Working With the Aging
Ladies and gentlemen, I stand here before you at a time in which the health care of older Americans has become a critical issue. Or should I say issues? We have more people needing more and more specialized care — this is critical. We have fewer and fewer people being asked to do more and more — that is critical. Current healthcare policy, especially for the aging, seems inadequate to address the challenges of what lies ahead. The situation seems very bleak at times. All signs seem to show that it will get bleaker. Well, I am here to tell you that I am the weatherman. I have weathered this storm with you. And I can tell you that the forecast looks good, if we can just keep our eyes on what is important and understand what tools we have to get through this, and overcome the challenges that the next years hold for us.
I like to think of myself, when I think of myself, as the captain of my own ship. And the ship that I am piloting through these new and changing times of healthcare is definitely weathering some storms. As we all know, the health status of our aging population is going to cause us to rethink many of our set beliefs about providing health care to older adults. I don’t just mean in the ways of policy, but also regarding our cultural values. We know that simply caring for disease and disease states of our older patients are no longer enough. We are caring for the patient, we are caring for the caregivers, and we are caring for the families and the extended families. Hopefully we are also caring for ourselves. And we know that in this fight, we are still on the uphill slope. To paraphrase Paul Revere, “The elderly are coming! The elderly are coming!”
By the year 2030, over seventy million United States citizens will be over age 65. By the same year, 8.5 million will be over 85. These are our patients, the ones who are the most likely to need polypharmacy, to have disabilities, even to require constant total care giving. These patients will be from ethnically diverse cultures. These patients will need specialized care. This is the perfect storm that you and I have to weather as we travel along, each in our own little boat.
But I am here to tell you. All of this is good news. You may look at me, and think that I am crazy, but I am telling you that this is all good news. Every single one of you here is here because you care for the elderly, or you care about the elderly, or you care about someone who cares. And I have good news for all of you.
What I have to say is very simple. Because no matter whatever the challenges are that we face, I want you to keep one thing uppermost in your minds and in your thoughts. And that is that God is present, in all that we say, in all that we do, in all the challenges that we face every day. No matter what, with God, all things are possible. As we pilot our boats through the storm, God is beside us and with us and guiding us. Let me give you some good news to help to demonstrate this. We are facing a larger elderly population but the good news is that more and more of the people we care for can expect to enjoy a healthy old age. This does not mean that the people we care for will not have challenges. Most of those elderly that we are expecting will be living with some sort of chronic condition, like chronic obstructive pulmonary disease, diabetes, hypertension, etc. And we as caregivers know that these chronic problems will cause limitations in the patient’s daily lives and daily activities. The can cause hospitalization, or the necessity for extended stays in the hospital or transition into nursing homes. It is in situations like these where we need to remember, as caregivers that we are not only ministering to the body but also to the spirit. Educators and psychologists speak of the teenage years as a turbulent times, but I believe that the elderly have as much emotional upheaval and confusion as any teenager ever had, even after a lifetime of experience and knowledge. It is at this point where we can minister to the spirit. We can remind our patients who are going through rough patches, their own perfect storm, that no matter how badly they feel, no matter how lonely or isolated or displaced they may seem to be we need to let them know that they are not alone. God is always with them, as he is with us. We can provide this message in the most gentle of terms, with no evangelism intended. It can be given to any faith or creed. Basically we want to make sure that our patients, the people that we care for, know they are cared for physically and mentally and spiritually as well. Older adults need a variety of resources to help them, an active religious life can be the difference between isolation and depression and a healthy interaction. Especially when our elderly patients do not have family close by, or family members who are willing to help care for them, this is a time when spirituality is especially important.
Emotional support for the patient and the family itself will require the most basic change in the existing value system, which places greater emphasis on the medical treatment of chronic medical conditions and not on the emotional needs of the patients and the caregivers. We are treating heart conditions, but ignoring the heart.
These challenges are not ours and ours alone. It is our burden to understand that, in the coming storm, there will be fewer of us to go around. There will be fewer of us and we will be asked to do more and more. There is a well-documented nursing shortage. This will only get worse in the years to come and presents another wave in the storm. In addition, nurses have little or no preparation for the treatment of gerontological patients as part of their regular nursing education. This is an even greater problem when we speak about advanced practice nursing, physician assistants and physicians. It is my greatest hope that new policies in education will make the requirement for a greater number of educational credit hours for all medical disciplines on the care of the aging and elderly. New policies must be put in place for ongoing continuing medical education on the elderly as a condition of license renewal. This can be one of our strongest tactics to weather the storm. Preparation is the key.
The cost of care will also be another challenge for us to deal with. We know that older adults and their families face a significant burden in trying to get care and cover prescriptions. Families can see whole life savings funneled away in the care of an elderly person. We are not only talking about hospitalization, but also things like prescriptions, payment of mental health coverage and also the lost work time of unpaid family caregivers can cause a significant financial strain on the family and the patient him or herself. We all know that the coverage of prescriptions, usually not reimbursed by Medicare, is a hot button political issue. Recent legislation may or may not make a difference. But the cost of prescription medication can be devastating. I can give you the example that the average annual cost of medication for the treatment of diabetes is somewhere around $1,400. Most Medicare patients will pay out of pocket about $600 for their medications. It is not surprising that 20% of older adults have taken less medication than prescribed in the last two years, or have skipped doses to make medication last longer, or to spend less money on things like food or heat because it is the only way they feel they can afford the medication. Can you imagine how disheartening this can be?
As people get older they need help with the activities of daily living doing things like cleaning their houses, cooking meals, doing personal care work, the little things that will allow them to stay in their own homes. Remember that Medicare does not reimburse for this type of care and older folks will have to pay out of pocket or else ask for help from family members, many of whom are not going to be paid and have to add this on to the work of their already busy lives. I wonder how many of you have been in this same situation yourselves? There can be a lot of frustration — from family members who feel overwhelmed, from caregivers who feel overburdened, from the elderly who are frustrated that…