willingness among providers, private foundations, and federal and state policy makers to commit resources to learning about better ways to finance and deliver care. The committee supports the continued development of newer models, especially in areas that have traditionally been overlooked or for more effective use of the workforce.

Recommendation 3-2: Congress and foundations should significantly increase support for research and demonstration programs that

  • promote the development of new models of care for older adults in areas where few models are currently being tested, such as prevention, long-term care, and palliative care; and

  • promote the effective use of the workforce to care for older adults.

Delivering care within all of these new models will require adaptations by the workforce. For example, many successful models require providers of different disciplines to work collaboratively in interdisciplinary teams, but reimbursement for team care is currently lacking, and many providers are not trained to work effectively in teams. Also, several successful models of care require members of the health care team, including patients and their families, to take on new roles and assume greater levels of responsibility. Shifting various patient-care responsibilities (e.g., through job delegation) will be essential to create meaningful improvements in the efficiency of the health care workforce, but will require the training of many workers both in the skills needed to deliver more technical services, as well as the skills needed to be effective delegators and supervisors.

Recommendation 3-3: Health care disciplines, state regulators, and employers should look to expand the roles of individuals who care for older adults with complex clinical needs at different levels of the health care system beyond the traditional scope of practice. Critical elements of this include

  • development of an evidence base that informs the establishment of new provider designations reflecting rising levels of responsibility and improved efficiency;

  • measurement of additional competence to attain these designations; and

  • greater professional recognition and salary commensurate with these responsibilities.

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