After COVID-19, what is the future of health care for older Americans?


Once the coronavirus pandemic fades — whenever that happens — two health trends for America’s older adults seem nearly unquestionable. Medical appointments through telehealth will be common, especially for those on Medicare. And the need for geriatricians will be great.

Since people over 65 have accounted for roughly 80% of the COVID-19 deaths in the U.S, according to the Centers for Disease Control and Prevention, the older adult population has been at the heart of the pandemic.

Here’s what experts forecast regarding telehealth and physicians specializing in geriatrics post-pandemic:

Telehealth

In 2019, only 11% of U.S. consumers used telehealth — medical appointments via video or telephone — according to McKinsey &  Company Health Care Systems and Services. But in recent months, McKinsey says, 46% have.

Partly, the growth in telehealth has come because so many Americans haven’t been allowed into their doctors’ offices. Partly, doctors have come to embrace these types of appointments. But a key factor has been Medicare rule changes covering telehealth for people 65 and older in important ways.

Related: Where will America’s oldest people live after COVID-19?

During the pandemic, Medicare beneficiaries can receive telehealth in any location, including their homes. Before that, they had to either live in a rural area or go to a clinic, hospital or certain other types of medical facilities.

See: 5 things you probably didn’t know about Medicare

And throughout the coronavirus outbreak, Medicare can pay physicians the same rate as for in-person visits.

Pre-COVID-19, telehealth through Medicare also required interactive audio and video between the practitioner and the patient; now, audio alone is allowed.

Medicare has recently more than doubled the number of services beneficiaries can receive through telehealth — adding 135, including physical, occupational and speech therapy services.

The result of all this? Before the pandemic, about 13,000 people in fee-for-service Medicare received telehealth in a week. These days, roughly 1.7 million do. Over 9 million Medicare beneficiaries have received a telehealth service during the pandemic.

Private Medicare Advantage plans can now offer the latest telehealth technology as part of their basic benefit, too. Now, more than half of those plans do, for up to 13.7 million enrollees.

Said Seema Verma, administrator for the federal Centers for Medicare and Medicaid Services, in a July 15, 2020 Health Affairs blog about Medicare’s telehealth expansion: “It’s hard to imagine merely reverting to the way things were before.”

Rep. Kevin Brady, the lead Republican on the House Ways and Means Committee, is currently drafting legislation to make permanent Medicare’s telehealth changes created in the pandemic.

Penny Shaffer, South Florida market president of Florida Blue, the state’s oldest and largest health insurer, says the increase in telehealth for older adults has been the biggest health care impact of COVID-19 for them.

“There’s a lot to say for the convenience of interacting with a provider from the comfort of your home: it’s safer in many ways, given no travel or transport is required, and there’s no interaction with other patients in waiting rooms,” she notes.

But, as Judith Graham of Kaiser Health News recently wrote, not all Americans have access to technology or can afford tech devices. Some have health issues (like dementia, hearing loss and impaired vision) preventing them from using telehealth. And some need translation services.

Read: How to get the most out of a telehealth appointment: 9 tips

Mario Schlosser, CEO of the tech-focused health insurer Oscar, noted that the total number of health visits by his policyholders during the pandemic has dropped in half.

Shaffer, of Florida Blue, acknowledges that while telehealth isn’t the right method for every condition, patient or situation, “there are a number of encounters that can be satisfied with a telehealth visit.”

Florida Blue, like other health insurers, envisions even greater use of technology and virtual visits in the future to monitor patients with chronic conditions and as a postsurgical tool, to reduce the risk of infection.

That prediction was echoed by Catherine McCallum, a clinical social worker and aging care management consultant who runs Coral Life Strategies in Bethesda, Md.

Also see: Why older Americans are more likely to be harmed by medical care

McCallum also likes telehealth patients’ ability to schedule appointments quickly, rather than having to wait too long for an appointment. “But,” she adds, “not all medical practices set up their own secure line; some rely on Zoom
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or another platform, which has shown to be less secure.”

McCallum says there can be other difficulties and limitations relying on video health visits, especially for counseling patients, too.

“Right now, when we speak with patients using applications like Zoom, especially older adults, we have to get very specific about what they need to do and how to interact with the computer or smartphone,” she says. “And we have to remind them to turn off other devices.”

However, McCallum is confident that older patients will increasingly become more comfortable with the technology — and that it will become more available and user friendly.

As an insurer, the long-term financing of telehealth is very much a concern for Shaffer. She fears that post-COVID-19, Medicare reimbursement rates will return to paying doctors less for telehealth visits than in-person ones.

Schlosser, of Oscar Health, feels that identical reimbursement rates for virtual and in-person visits will be unsustainable, but acknowledges that health providers will want to ensure they’re compensated adequately for virtual visits.

He also believes that once the pandemic crisis passes, people who pay for their own health care are likely to raise more questions about why doctors are charging the same for telehealth visits as for in-person visits since they don’t always feel that they get the same level of service.

And Robert Sullivan, a health care consultant and formerly the chief operations officer for Health Industries Advisory at the tax and consulting firm PricewaterhouseCoopers, predicts that the greater use of technology for medical records during the pandemic will have a long-lasting, positive effect on health care costs due to better medical database management.

“For the longest time,” he says, “all your medical records were with your family physician. And if you needed to send information to a specialist or just needed to check on your own status, you had to get the information from your doctor. That was costly for the provider as well as for the insurance companies.”

But there’s been a huge growth in the use of third-party data management of medical records during COVID-19. That portability, Sullivan believes, will save money for doctors’ offices and insurers.

Geriatric medicine

“The big change for me as a result of COVID-19 is the heightened awareness of the need for more geriatric physicians,” says Sullivan. “We’re already woefully short of the number of geriatric physicians and that number is going to get even worse in the future.”

According to the American Geriatric Society, there are about 7,000 certified geriatricians in the United States. But the federal Health Resources & Services Administration, which tracks data on the workforce that’s needed, estimates that by 2025, the U.S. needs to have close to 23,000 geriatric physicians to accommodate the number of boomers, who’ll then be 61 to 79.

Read: The case for defunding nursing homes and replacing them with a radically different model

One of the reasons for this discrepancy: the expected income for those going in geriatrics.

“Geriatric medicine has not been the most lucrative specialty,” Sullivan says.

The American Geriatric Society reports that the average income for a geriatrician is lower than even for family practice, even though the specialty requires an additional year of schooling. According to ZipRecruiter, the average pay for a geriatrician in the U.S. is $198,740. By contrast, average pay for family physicians is about $208,000.

Still, Sullivan says he’s optimistic about future prospects for geriatricians.

“I think the pandemic put the spotlight on older adults, which will likely increase the number of people going into the field. And,” he adds, “it’s also likely to increase the income for geriatric physicians as the demand becomes greater.”

Young people seem to agree.

In his School of Aging Studies class at the University of Maryland Baltimore County, Prof. Steve Gurney, asked his young college students whether they thought there would be more emphasis in the health community on geriatric medicine in the post COVID-19 world. Almost all of the comments were similar to this one:

“COVID-19 made us more aware of the health risk factors our elderly population faces. People, including myself, have kept our older generation in mind more now than ever before. And moving forward, people will have a better understanding of geriatric medicine and its importance.”



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This sector could have a half million job openings and opportunities for older workers


Although the coronavirus continues to rattle global markets and industries, some analysts expect to see greater demand for advanced manufacturing talent in the U.S. as the pandemic diminishes. That could create opportunities for older men and women, including white-collar professionals struggling to find jobs.

Before COVID-19, there were 500,000 manufacturing jobs open in the U.S., according to the National Association of Manufacturers (NAM). “We’re going to have a need very quickly to ramp up on hiring in those facilities that may have been shut down during the crisis or that need to expand operations,” said NAM president and CEO Jay Timmons in a recent press conference.


“The fact that one can get a certificate in about nine months and totally re-career into a nearly guaranteed job is an incredible opportunity for an older worker.”


— Nora Duncan, Connecticut state director of AARP

As manufacturers frantically try to keep up again with demand for essentials and lifesaving PPE (Personal Protective Equipment) for health care workers as cases rise across the country, their innovation and high-tech problem-solving could help dispel misconceptions that all manufacturing jobs are dirty and physically demanding, said Sara Tracey, project manager of workforce services for the Ohio Manufacturers’ Association in Akron, Ohio.

Manufacturing jobs and what they pay

Entry-level manufacturing jobs in industries such as aerospace, technology and defense include CNC operators, set-up technicians and programmers, as well as inspectors, higher-end assembly technicians and quality assurance.

The pay typically ranges between $35,000 and $65,000, including overtime and benefits, said Richard DuPont, director of community and campus relations for the Advanced Manufacturing Technology Center at Housatonic Community College in Bridgeport, Conn. More experienced professionals can earn upward of $95,000.

80% of older Americans can’t afford to retire – COVID-19 isn’t helping

In Ohio, manufacturers have been training and moving some workers into higher positions so the companies can hire and train new candidates for vacated ones, Tracey noted. Resources such as the Making Ohio website let people explore careers in manufacturing, including robotics, automation and 3-D printing.

Industrial maintenance is an important career pathway these days, as well, Tracey said. This sector is expecting more retirements in the near future, which will create jobs from “traditional machine mechanics to troubleshooting state-of-the-art electronic or robotic processes,” Tracey noted.

Also see: Cannabis, whiskey, and mobile bike repair: These entrepreneurs are thriving in the pandemic

Connecticut, among other states, now offers training programs with community colleges, state manufacturers and other organizations.

From banking to precision tools

This kind of training helped Allison Clemens-Roberts, who is over 50, find work after losing her clerical job in the pensions department of a Connecticut bank in 2017. A severance package gave her time to look for work, but she couldn’t find even temporary employment. She blames age discrimination by white-collar employers.

“There’s no way to hide how old you are. They can ask when you graduated from school,” Clemens-Roberts said.

But while she was out of work, Clemens-Roberts received a postcard from AARP offering a 25% tuition scholarship on advanced manufacturing programs at Goodwin University, a career-focused school in East Hartford, Conn.

She wasn’t interested until her husband Frank saw a TV commercial touting the benefits of Goodwin’s manufacturing and other programs.

“He said, ‘Why don’t you think about changing careers?’” Clemens-Roberts recalled.

So, with several months left on her severance, she enrolled in a full-time, six-month CNC (Computer Numerical Control) Machining, Metrology and Manufacturing Technology certification program. It would prepare her for a job working with automated machine tools which requires mathematical skills, attention to detail and critical thinking.

SectorWatch: 80% of older Americans can’t afford to retire – COVID-19 isn’t helping

Scholarships cut Clemens-Roberts’ tuition bill from $7,000 to $3,200. After a two-month paid internship at TOMZ, a manufacturer of precision components for major medical devices in Berlin, Conn., she was hired in April 2019. Six months later, TOMZ reimbursed Clemens-Roberts $1,500 for her education tab.

Clemens-Roberts said her family is now in a better financial position than when she was working in a bank, living paycheck-to-paycheck. Considered an essential worker, she has kept her full-time job through the pandemic, except for three days in March.

“I never thought I would go to college and participate in a graduation — in cap and gown,” Clemens-Roberts said. “That was a big surprise. And [actor] Danny Glover was the speaker. A bucket-list experience.”

There’s “obviously age discrimination, among other things, at play” for job seekers over 50, said Nora Duncan, Connecticut state director of AARP. “The fact that one can get a certificate in about nine months and totally re-career into a nearly guaranteed job is an incredible opportunity for an older worker.”

While AARP helped Clemens-Roberts pay for the tuition initially, the internship helped her get hired as a machine operator.

Older and younger manufacturing workers helping each other

The search for skilled manufacturing labor across the country is creating opportunities for workers of all ages, said DuPont. And older and younger generations working together are assisting each other.

The older students help younger classmates with life skills, while younger students can help with technology,” said DuPont. “Together, they make excellent teams.”

Don’t miss: How will the robots see you through the pandemic?

Just ask Fernando Vega, 62, who is now a quality inspector at Forrest Machine, in Berlin, Conn. It makes precision-machined parts and other components for the aerospace and commercial industries. In the 1990s, he was a quality inspector before recessions and outsourcing forced him to consider other careers.

He tried working for a nonprofit and though Vega found the work rewarding, it wasn’t financially sustainable.

So, Vega went back to school in spring 2018 to study advanced manufacturing at Goodwin.

“I was in a class of 18, and at first everyone kept to themselves. But when it came time to read blueprints, there was some panic and I said, ‘Don’t panic, I’ll show you.’ The [younger] students helped me with trigonometry, and then we started to work together.”

Vega has worked at his manufacturing job throughout the pandemic. At one point, he was putting in 50 hours a week, but that was reduced to 40 hours plus overtime.

Vega recalled promising his mother that he would go to college. “But that was a long time ago,” he said. His mother never got to see him graduate but Vega feels he’s fulfilled his promise — not only to her, but also to himself. “I love my job,” he said.



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Kids under age 5 may carry a much higher coronavirus viral load than older children and adults: study


A small study is raising questions about whether young children could be coronavirus super spreaders, even as the country deliberates how to reopen schools in the coming weeks.

But how contagious are kids? And could reopening schools lead to more community outbreaks if children (and teachers) become exposed to COVID-19 in classrooms, and then spread the virus to their families? A small Chicago study published in JAMA Pediatrics this week is renewing such questions, as it suggests that small children infected with COVID-19 carry at least as much of the virus as adults do — if not much, much more.

Dr. Taylor Heald-Sargent, a pediatric infectious diseases specialist at Lurie Children’s Hospital of Chicago, analyzed 145 nasal swabs from patients with mild to moderate cases of COVID-19 within a week of showing symptoms. Her team tested for the genetic pieces of the virus (RNA) in the samples. And they found that older children and adults had similar amounts of the viral genetic material, which can be extrapolated to measure how much live virus they carried. (Live viral cultures are used in research settings, not clinical settings like this one, which is why they went this route.)

The most alarming finding, however, was that kids under 5 had significantly more of the viral genetic material in their noses — 10 to 100 times more, in fact, compared to older children and adults.

“People thought maybe [young children] can’t get infected, and that is not the case. They definitely do get infected,” Heald-Sargent told MarketWatch. “And once they get infected, they have rip-roaring amounts of virus.”

There are some caveats to keep in mind with this report -— namely that it was a small study, and it wasn’t looking at samples of live virus, but rather the genetic material that the virus leaves behind.

The study also did not measure transmissibility, and so these findings do not prove that children are more contagious. But it does provide more evidence that kids can indeed become infected with COVID-19, which suggests that it is also possible for them to spread it.

“There has been some suspicion that kids may actually not transmit it to adults, which would be a good thing, but I do not think we can hold out that hope,” Dr. Sunil Sood, a pediatric infectious disease specialist from Northwell Health’s Southside Hospital who was not part of the study, told MarketWatch.

“I see no biological reason why they wouldn’t be contagious,” he continued. “Why would this virus be different from other respiratory viruses — even coronaviruses that cause common colds? Kids transmit them to other kids and adults commonly, so why would this virus be any different?”

Of course, this virus has proven to be different at almost every turn — from its growing laundry list of symptoms to how many asymptomatic patients could be unknowingly carrying the virus — which has helped make it so difficult to bring under control.

“It’s so confusing,” Heald-Sargent said. “We’re learning more every day, so it’s hard to weigh each piece of data on its own. You have to take it collectively.”

Her paper is consistent with research that has come out of France and Germany. A recent study of 47 COVID-19 infected children between the ages of 1 and 11 in Germany found that even asymptomatic kids had viral loads on par with those of adults — if not higher. And a French study also found that children without symptoms appear to have COVID-19 viral loads similar to those of children with symptoms.

And in May, another JAMA study found that children age 4 and under are largely responsible for spreading respiratory syncytial virus (commonly called RSV) in adults over 65. “We know for sure that kids spread RSV,” Sood told MarketWatch. While it’s predominantly found in younger kids, he noted that it can cause severe cases of pneumonia in seniors.

“So what I think our paper adds [to the discussion of kids and coronavirus] is this answer to whether children can get infected. They can,” Heald-Sargent said. “We don’t know that they’re spreading it, but we need to be cautious. It doesn’t mean schools can’t open; we just need to be safe about it.”

“This paper should reinforce to any skeptical parents that kids need to wear masks so that they are less likely to transmit the virus to others,” Sood added. “They may have a high virus count in their noses, even without being very sick themselves.”

The CDC states on its site that children do not appear to be at higher risk for COVID-19 than adults, based on available evidence. But it does caution that “the more people children interact with, and the longer that interaction, the higher the risk of COVID-19 spread.”

To keep families safe, the CDC suggests practicing good hygiene, such as: washing hands often; cleaning and disinfecting high-touch surfaces daily; and laundering clothes and plush toys as needed. It also recommends practicing social distancing with kids: avoiding people who are sick, sneezing or coughing; keeping at least six feet away from other people outside of your household; and having kids ages 2 and up wear cloth face masks in public settings where it is difficult to follow social distancing. Its guidelines for reopening schools also include encouraging mask wearing, spreading desks at least three feet apart and canceling group activities like choirs and assemblies.

The CDC has also stated that “decisions about how to open and run schools safely should be made based on local needs and conditions.”

Follow MarketWatch’s coronavirus coverage here.



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COVID-19 is not as big a threat to typical older workers as you might think


Working longer is the best way to ensure a secure retirement, and people appear to have gotten the message.

Lately I am worried that the COVID-19 pandemic could reverse the trend toward increased labor-force participation of older people. With the constant commentary about older people being more vulnerable, individuals may simply withdraw, viewing the environment — in the absence of a vaccine — as too treacherous. Or employers, whose enthusiasm for older workers is always questionable, may discourage them from participating.

Read: For older workers, there are risks if they return to the office — and risks if they don’t

I wanted to take a look at the underlying relationship between age and COVID-19. The Centers for Disease Control and Prevention (CDC) report deaths from COVID-19 by age group (see table 1). The death counts, which are available through June 6 are based on death certificates. Since it takes several weeks for death certificates to be submitted and processed, the totals are substantially lower than those reported by state and local health departments. The data in table 1 show that the death rate increases with age.

The question is how to think about these numbers in the context of older workers. The very high death rates for those ages 85 and older and for those 75 to 84 are not really relevant for a discussion of workforce issues. The more pertinent question is whether a death rate of 27 per 100,000 of the population for those 55 to 64 compared with 11 per 100,000 of the population for those 45 to 54 is something that should determine whether it is wise to keep working. Of course, both these percentages are currently higher as the total number of deaths has surpassed 112,000, but the ratio of one age group to another probably hasn’t changed.

The only other thing I could think of was to compare the pattern of COVID-19 to deaths from some other illness. The CDC groups together influenza and pneumonia, and the death rates by age from these two diseases is shown in table 2 for a similar four-month period during the peak of the 2017-2018 flu season. Again, the pattern is age-related, but remains relatively low for those ages 55 to 64. And, interestingly, while the death rates for influenza and pneumonia are lower than those for COVID-19, the relative risk of dying for people 55 to 64 compared with those 45 to 54 is actually similar for both.

The bottom line from all these numbers is that most older workers are ages 55 to 64, not 85 and over, where the shockingly high death rates have occurred. They, like the rest of us, need to be careful as the economy opens up. But their situation does not differ dramatically from that of prime-age workers 45 to 54, and should not be a major determinant of their work/retirement decision.



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Why millions of older workers will pay a big financial price—forever—from the coronavirus


How much worse can it get?

More than 30 million Americans—about one-sixth of the U.S. workforce—have now been laid off in the last six shattering weeks. One in six. It’s almost impossible to grasp such a mind-numbing figure.

And while layoffs have hit both younger and older workers, it’s a good bet that when the economy begins to reopen and Americans go back to work, older workers—age 50 and over—will be last in line.

They always have been. Even in good times, and laws not withstanding, age discrimination is rampant. There’s also a perception among potential employers—unfair though it may or may not be—that older workers want too much money, aren’t up to date on certain skills, and won’t mesh well with younger colleagues.

Read: COVID-19 crisis sparks an ‘early retirement’ wave

History offers a lesson in what the future holds for older Americans hoping to get back to work. In the last big jobs wipeout—the “Great Recession” of a dozen years ago—a study by the Urban Institute, a Washington-based think tank, said that although older workers generally experienced lower unemployment than their workers aged 25 to 34, it took twice as long to find work. A third of older job seekers (34%) were still looking after a year, and two-fifths (41%) were still searching after a year and a half.

And after finally finding a job after all that time on the sidelines, what did they get? A median pay cut of a whopping 23% (median means half, so half took a pay cut worse than that). By contrast, workers aged 25-34 typically took an 11% haircut.

Imagine that: Waiting a year, maybe two—and then taking a huge pay cut.

“There’s no question that older workers see much longer durations of unemployment,” says Jennifer Schramm, a senior strategic policy adviser in the AARP Public Policy Institute. She adds that In that downturn, a vicious circle emerged. The longer you were out of work, the more tainted you became.

“HR professionals were talking about discrimination against the long-term unemployed, and how some organizations were actually talking about how they weren’t looking for people who had been unemployed for a certain amount of time.” This is clearly discriminatory, of course.

Aside from coronavirus itself, which has now taken some 63,000 lives in less than three months, what’s scary about this downturn is how it could alter the already one-sided relationship between employers and employees.

Read: How will the coronavirus pandemic affect Social Security’s finances?

Journalist Peter Gosselin, whose 2009 book “High Wire: The Precarious Financial Lives of American Families” looked at Americans’ deepening economic anxiety—which unquestionably resonated with readers in 2009—calls the current situation a “cataclysmic event” that will accelerate one big trend that was already under way in this country: the shifting of economic risk from employer to employee.

“Employers lack a clear sense of which way the world is going,” he says. “So they want to make as few commitments (to people) in terms of making their products of services as they can. Employees are a major commitment.”

Gosselin predicts the current environment, rife with fear and uncertainty, will give companies more leeway to “loosen the employer-employee tie.” This will hurt workers of all ages but will most heavily on older workers, he adds.

All of this feeds Into the broader problem of retiring at a reasonably young age with a reasonably decent financial cushion. When you are out of the labor force for an extended period, it hurts on two crucial fronts: 1) you’re obviously not contributing to a 401 (k) or IRA, and 2) You’re missing out on potential company matches (though as I wrote recently, some companies are now cutting such payments to save money).

So anyone out of a job now—and 30 million are in that boat—are paying a price not just today, but over the long run. Why? Because they’re investing less in a market that typically goes up.

It gets worse.

Since Social Security is based on an average of your long-term earrings, anyone who was forced to take a pay cut after the last recession—or winds up taking one in the future—will see that all-important average income figure decline. Thus, you could live to 100—and your monthly check will be lower, for years and years, because you were forced to take a lower-paying job way back in 2020.



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