Without changes at the national level, older Americans will lack access to affordable, quality health care--including mental health care--concludes the Institute of Medicine in its report, Retooling for an Aging America: Building the Health Care Workforce, released April 14. The American Association for Geriatric Psychiatry (AAGP) has long been concerned about the workforce in the area of late-life mental health care, particularly the declining numbers of doctors entering the field of geriatric psychiatry--those pursuing a research career, becoming clinician-educators, and entering clinical practice. The diminishing workforce in these areas will inevitably lead to inadequate access to quality mental health care for the aging Baby Boomers generation.

Last year, the Institute of Medicine undertook a project to examine the optimal health care workforce for older Americans in an aging society. The aim of the study was to determine the health care needs of Americans over 65 years of age, and address those needs through a thorough analysis of the forces that shape the health care workforce, including education, training, modes of practice, and financing of public and private programs. A committee of 15 experts, including AAGP’s President-Elect Charles F. Reynolds, III, MD, met over a period of 15 months to study the best use of the workforce, how the workforce (both generalist and specialist) should be educated, the most effective organization of health care delivery, and needed improvements of public programs such as Medicare and Medicaid.

AAGP lauds the IOM for including a focus on the geriatric mental health care workforce. “We appreciate that the IOM recognizes the emerging public health crisis regarding older adults, and we are particularly appreciative of the expertise that was involved under the leadership of the committee chair Dr. Jack W. Rowe and the participation of Dr. Reynolds,” said AAGP President Bruce G. Pollock, MD, PhD, FRCPC.

The prevalence of mental illness among older adults and the compounding effects of mental illness plus other illnesses argue for legislative and regulatory changes to increase access to care. With 1 in 10 Americans over age 65 and nearly half of those over 85 suffering from Alzheimer’s disease, one-third of people age 71 and older having some cognitive impairment, and upwards of 5 percent of the elderly in the community and 13 percent of those in home health care living with depression, greater investments into a quality mental health care system are sorely needed.

Today there are just 3.9 geriatric psychiatrists for every 10,000 Americans age 85 and older and just 1.1 for every 10,000 over 75 years of age, according to the Association of Directors of Geriatric Academic Programs (ADGAP). It is estimated the country needs 5,000 geriatric psychiatrists, yet last year there were fewer than 1,600 board-certified geriatric psychiatrists in the United States.

The IOM report acknowledges that “the costs associated with extra years of geriatric training do not translate into additional income, and geriatric specialists tend to earn significantly less income than other specialists or even generalists in their own disciplines.” AAGP’s Pollock explained, “While the demand for specialized mental health care is great, physicians face several financial disincentives to entering the field of geriatric psychiatry such as annual scheduled cuts to Medicare physician payments and discriminatory coverage of mental health benefits under Medicare. This affects providers as well patients.” Although Medicare Part B pays 80 percent of covered medical services, the program pays just 50 percent of covered mental health services, and many of those services are undervalued in payment system. In addition, physician payments under Medicare are scheduled to be cut by 10 percent beginning in July, unless Congress intervenes.

The small numbers of specialists in geriatric mental health care, including geriatric psychiatry, combined with increases in life expectancy and the growing population of those age 65 and over, estimated to be 20 percent of the U.S. population in 2030 (up from 12 percent in 2006), foretells a crisis in health care that will impact older adults and their families nationwide. “Unless changes are made now, older Americans will face long waits, decreased choice, and suboptimal care,” AAGP President-Elect Charles F. Reynolds, III, MD, said. The AAGP urges Congress, the regulatory agencies, and health care thought leaders to act upon the IOM’s report and make the necessary changes to recruit and retain a skilled workforce in geriatrics and geriatric mental health care, and to adopt an efficient and effective organization of geriatric medical and mental health care services

Interviews available upon request.

The American Association for Geriatric Psychiatry (www.AAGPonline.org) is a national association representing and serving its members and the field of geriatric psychiatry. AAGP’s mission is to enhance the knowledge base and standard of practice in geriatric psychiatry through education and research and to advocate for meeting the mental health needs of older Americans.

CONTACTS:
Kate McDuffie, E-mail: kmcduffie@aagponline.org, Phone: 301.654.7850 x113
Marj Vanderbilt , E-mail: mvanderbilt@aagponline.org, Phone: 301.654.7850 x107

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