Focus on Gerontology, Part 1: Not Enough Care to Go Around

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Thomas Hornick is Acting Director of the Cleveland Geriatric Research Education Clinical Center and an Assistant Professor of Gerontology at Case Western Reserve University.

Thomas Hornick: I'm a geriatrician.

Hornick is a physician at the Louis Stokes Veterans Affairs Medical Center. Walking the halls of the VA in his white coat, the tall doctor, in his mid-40s, can see above the heads of most of his patients. Dr. Hornick is one of just a few hundred certified geriatricians in Ohio.

Thomas Hornick: This morning I was talking to one of our patients, was talking about his experiences in the streets of Pittsburgh. He used to mine coal for the home fires with his dad, you know carry it home in his wagon. He used to deliver papers from the age of seven. He talked about the holes in his shoes during the Depression and not being able to afford adequate footwear.

Hornick says it's the personal stories and histories he hears every day combined with the broad range of medical conditions that inspired him to pursue a career in gerontology.

Thomas Hornick: We have 80-year-olds, 90-year-olds who are competing in national masters' events. We have 80-, 90-year-olds who are so frail they can't get out of a chair. They all need very specific and appropriate care.

But providing specific and appropriate care requires a lot of time and dollars. Because he works at the VA, which is federally funded, Hornick is not subject to as many limitations of Medicare and Medicaid compensation. Most hospitals and practices however, do rely on Medicare and Medicaid payments and since money is tight, programs for older patients are being compromised. Just last month, Akron General Medical Center closed its Geriatric Center. Richard Streck is Senior Vice President of Medical Affairs at Akron General. He says for instance, reimbursements simply weren't enough to cover one of the center's main focuses, a comprehensive evaluation for patients.

Richard Streck: So you've got multiple professionals dealing with a patient over a period of four to five hours, the reimbursement from Medicare for that assessment was $85. It wouldn't even come close to covering our costs.

Streck says with the Geriatric Center closed, Akron General is now working to transfer older patients to primary care physicians while retaining a small staff of geriatricians.

Richard Streck: What we've tried to do is have our, the geriatricians, focus on the medical problems at hand and then refer the patients off for the additional services they may need.

And that lends itself to something else that often makes gerontology unique. Geriatricians need to be able to not only decipher a wide range of medical problems but also to regularly work with a team of specialists that often include social workers, psychologists, even nutritionists, and patient educators. The coordination of those services is not reimbursed, and neither is spending extra time in a waiting room or making phone calls to follow-up with family members of a patient. Maria Schimer is Director of the Office of Geriatric Medicine and Gerontology at the Northeastern Ohio Universities College of Medicine. Schimer says the startling reality is that the state does not have enough doctors that have that kind of holistic training.

Maria Schimer: Currently Ohio only has 321 certified geriatricians, which is only about 4.5 geriatricians for every 10,000 who are over the age of 75.

The Federal Administration on Aging reports 6,000 Americans turn 65 and older every day. Within a decade, that number is going to climb to 10,000 persons each day. Dr. Thomas Hornick says with the increased demand for aging specialists, there's not only a lack of doctors in practices and hospitals, but in the classroom as well.

Thomas Hornick: Many programs who wanted geriatricians were unable to find them. And we get a lot of notices for job opportunities for practicing or academic geriatricians and there just aren't people to fill them.

Recognizing that need, the state's medical schools are taking a closer look at incorporating more geriatric training requirements for all disciplines, especially since too few students are willing to follow in Dr. Hornick's shoes. With medical school graduates averaging a debt upwards of a $100,000, the low paying field of gerontology and the unglamorous work of caring for the elderly, doesn't put it at the top of the list when deciding on a career path. In Cleveland, Renita Jablonski, 90.3.

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