St. Louis Missouri (MO) Small Business Social Media Marketing

By JERALD WINAKUR
Special to the Star-Telegram

This is the age of bailouts. Captains of industry parade through Washington with their hands out. There is uncertainty in the air, downright fear. The lobbying jackals circle. The scent of money is strong.

As a geriatrician who has practiced medicine in America for the last 32 years, I find the magnitude of largesse dispensed to failing industries unimaginable.

I have lived with Medicare price controls for decades and have managed to keep my head above water. Barely.

The situation is so absurd that geriatrics is the only specialty that rewards extra years of training with a decline in average income from general internal medicine — the base specialty from which most geriatricians first graduate.

Geriatricians are an idealistic lot: They have great respect for the elderly and just want to take care of their patients. They don’t count for much in the corridors of power.

Just a few short months ago, I thought I had reason to be optimistic about my chosen field.

Three of America’s oldest old were showcased by men who will lead our nation.

President-elect Barack Obama’s grandmother and Vice President-elect Joe Biden’s and Sen. John McCain’s white-haired mothers were prominent during the campaign.

Each candidate spoke reverentially of the important role his elder played in his life. I worry now that the images of these strong women displayed in old photographs, their interviews on talk media and their appearance on stage holding the hands of their sons were just attempts to garner votes in Florida and Arizona.

Those of us involved in caring for the burgeoning population of elderly in our nation await the storm surge of the old old (75-84) and oldest old (over 85): 72 million people, 20 percent of our population in the next 23 years. Only one out of 20 of those 85 and older is fully mobile, half have some degree of dementia. As many as 18 million will be diagnosed with Alzheimer’s disease by 2050.

Who will care for them? For us?

While every eight seconds, a boomer turns 60, the number of certified geriatricians in the U.S. has declined 19 percent in the last 10 years, to 7,000. Physician ranks grow by a mere 315 new geriatricians each year, fewer than those headed into retirement.

In 2003, 2 percent of physicians in the residency portion of their training programs indicated an interest in geriatric medicine.

In 2005, there was but one geriatrician for every 5,000 patients older than 65. America has a deficit of 14,000 geriatricians that will grow to 34,000 by 2030.

This crucial deficiency is not even on the radar screens of most policymakers.

It is not only a doctor shortage that we face. All the members of the “geriatric team” — nurses, therapists, social workers, care managers, psychologists and trained aides — are scarce as well.

A million RNs will retire in the next few years with few to replace them. Healthcare employees in nursing homes are woefully overworked, underpaid, under-trained and have the highest rates of depression of any group of workers in the nation.

And yet, they are the ones primarily responsible for the hour-by-hour, shift-by-shift care of our loved ones in long-term care facilities: our grandparents, our mothers and fathers — and soon ourselves.

The money to be spent on fixing the economy might reach nearly $2 trillion before this is all over. By contrast, Medicare and Medicaid together spend about $150 billion per year on long-term care.

Eliminate the yearly cutbacks in this funding and throw in but a few billion extra and just imagine what could be done to improve care for elders as we rethink and grow this essential industry.

My father recently died after an eight-year struggle with Alzheimer’s. My family, along with a dedicated home-health aide, kept him at home until the end. I am fortunate and was able to help with his care, and I expected nothing from any government agency. Most families cannot afford this.

After I wrote about my family’s struggle with my father in an essay titled What Are We Going To Do With Dad? published in Health Affairs and then The Washington Post, I received thousands of e-mails from across the country. One was from a man who put his elderly aunt and uncle in a nursing home in Costa Rica because it fell to him to care for them, and he researched an affordable alternative in a foreign country.

Is outsourcing the care of our loved ones the “next big thing” in globalization? Who will visit them, advocate for them, celebrate birthdays and anniversaries and holidays with them? Who will value them so that they will, in turn, feel valuable?

I have a better idea: Let’s invest in the well-being of our elderly.

Let’s improve and rethink the infrastructure that is crucial to their care in their old old years.

Let’s pour some billions into training those specialized in caring for the oldest among us, into research aimed at reducing frailty and improving quality of life in newly imagined settings.

Let’s provide more and better assistance to families who want to keep their relatives at home, the least expensive alternative by far.

Let’s continue to professionalize the elder-care work force and award advanced certification for added achievement, along with commensurate pay increases and benefits.

We need these folks — millions and millions of them — their hands-on work, compassion and skills. Their importance, their mission will only grow as our society ages. These are jobs that cannot be outsourced, skills that can be honed here in America and used to benefit all of us as the years go by.

It is time to invest in your mother. In all of our mothers and fathers. In us.