Crisis of Recruitment: Stereotypes Hinder Staffing in Geriatric Services

Nursing home stereotypes contribute to poor care outcomes.

Whether fueled by fear or misinformation, many Americans assume nursing homes are depressing and isolating institutions housing people who have little to contribute to society. These assumptions are compounded by ageism, a major social problem that needs to be changed.

And in my experience, they are not true for the majority of Americans in nursing homes.

As all new doctors start their medical residencies in July, it seems appropriate to look at how these inaccurate stereotypes affect the recruitment of talent in geriatric services. I see this disconnect as I teach doctor of physical therapist students at Northwestern University’s Feinberg School of Medicine and few express an interest in working with older adults.

Of the 204,000 physical therapists nationwide, only 2,133 hold a geriatric specialization. The lack of interest is common across health professions. Less than 1 percent of registered nurses are certified in geriatrics and 37 percent of geriatric medicine fellowship training slots go unfilled.

Students often report that they believe nursing homes are less prestigious clinical settings and unrewarding places to work. These biases make it harder to recruit healthcare providers to work with in these settings contributing to workforce shortages.

By 2050, 20 percent of the population will be 65 or older and we will need an appropriately trained healthcare workforce to care for an aged population.

In the US, 15,600 nursing homes provide specialized care for 1.4 million older adults. Nursing home staff have training to assist with tasks such as feeding tube management or incontinence care that family caregivers may struggle to provide in-home.

The communal nursing home environment also provides a social network with activities to keep residents from being isolated. Nursing homes offer peer socialization, assistance with daily living tasks, and meals; all necessary aspects to age well.

While 90 percent of older adults report they intend to age in their own homes, nursing homes may be the safest residence for those with substantial physical and/or cognitive impairments.

The assumption that moving into a nursing home means giving up personal freedom may delay care for vulnerable older adults who would otherwise thrive within a supportive, nursing home environment.

As a physical therapist, I have witnessed families agonize over the decision to move a loved one into a nursing home and seen guilt worsen the mental and physical health of these caregivers. We can improve the health of these family members by reducing the judgment and social stigma that surround moving into a nursing home.

Certainly not all nursing homes provide quality care.

According to 2012 Centers for Medicare and Medicaid Services data, 3.1 percent of nursing homes received citations for substandard care. Research suggests that 25 percent of nursing home residents face neglect or abuse.

Some nursing homes are dangerous and live up to the stereotype of being a depressing institution housing people waiting to die. But continuing to perpetuate the generalization to avoid all nursing homes does no one any good.

To combat the stereotype of nursing homes as institutions where people go to die, we need greater representation of the positive aspects of nursing homes. There are many examples of nursing homes that increase resident self-worth and quality of life by providing care directed around the individual person’s preferences.

There is some evidence that having personal experiences with nursing homes and the elderly can reduce ageism and disrupt stereotypes.

After my own students spent a day in a nursing home, one student reflected, “I used to think working in a nursing home would be boring and depressing. Now I see this population can be extremely fun to work with.”

Aging is inevitable and we all may face moving into a nursing home some day. By viewing nursing homes as a place to receive care that other environments cannot provide rather than a home of last resort, we ensure that older adults live out their remaining years safely, securely, and with the support they need.

Margaret Danilovich is an assistant professor at Northwestern University Feinberg School of Medicine — Department of Physical Therapy and Human Movement Sciences. She is a Public Voices Fellow in The OpEd Project.

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