocated
to rebalance spending, the number of Medicaid beneficiaries receiving care in
home and community-based settings has grown from 42 percent in 2006 to 57
percent in 2012, while the number of beneficiaries receiving facility-based care
has decreased from 58 percent in 2006 to 43 percent in 2012.44
Moving forward, Ohio’s Office of Health Transformation will continue in its efforts
to ensure Ohioans have access to long-term care in home and community-based
settings. Through participation in the Balancing
Incentive Payments (BIP) Program – which
directs half of all Medicaid spending to home
and community-based services – Ohio will
receive over $169 million to rebalance longterm care and expand access for Medicaid
beneficiaries.45 Various pilot programs in
conjunction with state investment create
more choice for Medicaid beneficiaries,
which mean additional opportunities for
seniors seeking care.
Issue Brief
11
The Center
for Health Affairs
Workforce
While the debate surrounding the cost of providing care for boomers is often
front and center, the impact of mass retirement on the nation’s workforce is
similarly important. In many ways, concerns about the long-term impact of the
boomers on the U.S. workforce stem from two areas: the availability of jobs for
younger generations and the shortage of healthcare professionals to provide care
for the aging population. Ensuring the nation’s workforce is adequately prepared
to provide services – particularly healthcare services – will be one of the most
pressing tasks of younger generations. In addition, with the average American
spending more time in the workforce than ever before, maintaining satisfactory
job growth in other sectors so that college graduates have the ability to find gainful
employment will continue to be a challenge.
National Workforce
For years now, many have warned that the delayed retirement of older people will
prevent new workers from entering the workforce. This is a theory which applies
to all sectors of our economy, not just healthcare. In fact, many countries from
across the globe choose to make national labor policy with this premise in mind,
claiming that when older people work more years it reduces job opportunities for
younger people. This notion, referred to as the “lump of labor theory”, has long
been used to forecast labor models in other countries – but is this an accurate
model for the United States?46
According to most economists and labor experts, the lump of labor theory did
not affect labor markets in the U.S. during the Great Recession.47 That is to
say, there was no “crowding out” of the younger generation in the labor market
by the baby boomers in recent years. In fact, during the Great Recession,
the boomers experienced a 1 percent increase in employment, which economists
have associated with an additional 0.28 percent increase in hourly wages
for today’s youth.48
Since the unemployment rate is
Even after controlling for education,
sex and age, data suggest that
expected to steadily decrease over
boomers choosing to work longer and
the next decade, it is likely that
delay retirement have no correlation
opportunities for college graduates
with the ability of younger workers to
will continue to get better in the
find employment. Experts agree that
coming years, even as many
the pliability of the U.S. labor market
boomers decide to stay in their
will be sufficient in its response to
current positions.49
future demands from both younger
workers seeking employment and
older workers delaying retirement. In other words, new workers and advancing
workers are still likely to experience increased employment and higher wages,
even if the baby boom generation decides to stay in the workforce longer.50
12
Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
Healthcare Workforce of the Future: Who will Deliver Care?
Despite fears that younger generations will face job insecurity in the coming
decades, demand for new workers in the healthcare industry has never been
higher. In fact, rather than job insecurity, the healthcare industry is expecting
workforce shortages in many key professions. What’s creating the demand for
healthcare professionals? By and large, there are two main drivers: retiring boomers
with long-time jobs in the healthcare workforce and an increased demand in
the overall healthcare services needed to care for the elderly. While some
boomers will ultimately stay in the field longer, demand for healthcare
professionals will continue to outpace supply as the generation grows older and
requires additional support.51
Nurses
One of the most frequent causes for concern in the healthcare workforce is the
rising average age of registered nurses. According to the U.S. Department of
Health and Human Services, the average age of registered nurses (RNs) in the
U.S. has been steadily increasing for the past decade; however, with 45 percent
of nurses 50 years of age or older in 2008, a mass exodus of experienced nurses
is expected in the near future.52 Combined with the impending uptick in the
demand for healthcare services, ensuring additional workers are seeking a career
in the nursing field will be essential to properly caring for the elderly.
In an effort to address nursing shortages and keep RNs working, many employers
have already offered RNs the opportunity to cut back on their hours, but still
keep their jobs. The notion is simple:
keeping RNs on the job permits younger
generations to complete their training
and also guarantees an experienced
healthcare workforce is available today.
The added flexibility for RNs is equally
NEONI, The Center for Health
appealing – nearly 20 percent of the
54
Affairs workforce initiative, has
nation’s nurses are working part-time.
Other efforts to address the nursing
conducted a series of supply and
workforce shortage have long been
demand studies to model the
underway in the country. Based on
nursing workforce in Northeast
projections from the Bureau of Labor
Ohio. According to the Nursing
Statistics (BLS), the healthcare industry
Forecaster, the region is expecting
is anticipated to add 5 million jobs by
a shortage of nearly 6,000 full-time
2022, with the largest growth expected
55
registered nurses and nearly 3,000
to be RNs.
licensed practical nurses by 2020.53
Issue Brief
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The Center
for Health Affairs
Primary Care Workers
One of the greatest challenges the healthcare
industry is facing in its efforts to prepare for
the needs of the elderly is training and hiring
the health professionals needed to care for
this population, such as primary care workers.
Yet, it is no secret that today the nation is
facing a significant primary care shortage. As
the situation stands, nearly 40,000 primary
care physicians are needed to meet the
demands of the nation – a number that is
only expected to rise as insurance coverage
is expanded to more people through the
ACA and the baby boom generation ages.56
Training so many new physicians will take
years of education and a significant expansion
in the capacity of teaching hospitals, which
makes filling the primary care gap with newlytrained physicians even harder than it sounds.
As it stands, older Americans
are expected to account for
81 percent of the primary
care demand surge between
2010 and 2020.57 Primary
care services for the elderly
range from annual checkups
by a family practice doctor or
physician assistants, to visits
which require the assistance
of a geriatric specialist.
One way to ease the growing demand on physicians is to allow registered nurses
to function within the full scope of their medical training. The potential for RNs
to provide some primary care services in long-term care facilities, nursing homes
and at a patient’s home can have a profound impact on the expected shortage.
However, if RNs are not utilized to deliver more primary care services in the future
and instead remain in their current role, the shortage of primary care physicians is
expected to reach 20,400 by 2020.58
In an effort to prepare a sufficient number of primary care providers, from nurse
practitioners (NPs) to physicians assistants (PAs), key provisions in the ACA support
additional training opportunities for a number of fields in
the healthcare industry.59 Because of these efforts, the
primary care workforce is expected to grow more rapidly
than physician supply – with NPs rising by 30 percent
and PAs by 58 percent by 2020.60 This trend in the
healthcare workforce is good news for the
retiring baby boomer generation, as they
will undoubtedly require this level of care
as they age. In fact, the U.S. Department
of Health and Human Services estimates
that if the growing supply of NPs and PAs
are properly integrated into the healthcare
delivery system, they will account for 28
percent of all primary care services and
reduce the shortage of primary care
physicians from 20,400 to 6,400 by 2020.61
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Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
Estimated Use of PCPs (FTEs) per 100,000 Persons
Within Each Age Group, 2010
Practitioners per 100,000 Population
250
Nurse Practitioners
Physician Assistants
200
Pediatrics
Geriatrics
150
General Internal Medicine
General & Family Practice
100
50
0
0-5
6-17
18-20
21-44
45-64
65-74
75+
Age Group
Source: Health Workforce News.
“Projecting the Supply and Demand for Primary Care Practitioners Through 2020.”
Geriatric Expertise
To be sure, a shortage of primary care physicians and nurses will be a challenge
in the coming years as the baby boom generation grows older. Making this
shortage even more acute is the fact that many existing care providers and
many of those being trained have no special training in geriatrics. Yet, not
surprisingly, demand for professionals trained in geriatrics – including doctors,
physician assistants, social workers and many others – is expected to be especially
high in the coming decades.62
Elderly people often have a complex disease profile that requires special
understanding of multiple conditions and how to treat them in tandem.
Chronic conditions, for example, affect nearly 90 percent of adults over 65.63
Providing the comprehensive care elderly people need requires a team of
healthcare professionals who are trained to treat everything from arthritis to high
blood pressure.
Many have asked why more physicians aren’t seeking careers in geriatrics. Simply
stated, the biggest barrier to training new geriatric specialists comes down to cost.
Since the majority of patients who seek geriatric care pay for their care through
Medicare, which typically pays less for care than private insurance, geriatric
professionals often receive less pay than their counterparts in other disciplines.64
While the fulfillment of caring for the elderly may outweigh the cost in the long
run, physicians seeking a career in geriatrics are left with the significant burden of
medical school debt. Some experts suggest that one way to make the field more
attractive and incentivize students to take on additional training in geriatrics is to
implement a loan forgiveness program.65
Issue Brief
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The Center
for Health Affairs
Conclusion
Since 2011, when the first baby boomer turned 65 years old, the nation has been
challenged to answer a host of questions that will ultimately define what the
country looks like after the boomers. Whether it’s a question of where care is
delivered or what will happen upon retirement, each answer has the potential
to powerfully impact the baby boom generation. And, based solely on the size
of the group, the way in which these questions are answered has the ability to
affect the lives of more citizens than ever before. Sweeping changes to the type
of health insurance offered through Medicare, or changes in who is licensed to
provide primary care services in the coming decades are both examples of how
the country is preparing for the future.
While the ACA made great strides in terms of ensuring the infrastructure is in place
down the road to care for seniors, further discussion is warranted. All Americans
will in one way or another are impacted by how the boomer generation is treated.
Younger generations are certainly thinking about the type of care available for
their parents, and how to ensure the same care is available to them as they age.
Those just turning 65 are looking forward to retirement and adjusting to a new
way of life. Still, trailing boomers who have several years before reaching their
sixties are presumably thinking about how long they plan to stay in the workforce.
There is virtually no group of Americans who isn’t impacted in at least one way
by the baby boomers, which is why discussing their future is such a necessary
national conversation. Beyond fiscal considerations or workforce projections, this
conversation behooves citizens to begin thinking about one another in a more
altruistic nature; ensuring fellow citizens are mindful of the treatment of others
and keeping the same promise for generations to come.
Suggestions for Stakeholders
• Develop strategies that will enable the growing number of people who prefer
in-home care to stay in their homes as long as possible.
• Invest in primary care. With all of the worry surrounding the primary care
shortage, it is more important than ever that new physicians, nurses, and
other medical professionals finish their training and quickly integrate into the
healthcare system.
• Allow nurse practitioners and registered nurses to contribute more to the
delivery of primary care. Doing so will make sure those over 65 have regular
access to the care they need.
• Support educational programs that provide geriatric training to future care
providers.
16
Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Leading Advocate for Northeast Ohio Hospitals
Endnotes
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
U.S. Census Bureau. “The Older Population in the United States: 2010 to 2050.” May 2010.
http://www.census.gov/prod/2010pubs/p25-1138.pdf
Ibid.
Ibid.
Ibid.
Barbara A. Butrica, Karen E. Smith, and Howard M. Iams, “This is Not Your Parents’ Retirement:
Comparing Retirement Income Across Generations.” Social Security Bulletin 72, no. 1 (2012).
http://www.ssa.gov/policy/docs/ssb/v72n1/v72n1p37.pdf
Social Security Administration. “Brief Graphic Organizational History.”
http://www.ssa.gov/history/orghist.html (accessed January 19, 2014).
Virginia P. Reno and Elisa A. Walker, “Social Security Benefits, Finances, and Policy Options: A Primer.”
National Academy of Social Insurance. 2013.
http://www.nasi.org/sites/default/files/research/2013_Social_Security_Primer_PDF.pdf
Ibid.
Ibid.
Virginia P. Reno and Joni Lavery, “Can we Afford Social Security When Baby Boomers Retire?” National
Academy of Social Insurance. May 2006.
http://www.nasi.org/sites/default/files/research/SS_Brief_022.pdf
Social Security Administration. “Brief Graphic Organizational History.”
http://www.ssa.gov/history/orghist.html (accessed January 19, 2014).
Ibid.
Kaiser Family Foundation, Kaiser Slides, http://kff.org/health-costs/slide/medicare-benefit-paymentsby-type-of-service-2012/ (accessed January 24, 2014).
Medicare Resource Center, “A Brief History of Medicare in America,” http://www.medicareresources.
org/basic-medicare-information/brief-history-of-medicare/ (accessed February 3, 2014).
Virginia P. Reno and Elisa A. Walker, “Social Security Benefits, Finances, and Policy Options: A Primer.”
National Academy of Social Insurance. 2013. http://www.nasi.org/sites/default/files/research/2013_
Social_Security_Primer_PDF.pdf
2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. May 31, 2013. http://downloads.cms.gov/files/TR2013.pdf
Ibid.
Kaiser Family Foundation. “Medicare: A Primer.” April 2010. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7615-03.pdf
2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. May 31, 2013. http://downloads.cms.gov/files/TR2013.pdf
Kaiser Family Foundation. “Medicare: A Primer.” April 2010. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7615-03.pdf
Kaiser Family Foundation. “Policy Options to Sustain Medicare for the Future.” January 2013.
http://kaiserfamilyfoundation.files.wordpress.com/2013/02/8402.pdf
Kaiser Family Foundation. “Medicare: A Primer.” April 2010. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7615-03.pdf
Kaiser Family Foundation. “Medicare and the Federal Budget: Comparison of Medicare Provisions in
Recent Federal Debt and Deficit Reduction Proposals.” October 2013. http://kaiserfamilyfoundation.
files.wordpress.com/2013/10/8124-03-medicare-and-the-federal-budget.pdf
Ibid.
Kaiser Family Foundation. “Policy Options to Sustain Medicare for the Future.” January 2013.
http://kaiserfamilyfoundation.files.wordpress.com/2013/02/8402.pdf
Ibid.
Ibid.
Ibid.
Ibid.
Ibid.
Ibid.
Ibid.
Kaiser Family Foundation. “A Short Look at Long-Term Care for Seniors.” The Journal of the American Medical Association 310, no.8 (2013): 786. http://jama.jamanetwork.com/article.aspx?articleid=1733726
Ibid.
Ibid.
Kaiser Health News, “Medicaid’s Ticking Time Bomb – Long Term Care – Could Wipe Out State Budgets, June 2010, http://www.kaiserhealthnews.org/stories/2010/june/23/medicaid-long-term-care-ft.
aspx (accessed February 7, 2014).
H. Stephen Kaye, Charlene Harrington, and Mitchell P. LaPlante, “Long-Term Care: Who Gets It, Who
Provides It, Who Pays, and How Much?” Health Affairs 29, no. 1 (2010): 11-21.
Issue Brief
17
The Center
for Health Affairs
38. Kaiser Family Foundation. “A Short Look at Long-Term Care for Seniors.” The Journal of the American Medical Association 310, no.8 (2013): 786. http://jama.jamanetwork.com/article.aspx?articleid=1733726
39. United States Department of Justice. “Olmstead: Community Integration for Everyone.”
http://www.ada.gov/olmstead/olmstead_about.htm (accessed January 19, 2014).
40. Ibid.
41. Ibid.
42. Kaiser Family Foundation. “Medicaid Long-Term Services and Supports: An Overview of Funding Authorities.” September 2013. http://kaiserfamilyfoundation.files.wordpress.com/2013/09/8483-medicaid-ltss-overview-of-services-and-funding-authorities.pdf
43. Ohio Department of Medicaid. (2013). “Ohio Recognized as National Leader in Transitioning Individuals into Home and Community Based Care Settings.” (News Release). http://www.healthtransformation.ohio.gov/LinkClick.aspx?fileticket=fZEelvzaxCo%3d&tabid=125
44. Ohio Office of Health Transformation. (2013). “Prioritize Home and Community Based Services.”
http://www.healthtransformation.ohio.gov/LinkClick.aspx?fileticket=1CQrmxKW4cM%3d&tabid=125
45. Ohio Office of Health Transformation. (2013). “Kasich Administration to Increase Access to Home- and
Community-Based Care: Ohio awarded $169 million for implementing additional Medicaid reforms,
“rebalancing.”” (News Release). http://www.healthtransformation.ohio.gov/LinkClick.aspx?fileticket=
KMILkunrzY4%3d&tabid=125
46. Alicia H. Munnell and April Yanyuan Wu, “Are Aging Baby Boomers Squeezing Young Workers Out of
Jobs?” The Center for Retirement Research at Boston College. October 2012.
http://crr.bc.edu/wp-content/uploads/2012/09/IB_12-18-508.pdf
47. The Pew Charitable Trusts. “When Baby Boomers Delay Retirement, Do Younger Workers Suffer?” September 2012. http://www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/Reports/Economic_Mobility/EMP_retirement_delay.pdf
48. Ibid.
49. U.S. Department of Labor, Bureau of Labor Statistics, “Monthly Labor Review.” December 2013. http://
www.bls.gov/opub/mlr/2013/article/the-u-s-economy-to-2022-settling-into-a-new-normal.htm
50. Alicia H. Munnell and April Yanyuan Wu, “Are Aging Baby Boomers Squeezing Young Workers Out of
Jobs?” The Center for Retirement Research at Boston College. October 2012.
http://crr.bc.edu/wp-content/uploads/2012/09/IB_12-18-508.pdf
51. U.S. Department of Health and Human Services. “Projecting the Supply and Demand for Primary Care
Practitioners Through 2020.” November 2013. http://bhpr.hrsa.gov/healthworkforce/supplydemand/
usworkforce/primarycare/primarycarebrief.pdf
52. U.S. Department of Health and Human Services. “The Registered Nurse Population.” March 2010.
http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyinitial2008.pdf
53. The Center for Health Affairs. “NEONI’s Nursing Forecaster: Predicting the Future Supply and Demand
for Nurses.” http://www.chanet.org/WorkforceNEONI/SupplyAndDemandData/Nursing.aspx (accessed January 19, 2014).
54. U.S. Department of Health and Human Services. “The Registered Nurse Population.” March 2010.
http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyinitial2008.pdf
55. U.S. Department of Labor. “Economic News Release: Employment Projections: 2012-22.” December
2013. http://www.bls.gov/news.release/ecopro.htm
56. Robert Wood Johnson Foundation. “How Can We Expand the Primary Care Workforce?” January 2012.
http://www.rwjf.org/en/research-publications/find-rwjf-research/2012/01/how-can-we-expand-theprimary-care-workforce-.html
57. U.S. Department of Health and Human Services. “Projecting the Supply and Demand for Primary Care
Practitioners Through 2020.” November 2013. http://bhpr.hrsa.gov/healthworkforce/supplydemand/
usworkforce/primarycare/primarycarebrief.pdf
58. Ibid.
59. Robert Wood Johnson Foundation. “How Can We Expand the Primary Care Workforce?” January 2012.
http://www.rwjf.org/en/research-publications/find-rwjf-research/2012/01/how-can-we-expand-theprimary-care-workforce-.html
60. U.S. Department of Health and Human Services. “Projecting the Supply and Demand for Primary Care
Practitioners Through 2020.” November 2013. http://bhpr.hrsa.gov/healthworkforce/supplydemand/
usworkforce/primarycare/primarycarebrief.pdf
61. Ibid.
62. The American Geriatrics Society. “Geriatrics Health Care Workforce.” http://www.americangeriatrics.
org/advocacy_public_policy/workforce_issues/ (accessed February 4, 2014).
63. Eldercare Workforce Alliance. “Caring for an Aging America: Meeting the health needs of older adults.”
http://www.eldercareworkforce.org/research/issue-briefs/research:qanda/ (accessed February 4,
2014).
64. Ibid.
65. The American Geriatrics Society. “Geriatrics Health Care Workforce.” http://www.americangeriatrics.
org/advocacy_public_policy/workforce_issues/ (accessed February 4, 2014).
18
Bracing for the Boomers: Addressing the Healthcare and Workforce Challenges of a Generation
The Center for Health Affairs is the
leading advocate for Northeast
Ohio hospitals, serving those
organizations and others through
a variety of advocacy and business
management services. The Center
also works to inform the public
about issues that affect the
delivery of healthcare. Formed by a
visionary group of hospital leaders
97 years ago, The Center continues
to operate on the principle that
by working together hospitals
can ensure the availability and
accessibility of healthcare services.
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