Health care policy in the United States is dominated by three major concerns: reducing the number of individuals who lack insurance coverage, improving quality of health services, and reducing health costs. Considerations about the health workforce relate to the latter two of these concerns, but the topic does not always receive the attention it deserves. While the federal government has some jurisdiction over workforce issues, the nation’s 50 states represent battlegrounds where organizations in the health professions compete over scope of practice issues. Members of some professions argue that they are capable of independently providing high quality care at lower cost, but they are opposed by claims that patient safety would be compromised if the scope of practice is broadened to include other groups.
Meanwhile, the U.S. population continues to grow larger and much of that growth occurs among the oldest cohorts. Advancing age often is accompanied by increases in chronic disease and disability, placing greater demands on the necessity of having a sufficient cadre of competently-prepared health care practitioners. Occasionally, studies are done that shed valuable light on what is occurring within the health professions. For example, a cross-sectional study published on April 9, 2024 in JAMA Network Open involved 7,887 nurses who were employed in a non–health care job, not currently employed, or retired, the top contributing factors for leaving health care employment were planned retirement (39% of nurses), burnout or emotional exhaustion (26%), insufficient staffing (21%), and family obligations (18%). Age distributions of nurses not employed in health care were similar to nurses currently employed in health care. Although the increase in new registered nurses is expected to outpace retirements, health care systems continue to struggle with recruiting and retaining these individuals. It certainly would be of immense value to have similar investigations undertaken in order to develop clearer profiles of other groups, such as physical therapists, occupational therapists, and medical laboratory personnel.
U.S. Dementia Care Spending By State: 2010–2019
A separate item in this issue of the newsletter is about dementia from the standpoint of biomarker testing. According to a paper appearing in the April 2024 issue of the journal Alzheimer’s and Dementia, the fourth largest cause of death for individuals 70 years of age and older in the United States is dementia. It is tremendously costly, leading to $80 billion per year in direct medical spending attributable to this disorder. Given the progressive nature of cognitive and functional impairment that accompanies dementia and the associated caregiving needs, the cost of informal care can elevate these cost estimates.
Still, a concern is that existing estimates of the indirect costs of dementia are dated and do not report on differences across the nation. Researchers used data from multiple surveys to create cost estimates and projections for informal dementia caregiving at the state level from 2010 through 2050. In 2019, the annual replacement cost of informal caregiving was $42,422 per prevalent case, and the forgone wage cost was $10,677 per prevalent case ($58 billion overall). In 2019, it would have cost $230 billion to hire home health aides to provide all this care. If past trends persist, this cost is expected to grow to $404 billion per year in 2050.
Vaccination For Healthy Aging
As noted above, the population is aging. In a paper in the May 2024 issue of the periodical Science Translational Medicine, the WHO estimates that the number of individuals 65 years of age and older will grow to 2.1 billion during the next three decades, nearly doubling as a proportion of the global population that is 65 and older and tripling the number of persons 80 and older. Also, as the world’s population ages, vaccination is becoming a key strategy for promoting healthy aging. Despite scientific progress in adult vaccine development, obstacles such as immune-senescence and vaccine hesitancy remain. In order to unlock the potential of adult vaccines fully, immunization programs must be enhanced, misinformation dispelled, and investments made in research that deepens an understanding of aging and immunity. A strategy for harnessing the full potential contribution of vaccination to healthy aging entails key actions, e.g. expanding the knowledge base and allowing for timely development of new vaccines.