In St. Louis, a group of students aboard a well-equipped van visits senior centers, a nursing home, a church and other sites, learning to conduct comprehensive, one-hour geriatric examinations.
The team – future doctors, social workers, psychologists and therapists – is looking for common problems such as weakness, muscle weakness and cognitive decline. The patients they see receive free printed plans to help guide their care.
Across Oregon, local health care providers 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 frontline public health workers to know how to provide care for older adults,” said Laura Byerly, a geriatrician at Oregon Health & Science University who is leading the effort.
And in Louisville, the same federally funded program provides training for geriatricians throughout Kentucky. However, sometimes a less formal approach is required.
Sam Cotton, a social worker who runs a dementia program, recently heard from a local Methodist church whose members were caring for relatives with dementia. Can someone speak to the congregation about this responsible role? Cotton, an assistant professor at the University of Louisville, said, “Of course she'll be there.”
These programs and 39 more like them across the country are eager to highlight a troubling fact: the number of geriatricians and other health care providers knowledgeable about aging is not keeping pace with the growing population of people aged 65 and older.
Thus, since 2015, Congress has authorized funding for the Geriatric Workforce Enhancement Program (GWEP), which trains approximately 70,000 individuals per year.
Recently, those grants to universities and hospitals, worth up to $1 million each this year, came under threat. In July, annual payments to recipients, some of whom had been in the program since the program's inception in 2015, were significantly reduced without warning or explanation.
Instead of the expected $41.8 million, grant recipients collectively received $27.5 million, representing a 34% shortfall, according to the Eldercare Workforce Alliance. And it looks like new cuts are in store for us.
The Trump administration's proposed fiscal year 2026 budget would eliminate GWEP, as well as many other programs funded through the Health Resources and Services Administration, an agency of the Department of Health and Human Services.
Although the program has always enjoyed bipartisan support, and has been authorized multiple times For five years, the President's budget reduced that figure to zero, citing “an attempt to streamline the bureaucracy, restore an appropriate balance between federal and state responsibilities, and save taxpayer funds.”
10 weeks passed, and there was no clarification – was the missing money simply put aside or gone forever? — program directors frantically called their congressional representatives, contemplating painful layoffs and an uncertain future.
“This money was embezzled, signed and sealed, so where is it?” Cotton said last month. In addition to her role in the Louisville program, she is president of the board of the National Association of Geriatric Education Centers.
Questions from grant recipients to the funding agency HRSA did not yield answers. Then, on September 10, the programs discovered that, just as mysteriously as they had disappeared, the rest of the allocated funds had suddenly materialized.
And GWEP has been reinstated in both 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 partly reflect the efforts of GWEP's influential Republican Sen. Susan Collins of Maine, who faces re-election next year.
In his Sept. 3 Senate speech, Collins called the program “a modest investment that will help ensure that our older Americans receive the expert care they need, that their caregivers receive training, and that other support workers 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 enrolls about 9,800 people annually.
The payments, withheld for 10 weeks, equaled the amount each grant earmarked for training for Alzheimer's and dementia patients, program directors found. The programs were supposed to allocate $230,000 of the $1 million grant to train professionals and community members in dementia, but some chose to spend more and therefore had larger deficits.
GWEP at Louisiana State University, for example, initially received only $152,000 of an expected $976,659 and suspended (temporarily, the director hopes) all of its geriatric rotations and fellowships in Louisiana and Mississippi.
What's happening? HRSA, the federal agency that funds the programs, said in an email that “all grant programs have been carefully reviewed to ensure alignment with the administration's priorities,” which has resulted in “slight delays in making certain payments.”
“It’s surprising to me that anyone would question the value of having staff knowledgeable about elder care,” said Carol Johnson, the agency’s administrator under the Biden administration.
“Everyone in this area had hoped that this program would grow and not wither,” she added.
In recent years, allocations have increased only slightly. However, “recipients are very creative,” Johnson added. “This is a '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 decline slightly in coming years, even as the need for such specialists grows. It is difficult to attract medical students and doctors to a relatively low-paying specialty whose patients are largely covered by Medicare, although surveys show that high job satisfaction among geriatricians.
Most older patients receive care not from geriatricians, but from primary care physicians, other health care specialists, physician assistants, nurse practitioners, social workers, pharmacists, and direct care workers.
Accordingly, GWEPs emphasize disseminating 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, especially in rural and underserved areas. They also educate patients and their families.
For example, a Saint Louis University program recently introduced an internship for registered nurses (CNAs) working in a suburban nursing home.
“Turnover among 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 do not allow for in-depth exploration of the specific needs and characteristics of older patients.
Six women enrolled in the first apprenticeship class in St. Louis, designed to train 10 people at a time. Over the course of a year, they will receive 144 hours of training in subjects such as medications, fall prevention and dementia.
The curriculum includes both face-to-face sessions with a geriatrician and a geriatric nurse practitioner, as well as over 40 short videos created by the GWEP team. Assistants “can watch videos on their phones during breaks,” Berg-Weger said.
At the end of the year, graduates become certified geriatrics specialists and receive a $1,000 program stipend and a 12% raise from their employers. “Our plan is to offer this to other institutions,” Berg-Weger said.
And GWEP in other states if they survive.
New Old Age is created in collaboration with New York Times.
KFF health news is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF, an independent source of health policy research, polling and journalism. Find out more about Kff.
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