Fong Law Group

On Medicare? What You'll Pay for Now That the PHE Has Ended

The Biden administration officially ended the COVID-19 Public Health Emergency on May 11, 2023. Certain policies that were implemented in early 2020 during the public health emergency will now expire. As a result, seniors are among those who may see some of the health care costs related to COVID-19 change. Other health care services may or may not be affected, depending on what type of coverage you have.

Here are some of the highlights:

If You Are Enrolled in Original Medicare

• With the end of the COVID-19 public health emergency, you will likely have to pay for:
  • At-home and over-the-counter COVID tests
  • Care in a skilled nursing facility if you have not first spent at least three days in a row admitted to a hospital (Note that being “under observation” at a hospital is not the same as being “admitted.”)
• You generally will not have to pay for:
  • Laboratory COVID tests ordered by a health care provider, if you have Medicare Part B (Note that you may have to pay for part of the cost for your visit to the health care provider’s office)
  • COVID vaccines and boosters from a health care provider who takes Medicare
  • COVID oral antiviral treatments such as Paxlovid
• Other considerations
  • In most cases, you will continue to have access to telehealth services from home through the end of 2024
  • With the end of the public health emergency, Medicare beneficiaries with Part D coverage may no longer receive three-month supplies of prescription medications

If You Are a Medicare Advantage Member

• Now that the public health emergency has ended, you may have to pay at least part of the cost for:
  • At-home and over-the-counter COVID tests
  • Laboratory COVID tests ordered by a health care provider, including part of the cost of your visit to the health care provider’s office
  • Visits to out-of-network physicians
• You will not have to pay for:
  • COVID vaccines provided by an in-network physician
• Other considerations
  • Check with your individual plan regarding telehealth service access

For more information, visit the “What Does the End of the PHE Mean for You?” resource on the Centers for Disease Control and Prevention website.

An Epidemic: Substance Abuse a Growing Problem Among Seniors

The United States population of aging adults has grown exponentially over the past decade. According to projections published by the U.S. Census Bureau, the number of Americans aged 60 and older increased by 34 percent from 55.7 million to 74.6 million between 2009 and 2019. Unfortunately, amid their growing numbers, more and more seniors are facing a substance use disorder problem that in large part has remained silent.

What Are Substance Use Disorders?

According to the Centers for Disease Control and Prevention, substance use disorders include “treatable, chronic diseases characterized by a problematic pattern of use of a substance or substances leading to impairments in health, social function, and control over substance use.”

Seniors are an overlooked group regarding substance abuse issues, but the problem is growing nationwide. Learning the extent and cause of substance abuse among seniors can help improve outcomes for this population.

Rates of Substance Abuse and Misuse Among Older Adults

Seniors often get disregarded in conversations about substance misuse. Yet according to some estimates, nearly 1 million adults aged 65 and older were reported to be living with an addiction as of 2018. Today, that number could be much higher.

Drug Abuse

Drug abuse among older adults is a dangerous problem, in part because health care providers and caregivers so often overlook it. It may even be diagnosed incorrectly as a health condition related to aging.

Seniors are likely to use one or more prescription medications. Adverse drug interactions between multiple prescriptions, nutritional supplements, and over-the-counter medication can inadvertently harm one’s health.

Misuse of certain prescriptions can also lead to a substance use disorder. Opioids, for example, have been prescribed to millions of people suffering from chronic pain. The proportion of U.S. adults aged 55 and up who have sought treatment for opioid use disorder has been surging over the past two decades; between 2013 and 2015 alone, it jumped more than 50 percent. One 2006 study stated that at least one in four older adults were using prescription drugs that have potential for abuse.

Many seniors are at risk of developing a dependence on nonprescription, over-the-counter, and illicit drugs as well. Meanwhile, research has suggested that American seniors use illicit drugs at a higher rate than older adults from most other countries.  

Alcohol Use

Surveys show that alcohol use among people 65 and older has increased 22 percent over the past two decades. The extent of alcohol abuse remains unknown due to the impact of underreporting. However, seniors in some studies do report binge drinking and at-risk drinking.

People binge drink when they have five or more drinks in one setting. According to one study, more than a tenth of older adults in the U.S. are regular binge drinkers.

Research published by the National Library of Medicine defines at-risk drinking as consuming more than three drinks on one occasion or having more than seven drinks in one week. The prevalence of at-risk drinking among men is estimated at 16 percent and 10.9 percent among women.

Note that the National Institutes of Health offers a series of free worksheets that can help you evaluate your use of alcohol and learn how to make positive changes.

Why Do Seniors Abuse Substances?

Seniors are less likely to abuse substances for a euphoric effect. Older adults typically use drugs and alcohol to self-medicate against the physical and emotional pain that comes with aging.

Some common causes of substance abuse among people aged 65 and older include:

• Loss of a spouse or family member
• Decreased income
• Change in living arrangements
• Trouble sleeping
• A mental and physical decline in health
• Conflicts with family
• Lack of purpose
• Retirement

A senior’s coping style early in life may correlate with late-life substance abuse. People with avoidant coping styles tend to rely on substances to deal with stress and change. If seniors spend their lives avoiding stress or problems, they are more likely to develop a late-life drinking problem than those who cope in other ways.

Social Factors Leading to Substance Abuse Among Older Adults

Various social factors appear to increase the chance of late-life drug and alcohol abuse. The following social factors are among those that may lead to increased substance misuse:

• Unexpected or forced retirement
• Social isolation
• Being divorced, separated, or single
• Lack of religious affiliation
• Affluence or feeling comfortable with the availability of financial resources
• Grief

Physical Factors Leading to Substance Abuse Among Aging Adults

Older adults with substance abuse disorder typically have these physical factors in common:

• Comorbidities
• Chronic medical conditions
• Reduced mobility
• Chronic pain
• Poor health status

Psychiatric Risk Factors Leading to Substance Abuse Among Seniors

Psychiatric risk factors among older adults with substance abuse disorder include:

• History of substance use disorder
• Current or previous mental illness
• Feeling socially isolated
• Having an avoidance coping style

Symptoms of Substance Abuse Among Older Adults

Substance abuse is a serious medical condition. Prompt diagnosis and treatment can help seniors get the help they need to improve their quality of life. Caregivers and medical providers should watch out for the following symptoms of substance misuse:

• Depression and loss of interest in previously enjoyable activities
• Use of a prescription drug more often than what is outlined in the instructions
• Memory problems
• Change in appetite
• Social withdrawal
• Irritability and sadness
• Change in sleeping patterns
• Decline in hygiene

Leading Substance Use Disorders According to Region

Substance misuse is occurring everywhere in the U.S., regardless of age, but certain areas are seeing abuse of specific types of substances. The Agency for Healthcare Research and Quality compiled the following data for 2016 through 2018 about regions nationwide:

• New Jersey and parts of Appalachia have a concentration of opioid-related substance use disorders.
• The Midwest, Appalachia, Rhode Island, and Nevada saw a higher concentration of alcohol dependency issues than other parts of the country.
• Appalachia saw a more-significant-than-average concentration of sedative-related substance use disorders.
• Stimulant-related disorders appeared more in the Midwest, the South, and Appalachia.
• Cannabis-related substance abuse disorders occurred in Mississippi and other Southern states.

Health Impacts of Substance Abuse on Seniors

The health implications of substance abuse disorder are more significant for older people. Older people are more vulnerable than other groups to the effects of drug use on mental health. Seniors who take prescription medication risk negatively impacting their mental state by mixing their medicine with recreational drugs or by abusing alcohol.

Drug and alcohol abuse can also lead to increased fall risk, physical impairment, adverse psychiatric effects, worsening of other physical conditions, and death.

In fact, among people aged 65 and over, certain types of opioid overdose deaths increased by 53 percent between 2019 and 2020 alone. The number of alcohol-related deaths for this age group rose by 18 percent over the same timeframe.

Recovery Options for Older Adults

Whether a senior should receive inpatient or outpatient treatment depends on their needs. Older adults with a substance use disorder may benefit from inpatient treatment if they meet some of these criteria:

• A high likelihood of relapse
• Suicidal thoughts or thoughts of self-harm
• Likelihood of experiencing withdrawal symptoms
• No familial support
• Previous attempts at detox
• Co-occurring severe medical conditions that need continuous monitoring

Seniors may also need the following to get the most out of recovery:

• Careful case management
• Family, group, and individual counseling
• Cognitive behavioral therapy

How Can the Health Care Industry Help Older Adults With Substance Use Disorder?

Much work is needed to decrease the substance abuse rates among older adults. There is a critical need to address this problem.

Primary care physicians are the first line of defense. Education for clinicians should include skill and strategy development to treat substance abuse issues among older adults. Health care workers should know how to identify substance misuse with proper screening and assessments. Understanding co-occurring disorders and the connection between mental illnesses and substance use disorders is also crucial.

If you notice signs of addiction in a loved one, it is essential to get them professional help. In addition to improving their quality of life, you may save them from succumbing to this disease.

On Medicare? What You'll Pay for Now That the PHE Has Ended

The Biden administration officially ended the COVID-19 Public Health Emergency on May 11, 2023. Certain policies that were implemented in early 2020 during the public health emergency will now expire. As a result, seniors are among those who may see some of the health care costs related to COVID-19 change. Other health care services may or may not be affected, depending on what type of coverage you have.

Here are some of the highlights:

If You Are Enrolled in Original Medicare

• With the end of the COVID-19 public health emergency, you will likely have to pay for:
  • At-home and over-the-counter COVID tests
  • Care in a skilled nursing facility if you have not first spent at least three days in a row admitted to a hospital (Note that being “under observation” at a hospital is not the same as being “admitted.”)
• You generally will not have to pay for:
  • Laboratory COVID tests ordered by a health care provider, if you have Medicare Part B (Note that you may have to pay for part of the cost for your visit to the health care provider’s office)
  • COVID vaccines and boosters from a health care provider who takes Medicare
  • COVID oral antiviral treatments such as Paxlovid
• Other considerations
  • In most cases, you will continue to have access to telehealth services from home through the end of 2024
  • With the end of the public health emergency, Medicare beneficiaries with Part D coverage may no longer receive three-month supplies of prescription medications

If You Are a Medicare Advantage Member

• Now that the public health emergency has ended, you may have to pay at least part of the cost for:
  • At-home and over-the-counter COVID tests
  • Laboratory COVID tests ordered by a health care provider, including part of the cost of your visit to the health care provider’s office
  • Visits to out-of-network physicians
• You will not have to pay for:
  • COVID vaccines provided by an in-network physician
• Other considerations
  • Check with your individual plan regarding telehealth service access

For more information, visit the “What Does the End of the PHE Mean for You?” resource on the Centers for Disease Control and Prevention website.

An Epidemic: Substance Abuse a Growing Problem Among Seniors

The United States population of aging adults has grown exponentially over the past decade. According to projections published by the U.S. Census Bureau, the number of Americans aged 60 and older increased by 34 percent from 55.7 million to 74.6 million between 2009 and 2019. Unfortunately, amid their growing numbers, more and more seniors are facing a substance use disorder problem that in large part has remained silent.

What Are Substance Use Disorders?

According to the Centers for Disease Control and Prevention, substance use disorders include “treatable, chronic diseases characterized by a problematic pattern of use of a substance or substances leading to impairments in health, social function, and control over substance use.”

Seniors are an overlooked group regarding substance abuse issues, but the problem is growing nationwide. Learning the extent and cause of substance abuse among seniors can help improve outcomes for this population.

Rates of Substance Abuse and Misuse Among Older Adults

Seniors often get disregarded in conversations about substance misuse. Yet according to some estimates, nearly 1 million adults aged 65 and older were reported to be living with an addiction as of 2018. Today, that number could be much higher.

Drug Abuse

Drug abuse among older adults is a dangerous problem, in part because health care providers and caregivers so often overlook it. It may even be diagnosed incorrectly as a health condition related to aging.

Seniors are likely to use one or more prescription medications. Adverse drug interactions between multiple prescriptions, nutritional supplements, and over-the-counter medication can inadvertently harm one’s health.

Misuse of certain prescriptions can also lead to a substance use disorder. Opioids, for example, have been prescribed to millions of people suffering from chronic pain. The proportion of U.S. adults aged 55 and up who have sought treatment for opioid use disorder has been surging over the past two decades; between 2013 and 2015 alone, it jumped more than 50 percent. One 2006 study stated that at least one in four older adults were using prescription drugs that have potential for abuse.

Many seniors are at risk of developing a dependence on nonprescription, over-the-counter, and illicit drugs as well. Meanwhile, research has suggested that American seniors use illicit drugs at a higher rate than older adults from most other countries.  

Alcohol Use

Surveys show that alcohol use among people 65 and older has increased 22 percent over the past two decades. The extent of alcohol abuse remains unknown due to the impact of underreporting. However, seniors in some studies do report binge drinking and at-risk drinking.

People binge drink when they have five or more drinks in one setting. According to one study, more than a tenth of older adults in the U.S. are regular binge drinkers.

Research published by the National Library of Medicine defines at-risk drinking as consuming more than three drinks on one occasion or having more than seven drinks in one week. The prevalence of at-risk drinking among men is estimated at 16 percent and 10.9 percent among women.

Note that the National Institutes of Health offers a series of free worksheets that can help you evaluate your use of alcohol and learn how to make positive changes.

Why Do Seniors Abuse Substances?

Seniors are less likely to abuse substances for a euphoric effect. Older adults typically use drugs and alcohol to self-medicate against the physical and emotional pain that comes with aging.

Some common causes of substance abuse among people aged 65 and older include:

• Loss of a spouse or family member
• Decreased income
• Change in living arrangements
• Trouble sleeping
• A mental and physical decline in health
• Conflicts with family
• Lack of purpose
• Retirement

A senior’s coping style early in life may correlate with late-life substance abuse. People with avoidant coping styles tend to rely on substances to deal with stress and change. If seniors spend their lives avoiding stress or problems, they are more likely to develop a late-life drinking problem than those who cope in other ways.

Social Factors Leading to Substance Abuse Among Older Adults

Various social factors appear to increase the chance of late-life drug and alcohol abuse. The following social factors are among those that may lead to increased substance misuse:

• Unexpected or forced retirement
• Social isolation
• Being divorced, separated, or single
• Lack of religious affiliation
• Affluence or feeling comfortable with the availability of financial resources
• Grief

Physical Factors Leading to Substance Abuse Among Aging Adults

Older adults with substance abuse disorder typically have these physical factors in common:

• Comorbidities
• Chronic medical conditions
• Reduced mobility
• Chronic pain
• Poor health status

Psychiatric Risk Factors Leading to Substance Abuse Among Seniors

Psychiatric risk factors among older adults with substance abuse disorder include:

• History of substance use disorder
• Current or previous mental illness
• Feeling socially isolated
• Having an avoidance coping style

Symptoms of Substance Abuse Among Older Adults

Substance abuse is a serious medical condition. Prompt diagnosis and treatment can help seniors get the help they need to improve their quality of life. Caregivers and medical providers should watch out for the following symptoms of substance misuse:

• Depression and loss of interest in previously enjoyable activities
• Use of a prescription drug more often than what is outlined in the instructions
• Memory problems
• Change in appetite
• Social withdrawal
• Irritability and sadness
• Change in sleeping patterns
• Decline in hygiene

Leading Substance Use Disorders According to Region

Substance misuse is occurring everywhere in the U.S., regardless of age, but certain areas are seeing abuse of specific types of substances. The Agency for Healthcare Research and Quality compiled the following data for 2016 through 2018 about regions nationwide:

• New Jersey and parts of Appalachia have a concentration of opioid-related substance use disorders.
• The Midwest, Appalachia, Rhode Island, and Nevada saw a higher concentration of alcohol dependency issues than other parts of the country.
• Appalachia saw a more-significant-than-average concentration of sedative-related substance use disorders.
• Stimulant-related disorders appeared more in the Midwest, the South, and Appalachia.
• Cannabis-related substance abuse disorders occurred in Mississippi and other Southern states.

Health Impacts of Substance Abuse on Seniors

The health implications of substance abuse disorder are more significant for older people. Older people are more vulnerable than other groups to the effects of drug use on mental health. Seniors who take prescription medication risk negatively impacting their mental state by mixing their medicine with recreational drugs or by abusing alcohol.

Drug and alcohol abuse can also lead to increased fall risk, physical impairment, adverse psychiatric effects, worsening of other physical conditions, and death.

In fact, among people aged 65 and over, certain types of opioid overdose deaths increased by 53 percent between 2019 and 2020 alone. The number of alcohol-related deaths for this age group rose by 18 percent over the same timeframe.

Recovery Options for Older Adults

Whether a senior should receive inpatient or outpatient treatment depends on their needs. Older adults with a substance use disorder may benefit from inpatient treatment if they meet some of these criteria:

• A high likelihood of relapse
• Suicidal thoughts or thoughts of self-harm
• Likelihood of experiencing withdrawal symptoms
• No familial support
• Previous attempts at detox
• Co-occurring severe medical conditions that need continuous monitoring

Seniors may also need the following to get the most out of recovery:

• Careful case management
• Family, group, and individual counseling
• Cognitive behavioral therapy

How Can the Health Care Industry Help Older Adults With Substance Use Disorder?

Much work is needed to decrease the substance abuse rates among older adults. There is a critical need to address this problem.

Primary care physicians are the first line of defense. Education for clinicians should include skill and strategy development to treat substance abuse issues among older adults. Health care workers should know how to identify substance misuse with proper screening and assessments. Understanding co-occurring disorders and the connection between mental illnesses and substance use disorders is also crucial.

If you notice signs of addiction in a loved one, it is essential to get them professional help. In addition to improving their quality of life, you may save them from succumbing to this disease.

Affordable Housing Options for Low-Income Older Adults

Safe housing that meets older adults’ needs is essential to healthy aging in communities. Many seniors with low, fixed incomes struggle to balance housing expenses with the costs of health care, transportation, and groceries.

Finding inexpensive, safe, and accessible housing can be challenging. However, several affordable housing options are available for older people with low incomes.

Section 202 Supportive Housing for the Elderly

The Section 202 Supportive Housing for the Elderly Program provides affordable housing and supportive services for older people with limited means. Through this program, seniors can maintain independence while receiving benefits such as transportation and assistance with activities of daily living (ADLs). The support allows them to continue living independently.

The United States Department of Housing and Urban Development (HUD) requires Section 202 facility owners to maintain the buildings and regularly inspect them to ensure the tenants have a safe environment. Rent typically comprises 30 percent of the tenant’s income.

Older adults who meet specific thresholds may enroll in Section 202 Supportive Housing for the Elderly Program.

• The head of the household must be 62 years old or older.
• There are also income requirements, which vary depending on location. Seniors must meet HUD’s income limits criteria. Generally, it is less than 50 percent or less of the area’s median family income.

The program has several benefits for those who qualify:

• Low housing costs provide peace of mind and stability.
• Units designed for older adults are more accessible, including features such as wheelchair ramps, wider doors, and bathroom grab bars.
• Senior communities ease loneliness and foster social connections.

Housing Vouchers

Housing vouchers are another option for seniors. Local housing agencies provide housing vouchers to low-income households that help cover rent. These vouchers are available to families living below 50 percent to 80 percent of the poverty level; income thresholds vary by area and agency. Dwellings must satisfy housing quality standards, and owners must maintain the units.

While families can obtain vouchers regardless of age, elders and those with disabilities can receive an additional deduction.

Although housing vouchers can help some older adults and their families, limited availability and long waiting lists characterize housing voucher programs. Per the Center on Budget and Policy Priorities, only one in four qualifying households receive vouchers.

Home Sharing

Home-sharing programs can help older adults living alone stay in their homes while providing an affordable housing option for older adults. In addition to helping with costs, home-sharing can prevent loneliness, particularly benefiting older adults whose spouses have passed or children have moved away.

Through Senior Homeshares, older adults with homes can find housemates who are also elderly, helping to lessen the cost of living. The service pairs older adults with spare rooms in their homes with those on fixed incomes searching for safe, affordable housing.

Additional Options

Most affordable housing programs, such as Section 202 and housing vouchers, have waiting lists as demand exceeds availability. Additional options exist for older adults who need more immediate help with housing costs.

• Older adults who own their homes can apply for a reverse mortgage, allowing them to continue living at home. Reverse mortgages draw upon existing equity in a home to supply regular payments, which can supplement retirement income. The federal government insures the Home Equity Conversion Mortgage (HECM).
• For those with health care needs who have very low incomes and few assets, Medicaid could cover the cost of nursing home care.
• Medicare pays for certain in-home health services for homebound older adults. Although Medicare does not cover rent or mortgage payments, in-home care covered by Medicare can lessen total expenses.
• Individuals might consider moving in with family or friends to share living expenses and benefit from support.

For older adults struggling to afford housing costs, several options exist. The best choice depends on your unique circumstances. For assistance obtaining more affordable housing as you age, consult with your attorney.

Will Robotics and AI Be the Future of Elder Care?

Adults 65 and older constitute the fasting-growing age demographic in the United States. When it comes to elder care, this expanding population is facing a scarcity in people equipped to support them as they get older.

One estimate predicts a shortage of 151,000 paid direct care workers and 3.8 unpaid family caregivers by 2030, increasing to a gap of 355,000 paid workers with 11 million unpaid family caregivers by 2040.

Technological advancements in robotics and artificial intelligence may be opening the doors to new possibilities for supporting aging people.

Innovations for Aging in Place and Beyond

Many older adults wish to stay in their homes for as long as possible. According to AARP, 77 percent of adults over 50 want to continue residing in their homes for as long as they can.

Yet aging can lead to challenges with mobility and memory, such that older individuals often need additional assistance to live independently. Innovations in robotics and artificial intelligence may have the potential to provide support on this front, allowing seniors to continue living at home as they age.

Developments in robotics and AI could also fulfill unmet needs in nursing homes and assisted living, increasing efficiency, helping caregivers complete tasks, and reducing the number of staff required.

Meanwhile, artificial intelligence technologies may be able to help older adults manage health conditions from home as well as receive more efficient care in hospital settings.

Robots Helping Out in Health Care Facilities

How might robots help seniors in their homes, nursing homes, assisted living facilities, and beyond? Here is a glimpse into some emerging products:

• Panasonic has developed robotic exoskeletons designed to augment wearers’ abilities. This self-reliance support robot aims to help aging people perform everyday tasks, get in and out of bed, and sit on chairs or the toilet. The device could help individuals to perform physical tasks without assistance. Another portable exoskeleton, the APO, may be another type widely used one day in health care to help prevent falls in seniors.
• The TUG robot is already assisting in hospitals by delivering medicine, meals, supplies, and tests, freeing nursing staff to focus on tasks requiring more education and expertise.
• Social robots may prove another avenue for improving older adults’ mental health. Paro, a robotic seal, gives patients the benefits of pet therapy in health care settings and dementia wards where bringing live animals would be impractical. Similar to pet therapy, some individuals may find it easier to connect with robots than with people.

In the coming years, other kinds of socially assistive robots may become increasingly common in elder care. These types of robots engage with residents, provide entertainment and interaction, perform tasks, or help ensure safety:

• A socially assistive robot called Stevie, designed at Trinity College Dublin in Ireland, was tested at a Washington, D.C., nursing home from 2018 to 2020. Stevie entertained residents by telling jokes, playing bingo, and leading karaoke. It also provided reminiscence therapy using stories and music and could clean the facility with ultraviolet light. Recognizing commands like “help me,” the robot also can alert staff when residents needed assistance.
• Pepper, a humanoid robot funded by the Minnesota Department of Human Services, is similarly designed for socializing with residents. Able to recognize faces and read human emotions, Pepper is being introduced into nursing homes and other elder care facilities.
• Aeo, a robot created by Aeolus Robotics, interacts with residents socially. In addition to taking selfies with residents, it performs various essential functions, such as disinfecting surfaces, opening doors, pressing elevator buttons, and alerting staff when a resident has fallen or needs help.

Technology at Home

Older adults who live alone and people with disabilities can already use Personal Emergency Response Systems (PERS), also known as Medical Emergency Response Systems. These lightweight, battery-powered wearable devices allow individuals to call for help at the push of a button. For an installation fee and a monthly monitoring charge, users receive a device that contains a radio transmitter and a console that connects to a telephone. An emergency response center monitors incoming calls.

Technology using artificial intelligence, motion sensors, and camera monitors can also provide more comprehensive assistance and monitoring for seniors aging in place:

• CarePredict, a device worn on one’s dominant arm, tracks the wearer’s activity. When it detects deviations from behavioral patterns, it alerts a caregiver.
• With Envoy at Home, caregivers can place small sensors in their loved one’s home that alert them when their loved one could be at risk, such as when they leave home, exhibit disturbed sleep, visit the restroom frequently, or display inactivity.
• Integrating AI with smartphone usage is one more emerging area in senior care. A 2021 survey by Pew Research Center found that the majority of older adults use smartphones. Technology utilizing smartphones could make in-home health monitoring more accessible, particularly for homebound seniors who may postpone doctor visits or rely on telehealth.
• With AliveCor, older adults can monitor and track their heart activity on their phones. AliveCor is a wireless personal electrocardiogram (EKG) placed on the back of the smartphone. Using an application, individuals can view their EKG results and can share results with their cardiologists.
• Using the smartphone’s camera, artificial intelligence, and machine learning, Healthy.io makes medical assessments of urine by analyzing the concentration of chemical elements and chemical compounds in urine.
  Healthy.io also empowers users to take photos of their wounds for a digitalized wound assessment, which can track healing and help doctors make recommendations.
• Luminostics is a diagnostic platform that attaches to a smartphone. It can recognize bacteria, viruses, proteins, and hormones from bodily fluids.

A Growing Market

Advances in medical technology are already helping health care providers manage, identify, and treat medical conditions in older adults.

According to Healthcare Dive, the Food and Drug Administration (FDA) authorized 91 AI- or machine-learning-enabled medical devices in 2022 alone. These include tools for radiology, cardiology, neurology, and more.

Going forward, AI may also become the norm for performing administrative tasks in clinical settings, giving health care workers more time to spend directly helping patients.

2023 AARP Report Recommends Supports for Family Caregivers

Many older Americans choose to have their family members care for them as they age. Despite the comfort a familiar face may provide, there is a significant cost for the loved ones who sacrifice their time, and often their upward economic mobility, to ensure that they can secure proper care for their senior parent.

In a report issued in March 2023, AARP stresses the importance of supporting family caregivers in their financial, emotional, physical, and professional lives. The analysis gives a glimpse into the experiences of family caregivers and also offers recommendations on policies, practices, and programs – across public as well as private realms – that policymakers should consider enacting or enhancing in support of caregivers and the individuals who are in their care.

How Much Does It Cost to Be a Family Caregiver?

Being a family caregiver can come at a great financial cost. The average cost of caregiving has risen exponentially in the past several years, and the trend is expected to increase more over time.

In its report, AARP estimates the value of family caregiving in 2021 at $600 billion dollars in unpaid contributions – up from $470 billion dollars in 2017.

The monetary value of caregiving is not the only cost of care. For family caregivers, some of the intangible costs of included:

• spending an average of 18 hours per week to tend to the needs of their loved ones
• facing higher risks of chronic loneliness, which may have negative health effects
• neglecting their own self-care

What Are the Major Issues in Family Caregiving?

According to the AARP report, by 2034, the population of people over 65 will outnumber the population of children under 18. With this historic shift, the researchers suggest that the impact on family caregiving will become even more prominent in several key areas:

The Need for Tailored Support for Diverse Caregivers and Their Families

Family caregivers across diverse cultures, ethnicities, sexual orientations, and gender identities often face concerns about access to support that is specific to their community. Ensuring that affordable, inclusive, readily available policies and services are in place to meet these needs of these caregivers will continue to be critical.

Direct Care Workforce Shortage

Amid a shortage of professional caregivers that only worsened during the COVID-19 pandemic, AARP notes that the turnover rate among the direct care workforce averages between 40 percent and 60 percent each year. Failing to recruit and retain a dedicated workforce in caregiving as the aging population grows will inevitably add to the burden carried by unpaid family caregivers.

Economic Impact on Working Caregivers

Most family caregivers – nearly two-thirds of them in 2019, according to AARP – hold a full- or part-time job in addition to caring for their loved ones. These workers often take an economic hit because they need to split their time between their jobs and their home responsibilities.

Without such supports as telecommuting, paid leave, and respite care, they may have no choice but to call out of work, turn down promotions, or even leave their job altogether to dedicate themselves fully to providing care. This can then mean additional financial stress as well as adverse effects on their career and future earning potential.

A Growing Sandwich Generation

In 2019, about 30 percent of older Americans were living with their children or grandchildren. The so-called “sandwich” generation represents those who are responsible for caring for their children and their aging parents at the same time, while also working. These caregivers, who are likely to report more emotional and financial pressure, now tend to include workers across an ever-expanding age span – from 35 to 64.

Recommendations

The AARP’s report recommends specific policies and practices to support family caregivers going forward. These recommendations to policymakers include the following:

• Including family caregivers in planning and decision making across health care settings
• Improving access to respite care for family caregivers
• Ensuring that publicly funded programs and supports for caregivers are inclusive, culturally appropriate, and designed to meet the needs of diverse populations
• Offering family caregivers a tax credit
• Expanding protections for workers who rely on the Family and Medical Leave Act and related state programs while providing long-term care for family members, including instituting paid leave for working family caregivers
• Allowing for other programs that pay family caregivers
• Improving Social Security benefits for people who provide long-term care services to family members

Additional Resources

Having a care plan in place for your loved ones in advance may help decrease the financial costs and other stresses associated with paying for long-term care for aging adults. Your elder law attorney can help you create a comprehensive long-term care plan that will address the costs associated with tending to the people you love. 

What Is Hospice Care at Home?

Hospice care is a type of health care that patients with terminally ill conditions rely on at the end of their lives. This type of care focuses on pain management and emotional, spiritual, and familial support for patients nearing the end of their lives.

There are several options for receiving hospice care, including being cared for at home. The type of intimate care a patient receives while in hospice is more conducive to being received at the patient’s home. This becomes a team effort, and it helps to have a peaceful environment when receiving care.

Who Can Benefit From This Type of Care?

Patients with serious illnesses like cancer, heart disease, dementia, kidney failure, or other fatal conditions benefit from hospice care. This type of care can help the patient live a more comfortable life while decreasing the emotional burden of grief for families by preparing them for the loss of their loved one.

When Is Hospice Recommended?

Hospice care should not only be considered by those who have loved ones nearing the end of their lives. While most of these services are generally reserved for people with six months or less to live, early hospice care can be beneficial for patients and their families as well.

You may wish to consider such services in the following cases:

• The patient has a serious decline in their physical well-being
• After a diagnosis of Alzheimer’s disease or dementia
• You have decided to forgo any treatment to improve your physical treatment or care for your illness

Who Makes Up a Hospice Care Team?

Your hospice team can consist of many different types of people. Various professionals and volunteers may be involved in end-of-life care. Some of those you may see on your care team can include:

• Doctors
• Nurses
• Social workers
• Spiritual advisors
• Trained volunteers

Who Pays for Hospice Home Care?

Like any other health care option, these services can quickly become very expensive. Fortunately, there are several ways to cover the cost, including:

Government Programs

If you qualify for government assistance, there may be insurance plans specifically designed to cover the cost of hospice care.

Seniors enrolled in Medicare Part A may qualify for a Medicare hospice care benefit. This benefit program allocates money to pay for such care at home.

For terminally ill patients on Medicaid, hospice care may be covered depending on the state.  

The Department of Veterans Affairs may also provide coverage for these care benefits for seniors who have served our country.

Private Insurance

Check the terms of your insurance policy to determine if your health insurance covers hospice care. Your policy may cover all or part of your hospice care needs.

Options for Uninsured Patients

Even if you do not have health insurance, you may still have coverage options. There are charitable organizations that work with elderly and disabled individuals who need help paying for hospice care services. Hospice care organizations also often have internal departments that work with patients who qualify for this type of care but are indigent or do not have health insurance.

Is In-Home Hospice Right For You?

Making this choice is an important part of your end-of-life care plan. Be sure to gather as much information as you can before deciding whether this type o care is best for you. For example, you may want to consult Medicare’s hospice compare website or CaringInfo.org’s website for other hospice locator tools.

If you have questions about Medicare or Medicaid, contact your elder law attorney to learn more.

Study: Certain Social Risks May Cause Early Death in Seniors

Using survey data from more than 8,000 adults aged 65 and older, researchers have identified eight social factors that may lead to early death in older adults.

As part of the study, researchers from Massachusetts General Hospital and the University of California, San Francisco, developed a tool called the Social Frailty Index to examine factors that predict mortality, including age, gender, and medical conditions, as well as social characteristics.

The findings have applications in clinical, population health, and research settings. Clinicians may be able to use the index to help their older patients participate in advanced care planning. The index also helps identify at-risk seniors who could benefit from changes to their social interactions that could extend their lives.

8 Social Characteristics Shared by Study Participants Who Died Prematurely

Following 8,250 seniors for four years, the research team discovered that 22 percent of the group died within four years of their baseline interview.

The participants who died prematurely had the following eight social characteristics in common:

1. Poor neighborhood cleanliness
2. Low perceived control over their financial situation
3. Meeting with children less than yearly
4. Not working for a salary
5. Not being active with children
6. Not volunteering
7. Feeling isolated
8. Being treated with less courtesy or respect

Why Are the Social Frailty Index Findings Important for Older Adults?

The Social Frailty Index reveals the potential impact of healthy social connections on seniors’ physical health, according to the study’s authors. These findings, they state, are significant because medical providers previously had not accounted for these characteristics. Health care providers taking these findings into account may be able to give patients a complete care management plan.

“We often overemphasize the importance of medical conditions when thinking about longevity,” Sachin J. Shah, the study’s lead researcher, said in a news release. “This research demonstrates that our social lives are as important as medical conditions.”

The data collected from the study also helps predict the likelihood that a senior can safely and comfortably age in place. Solid social connections correlate with the ability of older adults to live independently.

Failure to consider social factors can lead to more significant inequities. For example, one of the authors states, Medicare penalizes hospital readmissions. Because of the expense of rehospitalization, some hospitals may refuse to admit Medicare recipients. Omitting risk factors creates a more significant barrier to proper treatment for marginalized groups. Patients can therefore avoid rehospitalizations if clinicians recognize and account for social factors when assessing a patient’s risk factors.

What Can Seniors Take From the Study?

This study’s findings suggest that friends, family, and community can help you live a longer and happier life. Armed with the knowledge from this study, seniors and their caretakers can structure their lives to address the eight social factors listed above.

This study also provides older adults and caregivers with the language to address these conditions with doctors, estate planners, geriatric care managers, and other family members to help ensure their needs get met.

Becoming a Family Caregiver for an Ailing Loved One

Taking on the responsibility of providing full-time care for an aging or disabled loved one can be a rewarding experience. Being a primary caregiver helps you rest assured that your loved one is receiving compassionate care from someone who will go above and beyond to ensure they are comfortable and looked after.

Despite your good intentions to create a comfortable environment for your loved one, full-time caregiving is a significant time commitment. There is also a financial reality that the caregiver must face. Fortunately, family members who want to serve as caregivers may have options to help cover the expense.

What Is a Caregiver, and What Do They Do?

Professional caregivers work intimately with seniors to meet their needs as they age. As individuals get older, their needs change and they may need more help going about their day.

Examples of the kinds of help caregivers provide include:

• Bathing and grooming
• Help with toileting
• Medical appointments and medication compliance
• Transportation
• Companionship
• Cooking, cleaning, and grocery shopping
• Care for animals
• Laundry
• Coordinate benefit care/speak to insurance companies on the senior’s behalf, if authorized

Family Caregivers: Know the Downsides

Having a family member serve in the role of caregiver can make for a better experience for your loved one and, in some ways, give you peace of mind as well. However, there are some downsides to be aware of if you are considering becoming a family caregiver.

Your own health, both physical and emotional, can be negatively affected when taking on the burden of caring for a family member. Be sure to engage in self-care, maintain a healthy diet, and watch out for signs of stress and burnout. When you do need a break, consider looking into respite care.

If your loved one has specific medical issues that will require the attention and expertise of a professional health care provider, you may want to reassess whether you should take on the role of family caregiver.

Taking care of a loved one who is getting older or who is disabled will likely require a great deal of your time, too. You may find yourself not performing as well at work or having a longer commute as you fulfill the needs of your ailing loved one. Not to mention that your own immediate family may be missing out on valuable time with you while you are caregiving elsewhere.

In turn, this could mean you will have less time to hold down a full-time job. In fact, a 2020 AARP survey showed that about 20 percent of family caregivers reported experiencing a high level of financial stress. Nearly 30 percent of them stopped saving altogether as a result of providing care for their loved one.

In these challenging economic times, you must be able to support yourself while ensuring the best care for your aging family member.

Can Family Members Get Paid for Their Work as a Caregiver?

Fortunately, certain programs are available to help family members care for ailing relatives. You may need to do a bit of research to find the right option for your circumstances.

• Medicaid Self-Directed Care

For individuals on Medicaid, the Medicaid Self-Directed Care Program is one option that gives them the authority to manage their services. In certain states, this program offers recipients the ability to use the resources allocated for home care to pay a family member to help them with their daily needs. The Medicaid Self-Directed Care Program lets seniors have more autonomy over their care.

Note that such programs vary by state, however, and not all states will have an option like this. Each state may also use different criteria to define who qualifies as a “family” caregiver. Find your local Area Agency on Aging to learn more about the possibilities, or call your local Medicaid agency.

Note that, generally, Medicare will not cover the costs of caregiving by a family member.

• Veteran’s Benefits

If your loved one is a military veteran, there are special benefits available to cover their home care, including the Veteran’s Directed Home and Community Based Services program. This program gives veterans a flexible spending budget that the veteran can use to pay a family member to act as their caregiver.

• National Family Caregiver Support Program

Note that this program does not pay caregivers directly. Rather, it helps fund several different types of services for family caregivers, from training in caregiving to respite care. Learn more about this program.

• Long-Term Care Insurance

If you are thinking ahead to who will care for you as you age, you may consider long-term care insurance when creating an estate plan. Certain long-term care insurance policies allow the policyholder to pay family members to work as caregivers. However, that is not true for every policy. Some policies do not allow policyholders to pay family members to work as caregivers if they live in the policyholder’s home.

Before taking out this type of insurance policy, you should speak to your attorney to ensure you are properly advised.