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Older Americans Worry They Can't Afford Their Own Health Care

KFF Health News —

What weighs most heavily on older adults' minds when it comes to health care?

The cost of services and therapies, and their ability to pay.

"It's on our minds a whole lot because of our age and because everything keeps getting more expensive," said Connie Colyer, 68, of Pleasureville, Kentucky. She's a retired forklift operator who has lung disease and high blood pressure. Her husband, James, 70, drives a dump truck and has a potentially dangerous irregular heart rhythm.

Tens of millions of seniors are similarly anxious about being able to afford health care because of its expense and rising costs for housing, food and other essentials.

A new wave of research highlights the reach of these anxieties. When the University of Michigan's National Poll on Healthy Aging asked people 50 and older about 26 health-related issues, their top three areas of concern had to do with costs: of medical care in general, of long-term care, and of prescription drugs. More than half of 3,300 people surveyed in February and March reported being "very concerned" about these issues.

In fact, five of the top 10 issues identified as very concerning were cost-related. Beyond the top three, people cited the cost of health insurance and Medicare (52%), and the cost of dental care (45%). Financial scams and fraud came in fourth place (53% very concerned). Of much less concern were issues that receive considerable attention, including social isolation, obesity and age discrimination.

In an election year, "our poll sends a very clear message that older adults are worried about the cost of health care and will be looking to candidates to discuss what they have done or plan to do to contain those costs," said John Ayanian, director of the University of Michigan's Institute for Healthcare Policy and Innovation.

Older adults have good reason to worry. One in 10 seniors (about 6 million people) have incomes below the federal poverty level. About one in four rely exclusively on Social Security payments, which average $1,913 a month per person.

Even though inflation has moderated since its 2022 peak, prices haven't come down, putting a strain on seniors living on fixed incomes.

Meanwhile, traditional Medicare doesn't cover several services that millions of older adults need, such as dental care, vision care or help at home from aides. While private Medicare Advantage plans offer some coverage for these services, benefits are frequently limited.

All of this contributes to a health care affordability squeeze for older adults. Recently published research from the Commonwealth Fund's 2023 Health Care Affordability Survey found that nearly a third of people 65 or older reported difficulty paying for health care expenses, including premiums for Medicare, medications, and expenses associated with receiving medical services.

One in seven older adults reported spending a quarter or more of their average monthly budget on health care; 44% spent between 10% and 24%. Seventeen percent said they or a family member had forgone needed care in the past year for financial reasons.

The Colyers in Pleasureville are among them. Both need new dentures and eyeglasses, but they can't afford to pay thousands of dollars out-of-pocket, Connie said.

"As the cost of living rises for basic necessities, it's more difficult for lower-income and middle-income Medicare beneficiaries to afford the health care they need," said Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund. Similarly, "when health care costs rise, it's more difficult to afford basic necessities."

This is especially worrisome because older adults are more prone to illness and disability than younger adults, resulting in a greater need for care and higher expenses. In 2022, seniors on Medicare spent $7,000 on medical services, compared with $4,900 for people without Medicare.

Not included in this figure is the cost of assisted living or long-term stays in nursing homes, which Medicare also doesn't cover. According to Genworth's latest survey, the median annual cost of a semiprivate room in a nursing home was $104,000 in 2023, while assisted living came to $64,200, and a week's worth of services from home-health aides averaged $75,500.

Many older adults simply can't afford to pay for these long-term care options or other major medical expenses out-of-pocket.

"Seventeen million older adults have incomes below 200% of the federal poverty level," said Tricia Neuman, executive director of the Program on Medicare Policy for KFF. (That's $30,120 for a single-person household in 2024; $40,880 for a two-person household.) "For people living on that income, the risk of a major expense is very scary."

How to deal with unanticipated expenses in the future is a question that haunts Connie Colyer. Her monthly premiums for Medicare Parts B and D, and a Medigap supplemental policy come to nearly $468, or 42% of her $1,121 monthly income from Social Security.

With a home mortgage of $523 a month, and more than $150 in monthly copayments for her inhalers and her husband's heart medications, "we wouldn't make it if my husband wasn't still working," she told me. (James' monthly Social Security payment is $1,378. His premiums are similar to Connie's and his income fluctuates based on the weather. In the first five months of this year, it approached $10,000, Connie told me.)

The couple makes too much to qualify for programs that help older adults afford Medicare out-of-pocket costs. As many as 6 million people are eligible but not enrolled in these Medicare Savings Programs. Those with very low incomes may also qualify for dual coverage by Medicaid and Medicare or other types of assistance with household costs, such as food stamps.

Older adults can check their eligibility for these and other programs by contacting their local Area Agency on Agency, State Health Insurance Assistance Program or benefits enrollment center. Enter your ZIP code at the Eldercare Locator and these and other organizations helping seniors locally will come up.

Persuading older adults to step forward and ask for help often isn't easy. Angela Zeek, health and government benefits manager at Legal Aid of the Bluegrass in Kentucky, said many seniors in her area don't want to be considered poor or unable to pay their bills, a blow to their pride. "What we try to say is, 'You've worked hard all your life, you've paid your taxes. You've given back to this government so there's nothing wrong with the government helping you out a bit.'"

And the unfortunate truth is there's very little, if any, help available for seniors who aren't poor but have modest financial resources. While the need for new dental, vision and long-term care benefits for older adults is widely acknowledged, "the question is always how to pay for it," said Neuman of KFF.

This will become an even bigger issue in the coming years because of the burgeoning aging population.

There is some relief on the horizon, however: Assistance with Medicare drug costs is available through the 2022 Inflation Reduction Act, although many older adults don't realize it yet. The act allows Medicare to negotiate the price of prescription drugs for the first time. This year, out-of-pocket costs for medications will be limited to a maximum $3,800 for most beneficiaries. Next year, a $2,000 cap on out-of-pocket drug costs will take effect.

"We're already seeing people who've had very high drug costs in the past save thousands of dollars this year," said Frederic Riccardi, president of the Medicare Rights Center. "And next year, it's going to get even better."

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Another Health Benefit Of Running: It Can Be A Powerful Antidote To Loneliness

Darren DeMatoff, 57, had an interesting realization a few years ago: Many of his close friends were up to 30 years younger. And then it dawned on him why: They'd met in a running group.

"Running is a great equalizer. It is a place where people find common ground, face similar challenges, overcome similar obstacles, and achieve personal milestones," DeMatoff, the owner of a Chicago interior accent design and manufacturing company, tells Fortune. "When meeting runners and running together, age doesn't even enter the equation."

It's a valuable lesson he's learned through his involvement in the Chicago Area Runners Association (CARA), a group he has been involved with since he decided to run his first marathon in 1995. Now he's the vice president, and believes strongly that running, when done with others, can be a particularly salient—if surprising—antidote to the loneliness epidemic, currently affecting nearly one in two people in the U.S.

Because while running is by definition a solo activity, it can also be done with others—which in turn brings layer upon layer of physical and mental health benefits.

Why it's needed

U.S. Surgeon General Dr. Vivek Murthy called loneliness an "epidemic" in May of 2023.

"We are called to build a movement to mend the social fabric of our nation…[and] each of us can start now, in our own lives, by strengthening our connections and relationships," reads his advisory on the healing effects of social connection and community. Those in running groups believe those are good places to start.

"I think everyone is looking for new friendships as they go through life, and it can get harder as you get older," Rob Simmelkjaer, CEO of the nonprofit New York Road Runners (NYRR), tells Fortune.

In 1997, he trained for and ran his first marathon alone, and the experience was "just fine," he says. "But it was nothing like when I did it again years later on a team, and met people in the park to train with every day," he adds. That provided him both accountability and time to socialize, leading to a better time in his next marathon. But Simmelkjaer admits it's not really about the running for him.

New York Road Runners CEO Rob Simmelkjaer high-fives participants of a free youth running group, Run for the Future.

New York Road Runners

"It's about the kind of people that you're going to surround yourself with," he says. "You'll talk about your careers, your life stories, your family. But running is a nice common ground to have with someone else… You get something very different out of it when you're doing it with other people."

But why running?

For starters, it's been long established that running has many physical benefits—doing so for as little as five to 10 minutes a day, for example, even at slow speeds, can significantly lower your risk of dying from heart disease. It also has a positive impact on brain health. According to Johns Hopkins Medicine, regular cardiovascular workouts, like running, can improve working memory and focus, plus boost mood.

And a 2020 review in the International Journal of Environmental Research and Public Health associated running with improvements in mental health, particularly in depression and anxiety disorders. The stress hormone cortisol is released through regular exercise, which means running can also be a healthy way to regulate your stress response, according to a recent article by Runner's World. Running also helps trigger the release of endorphins, dopamine, and serotonin, all chemicals that are often impacted by mental disorders.

Now add to all that the benefit of social connection, which, according to the CDC, can help decrease the risk of heart disease by 29%, stroke by 32%, and dementia by a whopping 50%.

Research from AARP Services, UnitedHealthcare, and OptumLabs found in 2023 that moderate and high physical activity were associated with lowering severe loneliness and social isolation by up to 30%. Similarly, a 2023 study showed that physical activity—as long as it's something that brings enjoyment and is not overly difficult—can decrease feelings of loneliness.

If you're already one of the 50 million Americans who run for exercise, switching things up by joining a group or running with friends could be a simple yet powerful loneliness antidote.

"When you can breathe and eliminate feeling alone, running is a saving grace," Shawanda Weems, 48, a middle-school English language arts teacher and track coach in the Bronx, tells Fortune. "It can free you. Running is a prescription-free way of dealing with loneliness available to all."

Shawanda Weems

Simmelkjaer says he knows people who have met spouses, close friends, and mentors through NYRR, where it's typical to see CEOs running with early-career individuals who have similar skill levels.

Weems would agree with that testament. She says she's witnessed track bring her students together, and that she's "cultivated long-term friendships with those same students as they mature into adulthood," including with Kiara Fernandez Chavez, 28. The pair ran the New York City Marathon together through NYRR in 2016, and Weems says she wouldn't have done if not for her friend's motivation.

"To have her suggest that we embark on this adventure was not a goal of mine at the time," says Weems. But completing it together, she adds, was "one of the highlights of my adult life."

It's just one testament to the power of running with others. "If you get in with the right group, you'll realize that the runs are the mechanism for bringing people together," says Simmelkjaer. "And that's really what we all need in life."

Study Finds Home Health Aides Struggle With Mental Health

image:

Dr. Madeline Sterling

Credit: Weill Cornell Medicine

Home health aides (HHAs) are vulnerable to stress, isolation and depressive symptoms, which impact their own health as well as their patients' desire to age in place, according to Weill Cornell Medicine researchers. HHAs are a rapidly growing workforce trained and certified to provide personal and medical care, as well as emotional support, in the home.

"As a doctor, I've learned that home health aides are a critical part of patients' well-being," said senior author Dr. Madeline Sterling, associate professor of medicine at Weill Cornell Medicine and a primary care physician at NewYork-Presbyterian/Weill Cornell Medical Center. "Our study identified aspects of their job that affect their mood and stress levels, and suggested ways to address these challenges, including interventions that bring them closer to their colleagues."

As part of the study, published June 6 in JAMA Network Open, researchers interviewed 28 HHAs in New York City at risk of poor mental health. The study was conducted in collaboration with 1199SEIU Training and Employment Fund, a part of the 1199SEIU United Healthcare Workers East, the largest health care union in the United States.

The Need for Home Health Aides Outstrips Availability

Several themes emerged from the study including how interactions with patients and their families can affect aides' moods in both positive and negative ways. The researchers also explored the participants' attitudes toward mental health and well-being which can carry stigma due to personal and cultural factors. While the aides reported having different coping mechanisms, many said they would welcome more support, including programs that bring them closer to their colleagues.

The need to address the emotional well-being of HHAs comes at a time of increased demand for their services. "We have tsunami coming of people who will require care at home," said co-author, Faith Wiggins, director of long-term care at 1199SEIU Training and Employment Fund. In fact, a 2022 report from the American Association of Retired Persons (AARP) found 800,000 people on waiting lists for home care and waits often lasting years.

Dr. Sterling noted that HHAs are an "overlooked and undervalued but increasingly vital workforce." The Centers for Disease Control estimates that 73 million people in the United States will be 65 years or older by 2030, and the majority would like to age at home. Home health care also has the added benefit of lower cost than institutionalized care.

Previous research from Dr. Sterling, who is also the director of the Initiative on Home Care Work at Cornell's School of Industrial and Labor Relations, found that before Covid-19 more than a quarter of HHAs nationally had fair or poor general health, and a fifth had poor mental health. Post pandemic, their health has worsened according to studies by Dr. Sterling and Wiggins and others.

These professionals are paid hourly rates slightly above minimum wage with few benefits—under what can be difficult and isolating circumstances. "We need a way to repair those problems and retain their talent," said Wiggins.

The new study outlines ways to address the challenges faced by HHAs through improving salaries and benefits and interventions that support mental health. Organized peer coaching, for instance, could help train and support aides, and enhance workplace safety and healthy behavior. If issues related to mood and stress were incorporated into peer coaching, aides would benefit even further. Acquiring coaching skills could also help provide a home health career ladder or pathway for aides to earn higher wages as health coaches.

The authors suggest additional research is needed to test and implement culturally and occupationally tailored interventions. "For our patients to do well," Dr. Sterling said, "we need to support this workforce."

This study was supported by Clinical Scientist Development Award DDCF 2022053 from the Doris Duke Charitable Foundation.

Journal

JAMA Network Open

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