In St. Louis, a team of students aboard a well-equipped van visits senior centers, a nursing home, a church, and other sites, learning to conduct comprehensive, hourlong geriatric assessments.
The team — future doctors, social workers, psychologists, and therapists — looks for such common problems as frailty, muscle weakness, and cognitive decline. The patients they evaluate, free of charge, receive printed plans to help guide their care.
Across Oregon, community health workers have enrolled in an eight-hour online training program — with sections on Medicare and Medicaid, hospice and palliative care, and communication with patients and families — to help them work with older adults.
“We need these front-line public health workers to know how to provide age-friendly care,” said Laura Byerly, the geriatrician at the Oregon Health & Science University who leads its efforts.
And in Louisville, the same federally funded program provides geriatrics training across Kentucky. Sometimes, though, it takes a less formal approach.
Sam Cotton, the social worker who directs its dementia program, recently heard from a local Methodist church whose parishioners were caring for relatives with dementia. Could someone talk to the congregation about this demanding role? Cotton, an assistant professor at the University of Louisville, said sure, she would be there.
These programs, and 39 more like them across the country, aim to address an alarming fact: The number of geriatricians and other health care providers knowledgeable about aging has failed to keep up with the burgeoning population age 65 and older.
Since 2015, therefore, Congress has authorized funding for the Geriatrics Workforce Enhancement Program, or GWEP, which trains about 70,000 people a year.
Recently, these grants to universities and hospitals, up to $1 million each this year, appeared imperiled. In July, without warning or explanation, the annual disbursements to the recipients, some of which had participated since the program began in 2015, were substantially reduced.
Instead of an expected $41.8 million, the grantees collectively received $27.5 million, a 34% shortfall, according to the Eldercare Workforce Alliance. And more cuts appeared to be coming.
The Trump administration’s proposed budget for fiscal 2026 eliminated GWEP, along with many other programs funded through the Health Resources and Services Administration, an agency of the Department of Health and Human Services.
Although the program had always drawn bipartisan support, and had been repeatedly authorized for five years, the president’s budget zeroed it out, citing “an effort to streamline the bureaucracy, reset the proper balance between federal and state responsibilities, and save taxpayer funds.”
As 10 weeks passed without clarification — was the missing money merely delayed or gone for good? — program directors frantically called their congressional representatives while contemplating painful layoffs and an uncertain future.
“This money was appropriated, signed, and sealed, so where is it?” Cotton said last month. Besides her role in the Louisville program, she serves as board president of the National Association of Geriatric Education Centers.
Grantees’ questions to HRSA, the funding agency, brought few answers. Then, on Sept. 10, the programs discovered that, as mysteriously as they had vanished, the rest of the allocated funds had suddenly materialized.
And GWEP has been restored to both the House and Senate bills funding the federal health department, though the bills could still change or be voted down — or a continuing resolution could freeze current funding.
The rescue may reflect, in part, the efforts of a powerful GWEP supporter, Republican Sen. Susan Collins of Maine, who faces reelection next year.
In a Senate floor speech on Sept. 3, Collins called the program a “modest investment that will help ensure that our older Americans have the expert care that they need, that their caregivers are provided with training, that other support employees and health care providers receive the skills that they need.”
Still, “it has been a roller coaster, to say the least,” said Marla Berg-Weger, GWEP co-director at Saint Louis University, which trains about 9,800 people annually.
The payments withheld for 10 weeks equaled the amount that each grant had earmarked for Alzheimer’s and dementia training, program directors found. The programs were required to designate $230,000 of a $1 million grant to dementia training for both professionals and community members, but some had chosen to spend more and therefore had larger shortfalls.
The GWEP at Louisiana State University, for instance, initially received just $152,000 of its expected $976,659 and halted (temporarily, the director hopes) all its geriatric rotations and internships in Louisiana and Mississippi.
What has been going on? HRSA, the federal agency funding the programs, said in an email that “all grant programs have been thoroughly reviewed to ensure alignment with administration priorities,” causing “brief delays in executing certain payments.”
“It’s surprising to me that anyone would question the value of having a workforce knowledgeable about care for older adults,” said Carole Johnson, the agency’s administrator during the Biden administration.
“Everybody in the field hoped this program would grow, not wither,” she added.
Appropriations have increased only slightly in recent years. Yet “the recipients are very resourceful,” Johnson added. “It’s a ‘big bang for the buck’ program and a smart use of federal resources.”
The number of practicing geriatricians — 6,580 this year, according to HRSA estimates — is likely to decrease slightly in the coming years, even as the need for such expertise climbs. It’s hard to attract medical students and doctors to a relatively low-paying specialty whose patients are mostly insured by Medicare, though surveys have shown high job satisfaction among geriatricians.
Most older patients receive care not from geriatricians but from primary care doctors, other medical specialists, physician assistants, nurse practitioners, social workers, pharmacists, and direct care workers.
Accordingly, GWEPs emphasize extending knowledge about care for elders — whose risks, symptoms, goals, and treatments often differ from those of younger patients — to a wide array of providers, especially in rural and underserved areas. They also educate patients themselves and family caregivers.
The Saint Louis University program, for example, recently introduced an apprenticeship for certified nursing aides, or CNAs, working at a suburban nursing home.
“The turnover of nursing home employees in general, and CNAs in particular, is very high,” Berg-Weger explained. These jobs are often poorly paid and stressful, and the 75 hours of training required for certification doesn’t delve deeply into the particular needs and characteristics of older patients.
Six women have enrolled in Saint Louis’ first apprenticeship class, designed to accommodate 10 at a time. Over a year, they’ll receive 144 hours of education on such subjects as medications, fall prevention, and dementia.
The curriculum features both in-person classes with a geriatrician and a geriatric nurse practitioner, and more than 40 short videos the GWEP team has produced. Aides “can watch on their phones during their breaks,” Berg-Weger said.
At the end of the year, graduates become certified geriatrics specialists and receive a $1,000 stipend from the program and a 12% raise from their employers. “Our plan is to offer this to other facilities,” Berg-Weger said.
And to GWEPs in other states, if they survive.
The New Old Age is produced through a partnership with The New York Times.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.Some elements may be removed from this article due to republishing restrictions. If you have questions about available photos or other content, please contact NewsWeb@kff.org.