Remarks to the Geriatric Education Center Directors' Meeting

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration

Baltimore, Md. 
March 11, 2002

It’s my pleasure to welcome you and thank you for your contribution to the work of this Nation. Your efforts have significance not just to us at HRSA but to communities across the nation that are searching for better ways to deliver quality health care services to older Americans. And it is appropriate that we meet today to keep on working on America’s health, because as the President and Secretary have said – the best way to honor those lost on September 11 is to continue to make America the best community for all its people.     

Our mission at the Health Resources and Services Administration is to improve the nation's health by assuring equal access to comprehensive, culturally competent, quality health care for all.  Your work assists in the fulfillment of this mission and fits into the comprehensive strategy within the Department of Health and Human Services to improve the delivery of health care to America’s uninsured and underserved individuals and families.

Longer life expectancy of the U.S. population and the entrance of the baby boom generation into the later years of life – one turns 50 every minute of every day -- demand the attention of all of us in the health care community. The sheer growth in the numbers of older people has serious implications for the health care system and the continuing quality of care of older people. You know the numbers. Between 1900 and 2000, life expectancy almost doubled. Over the next 25 years, the number of people over 65 will grow at a rate five times that of those under 65.  In fact the over 85 group is the fastest growing segment of the population. What we need is a coordinated strategy to address all these emerging health challenges.

It is the Administration’s goal to ensure greater access to quality health care for all Americans. And, of course, improving geriatric care is and will continue to be a critical part of this overall effort.

As Sam told you, I have been at HRSA for almost a year now.  And I am very pleased with the changes we’ve implemented to streamline HRSA’s internal structure and improve administration of the programs we fund and oversee.

Many of the programs affected by these changes are of vital interest to you who work in our Geriatric Education Centers.  So I want to spend a little time here going over what we’ve done and why – and explain how these changes fit in with the President’s design for HRSA’s future.

Last July we announced the transfer of the National Health Service Corps, the Division of Scholarship and Loan Repayment, and the Division of Shortage Designation from the Bureau of Primary Health Care to its sister entity within HRSA, the Bureau of Health Professions.  We made the change to improve internal efficiency and streamline duplicative operations, which are good reasons by themselves.  But we also made the change with an eye to the future.  Community health centers and the Corps are at the heart of President Bush’s multi-year plan to expand health care services to America’s neediest citizens.  To make the plan work, we need to make sure these programs are operating at peak performance.

Moving the National Health Service Corps to the Bureau of Health Professions makes sense because it puts in a single bureau the entire spectrum of HRSA’s recruitment, training, loan, scholarship and placement programs for health professionals.  Consolidating responsibility for health professions programs in one HRSA bureau increases the internal coordination needed to ensure that the right number of health care professionals serve in the right places.

We also created a new division within BHPr – the Division of State, Community and Public Health. This unit consolidates many standing HRSA training programs into one organizational unit. Jeff Dunlap, whom you all know well, heads up this Division with responsibility for all our geriatrics training programs.  I also want to recognize Bernice Parlak who back in 1995 produced the National Agenda for Geriatric Education and since that time, she and her staff have provided superb guidance to our geriatrics programs.

We streamlined operations at the Bureau of Primary Health Care to better focus staff and resources on the President’s push to expand the health center network.  This expansion will be a top priority for HRSA for many years, and it will be a very visible task of great importance to the Nation.  BPHC’s leadership in building and maintaining the health center system is widely respected.   Now, with the restructuring, they can turn their full attention toward making the expansion a success. And BHPr can focus on the Corps as part of its health professions agenda.

Passage of the FY 2002 budget has put the President’s plan into motion.  Health centers received an increase of $175 million in 2002, to a total of more than $1.34 billion.  These additional funds represent a down payment on the President’s five-year plan to create new or expand health center sites in 1,200 communities and increase the number of patients served annually to more than 16 million.  His 2003 proposed budget would raise the health center funding total to $1.5 billion, a $114 million increase. 

The President also has big plans for the NHSC.  The President’s 2003 budget proposal would give the Corps a $44 million increase to $191.5 million.  The added funds would provide scholarships or loan assistance to about 1,800 professionals practicing in underserved areas - an increase of about 560 participants.

In addition, President Bush’s fiscal year 2003 budget proposes a total of $15 million, nearly a 50 percent increase above last year’s funding, to expand the Nursing Education Loan Repayment program. This will help address the Nation’s growing need for nursing professionals.  The increase will support 800 new nursing education loan repayment agreements.  The program repays a substantial portion of the education loans of nurses who agree to work for two years in designated public or nonprofit health facilities.

To highlight the critical need for more nurses, Secretary Thompson and Education Secretary Rod Paige recently visited a junior high school in Washington, D.C. to launch a national campaign to encourage school children to consider careers in nursing and other health professions.

At that time we released the “Kids into Health Careers” tool kit which has information on more than 270 health careers, including nurses, physical therapists, x-ray technicians, and emergency medical technicians. We are very excited about this innovative program and expect tremendous results as we go forward.

Secretary Thompson has also charged us with finding ways to strengthen health care services for the millions of people who live in rural America.  Almost a quarter of the Nation’s population lives in rural areas, yet only an eighth of our doctors work there.  Because rural families earn less than urban families, many of the health problems associated with poverty are more serious there, including high rates of chronic disease.  And you know that health care access for the rural elderly is a serious and growing problem.

Last July, the Secretary created a Department-wide task force to look at all these issues. HRSA’s Office of Rural Health Policy played a leading role on this task force because of our long experience working with rural healthcare providers and consumers to seek solutions to the problems they face.  The task force requested public comment on how HHS could better serve rural America and more than 450 people answered the call. We learned a lot from these comments. For example, we learned that transportation is a critical issue in determining access to rural health care…that multiple program application and evaluation processes make it hard for rural organizations with limited resources and staff to take full advantage of funding opportunities…and we learned that there is great demand in rural areas for more oral and mental health care. The task force and Secretary Thompson will be addressing these issues and many more in coming weeks. 

Our telehealth program is also a vital and growing part of HRSA’s outreach efforts. The Secretary and I intend to ensure that telehealth consultation and distance-learning are not just innovative grant programs in their own right – which will continue -- but that they rapidly become vital parts of all HRSA services.  We want to use telehealth technologies to fill the gaps for people and communities who might otherwise go without critical health care.  This is especially important since September 11, with our new focus on public health preparedness.  The President’s budget priorities and the Department’s new concerns with confronting bioterrorist threats make telehealth an important part of our response.

These initiatives taken together have one all encompassing goal: to expand access to quality health care for all Americans who need it.  And by expanding access, we can do a better job of meeting the many needs of the Nation’s older Americans.

Now let me give you a few highlights of some things we are already doing to improve the geriatrics focus in all our programs.

In fiscal year 2000, HRSA-supported Community Health Centers treated some 683,000 geriatric patients. The number of patients over 85 was more than 75,000.

We’ve also had great success through our community health centers in developing time-tested model systems of care for chronic diseases.  We call them our “collaboratives.”  For example, our Diabetes Collaborative includes 83 health centers that have joined together to look at new ways to delay and/or decrease the complication of this disease.  In addition, other health centers are participating in collaboratives on asthma and depression. 

Taking the lessons learned from these projects, we are now ready to pilot a Cancer Collaborative in 10 health centers that will be rolled out this year, starting this month.  These collaboratives will impact geriatrics care because they result in improvements in treatment, patient self-management, practice design, and patient population tracking systems. 

Through our Ryan White CARE Act programs, we serve nearly 75,000 people over the age of 50.

In our maternal and child health programs, we are ever mindful of the growing numbers of grandparents raising their grandchildren and the many women who must care for their own children and aging parents at the same time.

And, of course, in our Bureau of Health Professions, geriatric training is a top priority.

The Bureau of Health Professions addresses the needs of the aging population by supporting interdisciplinary education and training in geriatric care in all of its supported programs.  The Bureau’s initiative in geriatrics emphasizes faculty development, increasing the number of geriatric health care providers, integrating geriatric content into all health professions curricula, and providing continuing education offerings in geriatrics to all health professionals to promote access to quality geriatric health care and services. I have asked Sam Shekar to lead an internal working group made up of all HRSA units involved in geriatrics. With this effort, we will ensure coordination of these programs and tap into the collective creativity of all as we work to anticipate needs and meet them with zeal and shared commitment.

With your leadership, our 36 Geriatric Education Centers provide the only national network that trains health professionals from many different disciplines how to serve a growing and diverse community of older Americans. In 2002, we have funding for approximately 12 new centers – that’s an $8 million increase, bringing the total to $20 million.

Since 1983, you’ve trained some 400,000 health care professionals, but there are still millions of health professionals who need the unique training you provide.  I got to see the results of this work first-hand as I was the “kid” who helped my 81 year-old Dad through three years of cancer. Then my brother and I helped our mother live independently until one month shy of her 94^th birthday. We worked with a wonderful assisted living site where she spent the last year and half of her life. The physicians, nurses and others who brought special skills to her my mother’s care extended her life, making her time happy and rewarding both for her and for all of us who loved her.

The Bureau of Health Professions also supports intensive one and two year fellowships to support a geriatric training program for physicians, dentists, and behavioral mental health specialists.

In addition, we will sponsor a geriatric academic awards program in 2002 for medical school faculty, a geriatrics program for nurses in long-term care facilities, and a nursing faculty development program in geriatrics.  

In closing, let me say that I believe the Geriatric Education Centers are one of the best tools the federal government has to ensure that we have enough health professionals trained to meet the needs of older Americans.

As leaders in the field of geriatrics, you have a unique opportunity to permanently impact the way we deliver health care to geriatric patients in communities nationwide. 

I greatly appreciate the work that you have done, and the work that you will do in the future. Working together, we can succeed in our common mission.