Improving Patient Experiences and Outcomes Through Personal Care Aide Training

Retooling the Health Care Workforce for an Aging America: A Current Perspective

A 2008 Institute of Medicine (IoM) report outlined a vision for health care and a workforce capable of addressing health and extended care needs of our aging population. It highlighted dramatic shortages necessitating bold action and outlined recommendations aimed at building a sizable and qualified workforce. This study updates report findings and progress made on its recommendations. Through review of publicly accessible, internet-based literature and government and professional organization websites, current workforce data and recent policy changes are compared to the report's statistics and recommendations. Direct comparisons are limited by changing definitions, context, and data collection and analyses methods. Future workforce-need projections are estimated using reports from various sources. Inability to forecast medical advances, socioeconomic changes, and world events affects the accuracy of these projections. Nonetheless, clear conclusions emerge despite such limitations. Progress toward fulfilling the IoM goals is variable and insufficient. The current and projected numbers for all geriatric health providers remain inadequate compared to estimated 2030 demand. Challenges in meeting estimated needs persist essentially unchanged. The 2008 IoM framework and recommendations remain relevant and constitute an important roadmap to complete unfinished goals. Initial findings from this update provide a platform for developing practice and policy reforms.

Paid Caregivers in the Community-Based Dementia Care Team: Do Family Caregivers Benefit?

PURPOSE

Older adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience.

METHODS

Using data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving).

FINDINGS

About one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (-0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33).

IMPLICATIONS

The provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.

Pursuing Age-Friendly University (AFU) principles at a major university: Lessons in grassroots organizing

Population aging presents challenges and opportunities that Michigan State University (MSU) is now taking on in a strategic way, but it has been a long road to reach a major milestone of establishing a program called AgeAlive. AgeAlive builds on fifty years of advocacy for coordinated aging-related programming and a more current grassroots effort that has led to a commitment to building an aging network connecting research, education, and outreach efforts based on Age-Friendly University principles. This case study describes AgeAlive's path from inception to a recognized program with a clear vision and strategic plan. Concrete goals include a complete inventory of aging-related activity on campus, a virtual hub for networking and information exchange, educational opportunities for students and elders, and building new retirement pathways. The MSU experience may benefit others interested in developing similar programs by offering strategies for moving forward amidst challenges inherent in large-scale, research-intensive institutions.