Today’s test: Fill in the blank.

Please complete this sentence:

Because the number of older adults is growing rapidly (some 10,000 turn 65 each day) and, therefore, rates of chronic illness and health care use/spending are increasing rapidly, we must ____________________________________.

Reasonable people can disagree about what new ideas or plans might fill in that blank. Perhaps there should be a much bigger role for non-physician primary care professionals specially trained in geriatrics to bridge the ambulatory care void and help people stay healthier and out of expensive hospitals. Perhaps there should be a radical commitment to a public health approach that goes beyond kids and addresses high value secondary and tertiary prevention for high cost illnesses. Perhaps we should try to do what the 2008 IOM Retooling committee report recommended: greatly expand the health care workforce specializing in geriatric care; increase the geriatrics training of nearly all non-specialists; and use our existing workforce more effectively (including patients and paid and unpaid direct care workers).

I'd love to know what people think about this. We are in the midst of strategic planning to determine how best to put new grant money to work in 2013.

However, the one thing that makes absolutely no sense to me is to carry on as we have been. Continuing the failed approaches of the past without change and expecting different results is the definition of madness. And yet this seems to be the recommendation of many health care leaders.

I was reminded of this in July when Darrell Kirch, MD, the head of the Association of American Medical Colleges, wrote to President Obama to protest cuts to Graduate Medical Education funding that were then under discussion. He wrote:

The crux of the argument is because the population is aging, we must keep on as we have been. How the head of the organization that sponsors Academic Medicine, the journal where "The Most Terrifying (Study) Ever" was published could make this claim, I don't understand. (The study shows the pervasive failure of graduate medical education to prepare physicians to care for older adults.)

An even clearer example is the "Social Work Reinvestment Act of 2008," advocated by the National Association of Social Workers (NASW). In this proposed legislation, the needs of older adults and defects in their care are cataloged in impressive detail. (E.g., 1 in 7 Americans over 70 have some form of dementia; only 9 percent of social workers specialize in gerontology; from 2000 to 2004 reports of elder and vulnerable adult abuse/neglect increased 19.7 percent.) And yet the proposed remedy is just more of the same — funding for social work education in general with no particular requirements. This proposal just ignores what we know — that social workers, like other health professionals, get minimal exposure to geriatrics in generalist training and avoid specialization in elder care as much as possible because of its low pay, difficulty, and lack of prestige.

Both AAMC and NASW have good intentions and they have been and will be partners of ours in the future. I agree that more education funding and, at least, avoiding cuts are important if we are to maintain our current mediocre quality of care. However, I don't think that either organization fully understands the implications of the geriatric care crisis. Our current care is unacceptably poor and the impact on the lives of older people and the public purse is unsustainable. If we are going to enable older Americans to live to their full potential of health and independence they will need health care providers who are more knowledgeable and a health care system that makes it easier to do the right thing by them. Maintaining the status quo will not succeed.

Try, fail, learn . . . try something different.