Many of my friends nodded politely a few weeks back when I told them that I had been elected to the Institute of Medicine (IOM).
They knew from the tone of my voice that this election was a huge honor for me. But, despite my enthusiasm, the announcement was generally met by a few moments of awkward silence.
Some of my friends admitted that they had no idea what the IOM actually does -- or what I would do as a member.
The other half couldn't understand how I had ever gained acceptance into this eminent group of distinguished medical and health professionals. (No offense intended, they assured me.) These friends had always assumed that the third word of the IOM's title -- medicine -- meant that non-physicians like me "need not apply."
Never at a loss for words, I offered my own unsolicited responses to two questions I believe my friends -- and others -- should be asking about the IOM.
What is the IOM and What Does It Do?
The Institute of Medicine, the health arm of the National Academy of Sciences, has been working for almost 45 years to provide the evidence that both government and the private sector need to make informed health decisions.
It takes 54 pages just to list the titles of the IOM reports that have been published since 1970. That list is akin to a time capsule containing evidence-based data about -- and recommendations for how to address -- the most pressing health challenges of the past four decades: post traumatic stress disorder, obesity, sports-related concussions, end-of-life care, food safety, HIV, pandemic influenza, depression, Medicare and Medicaid, veterans health issues, climate change, and nursing home quality, to name just a few.
When the IOM releases a report, people pay attention. Researchers know that if they have the imprimatur of the IOM and its expert committees behind them, it's more likely that Congress, federal health agencies, and influential health organizations will read their research findings and possibly even implement their recommendations.
I'm looking forward to lending my expertise to a host of IOM committees over the next few years. My enthusiasm is due, in part, to the powerful experiences I had while participating in two groundbreaking IOM studies.
Building the Health Care Workforce: A 2008 report called Retooling for an Aging America: Building the Health Care Workforce sounded an urgent call to reform the way we train and use the workforce that cares for older adults.
The IOM's ad hoc Committee on the Future Health Care Workforce for Older Americans concluded that the health care workforce will be too small and unprepared to meet the needs of a growing older population.
I contributed to the committee's report, which recommended a host of solutions to strengthen the workforce, like broadening the duties and responsibilities of workers at various levels of training. The report also suggested that we have to do a much better job of preparing informal caregivers to care for aging family members and friends.
Not long after the report was released, 25 organizations, including LeadingAge, established the Eldercare Workforce Alliance. The Alliance is still working to support programs that increase workforce capacity, strengthen workers' competencies, and improve coordination of care.
Geriatric Mental Health and Substance Abuse
A 2012 IOM report entitled, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? drew much-needed attention to the high prevalence of mental health and substance abuse-related conditions among older adults.
The Committee on the Mental Health Workforce for Geriatric Populations, of which I was a member, found that nearly one in five older adults in America has one or more mental health (MH) and substance use (SU) conditions. Depression and dementia are the most prevalent. And these issues are growing more serious with each passing year.
The bottom line is that there won't be enough health professionals to diagnose and treat mental health conditions in the future. Training is a big reason for that. The committee concluded that there is little, if any, training in geriatric MH/SU across the workforce.
Basically, MH/SU specialists are not trained in geriatrics, and geriatric specialists are not trained in MH/SU. Other health care providers, including primary care providers, are not trained in either area.
Among the committee's five recommendations was a call to make sure that each professional caregiver who works with older adults is competent to meet their MH/SU-related needs. Of course, this will mean revamping how the health care workforce is trained and licensed. That's a big undertaking, and one that needed the IOM's support to gain any traction.
How Does a Non-Physician Get Elected to the IOM?
My friends were right to wonder how a non-physician could become a member ofthe IOM. Most IOM members are physicians and clinicians. But the IOM has been including more social scientists, and health services researchers and administrators, over the past few years. That's important, not just for me, but for the field of long-term services and supports.
I take my election as an acknowledgement by the IOM that long-term services and supports are vitally important to America's health and wellbeing. I believe the IOM is beginning to understand that the narrow medical model simply can't address all the factors that make Americans sick or help them stay well.
Our growing aging population is a perfect illustration of this basic truth. Older people have a variety of needs -- both medical and social -- that influence their quality of life. And it will take a coordinated and broad-based effort -- from both medical professionals and providers of aging services -- to help them address those needs.
We in the field of long-term services and supports have known this for a long time. I'm looking forward to spreading this message to other health care sectors as a member of the Institute of Medicine.
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