One of the great unsung pillars of geriatric care in the United States is the Veterans Administration. While the needs of young veterans returning from our current conflicts have gotten a lot of press and well-deserved attention, we can’t forget the needs of those who served in all of our prior conflicts, 55% of whom are 60 or older. (This represents 12.5 million people, 4.8 million of whom are over 75.) At this point, the veterans of World War II are rapidly disappearing, but the veterans of Korea, Vietnam, and the long cold war are reaching the age when they will need high quality, comprehensive, and geriatrically expert care.
To help it meet the needs of this population, the VA has long been a top funder of health professionals, supporting approximately a quarter of fellowship slots in geriatric medicine and a half of those in geriatric psychiatry. Through its Geriatric Research Education and Clinical Centers (GRECCs), the VA is also one of the few supporters of health professionals (of all kinds) who have clinical training in geriatrics and want up to two years of advanced training for academic careers.
Because of the needs of its population, both young and older, the VA is also one of the nation’s largest employers of social workers–some 9,000 at the master’s level–who provide mental health treatment, case management, and a wide array of psychosocial services to veterans and their families. The rest of the health system has only recently begun to acknowledge the connection of physical health to mental health and social environment; for the VA, this is old hat. Indeed, what is cutting edge in other health systems, like electronic medical records, medical homes, and continuous quality improvement, is an everyday reality for the VA.