key: cord-0780670-jt822nps
authors: Resnick, Barbara
title: The Impact of COVID-19 on Building the Next Generation of Caregivers Focused on Care of Older Adults
date: 2021-04-30
journal: Geriatr Nurs
DOI: 10.1016/j.gerinurse.2021.04.009
sha: a836abeafdf83f0e52470b29a60189bfb056e34e
doc_id: 780670
cord_uid: jt822nps

nan

There are many reasons for the shortage of health care providers in geriatrics.

The first being that salaries and benefits are not competitive with those offered in acute or even primary care settings 2 . Although there have been some adjustments and increased opportunities recently with availability to bill for health promotion, completion of advanced directives and telehealth related activities, Medicare payments for care provided to older adults is still lower than specialty care and reimbursement for more invasive procedures such as joint replacements. Low pay is particularly noted for the direct care work force. Further, there is still that long standing perception that long term care facilities are depressing to work in, and that care and opportunities for learning are limited. For those of us working in long term care facilities we appreciate the fun and joy that comes with working with older adults in these settings, we recognize that each day is like working in the emergency room as we never know what can or will happen and we also appreciate the ongoing learning that comes from diagnosing disease states that are often quite rare but increase in presence with aging. We need to expose students to these experiences to increase their awareness of the many opportunities in long term care.

Already in crisis in terms of our ability to engage, excite and develop the next generation of health care providers focused on care of the older adults COVID-19 happened in 2020 and deepened the problem. The pandemic has disrupted academic and clinical work across all disciplines but particularly so for geriatric specialty education. It was recognized a few months into the pandemic that the health care system was not supporting the long-term care workforce and in the summer of 2020 the Centers for Medicare and Medicaid Services (CMS) developed an expert panel to make recommendations. These recommendations included such things as increasing organizational capacity to improve safety and quality around infection control, staffing, and physical design. There was nothing to require, encourage or support the development of more providers with the skills to provide care to older adults in these settings. In fact regulations were developed that prohibited or discouraged facilities from allowing students into facilities for clinical experiences. Truly this is a crisis at a time when skill development and exposure to working in long term care is most needed.

Without exposure students can't learn of the many benefits and opportunities in long term care. We need the CMS and state health departments to require that facilities allow students entry into settings to learn geriatrics and how to provide care to older adults in these settings. Certainly they can be required to adhere to the same infection control practices that are required for all staff.

In academic education of nurses, physicians, pharmacists and others we have adjusted such that didactic information is provided online, the use of simulation has been optimized and innovative approaches to clinical experiences have been used such as telehealth opportunities. I don't believe we can say what the outcomes of these changes are quite yet but they do not provide the critically important hands on clinical care to older adults. There may be some silver linings to these changes in the education such as an increased focus in medical education on community based public health and an increased recognition of the critically important value of all members of the health care team 3 . In nursing, State Boards of Nursing and certification groups have made some concessions in terms of increasing the amount of simulation that can be For those of you in administrative and leadership roles in long term care I encourage you to let us bring students back into your facilities to learn about the wonderful world of long-term care, geriatrics, and how to prevent and manage COVID-19 in these settings. For those of you working in these settings, despite being busier than ever as we deal with infection control and management, please consider volunteering as a preceptor. We all need to work together to develop a sufficient and exemplary next generation of health care providers ready to provide care in the longterm care environment.

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