National Nurses United

KEN LOVE/AKRON BEACON JOURNAL/KRT/NEWSCOM Aging:Final 9/4/07 4:06 PM Page 13 One reason why there are fewer geriatric doctors is that they are among the lowest paid in the profession. While radiologists and orthopedic surgeons average $400,000 a year, geriatricians average $150,000 a year. Brunner, however, is not overly sympathetic to this argument. "It is hard to feel bad about any doctor's income," he said. "The problem is not that we don't pay doctors enough." The shortage is not restricted to doctors. Only 720 of the 200,000 pharmacists in the U.S. have geriatric certification, and the situation is only slightly better for social workers. Bonnie Martin, RN, NP works in geriatrics in San Francisco and is a member of CNA/NNOC's board of directors. She said the situation in nursing is "very similar." According to Martin, "very few RNs choose to work with the elderly and very few [nurse practitioners] attend geriatric programs." Much of the care for the elderly "is left to LVNs [licensed vocational nurses] and certified nursing care, in spite of the fact that the elderly need more complex nursing care than most other patient populations." Stanley and Mezey argue that "evidence shows that older-person care delivered by nurses with specialized geriatric knowledge and skills improves outcomes" by improving patient assessment, reducing falls, and lowering costs. Yet less than 1 percent of the 2.7 million nurses in the United States and Canada are certified in geriatrics and only 27 percent of nurses in baccalaureate programs have required classes in geriatric medicine. Martin said the reason is that "nurses in [long-term care] tend to be paid significantly less, have fewer benefits, and are not considered among the nursing 'elite,' an outgrowth of how little we value our elderly." So elder care falls increasingly on aides, whose pay averages $9.34 an hour. The low pay and lack of benefits result in high annual turnover. In addition, the traditional pool for such aides—women aged 25 to 54 with little education—is not growing to match the rise in the elder population. SEPTEMBER 2007 Even if there were no shortage of attentive, trained medical providers however, another dimension of the problem is our failure to consider class, race, and gender as part of Landau's "total terrain" of elder care. There has long been a significant gap between the care that whites, compared to nonwhites, receive, and who delivers that care. In 2004, a commission headed by Lewis W. Sullivan, former secretary of the U.S. Department of Health and Human Services, found that "from cancer, heart disease, and HIV/AIDS to diabetes and mental health, African Americans, Hispanic Americans, and American Indians tend to receive less and lower quality care than whites, resulting in higher mortality rates." Inferior care, Wallace said in an interview, has a "weathering effect" on people, meaning that the "accumulated impact of being poor, living in poor conditions, and the high stress of living in a racist environment" all contribute to deteriorating health. For instance, Wallace says that rates of "food insecurity" among nonwhites is twice that of non-Latino whites, and that food insecurity is associated with a host of chronic diseases like diabetes, hypertension, and coronary heart disease. This disparity of access to healthcare hits on what U.C. Berkeley's Satariano refers to as "the middle years, where the accumulation of insults the poor suffer play out. It is during these middle years that we begin to lose some of our resistance to disease." New research finds that poverty-level income—$10,210 for a single person, $13,690 for a couple—falls short of meeting basic needs. According to the National Academy of Social Insurance, people need to earn between 150 percent to 300 percent above the poverty line "to meet basic living expenses without assistance." Gender inequity is yet another facet of the problem and can even compound it. Women ages 45 to 55, with a family income of less than $35,000 a year, make up the overwhelming bulk of people who volunteer their labor to care for aged parents or grandparents. Some 80 W W W. C A L N U R S E S . O R G REGISTERED NURSE 13

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