Clinical Care

Geriatricians and geriatric nurse practitioners are specially

trained to meet the unique needs of older adults. Specialized care can be helpful when an older person is coping with multiple chronic conditions or managing multiple medications, as some drugs may negatively interact with others or have side effects that impact well-being.

Changes over time. Nationally, the number of family medicine and internal medicine geriatricians and nurse practitioners per 100,000 adults ages 65 and older increased 8% from 33.8 to 36.4 between 2021 and 2022, and 26% (from 29.0) since 2018. There were 20,344 geriatric providers in 2022, an increase of 1,553 providers since 2021. Between 2021 and 2022, the rate of geriatric providers increased by 8% or more in 23 states and the District of Columbia, led by 67% in North Dakota (13.0 to 21.7 providers per 100,000 adults ages 65 and older), 21% in Oklahoma (17.9 to 21.7) and 18% in South Dakota (14.6 to 17.3).

Disparities. The rate of geriatric providers was 3.8 times higher in Rhode Island (63.9 providers per 100,000 adults ages 65) than Idaho (16.8), the states with the highest and lowest rates in 2022. However, the highest rate was in the District of Columbia (90.9).

Home health

and personal care

aides enable older adults to remain in their homes as they age. These aides provide

short-term skilled nursing services, such as aiding in recovery from surgery, as well as long-term care for those with disabilities, functional decline or chronic illness. There is currently a shortage

of these workers in many communities and the need is expected to increase. The Bureau of Labor Statistics projects

employment of home health and personal care aids will grow by 25% between 2021 and 2031.

Changes over time. Nationally, the number of personal care and home health aides per 1,000 adults ages 65 and older increased 5% from 57.7 to 60.3 between 2020 and 2021, and 29% (from 46.9) since 2016. In 2021 there were nearly 3.4 million home health care workers, an increase of 154,890 since 2020. Between 2020 and 2021, the rate of home health care workers increased by 5% or more in 18 states, led by 24% in New Jersey (37.5 to 46.4 workers per 1,000 adults ages 65 and older), 20% in California (100.0 to 120.4) and 15% in both Michigan (37.8 to 43.4) and Rhode Island (36.2 to 41.8). Over the same period, the rate decreased by 5% or more in 14 states, led by 29% in both Hawaii (32.8 to 23.4) and Vermont (56.5 to 40.3) and 15% in Maryland (33.1 to 28.0).

Disparities. The rate of home health care workers was 9.4 times higher in New York (137.6 workers per 1,000 adults ages 65 and older) than Florida (14.6), the states with the highest and lowest rates in 2021.

While standard medical care may focus on finding a cure, hospice care emphasizes pain control and emotional support

for patients and their families. Hospice care is provided in a patient’s home — where most individuals prefer to die

— or in a freestanding hospice facility, hospital or long-term care facility.

Changes over time. Nationally, the percentage of Medicare decedents who were in hospice at time of death decreased 8% from 50.7% to 46.7% between 2018 and 2020. Hospice care decreased by 8% or more in nine states and the District of Columbia, led by 22% in the District of Columbia (33.2% to 25.8%), 18% in New York (30.0% to 24.7%), 13% in both Delaware (59.4% to 51.9%) and New Jersey (45.6% to 39.5%) and 11% in Rhode Island (57.5% to 51.2%). Over the same period, hospice care increased 32% in Alaska (22.8% to 30.1%); other states had increases but none equal to or greater than the national change.

Disparities. Hospice care was 2.5 times higher in Utah (60.7%) than New York (24.7%), the states with the highest and lowest percentages in 2020.

As of February 2023, 94.3% of adults ages 65 and older had completed a primary COVID-19 vaccination series, and 41.3% had received a bivalent booster dose; booster vaccination in this population doubled between October 2022 and February 2023. Roughly a quarter of older adults who had COVID-19, however, experienced symptoms consistent with long COVID. By age group, the prevalence of long COVID was 28.5% among those ages 60-69, 21.9% among those ages 70-79 and 24.5% among those ages 80 and older.