The Coming Crisis in Aging

Turnover among nurse aides averages 71% percent, and as many as 90% of home health aides leave their jobs within the first two years, according to the Institute of Medicine, an arm of the National Academy of Sciences, Washington.

The IOM advocates raising the federally required minimum number of hours of training for direct-care workers from 75 hours to at least 120. As it stands now, more training is required for dog groomers and manicurists than for home health care workers.

Medicare, Medicaid and other health plans need to pay more for the services of geriatric specialists and direct-care workers to attract more health professionals to geriatric careers and to reduce turnover among care aides.

Medicare, which subsidizes teaching hospitals for graduate medical education, could mandate that those schools provide adequate geriatric care training of resident physicians.

States could also mandate continuing geriatric education for physicians to become licensed in their states or to receive funds from Medicaid.

Family members and other informal caregivers can only do so much to care for aging loved ones.

And there's only so much the government can do, as well. The Urban Institute projects that entitlement programs such as Social Security, Medicare and Medicaid will consume an estimated 80% of all federal tax dollars by 2040.

For many, growing older involves an expected loss of vigor and fitness. But it doesn't have to be so. Some measures that can help moderate the effects of aging include more research on Alzheimer's disease and other forms of dementia. These illnesses can last 20 years. Reducing their progress can assure a significant reduction in health care needs by the elderly.

Wellness programs for all adults will help, too. Health care has to begin with improved diet and exercise and on the availability of regular medical care throughout the working years of adults, to help assure their healthy aging.