Emerging Trends in Health Care

Increased focus on the current demographic changes of the aging population will most likely be the most important health care trend within the next 20 years.

Americans are living longer than ever before as a result of technological advancements in medicine. Now more than ever, people are living into old age with physical and cognitive disabilities. By the year 2019 the aging population (65 and older) will increase to about 50 million people in the United States. The U.S Census Bureau reported in 2004 that the over -80 population will increase to about 7 million of those in need of health care services. Most of health care spending is exhausted through end of life care and chronic illness. Not surprisingly , the Kaiser Family Foundation reports that "Medicaid's long-term care users (LTC) reveals that the 7% of Medicaid beneficiaries using LTC account for over half (52%) of all Medicaid spending. Medicaid's LTC users not only use LTC services, but they also use the program's acute care services more intensively than non-LTC users. Three-quarters of the spending by these high-cost LTC users went towards LTC (community-based and institutional care) and the remaining 25% went towards acute care and other supportive services. These high-cost beneficiaries are among the most disabled and chronically ill of the Medicaid population, with over half being elderly, one-third being disabled and under age 65, and 11% being adults or children not classified as disabled."

As health care service costs increase, so will the ability of people to pay for them. These costs include but are not limited to the use of pharmaceuticals, ED visits and hospital stays, surgeries and increased use and dependence on technology. With such a rapid rate of growth in this population the types of volume of services required will have a significant impact on the economy, consumers, and health care professionals.

This trend will impact nursing in two ways. First, the median age of a nurse is about 47 years old. These nurse ‘baby boomers” will begin to retire in 15 years leaving a dearth of nurses to take care of the octogenarians that will need nursing care. As nurses retire and as less people choose nursing as a career, or are not admitted to programs due to lack of faculty, the outcome will result in a labor shortage. Sadly, the nurses who spent their lives taking care of others will not have anyone to take care of themselves. Another aspect of labor issues concern the increased need for nurse specialization in the field of gerontology. The aged need specialized care, similar to that of pediatric nursing and Medicine. Secondly, the volume and acuity of these patients will increase in the hospital and nursing home settings. Most of these patients will be admitted to a medical-surgical or rehab floor in the hospitals and nurses work on these units tend to be arduous and stressful and will likely contribute to nurse burnout. There will be an imbalance in nurse to patient ratios, and as a result of all of these factors quality and patient safety will suffer.

Parallel to the increasing aging population is the growing demand for policy development, research, and assistance with Long-term care (LTC) needs. Home and community based services (HCBS) for the elderly offered through Medicaid waiver programs have released some of the strain on the system. Participants and families are happier and healthier in their homes. The cost for providing services in the home is significantly less than they would be in the nursing home. Perhaps this trend will increase as the consumer demands it. However, the same challenges of nursing and paraprofessional workforce face HCBS as in the nursing homes. As a result recruitment and retention of quality workforce in LTC is essential in maintaining and effective system.