Q&A with Dr. Lenard Kaye, Director of the UMaine Center on Aging and Professor of Social Work at the University of Maine

As the Baby Boom generation retirements begin, is the health workforce prepared to provide services these educated consumers will need and demand? What attracts students to gerontological practice and how can we help them learn about the wide-range of career options? In this interview with UMaine Center on Aging director Dr. Lenard Kaye, we learn about innovative educational programs and partnerships in Maine that address the need for a well-prepared geriatrics workforce. Dr. Kaye, a prolific writer in the field of health care and aging, is a Fellow of the Gerontological Society of America, a National Research Mentor for the Hartford Geriatric Social Work Scholars Program, and sits on the editorial boards of the Journal of Gerontological Social Work and Geriatric Care Management Journal.

Could you share with us some of the changes you see coming as the U.S. population ages, particularly how the needs of the baby boomers will impact the health workforce?

The aging of the U.S. population is destined to dramatically impact every conceivable facet of American life. How could some 78 million baby boomers now turning 65 years of age at the rate of 10,000 a day not change our lives and not alter the delivery of health care in significant ways? We need to remember that Boomers, born between 1946 and 1964, are healthier, more mobile, more educated, more skilled, and more outspoken than any previous generation of Americans. Their expectations will be higher and they will let their views (both positive and negative) be known loudly and clearly. The implications for the health workforce are clear. I anticipate Boomers will make heavier use of health care resources and demand that those services be of the highest quality. Boomers will want more health care choices available to them including the availability, in particular, of nontraditional health care including a heavy dose of health promotion and illness prevention services. They will not allow themselves to be treated as passive, vulnerable victims but will rather insist they be viewed as the educated consumers they are with a critical eye continuously assessing the manner in which health care is provided. They will expect a greater voice in the development of their personal health care plan. And, they will be more honest, direct, and open in their style of communication with the health professionals that serve them. Get ready, the Boomers have arrived and will surely drive dramatic changes in the design and delivery of health care in the years ahead.

One goal of the UMaine Center on Aging is to provide aging-related education and training. How do you attract students to this field? Is there enough interest in working with older adults and awareness of the growing demand?

My entire career has focused on special efforts at attracting students to the field of gerontological practice. It is hard work given that a career working with children, youth, and young families has always been far more attractive (for reasons I guess I have not fully understood). In any case, what seems to work best is to tie a decision to work in health care with older adults to the making of a smart career choice in an occupational field that will have consistently strong work force needs far into the future. Offering students specialized training opportunities and a range of hands-on service-learning opportunities in the community is also very important. We have been able attract funding to the University that has made possible the establishment of a number of specialized gerontological and geriatrics education programs for both undergraduate and graduate social work students including the Hartford Partnership Program for Aging Education, and the Certificate in Leadership in Rural Gerontological Practice. I am especially pleased to report that we are working with other faculty on campus and providers in the community to offer an Interprofessional Graduate Certificate in Gerontology. This proposed program, that will stress interprofessional teamwork in the health care of older adults, will be offered entirely on-line and be available to both community practitioners and students everywhere. It is designed to increase the knowledge, skills, and abilities of health and human service professionals who provide care to older adults and their caregivers in a variety of settings. We expect University approval for this 5-course, 12-credit program soon and know that social workers, nurses and nurse practitioners, speech-language pathologists, dieticians, and others in the health and human-service fields who were prepared as generalists will benefit from the focus on the needs of older adults and their caregivers. Being able to offer students these kinds of high visibility programs that represent unique opportunities for them to take advantage of and put on their resumes as they prepare to enter the job market is important. The fact is, students are attracted to opportunities that will make them more marketable in the job market.

Would I like to see more students show an interest in a career in geriatrics? Of course I would. But, the numbers of students participating in aging-related education programs has grown significantly in recent years at the University and that is very satisfying. We must be doing something right.

What are some of the partnerships you’ve developed to ensure students get the real-world field experience? How do these learning opportunities in the community benefit the students and the older adults participating?

The fact that our by-line at the Center on Aging is “Forging Partnerships for an Aging Community” is very telling and should underscore the importance placed on collaboration and partnering. We know that we will never achieve our goals and objectives if we go it alone. Rural communities have traditionally had scarce resources to work with, and Maine is no different. To succeed in preparing the state for the consequences of an aging citizenry, we will need to work together and combine our precious few resources and available expertise. The principle of collaborative practice has been especially important in developing and maintaining a roster of aging-related, community internship sites for BSW and MSW students studying at the School of Social Work. Building strong and lasting relationships with colleagues in the community has resulted in a very good mix of service-learning opportunities for students including internship programs at the local Area Agency on Aging, the State Office on Aging and the Office of Adult Protective Services, local adult day care programs, home health care agencies, a senior center, senior housing and continuing care retirement communities, residential homes, acute care and psychiatric hospitals and medical centers, church-based social centers, volunteer and home visiting programs, and the Center on Aging itself. You will notice that, taken together, these internship locations represent a mix of agencies serving both the well and the impaired aged.

I am also proud to say that the School of Social Work has pioneered a placement sequence that ensures students preparing for careers working with older adults have the opportunity to rotate through a range of organizations serving older people rather than just have students experience a single type of service meant to meet the needs of a particular group of older people. In this way, our students’ eyes are opened to the wide range of career choices available to them and the enormous diversity that characterizes the older adult population.

Are there particular characteristics or background that you find make for successful geriatrics practitioners?

I don’t think that the decision to work with older adults requires a particular mindset or set of unique personal qualities. Helping professionals hopefully bring with them a keen sense of caring and a commitment to maximizing the quality of life of those they serve. Those who work with elders are no different. Such individuals do need to be careful not to bring undue negative bias to their work. Healthy measures of positive, hopeful, and respectful appreciation for the abilities, capacities, and experiences of our elders is crucial in order that a nihilistic (hopeless) or paternalistic mentality not dominate practitioners’ attitudes, values, and behaviors. A commitment to helping people is, of course, the other key ingredient that you need to have in good supply.

How can interdisciplinary training around geriatrics help ensure that providers will be better able to meet the needs of their patients?

Interdisciplinary or interprofessional training is crucial for ensuring that providers meet the unique and varied needs of older patients and clients. Given that we live in the age of specialization, geriatrics service delivery teams must reflect a variety of expertise including skill sets that can respond to the physical, psychological, social, economic, and environmental stressors that confront older adults. No single health care professional (at least none that I know of) can claim to have a fully equipped personal tool kit available to respond to all possible challenges that might arise when working with an older patient.

What roles do social workers fill in ensuring and providing quality geriatrics care? What knowledge, skills and background do social workers bring to geriatric interdisciplinary teams?

Social workers bring extraordinary people skills to service delivery. No professional can claim greater awareness of the needs and resources that older adults and their families bring to the provider-patient relationship. Because of this, social workers bear special responsibility for ensuring that the voice of the older adult and his or her family is encouraged and respected during the course of assessment, service planning, goal setting, and service delivery. In this respect, social workers should be viewed as patient advocates, empowering the older adult to play a significant role in shaping their own course of treatment. A social worker, as much as any professional, also appreciates the multiple influences that impact older adult well-being. Our perspective is very much a multi-dimensional one in which we realize the significant roles played by biological/physical, social, psychological, economic, racial, cultural, environmental, and other factors in determining health. Of course, a social worker should also be the geriatrics team member who is most informed about the range of services, entitlements, and benefits that may be available to and needed by older patients and clients in a particular community. And they are obliged to keep that roster of available community resources current including the most effective and efficient entry points for obtaining particular services or benefits. Here, too, social workers frequently assume the role of advocate, fighting for benefits and entitlements that people should rightfully receive. Finally, social workers are well prepared to serve as overall care managers on geriatrics teams, ensuring that the entire process from initial contact with the client or patient to case closing is well orchestrated and as seamless as possible from one stage to the next.

What are you most worried that current and future health professionals don’t know about meeting the needs of older adults?

In 2008, and now in 2012, the Institute of Medicine (IOM) has highlighted the urgency of expanding and strengthening the geriatric health care workforce including the geriatric mental health and substance use workforce. The IOM indicated that the breadth and magnitude of inadequate workforce training and personnel shortages have grown to enormous proportions.

The Maine Department of Labor also projects the need for increased numbers of gerontological specialists as well as generalist care providers who possess up-to-date knowledge, skills, and abilities in the care of older adults. Go to any other state department of labor as well as the U.S. Department of Labor and you will find similar warnings. At the same time, the number of academic programs dedicated to the study of aging and the needs of older adults have unfortunately declined rather than grown in the past decade.

To say that these trends cause me to worry about the future is no understatement. I worry that not enough individuals will be available to competently serve the expanding numbers of older adults ultimately needing our services in the years ahead, especially in rural communities where the geriatrics workforce is especially scarce. I also worry that too many providers, like the general public, will bring an outdated mentality about older adults to their work that has been unfortunately influenced by widespread biases and stereotypes of our elders – views that do not emphasize enough the abilities, resources, and capacities that older adults display even in the face of what might be declining physical and mental health.

Could you tell us about some of the ways you reach out to health care providers to provide continuing education related to geriatrics?

Because specialized geriatrics and gerontological education in such a rural, aging, and economically depressed state as Maine is relatively scarce, the UMaine Center on Aging takes its role in providing such programming extremely seriously. We are a prominent partner in the planning of the annual Maine Geriatrics Conference, that represents the longest running (22 years!) and most comprehensive program offering of clinical geriatrics best practices in the state. We also partner with others including the University of Maine School of Social Work in the planning of the annual University of Maine Clinical Geriatrics Colloquium which has been offered for the last six years and previously addressed such inadequately addressed issues as older adult substance misuse and abuse, sexuality and sexual orientation, and physical and emotional trauma. While these conferences draw attendees from throughout northern New England, we have also been the lead planner for the International Symposium on Safe Medicine which addresses the safe use, collection, and disposal of pharmaceuticals and draws local, national, and international audiences. All of our educational programming includes special attention to the unique challenges and opportunities posed by delivering health care in small towns and rural communities. And, by the way, we also offer a wide variety of community workshops for older adults themselves who are interested in enriching their skill set when volunteering in communities (this is offered through the Center’s Encore Leadership Corps).

What other information would you like to share?

Since the UMaine Center on Aging was established in 2002, it has become increasingly clear to me that a public university-based center on aging located in a rural community must be willing to stretch the limits in defining its mission, goals, and objectives. I firmly believe that performing research and evaluation, education and training, and service consultation and delivery functions has insured that we will be of maximum value in a resource scarce community. It has allowed us to work in more meaningful ways, with more organizations and agencies, large and small, and step out of the ivory tower more frequently than I ever would have thought possible. Certainly, my social work roots and principles of practice have encouraged such a perspective from the very beginning.

I strongly encourage everyone to learn more about the wide range of research, evaluation, education, training, and community services offered by the University of Maine Center on Aging and its partners by going to http://mainecenteronaging.umaine.edu/.

Dr. Kaye can be reached at len.kaye@umit.maine.edu or 207-262-7922.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.