With the passage of the American Rescue Act and the acceleration of the US vaccination campaign, the Biden administration and the 117th US Congress have achieved some of their major goals in just the first few months of 2021. The American Geriatrics Society (AGS) is pleased to see some of our short-term priorities reflected in these accomplishments. In February, we sent letters to the White House and US Capitol to enumerate our long-term, core objectives. The letters we wrote reinforced the importance of prioritizing programs and policies that prepare for future public health emergencies, support a workforce with the skills and competence to care for us all as we age, and improve the clinical care provided to older Americans and their families. They also reaffirmed our Society’s commitment to working collaboratively with federal leadership on our goals.
At the AGS, our vision of the future necessitates federal policies that address the following situations and programs.
Prepare for future pandemics, public health emergencies (PHEs) and disasters
The current COVID-19 PHE has underscored the gaps
in our planning for a pandemic, which has contributed to its disproportionate impact on older Americans and particularly those of color. We can prepare for future PHEs by eliminating age-discriminatory Crisis Standards of Care; revising PHE guidance such that it includes
all health care workers in all settings—including geriatrics experts in emergency preparedness workgroups; and investing in solutions that address health, social, and
Increase older Americans’ access to geriatrics health care professionals
Geriatrics health care professionals specialize in providing goal-based, holistic care, and championing interprofessional teams. The federal government could address the current shortage of these professionals by creating financial incentives for new clinicians to enter and stay in primary care and geriatrics, which are currently underfunded.
Increase funding for Title VII geriatrics training programs
The Geriatrics Workforce Enhancement Program (GWEP) and the Geriatrics Academic Career Awards (GACAs) are the only federal mechanisms supporting the education and engagement of clinicians and frontline workers in the improvement of care for older adults. Sustained and enhanced investment will expand the reach of these resources to serve additional older Americans across the United States.
Ensure the competence of the nation’s workforce caring for older Americans
The Consolidated Appropriations Act, 2021 includes authorization for Medicare to support 1000 new Graduate Medical Education slots, but funding does not require that hospitals and other sites provide training that builds a health professional workforce qualified to care for older adults. We call on Congress to mandate all Medicare-supported training to include geriatrics principles for all appropriate trainees in order to prepare a workforce that is competent to care for all of us as we age.
Ensure the nation’s health care workforce has training in palliative care
Pain management is a key concern for older adults, particularly those aged 80 years and older, who are at the highest risk for multiple health problems and are more likely to have chronic conditions with persistent pain. We believe that all health professionals should have training in geriatrics and palliative care to manage older patients’ pain.
Help the health care workforce overcome challenges that lead to inequity
Gender-related wage gaps exist for home care workers and nursing assistants, the vast majority of whom are women and who provide most of the hands-on care for older people. The federal government should push for increasing direct care workers’ compensation and benefits while strengthening their training requirements and advancement opportunities; ensure equal pay for women; and guarantee access to paid family leave.
Support innovative models of care
Studies have shown that programs providing coordinated and interdisciplinary geriatrics team-based care, can prevent complications and enhance the quality and efficiency of care provided across the health care continuum, but they remain limited in scope. We need to support expanding these models while also continuing to learn about best practices in providing quality care for older adults with complex needs.
Strengthen long-term care services and supports
Medicaid remains the primary payer for both institutional and community-based long-term support and services, but many older Americans can only qualify for Medicaid by “spending down” their assets. The AGS supports policies to expand access to not only skilled nursing facilities, but a wider range of long-term care options, including in-home and other care that enables older adults to live independently as long as possible. Our Society also supports policies to better support and train family members caring for older loved ones.
Prioritize research in diverse older populations across federal agencies
A sizable number of federally funded clinical studies lack age, racial, ethnic, and gender diversity. Removal of upper age limits and meaningful inclusion of diverse older adults in these trials will help us learn how to optimize health and resilience.
Letters from the AGS also stressed our commitment to creating a just society where all people are full members of their communities and entitled to equal protection and treatment. In late 2020, the AGS launched a multiyear, multipronged initiative addressing structural racism and ageism in health care, and the Society looks forward to working collaboratively with the Biden administration and Congress to “address these complex issues by implementing policies that support all of us to age well in our own communities,” as our letters said.