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In 2017, as part of a study to understand the evolving roles of nurses, physicians and social workers in leading and working in teams, our interprofessional team explored 22 sites of care for frail elderly adults in five US regions (Chicago IL, Denver CO, Tampa/Orlando FL, San Diego CA, New England).. The purpose of these site visits was to understand the current range of models of care for frail elders living in community, the roles of health professionals within those care models, and to inform national measure development. We selected regions based on elder population density, scope of NP practice, and screened over 100 sites to identify physician, nurse and social work led teams. We included general primary care, PACE, academic geriatrics, home based primary care, assisted living, FQCHC, palliative care, mobile health. We interviewed 108 key informants. We found considerable variation in staffing/elders within each site type.

Social workers (SW) and community health workers (CHW) have emerged as key workforce personnel in efforts to care for elders in the U.S. However, little is known about the presence and roles of these professionals in outpatient practices. This paper presents findings from a nationally representative survey of geriatrics and primary care practices. Key findings include: reported challenges in meeting the social service needs of elders, underutilization of SW, and fuller utilization of social work competencies in practices in which both SW and CHW were present. These findings offer a unique perspective of SW on interprofessional teams and have implications for the future of the profession.

As the US population ages, primary care is expected to be the health care “home” for older adults, and several initiatives are aimed at helping to transform primary care practice to care for this population. Wide variation in staffing has been observed. Meyers et al proposed ideal models of primary care staffing for a general population and for a frail elderly population (2018). We developed the 2018 Survey of Primary Care and Geriatric Clinicians to measure optimal team configuration in clinical practices caring for older adults. A majority employed NPs, MDs and PAs, with [r = -.53] between % of clinician labor of NPs and physicians). High-NP practices are more likely located in states with full scope of practice, perform well for frail elders and are less expensive. Meyers' models, with fewer physicians, more SW and CHWs, more RNs, perform better for frail elders, and are less expensive.