I recently had the pleasure of speaking to NICHE, (Nurses Improving Care for Healthsystem Elders) a joint venture of the Hartford Institute and the New York University School of Nursing dedicated to improving the quality of geriatric nursing. NICHE understands that caring for elders is not like caring for younger patients, and it has developed new techniques to both assess the needs of seniors and provide them with high-quality, appropriate care.
It is hard to understand why the medical industry has been so slow to recognize this need. After all, hospital administrators learned long ago that it takes the skills of pediatric nurses to provide the best possible care for sick infants. Somehow, it has taken them longer to recognize that older patients also have unique needs. For instance, they are likely to have multiple chronic diseases that can complicate whatever acute episode landed them in the hospital. They may react differently to medications than younger patients. And their care may require more time and patience.
It is hard to overstate the need for nurses who can care for older patients. Not only does this work require special training but the demand for these skills is exploding. As the Baby Boomers age, more than 33 million Americans are now 65 or older. Yet the number of physicians with a geriatric specialty is actually shrinking—it is now only about 7,000. Increasingly, Registered Nurses and nurse practitioners who are skilled in geriatrics are likely to take a larger role in caring for senior patients.
Unfortunately, only about 1 percent of RNs have geriatric certificates, far too few to fill the need. Worse, more than half of nursing schools have no geriatric program. The good news is that some recent nursing grads—including many in their 40s who are looking at second careers—are interested in the specialty. In contrast with younger nurses, many of these older nurses may have had personal experience caring for a parent or other aging relative.
Hospitals that understand the need are following two different models. Some have developed special units (often called ACE units) geared to elders, and even created distinct emergency departments for them. Others, with large numbers of older patients, are implementing these changes throughout their facilities.
Until now, the NICHE focus has been on hospital care, and more than 300 facilities have been certified as NICHE hospitals. But as more post-acute and post-surgical care is shifting to skilled nursing facilities, NICHE has begun reaching beyond hospitals. This has tremendous potential for improving the quality of care in nursing facilities as well as saving health care dollars (Medicare may pay $500-a-day to care for a post-acute patient in a nursing home but four times that much in a hospital).
The 2010 health reform law is driving health systems to better integrate care for Medicare patients. The law includes new incentives to keep seniors with chronic disease out of the hospital. But that will require intensive care management—work that is ideal for geriatric nurses. The demand for these health professionals is there. We can only hope that nursing students as well as mid-career nurses take advantage of the opportunity.