Entry-level competencies for health professionals who work with older adults

John O. Barr, Jennifer Nitz and Rita A. Wong

Overview and introduction

In most Western countries, individuals wanting to practice physical therapy must complete a course of study intended to prepare them to meet standards of practice in physical therapy and to behave in accordance with the codes of conduct for healthcare practitioners established in that country. Designated groups in each country establish and enforce these standards. These standards of practice are generally written broadly to capture the overarching scope of practice of the profession and the knowledge, skills and behaviors necessary for safe, effective, ethical and patient-centered professional practice. Competencies specific for practice with older adults are generally not separately identified in national standards for physical therapist practice. Rather, standards of practice include statements that practitioners are competent to practice across all categories of patients pertinent to the profession, including older adults. It is clear from these standards that all major categories of patients/clients (including older adults) need to be included in entry-level professional education processes, but this does not help the educator or clinician determine what knowledge and skills are most important.

In April, 2008, the Institute of Medicine’s Committee on the Future Health Care Workforce for Older Americans released its 312 page report Retooling for an Aging America: Building the Health Care Workforce (IOM, 2008). This report called for fundamental reform in the way that the healthcare workforce in the United States of America is both trained and used in the care of older adults. A key recommendation of this report was that licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in the care of older adults.

Responding to this report in June of 2008, the American Geriatrics Society convened 21 organizations representing professionals involved with care of older adults, a group that subsequently became the Partnership for Health in Aging (PHA), which has since grown to 36 organizations. An initial PHA workgroup was comprised of representatives from disciplines having consensus-based, endorsed and/or validated geriatric competencies (i.e. Medicine, Nursing, Pharmacy and Social Work). This workgroup: identified the need for a set of core competencies related to care of older adults by health professionals at completion of their entry-level professional degrees, and that were relevant and capable of being endorsed by all health professional disciplines; and determined competency criteria. By May of, 2009, the workgroup was expanded to include 10 disciplines (adding Dentistry, Nutrition, Occupational Therapy, Physical Therapy, Physician Assistants and Psychology).

Meeting through a regular series of conference calls that employed an iterative process, the workgroup developed a comprehensive matrix of 73 competencies in eight domains. After common themes and areas of overlap were identified, the resulting 23 competencies in six domains were approved by the workgroup, and these were circulated to 28 professional organizations for review and comment. Subsequent feedback was reviewed and final wording for the competencies was based on workgroup member consensus. The final competencies were returned to the 28 professional organizations, their official endorsement was attained, and Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree was published online in September, 2010 (Partnership for Health in Aging, 2010).