Policy Issues in the Care of Older Adults

A successful future for geriatrics is inescapably tied to successful advocacy, but geriatricians have historically been timid in their involvement in public policy. This opportunity was highlighted by the COVID-19 pandemic, the impact of which has changed public policy dynamics. In 2020, US healthcare lobbying expenditures were $713.6 million, with most coming from pharmaceutical and health product manufacturers, non-geriatric medicine-specific providers, and payers. The number of geriatricians has been declining for over two decades. Gaining expertise in public policy requires an understanding of the structure of government in the US Geriatric medicine holds an important role insofar as physicians are responsible, either directly through orders or actions, for the vast majority of Medicare expenditures. The long-term care workforce is part of this, and dramatically declined further during the pandemic. The increased concentration of older adults demographically impacts the importance of addressing the growing needs of the geriatric workforce. Long-term services and supports (LTSS) is an important component of state Medicaid spending. The integration of a geriatrics approach to care into Medicare, Medicaid, and the workforce must be considered an essential and core public policy concept. Graduate Medical Education reform is essential to the future of the care of older adults in the United States. Legislation is necessary to require that all physician training subsidized by taxpayer dollars should, at a minimum, result in basic geriatric competencies. The reimbursement system shouldn’t discourage physicians from entering the field of geriatrics or in caring for older adults.