By Judith Graham MARCH 18,
2020
Close
down group meals for seniors. Cancel social gatherings.
The
directive, from the Illinois Department on Aging, sent shock waves through
senior service organizations late last week.
Overnight,
Area Agencies on Aging had to figure out how to help people in their homes
instead of at sites where they mingle and get various types of assistance.
This is
the new reality as the COVID-19 virus barrels into communities across America.
Older adults — the demographic group most at risk of dying if they become ill ―
are being warned against
going out and risking contagion. And programs that serve this population are
struggling to ensure that seniors who live in the community, especially those
who are sick and frail, aren’t neglected.
This
vulnerable population far outstrips a group that has received more attention:
older adults in nursing homes. In the U.S., only 1.4 million seniors
reside in these institutions; by contrast, about 47 million older adults are
aging in place. An additional 812,000 seniors make their homes at assisted
living facilities.
While
some of these seniors are relatively healthy, a significant portion of them are
not. Outside of nursing homes, 15% of America’s 65-and-older population
(more than 7 million seniors) is frail, a condition that greatly reduces their
ability to cope with even minor medical setbacks. Sixty percent have
at least two chronic conditions, such as heart disease, lung disease or
diabetes, that raise the chance that the coronavirus could kill them.
But the
virus is far from the only threat older adults face. The specter of hunger and
malnutrition looms, as sites serving group meals shut down and seniors are
unable or afraid to go out and shop for groceries. An estimated 5.5 million older
adults were considered “food insecure” — without consistent access to
sufficient healthy food ― even before this crisis.
As the
health care system becomes preoccupied with the new coronavirus, non-urgent
doctors’ visits are being canceled. Older adults who otherwise might have had
chronic illness checkups may now deteriorate at home, unnoticed. If they don’t
go out, their mobility could become compromised — a risk for decline.
Furthermore,
if older adults stop seeing people regularly, isolation and loneliness could
set in, generating stress and undermining their ability to cope. And if paid
companions and home health aides become ill, quarantined or unable to work
because they need to care for children whose schools have closed, older adults
could be left without needed care.
Yet
government agencies have not issued detailed guidance about how to protect
these at-risk seniors amid the threat of the COVID-19 virus.
“I’m
very disappointed and surprised at the lack of focus by the CDC in specifically
addressing the needs of these high-risk patients,” said Dr. Carla Perissinotto,
associate chief for geriatrics clinical programs at the University of
California-San Francisco, referring to the Centers for Disease Control and
Protection.
In this
vacuum, programs that serve vulnerable seniors are scrambling to adjust and
minimize potential damage.
Meals
on Wheels America CEO Ellie Hollander said “we have grave concerns” as senior
centers and group dining sites serving hot meals to millions of at-risk older
adults close. “The demand for home-delivered meals is going to increase
exponentially,” she predicted.
That
presents a host of challenges. How will transportation be arranged, and who
will deliver the meals? About two-thirds of the volunteers that Meals on Wheels
depends on are age 60 or older ― the age group now being told to limit contact
with other people as much as possible.
In
suburban Cook County just outside Chicago, AgeOptions, an Area Agency on Aging
that serves 172,000 older adults, on Thursday shuttered 36 dining sites, 21
memory cafes for people with dementia and their caregivers, and programs at 30
libraries after the Illinois Department on Aging recommended that all such
gatherings be suspended.
Older
adults who depend on a hot breakfast, lunch or dinner “were met at their cars
with packaged meals” and sent home instead of having a chance to sit with
friends and socialize, said Diane Slezak, AgeOptions president. The agency is
scrambling to figure out how to provide meals for pickup or bring them to
people’s homes.
With
Mather, another Illinois organization focused on seniors, AgeOptions plans to
expand “Telephone Topics” — a
call-in program featuring group discussions, lectures, meditation classes and
live performances — for seniors now confined at home and at risk of social
isolation.
In New
York City, Mount Sinai at Home every day serves about 1,200 older adults who
are homebound with serious illnesses and disabilities — an extraordinarily
vulnerable group. A major concern is what will happen to clients if home care
workers become sick with the coronavirus, are quarantined or are unable to show
up for work because they have to care for family members, said Dr. Linda
DeCherrie, Mount Sinai at Home’s clinical director and a professor of
geriatrics at Mount Sinai Health System.
With that
in mind, DeCherrie and her colleagues are checking with every patient on the
program’s roster, evaluating how much help the person is getting and asking
whether they know someone ― a son or daughter, a friend, a neighbor — who could
step in if aides become unavailable. “We want to have those names and contact
information ready,” she said.
If
caregivers aren’t available, these frail, homebound patients could deteriorate
rapidly. “We don’t want to take them to the hospital, if at all possible,”
DeCherrie said. “The hospitals are going to be full and we don’t want to expose
them to that environment.”
In San
Francisco, UCSF’s Care at Home program serves about 400 similarly vulnerable
older adults. “Testing [for the coronavirus] is even more of a problem for
people who are homebound,” said Perissinotto, who oversees the program. And
adequate protective equipment ― gloves, gowns, masks, eye shields — is
extremely difficult to find for home-based providers, Perissinotto said, a
concern voiced by other experts as well.
To the
extent possible, UCSF program staff are trying to do video visits so they can
assess whether patients are symptomatic ― feverish or coughing — before going
out to their homes. But some patients don’t have the technology that makes that
possible or aren’t comfortable using it. And others, with cognitive impairments
who don’t have family at home, may not be able to respond appropriately.
At
UCSF’s general medicine clinic, nonessential medical visits have been canceled.
“I have a lot of older patients with chronic pain or diabetes who otherwise
would come in for three-month visits,” said Dr. Anna Chodos, a geriatrician and
assistant professor of medicine who practices in the clinic. “Now, I’m talking
to them over the phone.”
“I’m
less worried about people who can answer the phone and report on what they’re
doing,” she said. “But I have a lot of older patients who are living alone with
mild dementia, serious hearing issues and mobility impairments who can’t work
their phones.”
Judith
Graham: khn.navigatingaging@gmail.com, @judith_graham
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