Get ready for some new old news. As reported by Forbes, a recently released study from the Commonwealth Fund foundation shows that 23% of Americans 65+ who needed help with the activities of daily living during the pandemic did not receive such help because caregiving services were cancelled or extremely limited. We are talking about things such as eating and getting dressed. Another 37% of older Americans suffering from two or more chronic conditions reported disruptions in their health care due to the pandemic.
“All of these findings are despite our nation spending the highest percentage of its Gross Domestic Product overall on health care,” reports Forbes. “And despite the vast majority of Americans 65+ having health insurance, either through traditional Medicare, private Medicare Advantage plans or Medicaid.”
As a result, older Americans, many of whom are extremely isolated, have daily needs that we, as a country, seem ill equipped to meet or even properly monitor.
As outlined in a recent post, Dr. Elisabeth Rosenthal, Editor-in-chief of Kaiser Health News believes there is a “win-win” solution at hand that addressed two of America’s toughest current problems. “Have letter carriers spend less time delivering mail, much of which now involves fliers and solicitations. Instead, include in their responsibilities … home visits and basic health checks on the growing population of frail and elderly.” After all, she reasons, given that digital communications continue to replace “snail mail” and the U.S. Postal Service is looking at $160 billion into debt, “it just makes sense financially and socially for the agency to evolve to meet the nation’s current needs.”
For those who see this as a farfetched idea, she points out that programs such as this are now underway and being done successfully and profitably in other countries, primarily France and Japan. “In France, since 2017, families have been able to pay a small monthly fee to La Poste — about 20 euros or $24 — to have home check-ins for an older relative,” she writes. “Japan launched a similar postal program through a public-private partnership in 2017 to underwrite paid, monthly, half-hour visits (a friendly chat and health check) with members of the aging at-home population.”
“Postal workers are already on virtually every block of America six days a week,” she adds, many are well-known and beloved by the residents they serve. They could be retrained to do home visits of older homebound Americans, something that was suggested by the Postal agency’s inspector general a decade ago.
“Tens of millions of older Americans — the “old old” — are not so sick that they need a hospital but are unable to live safely at home without help,” she writes. “Patients with early dementia fending for themselves at great risk. People who need help preparing medicine or meals can be missing both … Why not instead redeploy some of the U.S. Postal Service’s vast supply of human resources to deliver a service our aging population — and our country — desperately needs?” she pleads.
One approach for accommodating such a program would be to have mail delivered only a few times a week, or possibly every other day. On the off days, a “new on-the-ground home health workforce” would be deployed.
And herein lies the “why not” to such a solution. Every indicator tells us that the public will not accept the inconvenience or disruption of such as change in mail delivery, especially to accommodate older Americans. The sad truth is that ageism — discrimination by age — in this country is not only an accepted bias, but it has also been amplified during the pandemic.
Kaiser Health News reporter Judith Graham notes, “Ageism in health care settings (is) a long-standing problem that’s getting new attention during the covid pandemic, which has killed more than half a million Americans age 65 and older … and remains central during the COVID-19 pandemic in a variety of disturbing ways, some of which may have enduring consequences.”
In these settings, she says demonstrations of ageism can be explicit. As an example, she cites plans for rationing medical care called “crisis standards of care” that specify treating younger adults before older adults. “Embedded in these standards, now being implemented by hospitals in Idaho and parts of Alaska and Montana, is a value judgment: Young peoples’ lives are worth more because they presumably have more years left to live.” Or, as the American Psychiatric Association describes it, “health care rationing devalue older adults’ lives as unworthy or a reasonable ‘sacrifice.'”
“The assumption that all older people are frail and helpless is a common, incorrect stereotype,” says Graham. “The assumption that older people aren’t resilient and can’t recover from illness is implicitly ageist.”
This is nothing new. According to a 2015 report, “Nearly 20% of Americans aged 50 and older say they have experienced discrimination in health care settings, which can result in inappropriate or inadequate care … One study estimates that the annual health cost of ageism in America, including over- and undertreatment of common medical conditions, totals $63 billion,” Graham reports. The study went on to find that one in every five nursing home resident has persistent pain and a significant number don’t get adequate treatment.
“Many older adults actively contribute to society, as family caregivers, health care providers on the front line of the pandemic, direct care workers in long-term care settings, and in supportive functions such as housekeeping and food services,” American Psychiatric Association says. Many are “caregivers for family members who are frail, disabled or cognitively impaired. Spouses are the primary caregivers for over a third of older adults. Almost two million older people are caregivers for their grandchildren … facilitating the parents’ ability to work.
“Any discussion today addressing marginalization and discrimination against underrepresented groups must include older age,” the Association adds.
The COVID-19 pandemic has taken a cruel toll on the health of older Americans. We can only hope and pray that we are prepared to now make the sacrifices necessary to direct a turn for the better.
