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Tag: Older adults

  • Why see a geriatrician?

    Why see a geriatrician?

    Today, more than 55 million Americans are over 65. The US has an older population than it has ever had. Sadly, the physician population has not grown to meet the needs of older Americans reports Pamela Paul for The New York Times.

    How many board-certified geriatricians are there in the US? Just over 7,000. Only one for every 10,000 older adults. The number has shrunk more than 25 percent in the last 25 years.

    Older adults with multiple chronic conditions can fare much better with treatment from a geriatrician. Much like with children, taking care of older adults is different from taking care of working people. As we age, our brains and bodies change.

    While there are a range of doctors who treat older adults, many of them have never received appropriate training to do so. That training can be invaluable. We have less muscle mass, smaller kidneys and weaker immunological systems by the time we are 65.

    When it comes to geriatric care, physicians should be looking at both the prescription drugs and over-the-counter drugs you take, your cognition, your movement and what you most care about. Geriatricians must consider which of a patient’s medical needs are most important. Patients’ life desires should rank high, be it going on vacation or having better balance. Physicians need to keep in mind that patients might not be able to follow a treatment plan.

    Geriatricians work to help promote as good health as possible. For example, my dad’s geriatrician got my dad off of a few of the prescription drugs he was taking after testing their efficacy over a several month period and finding that they were not benefiting him. His geriatrician also kept a doctor who saw my dad in the emergency room from prescribing him a new and costly medication he did not need. And, that’s not all.

    My dad’s geriatrician arranged for a nurse to visit him every two weeks to check his blood because he was on a blood thinner. She prescribed physical therapy for him because he was shuffling his feet when he walked and she worried about his risk of falling. After talking to him and me about his social network, she thought it would be helpful if he had more social interactions. So, she arranged for the hospital social worker to see him and help him find a program that engaged him socially.

    Why aren’t more physicians becoming geriatricians? It’s a fulfilling profession. But, it’s not glamorous. It requires spending more time with patients. It’s challenging because patients are ultimately not going to improve a lot. It requires an extra year of training over primary care. And, the pay is relatively low, averaging about $258,000 a year.

    Here’s more from Just Care:

  • Important resources for older adults

    Important resources for older adults

    With the government and public health experts calling for social distancing and, where possible, social isolation, to contain the spread of the coronavirus, it’s important to be aware of free and low-cost national and community resources. Right now, many are likely to be oversubscribed and underfunded, so be persistent. Here are several of the most critical ones:

    • Administration for Community Living, (ACL), acl.gov, an arm of the US Department of Health and Human Services, which among other things funds services and supports to help older adults and people with disabilities live where they choose and participate as much as they choose in their communities
    • Aging and Disability Resource Centers, (ADRCs) provide information about public and private program options as well as guidance, counseling and assistance
    • Aging Life Care, a trade association of geriatric care managers: aginglifecare.org or 1-520-881-8008
    • Area Agencies on Aging, (AAAs or triple A’s), eldercare.acl.gov, coordinate and offer services that can help you, including offering home-delivered meals and homemaker assistance
    • FindHelp, findhelp.org, a social care network that enables you to search online by zip code for free or reduced cost services, such as medical care and food
    • Centers for Independent Living, (CILs), acl.gov/programs/aging-and-disability-networks/centers-independent-living, offer community-based centers run by and for people with disabilities and offer a broad range of services to empower people to live independent, fully-integrated lives in their communities
    • Eldercare Locator, eldercare.acl.gov or 1-800-677-1116 (toll-free), can connect you to your local ADRC or AAA and to a variety of other services.
    • Heating and Energy Assistance Program, HEAP, benefits.gov/benefit/623, assists eligible low-income households with their heating and cooling energy costs, as well as bill payment assistance, energy crisis assistance, weatherization and energy-related home repairs
    • Leading Age, leadingage.org, a trade association for the community of non-profit institutions, organizations and housing programs serving older adults
    • Leading Age Aging Services Directory, leadingage.org/find-member, lets you know about 18 types of non-profit resources in the community, including nursing, transportation, home-delivered meals and dementia care and learn about retirement communities, assisted living, and subsidized housing
    • Legal Services for the Elderly, provides critical help for older adults in accessing long-term care options and other community-based services, call the eldercare locator at 800-677-1116 or visit lsc.gov
    • Meals on Wheals, mowp.org, agency that delivers free meals to older adults in their homes
    • Medicaid State Contacts, medicaid.gov/about-us/contact-us/contact-state-page.html
    • Medicare Enrollment, secure.ssa.gov/iClaim/rib
    • Migrant Health Centers, National Center for Farmworker Health, ncfh.org
    • National Adult Day Services Association (NADSA), nadsa.org, a trade association for the more than 5,000 adult day services centers that provide day services as a form of long-term care to more than 260,000 people and family caregivers each year
    • National Association of Free and Charitable Clinics, nafcclinics.org
    • NeedyMeds, needymeds.org, helps people find affordable healthcare including free and low-cost medicines, medical, mental health and dental care
    • Rural Health Clinics, ruralhealthinfo.org
    • State Health Insurance Assistance Program (SHIP), 1-800-677-1116 or shiphelp.org, provide free state-based assistance navigating Medicare and other health care resources for older adults
    • State Pharmaceutical Assistance Programs, SPAPs, medicare.gov/pharmaceutical-assistance-program/state-programs.aspx, offer services in more than two dozen states that may help people with Medicare cover their prescription drug costs
    • Supplemental Nutrition Assistance Program, SNAP, fns.usda.gov/snap/supplemental-nutrition-assistance-program, provides credit to older people so that they can buy food at participating stores

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  • Best exercise for older adults? The squat

    Best exercise for older adults? The squat

    Michelle Crouch writes for AARP Magazine that the best exercise for older adults is the squat. Why? Because more than anything else, as you get older, you want to be able to get up from a chair and sit back down in a chair or a car or a toilet, with facility.

    It’s not to say that you shouldn’t be working all your muscles up and down your body. You should be walking every day for at least 20 minutes, if you can. Planks and pushups are great for strengthening your core. Crunches are good for tightening your abs.

    But, if you can only do one exercise, the squat is most critical. If you can’t squat, you will face a series of challenges throughout the day. Squats make your calves, your quads, your hamstrings and glutes stronger. They also strengthen your lower back and core. These muscles all help with activities of daily living, such as dressing, bathing, and toiletting.

    Squats have other benefits. They can help protect your knees and hips. They can help with balance. They can keep you from falling.

    The strong leg muscles squats help you develop also help you live longer. One study found that people with strong quadriceps had a smaller risk of dying over six years than people with weak quadriceps.

    If you’ve never practiced a squat routine, here’s what to do: Hold on to the kitchen counter or another comparable surface. That will help ensure you are stable. Your feet should be about as wide apart as your shoulders or a little wider, if that’s more comfortable. Point your toes outward a bit.

    From the standing position, while keeping your back straight and feet solidly on the ground, move your hips back in the same fashion as you would move your hips back to sit on a chair. Your weight should be on both feet, with more weight on your heels. Your knees should not be over your toes.

    Repeat this exercise eight or ten times twice, at a relatively fast clip. Two seconds to go down and two seconds to go up. Do this routine three times a week. And, be sure not to hunch over.

    As you get stronger, you can remove your hands from the counter and cross them on your chest or keep them by your side. You should be able to do 15 squats twice without tiring. You can then try holding some weights as you squat.

    Here’s more from Just Care:

  • Medicare Advantage plans are not addressing loneliness among their enrollees

    Medicare Advantage plans are not addressing loneliness among their enrollees

    Loneliness is prevalent amount older adults in Medicare Advantage plans, reports Alexa Mikhail for Fortune. Most older adults no longer work and have few outlets for social interaction. The government is not addressing their lack of social stimulation. Their Medicare Advantage plans, government health plans administered by corporate health insurers, which are paid to manage their enrollees’ health, should be helping to address their enrollees’ loneliness.

    A survey of 28,000 older adults in Medicare Advantage plans finds that more than half of them (three  in five) are lonely or extremely lonely. Family are often not near by. Friends are often not around. As a rule, their Medicare Advantage plans do not help them. Consequently, older adults who suffer from loneliness are at greater risk for a range of health issues, including dementia, depression and anxiety.

    What can isolated adults do in an emergency? One in five older adults have no one to turn to in an emergency. Two in five struggle to find social support. Medicare Advantage plans do not make it their business to foster social interaction among their enrollees, even though it’s an important way to promote their well-being.

    Many older adults struggle mentally and physically as a result of social isolation. They need help taking their medicines and remodeling their homes, but they can’t get help. They don’t have easy and safe access to a bathroom, shower, kitchen and bedroom. They can’t get to their doctors’ appointments. It’s not clear that any Medicare Advantage plans are helping to ensure these basic needs are met or even to minimize enrollees’ risk of falling, even though these corporate health plans are receiving some $140 billion in overpayments each year from the government.

    Half of older adults have annual incomes under $30,000 and deteriorating health. Loneliness means that they are as much as three times more likely to end up in an emergency room than people who have family or other social companions around to help.

    If Medicare Advantage plans were putting enrollees’ needs ahead of their profits, they would be promoting social engagement among their enrollees and otherwise spending money on their enrollees in meaningful ways.

    Here’s more from Just Care:

  • People under 65 with Medicare less satisfied than people over 65

    People under 65 with Medicare less satisfied than people over 65

    People under 65 with disabilities are less satisfied with Medicare than adults over 65, reports Kaiser Family Foundation. The reason is likely that people with disabilities need a lot more health care than older adults and face obstacles to care that people who are relatively healthy do not face. Still, people under 65 with Medicare are more satisfied with their health care coverage than people who have Medicaid, employer coverage or coverage through a state health insurance exchange.

    Medicare covers about 66 million people. Nearly eight million (12 percent) of them are under 65 and enrolled in Medicare because of long-term disabilities, including End-Stage Renal Disease and ALS. People with disabilities on Medicare are more likely to be people of color, people with lower incomes and lower education levels; they also tend to be people in worse health than people over 65 in Medicare.

    No matter how you qualify for Medicare, you are supposed to get the same Medicare benefits. But, people under 65 are not guaranteed the right to Medicare supplemental insurance or Medigap–coverage that generally picks up most or almost all of people’s out-of-pocket costs–from a commercial insurer. So, unless people qualify for Medicaid or a Medicare Savings Program, they could have large out-of-pocket costs in Traditional Medicare and in Medicare Advantage. Not surprisingly, people with disabilities on Medicare report greater struggles getting and paying for care as well as less satisfaction with Medicare than people over 65.

    Overall satisfaction with Medicare jumps from 79 percent for people with disabilities to 92 percent for people over 65. Much of the concern among people with disabilities is around their ability to get care from good quality physicians and hospitals. Seven in ten of them reported having a problem with Medicare in the last year, whereas far fewer people over 65 (five in ten) say they experienced a problem with Medicare.

    It’s important to keep in mind that it’s a lot easier for people who do not use the health care system much or at all to be satisfied with their Medicare coverage than people who have complex conditions, as many people with disabilities under 65 do. About half of people with disabilities say they are in fair or poor physical health. Just 19 percent of people over 65 report that they are in fair or poor physical health. In fact, about half of people with Medicare use little or no health care in any given year.

    About 3o percent of people with disabilities say they have fair or poor mental health, as compared with just nine percent of people over 65. Twenty seven percent of them struggled to get mental health treatment they needed but was not covered, as compared with seven percent of people over 65. Eighteen percent said that they could not get medicines they thought they needed, as compared with five percent of people over 65.

    Nearly three in ten people with disabilities report having a hard time getting their Medicare plan to approve critical care, as compared with nine percent of people over 65. While the Kaiser Family Foundation does not distinguish those in Medicare Advantage plans from those in Traditional Medicare, only Medicare Advantage plans require prior approval before getting critical care.

    Twenty-four percent of people with disabilities reported not having their insurance pay for their care that they thought was covered, as compared to eight percent of people over 65. More than one in three people under 65 said they struggled to pay a medical bill as compared to nine percent of older adults.

    People under 65 experienced more difficulty getting care than older adults. They were more likely to skip or delay getting dental care, prescription drugs and medical care because of the cost than people over 65.  People under 65 also reported greater difficulty enrolling and understanding their options relative to people over 65.

    Here’s more from Just Care:

  • Silver tsunami leaves a large cohort of older adults unable to afford housing

    Silver tsunami leaves a large cohort of older adults unable to afford housing

    Shannon Majnabadi reports for the Wall Street Journal on the rise of homelessness among baby boomers. As America ages, more older Americans cannot afford housing. The high proportion of older adults unable to afford housing in the US has not been seen since the Great Depression.

    Judy Schroeder, 71. had few assets but was making ends meet in Naples, Florida, with the help of Social Security and a part-time job. Then, a rent increase of $500 and the loss of her job left her unable to afford her rent and homeless.

    Schroeder searched for an affordable rental apartment without success. In the meantime, she slept on friends’ couches. She tried to get support for low-income housing and was approved for a federal Section 8 housing voucher. The voucher would cover the cost of her rent minus 30 percent of her Social Security income, which she would contribute. Still, although she tried hard, she could not find an available qualifying rental unit.

    More older adults are homeless today. Housing is expensive. Social Security benefits do not tend to cover costs. Less expensive assisted living facilities are not managing to stay afloat.

    The rate of growth in homelessness among older adults is greater than any other age cohort. And older adults represent an increasing share of the total homeless population. Federal data show that, in 2018, 16.3 percent of people living in homeless shelters were over 55 and that, in 2021, 19.8 percent of people living in shelters were over 55.

    Homelessness among older Americans often stems from medical emergencies or the death of a spouse. Older adults are often taken by surprise. They had worked throughout their lives and thought they were prepared for retirement.

    Often older Americans find their rent unaffordable. It’s hard for them to move away when it means leaving their family and friends. And, it also means leaving their doctors.

    At the same time, even when apartments are affordable, landlords turn people with low incomes away. Many landords won’t accept tenants with incomes that are below three times the cost of their rent.

    Some older adults end up living in their cars. They park in places where there’s security. Meanwhile, they put their names on long waitlists for senior housing.

    People with Medicaid also often find themselves on waitlists for long-term care. In one area near Tampa, the waitlist is 2,600 older adults long.

    Putting aside the lack of affordable housing for older adults, many older adults looking for affordable housing truly need long-term care services as well.

    Here’s more from Just Care:

  • How to improve digital literacy among older adults and why it’s so important

    How to improve digital literacy among older adults and why it’s so important

    Richard Eisenberg writes for Fortune about the large proportion of people with Medicare at risk because they are not computer literate and might not even have access to a computer. A majority of people with Medicare can’t take advantage of telehealth services with their doctors or compare Medicare plans online, even though it’s so important. Here’s how to improve digital literacy among older adults in order to promote health equity and better health.

    Some people call the ability to use a computer or digital literacy a social determinant of health, much like eating well and having housing and access to transportation. Without these basics, your health is likely to be at risk. One article in Frontiers in Public Health called lack of computer literacy among older adults “an urgent problem.”

    Who is most affected by digital illiteracy? Older adults, particularly Black, Hispanic and Afro-Caribbean older adults, according to one study. Fewer than half of them have tablets and only six in ten of them have smartphones; of those, some don’t know how to use them. All in, 25 percent of older adults do not use the internet, as compared with 2 percent of people between 30 and 49.

    How does digital illiteracy get solved? First, people need access to broadband. But, today, 30 million Americans lack this access. Our federal government operates a program designed to make broadband access more accessible to people, but people are not taking advantage of this program because they don’t know about it or the application process is complex. The Federal Communication Commission also has a lifeline program to help pay for the cost of Internet and smart phones for people with low incomes.

    Only about one in three people with Medicare are able to communicate with their physicians via telehealth. Yet, without telehealth access, people might not be able to see their doctors. Traveling to the doctor’s office can be difficult.

    Being computer literate often can make it easy to schedule a doctor’s appointment, whereas being computer illiterate can make something as simple as scheduling an appointment difficult.

    The Centers for Medicare and Medicaid Service, which oversees Medicare, is planning to require Medicare Advantage plans to teach their members how to use a computer or smartphone to improve their health, beginning next year. The goal is to reduce health inequities stemming from lack of digital literacy and improve access to care for people with Medicare. But, the CMS proposal is still not set in stone, nor is it clear which of their members the Medicare Advantage plans would train or how.

    If you’re looking to train a family member or friend to use a computer or smartphone, check out the National Digital Inclusion Alliance. It offers a list of organizations that train people in digital literacy as well as ways to lower internet costs. Icario lets people know about low-cost internet services and support. Older Adult Technology Services (OATS) also offers training in digital health literacy.

    Here’s more from Just Care:

  • What to do when an aging parent needs help but doesn’t want it

    What to do when an aging parent needs help but doesn’t want it

    When helping my aging father, I struggled to respect his autonomy while ensuring his safety. Not easy. Judith Graham provides helpful tips in Kaiser Health News on how to assist an aging parent and, more generally, older adults, who need help but doesn’t want it.

    When older adults become frail, they are at risk of falls and other injuries to themselves and sometimes to others. But, they often do not want help. What to do? You might begin by exploring with them how comfortable they are in their home.

    Walk through their home with them. Watch how they get up from their sofa or dining chair. See how easy it is for them to plug in an appliance or get a pot in the kitchen. Let them know about helpful solutions, such as grab bars in the shower and path lights that go on when you pass by them.

    And, then, see how they are managing with their bills and other paperwork. Is it disorganized? Are the bills getting paid? Talk to them about the need to make sure that critical services are not erroneously terminated. Ask whether they would like help ensuring that they do not lose important services, like electricity and phone.

    If possible, take a look at their credit card statement. A lot of older adults are snookered into spending money on all kinds of products and services they should not be spending money on–anything from unnecessary supplements to warranties, to charitable contributions for sham charities. Consider discussing their expenses and how they can save money.

    Make sure your loved one knows never to provide their Social Security number, their Medicare number, their bank account number or other important identification over the phone or to anyone showing up at their home. Even if the person seems nice and trustworthy, your loved one should know that scams abound and to beware. Some scammers are even able to mimic the voice of a grandchild!

    But, don’t try to take over without permission. You can make things worse. You can lose a parent’s trust. You need to show respect for your loved one’s independence and empathy. They still can make their own choices, so you can’t take over without their consent.

    Of course, you should not step away if help is needed and your loved one resists it. Prioritize those things that could put your loved one’s health, safety or finances at risk. For example, if your mom is still driving, you might contact the local department of motor vehicles and her doctor. Her doctor can send a letter to the RMV asking to retest her. In that case, the RMV intervenes to ensure your mom can continue to drive.

    Appeal to your loved one’s best self–what you know and they know is the right thing for them to do. Or, go for an unannounced visit. Bring food. Ask for advice. If something seems off, arrange a doctor’s appointment and let them know it is to help them better accomplish their goals.

    Here’s more from Just Care:

  • Homelessness among older adults is on the rise

    Homelessness among older adults is on the rise

    Christopher Rowland reports for The Washington Post on rising homelessness among older adults. Increasingly middle class older adults are facing food and housing insecurity.

    As many as 250,000 older adults were homeless in part of 2019, according to one federal study. While they are a small portion of the baby boomers, their ranks are growing. Local communities are scrambling to address this crisis, through shelters designed specifically for older adults and specially trained staff. In California, one company is setting up an assisted living facility for older adults who are homeless.

    Some experts say that older adults are the “fast-growing group” of homeless people. Cities do not begin to have the resources to meet their needs and ensure their health and well-being. One organization in Arizona said that its client population of older adults grew more than 4o percent in 2022 to 1,717.

    The exact number of homeless older adults is hard to establish. But, estimates are that people who are older than 55 represent about one in six homeless people. In 2019, there were about 1.45 million homeless people. By 2030, projections are that the number of homeless older adults will more than double. 

    How did this happen? The cost of housing has risen dramatically across the US. Often, when a spouse or parent dies, it becomes impossible for the lone older adult to keep paying the bills.

    Nursing homes and other housing for older adults often cannot meet the needs of older adults who are homeless. They often suffer from mental illness and substance abuse; and they often have multiple chronic conditions.

    Today, hospitals treat homeless patients with serious illnesses and then discharge them back to shelters, where their health is often at risk because the shelters do not have the staff to provide them with the care they need. Often, these older adults relapse and need to be readmitted to hospital. Dehydration, heat stroke and burns are common ailments for homeless older adults when the temperature rises. Subsidized housing for homeless older adults is generally not available or only available after a long wait.

    Low-income older adults cannot always rely on Medicaid. Medicaid, which covers care for people with low incomes, does not pay for nursing home care or assisted living when you can care for yourself. Some homeless older adults can care for themselves and don’t meet the eligibility criteria. Nursing homes might determine they are not sufficiently infirm. And, if they are taken in, they can still be evicted.

    Some shelters have units called “respite” centers. Some local hospitals help support these centers located in shelters. The hospitals can then discharge these older adults to the respite centers where they can rest post-hospitalization. But, even respite centers can fail older adults because they might not have the resources to care for them appropriately.

    Here’s more from Just Care:

  • Multigenerational family housing can work

    Multigenerational family housing can work

    Paula Span reports for the New York Times on multigenerational family residences. Think of them as family compounds, with a main house and a separate unit for the extended family. These “accessory dwelling units” or ADUs can work well.

    Portland, Oregon is one of a number of big cities with ADUs. They are far more affordable than your standard home and come in all shapes and sizes. They could be a one or two bedroom structure that is a converted garage. Or, they could be a converted basement. They could be attached to the primary home or a totally separate unit.

    The value of these family compounds is that the different family units can have separate living spaces but easily share meals, activities, and tasks. The grandparents are there to babysit the kids or to take the dog for a walk.

    Older adults can downsize into an ADU and still have money in the bank. Building an ADU costs about $150,000 for around 600 square feet. If the older adults’ ADU is with a child or other loved one, they are likely to have built-in caregivers.

    ADUs are not only a great way to ensure that older adults are socially engaged, they are a cost-effective way to live, both for the occupants of the ADUs and the occupants of the primary residence.

    Some states and cities had zoning barriers or parking restrictions that made it hard to build ADUs. But, many are now changing their laws to encourage development of more ADUs.

    The ADU market is quite small, but it is growing rapidly. In just a five years, the number of ADUs built in California went from around 1,200 to around 20,000. In 2020, there were an estimated 1.4 million ADUs in the US. Most are located in Florida, Georgia, Texas and California.

    We still have a long way to go before we see a boom in the ADU market. The vast majority of the country–80 percent–includes neighborhoods that only allow for single-family homes. And, some communities that permit ADUs have parking rules and rules about occupancy that dissuade people from building ADUs.

    Here’s more from Just Care: