In our local area, the number of physicians who belong to the American Geriatrics Society and are board certified in Geriatric Medicine include one in Camp Hill, two in Harrisburg/Hershey, one in York, and one in Lancaster. If last week’s article about the shortage of geriatricians in our nation was unsettling, there are some additional health care professionals who have received advanced training in the care of older adults and are able to provide assistance to those struggling with complex medical conditions and needs. Recent years have seen some changes in the training and certification of these professionals, and greater numbers of these professionals would also be beneficial for the older adult population.
While the physician specialty related to the care and treatment of older adults is called geriatrics, other professionals who work with older adults focus on gerontology, which is the multidisciplinary study of the physical, mental, and social effects and implications of the aging process. For older adults, the outcomes of both preventative medicine and the treatment of disease are directly related to all of these aspects of aging, and care which revolves around the whole person is more likely to be effective.
Nurses who desire to focus their practice on the care of older adults can proceed in several directions. A registered nurse who has worked with older adults for at least 2000 hours over two years, and has obtained 30 hours of continuing education in gerontological nursing over the previous three years is eligible to take an exam to receive board certification in gerontology. This designation is noted as RN – BC (Registered Nurse, Board Certified). There are, however, numerous other certifications which are available so one would have to ask an individual nurse about which specialty the certification designates. Another step is available for nurses who obtain a master’s degree in a specialized program involving 500 hours of clinical practice and advanced coursework. This designation as called a Gerontological Clinical Nurse Specialist (GCNS). These advance practice nurses seek to improve the performance and outcomes of care for older adults while effectively controlling costs, and may work in clinical settings, research, teaching, consulting, and management. Certification as a Gerontological Clinical Nurse Specialist is available, but is not required, in all states. Dawn Hippensteel is a GCNS working for PinnacleHealth. She received her certification in early 2012, and believes that the ongoing time and monetary investment to achieve and maintain certification “shows that we have a commitment to improved patient care.”
Nurse Practitioners (NP) who focus on the care of older adults are nurses who have also attained a master’s degree. They take similar coursework to GCNS, but their clinical rotations are different. The American Nurses Credentialing Center used to offer certification as a Gerontological NP, however geriatrics training has now been merged with the training for adults and two new certifications are offered; Adult Gerontology Acute Care NP and Adult Gerontology Primary Care NP. There are mixed feelings among nursing professionals about this change. Some believe that it is an injustice to older adults, and that NPs will receive less training regarding the unique needs of older adults due to time constraints and the quantity of content which is already present in adult NP programs. Others see this change as an opportunity for more NPs to be exposed to at least some education about the care of older adults, which will be beneficial since this population utilizes a wide variety of health care services. Nurse practitioners can provide preventative care, diagnose illness, conduct routine physical exams, and prescribe medications. You may find a NP working for a hospital, outpatient clinic, long term care facility, hospice, home health agency, or in a medical practice.
An Aging Life Care Professional is an individual who is available to assist older adults in navigating the health care system and adapting to changes in daily functioning. This is a new name for professionals who were previously known as Geriatric Care Managers (GCM). They may have a degree in social work, nursing, gerontology, psychology, counseling, or other field. Designation as a certified care manager is available for those professionals who meet certain standards of knowledge and experience. They help older adults and their families identify needs and potential solutions to aging issues, connect them with resources and services to meet those needs, and provide ongoing medical management, education, advocacy, and caregiver support. Mary Beck, a local certified Advanced Aging Life Care Professional, has been in practice for just over two years, after spending nine years as a social worker for a local hospice agency. Her goal is to help older adults “live well with what’s going on at the moment.” She often works with physicians and hospital discharge planners to ensure that health care is provided according to an individual’s and family’s goals and is realistic for each specific situation. Although the role of an Aging Life Care Professional is not fully understood by many in the health care industry or in society as a whole, Mary generally finds that after a while, physicians are “thrilled” by her involvement and families wish they had known about these services ten years earlier.
As our county’s older adult population continues to expand, we can all work to increase the number of health care professionals trained to support this unique group by challenging negative stereotypes of aging and promoting positive interactions between young people and older adults.
Karen Kaslow, RN