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According to the U.S. Department of Labor, Bureau of Labor Statistics, the number of OTs in the field will increase from 99,000 in 2006 to 122,000 by 2016, a 23% increase. Karen Barney, PhD, OTR/L, FAOTA, chairperson of the department of occupational science and occupational therapy in Doisy College of Health Sciences at Saint Louis University in Mo., believes that even with this increase, OTs will be no exception to the widespread shortage of geriatric healthcare workers. “The need is not being met. We have a projected shortage overall in the field of about 26%, and much of the geriatric OT practice demand is driven by the increasing numbers of older adults and their associated chronic conditions,” she says.

According to the 2008 report “Retooling for an Aging America: Building the Health Care Workforce,” produced by the Institute of Medicine, “The future healthcare workforce will be woefully inadequate in its capacity to meet the large demand for health services for older adults if current patterns of care and of the training of providers continue.”

The AOTA supports “aging in place,” which enables older adults to continue living independently in their homes as they age by being provided with community support, being taught compensatory skills, and having homes modified to fit changing abilities.

With this concept, many specialty areas in geriatric OT practice, such as driver safety and community mobility, environmental modification, wellness and fitness, and low vision, continue to emerge to answer the needs of older adults who are living active, healthy lives longer than earlier generations. These emerging practice areas enrich traditional geriatric practice settings such as acute care, adult day care, skilled nursing, long-term care facilities, and home health.

Overcoming Obstacles

“In home health, the driving and the paperwork often negatively influence a decision to work in this area. Also, the patients tend to be more medically complicated, and there is less interaction and support with other team members,” says Cheryl Hall, OTR/L, an independent contractor working for MedStar Health Visiting Nurse Association in Baltimore, and owner of the Occupational Therapy Toolkit.

According to Barney, “Younger practitioners may lack confidence in their skills and therefore feel threatened by interacting with this adult population and their caregivers. Some individuals may be threatened by the concept of morbidity and mortality.”

To attract more OTs to geriatrics, she says, it is important to highlight the positive aspects of serving older adults, such as preventing financial and quality of life costs to society, fulfilling moral and ethical imperatives, and benefiting the individuals and their families receiving services.

Barney also believes it can be helpful to provide “course content that specifically focuses on the role of OT with older adults, stressing what OTs can do to support health and function, and dispelling myths and stereotypes.” This approach is most effective, she says, when students are provided with positive fieldwork experiences where they can become comfortable interacting with older adults.

On the Homefront

Nancie Ward, OTR/L, works for the Center for Elders Independence, a Program of All-inclusive Care for the Elderly in Berkeley, Calif. CEI PACE embodies the concept of aging in place. Ward illustrates that often an OT’s geriatric practice is what he or she makes of it — one doesn’t have to fall into a routine of treatment that leads to boredom and stagnation.

“There’s a lot you can do. There is a lot of flexibility; whatever you as an individual practitioner can bring to your practice — you have that opportunity,” she says.

Barney adds, “Home health with older adults, I think, is where some of the greatest creativity in therapy can take place because you’re not in a gym; you’re not in a big activity room; you are in the person’s home, which is as personal as it gets.”

Ward and Barney both cite the great appreciation older adults show and the room for creativity as the most fulfilling aspects of working with older adults. Hall adds that being able “to learn from their wisdom and history” and “to help them become self-sufficient” are also rewarding.

Hall, Ward, and Barney all report increasing the quality of life of older adults as the single most important and satisfying part of their job. “Many of our participants enroll in the last few years of their lives. It is always sad to say goodbye, but I know I have made a difference by contributing to the quality and comfort in those last few years. I find that very gratifying,” Ward says.

Resources
Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: The National Academies Press; 2008. http://www.iom.edu/CMS/3809/40113/53452.aspx. Accessed February 5, 2009.

Powell JM, Kanny EM, Ciol MA. State of the occupational therapy workforce: results of a national study. Am J Occup Ther. 2008;62(1):97-105.

Yamkovenko S. Occupational therapy: helping America age in place. AOTA. 2008; http://www.aota.org/News/Centennial/40313/Aging/Aging-in-Place.aspx. Accessed February 5, 2009.

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Teddie Genter, MS, OTR/L, is a medical writer for the Gannett Healthcare Group. To comment, e-mail oteditor@gannetthg.com.

© Copyright 2009 Gannett Healthcare Group