Addressing the Geriatric Care Workforce Shortage: A Comprehensive Analysis and Strategic Framework

Abstract

The United States is confronting a profound and escalating shortage in its geriatric care workforce, a predicament widely recognized as a ‘national crisis.’ This critical deficit is characterized by a stark and growing imbalance between the rapidly escalating healthcare needs of an aging population and the critically insufficient number of healthcare professionals specifically trained in geriatric medicine and related disciplines. The crisis is not confined solely to physician shortages; it encompasses a broader spectrum of care providers, including nurses, social workers, therapists, and direct care workers, all essential for comprehensive geriatric care. Compounding this challenge is a demonstrable decline in interest among medical graduates and other healthcare trainees in pursuing careers focused on older adults, a trend vividly illustrated by consistently low application rates for geriatric fellowship programs. This comprehensive research report undertakes an in-depth exploration of the multifaceted root causes underpinning the geriatric care workforce shortage, meticulously examines its pervasive societal, economic, and ethical ramifications, and critically evaluates a diverse array of national and international strategies currently under development or implementation to mitigate this burgeoning crisis. The report emphatically underscores the imperative for holistic policy reforms, the enhancement and expansion of interdisciplinary educational and training programs, and the widespread adoption of innovative, integrated care models designed to optimize the utilization of existing healthcare resources and ensure the consistent delivery of high-quality, person-centered care to the nation’s older adults.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

1. Introduction

The demographic landscape of the United States is undergoing an unprecedented and rapid transformation, with the population aged 65 and older projected to reach an estimated 73 million by 2030 and potentially exceeding 95 million by 2060, at which point they will constitute over 20% of the total population. This profound and irreversible demographic shift, often referred to as the ‘silver tsunami,’ presents unparalleled and complex challenges to the nation’s healthcare infrastructure, particularly within the specialized domain of geriatric care. The concomitant increase in chronic conditions, multimorbidity, functional decline, and cognitive impairment associated with advanced age places immense and distinct demands on healthcare systems that are, by many measures, unprepared and understaffed. The chronic shortage of geriatric specialists across all professional disciplines – including but not limited to geriatricians, gerontological nurses, geriatric social workers, and direct care workers – has emerged as a critical and escalating public health issue. Projections from various authoritative bodies indicate a dire shortfall of nearly 30,000 geriatricians by 2025, a figure that only partially captures the broader deficit across the entire geriatric care continuum (Eldercare Workforce Alliance, n.d.).

This report is meticulously structured to provide a comprehensive and nuanced analysis of the intricate factors contributing to this pervasive workforce shortage. It delves into the structural, financial, educational, and cultural elements that discourage healthcare professionals from specializing in or dedicating their careers to the care of older adults. Furthermore, it scrutinizes the wide-ranging implications of this deficit, extending beyond mere healthcare access to encompass significant societal, economic, and human costs, impacting older adults, their families, and the broader community. Finally, the report critically examines the innovative and collaborative strategies being developed and deployed at various levels – from policy formulation to technological integration – to address this urgent national crisis. By synthesizing existing knowledge and proposing actionable recommendations, this analysis aims to inform stakeholders and stimulate the necessary collective action to build a robust and sustainable geriatric care workforce capable of meeting the evolving needs of an aging America.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

2. Causes of the Geriatric Care Workforce Shortage

The geriatric care workforce shortage is not attributable to a single factor but rather stems from a complex interplay of economic disincentives, systemic educational deficiencies, intrinsic challenges associated with the nature of geriatric care, and prevailing societal perceptions. Understanding these multifaceted causes is fundamental to developing effective and sustainable mitigation strategies.

2.1. Financial Incentives and Compensation

One of the most significant and frequently cited barriers to entry into geriatric medicine and related fields is the perceived and actual disparity in financial incentives and compensation compared to other medical specialties. The economic realities often deter promising medical graduates from pursuing this critical area of care. Geriatric medicine, by its very nature, involves managing complex, often chronic, and intertwined conditions in a patient population that typically requires extensive time for assessment, coordination of care, and communication with family caregivers. These complexities are not always adequately reflected in existing reimbursement models, which historically have been skewed towards procedure-based or acute care interventions rather than time-intensive cognitive services inherent in comprehensive geriatric assessment.

Medicare and other insurance reimbursement structures often fail to sufficiently compensate for the nuanced and longitudinal care required by older adults. For instance, a geriatrician managing polypharmacy, multiple chronic diseases, cognitive impairment, and psychosocial challenges in a single patient may spend significantly more time per encounter than a specialist performing a single procedure, yet the reimbursement for the latter is often substantially higher. This creates a powerful economic disincentive for physicians burdened with substantial educational debt, which can often exceed $200,000 to $300,000 for medical school alone. Faced with such financial pressures, many graduates are compelled to gravitate towards specialties offering higher earning potential to repay loans and achieve financial stability. Surveys consistently indicate that anticipated salary is a significant factor in specialty choice among medical students and residents, placing geriatrics at a disadvantage (Accountable Healthcare, n.d.).

Furthermore, this financial disincentive extends beyond physicians to other crucial members of the geriatric care team, including gerontological nurses, social workers, and particularly direct care workers (e.g., Certified Nursing Assistants, Home Health Aides). These frontline caregivers, who provide the vast majority of hands-on care for older adults in various settings, often earn wages that are barely above minimum wage, frequently lack comprehensive benefits, and face limited opportunities for career advancement. This contributes to high turnover rates and a chronic struggle to recruit and retain staff in these essential roles, exacerbating the overall workforce crisis (SageCare, n.d.; MediStaff, n.d.). The economic undervaluation of geriatric care, therefore, permeates the entire spectrum of the workforce, creating a systemic barrier to robust staffing.

2.2. Limited Exposure During Medical and Health Professional Training

The historical and ongoing underrepresentation of geriatric-focused content and clinical experiences within medical, nursing, and allied health curricula represents another significant cause of the workforce shortage. Many healthcare professionals complete their foundational training with insufficient exposure to the unique physiological, psychological, and social aspects of aging, leaving them ill-prepared and often uncomfortable managing the complexities of older patients.

In medical schools, dedicated geriatrics clerkships or longitudinal experiences are often optional or entirely absent. When present, they may be brief or perceived as less central to the core curriculum compared to other specialties. This limited exposure results in several critical outcomes: medical students may not develop an appreciation for the intellectual challenges and rewards of geriatric medicine; they may harbor misconceptions about working with older adults, sometimes fueled by ageist biases; and they may simply not be aware of geriatrics as a viable and fulfilling career path. The scarcity of geriatrics-focused faculty within academic institutions further perpetuates this cycle, as there are fewer mentors to inspire and guide students toward the specialty.

Similar deficiencies exist in nursing education, where while some basic gerontological principles are often covered, the depth of specialization required for comprehensive geriatric nursing care may be lacking. For instance, specific training in managing complex dementia behaviors, advanced palliative care for older adults, or navigating intricate care transitions is often not uniformly robust across all nursing programs. Social work and allied health curricula also sometimes fall short in providing sufficient specialized training in gerontology, despite the critical role these professionals play in supporting the psychosocial well-being and functional independence of older adults (SWHR Policy Agenda, n.d.). Without early, comprehensive, and positive exposure, the pool of potential specialists remains shallow.

2.3. Perceived Complexity of Care

The inherent complexity of caring for older adults is a significant deterrent for many healthcare professionals, contributing to the perceived difficulty and emotional demands of the specialty. Unlike organ-specific specialties that often focus on a single disease or system, geriatric care requires a holistic and integrated approach to patients who frequently present with multiple interacting chronic conditions (multimorbidity), polypharmacy (the use of multiple medications, often leading to adverse drug interactions), cognitive impairment (ranging from mild cognitive decline to advanced dementia), functional decline, and complex psychosocial issues.

Managing a patient with heart failure, diabetes, chronic kidney disease, mild cognitive impairment, depression, and social isolation, all simultaneously, demands an extraordinary level of diagnostic acumen, therapeutic skill, and interdisciplinary coordination. The clinical presentations of diseases in older adults can be atypical, subtle, or masked by other conditions, making diagnosis challenging. Treatment decisions often involve careful balancing of risks and benefits, taking into account an individual’s functional status, life expectancy, and personal preferences, rather than simply following single-disease guidelines. Furthermore, the focus often shifts from cure to comfort, functional maintenance, and quality of life, which some practitioners may find less professionally gratifying than specialties perceived as offering more ‘definitive’ cures or interventions.

The emotional toll of frequently confronting issues such as disability, cognitive decline, and end-of-life care can also be considerable. The need for extensive communication with patients, their families, and a wide array of other healthcare providers adds layers of administrative and emotional burden. This perceived intellectual and emotional intensity, coupled with the financial disincentives, makes geriatrics appear less appealing to many who might otherwise be well-suited to the field.

2.4. Aging of the Healthcare Workforce

Paradoxically, the healthcare workforce itself is aging, mirroring the broader demographic trends of the general population. This demographic reality compounds the geriatric care workforce shortage, as a significant proportion of experienced geriatricians, gerontological nurses, and other specialists are approaching or entering retirement. The attrition of these seasoned professionals creates a ‘brain drain’ within the field, as years of accumulated knowledge, clinical wisdom, and mentorship capacity are lost.

For example, studies indicate that a substantial percentage of the current physician workforce is over 55 years old, with many planning to retire within the next decade (Simbo AI, n.d.). While specific statistics for geriatricians alone are harder to isolate, they are generally older than physicians in other specialties on average, suggesting an even more acute vulnerability to retirement waves. Similarly, the nursing profession faces a significant aging crisis, with a large cohort of registered nurses nearing retirement age and insufficient numbers of younger nurses entering the field or choosing to specialize in gerontology to replace them (blog.forthenurse.us, n.d.; en.wikipedia.org, n.d.). The same trend affects direct care workers, many of whom are themselves aging while performing physically demanding work. This means that as the demand for geriatric care surges, the supply of experienced providers is simultaneously diminishing, creating an unsustainable gap.

2.5. Undervaluation and Lack of Prestige

Beyond financial considerations, geriatric medicine and care often suffer from a systemic undervaluation and a perceived lack of prestige within the broader medical community and society at large. Historically, fields dealing with chronic conditions and end-of-life care have sometimes been viewed as less ‘glamorous’ or less intellectually stimulating compared to specialties focused on acute interventions, high-tech procedures, or cutting-edge research in diseases primarily affecting younger populations. This perception can deter ambitious students and residents who seek specialties associated with higher status, rapid advancements, or a clearer ‘curative’ role.

This undervaluation is partly rooted in societal ageism – a prejudice against older adults – which implicitly suggests that the care of the elderly is less important or less rewarding. Such biases, often unconscious, can seep into medical education and professional culture, influencing career choices. The focus in many medical settings is often on ‘saving lives’ or ‘curing disease,’ which, while vital, can overshadow the equally critical work of improving quality of life, maintaining function, and providing dignified care for those with chronic and progressive conditions. The triumphs in geriatrics might be more subtle – a patient maintaining independence, a family finding peace in palliative care, or an improvement in functional status – which may not garner the same recognition as a successful surgery or a dramatic recovery from a critical illness. This lack of overt prestige contributes to a cycle where fewer choose the specialty, further entrenching its lower status.

2.6. Inadequate Infrastructure and Support Systems

The existing infrastructure for training, practicing, and researching geriatric care is often insufficient to support the growing needs. This inadequacy further exacerbates the workforce shortage.

• Limited Fellowship and Residency Slots: Despite the clear need, the number of accredited geriatric fellowship positions and residency slots in the U.S. remains relatively low compared to other specialties. Even when available, these positions may not be adequately funded or widely publicized, making it difficult to attract applicants. The pipeline for future geriatricians is therefore constrained at a fundamental level.
• Lack of Dedicated Training Sites: There is often a dearth of dedicated geriatric clinics, long-term care facilities with strong academic affiliations, or integrated hospital-based geriatric units that can provide comprehensive and immersive training experiences. This limits the quality and breadth of exposure for trainees.
• Insufficient Administrative Support: Geriatric practice often involves extensive care coordination, interdisciplinary team meetings, and complex documentation requirements that are not always supported by adequate administrative staff or efficient electronic health record (EHR) systems. This adds to the workload and frustration of geriatric care providers, diverting their time from direct patient care.
• Limited Research Funding: Compared to other major disease areas (e.g., cancer, cardiovascular disease), research funding specifically allocated to geriatric syndromes, aging processes, and geriatric care models has historically been disproportionately lower. This can stifle innovation, limit the development of evidence-based practices unique to older adults, and reduce academic interest in the field.
• Lack of Workforce Planning: A coherent, long-term national strategy for projecting and addressing the geriatric care workforce needs across all disciplines has been inconsistent, leading to reactive rather than proactive policy responses. Without robust planning, the shortages are likely to persist and worsen.

2.7. Challenges for Direct Care Workers

The direct care workforce, comprising Certified Nursing Assistants (CNAs), Home Health Aides (HHAs), and personal care aides, forms the backbone of geriatric care, especially in long-term care facilities and home-based settings. However, this sector faces its own distinct and severe challenges that contribute significantly to the overall shortage:

• Low Wages and Lack of Benefits: Direct care workers typically earn poverty-level wages, often without health insurance, paid sick leave, or retirement benefits. This makes it difficult to attract and retain individuals in a physically and emotionally demanding profession. The average hourly wage for a HHA, for instance, often barely exceeds minimum wage, making it challenging to support a family (MediStaff, n.d.).
• Strenuous Work Conditions: The work is often physically taxing, involving lifting, transferring, and assisting individuals with complex personal care needs. Emotionally, it can be demanding, requiring resilience in the face of cognitive decline, behavioral challenges, and end-of-life situations.
• Limited Career Advancement Opportunities: There are often few clear pathways for career progression or professional development within the direct care workforce, leading to high turnover rates as individuals seek better opportunities in other sectors or healthcare roles.
• Inadequate Training and Support: While basic training is mandated, ongoing professional development, specialized training in areas like dementia care, and access to mental health support for managing stress are often insufficient.
• High Turnover and Burnout: The combination of low pay, challenging work, and limited support results in extremely high turnover rates, with some facilities reporting annual turnover exceeding 100%. This constant churn impacts continuity of care, quality of life for residents, and places immense strain on remaining staff (Agency Forward, n.d.).

Many thanks to our sponsor Esdebe who helped us prepare this research report.

3. Societal and Economic Impacts

The geriatric care workforce shortage ripples through society, generating profound and multifaceted negative consequences that extend far beyond the immediate healthcare system. These impacts affect the quality of life for older adults, burden their families, strain public finances, and ultimately impede the nation’s overall health and economic productivity.

3.1. Strain on Healthcare Systems

The most immediate and visible consequence of the geriatric care workforce shortage is the immense strain it places on an already stretched healthcare system. This strain manifests in several critical ways:

• Reduced Access to Specialized Care: With fewer geriatricians and other specialized providers, older adults experience longer wait times for appointments, if they can even secure one. This delay can lead to late diagnoses, progression of treatable conditions, and missed opportunities for preventive interventions tailored to older age. Many older adults, particularly in rural or underserved areas, may never access a geriatric specialist, relying instead on primary care physicians who may not have extensive geriatrics training.
• Increased Workloads and Burnout for Existing Staff: The limited number of geriatric specialists means that those who remain are often overwhelmed with large patient panels and complex cases. This leads to increased workloads, longer hours, and heightened professional burnout, which can further accelerate attrition from the field. Primary care physicians, nurses, and other generalists are forced to manage increasingly complex geriatric cases without adequate specialized support, adding to their own stress and potentially compromising care quality.
• Emergency Department Overcrowding and Hospital Readmissions: Without access to comprehensive outpatient geriatric care, older adults are more likely to experience preventable crises that lead to emergency department visits and hospitalizations. Lack of coordinated post-discharge care, often due to workforce shortages in home health or skilled nursing facilities, contributes to high rates of preventable hospital readmissions, creating a costly and inefficient cycle of care (Trella Health, n.d.).
• Suboptimal Chronic Disease Management and Preventive Care: Effective management of multimorbidity and the promotion of healthy aging require proactive, personalized, and coordinated care. The shortage hinders this, leading to poorly controlled chronic conditions, increased complications, and a missed focus on preventive strategies like fall prevention or cognitive health interventions that are crucial for older adults.
• Impact on Post-Acute and Long-Term Care: The shortage is particularly acute in post-acute care settings (e.g., skilled nursing facilities, rehabilitation centers) and long-term care facilities, which heavily rely on direct care workers and specialized nurses. Staffing shortages in these environments lead to lower quality of care, increased resident complaints, regulatory violations, and difficulties in meeting residents’ complex needs, sometimes forcing facilities to limit admissions (Agency Forward, n.d.).

3.2. Economic Consequences

The economic ramifications of the geriatric care workforce shortage are substantial and far-reaching, impacting healthcare expenditures, family finances, and national productivity.

• Higher Healthcare Costs: The lack of access to specialized geriatric care often results in a reliance on more expensive, reactive care settings. Preventable hospitalizations, emergency visits, and prolonged institutional stays due to unmanaged chronic conditions or inadequate home support significantly drive up healthcare expenditures. For instance, a lack of proactive geriatric assessment might lead to a fall that results in a costly hip fracture and extended rehabilitation, which could have been avoided with appropriate interventions.
• Increased Burden on Public Programs: As the population ages, the demand for Medicare and Medicaid services surges. The inefficiencies and higher costs stemming from the workforce shortage place increased pressure on these publicly funded programs, threatening their long-term fiscal sustainability. This necessitates difficult decisions regarding funding allocations and potentially higher taxes or reduced benefits in the future.
• Lost Economic Productivity: The shortage extends beyond the professional healthcare sector to impact the informal caregiving economy. As professional care becomes scarce or unaffordable, family members often step in to fill the gap. This frequently requires reducing work hours, taking extended leaves of absence, or even leaving the workforce entirely, leading to lost income, diminished career progression, and reduced tax contributions. The aggregate economic value of this lost productivity and the unpaid care provided by families is immense, often estimated in the hundreds of billions of dollars annually. For instance, the economic value of unpaid caregiving in the U.S. has been valued at over $600 billion per year, a cost largely absorbed by families (MediStaff, n.d.).
• Reduced Quality of Life and Economic Participation for Older Adults: Suboptimal care can lead to accelerated functional decline, reduced independence, and poorer health outcomes for older adults. This can limit their ability to remain actively engaged in their communities, pursue leisure activities, or contribute to the economy through volunteering or part-time work, thereby diminishing their overall quality of life and societal contributions.

3.3. Impact on Family Caregivers

Family caregivers, who are often spouses, adult children, or other relatives, constitute the largest component of the long-term care system in the U.S., providing an estimated 80% of all care for older adults. The geriatric care workforce shortage disproportionately transfers the burden of care from the professional sector to these informal caregivers, leading to severe and often unsustainable consequences (MediStaff, n.d.).

• Caregiver Burnout and Mental Health Issues: The increased responsibilities, lack of adequate support, and emotional toll of caring for an older loved one with complex needs frequently lead to high rates of caregiver burnout, stress, anxiety, and depression. Caregivers often neglect their own health, contributing to a secondary public health crisis.
• Financial Strain: As mentioned, many caregivers face significant financial strain due to lost wages or increased out-of-pocket expenses for care-related supplies and services. This can deplete savings, compromise retirement security, and lead to broader economic instability for families.
• Physical Health Deterioration: The physical demands of caregiving, coupled with chronic stress and lack of sleep, can lead to a deterioration of the caregiver’s own physical health, increasing their risk for chronic diseases and injury.
• Social Isolation: Caregiving responsibilities can limit a caregiver’s ability to maintain social connections, participate in community activities, or pursue personal interests, leading to isolation and reduced quality of life.
• Lack of Training and Resources: Family caregivers often lack formal training in medical tasks, personal care, or navigating the complex healthcare system, leading to feelings of inadequacy and potential errors in care, further impacting the older adult’s well-being.

3.4. Disparities in Care

The geriatric care workforce shortage exacerbates existing health disparities, disproportionately affecting vulnerable populations and widening the gap in health equity.

• Geographic Disparities: Rural areas, which often have a higher proportion of older adults and fewer healthcare facilities, are particularly hard hit. Recruiting and retaining geriatric specialists in these areas is exceptionally challenging due to lower population densities, fewer professional opportunities, and sometimes limited infrastructure. This leaves rural older adults with severely limited or no access to specialized care, forcing them to travel long distances or forgo care entirely.
• Socioeconomic Disparities: Lower-income older adults, who may lack the financial resources to seek care outside of their immediate community or pay for private services, suffer more acutely from the shortage. They may rely more heavily on public health systems that are already under tremendous strain due to staffing deficits.
• Racial and Ethnic Minorities: Minority older adults often face additional barriers to care, including language barriers, cultural insensitivity, and historical mistrust of the healthcare system. The shortage of culturally competent geriatric providers further compounds these challenges, leading to poorer health outcomes and persistent health inequities.
• Lack of Specialized Care for Specific Conditions: The shortage means fewer providers are available to specialize in specific areas of geriatric care, such as advanced dementia care, geriatric mental health, or palliative care, leaving many older adults with these complex needs underserved.

3.5. Decline in Quality of Life for Older Adults

Ultimately, the cumulative effect of the geriatric care workforce shortage is a significant and measurable decline in the quality of life for older adults. This is the most profound and concerning impact.

• Poorer Health Outcomes: Without access to timely and appropriate geriatric care, older adults are at increased risk for avoidable hospitalizations, complications from chronic diseases, adverse drug events, and functional decline. Conditions that could be effectively managed or prevented may worsen, leading to permanent disability or premature mortality.
• Reduced Functional Independence: Geriatric care emphasizes maintaining functional independence – the ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). When specialized care is lacking, older adults are more likely to experience functional decline, requiring greater assistance and potentially necessitating earlier institutionalization.
• Diminished Mental and Emotional Well-being: The physical health impacts are often accompanied by psychological distress. Chronic pain, isolation, loss of independence, and inadequate support can contribute to depression, anxiety, and a reduced sense of purpose among older adults.
• Lack of Person-Centered Care: The core philosophy of geriatric care is to provide person-centered care that aligns with an individual’s values, preferences, and goals. Workforce shortages often lead to rushed appointments, fragmented care, and a transactional rather than relational approach, undermining the very essence of quality geriatric care. This can result in care plans that do not fully reflect the older adult’s wishes, particularly concerning end-of-life decisions.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

4. Strategies to Mitigate the Shortage

Addressing the complex and pervasive geriatric care workforce shortage requires a multi-pronged, collaborative, and sustained approach that targets the root causes through policy, education, innovation, and societal shifts. No single solution will suffice; rather, a comprehensive ecosystem of interventions is necessary.

4.1. Policy Changes and Financial Incentives

Policy reforms and targeted financial incentives are crucial for making geriatric care a more attractive and sustainable career path. These measures can directly address the economic disincentives and systemic undervaluation that deter professionals.

• Enhanced Reimbursement for Geriatric Care: Fundamental changes to Medicare and Medicaid reimbursement models are essential. This includes increasing reimbursement rates for time-intensive cognitive services, comprehensive geriatric assessments, care coordination, and interdisciplinary team meetings. Shifting from a purely fee-for-service model towards value-based care models that reward quality outcomes, patient satisfaction, and coordinated care for complex older adults can better compensate providers for the true value of their work. For instance, bundled payments for specific geriatric syndromes or enhanced payments for practices achieving Age-Friendly Health System criteria could be explored.
• Loan Forgiveness and Scholarship Programs: Expanding and adequately funding loan forgiveness programs specifically for geriatricians, gerontological advanced practice nurses, and other geriatric specialists who commit to practicing in underserved areas is a proven strategy. Similarly, scholarships for students pursuing careers in geriatrics can alleviate financial burdens and incentivize entry into the field. The Biden administration’s investment of approximately $206 million into geriatric care training programs, for instance, aims to enhance the skills of primary care clinicians in geriatrics, signaling a recognition of this need at a national level (axios.com, 2024).
• Tax Credits and Incentives: Implementing federal or state tax credits for healthcare professionals who specialize in geriatrics or practice in designated geriatric shortage areas could provide additional financial motivation. Similar incentives could be considered for long-term care facilities and home health agencies that invest in specialized geriatric training for their staff.
• Funding for Geriatric Fellowship and Residency Programs: Increased federal funding for the creation and expansion of accredited geriatric medicine fellowship programs and gerontological nursing residency programs is critical to growing the specialist pipeline. This includes direct institutional support, as well as stipends for trainees.
• Support for Direct Care Workers: Policy changes must uplift the direct care workforce. This includes advocating for living wages, comprehensive benefits (health insurance, paid time off), and establishing clear career ladders with opportunities for skill advancement and increased pay. Federal and state grants can support employers in offering these benefits and training programs.

4.2. Enhanced Educational Programs

Reforming and enriching educational curricula across all health professions is paramount to equipping future workforces with the knowledge, skills, and positive attitudes necessary for geriatric care.

• Mandatory Geriatric Training Across Disciplines: Integrating comprehensive, mandatory geriatric training into all medical, nursing, social work, pharmacy, and allied health curricula is essential. This should include dedicated clerkships for medical students, expanded clinical rotations in geriatric settings for residents, and required courses focusing on gerontological principles for all health professional students.
• Interprofessional Education (IPE): Developing and implementing IPE models where students from different health professions (medicine, nursing, social work, pharmacy) learn together about geriatric care can foster a team-based approach, enhance communication skills, and prepare future professionals to collaborate effectively in complex care environments. This mirrors the reality of modern geriatric practice.
• Faculty Development Programs: Investing in programs to train current faculty in geriatrics and gerontology is crucial. This will ensure that there are enough qualified educators and mentors to teach the next generation of healthcare professionals and to inspire interest in the field. Academic institutions should also prioritize the recruitment and retention of geriatrics faculty.
• Expansion of Post-Graduate Training: Significantly increasing the number of accredited geriatric fellowship positions for physicians and advanced practice nursing programs specializing in gerontology is fundamental. These programs need to be well-funded and promoted to attract a diverse pool of applicants.
• Focus on Palliative Care and End-of-Life Training: Given the prevalence of chronic and life-limiting illnesses in older adults, integrating robust training in palliative care, advance care planning, and end-of-life communication across all curricula is vital. This equips professionals to provide compassionate and patient-centered care throughout the entire aging journey.

4.3. Innovative Care Models

Innovative care models can optimize the utilization of existing resources, improve access to care, and enhance the efficiency and quality of geriatric services, effectively multiplying the impact of a limited workforce.

• Team-Based and Interdisciplinary Care: Emphasizing interdisciplinary teams (IDTs) is a cornerstone of effective geriatric care. These teams typically include geriatricians, gerontological nurses, social workers, pharmacists, physical therapists, occupational therapists, dietitians, and mental health professionals. By leveraging the unique expertise of each team member, IDTs can address the multifaceted needs of older adults comprehensively, reduce the burden on individual providers, and ensure holistic care. The geriatrician, for example, can act as a coordinator and consultant, extending their reach through the expertise of the team.
• Telehealth and Remote Monitoring: Expanding the judicious use of telehealth services is crucial, especially for older adults in rural or underserved areas, or those with mobility challenges. Telehealth can facilitate virtual consultations, remote monitoring of chronic conditions (e.g., blood pressure, glucose levels), medication management, and mental health support. This reduces the need for in-person visits, saving patient and provider time and increasing access (brookings.edu, 2022). Policies supporting telehealth reimbursement and addressing digital literacy/access for older adults are critical.
• Age-Friendly Health Systems (AFHS): Promoting the adoption of the Age-Friendly Health Systems framework, which focuses on the ‘4Ms’—What Matters (patient preferences), Medication (avoiding problematic medications), Mentation (addressing delirium, dementia, and depression), and Mobility (promoting safe movement)—can ensure that all healthcare encounters are tailored to older adults’ unique needs. This systematic approach can improve quality across various care settings, even with workforce limitations.
• Programs of All-Inclusive Care for the Elderly (PACE): PACE is a highly effective model that provides comprehensive medical and social services to frail older adults who would otherwise require nursing home care. It integrates all necessary services (medical, social, rehabilitative) within a single coordinated entity, often with a multidisciplinary team. Expanding PACE programs can keep older adults in their homes and communities, reducing the demand on institutional care.
• Home-Based Medical Care (HBMC) / Hospital at Home: Expanding models that deliver primary and even acute medical care directly to older adults’ homes can be transformative. HBMC can provide proactive, preventive care to frail, homebound individuals, reducing emergency visits and hospitalizations. ‘Hospital at Home’ programs allow eligible patients to receive acute care services in their own homes, supported by technology and regular home visits from medical staff, reducing the strain on hospital resources.

4.4. Recruitment and Retention of Immigrant Caregivers

Given the demographic shifts and the severe shortage in the direct care workforce, recruiting and retaining immigrant caregivers represents a vital, albeit complex, strategy that requires thoughtful policy reform and ethical implementation.

• Streamlined Immigration Pathways: Policy changes are needed to create and expand clear, ethical, and efficient pathways for legal immigrants to enter the caregiving workforce. This could involve specific visa categories for healthcare support workers, expedited processing for qualified applicants, and recognition of foreign credentials. The current system often presents significant hurdles that discourage potential caregivers from entering the U.S. legally (brookings.edu, 2022).
• Training and Credentialing: Establishing robust programs to train immigrant caregivers in geriatric-specific care practices and to assist foreign-trained healthcare professionals (e.g., nurses, physicians) with credentialing and licensure processes in the U.S. is essential. This ensures that the workforce is not only expanded but also highly skilled and integrated into the existing healthcare system.
• Ethical Recruitment and Fair Labor Practices: It is crucial to implement policies that prevent the exploitation of immigrant caregivers, ensuring they receive fair wages, benefits, and safe working conditions. Protections against discrimination and abuse, as well as access to legal resources, are paramount to building a sustainable and ethical workforce. This includes addressing issues such as wage theft, excessive recruitment fees, and unsafe housing.
• Integration and Support: Providing support services for immigrant caregivers, such as language training, cultural competency programs, and assistance with community integration, can improve retention and overall job satisfaction. Creating an inclusive work environment that values their contributions is key.
• Comprehensive Immigration Reform: Broader immigration reform that acknowledges the U.S.’s growing care needs and creates a more flexible and responsive system for skilled and unskilled workers in critical sectors, including healthcare, will be necessary for long-term solutions (healthandagingpolicy.org, 2025).

4.5. Technology and Artificial Intelligence in Geriatric Care

Leveraging advancements in technology and artificial intelligence (AI) offers promising avenues to augment the capabilities of the geriatric care workforce, improve efficiency, and enhance patient outcomes, though ethical considerations must guide their implementation.

• AI for Predictive Analytics and Risk Assessment: AI algorithms can analyze vast amounts of patient data to identify older adults at high risk for falls, readmissions, cognitive decline, or adverse drug events. This allows healthcare providers to intervene proactively and allocate resources more efficiently, focusing attention where it is most needed.
• Personalized Care Plans and Decision Support: AI can assist in developing personalized care plans by synthesizing patient-specific data, evidence-based guidelines, and patient preferences. Decision support tools can help clinicians manage complex polypharmacy, identify potential drug-drug interactions, and suggest appropriate diagnostic pathways for geriatric syndromes, thus improving diagnostic accuracy and treatment efficacy.
• Robotics for Assistance and Companionship: Robotic technology, ranging from assistive devices for mobility and lifting to social robots providing companionship and reminders, can help address the physical demands of caregiving and alleviate social isolation. These tools can extend the reach of human caregivers and support independent living.
• Optimized Electronic Health Records (EHR) and Interoperability: Improving EHR systems to be more user-friendly for geriatric care, with integrated care plans, easy access to advance directives, and seamless information sharing across different providers and settings, can significantly reduce administrative burden and improve care coordination. Enhanced interoperability between health systems, pharmacies, and social services is crucial.
• Virtual Reality (VR) and Augmented Reality (AR) for Training and Therapy: VR can be used to train healthcare professionals in realistic scenarios for geriatric care, such as managing challenging behaviors in dementia. It can also be employed as a therapeutic tool for older adults, providing cognitive stimulation or virtual travel experiences to improve mental well-being.
• Tele-rehabilitation and Remote Monitoring Devices: Wearable sensors and smart home devices can continuously monitor vital signs, activity levels, sleep patterns, and fall risks, transmitting data to caregivers and clinicians for early detection of issues. Tele-rehabilitation platforms allow older adults to receive physical and occupational therapy remotely, increasing accessibility and adherence.

However, it is crucial to address the digital divide, ensuring equitable access to technology for all older adults, and to navigate ethical considerations related to data privacy, algorithmic bias, and the potential for technology to depersonalize care. Technology should always complement, not replace, the human element of compassionate care.

4.6. Public Awareness and Advocacy

Shifting public perception and fostering a greater societal appreciation for aging and geriatric care are fundamental long-term strategies for attracting talent and securing resources.

• Public Education Campaigns: Launching national and local campaigns to raise awareness about the critical importance of geriatric care, the unique healthcare needs of older adults, and the rewarding nature of careers in geriatrics. These campaigns can challenge ageist stereotypes and promote a positive view of aging.
• Advocacy for Funding and Policy Support: Sustained advocacy efforts are needed to influence policymakers at federal and state levels to prioritize geriatric care through increased funding for research, training programs, and service delivery. This involves engaging professional organizations, patient advocacy groups, and older adult communities.
• Promoting Geriatrics as a Fulfilling Career: Highlighting success stories, showcasing the intellectual challenges, and emphasizing the profound impact geriatric professionals have on the lives of older adults and their families can help recruit new talent. This includes outreach programs to high school and college students to spark early interest.
• Celebrating Geriatric Professionals: Recognizing and celebrating the contributions of geriatricians, nurses, social workers, and direct care workers can boost morale, enhance professional identity, and inspire others to join the field.

4.7. Workforce Well-being and Retention

Attracting new professionals is only half the battle; retaining the existing and future geriatric care workforce is equally vital. Addressing burnout and fostering supportive work environments are critical.

• Supportive Work Environments: Healthcare organizations must cultivate work environments that prioritize the well-being of their geriatric care staff. This includes fostering a culture of psychological safety, mutual respect, and recognition for their challenging work.
• Burnout Prevention Programs: Implementing comprehensive burnout prevention and resilience programs, including access to mental health services, stress management training, and peer support networks, can help retain professionals facing high emotional and physical demands.
• Flexible Work Arrangements: Offering flexible scheduling, part-time options, and opportunities for telework (where appropriate) can improve work-life balance and attract a more diverse workforce, including those who may be balancing caregiving responsibilities of their own.
• Professional Development and Career Advancement: Providing ongoing opportunities for professional development, specialized training (e.g., in dementia care, palliative care), and clear pathways for career advancement (e.g., from CNA to LPN, or from RN to NP) can increase job satisfaction and retention across all levels of the geriatric care workforce (HR Healthcare, n.d.).
• Competitive Benefits and Compensation: Beyond base salary, offering competitive benefits packages, including comprehensive health insurance, retirement plans, and paid time off, is essential for attracting and retaining talent in a competitive labor market (CWS Health, n.d.).

Many thanks to our sponsor Esdebe who helped us prepare this research report.

5. Conclusion

The geriatric care workforce shortage in the United States represents a multifaceted, escalating crisis with profound implications for the health, well-being, and economic stability of an aging nation. The convergence of a rapidly expanding older adult population and a critically insufficient supply of specialized healthcare professionals, exacerbated by financial disincentives, inadequate training, the complexity of geriatric care, and an aging workforce, creates an unsustainable trajectory. The repercussions are far-reaching, manifesting as immense strain on healthcare systems, escalating economic burdens, disproportionate impacts on family caregivers, the widening of health disparities, and ultimately, a tragic decline in the quality of life for millions of older adults.

Addressing this pervasive challenge demands a comprehensive, coordinated, and sustained national effort. It necessitates a paradigm shift in how society values and invests in the care of older adults. The strategies outlined in this report—ranging from fundamental policy reforms and enhanced financial incentives to transformative educational programs, innovative care models, the ethical recruitment of immigrant caregivers, the strategic integration of technology, proactive public awareness campaigns, and dedicated efforts to support workforce well-being—are not isolated solutions. Instead, they represent interconnected pillars of a holistic framework designed to build a robust, resilient, and compassionate geriatric care ecosystem.

Success in mitigating this crisis hinges on the collaborative commitment of policymakers, healthcare administrators, educators, professional organizations, researchers, and the public. Investing in a strong geriatric care workforce is not merely an act of compassion; it is a critical investment in the future health, economic productivity, and social fabric of the United States. By embracing these comprehensive strategies, the nation can ensure that its growing older adult population receives the high-quality, person-centered care they deserve, fostering dignity, independence, and well-being for all as they age.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

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