In-Home Care Providers Positioned to Fill Gaps Created by Geriatrician Shortage

Geriatricians, similar to in-home care providers, serve the elderly by helping with the process of aging. But the current amount of geriatricians is inadequate in the United States, a seemingly hidden shortage that could have a substantial effect on the rest of the health care sector in years to come.

That includes home-based care providers and other aging-in-place organizations.

Typically, one geriatrician — or a primary care doctor who specializes in treating conditions that affect older adults — can care for 700 patients, a Health Resources and Services Administration study found. That means the country will likely need at least 33,200 geriatricians in 2025 to help care for America’s rapidly aging population of baby boomers.

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The problem? Currently, there are only about 7,000 practicing geriatricians, according to a New York Times report.

With that looming shortage in mind, the question is whether home care providers can play a part in picking up the slack geriatricians are leaving behind.

Someone is going to have to, Dr. Laurie Archbald, a geriatrician and associate professor of medicine at University of Virginia (UVA), told Home Health Care News. 

Home health providers that already have robust in-home primary care service lines may have a unique advantage. Minnesota-based Lifesprk, for example, is one such company. In 2018, Lifesprk even brought on board Dr. Bill Thomas to lead its Lifesprk Health program.

“There are wonderful primary care providers that can put an eye to geriatric care,” Archbald said. “And with education, assistance and consultation — perhaps from geriatricians — [they] can also be suited to provide this type of care for older adults.”

While primary care physicians and home health companies may play a role in filling the looming geriatrician gap, there’s likely room for other players as well.

Several non-medical home care providers have augmented their leadership teams with chief medical officers and clinical-focused executives over the past few years, for instance.

In the future, home care agencies may become part of the equation.

Home care workers have long been considered the “eyes and ears” of the home. If more people in the home care industry were generally schooled in geriatric care, it could help fill the geriatric gap — at least to some extent. That’s true for all aging-related care professionals.

“One of the things we’re definitely focusing on at UVA is [making sure] all of our students at least have a basic understanding of the geriatric components,” Archbald said.

Additionally, if there are not enough trusted geriatrician voices available, hospitals and health systems may turn more frequently to their home-based care partners.

That’s not the only possible way that the lack of geriatricians could affect in-home care providers, though. There are other ways it could improve business, John Bradshaw, CEO of Georgetown Home Care, told HHCN.

“If a senior is hospitalized and then discharged, there are four key reasons that they are likely to be readmitted quickly, and one of those reasons is that they did not go see their primary care physician — in this case, a geriatrician — within two weeks of discharge,” Bradshaw said. “If there are fewer geriatricians, then suffice it to say they will be less likely to have a primary care physician (PCP).”

And that potentially means more re-hospitalizations.

A Washington, D.C.-based non-medical home care and staffing agency, Georgetown has already seen anecdotal evidence of this. 

“We have seen a spike in the number of patients we are caring for post-discharge that do not have a PCP,” Bradshaw said. “In those cases, the hospital is often trying to recommend a PCP. However, it’s really hard for a PCP to be successful with a new patient that just got discharged [when they have] no real relationship or history with that person.”

One of the reasons geriatricians are as sparse as they are is because of pay. That sort of work does not have the best return on investment for former students entering the field that are looking to pay off medical school.

Another recent shift in workforce demographics that could benefit home health providers is the amount of nurse practitioners (NPs). From 2010 to 2017, the number of NPs more than doubled from 91,000 to 190,000, a new study published in Health Affairs found.

The Home Health Care Planning Improvement Act of 2019, introduced last April, aims to allow NPs, among other groups, to certify home health care services under Medicare. Historically, only physicians have been able to order home health services and certify patients to receive the home health benefit.

If that piece of legislation ends up becoming law, home health providers may start scrambling for NPs.

In the end, the amount of geriatricians or NPs could have a big effect on the world of home health. But even if the geriatrician shortage doesn’t grow into a significant impact for providers, it is worth their time to take a closer look and find out if there are creative ways to take advantage of the challenge.

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