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Financial Gerontology and the Rehabilitation Nurse
Rehabilitation nurses, particularly those who work in geriatrics, recognize that the elderly have become increasingly heterogeneous, with many remaining active well into their 80s and beyond. As the baby boomers enter older adulthood, the senior healthcare market will be greatly affected. The areas of finance, economics, and marketing are seeing new trends that combine the expertise of financial planners with healthcare advisors and advocates for seniors. One emerging specialty area is financial gerontology. This article defines financial gerontology, presents emerging trends and certifications related to the field, and discusses implications for the rehabilitation nurse.
Today’s older adult population is quite different from that of decades ago. People over age 65 accounted for 12.3% of the U.S. population in 2002, with the 85 years and older age group growing fastest (Administration on Aging, 2004). This growth is expected to continue, with projections that by 2030, 20% of the population will be older than 65 (Administration on Aging).
Rehabilitation nurses, particularly those who work in geriatrics, recognize that the elderly have also become a more heterogeneous group, with many remaining active well past their 80s. As the baby boomers enter older adulthood, the senior healthcare market will be greatly affected. In recent years, nursing programs have taken steps to ensure that graduating nursing students have been educated about the aging process and are competent to care for older adults. However, nurses are not the only ones who recognize the imminent demographic shift toward the larger population 65 and older. In the areas of finance, economics, and marketing, new trends are emerging that combine the expertise of financial planners with healthcare advisors and advocates for seniors. One such specialty area is financial gerontology. This article defines financial gerontology, presents emerging trends and certifications related to this field, and discusses implications for the rehabilitation nurse.
What Is Financial Gerontology?
Financial gerontology was established as a discipline in 1988 but is just recently beginning to be more widely recognized. It is multidisciplinary, building on biology, psychology, sociology and demography “to understand the lifelong wealth-span issues and aspirations of older adults and their families” (American Institute of Financial Gerontology, 2004). Cutler (2004) defines financial gerontology as “the intellectual intersection of two fields—gerontology and finance—each of which has practitioner and academic components” (p. 29). Financial gerontology combines the knowledge and skills associated with financial planning and asset management with expertise in meeting the unique needs of older adults. Professionals working in this area use gerontological concepts, issues, data, and research findings to provide informed financial services to those in the senior market. Many topics are subsumed under this umbrella, but a few more directly influence future career paths and planning in rehabilitation nursing.
One way to assess the direction of financial gerontology is to examine related journals. The Journal of Financial Service Professionals has a monthly column on financial gerontology. Articles are written by authors in a variety of disciplines, including nursing, education, gerontology, financial planning, business administration, and others. A sample of recent article topics that appeared in the Journal of Financial Service Professionals and the credentials of the authors appear in Table 1.
The growing number of related certifications available lends further evidence for the emergence of financial gerontology. A special market is emerging for advising seniors about finances, money/asset management, insurance needs, living arrangements, healthcare decisions, and other related issues. Some of the services that financial gerontology professionals offer are directly related to the knowledge and skills possessed by most gerontological rehabilitation nurses. Three types of certifications are noted here as they are more specifically related to the practice of rehabilitation nurses. These include Certified Life Care Planner (CLCP), Chartered Advisor for Senior Living (CASL), and Registered Financial Gerontologist (RFG). Each certification is discussed in more depth in the following section.
A Certified Life Care Planner
A Life Care Plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, that provides an organized, concise plan for current and future needs, with associated costs, for individuals who have experienced catastrophic injury or have chronic healthcare needs (Weed, 1999, iii).
The life care plan first appeared in the rehabilitation literature in 1985 (Weed), with rehabilitation counselors and nurses being particularly well suited to provide this type of service. However, in recent years, people with a variety of backgrounds have obtained the CLCP through the Commission on Disability Examiner Certification (CDEC); the CLCP certification has been available for about 10 years. The certification is now offered through the Commission on Health Care Certification (CHCC). The University of Florida, Kaplan University, and MediPro Seminars offer 128 continuing education hours of coursework, both distance learning and online, to complete prerequisites for the exam (MediPro Seminars, 2004). A candidate must also submit an acceptable sample life care plan and meet certain practice requirements to sit for the exam. The topic areas for the CLCP credential are listed in Table 2. Passing criteria for the exam are set statistically according to each testing group using usual measures and standard deviations.
The American Association of Nurse Life Care Planners Certification Board offers the Certified Nurse Life Care Planner (CNLCP) designation, which has more stringent requirements related to experience (4,000 hours in case management), licensure (RN), and continuing education (60 units from approved life care planning courses or 500 hours of life care planning experience within 2 years of application) to be eligible to sit for the exam (Professional Testing Corporation, 2004). This certification ensures that the life care planner is an experienced RN, in contrast to the CLCP credential offered through the CHCC, which may be earned by professionals with diverse backgrounds.
Because life care planning is a relatively new area, nurses may see an increase in the number of older adults using such services in the future, both for catastrophic injuries and for chronic health problems that require comprehensive and long-term plans. Although not exclusive to the adult population, life care planning principles can help people predict healthcare and other costs over the projected life span, based on the variables presented in each individual situation. Rehabilitation nurses are in a unique position to meet the criteria for the CLCP or CNLCP designation. Nurses with advanced education or experience may already meet some of the requirements to sit for the certification exam. Much of the content includes inherent areas of expertise for gerontological rehabilitation nurses or case managers. Maintenance of either of these certifications involves the standard number of continuing education hours or credits, practice requirements, and renewal fees within a certain period of years.
Chartered Advisor for Senior Living
This certification from The American College is “designed to help you better understand and meet the unique needs of today’s seniors” (The American College, 2004). The American College, largely offering online certifications for professionals, suggests that long-term care specialists, life and health insurance agents, financial planners, accountants, attorneys, CPAs, trust officers, and nurse practitioners should obtain this certification (The American College). There are five courses required for this certification. The candidate must pass an online competency examination at an approved testing facility after completion of each self-study course. Successful completion of all five courses is required. Continuing education to maintain the designation is also required. Examples of courses and content for the CASL designation appear in Table 3. Candidates must, with their signature, agree to adhere to a specific code of ethics prior to receiving the status of CASL.
Registered Financial Gerontologist
The Registered Financial Gerontologist designation is offered by the American Institute of Financial Gerontology (AIFG), housed at Widener University (a private, nonprofit institution in Pennsylvania). The AIFG provides continuing education for “financial professionals advising older consumers and their families” (American Institute of Financial Gerontology, 2004). The RFG designation is endorsed by the American Society on Aging (ASA). Requirements for the RFG credential include meeting the background requirement, completing 6 courses (4 core and 2 electives) totaling 24 contact hours, passing a comprehensive exam, and completing the service learning requirement (American Institute of Financial Gerontology). Table 4 describes examples of the courses and content for the RFG certification. Much of the course content required for the RFG examination is familiar to rehabilitation nurses who work with older adults. In fact, rehabilitation nurses may already have greater expertise than professionals from disciplines other than nursing or the allied health professions who are pursuing this certification.
Conclusions and Implications for Rehabilitation Nurses
The U.S. population over age 65 is projected to double by 2035, and the first baby boomers are beginning to enter the senior market. As previously stated, the older age groups are becoming more heterogeneous. The baby boomer generation values independence and autonomy. They are informed consumers. With so many older adults in the population and the predictable increase in chronic conditions that comes with advanced age, the demand for rehabilitation services is likely to increase, leading to the need for more nurses educated in gerontological rehabilitation. There is more overlap between what rehabilitation nurses have to offer and other disciplines. Financial planners are taking courses in aging to cater to the older client, but are they adequately prepared to give advice in areas that relate to health care? This article described three certifications, obtained by taking several courses and passing an exam and practice component, available to the general public.
As shown in Tables 2–4, rehabilitation nurses already possess much of the health-related knowledge and skills needed for these designations. For example, life care planners are educated about disease processes and treatment needs of patients with problems such as spinal cord injury, brain injury, disfiguring burns, and other long-term conditions. This education is much less in-depth than what is covered in a typical nursing program, and the certified life-care planner without a nursing license will have no direct patient care experience, unlike the rehabilitation nurse, who possesses hands-on expertise. Rehabilitation nurses are also educated in communication and assessment skills as well as how to interact with an interdisciplinary team. These skills give the rehabilitation nurse a distinct advantage over others seeking these certifications.
The gap in knowledge for rehabilitation nurses will generally be in financial planning and asset management. The certifications discussed in this article may be areas for our specialty to explore. Some helpful Web sites for further exploration appear in Table 5. In addition, rehabilitation nurses may use their expertise in health care to branch into these other areas or partner with financial planners. Those with a background in finance, even if certified in one of the areas discussed in this article, often feel less able to answer health-related questions that inevitably arise when discussing topics such as purchasing long-term health insurance and other issues related to wellness or illnesses common to older adults. For example, a financial planner with a CASL may collaborate with a gerontological or rehabilitation clinical nurse specialist to offer a wider range of services to older clients. The financial planner may deal with areas related to asset management or insurance, for example, but refer his clients with healthcare questions to the nurse. These questions include which nursing home in the area would best suit them if they had to use their long-term care insurance, or what is the likelihood of experiencing costly complications from a particular age-associated disease they may have. The gerontological rehabilitation nurse may also act as an advocate for clients and families in many other areas, including health promotion, disease prevention, case management, life-care planning, and access to community resources.
There is tremendous potential for consulting. Even the area of financial planning is catering to the senior market. Rehabilitation nurses are in a unique position to positively affect the care of elders. Our practice is already interdisciplinary, comprehensive, and holistic. We are educated about the aging process, and, as rehabilitation experts, we emphasize maintaining independence across the life span. We also understand the role of socioeconomic factors in overall health and wellness. It is a bit of a puzzle that the financial sector seems to have taken the lead in learning healthcare information to market their services to the older adult. One must ask, “What is the nursing profession doing to ensure that seniors receive their healthcare information from the most qualified specialists?” As rehabilitation nurses, we have both the privilege and the responsibility to share our knowledge and expertise with older adults. This is a growing area of need, challenge, and opportunity.
About the Authors
Kristen L. Mauk, PhD RN CRRN-A APRN BC, is an associate professor of nursing at Valparaiso University, Valparaiso, IN. Direct correspondence to her at 429 Oak Breeze Drive, Valparaiso, IN 46383 or firstname.lastname@example.org.
James M. Mauk, BS ChFC CASL, is president of Mauk Financial Solutions, LLC.
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