You will find in this topic everything from the history of Medicare and Medicaid to the predictions for healthy aging for Baby Boomers. Gerontological nursing is very young in terms of an identified specialization, research, publications, and curricula. Prior to Medicare, subject matter in Growth and Development courses ended when teen-agers became adults. The whole period of adulthood and old age was left unaddressed.
Most practicing nurses today cannot remember what nursing was like prior to Medicare. The first patients to participate in this federally sponsored insurance program were admitted to certified hospitals on July 1, 1966. The first patients to receive nursing home care in this program were admitted on January 1, 1967. The progress made since that time has been phenomenal! Before Medicare, there were no textbooks on the subject of gerontological nursing; there was little information available on the subject of normal aging. Unlike today, there were no nurse faculty prepared to teach the subject, since there were no graduate programs in gerontological nursing.
Even with progress, work remains to be done if we are to provide quality nursing care for our growing elderly population. In the initial articles for this topic, a variety of authors share their perspective on relevant issues in the care of older adults, planning for long-term care, and possible solutions. In addition, specific information in several articles relates to the challenges facing Baby Boomers and the frail elderly.
In the first article, Bennett and Flaherty-Robb discuss key issues related to the enjoyment of healthful old age in America. These issues are discussed from a very refreshing perspective. Quality of life, how to attain and maintain it, is presented as the concept on which health professionals should focus their study and practice. In order for this to happen, the American cultural value system will need to change. At present, our system dwells on treatment of disease rather than prevention of disease and activities that promote health and quality of life. While treatment of disease is necessary, it should not be the main focus of all treatment and expenditures. Education of families and "like-families" in regard to aging members should be approached from a quality of life rather than a disease perspective. The term "compression of morbidity" is introduced. This term is related to middle aged persons who are looking toward a very active old age when their limitations will be limited to just a few days or weeks prior to death. Bennett and Flaherty-Robb address facts regarding the nursing shortage, treatment approaches related to "the experience of illness", and the demographics of the aging population.
When it comes to answering questions regarding care of elderly persons or long term care planning for today's Baby Boomers, have you ever been stumped because of the maze of government and private funding sources? What is Medicare? What is Medicaid? Who pays for these programs? Is it better for the older person to receive care in the home or in a nursing home…or perhaps is assisted living preferable? What about veterans...where should they receive long-term care? The second article, by Edlund and Lufkin, explains this all in a way that takes the mystery out of the federal-state-veterans and private insurance companies’ methods for funding and the eligibility for care needed by elderly persons to participate in these programs.
Both the maze of programs and the lack of qualified health care personnel challenge long-term care planning. Today’s nursing shortage is not new to anyone. However, the combination of the shortage, the aging nursing workforce, the aging population, and the lack of nursing faculty and nurses with specialized training in gerontology are reviewed by Mion in the third article. These intersecting forces will undoubtedly impact the ability to provide quality nursing care to older adults. Without positive steps to influence these trends, Mion asks, who will provide future health care delivery to the geriatric population in the US? The facts regarding the nursing shortage are addressed from a historical perspective using demographics of nurses providing care to elderly persons in acute, long-term, and community settings. Mion further provides demographics on nursing faculty and explains the impact the nursing faculty shortage has and will continue to have on nurses' ability to provide care to elders. The void in many basic curricula on the topic of gerontological nursing and the causes for the void are given. In addition, the effects of low staffing levels for gerontological nurses are provided. While the future for an adequate number of nurses and faculty in gerontological nursing doesn’t look immediately promising, Mion offers ten recommendations for addressing the problem over the long-term, including issues related to work environment, ergonomics, nursing image, and delivery of care models. The Nurse Reinvestment Act and collaboration of nurses in the service sector and those in academia are also seen as a positive direction for the future.
Most publications on aging lump all persons sixty-five years of age and older into one large group. Young, in the fourth article, has taken from this large group those whom she has classified as ‘frail’. The criteria for this group is given along with demographics and characteristics that further define the group. Young discusses challenges in caring for frail older adults. How the health care system addresses the needs of these frail elderly, who the formal and informal caregivers are, what health care costs in various settings, who pays for the care of these elders, and how these frail elderly persons impact the entire health care system are discussed. Issues that will impact the future care of frail elder are addressed by looking at today’s delivery system, what is funded, and what is actually needed. Public and family responsibility for care of frail elderly is reviewed. Questions such as: How are the various community-based services used? Who uses them? and What is their cost and effectiveness? are related to formal and informal caregivers in various minority groups. Creative solutions consider changing demographics, technological progress, and what nursing can do to enhance the care of the frail elderly.
If you are a Baby Boomer or have friends and acquaintances who are, the Hartman-Stein and Potkanowicz article will give you hope and direction for a healthy old age. Hartman-Stein and Potkanowicz, in the final article, provide an excellent review of the literature related not only to physical aging, but psychological and social aging as well. Good news for Baby Boomers is provided in an overview of findings related to behavioral determinants of healthy aging. Activities in which Baby Boomers may want to engage during the middle age years to promote a healthy old age are listed in detail. Many web site addresses are provided to help Baby Boomers assess, plan and evaluate their activities. Some of the common predictors of healthy old age are challenged, based on research that has been done with thousands of older persons. Many of the studies are longitudinal and provide information which nurses may use in planning their own healthy aging, as well as helping patients/clients to plan for a healthy life into the eighth, ninth, and tenth decades of life.
These articles will help you to appreciate how far we’ve come in providing nursing care to the elderly since the advent of Medicare in the 1960s. Most of all, these articles will help you think about aging, the integration of the various disciplines that influence gerontology, steps to enhance the health of the aging adult, and strategies to overcome the severe shortage of qualified gerontological nurses today.
We hope that you enjoy this OJIN topic, and add your own research or expertise by submitting a manuscript concerning one of the many areas of aging and health care that are not yet addressed in this issue.
Ella Kick, DNSc, RN
Ella Kick received a diploma in nursing from St. John Hospital in Cleveland, OH; she went on to earn the BSN and MSN degrees from Ohio State University, and the DNSc degree from Indiana University. She served as Director of Nursing in a chain of three nursing homes before the advent of Medicare. Ella later worked as a Medicare/Medicaid surveyor for the Ohio Department of Health prior to accepting a teaching position at University of Cincinnatti, where she was the first faculty person in the Master of Gerontological Nursing program in 1973. Since that time she has taught gerontological nursing in several colleges and universities, and held the first National Healthcorp Chair of Excellence in Nursing at Middle Tennessee State University. She received a Robert Wood Johnson Faculty Fellowship in Primary Care in 1977 during which time she worked with Dr. Frank McGlone, a distinguished geriatrician, at the Denver Clinic. She was the first chair of the ANA Council of Nursing Home Nurses and received the Distinguished Gerontological Nurse Award sponsored by that group in 1986. She also received the 1991 Tennessee Gerontological Nurse of the year. Dr. Kick, who has authored a number of gerontological nursing journal articles, is best known for her work in urinary incontinence in nursing homes. Today, Dr. Kick conducts continuing and inservice education programs for nursing homes and consults with insurance companies and law offices on the subject of negligence in nursing homes.