Access to Affordable Health Care
The Access to Affordable Health Care issue area focuses on building an expert, integrated and user-friendly system of health care and related services sensitive to the strengths and needs of older adults. It involves strategies such as outreach and education, advocacy for evidence-based policies and practices, and community collaborations.
Desired Outcome
Older adults can access affordable mental and physical health services, including medication.
Background
Americans are living significantly longer lives, in no small part due to preventive efforts that have reduced the number of deaths from heart disease and stroke. With increasing longevity, a growing number of older people are experiencing chronic disease, disability and depression during their "extra" years of life. Lifestyle changes and emphasis on preventive health care could help reverse this trend.
Although prevention and early detection efforts in Kent County are reaching many older adults, more holistic and integrated efforts are needed. Many Kent County elders are not getting basic Medicare-covered preventive measures such as flu shots, PSA tests for prostate cancer, mammograms, and bone density tests. Nearly one in four (23%) older Kent County residents describes his or her health as fair or poor. More than one-third (36%) say they've had one or more unhealthy days in the previous month - and in 14% of those cases, their physical or mental health interfered with their normal, everyday activities.
Recent research indicates that, among older patients, depression contributes as much to mortality as do cardiovascular disease and diabetes - and that, with treatment, older adults recover from depression as much as three times faster. In Kent County, eight percent - nearly 5,000 older people - say they need professional help to address depression or anxiety, but two-thirds of those have not gotten the help they need. Those lacking treatment include people who need help with everyday activities and low income elders.
An overwhelming proportion of Kent County's older population (97%) say they have a regular source of health care, with 89% saying they have a private doctor and almost all (97%) who needed medical care in the last year indicating that they had obtained it and had no trouble paying for it. However, low income elders, minorities, and those who have restrictions on their everyday activities (ADLs and/or IADLs) are significantly more likely than their counterparts to have had problems paying for medication and other health care needs.
Unhealthy Days
More than one-third of Kent County elders - approximately 22,500 people - reported that their physical or mental health was not good for one or more days in the previous month. Fourteen percent - 8,700 older adults - were unable to go about their normal daily activities as a result of poor mental or physical health. And for over 5,000 elders, poor health interfered with their daily activities for seven or more days in the previous month.
Gaps in Preventive Care
Immunizing against disease and early detection of health problems are key strategies for maintaining health, function and well-being as people age. Although nearly all Kent County elders have had a blood pressure check in the last year, a surprisingly large proportion have not had many of the Medicare-covered preventive health services such as bone density screenings (70%), mammograms (40%), and PSA tests for prostate cancer (27%).
Despite public awareness campaigns, full Medicare coverage for the flu vaccine, and more than 35,000 U.S. deaths from flu each year, 29% of Kent County elders - more than 17,800 older adults - did not get a flu shot in the past year. Kent County residents with less education, those aged 65-74, and White elders were least likely to get their flu shot last year.
Disparities also occur in access to physical exams, prostate cancer screenings, mammograms and hearing tests:
- Physical exams: Lower income elders, women, those with limitations on their everyday activities and those with less education were least likely to have had a physical exam last year.
- Prostate cancer screening: Minority male elders, those aged 65-74, those with less education, and those who describe themselves as being in good health were least likely to have been screened for prostate cancer last year.
- Mammograms: Women aged 75 to 84, those with low incomes, less education, one or more limitations on everyday activities and who consider their health poor were least likely to have had a mammogram last year.
- Hearing test: White women aged 65-74 who consider themselves in good health were least likely to have had a hearing test last year.
Most Elders Suffering from Depression or Anxiety Are Not Getting the Help They Need
Depression in older adults is an important indicator of general well-being and mental health; in fact, higher levels of depression are associated with higher rates of physical illness, greater functional disability, and higher health care costs. Nearly 5,000 Kent County elders report needing the help of a health care professional because of depression or anxiety. Over 1/3 of them have not gotten the help they need. Most likely, these numbers are low, as experience shows that people tend to under-report their need for mental health assistance.
People 85 years old and over, women, those less educated, and those who live alone are only slightly more likely to say they need professional help for depression or anxiety. But the prevalence of these issues varies by other characteristics. For example, Kent County elders reporting that they need help include:
- Twice as many with limitations on their activities of daily living (ADLs or IADLs) as those without limitations
- Significantly more low income elders
Elders Across the Board Have a Regular Source of Care...
A full 97% of Kent County elders report having a place that they usually go when they are sick or need advice about their health - and the proportions are fairly stable regardless of demographic differences. The majority of elders in the U.S. go to a private doctor for regular care; in Kent County, 89% identified a private doctor as their regular source of care: 90% of older women and 88% of older men. Six percent - about 3,800 elders in Kent County - rely on clinics and health centers.
...But Disparities Exist in Ability to Pay
A small proportion of older adults in Kent County (2%) report problems paying for health care needs. However, 5-8% - 3,000 to 5,000 elders - had a time in the past twelve months when they did not have enough money to fill a prescription or pay for dental care or eyeglasses and significant disparities exist by demographics. For example, those having trouble paying for:
- Prescriptions are three times as likely to be low income and twice as likely to be minorities and/or have limitations on their everyday activities. Those age 65 to 74 are seven times as likely as those 85 or more to have trouble paying for prescriptions.
- Dental care are six times as likely to be low income, five times as likely to be women and/or have restrictions on their everyday activities, three times as likely to be a minority, and twice as likely to be in poor health. Those between the ages of 75 and 84 are twice as likely as those age 85 or more to have trouble paying for dental care.
- Eyeglasses are six times as likely to be low income and twice as likely to be a minority, have less education, and/or restrictions on everyday activities. People age 85 or more are eight times as likely as those age 75-84 to have trouble paying for eyeglasses.
Recommendations
Access
Goal 1
Increase collaboration and integration of health care and social services in order to improve access.
Objectives
- Create a work group led by network 180 and the Area Agency on Aging of West Michigan to:
- Identify ways to increase knowledge and understanding among service providers in the aging, mental health and medical systems about currently available health care, aging, social services and mental health services.
- Mental Health Roadmap 12-07
- Develop information materials on depression, grief and loss issues that are targeted to older adults and include clear service/payment information.
- Create increased opportunities for collaboration, shared goals, and communication among the health care, aging, social services and mental health systems.
- Initiate dialogue to identify ways of increasing integration of older adult mental health services into primary health care (including care for sensory impairment conditions) and the community-based services system.
- Increase the number of older adults being served in the community mental health system by expanding the service continuum and increasing home-based options.
- Participate in state and local initiatives to decrease fragmentation and improve access through records-sharing with client approval.
- Leverage existing programs such as the Kent Health Plan and the Area Agency on Aging Medication Assistance program to ensure that older people have access to needed medications.
Elder Care Expertise
Goal 2
Increase health care providers' expertise in elder care issues.
Objectives
- Train all health care personnel in the normative processes of aging.
- Identify and disseminate evidence-based and emerging best practices standards.
- Train health care and social services providers to identify and reduce disparities in older adult health outcomes.
- Support the west Michigan Alliance for Gerontology Education (wmAge).
Goal 3
Increase family and friend caregivers' knowledge, skills and support.
Objectives
- Offer family and friend caregivers information and training on caregiver issues including dementia, personal care, and self care.
- Increase the number of research-based caregiver support programs available.
- Increase minority involvement in caregiver support services design and outreach.
- Support the Caregiver Resource Network.
Advocacy
Goal 4
Increase community expertise and support advocacy efforts on issues related to health care and the expanding older population.
Objectives
- Provide community education on costs, benefits and effectiveness of various health delivery and payment systems, including cost saving mechanisms such as medication re-use.
- Advocate for
- Parity in mental health coverage.
- Universal health care which is equitable and maintains provider participation through adequate resources
- Increased physical and mental health research targeting older adult needs, recognizing that investing in aging research will pay benefits in quality of life and savings.
Goal 5
Support efforts that educate and empower older adults to practice healthy behaviors.
Objectives
- Advocate for policies and programs which recognize that:
- Factors related to poor health outcomes are embedded in poverty and the social and physical environments in which people live
- Individual lifestyle choices impact health outcomes and resource needs
- Environmental factors impact health in communities.
Work Group
Co-Chairs
- Teresa Branson - Kent County Health Department
- Paul Ippel - network180
Members
- Nora Barkey - Area Agency on Aging of Western Michigan
- Chris Conklin - Gerontology Network
- Kristi Ghering - Kent Health Plan
- Al Jansen - Pine Rest Christian Mental Health Services
- Jacquie Johnson - network180
- Kate Luckert - Grand Rapids Community Foundation
- Suzann Ogland-Hand - Pine Rest Christian Mental Health Services
- Tom Oosterbaan - Senior Neighbors
- Kathy Sather - Cherry Street Health Center
- Jean Sennonyer - Grand Rapids Dominicans
- Cindy Smeenge - Priority Health
- Rick Stevens - Association for the Blind and Visually Impaired
- Chris Wood - Grand Rapids Dominicans
- Rick Zaudstra - Kent Health Plan