In St. Louis, students in well-equipped vans travel to senior centers, nursing homes, churches and other locations to learn how to conduct comprehensive one-hour geriatric assessments.
The future team of doctors, social workers, psychologists and therapists looks for common problems such as frailty, muscle weakness and cognitive decline. Patients they evaluate receive a free printed plan to help guide their treatment.
Community health workers across Oregon enrolled in an eight-hour online training program that included sections on Medicare and Medicaid, hospice and palliative care, and communicating with patients and families to help them work with older adults.
“We need public health workers on the front lines to know how to provide age-friendly care,” said Laura Byerly, a geriatrician at Oregon Health & Science University.
And in Louisville, the same federally funded program provides geriatrics training throughout Kentucky. But sometimes a less formal approach is needed.
Sam Cotton, a social worker who directs the dementia program, recently heard from a local Methodist church whose parishioners are caring for relatives with dementia. Is there someone who can talk to the congregation about this demanding role? Cotton, an assistant professor at the University of Louisville, was confident he would be there.
These programs and There are 39 more similar people Nationwide, it aims to address the alarming fact that the number of geriatric and other health care providers knowledgeable about aging has not kept pace with the rapidly growing population of people ages 65 and older.
Therefore, starting in 2015, Congress approved funding for the Geriatric Workforce Enhancement Program (GWEP), which trains approximately 70,000 people annually.
Recently, this year’s grants of up to $1 million to universities and hospitals appeared to be in jeopardy. In July, without prior warning or explanation, annual payments were drastically cut for some beneficiaries who had participated since the program began in 2015.
Instead of the expected $41.8 million, recipients received $27.5 million overall, a 34% shortfall, according to the Eldercare Workforce Alliance. And it looked like more cuts were coming.
The Trump administration’s proposed fiscal year 2026 budget eliminated GWEP, along with many other programs funded through the Health Resources and Services Administration, an agency within the Department of Health and Human Services.
Although the program has always enjoyed bipartisan support, I got approved repeatedly. For five years, the president’s budget has zeroed in on that, citing “efforts to streamline bureaucracy, reestablish an appropriate balance between federal and state responsibilities, and save taxpayer funds.”
Ten weeks have passed with no clear explanation, has the missing money simply been delayed or gone forever? — Program directors frantically called their congressional representatives as they contemplated painful layoffs and an uncertain future.
“This money has been appropriated, signed and sealed. Where is it?” Cotton said last month. In addition to her role at the Louisville program, she serves as chair of the board of directors for the National Association of Geriatric Education Centers.
Beneficiaries’ questions about HRSA, the funding agency, have gone largely unanswered. Then, on September 10, the program discovered that the remainder of its allocated funds had suddenly materialized, as mysteriously as it had disappeared.
And while GWEP was restored in both the House and Senate bills to fund the federal Department of Health, the bills could still be changed or defeated, and an ongoing resolution could freeze funding for now.
The structure may reflect, in part, the efforts of Republican Sen. Susan Collins of Maine, a strong GWEP supporter who is up for re-election next year.
In a speech on the Senate floor on September 3, Collins called the program “a modest investment that will help ensure that older Americans get the specialized care they need, provide training to caregivers, and ensure other support staff and health care providers have the skills they need.”
Still, “it’s been a roller coaster, to say the least,” said Marla Berg-Weger, co-director of GWEP at Saint Louis University, which trains about 9,800 students each year.
The payments held for 10 weeks are equal to the amount each grant is allocated to Alzheimer’s disease and dementia training, the program director said. The program was supposed to designate $230,000 of the $1 million grant toward dementia training for both professionals and community members, but the shortfall was larger because some chose to spend more.
For example, Louisiana State University’s GWEP initially received only $152,000 of the projected $976,659 and has suspended all senior rotations and internships in Louisiana and Mississippi (temporarily, the director hopes).
What’s going on? HRSA, the federal agency that funds the program, said in an email that “there is a brief delay in implementing certain payments as all grant programs have been thoroughly reviewed to ensure they are aligned with administration priorities.”
“It’s surprising to me that anyone would question the value of having a workforce knowledgeable about elder care,” said Carole Johnson, a former administrator at the agency during the Biden administration.
“Everyone in the field wanted this program to grow, not decline,” she added.
The budget has increased slightly in recent years. But “the beneficiaries are very capable,” Johnson added. “This is a ‘big bang for the buck’ program and a smart use of federal resources.”
The number of geriatricians, which numbered 6,580 this year, is likely to decline slightly in the coming years despite the growing need for this expertise, according to HRSA estimates. Surveys show that it is difficult to attract medical students and doctors to relatively low-paying specialties where most patients have Medicare insurance. high job satisfaction Among geriatric doctors.
Most older patients receive care from primary care physicians, other health care professionals, physician assistants, nurse practitioners, social workers, pharmacists, and direct care workers rather than geriatricians.
Therefore, GWEP emphasizes expanding knowledge about the care of older adults, whose risks, symptoms, goals, and treatments often differ from those of younger patients, to a variety of providers, especially in rural and underserved areas. We also educate patients themselves and their family caregivers.
For example, a St. Louis University program recently introduced an apprenticeship for certified nursing assistants (CNAs) working in suburban nursing homes.
“There is a very high turnover rate among nursing home staff in general and CNAs in particular,” Berg-Weger explained. These jobs are often low-paying and stressful, and the 75 hours of training required for certification does not delve deeply into the specific needs and characteristics of geriatric patients.
Six women have enrolled in St. Louis’ first apprenticeship program, which was designed to accommodate 10 people at a time. Over the course of a year, you will receive 144 hours of training on topics such as medications, fall prevention, and dementia.
The curriculum includes face-to-face classes with geriatricians and geriatric nurses and more than 40 short videos produced by the GWEP team. Berg-Weger said aides “can watch on their phones during breaks.”
At the end of the year, graduates become certified geriatricians, receive a $1,000 stipend from the program and a 12% salary increase from their employers. “Our plan is to offer this to other facilities,” Berg-Weger said.
And the same holds true for the survival of GWEPs in other states.
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