Gluing Together a Fragmented Healthcare System for Geriatrics Will Be Hard. It's Time for United Action

Area of Science:

• Geriatric Medicine
• Health Services Research
• Healthcare Policy

Background:

• Integrated Geriatric Clinical Service Lines (GCSLs) are difficult to establish in the US healthcare system due to workforce shortages, inconsistent geriatric education, ageism, and misaligned infrastructure.
• The US healthcare system's fee-for-service (FFS) model, increased specialization, and healthcare system consolidation hinder GCSL dissemination.
• Older adults with complex conditions require longitudinal, interdisciplinary care, which current systems often fail to provide.

Approach:

• This review examines systemic barriers within the US healthcare system that impede the widespread adoption of GCSLs.
• It identifies three key characteristics hindering GCSL implementation: historical FFS reimbursement, a rise in disease-specific specialty care, and healthcare system consolidation.
• The review proposes three strategic interventions to foster GCSL growth and improve care for older adults.

Key Points:

• Healthcare system features like fee-for-service reimbursement, specialization, and consolidation obstruct integrated geriatric care.
• Addressing these requires a multi-faceted approach including policy advocacy and innovative workforce development.
• Overcoming ageist attitudes and improving geriatric competency are crucial for effective GCSLs.

Conclusions:

• Significant systemic changes are needed to successfully implement and scale Geriatric Clinical Service Lines (GCSLs) in the US.
• Proposed interventions include local political advocacy for health policy legislation, expanding the geriatric workforce through non-traditional methods, and shifting corporate behavior in healthcare systems.
• These efforts are essential to improve care outcomes for older adults with complex medical, cognitive, and neuropsychiatric disorders.