Year: 2020
Type: article
Abstract: Heightened risks of the novel coronavirus for older adults have been apparent from the earliest days of the pandemic. 1Those risks translated to devastating outcomes.More than 40% of US fatalities have been residents and employees of nursing homes and other long-term care facilities. 2 Strategies to mitigate infection in congregate settings have sought to fix deficiencies, including shortages of personal protective equipment and personnel.Yet an important question is less commonly asked: how many nursing home residents-more than 1.3 million US residents-could live in the community instead?The default for funding institutional long-term care but not caregiving at home is one of many examples of structural ageism.A crucial yet often hidden source of inequity, structural ageism is the explicit or implicit bias against older persons arising from policies, attitudes, and actions of social institutions.3 This systemic discrimination has a synergistic effect with internal ageism, or negative beliefs that individuals acquire about aging, on the health of older adults.3 Long-Term Services and SupportsMost seniors, as well as their families, prefer to live at home or in community settings, such as assisted living facilities. 4Indeed, care for older adults has increasingly shifted from nursing homes to the community.Between 2012 and 2016, the number of US residents living in nursing homes did not change, while use of assisted living facilities increased by 14%.To live at home, many elders need long-term services and supports (LTSS).Unfortunately, the responsibility for LTSS often falls to family members who are unpaid (and untrained).Despite efforts to expand options for elderly individuals under the Affordable Care Act, Medicaid programs are mandated to cover nursing facility care but not home-based and community-based services, leading to variations in available resources for elderly individuals depending on the US state in which they live.4 Regardless of whether older adults live at home or in nursing facilities, public funding for LTSS is insufficient. 5Few US residents can afford out-of-pocket expenses for long-term care, and fewer (just 11% of adults older than 65 years) have private long-term care insurance.Medicaid pays for most LTSS, particularly for low-income populations.4 The value of LTSS can improve through evidence-based models, such as the Programs of All-Inclusive Care for the Elderly, and improving the quality of care in nursing homes, which remains variable despite efforts to increase oversight and transparency.More ambitious yet potentially necessary approaches include overhauling the current public insurance system to more directly support long-term care or creating a separate, publicly supported program to finance long-term care, with the goal of equitably expanding access to LTSS coverage.6 Pervasive InequityStructural ageism is not limited to long-term care policies; it is a component of nearly all current political issues.Efforts to suppress voting by mail are ageist, because they seek to either suppress political participation or expose older adults to illness.The absence of universal mask mandates reveals that some communities are willing to sacrifice the well-being of their elderly members for convenience.On returning to work, older adults who are employed may be vulnerable to
Source: JAMA Health Forum
Authors: Austin S. Kilaru, Rebekah E. Gee
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,000
OpenAlex ID: W3092735234