Nursing

DING2017

WarshawandBraggGeriatricCareEducation.pdf

28 | Spring 2016 • Vol. 40 .No. 1

G E N E R AT IO N S – Journal of the American Society on Aging

Copyright © 2016 American Society on Aging; all rights reserved. This article may not be duplicated, reprinted or distributed in any form without written permission from the publisher: American Society on Aging, 575 Market St., Suite 2100, San Francisco, CA 94105-2869; e-mail: [email protected]. For information about ASA’s publications visit www.asaging.org/publications. For information about ASA membership visit www.asaging.org/join.

Pages 28–37

H ealthcare for many older adults means maintaining maximum independence, not just extending years of life. Healthcare profes- sionals trained in gerontology can deliver such health services, but providing good healthcare for older adults is not the same as providing care for middle age and younger adults. The develop- ment of pediatric care systems and training came from the recognition that providing care for chil- dren is very different than providing care for adults. Similarly, providing care to older adults using the same approaches used to care for middle age or younger adults can lead to the wrong amount of care, in the wrong location, and to poor outcomes.

Well-documented weaknesses in the health- care system include an inadequate supply of professional workforce specialists in geriatrics or gerontology who can provide expert care and train other providers; limited training of all healthcare professionals in the best practices in care of older adults and chronic disease manage- ment; and, a shortage of well-trained direct care

workers—nurse aides, home health aides, and personal care aides.

Preparing the healthcare workforce to address the changing needs of a growing elder popula- tion is essential to ensure optimal quality care, especially for the frail elderly. Unfortunately, education in the health professions is slow to change. Clinician training in geriatrics or geron- tology is not meeting the needs of aging adults. Despite some improvements, geriatric princi- ples are still insufficiently represented in health- care training curricula and clinical experiences focused on gerontology are not robust.

Workforce training goals for an aging popula- tion are recruitment and training of geriatrics- gerontology specialists to lead care programs and systems and education programs; and ensuring all health profession students and providers have the skills to provide older adults with evidence-based, individualized, and co- ordinated team-based care that prioritizes patients’ goals, function, and quality of life (Aronson, 2015).

abstract The training of clinicians in geriatrics-gerontology care is not keeping up with demand for these services. Workforce training goals for an aging population are recruitment and training of geriatrics-gerontology specialists to lead care programs, systems, and education programs; and ensur- ing all health profession students and providers have the skills to provide older adults with evidence- based, individualized, and coordinated team-based care that prioritizes patients’ goals, function, and quality of life. Without an immediate and significant commitment to address these goals, many older adults will receive inadequate care. By extension, their children will be burdened with extraordinarily challenging responsibilities. | key words: Geriatrics, geriatricians, caregiving, workforce training

The Essential Components of Quality Geriatric Care By Gregg A. Warshaw and Elizabeth J. Bragg

Geriatrics-gerontology education and certification are key to providing the best care for older adults.

Spring 2016 • Vol. 40 .No. 1 | 29

America’s Eldercare Workforce: Who Will Be There to Care?

Pages 28–37

The success of new financing models to fund care for older adults also depends upon creating a well-trained workforce. The Affordable Care Act (ACA) is accelerating change, largely directed at improving quality and lowering cost, which places additional demands on an ill-prepared workforce. For example, the new Federal Coor- dinated Health Care Office, created to improve care coordination for dual eligible beneficiaries, created new Medicare-Medicaid integrated fi- nancing models to improve care coordination. To achieve improved patient outcomes will require effective team care and a workforce that is skilled in the care of frail older adults.

In this article, we review some of the new initiatives to prepare the professional geriatric and gerontology workforces—strategies created in response to the Institute of Medicine (IOM) report, Retooling for an Aging America (IOM, 2008). We also review data on workforce preparation and progress made to educate all healthcare providers who may interact with aging adults. Finally, we propose policies that could accelerate the creation of a healthcare workforce that is prepared to provide the best possible healthcare to older Americans.

Taking the Initiative: Responding to the IOM The IOM report’s pessimistic conclusions have encouraged a number of initiatives, led by pri- vate foundations, health professions societies, and the government. Although loosely coordi- nated and not yet sufficient, these activities are at least maintaining a focus on the challenges facing the healthcare workforce as the popula- tion ages. The Eldercare Workforce Alliance (EWA) is a group of thirty-one national organi- zations representing healthcare providers— physicians, nurses, direct care workers, psychol- ogists, social workers, pharmacists, physical therapists, eldercare employers, consumers, and family caregivers—that work to address the im- mediate and future workforce crisis in caring

for an aging America. EWA advocates for policies to expand the number and skills of the clinical workforce, and to provide support and training for family caregivers.

The Partnership for Health in Aging (PHA) consists of twenty-one organizations represent- ing healthcare providers who care for older adults. PHA already has developed a set of core competencies in the care of older adults; these are endorsed by most health profession disci- plines (PHA, 2010).

The Interprofessional Education Collabora- tive (IPEC), formed in 2009, represents six national education associations of schools of health professions (allopathic and osteopathic medicine, dentistry, nursing, pharmacy, and public health). IPEC initially developed core competencies for interprofessional collabora- tive practice to guide curricula development across health professions schools. More recent- ly, the Josiah Macy Jr. Foundation funded IPEC to launch an interprofessional education por- tal and to create a national clearinghouse of competency-linked learning resources on inter- professional education and models of team- based, or collaborative care.

The Veterans Health Administration (VHA) continues a long-standing commitment to im- prove their geriatrics/gerontology workforce through the VHA’s graduate medical education programs and the Geriatric Research, Educa- tion, and Clinical Centers. The John A. Hartford Foundation of New York City and the Donald W. Reynolds Foundation of Las Vegas have continued long-standing, robust investments in workforce development for the care of older adults.

The federal Bureau of Health Workforce (BHW), within the Health Services and Resourc- es Administration, is home to the National Cen- ter for Health Workforce Analysis (NCHWA),

There have been only 7,000 actively certified geriatricians for more than ten years.

30 | Spring 2016 • Vol. 40 .No. 1

G E N E R AT IO N S – Journal of the American Society on Aging

Pages 28–37

which documents and projects shortages and other trends influencing the adequacy of the U.S. healthcare system to meet current and future workforce needs. In 2013, the NCHWA established three affiliated research centers to address specific workforce topics related to an aging population. The Health Workforce Research Center at the University of California, San Francisco, focuses on long-term care. The University of North Carolina’s Health Workforce Research Center focuses on flexibility in profes- sional roles, new types of workforce members, and the creation of a workforce prepared to work in new models of care. The Oral Health Workforce Research Center at University at Albany, State University of New York, studies the oral health workforce and its ability to provide

services to vulnerable populations, such as older adults in institutional settings.

Making Progress to Prepare and Certify the Workforce Over the past five years, formal education and certifying efforts to prepare the workforce for an aging population have gained some momentum, but gains have been modest. Success varies among the health professions. Table 1 summa- rizes the current progress toward preparing selected health disciplines to care for older adults (see below).

Geriatricians and geriatric psychiatrists The number of geriatricians with up-to-date certification has remained flat at around 7,000

Table 1. Progress in Preparing the Geriatric/Gerontology Workforce, by Discipline*

Discipline Progress

Geriatricians Number of certified physicians has remained flat at 7,000 for the past 10 years. Many fellowship positions do not fill: approximately 300 geriatricians are trained each year. More international medical school graduates than United States medical graduates enter fellowship training.

Geriatric Psychiatrists Number of certified geriatric psychiatrists is less than 2,000; many fellowship positions do not fill. In 2014–2014, for the first time, more U.S. medical school graduates entered fellowship training than international medical school graduates.

Gerontology Advanced Practice Registered Nurses (APRN, NP & CNS)

In 2013, because so few NP and CNS were certifying in gerontology, the certification was phased out and combined with adult primary and acute care certifications. This greatly increased the number adult- gerontology certified APRN to 12,000.

Registered Nurses Certified in Gerontology

From 2013 to 2014, there was an increase of 1.7 percent in RN certified in gerontology. In 2014, 7,874 RN certified out of 3.1 million RN.

Gerontological Social Workers There is no certification in gerontology for social workers. In 2009, there were 10,387 graduates of a Bachelor of Social Work program and 1,318 in a Master of Social Work program specialized in aging.

Certified Geriatric Pharmacists In 2015, 2,158 pharmacists certified in geriatrics compared to 1,210 in 2010, a 78 percent increase.

Geropsychology In 2010, the APA recognized professional geropsychology as a special area of psychology. Starting in 2010, APA started accrediting a geropsychology postdoctoral program. In 2014, the American Board of Professional Psychology included geropsychology as a boarded specialty.

Geriatric Physical Therapy In 2015, there were 1,936 physical therapists certified in geriatrics compared to 1,006 in 2010, a 92 percent increase. Seven new residency programs since 2010 bring the total of programs to thirteen.

Gerontology-Certified Occupational Therapists

Certification in gerontology available with only eighteen occupational therapists certified in gerontology as of 2015.

* Discussion and references are in the article text.

Spring 2016 • Vol. 40 .No. 1 | 31

America’s Eldercare Workforce: Who Will Be There to Care?

Pages 28–37

for more than ten years. Likewise, the number of certified geriatric psychiatrists is fewer than 2,000 (American Board of Medical Specialists, 2014). Geriatricians and geriatric psychiatrists first graduate from an accredited allopathic or osteopathic family medicine or internal medi- cine residency program, or psychiatry residency program, then complete geriatrics fellowship training. The small number of certified geriatri- cians and geriatric psychiatrists do not reflect a lack of fellowship positions. In the past three academic years, more than 40 percent of these positions went unfilled (see Table 2, above) (Brotherton and Etzel, 2011, 2012, 2013, 2014).

Besides only training about 300 new geriatri- cians annually, another explanation for the low numbers of certified geriatricians is that many physicians do not maintain their time-limited certifications. Recertification is required every ten years and many younger physicians have decided that the time and cost of recertification

provide no benefit. Many geriatricians in private practice are paid less than their primary care colleagues without geriatrics training.

The barriers to recruiting and retaining physicians in geriatric medicine have not changed since the 2008 IOM report; these continue to be relatively low salaries, combined with high trainee debt, complexity of geriatrics cases, and extant negative stereotypes of work- ing with older adults. It remains to be seen if the new ACA care and financing models, as well as changes in Medicare’s approach to physician reimbursement, will lead to an increase in the numbers of physicians choosing geriatric medicine careers.

Advanced Practice Registered Nurses and Registered Nurses Advanced Practice Registered Nurses (APRN) are either nurse practitioners (NP) or clinical nurse specialists (CNS). NP and CNS can be

Table 2. Osteopathic and Allopathic Fellowship Programs in Geriatric Medicine and Geriatric Psychiatry

Specialty

2011–2012 2012–2013 2013–2014

Programs Positions

Fellows (percent of positions filled) Programs Positions

Fellows (percent of positions filled)

Osteopathic Family Medicine (FM) Geriatric Medicine

10 34 5 (15%) 13 40 8 (20%) 15 46 7 (15%)

Allopathic Family Medicine Geriatric Medicine

44 102 56 (55%) 41 102 65 (64%) 41 98 52 (53%)

Total FM 54 136 61 (45%) 54 142 73 (51%) 56 144 59 (41%)

Osteopathic Internal Medicine (IM) Geriatric Medicine

6 21 2 (9%) 6 21 1 (.04%) 11 36 1 (.03)

Allopathic Internal Medicine Geriatric Medicine

105 413 219 (53%) 105 410 246 (60%) 105 399 267 (67%)

Total IM 111 434 221 (51%) 111 431 247 (57%) 116 435 268 (62%)

Total GM 165 570 282 (49%) 165 573 320 (56%) 172 579 327(56%)

Osteopathic Geriatric Psychiatry (GP) 2 6 1 (17%) 2 6 0 (0%) 2 6 1 (16%)

Allopathic Geriatric Psychiatry 55 125 55 (44%) 55 121 68 (56%) 56 125 63 (54%)

Total GP 57 131 56 (43%) 57 127 68 (54%) 58 131 64 (49%)

Sources: Martinez and Biszewski, 2015; Brotherton and Etzel, 2011, 2012, 2013, 2014.

32 | Spring 2016 • Vol. 40 .No. 1

G E N E R AT IO N S – Journal of the American Society on Aging

Pages 28–37

certified by one of three credentialing organiza- tions. Despite the growing need for APRNs with expertise in gerontology, certification exami- nations for NP and CNS in gerontology were eliminated through a consensus process that included representatives of forty nursing organizations. The rationale for retiring the geriatric credential was never published (Aron- son, 2014). One possible explanation is that in 2012, only 300 APRN were certified in gerontol- ogy, compared to more than 4,000 in adult and acute care (American Nurses Credentialing Center [ANCC], 2012; American Academy of Nurse Practitioners Certification Program [AANPCP], 2012).

While no new certifications in these two areas will be awarded, currently certified APRN can maintain their gerontological credentials as long as they do not let their certificates expire. And APRN who were certified previously in gerontology and adult care can transition to the new Adult-Gerontology Certifications in either acute or primary care. While this change will increase the number of APRN who have ger- ontology skills, it runs the risk of eliminating

nursing specialists in gerontology to serve as faculty and clinical leaders (see Table 3, below). The APRN model of adult gerontology−, primary care−certified practitioners recently was pro- posed as a solution to the declining interest of physicians to specialize in geriatrics (Golden, Silverman, and Issenberg, 2015). If newly trained APRN maintain a focus in geriatrics care, they will be an important source of primary care for older adults, alongside primary care physicians and geriatricians.

The ANCC is the only certifying body that certifies Registered Nurses (RN) in gerontol- ogy. From 2013 to 2014, there was a small, 1.7 per- cent increase in the number of RN certified in gerontology (ANCC, 2014), a total of 7,874 gerontology-certified nurses of the more than 3.1 million RN in the United States (see Table 3).

Social workers There is no formal gerontology certification for social workers (National Association of Social Workers [NASW], 2015). The Council on So- cial Work Education (CSWE), the accrediting agency for social work education, estimated

Table 3. Certifications in Gerontological Nursing by the American Nurses Credentialing Center (ANCC), American Academy of Nurse Practitioners Certification Program (AANPCP), and American Association of Critical Care Nurses (AACN)

ANCC 2013

ANCC 12/31/14

AANPCP August 2014

AANPCP 12/31/14

AACN 12/31/13

AACN 12/31/14

Total 2013

Total 2014

APRN

Gerontological NP (GNP)* 4,361 4,124 510 281 N/A N/A 4,871 4,405

Adult-Gerontology Primary Care NP (A-GNP) (launched 1/2013 by AANPCP)

754 2,276 1,600 2,246 N/A N/A 2,354 4,522

Adult-Gerontology Acute Care NP [ACNPC-AG] (launched 1/2013)

576 2,002 N/A N/A 113 179 689 2,181

Gerontological CNS** 536 501 N/A N/A N/A N/A 536 501

Adult-Gerontology CNS [ACCNS-AG] (launched 7/2013 by AACN and 2014 by ANCC)

N/A 139 N/A N/A 84 183 84 322

Gerontological Nursing (RN) 7,739 7,874 N/A N/A N/A N/A 7,739 7,874

*Certification no longer offered, effective 12/2012. **Certification no longer offered, effective 12/2013. Sources: ANCC, 2014; AANPCP, 2014; AACCN, 2015.

Spring 2016 • Vol. 40 .No. 1 | 33

America’s Eldercare Workforce: Who Will Be There to Care?

Pages 28–37

that in 2011 there were 31,446 gerontological social workers, based on 9 percent of the NASW membership identifying aging as their primary area of focus (CSWE, 2011). They also reported that during the 2009–2010 academic year, 387 graduates (out of 13,836) in bachelor’s social work programs completed a specializa- tion in aging. During that same time, 19,673 students graduated with a Master of Social Work degree and 1,318 completed a specialization in aging (CSWE, 2011).

CSWE also houses the Gero-Ed Center, whose mission is to promote gerontological competencies in baccalaureate and master’s level social work programs.

Pharmacists In 2010, there were 1,210 certified geriatric pharmacists in the United States (personal communication with Tom Clark, executive director, Commission for Certification in Geriat- ric Pharmacy, October 2010) among the 269,900 staffed pharmacy positions reported by the U.S. Department of Labor (U.S. Bureau of Labor Sta- tistics, 2010). In 2015, the number of certified geriatric pharmacists increased to 2,158 (personal communication with Courtney Moore, director of operations, Commission for Certification in Geriatric Pharmacy, August 28, 2015). Fellowships and postgraduate residency programs specializing in geriatrics provide advanced pharmacy training in geriatrics. In 2010, there were twelve specialty residencies in geriatrics accredited by the Ameri- can Society of Health System Pharmacists (ASHP), and this increased to nineteen programs by 2015 (ASHP, 2015).

Psychologists Since 2010, the American Psychological Asso- ciation (APA) has recognized professional geropsychology as a specialty area that requires advanced knowledge and skills (APA, 2015). In 2014, geropsychology was included among psychology specialties boarded by the American Board of Professional Psychology.

The Department of Veterans Affairs sponsors postdoctoral geropsychology training programs. Other programs exist outside the VHA that pro- vide postdoctoral specialty training in gero- psychology. The Council of Geropsychology Training Programs (CPGTP) is a group of

forty-one organizations providing geropsychol- ogy training, including fourteen that provide post-doctoral training in professional geropsy- chology (CPGTP, 2015). There is one APA- accredited geropsychology postdoctoral residency program (out of 111 accredited programs) at the VA Pittsburgh Healthcare System. A second program is under review for accreditation (APA, 2015). However, programs were only accredited starting in 2010, and as more residency programs are re-accredited, the number of programs list- ing geropsychology as a specialty, rather than just an area of emphasis, should increase.

Physical therapists In 2010, 103 physical therapists were newly cer- tified in geriatrics and, by 2015, that number doubled to 215 (American Board of Physical Therapy Specialties [ABPTS], 2015). As of June 2015, 18,071 individuals have been board- certified as clinical specialists in physical therapy, with 1,936 certified in geriatrics (ABPTS, 2015). This is an increase of 930 certified physical therapists since 2009. In 2010, there were only six American Physical Therapy Association geriatrics residencies and that number increased to thirteen by 2015 (American Board of Physical Therapy Residen- cy and Fellowship Programs, 2015).

Occupational therapists Occupational therapists must have a master’s degree for entry-level practice, and occupational therapy assistants must have an associate’s degree. Both must pass an initial certification exam. The American Occupational Therapy

‘A training gap exists and could be corrected.’

34 | Spring 2016 • Vol. 40 .No. 1

G E N E R AT IO N S – Journal of the American Society on Aging

Pages 28–37

Association offers board certification in geron- tology. There are eighteen occupational thera- pists certified in gerontology (American Occu- pational Therapy Association, 2015), and four approved residency sites for occupational therapy, but none in gerontology.

Barriers to Progress For many faculty and practitioners, the geriat- rics/gerontology “training gap” is underappre- ciated. It is assumed that a well-trained clinician who can provide good care to adults can also provide good care for the very old. In fact, the failures of the workforce to provide good care sometimes are recognized by health profession- als only when their own relatives are struggl- ing. Clinicians are most comfortable manag- ing clinical problems for which they have the most training experience. The care of common medical problems in middle-aged and older

adults, such as pneumonia, congestive heart failure, and diabetes mellitus, is basic to the clinical training of most clinicians and often is well-managed, even in the very old. However, when clinicians are presented with frail elders with multiple chronic problems, or common geriatric syndromes, the care provided is not of the same quality as that provided by geriatrics/ gerontology professionals (Wenger et al., 2009). A training gap exists and could be corrected.

One barrier to correcting this gap involves professional training sites. Many health profes- sions concentrate training in hospitals wherein the faculty has more experience caring for patients and there is financial support for training. Ambulatory settings now are used more often for training, but experiences for learners in the home and long-term-care insti- tutions remain less common. A recent IOM report on graduate medical education recom-

mended significant changes to the post-graduate training of physicians (IOM, 2014).

Another barrier is the inadequate numbers of geriatrics/gerontology–trained faculty. Despite considerable progress, ageism still exists within healthcare training programs and healthcare practice. The response to the aging population by leaders in health professions schools has been remarkably complacent, demonstrated by a minimal investment in trained geriatrics/ger- ontology clinician-educators and inadequate training curriculums. Negative cultural and professional stereotypes discourage health professions students from selecting careers working with older adults. It also remains more attractive to work with patient populations in which cures are more likely and chronic disease is less common. The accumulated clinical and social challenges associated with caring for frail older adults are daunting for many young learners. There also is considerable evidence that clinicians working exclusively with older adults receive less compensation than their colleagues. This is a significant barrier in an era of high student debt.

Meeting the Challenge Accelerating progress toward a well-prepared workforce requires improved tracking of training outcomes and expanded or new policy initiatives.

For most health professions, it is difficult to track the progress made over the past seven years toward preparing the workforce for an aging society. The 2008 IOM report recom- mended that the BHW prepare an annual review of workforce and aging. This has not been funded adequately or implemented: Congress should make this a priority.

To attract young professionals committed to geriatrics/gerontology academic careers, public and private payers will need to expand financial incentives to enter such specialties. Congress should appropriate funds for the ACA workforce provisions that authorize training, scholarship,

Lower compensation is a significant barrier in an era of high student debt.

Spring 2016 • Vol. 40 .No. 1 | 35

America’s Eldercare Workforce: Who Will Be There to Care?

Pages 28–37

and loan forgiveness for individuals who work with or are preparing to work with older adults (IOM, 2012). Modest state scholarship and loan forgiveness programs are widely available to encourage primary care physicians and other health professionals to work in underserved areas. Geriatricians qualify for participation in most of these programs, but interest has been low.

A unique geriatrician and geriatric psychia- try recruitment program is available in South Carolina. Since 2005, fourteen physicians have received $35,000 per year of fellowship training loan forgiveness for establishing a practice in South Carolina for five years (South Carolina Office on Aging, 2005). The expansion of specialized recruitment programs to more states, other healthcare disciplines, and an increase in loan forgiveness amounts could be attractive to young health profession students, most of whom are carrying large debts and considering higher paying career paths. The BHW should receive more budget support for their new Geriatrics Workforce Enhancement Program grants program and restore and ex- pand the Geriatric Academic Career Awards program for early and mid-career geriatrics/ gerontology clinician-educators.

Curriculum planners in health professions schools and accreditation organizations should incorporate into their training curricula the geriatrics/gerontology and teamcare educational competencies established by the American Ger- iatrics Society, the Interprofessional Educa- tion Collaborative, and other professional societies. This process has begun, but efforts vary greatly among training programs. The principal source of funding for physician resi- dency and fellowship training is the Medicare Trust Fund. Policy makers can encourage the Centers for Medicare & Medicaid Services to modernize graduate medical education payments and training to benefit the Medicare

population. Graduate Medical Education funding policies should incentivize training in settings outside the hospital—settings where older people frequently receive care, such as in the home and in long-term-care institutions. And, health professions schools’ certifying bodies and post-graduate training accreditation standards must mandate training in geriatrics/ gerontology for all students and for post-graduate trainees in all specialties. Professional certi- fication organizations (e.g., specialty boards) should ensure geriatrics competency through initial certification examinations and mainte- nance of certification education.

Summary The remarkable success of our public health and medical care advances has led to many more Americans living into their eighties and well beyond. This accomplishment has changed the landscape of our society and the demands on our healthcare system. Caring for older adults is part- icularly challenging and requires a large and well-trained workforce, however, the current workforce has inadequate numbers of profession- als prepared to care for this population. Without an immediate and significant commitment to develop the healthcare workforce to meet this challenge, many older adults will receive inad- equate care. By extension, their children and grandchildren will be burdened with extraordi- narily challenging responsibilities for which they will not receive sufficient support.

Gregg A. Warshaw, M.D., is a clinical professor of Family Medicine and Internal Medicine (Geriatrics Division), at the School of Medicine, University of North Carolina, in Chapel Hill. He can be contacted at [email protected]. Elizabeth “Libbie” J. Bragg, Ph.D., R.N., is an assistant professor in the School of Nursing at Xavier University, in Cincinnati, Ohio. She can be contacted at [email protected].

36 | Spring 2016 • Vol. 40 .No. 1

G E N E R AT IO N S – Journal of the American Society on Aging

Pages 28–37

References American Academy of Nurse Practitioners Certification Pro- gram (AANPCP). 2012. American Academy of Nurse Practitioners Certification Program 2012 Handbook. https://www.aanpcert. org/ptistore/resource/documents/ 2012%20Annual%20Report.PDF. Retrieved May 1, 2013.

AANPCP. 2014. American Academy of Nurse Practitioners Certification Program 2014 Handbook. www. aanpcert.org/ptistore/control/ index. Retrieved July 18, 2015.

American Association of Critical Care Nurses. 2015. “Exam Statis- tics.” www.aacn.org/wd/certi fications/content/statistical. pcms?menu=certification. Retrieved July 18, 2015.

American Board of Medical Specialists (ABMS). 2014. 2013– 2014 ABMS Board Certification Report. Chicago, IL: ABMS.

American Board of Physical Ther- apy Specialties (ABPTS). 2015. “ABPTS Certified Specialties Statistics.” www.abpts.org/ About/Statistics/. Retrieved August 30, 2015.

American Board of Physical Therapy Residency and Fellow- ship Programs. 2015. Directory of Programs. www.abptrfe.org/ DirectoryofPrograms/. Retrieved August 30, 2015.

American Nurses Credentialing Center (ANCC). 2012. “2012 ANCC Certification Data.” Silver Spring, MD: ANCC.

ANCC. 2014. “2014 ANCC Certifi- cation Data.” www.nursecreden tialing.org/Certification/Faculty Educators/FacultyCategory/ Statistics/2014-ANCC-Certifi cation-Statistics.pdf. Retrieved July 15, 2015.

American Occupational Therapy Association. 2015. “Board-Certified Practitioners.” www.aota.org/ Education-Careers/Advance- Career/Board-Specialty-Certifica tions/BoardCert.aspx. Retrieved August 30, 2015.

American Psychological Associa- tion. 2015. Commission on Accredi- tation Newsletter. www.apa.org/ ed/accreditation/newsletter/ 2015/05/may.pdf. Retrieved August 30, 2015.

American Society of Health System Pharmacists. 2015. Directory of Residency Programs. https://accred. ashp.org/aps/pages/directory/ residencyProgramDirectory. aspx?pageno=1. Retrieved August 29, 2015.

Aronson, L. 2015. “Necessary Steps: How Health Care Fails Older Pa- tients, and How It Can Be Done Better.” Health Affairs 34(3): 528–32.

Aronson, M. E. 2014. “Discontinu- ing Geriatric Expertise Certifica- tion for Nurses.” www.medscape. com/viewarticle/835847?src=email this. Retrieved August 15, 2015.

Brotherton, S. E., and Etzel, S. I. 2011. “Graduate Medical Education 2010–2011.” Journal of the Ameri- can Medical Association (JAMA) 306(9): 1015–30.

Brotherton, S. E., and Etzel, S. I. 2012. “Graduate Medical Educa- tion 2011–2012.” JAMA 308(21): 2264–79.

Brotherton, S. E., and Etzel, S. I. 2013. “Graduate Medical Educa- tion 2012–2013.” JAMA 310(21): 2328–46.

Brotherton, S. E., and Etzel, S. I. 2014. “Graduate Medical Educa- tion 2013–2014.” JAMA 312(22): 2427–45.

Council of Professional Geropsy- chology Training Programs. 2015. “Geropsychology Training Pro- grams.” www.copgtp.org/index. php?target=home. Retrieved September 11, 2015.

Council on Social Work Education. 2011. Geriatric Workforce Needs. Alexandria, VA: National Center for Gerontological Social Work Education. www.cswe.org/ CentersInitiatives/GeroEdCenter/ Initiatives/WorkforceDevelopment /70124.aspx. Retrieved August 28, 2015.

Golden, A. G., Silverman, M. A., and Issenberg, S. B. 2015. “Address- ing the Shortage of Geriatricians: What Medical Educators Can Learn From the Nurse Practi- tioner Training Model.” Academic Medicine 90(9): 1236–9.

Institute of Medicine (IOM). 2008. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: The National Academies Press.

IOM. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? Washing- ton, DC: The National Academies Press.

IOM. 2014. Graduate Medical Education That Meets the Nation’s Health Needs. Washington, DC: The National Academies Press.

Martinez, B., and Biszewski, M. 2015. “Appendix 1: Osteopathic Graduate Medical Education, 2015.” The Journal of the American Osteopathic Association 115(4): 268–74.

National Association of Social Workers. 2015. “Social Work Credentials.” www.socialworkers. org/credentials/default.asp. Retrieved August 30, 2015.

Spring 2016 • Vol. 40 .No. 1 | 37

America’s Eldercare Workforce: Who Will Be There to Care?

Pages 28–37

Partnership for Health in Aging. 2010. “Multidisciplinary Compe- tencies in the Care of Older Adults at the Completion of the Entry- level Health Professional Degree.” www.americangeriatrics.org/files/ documents/pha/PHAMultidisc Comps.pdf. Retrieved September 4, 2015.

South Carolina Office on Aging. 2005. “Geriatrics Loan Forgiveness Program.” http://aging.sc.gov/ programs/Pages/GeriatricLoan ForgivenessProgram.aspx. Retrieved October 6, 2015.

U.S. Bureau of Labor Statistics. 2010. Occupational Outlook Handbook. www.bls.gov/ooh/ healthcare/home.htm. Retrieved September 20, 2015.

Wenger, N. S., et al. 2009. “A Practice-based Intervention to Improve Primary Care for Falls, Urinary Incontinence, and De- mentia.” Journal of the American Geriatrics Society 57(3): 547–55.

Acknowledgment The authors thank Greg Hinrichsen, Ph.D., for his assistance regarding geropsychology.

C O M I N G U P I N

Summer 2016

LGBT Aging

Karen Fredriksen-Goldsen, Guest Editor

With the increasing diversity of the older adult population, the number of LGBT older adults is rapidly growing. Recent research documents social, health, and economic disparities among these populations. Considering current political and cultural will, recent landmark legal decisions on gay marriage and federal rulings on housing and workplace rights for LGBT persons, now is the time to address the issue of LGBT aging.

This Summer 2016 issue of Generations will showcase cutting-edge practices, programs, policy initiatives, and research designed to better address the unmet needs and lack of access to services for LGBT older adults, their families, and communities.

Generations

Copyright of Generations is the property of American Society on Aging and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.