Research

October 14, 2021

The magnitude of the tragedy is unfathomable: Americans have lost nearly 187,000 family members living in nursing homes to COVID-19.

Even when residents survive outbreaks in the facilities, their family caregivers experience trauma. Barred from visiting residents during the lockdowns, caregivers observed – on Zoom, over the phone, or from the other side of a nursing home window – loved ones suffering from the devastating impact of isolation.

“To think in her final year[s] when she is most vulnerable and most in need of love and support from her children and was denied this for 6 months is in my opinion devastating,” one caregiver said in a survey of 518 caregivers, the vast majority of them women and mainly daughters.

Granted, nursing homes – and the entire country – were not prepared for a once-in-a-century pandemic that has been difficult to control, given that COVID-19 is often asymptomatic. The lockdowns were a health precaution. Many nursing homes were also put in an untenable position when COVID-19 created staff shortages as nursing assistants and other workers took time off after contracting the disease or simply quit their jobs. And perhaps better communication between nursing home staff and family members would have eased some of the concerns.

Nevertheless, the caregivers’ perceptions of what unfolded inside nursing homes are alarming. “Anger,” “helplessness” and “heartbreak” were common reactions, conveyed in the survey compiled in the Journal of Aging & Social Policy.

The situation became so untenable for 30 of the caregivers surveyed that they pulled their parent or family member out of a facility and brought them home to live with them.

Four themes pervaded their descriptions of what their loved ones were going through: social isolation, cognitive and emotional decline, inhumane care, and a lack of oversight at the long-term care facilities.

The source of many caregivers’ concerns were nursing homes’ decisions to confine residents to their rooms to prevent contagion. But one caregiver said that while her mother’s facility went to great lengths to keep her healthy, the staff did little to ease her isolation: “Almost no effort has been made to ensure [her] mental health due to the isolation. Staff rarely stay and visit with Mom, no special in-room activities or stimulation has been attempted.” …Learn More

September 28, 2021

Hearing loss can amplify cognitive decline by isolating retirees and forcing them to divert precious brain power to participate in a conversation. People who lose teeth have trouble eating, sacrificing their health. And poor vision, uncorrected by cataract surgery or the proper magnification in eyeglasses, is dangerous when driving at night.

These problems are facts of aging. But Medicare doesn’t cover their often-expensive solutions such as hearing aids, dental implants, or eyeglasses. A report by the Kaiser Family Foundation identified a gap between need and access is wide.

Among the 16 percent of Americans over 65 who said in a survey that they couldn’t get hearing, dental or vision services, nearly three out of four couldn’t afford them.

Three charts, based on Kaiser’s analysis of the survey data, show the average out-of-pocket spending for hearing and dental care was around $900 for the Medicare beneficiaries who used the services in 2018. The cost of vision care was significantly less, averaging $230.

Retirees usually don’t need all three services in a single year. For example, dental implants cost thousands of dollars, and an individual might get one or two in a lifetime. But when retirees do get the expensive dental care, a new Kaiser report shows the bill can really pack a wallop – and become an obstacle to getting the necessary care. …Learn More

September 21, 2021

A Jewish child rides the Kindertransport out of Nazi-controlled Austria to safety in England, eventually coming to the United States. A Japanese-American mother is confined to an internment camp. A child of Mexican farm workers in California goes to bed hungry. A young African-American organizes sit-ins for Civil Rights.

Taken together, the early life stories shared by the individuals in a new PBS feature, “Lives Well Lived,” are a compendium of U.S. history. The trailer that appears above can’t do justice to the full video, which can be viewed free of charge on the PBS website until Sept. 29.

Despite their trials, these individuals have embraced life with a zeal and perseverance that are surely part of the secret to how they have made it into their 80s or 90s. And there is a growing body of scientific evidence that the healthy lifestyle and even the positive attitude these seniors display improve longevity.

“When I wake up in the morning, I expect something good to happen,” one woman said. “Sometimes it’s postponed to the next day or the day after, but inevitably something wonderful happens.” …Learn More

Research

September 16, 2021

Nothing causes dread in a retiree quite like the prospect of having to go into a nursing home someday or becoming dependent on someone who comes into the house to help with routine daily needs.

But media reports or studies with alarming predictions of infirmity in old age are not very useful to retirees or their family members. A new study provides a more nuanced picture of the various scenarios that can play out.

Researchers at the Center for Retirement Research estimated that roughly one in five 65-year-olds will die without using any care, and another one in five will need only minimal care.

But one in four will have such severe needs that they will require high intensity support for three years or more. The largest group of people – 38 percent – will fall somewhere in the middle: they are likely to need a moderate amount of care for one to three years. A strong indicator of how much assistance someone will require is whether they are healthy in their late 60s.

To determine future need, the researchers combined two dimensions of care: intensity and duration. The intensity of care varies widely. Many retirees can remain largely independent if they hire someone for a couple days a month to clean house or manage their finances, while others will need round-the-clock support.

The duration of care also varies. The researchers divided duration into three categories: less than a year, one to three years, and more than three years. Many retirees need assistance for only a few days or weeks after being released from the hospital. But others, including people who develop severe disabling conditions such as dementia, may need years of care.

The researchers used 20 years of biennial surveys of older Americans and data on caregivers to predict the share of 65-year-olds who will have minimal, moderate, or severe lifetime needs.Learn More

August 24, 2021

Last year, millions of older Americans went into hiding to protect themselves from the ravages of COVID-19.

Did the isolation take a psychological toll? How did they respond to infrequent contact with friends and family? Researchers in a recent webinar tried to understand the unique phenomenon of loneliness in a modern pandemic.

What we know from the National Poll on Healthy Aging in the early months of the pandemic is that more than half of older workers and retirees between 50 and 80 said they “felt isolated from others” – twice the levels seen in 2018.

In a different survey conducted every two months for most of last year, loneliness was “common and it was incredibly persistent during the first six months of the pandemic,” said Lindsay Kobayashi, a University of Michigan epidemiologist involved in the COVID-19 Coping Study, a survey of adults over age 55.

Two groups in particular suffered rates of loneliness that were twice as high as their peers: older people who live alone and residents of senior communities and nursing homes, where staff often separated the residents or confined them to their rooms in an attempt to protect their health.

A larger share of Black Americans also expressed feelings of loneliness than whites and Hispanics, and women were generally more lonely than men. “I’m very afraid that we are going to get so used to being alone, on our own, by ourselves that we won’t reconnect the way we need to,” a 76-year-old woman told the Coping Study researchers last fall.

But the news isn’t all bad. Feelings of loneliness, especially among the oldest retirees, had subsided a bit as early as November as news reports emerged that the vaccines were effective. Older people also found ways to cope with their isolation, and some even felt the pandemic gave them a renewed sense of purpose, according to a pair of studies in The Gerontologist. …Learn More

May 13, 2021

One telling indication that retirees are in serious financial straits is when they take less of their medications or don’t fill prescriptions.

Nearly one in four low-income retirees has difficulty paying for medications, despite passage of Medicare Part D in 2006, which reduced out-of-pocket drug costs. Between 2011 and 2015, the average Medicare beneficiary spent $620 to $700 a year on prescriptions, and people with diabetes, lung disease, and cardiovascular disease spent more than $1,000 a year.

One way retirees can address such hardships would be to tap some of the equity in their homes. Although a homeowner probably wouldn’t use this strategy just to cover drug copayments, new research finds that older Americans who tap equity significantly increase their adherence to their medications – and this finding has broader significance for improving their retirement security.

Most older homeowners are, on the one hand, reluctant to pull cash out of their homes – often their largest asset – through a home equity loan, mortgage refinancing, or reverse mortgage. Yet many of them don’t have enough income to live comfortably and could put this asset to good use to reduce their debt or pay medical bills if they become seriously ill.

To test how home equity might help retirees, the researchers used a series of surveys between 1998 and 2016 that have data on older people’s finances and ask whether, at any time in the past two years, they took “less medication than prescribed … because of the cost?” The analysis controlled for various influences on financial well-being, including education, marital status, and cognitive health, as well as financial resources.

Extracting home equity improved adherence to medications in the short term, particularly for homeowners over 65 who have little wealth outside of their homes. Separately, the researchers showed that retirees who tapped home equity were significantly more likely to take their medications at a critical time – after experiencing a serious illness.

“Housing wealth can play an important role in reducing economic insecurity,” concluded the study, which was funded by the U.S. Social Security Administration. …Learn More

Research

April 13, 2021

About 13 percent of the older people in a recent study – average age 74 – who were initially living independently moved into a nursing home within five years.

Perhaps because they know their vulnerabilities, their expectations of whether they would one day need nursing home care helped predict their actual nursing home use, the study found.

In fact, the researchers said, the accuracy of the predictions showed that the older people must have taken into account personal information that went beyond what was apparent in the 1998-2016 survey data used in the study, which included details about their health, ease of functioning, and other influences on whether they need care.

However, foresight did not translate into facing up to the financial implications of a nursing home stay.

Nursing homes are expensive, currently averaging $7,700 per month for a room that is shared with another resident. The 10 percent of older people with a private long-term care insurance policy can pay for their care. Poor people’s nursing home expenses are covered by Medicaid.

It’s the people who fall outside these two groups who aren’t always clear about how to pay for a nursing home stay if they need it. Their lack of preparation for this expense was underscored in another of the study’s findings: the people who say they’re more likely to go into a nursing home were no more likely to have built up their savings to pay for it.

Of course, Medicaid is also a backup plan for nursing home residents who start out paying for their care but run through all of their savings. This study helps to explain why Medicaid covers six in 10 nursing home residents.

To read this study, authored by Padmaja Ayyagari and Yang Wang, see “Nursing Home Use Expectations and Wealth Accumulation Among Older Adults.” …Learn More