Geriatric nurse practitioners could save the nation money and maintain quality services
Geriatric nurse practitioners may be the future of age care at a time when doctors are getting difficult to find. Their skills and low cost are perfectly fit for complementing absent physicians.
Geriatric nurse practitioner represents a possible solution to the worsening shortage of doctors trained to treat the elderly. A health-care model that relied heavily on nurse practitioners for senior citizens rather than physicians could save the nation a lot of money without compromising quality.
“We’ve achieved a 45% reduction in hospitalizations with no negative impact,”says Evercare Chief Executive Dr. John Mach, himself a geriatrician.
Their mission is to see that her patients get the best medical attention possible, the kind of care nursing-home staff and primary-care doctors might be too busy to provide.
They also meets frequently with the families of her clients, discussing such uncomfortable issues as end-of-life directives, frequently left unaddressed until the patient is in crisis.
To many of them, geriatrics is a very, very rewarding field.
Each year, U.S. medical schools graduate about 16,000 students, and only 2% seek careers in geriatrics. In a 2006 survey, only 49% of medical school graduates said they received any geriatrics training as part of their medical education. Those numbers translate into a looming health-care crisis as the Baby Boom generation starts hitting old age.
Based on Census Bureau projections, the number of Americans aged 65 and older will double in size, from 35 million in 2000 to 70 million in 2030, while those 85 and older, already the fastest-growing age group, are expected to increase from 4.2 million to almost 9.6 million.
As a result, the Alliance for Aging Research estimates there will be a need for 36,000 geriatricians by 2030. In 2005 there were only 6,615 of these certified specialists for the aged–one for every 2,500 people over 75. By 2030 there will likely be only one per 3,600.
Nurse practitioners, already used to serving poor and rural populations where doctors are scarce, may be more inclined to take on the aged.
This class of highly trained nurses, who usually hold master’s degrees, are meant to work in collaboration with a doctor, although in 16 states they are allowed to practice independently. They can diagnose and manage acute and chronic illnesses and can write prescriptions in all 50 states. They can also specialize in geriatrics.
Doctors, however, are not keen on the idea of turning elder care over to NPs.
Even Evercare insists the 500 NPs it employs in 38 states are not meant to replace doctors but to work with them.
Yet study after study has found the primary care provided by NPs is as good as that of a doctor.
The federal Office of Technology Assessment determined back in 1987 that NPs can effectively treat 80% of all adult patients, and “outcomes are equal to or better than care by physicians.”
Some of the most persuasive arguments for boosting reliance on NPs are economic in nature. A 2003 study by the University of Minnesota, performed for the federal agency that administers Medicare, found that Evercare’s greater use of NPs reduced hospitalizations by half when compared with an equivalent population of nursing home patients not enrolled. “On average, using an NP is estimated to save about $103,000 a year in hospital costs per [nurse],” concluded the study, led by Kane. Plus, the nurses themselves are compensated by Medicare at only 85% of the rate of doctors.
Cutting the cost of elder care is no small matter because, while some American hospitals have top-notch geriatric programs, they usually lose money.
Mount Sinai’s Brookdale Chairman Dr. Albert L. Siu. “It’s almost impossible to practice geriatric care under Medicare and make money.”
Given that a third of all hospital patients are on Medicare, and count for almost half of all hospital charges, any inpatient reduction in this population could represent a huge savings. The problem is, there’s a shortage of nurses as well as doctors.
The John A. Hartford Foundation, a New York-based non-profit focused on improving elder care, is trying to reduce this deficit, with some success. For the past seven years, the foundation has been funding geriatric nurse training centres and scholarships. “There’s been a huge increase in graduates as a result,” says Kathleen Dracup, dean of the University of California at San Francisco’s nursing school.
As it happens, symptom management is just what aging patients with a multitude of ailments often require. And NPs are often better prepared, logistically and mentally, to provide it.
Whether there will ultimately be enough NPs to staff such clinics, and doctors to back them up, is still a question. A handful of states are increasing funding for geriatric training, but the federal government has done little to nothing.
(Business Week : “The Right Cure For Ailing Elder Care ? Nurse practitioners could save the nation money -while providing quality service”)