Charter Lane is a quiet cul de sac with 12 older homes in a Midwestern town. Most residents of this tree-lined street have lived there for years, moving into new construction just before or just after giving birth to their first children. Now many of the original residents are enjoying empty nests.
However, as they age, they are beginning to experience health problems. Mrs. J broke her hip 6 months ago and is having balance and strength problems. Mr. C has congestive heart failure and Mr. O is undergoing treatment for colon cancer.
With children living across the country, thus dispersing each household's support system, this neighborhood decided to try a new initiative called Naturally Occurring Retirement Communities (NORCs). They formed an association, pooled their resources and hired a geriatric care manager to help them negotiate the healthcare system and enable them to stay in their homes. Their collaboration also enables them to pool tasks like lawn mowing, grocery shopping and other chores, as each member's abilities allow.
While Charter Lane doesn't exist, NORCs do. And already senior citizens in neighborhoods across the country are experiencing the dilemmas described above.
Anticipating Needs
By 2030, the U.S. population 65 years and older is expected to double from 2000. Those 72.1 million senior citizens will require initiatives like NORCs (www.norcs.org), as well as other creative concepts that will give them the care they will need in the setting of their choice.
A solid-based education in gerontology - an understanding of the physical, psychological, financial and social issues of senior citizens - will be required to provide that care for the residents of fictitious Charter Lane and elsewhere across the country. Some nurse leaders say that education was lacking in nursing programs until recently.
"There is a lack of understanding that geriatrics and long-term care are unique specialties and require specific competencies," said Charlotte Eliopoulos, executive director of the American Association for Long Term Care Nursing (AALTCN), headquartered in Cincinnati.
"It's all about how to maintain the best quality of life possible for seniors using the science of geriatrics," said Marie P. Boltz, PhD, RN, GNP-BC, associate director, Hartford Institute for Geriatric Nursing, Practice Initiatives, which sponsors NICHE (Nurses Improving Care for Healthsystem Elders) at New York University, New York.
You don't have to go back to school to beef up your knowledge of that science. Education in many forms is out there: inservices, online instruction, in person and online certification courses, intermittent college courses or shadowing a nurse in geriatrics.
Two Who Get It
Two nurses who have taken advantage of the certification route are Ellen Ball, AS, RN, NADONA/LTC, and Ottamissiah "Missy" Moore, 
BS, LPN, CHLPN, CLNI, WCC, GC, SD-CLTC. Both decided many years ago that, "to be your clinical best, you have to have the tools to do the job," explained Moore, who is president of the National Federation of Licensed Practical Nurses (NFLPN) and staff development specialist at Washington Center for the Aging Services, Washington, DC.
"Any decision you make in long-term care is life and death," said Ball, who recently retired as director of nursing at Pearl's II Eden for Elders in Princeton, MO, an LTC facility.
Beginning her education as a certified nurse assistant, who would borrow medical journals from physicians she worked with to learn more about geriatric care, Ball took medical technician classes and then decided to become an RN. "I wanted to know everything I needed to know to take care of residents," she told ADVANCE. "I wanted to know the signs of diabetes, impending stroke, everything." Throughout her career she earned no fewer than 12 different LTC certifications to increase that knowledge base.
Moore, who in March was named Nurse of the Year by the Black Nurses Association of Greater Washington - the first LPN to be recognized in 32 years - now educates other nurses on geriatrics. She earned her first certification from the AALTCN in staff development.
"I took the course on my own and paid for it myself, but it jump-started my career," noted Moore, who also is a trustee on the DC Board of Nursing.
Knowledge Is Power
It isn't just LPNs and RNs who are assessing their skill sets in geriatrics. Recognizing gerontology knowledge is essential, nurse practitioners implemented a new policy effective 2015 that all nurse practitioner academic programs include education in eldercare because "gerontological nursing principles are needed across multiple populations," explained Elizabeth Galik, PhD, CRNP, president of the Gerontological Advanced Practice Nurses Association (GAPNA) and assistant professor at University of Maryland School of Nursing in Baltimore. "Whether you're an NP who practices in an adult setting, or in women's health or behavioral health, you will encounter older patients," she said.
"Some NP programs have already done this and I have found these blended programs have exposed students to geriatrics to a greater extent and increased their interest in this population where previously they had none," she said.
And for those who don't want to or can't return to school, organizations like GAPNA (www.gapna.org), NICHE (www.nicheprogram.org), AALTCN (ltcnursing.org) and Advancing Excellence in America's Nursing Homes (www.nhqualitycampaign.org) offer educational opportunities. "GAPNA has started an online CE library for members and others, and offers free CEs that rotate over time," Galik said.
"The Advancing Excellence campaign has a lot of good, free resources on their website," Eliopoulos pointed out, knowing cost can be an impediment for many nurses.
Eliopoulos said AALTCN, of which she is co-founder, is rising to the challenge of getting front-line LTC nurses interested in upgrading their geriatric knowledge. "We have developed certification programs they can do online, such as RN or LPN in long-term care, staff development, culture change nurse coordinator, director of nursing in LTC, basics of geriatric care training and safety specialist," she enumerated. "We feel certification is a good way to get RNs and LPNs on the education track."
In traveling across the country for AALTCN, Eliopoulos has learned "there is a good business case for nurses to get more education in geriatrics. Facilities that encourage education tend to retain nurses and those nurses really want to work with older patients."
NICHE Learners
Another source of geriatric research and best practice protocols is NICHE, founded in 1992 in anticipation of a growing older population. This group, now part of the Hartford Institute for Geriatric Nursing, offers numerous education programs on caring for older adults. Their website offers resources for all levels of caregivers including patient care associates, Boltz, who is also assistant professor at New York University College of Nursing, pointed out.
Hospitals can become NICHE-designated (for more on NICHE and its programs see related article), meaning they have access to leadership training; evidence-based, best-practice models; an assessment profile; resources and education programs offered by NICHE nurse instructors.
A unique aspect of NICHE is that it does not tell a facility how it should change its care of older adults. It provides services and education to encourage custom-made programs for an individual hospital's population needs and offers the education nurses need to achieve the hospital's geriatric care goals.
Motivation Is Key
A perennial challenge, sources say, is motivating nurses to want to update their knowledge of gerontology. Eliopoulos has seen this in long-term care, what with little extra money to pay for certification and a reluctance to release staff for an hour's inservice program. "If leadership is committed to education then that filters down," she has learned from experience.
Boltz too has observed that leadership is critical. She has also seen an increased interest in geriatrics because "CEOs and CNOs are dealing with older family members and they are seeing great care and gaps in care, which has brought the need home for them."
So how do you encourage nurses to learn more about geriatrics, ADVANCE asked? Moore has found that simple works best: "Ask them what they want to learn, and offer food."
Gail O. Guterl is a frequent contributor to ADVANCE.