July 25, 2008
Maryland Health Care: The Boomer Impact
By Danielle Ulman
The baby boom ended more than 40 years ago, but as that generation marches boldly into its 60s -- and into the nation's hospitals -- the health care system will feel the ripple effect.
The first boomers turned 60 in 2006, setting off concerns about the readiness of the medical community to handle the influx of aging patients likely headed their way over the next 20 years.
Many in Maryland's medical field are bracing themselves for the impact the state's 1.55 million aging baby boomers could bring. Hospitals are expanding programs and facilities, medical groups are angling to make the state more physician friendly, and lawmakers have passed legislation to get a commission on boomers going.
"In hospitals, in terms of growing larger and making changes, they all have to do with anticipating that at the end of this decade and the beginning of the next, they've got to have a whole lot of new facilities and programs in place," said Nancy Fiedler, senior vice president of communications for the Maryland Hospital Association.
Boomers, notorious for their profound impact on the nation's infrastructure, are predicted to live longer and require an unprecedented amount of care from a system that is already taxed.
Earlier this year, the Maryland Hospital Association and MedChi, the state's medical society, reported that the state is suffering from a physician shortage. Maryland fell 16 percent below the national average of doctors in a clinical practice. The report suggested that the problem will worsen by 2015, when 32 percent of the current work force could retire.
In November, the hospital association said the state is undersupplied with nurses. Job vacancies at area hospitals averaged 13 percent in 2006, and that number will likely grow.
"We've got graying nurses and graying physicians," Fiedler said. "We need to not only replace those individuals who are baby boomers themselves but in many cases, because there are so many baby boomers who are living longer and need to have their chronic diseases managed, there need to be more doctors and nurses than there ever have been before."
The medical professional shortage is also born of a lack of people to teach the courses and not enough room in the schools. Two years ago, nearly 2,000 qualified candidates were denied entry to nursing programs in the state because they were full, the hospital association reported.
"Part of our recommendation is that they increase medical school slots and residency slots, but that takes 10 years to bear fruit," said Bruce Smoller, president of MedChi's board of trustees.
Joe DeMattos, the Maryland state director of AARP, said the state has work to do.
"At the end of the day you still need trained health care professionals, and at the end of the day we don't have enough of those people," he said. "No state is in the ideal position to reposition itself for the aging of America in the next 60 to 90 days. This work will take two or three or four years to get done."
Area hospitals are working on figuring out what that repositioning of the system will mean. The Anne Arundel Medical Center will finish its latest expansion in 2011, complete with new parking garages, a bigger emergency room and the addition of programs.
"Vision 2010 recognized that we will start to see the largest influx of baby boomers hitting the next stage of life, and as research shows, the older we get, the more services we need," said Martin L. "Chip" Doordan, president of the medical center.
The hospital is preparing to take on more sports injuries common to boomers, or what Dotsie Bregel, founder of the National Association of Baby Boomer Women, said is called "boomeritis," the deterioration in muscle, bone strength and agility frequently associated with aging.
"We're the generation that ushered in the exercise craze, so we're going to want to stay healthier and keep our bodies and minds active for as long as we can," she said. "A lot of our bodies are wearing out because we started the exercise craze. We have tendonitis, bursitis, arthritis."
That type of active lifestyle means boomers will also require more hip replacements and joint reconstruction.
The University of Maryland Medical Center expects to grow its units in chronic diseases and musculoskeletal diseases, offering more joint replacements and spine surgeries.
Although Sinai Hospital isn't expecting boomers to start rushing to the hospital in droves, its vice president, Lorrie Liang, said the hospital has expanded in some areas.
"We're expecting there to be a gradual increase in demand for services," she said. "We've grown our orthopedic department. We have created a division for preserving and reconstructing joints."
Sinai is in the planning stages of creating an institute for aging, "in response to what we think will be a different type of geriatric care for the baby boomers than perhaps our parents and grandparents," Liang said.
The program could have geriatricians coordinating patient care for a team of physicians, but doctors that specialize in elder care are increasingly hard to come by.
Colleen Christmas, assistant professor of medicine in the division of geriatric medicine at the Johns Hopkins School of Medicine, said the specialty is largely ignored because physicians need additional years of education and get paid less than internists. There's also the perception problem.
"It's high drama, what we do. I think people think of geriatricians as doing boring work," she said. "When you look at jokes about geriatrics on TV shows, there are always punch lines about incontinence and people being demented."
Hopkins has geriatricians practicing collaborative care, similar to what Sinai is planning to do, because older patients generally have multiple diseases or ailments that need to be monitored.
The American Geriatrics Society estimates that there is one geriatrician for every 2,500 Americans over 75, and although there will be more demand for them in the coming years, the society estimates that in 2030 there will be one geriatrician for every 7,665 older adults.
"The actual number of geriatricians has decreased over the years rather than increased," said Charlene C. Quinn, assistant professor of epidemiology and preventive medicine at the University of Maryland School of Medicine.
"In my view, what we need to do is maybe we don't try to have geriatricians per se, or their role changes so they become more of a consultant," she said.
The physician shortage aside, Maryland is headed in the right direction, said AARP's DeMattos.
The General Assembly passed legislation last year to form a commission on baby boomers that will study the impacts of boomers on the economy, the health care system and society in general. DeMattos said that appointments to the commission are being finalized.
"In terms of baby boomers, Maryland is actually ahead of the game," he said. "They are the only state in the country to have passed and created a baby boomer commission."
While the state has been working on putting a commission together, University of Maryland, Baltimore County has been studying the management of aging services at its Erickson School.
"In the past, programs focusing on aging people or older folks looked at the fact that they were declining and how to serve them," said Kevin Eckert, the school's dean. "Our focus is the changing nature of the boomers and what kinds of services we need to offer and how we think about old people."
The doomsday scenario of boomers breaking the health care system is not what Eckert envisions.
"I believe there will be a change in aging over the next couple of decades," he said. "People are going to age differently; they're still going to have needs, but they're going to be healthier."
Perhaps not coincidentally, the people at Erickson Retirement Communities subscribe to that same school of thought.
"We expect that the baby boomers, as they enter their 60s and 70s, will continue to have a greater focus on prevention and wellness than perhaps the previous generation, and we're preparing to meet their needs by also having a high degree of focus on preventive and wellness services," said Matt Narrett, chief medical officer for the company.
Erickson has also expanded its health care services to include an off-campus facility in Columbia to care for the baby-boomer generation.
The company has 23 retirement communities nationwide, two of which are in Maryland. Narrett said 88 percent of residents at the Charlestown facility in Catonsville use the company's medical services.
Erickson also offers electronic medical records that residents can download. The system organizes medication lists and residents can give family members access to their records.
"We are prepared for a generation of residents who are perhaps more technologically savvy," Narrett said.
Long-term care insurance is a product that is burgeoning as boomers have seen their parents fall ill without a way to pay for their care, said Neil Epstein, a long-term care specialist at PSA Insurance & Financial Services in Baltimore.
The state government rolled out a long-term care educational push a few years ago to encourage Marylanders to look into the insurance. The state will add a partnership program that says if patients deplete their long-term insurance benefits, they can qualify for Medicaid and still retain a certain amount of assets, which they previously could not do.
"Long-term care is the No. 1 problem that faces seniors," Epstein said. "The government doesn't want to be the long-term care insurer of choice, and they are right now. If we continue the way we are going, we will bankrupt our country."
Originally published by Danielle Ulman.
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