Drawing Students' Attention to Eldercare: Q&A with Chad Cole, MPA

The Loma Linda University School of Allied Health Professions is helping students see the benefits of working in geriatrics.

Like most medical students, Chad Cole, MPA, didn't begin his studies with the intent of working in geriatrics.

Initially interested in surgical specialties, it wasn't until after he graduated and completed his boards in primary care and later family medicine that his interest shifted to eldercare.

Now as an instructor in geriatrics for the physician assistant program at Loma Linda University's School of Allied Health Professions, he's hoping to encourage more students to consider specializing in geriatrics and eldercare.

Despite the uptick in demand for aging services, nursing homes and home health agencies are struggling to compete with larger providers and organizations that can offer higher wages. With the anticipated influx of older adults into the latter half of the healthcare continuum, it's important that eldercare be pushed to the forefront for students.

HealthLeaders spoke with Cole about introducing students to geriatric healthcare. The following transcript has been edited for brevity and clarity.

HealthLeaders: How many students do you see coming into the program already knowing they want to work in geriatrics?

Chad Cole: The voiced interest in my class and in a lot of the students that I see has not been that great in geriatrics. What we're hoping to do is get them a little more clinical experience in their clinical year training, working with me in the geriatric clinic, and maybe show them the kind of challenges we face, the resources out there, and hopefully spark a greater interest to go into geriatric medicine.

HL: Why are students hesitant about working with older patients?

Cole: I think our society doesn't value older patients in general as much as others. We kind of shy away from aging and I think we need to really realize what a valuable resource those patients can be, with their wisdom and all the experiences they've had in their lives. From a clinical standpoint, I think students view geriatric patients as much more complicated than standard adult or family medicine patients since they tend to come with more comorbid conditions and more medications.

Then you're having to think of what the potential interactions of everything else are, and as a new graduate, I think that perceived level of complexity can be somewhat intimidating.

HL: Does geriatric medicine have any similarities to other areas of healthcare?

Cole: In pediatrics they require a lot more care, they're less independent, and it kind of gets back to that. We watch them as they age, especially in memory care, starting to lose areas of independence, and we assess these things called “activities of daily living:” Can you bathe yourself? Can you feed yourself? Those start to become a bigger burden, especially in Alzheimer's or dementia as the disease progresses, where they start losing those abilities to be independent.

Their biggest goal is often to remain independent and in the home as long as possible, so we have certain resources to try and help. There's adult daycare centers and in-home support services to really try and get them as much help as possible to remain as independent as possible.

HL: Could introducing students to geriatric medicine before they graduate create a pipeline of talent for post-acute/aging services providers?

Cole: If we can catch the students during their clinical year, give them that that exposure, [I can] share my own experience—we can maybe help them to think about ways they can help their own family. Maybe spark an interest in geriatric medicine as well, and really encourage them to look into the growing challenges in the upcoming decades with our aging population, and the opportunity that creates for them after graduating.

HL: Healthcare is a calling, so for an area like geriatrics, does it stem from compassion or empathy? Or does it develop over time?

Cole: It can be both. In my experience, compassion and empathy develop out of some personal experience before school, as far as seeing community caregivers, seeing parents or grandparents age. Oftentimes if [students] had grandparents living in the home and they helped with the care, those are the ones who tend to come already with that built-in compassion and desire to do this job.

I'll joke around sometimes with students or friends that there's easier ways to make good money. If you're doing the job just because you think you're going to make a good living, there's better reasons to do it and easier ways to do it.

For me, it was watching my parents care for their parents, how much work that involved, and watching some of that loss of independence over time. Also, sparking that interest of really wanting to know what else is out there and what can be done to honor that stage of a person's life.

HL: How can skilled nursing facilities and home health agencies attract students to their organizations?

Cole: When I got hired in geriatrics at Loma Linda, they were hiring one person for the outpatient clinic, which is where I started, and they hired one more classmate for the skilled nursing facility, which was  a registered dietitian at a skilled nursing facility previously. I think they may want to consider recruiting from people who have worked in [similar environments].

Those candidates have seen what the job entails, the challenges, and hopefully have developed a passion for it.