About a third of COVID-19 deaths in the U.S. occurred at a nursing home. A million more residents and workers tested positive for the virus. What this country did right and wrong to protect the most fragile among us will be debated for years.
One thing is sure: We cannot let the lessons of the pandemic go unheeded.
With new funding opportunities, the amplification of telehealth, and the rise of Medicare Advantage, we can begin to fix the problems in our healthcare delivery system for older Americans.
New government funding
For the first time ever, billions of federal relief funds are available for states and community service providers to expand, enhance, and strengthen the programs that keep our elderly loved ones safe, engaged, and healthy. From $1.5 billion in additional support in the Older Americans Act to a 10% Medicaid enhanced match in the American Rescue Plan, this is an unprecedented time for states to take advantage of federal programs to serve more people in the community.
These funds offer a triple win: top preference, strong outcomes, and fiscal soundness. They include support for nutrition, family caregivers, aging and disability services, infection control, and more. And additional funding is expected to come later this summer with the American Jobs Plan legislation.
The biggest opportunity area is more at-home support for seniors.
Throughout 2020, people who usually would be candidates for assisted living or nursing home care were unable to move in due to coronavirus lockdowns. So, they stayed in their homes with help from caregivers – children, friends, spouses, or paid home health workers.
The result for many seniors was excellent. They remained in a place they knew, in routines they preferred, where exposure was reduced. Most seniors are happier at home, and aging at home reduces the demand on tax-financed facility-based programs. Those programs then have funds to provide more home-based aid to seniors – some as simple and impactful as free installation of grab bars or ramps to prevent falls, or meal delivery services to reduce the effects of social isolation.
For example, during quarantine, we learned again how important certain services were for breaking through social isolation. Even pre-pandemic, four of every 10 elderly people receiving home delivery services for meals said the food drop-off was their primary social contact of the day.
Services such as Meals on Wheels provide much more than nutrition. They also enable regular check-ins that could be lifesaving in the case of abuse or neglect, among other things, and allow people to feel connected and noticed. This lifeline became even more vital amid coronavirus shutdowns. Demand for meal services, as an example, doubled in many places like New York.
Have we historically been too quick to move some seniors into nursing homes? Community-based programs, such as meal-delivery services, produce results that far exceed the bottom line, particularly during a crisis. The pandemic prompted a long-overdue return to supporting our elders with these services and a sensible cry to keep them safe in their home.
On a government and state level, community-based programs should be a central part of eldercare going forward. They are shining examples of how well a care system can work when it is integrated and centered on keeping people safe in the community while honoring their preferences.
The appetite of our nation for consumer involvement has never been more supportive and we need to deliver on its promise with options like buy-in programs, by screening and diverting where we can, and by expanding information systems so Americans have greater awareness of community programs and services.
Earlier this year, the Centers for Medicare & Medicaid Services announced that it will support the permanent extension of certain telehealth access and reimbursement policies beyond COVID-19, and Congress has several telehealth expansion bills it is considering.
While pre-pandemic I would have chuckled at the thought of my father being willing to visit his doctor online, after a year of COVID-19 he has learned to overcome technological hurdles. Many of his medical checkups are now virtual. He appreciates the ease and immediacy of using a computer to reach his doctors and nurses.
For him and other seniors, telemedicine reduces the need for trips to a physician’s office, reduces exposure, and improves access to care. For doctors, it means they can see more patients with fewer logistical problems. For expensive government programs like Medicare, telehealth provides greater efficiency, healthier people, and reduced costs.
It will be important to make sure the pendulum doesn’t swing too far on this kind of remote care. In-person visits will still be crucial for certain check-ups and diagnoses, and nothing beats the unspoken personal and environmental cues that are picked up only through traditional in-person visits. However, telehealth has passed its first major test during the pandemic and created an additional access point for those who have difficulties getting to the doctor in the first place.
More importantly, services like telehealth allow seniors to continue living at home and in their communities for as long as possible. The rise of telemedicine fills gaps where needed treatment is lacking and may help to chip away at the downstream cost and health impacts of marginal care.
With one in three seniors currently enrolled in Medicare Advantage, these plans also have an opportunity to gain a greater foothold in healthcare through digital enablement.
Post-pandemic, seniors and baby boomers will expect an increasingly digital experience – one that Medicare Advantage plans are incented to offer. Making it easy for seniors to access and navigate medical services will enhance member engagement, satisfaction, and health.
Across the country, health plans are collaborating with healthcare providers to make it easier for them to support their patients. For example, by monitoring expensive conditions by pairing seniors with virtual and on-demand specialty support services, providers can address health issues at their earliest stages to improve timely access to care. Increased access to specialty care via telehealth has been shown to reduce urgent care visits by 45% while decreasing costs per visit. It can also prevent premature transitions into a nursing home setting.
The pandemic has shifted the world of eldercare on its axis. With smart investments, use of funds, and a focus on whole-person care, we can continue to move forward. Community-outreach programs, telehealth, and Medicare Advantage all provide a renewed emphasis on aging at home that are beneficial additions to programs aimed at keeping our elderly loved ones healthy and well.