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Geriatric Care in the USA

Contributor: Charles Semelka, MD

Origin/affiliation: Geriatrics Fellow, Wake Forest University, USA

While US healthcare spending is the highest in the world, our public health system often fails to keep our older adults healthy. For example, we have one of the lowest projected life-spans among developed countries. Furthermore the cost of living in a nursing homes is exorbitant. While it varies by state, average costs of living in a US nursing home is between $80,000 - $100,000 US dollars per year. My own grandmother complains regularly of the $2000 monthly rate for her nursing home room and board in Canada.

One of the barriers to change is poor public image. I have heard the term “warehousing” used to describe leaving older people in nursing homes. In the US we lack a comprehensive social contract. While we may have lower tax rates compare to other developed nations, we lack affordable healthcare and higher education. Looking at data from the US government we need about 3 nursing homes beds per 100 people over age 65.1 As the population shifts to a greater proportion of older Americans, we are facing a crisis. The cost of housing and healthcare for vulnerable older adults is becoming an issue Americans can no longer afford to ignore.

Furthermore, as geriatricians we fill a role other physicians are unwilling to do. Only 50% of the available US geriatrics fellowship spots typically fill. Projected career salary actually decreases following geriatrics fellowship. We help older adults with some of life’s most difficult decisions: when to stop driving, when to move into a nursing home, and when to avoid aggressive medical procedures that are unlikely to benefit their quality of life. However geriatricians are some of the happiest physicians. There are certainly challenges ahead in this career field, and I couldn’t be happier with my decision to pursue a career in Geriatrics.

1. Wang, Yun, et al. "Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016." BMC geriatrics 19.1 (2019): 103.

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