A Missing Piece in the Infrastructure to Promote Healthy Aging Programs: Education and Work Force Development

There are compelling data available, both for the rapidly expanding older adult population, and for the value of evidence-based health promotion and disease management programs (EBHPs). The systems approach to transforming our aging services delivery system has been brilliant, but there is an important system missing – our educational system. Building the infrastructure to create embedded and accessible healthy aging programs must take into account workforce preparation. Most of the people currently working in the aging services delivery system are doing so without the benefit of any formal education or an organized course of study about older adults and aging services. For the state of California,61% of aging services agencies reported zero current staff with formal gerontology education, defined as having had even one academic course in aging content (1). In a national study, less than half (46.6%) of responding Area Agencies on Aging (AAAs) had at least one staff with either a certificate or degree in gerontology and almost 27% have an Evidence-Based Program (EBP) Coordinator position (2, 3). There was no data reported on aging services workforce preparedness in program planning, implementation, and evaluation of EBHP, even for the EBP Coordinator positions. There are several reasons, even with the availability of over 600 gerontology higher education programs nationwide, that our current aging services workforce lacks needed academic preparation. The first reason is a historical one: beginning employment in aging services may have pre-dated the widespread availability of gerontology education programs. Recent labor force studies have documented the “aging” of the aging services workforce, with impending mass retirement of longtime leaders and service providers. In fact, the California labor force study noted above documented that 52% of the aging services workforce is age 50 or over (1). And, the national study of aging services personnel echoed concerns about the “aging” of the aging services workforce, noting that about 20% of current staff is projected to retire within the next 5 years (by 2015) (2, 3). This means that workers nearing retirement age may have been entering college in the late 1960s and early 1970s. The first gerontology education programs at colleges began about 1972, and there were very few available until the 1980s. These anticipated high rates of retirement will soon lead to rapid turnover and the opportunity for new personnel replacements, perhaps with gerontology education backgrounds, at all levels. However, this “opportunity” assumes that current health and aging services leadership often without formal “aging” education will deem it a priority to hire available individuals with gerontology degrees or aging specialty education. The second reason for aging services workforce preparation deficits is also historical. Workforce preparedness for our aging society has been an important topic for decades – beginning with the landmark publication of the U.S. Health Services Resource Administration, Bureau of Health Professions (HRSA BHPr), entitled,“A National Agenda for Geriatric Education: White Papers” (4). The National Agenda documented the lack of training and preparedness for the many needed health and social service professions and concerns for major service delivery systems and higher education. A number of important recommendations were made in this report. Unfortunately, slow and incremental progress has been achieved in addressing them, especially in the area of public health and aging. The documented gaps in preparedness from the 1995 report were resounded in the 2008 Institute of Medicine Report,“Retooling for An Aging America”(5). The 2008 IOM Report summarized critical workforce preparedness deficits and called for increased competencies in every type of health and social services personnel at every level. The interesting thing is that geriatric and gerontologic competencies do exist for many health and social service disciplines, including medicine, nursing, social work, pharmacy, gerontology, and others (6–11). Public health currently does not have competencies specific to addressing the needs of older adults (12). In spite of the call for action, the existence of professional competencies, and the estimated 600 current gerontology programs in higher education, are we graduating a sufficient number of people to fill positions vacated by retirement? The answer is no. We are losing ground, and we did not have much “ground” to lose. A recent article in the Chronicles of Higher Education discussed an 11% reduction in the number of gerontology degree programs between 2000 and 2010 (13). The reasons cited were low enrollments, budget cuts for higher education programs, and few student incentives, such as availability of scholarships. It is clear that reductions in state budgets for higher education, and lack of funding at the federal level, have taken