Haims: Part II — Aging and disabilities

Courtesy photo
This is the second installment of a three-part series on aging and disabilities.
In our world of modern medicine, to be outside the boundaries of “the norm,” is considered abnormal, or bad, and as such must be treated and corrected, or you may then be labeled “disabled.” The federal government has established guidelines for nearly every aspect of our health, and our culture has set guidelines to be as perfect looking as any number of movie stars, or models seen on TV and in magazines.
As such, I do know that as we gain weight, lose hair, need to wear glasses, or even age; we drift further and further away from those guidelines and become out of favor in the public’s eye. Could this be happening in the provision of medical services? Is it possible that as we age the method of care giving, whether intentionally or unintentionally, is slanted towards the young, creating a bias towards older patients?
Over the years, I have often heard our elder clients mention that their perception of their medical provider’s attention to their overall well-being has been lackluster and therefore has been a disincentive to them seeking further medical treatment. I get it, medical providers are frequently regulated to office visits of 10 to 20 minutes and therefore find it challenging to address multiple chronic conditions, medication interactions, and the coordination of care with various specialists that requires more time than a standard office visit. Consequently, this leaves people feeling undervalued.
Office visits that are rushed, for any reason, exacerbate disparities in health care. Tackling such disparities of healthcare necessitates not only a transformation in the structure and reimbursement (Medicare) of primary care, but also in the provision of medical providers who specialize in elder care — like geriatricians. Unfortunately, in all of our mountain towns, we have no geriatricians to act as a quarterback and direct patients to the resources they may require.
The sheer number of people over 65 in our mountain towns should justify the cost of bringing in a geriatrician. Sadly, this does not seem to be the case. Further complicating this hole in the provision of senior care is the fact that there are few geriatricians available, reimbursement rates from Medicare are low, and a lack of prestige associated with the field. (Less than 1% of medical providers in the United States are geriatricians)
In the Vail Valley, our local hospital has found some ways to address servicing seniors and others who are challenged in managing their care. Over the past few years, the hospital has collaborated with a number of local providers to develop a patient-centered medical home program that organizes care around patients’ needs. By utilizing a multidisciplinary team including physicians, nurses, social workers, care coordinators, and in-home care providers, we are making progress.
Over the past decade, pay-for-performance reimbursement protocols have been transitioned into fee for service Medicare reimbursement protocols. While the intent of this transition is to drive improvements in the delivery of care, there are fundamental drawbacks. As the number of commercial payers continues to shrink, the amount of payer types with lower reimbursement rates will increase. This will affect the bottom line of hospitals and medical providers and thus presents a substantial financial challenge to our health care system.
Well, perhaps you are still skeptical that modern medicine treats older patients differently than its younger patients. However, it does appear that given our cultural bias (i.e., youth over age, beauty over average, thin over heavy, etc.), why would we find it implausible to see our medical profession follows the cultural guidelines (just look at cosmetic surgery and the boom that has experienced in the last few decades)?
Consider the dispensing of medications. Wander through nearly any nursing home and spot-check the medications that elder folks are taking versus those of younger folks with similar illnesses. You may likely find residents in nursing homes are far more medicated than people living at home with the same afflictions. We have treated our elderly differently than we treat our less aged populations.
Is this bad?
Do our elderly require such variations in treatment? Are there financial components driving this difference in treatment? Are there staffing and training factors? (How does Medicare factor in? How have each of us prepared for our aging and has our country in general prepared for what lies ahead?)
Postponing action until “tomorrow” is not acceptable. The challenges of an aging population is not a distant or hypothetical scenario — rather, it is here and present now. We have the responsibility and potential to address this. The question is, will we rise to the occasion?
In 2023, Senate Bill SB23-031 was established. “The act creates the Colorado multidisciplinary health-care provider access training program (program) to improve the health care of medically complex, costly, compromised, and vulnerable older Coloradans. The program coordinates and expands geriatric training opportunities for clinical health professions graduate students (students) enrolled in participating Colorado institutions of higher education.” If you are interested and have time, take a look at the act.
Although progress is being made and solutions are being developed to better the provision of healthcare to our older population, we must bridge traditional silos in the provision of care and restructure medical reimbursements. Regardless of age, in order to make informed decisions about our health, we must ask questions and be our own advocate.
Judson Haims is the owner of Visiting Angels Home Care in Eagle County. He is an advocate for our elderly in Eagle, Garfield and Pitkin counties and is available to answer questions.
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