GRAND FORKS - In the coming decades, as the "huge wave" of baby boomers starts to reach their 70s, 80s and older, jobs in health care and senior housing will explode, said Phil Gisi, president and CEO of Grand Forks-based Edgewood Management Group.

But young people may not be fully aware of the "great opportunities" that await them in this sector of the job market, said Gisi, whose company owns and operates senior living facilities across the Upper Midwest.

"People realize that there will be a lot more people in old age, but they don't see the lack of workers available to care for those people, what with the birth rate collapsing in the early '70s," said Gisi. Edgewood owns and operates assisted-living and memory-care facilities in 55 communities.

"There'll be a significant need for health care workers in all of our communities," he said. "The demand will continue to grow."

The time frame of 2020 to 2040 will be a period of significant aging of the population, based on U.S. Census data, which will dramatically increase the demand for senior housing and health care.

In that time period, the number of people who are 65 or older will increase by 46 percent, he said. "There will be 10,000 people turning 65 each day."

The need will be particularly intense for nurses, nurse practitioners, physicians, and physical and occupational therapists, Gisi said.

"If you're trained, and a good worker, the sky's the limit."

And he's just talking about workers who interact with patients or residents one-on-one.

"Not everyone wants to be a direct caregiver," he said. There also will be opportunities in management, accounting, human resources and other occupations.

"We have a lot of accountants who are working for us," he said. "They are easy to find compared to CNAs (certified nurse assistants) and therapists."

'Huge need'

Dr. Gayle Roux, dean of the University of North Dakota's College of Nursing and Professional Disciplines, agrees.

The approaching wave of baby boomers "produces a huge need for people who are certified in caring for the needs of baby boomers and the aging population," she said.

It's a nationwide concern, but may be especially problematic in North Dakota where people tend to live longer.

"North Dakota certainly could be very hard hit," she said. "We have kind of a double whammy ... and part of that is good. People here tend to 'age well in place'-meaning, in their homes-and we have a higher ratio of the 'older old,' those who are 85 and older, than almost any other state."

The country is dealing with a nursing shortage, said Roux, although "some experts feel it's somewhat of a maldistribution."

"The need for nurse practitioners, physician assistants, physical therapists and occupational therapists is significant, particularly in smaller cities and rural areas," she said.

Studies show the impact of the glut of boomers will be felt in various settings-from hospital to outpatient care to home health services, Roux said. But "we will need more care providers in the outpatient settings and clinics."

The challenge for universities, in responding to pressure to increase enrollment, will be "to balance all the variables to maintain the quality of the program, to advance our curriculum to match the high-tech environment, but also so we can recruit and retain faculty and clinical preceptors who are willing to work with the student population," Roux said.

"So there are multiple variables we have to look at."

It's also important that students be exposed to nursing as an "exciting, rewarding and very scientific" career, she said.

Sustained shortage

Janice Hamscher, Altru Health System's chief nursing officer, sees the looming demand for nurse practitioners contributing to the nursing shortage.

"This shortage will be different that other shortages, and it will be sustained," she said, "because of the demand for services-because of the large number of patients-and workforce shortages, such as physicians."

More nurse practitioners and physician assistants will be needed to take on some responsibilities that typically have been handled by doctors.

Although hospital stays are decreasing, due in part to advances in technology, patients are more seriously ill than in the past, producing a greater demand for highly skilled nurses, she said.

After a hospital stay, more patients are returning to their homes sooner to continue the recovery process.

"We've learned that it's better to be at home," Hamscher said. "Patients are more comfortable at home. They're less likely to fall, because they're in a familiar setting and they're not strapped to equipment."

That will affect the need for more home health services.

In-home health care

In senior living facilities, health care services-and coordination of those services-are an increasingly important aspect of their mission, along with providing housing, social activities and good meals, Gisi said.

"We offer needs-based senior housing. It's more than just social-living in an apartment and having activities," he said. "Health care is part of it now, it's much more important. That's been a change in the last 10 years-and in the last three to four years especially."

This is due, at least in part, to hospitals' preference to discharge patients to the home, with home health services, he said. That "home" may be an assisted living facility, which will provide more services such as physical therapy, outpatient therapy, speech therapy and hospice care.

Facilities are being designed to include space where doctors, nurse practitioners and other providers can see patients.

More employees are managing residents' chronic diseases and medications.

"We doubled the size of our quality assurance team-registered nurses with degrees-in the fall of 2016," Gisi said.

The trend can also be traced to Medicare policies that tie reimbursement to quality of care.

The federal government's pressure to reduce hospital readmissions is an example.

"It matters what happens to people after they are discharged from the hospital," Gisi said. "If you're not providing quality care, Medicare is not going to pay you."