In St. Louis, a team of students in a well-equipped van visits senior centers, a nursing home, a church and other sites, learning how to conduct comprehensive, hour-long geriatric assessments.
The team, made up of future doctors, social workers, psychologists and therapists, researches common problems such as frailty, muscle weakness and cognitive decline. The patients they evaluate receive free 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 communicating with patients and families — to help them work with older adults.
“We need these front-line public health workers to know how to provide senior-friendly care,” said Laura Byerly, a geriatrician at Oregon Health and Science University who is leading its efforts.
And in Louisville, the same federally funded program provides geriatrics training throughout Kentucky. Sometimes, however, it takes a less formal approach.
Sam Cotton, the social worker who runs its dementia program, recently heard from a local Methodist church whose parishioners were caring for loved ones with dementia. Could someone please tell the congregation about this demanding role? Cotton, an assistant professor at the University of Louisville, said of course she would be there.
These programs, and 39 other similar programs 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 pace with the burgeoning population aged 65 and older.
Since 2015, Congress has therefore authorized funding for the Geriatrics Workforce Enhancement Program, or GWEP, which trains approximately 70,000 people per year.
Recently, these grants to universities and hospitals, worth up to $1 million each this year, seemed under threat. In July, without warning or explanation, annual disbursements to beneficiaries, some of whom had participated since the program began in 2015, were significantly reduced.
Instead of the expected $41.8 million, recipients collectively received $27.5 million, a 34 percent shortfall, according to the Eldercare Workforce Alliance. And more cuts seemed to come.
The Trump administration’s proposed budget for fiscal year 2026 eliminated GWEP, along with many other programs funded by the Health Resources and Services Administration, an agency of the Department of Health and Human Services.
Although the program always had bipartisan support and was repeatedly authorized for five years, the president’s budget canceled it, citing “an effort to streamline bureaucracy, restore the proper balance between federal and state responsibilities, and save taxpayer dollars.”
As 10 weeks have passed with no clarity, has the missing money simply been delayed or has it disappeared for good? — program directors frantically called their representatives in Congress while contemplating painful layoffs and an uncertain future.
“This money has been appropriated, signed and sealed, so where is it? » Cotton said last month. In addition to her role in Louisville’s program, she serves as board chair of the National Association of Geriatric Education Centers.
Grantees’ questions to HRSA, the funding agency, yielded few answers. Then, on September 10, the programs discovered that, as mysteriously as they had disappeared, the rest of the allocated funds had suddenly materialized.
And GWEP was reinstated in House and Senate bills funding the federal Department of Health, although 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 re-election next year.
In a speech on the Senate floor Sept. 3, Collins called the program “a modest investment that will help ensure that our older Americans get the specialized care they need, that their caregivers receive training, that other support staff and health care providers receive the skills they need.”
Still, “it’s been a roller coaster to say the least,” said Marla Berg-Weger, co-director of GWEP at Saint Louis University, which trains about 9,800 people each year.
The payments withheld for 10 weeks equaled the amount each grant set aside for Alzheimer’s and dementia training, program directors found. Programs were required to spend $230,000 of a $1 million grant on dementia training for professionals and community members, but some chose to spend more and therefore had larger deficits.
Louisiana State University’s GWEP, for example, initially received only $152,000 of the expected $976,659 and has halted (temporarily, the director hopes) all of its geriatric internships and rotations in Louisiana and Mississippi.
What happened? HRSA, the federal agency that funds the programs, said in an email that “all grant programs have been carefully reviewed to ensure alignment with Administration priorities,” causing “brief delays in the completion of some payments.”
“It surprises me that anyone would question the value of having a competent elder care workforce,” said Carole Johnson, agency administrator under the Biden administration.
“Everyone on the ground hoped that this program would grow, not wither,” she added.
Credits have only increased slightly in recent years. Still, “the beneficiaries are very resourceful,” Johnson added. “This is a very cost-effective program and a smart use of federal resources.”
The number of practicing geriatricians — 6,580 this year, according to HRSA estimates — is expected to decline slightly in coming years, even as the need for such expertise increases. It’s difficult to attract medical students and doctors to a relatively low-paying specialty whose patients are mostly insured by Medicare, even though surveys have shown high job satisfaction among geriatricians.
Most older patients receive care not from geriatricians but from primary care physicians, other medical specialists, physician assistants, nurse practitioners, social workers, pharmacists, and direct care providers.
As a result, GWEPs emphasize extending knowledge about caring for older adults—whose risks, symptoms, goals, and treatments often differ from those of younger patients—to a wide range of providers, particularly in rural and underserved areas. They also educate patients themselves and family caregivers.
Saint Louis University’s program, for example, recently introduced an apprenticeship for certified nursing assistants, or CNAs, working in a suburban nursing home.
“Staff turnover in nursing homes in general, and CNAs in particular, is very high,” Berg-Weger said. These jobs are often low-paid and stressful, and the 75 hours of training required to obtain certification do not delve into the particular needs and characteristics of older patients.
Six women enrolled in St. Louis’ first apprenticeship class, designed to accommodate ten at a time. Over the course of a year, they will receive 144 hours of training on topics such as medications, fall prevention and dementia.
The program includes both in-person classes with a geriatrician and geriatric nurse practitioner, as well as more than 40 short videos produced by the GWEP team. Caregivers “can watch on their phones during their breaks,” Berg-Weger said.
At the end of the year, graduates become certified specialists in geriatrics and receive a $1,000 stipend from the program as well as a 12% raise from their employer. “Our plan is to bring 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.
