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Aging population, uptick in number of retiring professionals stress health care industry

| Saturday, June 3, 2017, 10:36 p.m.
Dr. Matthew D’Onofrio of Walworth Medical Associates examines Charles Wolfe, 81, of Jeannette, as part of a regular physical checkup and a booster for pneumonia on Wednesday, May 3, 2017.
Shane Dunlap | Tribune-Review
Dr. Matthew D’Onofrio of Walworth Medical Associates examines Charles Wolfe, 81, of Jeannette, as part of a regular physical checkup and a booster for pneumonia on Wednesday, May 3, 2017.
Drs. Courtney and Ryan Floyd, outside the Mountain View Family Health Center in Greensburg. The married couple chose to stay in Westmoreland County after completing a residency program through Excela Health.
Christian Tyler Randolph | Tribune-Review
Drs. Courtney and Ryan Floyd, outside the Mountain View Family Health Center in Greensburg. The married couple chose to stay in Westmoreland County after completing a residency program through Excela Health.
Drs. Courtney and Ryan Floyd outside the Mountain View Family Health Center in Greensburg. The married couple chose to stay in Westmoreland County after completing an Excela Health residency program.
Christian Tyler Randolph | Tribune-Review
Drs. Courtney and Ryan Floyd outside the Mountain View Family Health Center in Greensburg. The married couple chose to stay in Westmoreland County after completing an Excela Health residency program.
Dr. Matthew D’Onofrio of Walworth Medical Associates examines Charles Wolfe, 81, of Jeannette, as part of a regular physical checkup and a booster for pneumonia on Wednesday, May 3, 2017.
Shane Dunlap | Tribune-Review
Dr. Matthew D’Onofrio of Walworth Medical Associates examines Charles Wolfe, 81, of Jeannette, as part of a regular physical checkup and a booster for pneumonia on Wednesday, May 3, 2017.
Dr. Matthew D’Onofrio of Walworth Medical Associates examines Charles Wolfe, 81, of Jeannette, who came in to see the doctor for his regular physical checkup and a booster for pneumonia Wednesday, May 3, 2017. Wolfe, who lives with his wife, Janet, receives regular help from home caregivers after his wife had to have her leg amputated because of an infection.
Shane Dunlap | Tribune-Review
Dr. Matthew D’Onofrio of Walworth Medical Associates examines Charles Wolfe, 81, of Jeannette, who came in to see the doctor for his regular physical checkup and a booster for pneumonia Wednesday, May 3, 2017. Wolfe, who lives with his wife, Janet, receives regular help from home caregivers after his wife had to have her leg amputated because of an infection.
Dr. Matthew D’Onofrio of Walworth Medical Associates talks to Charles Wolfe, 81, of Jeannette, during a regular physical checkup on Wednesday, May 3, 2017.
Shane Dunlap | Tribune-Review
Dr. Matthew D’Onofrio of Walworth Medical Associates talks to Charles Wolfe, 81, of Jeannette, during a regular physical checkup on Wednesday, May 3, 2017.

Editor's note: This is the first of a two-day package as part of the Tribune-Review's look at the impact of baby boomers continuing to retire and swelling the region's aging population. Coming Monday: a look at access to health care and transportation for seniors.

Dr. Matthew D'Onofrio has seen his patient pool get a lot grayer since he opened his practice more than 20 years ago.

Those he first treated in their 50s and 60s are now in their 70s and 80s. They require more medical resources, and many don't have family in the area. Doctors such as D'Onofrio often use appointment time to discuss basic needs such as nutrition, hygiene and making sure patients take their medication. It's too much to do with too little time, he said.

"From a medical standpoint, I think we feel some frustration because it's almost like, 'What can I do in a 15- or 20-minute visit?' " D'Onofrio said. "I bet this morning I had four 85-year-olds."

As the nation's largest generation — baby boomers, born between 1946 and 1964, with the largest spike nationally in 1957 with 4.3 million births — continues to retire, few institutions and social services stand to be more stressed by demographic changes than health care. The result is playing out in Southwestern Pennsylvania, where challenges posed by the region's aging population include:

• A growing demand for medical services.

• A growing need for doctors, nurses and home aide professionals to offset a wave of retirements.

• The need for more efficient methods of delivering care, such as home care services and performance-based payment models.

But with those problems come opportunities, and several Pittsburgh groups long have worked to prepare for the coming changes.

"I think if we can get it right here in Pittsburgh and Western Pennsylvania, I think that could be a lesson for the rest of the country," said Dr. Charles Reynolds, director of UPMC's Aging Institute.

Boom years

The number of Americans age 65 and older is expected to nearly double during the next four decades, from 43.1 million in 2012 to 83.7 million by 2050, according to a Dartmouth Institute for Health Policy & Clinical Practice report. The number of people 85 and older is projected to more than triple, from 5.8 million to 19 million.

People in their 60s visit doctors and use medical services more than preceding generations, said Stephen Foreman, a health care economist at Robert Morris University. They also have different ailments and illnesses.

They smoke at half the rate current seniors did when they were middle-aged, according to a United Health Foundation report. But they have a 55 percent higher diabetes rate and a 25 percent higher obesity rate.

Those facts, coupled with people living longer, mean demand for medical services is growing.

The Pittsburgh region continues to grow older as its population shrinks. The trend started more than three decades ago, spurred by the collapse of steel and loss of heavy industry. The seven-county metropolitan area — which includes Allegheny and Westmoreland — was home to 2.65 million in 1980, according to Census data. The population was estimated at 2.34 million in 2016.

Replacing retirees

By 2024, the health care industry will create more than 49,000 new jobs in the Pittsburgh metropolitan area, according to the state Department of Labor and Industry.

Jeffrey Doerfler already is scrambling to hire staff at Community Care Inc., a home care agency with offices in Washington, New Stanton and Mt. Lebanon that has gone from providing "about 1,500 hours of care per week about three or four years ago to 3,000 hours today," he said.

Some families contract privately for such services. But publicly funded programs, such as Medicaid and Department of Veterans Services, participate to stretch public dollars by keeping more seniors at home and out of nursing care.

"The only thing holding the industry back now is the lack of qualified and interested employees to provide home care," Doerfler said. "If 100 people applied for those jobs, we could give each of them full-time employment."

Nearly a third of the 4,700 employees at Excela Health — Westmoreland County's largest employer and medical provider — are 55 or older. Officials anticipate staff retirements will only compound problems created by a graying population.

"In January, we saw over 60 retirements alone," said Laurie English, Excela's chief of human resources.

With half of U.S. nurses 50 or older, competition is brisk to attract younger people to the field.

The nursing program at Westmoreland County Community College, which graduated 487 registered nurses between 2012 and 2016, helps funnel young nurses to Excela facilities to complete clinical rotations. It's one of several similar programs offered by the region's universities and hospital-based schools. Penn State New Kensington offers a nursing major, and the University of Pittsburgh at Greensburg plans to introduce a nursing program in the fall.

Dr. Carol Fox, Excela's medical director, said she anticipates shortages affecting nearly all subsets of physician specialties.

"We do focus on our primary care providers today to work with the geriatric population, but certainly additional fellowship-trained physicians would be ideal," she said.

Excela's three-year family practice residency program in Latrobe is key to that plan. The program graduates eight residents a year. About half stay in the region.

Ryan and Courtney Floyd, husband-and-wife family practice doctors, graduated last summer, bought a home and joined Excela offices in Unity and Derry.

Last month, the couple had their first child, a son.

As young doctors, they've gotten to know a cross section of the community and see their patients on the street, at the grocery store and in church.

"The (retention) of residents has been unbelievable," Courtney Floyd said. "I think four of seven (residency program graduates) are staying this year and, with our class, it was four of six."

Keeping up

Joel Tamburo, 66, of New Kensington and his wife, Joyce, 65, already experienced the effect of the medical professional shortage.

The neurologist who treated Joel Tamburo for multiple sclerosis for 16 years recently left University of Pittsburgh Physicians Neurology in Oakland.

"They haven't been able to get another neurologist," Joyce Tamburo said. "So, now we see a physician's assistant. Sooner or later, a lot of us are going to be seeing physician's assistants. There are shortages in all specialties. It's coming."

In Southwestern Pennsylvania, several groups have long worked to prepare for the coming changes. Among them, UPMC's Aging Institute is researching, among other things, best practices in dementia care, reducing hospitalizations and supporting informal caregivers.

Deborah Brodine, president of UPMC Community Provider Services, said such initiatives have helped position the region for the coming "silver tsunami."

"That's not to say we've solved all the problems, because the issues are obviously going to grow," she said.

Some experts said shifting industry practices and demographic changes across the nation should prompt larger discussions about aging and health.

Diseases such as pancreatic and ovarian cancer that used to be fatal within months are now managed for years, D'Onofrio said. He suggested doctors' conversations with ill, elderly patients and their families could focus on delivering compassionate, empathetic care, while being cognizant that health care resources are limited.

"And usually when you sit down with the children, or whoever the power of attorney is, eight times out of 10 they'll say, 'You know what? We agree with you. Keep Mom or Dad comfortable.' "

Other experts cautioned about making too many assumptions about the aging population and health care resources.

Dr. Julie Bynum, an associate professor at The Dartmouth Institute for Health Policy & Clinical Practice, challenged the notion that finite health care resources should drive how health care is delivered to baby boomers as more of them enter their twilight years.

"We can scapegoat the population change, but we can also change the way we deliver health care," she said. "We should think about what we're delivering and how much return there is for people getting care."

Michael Walton, Debra Erdley and Brian Bowling are Tribune-Review staff writers. Reach Walton at 724-850-1290 or mwalton@tribweb.com. Reach Erdley at 412-320-7996 or derdley@tribweb.com . Reach Bowling at 724-850-1218 or bbowling@tribweb.com .

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