Patient Voice: An Aging Population and the Hurdles Ahead

From the Editor:

At Patients Rising, the voice of the patient (or caregiver) should always rise above the din. Today, we welcome Starr Burke who has a lot of experience working with the elderly. She’s seen the challenges for an aging population, and shares them here, plus a possible solution.

Here’s Starr…

The American Population is aging—by 2034, the U.S. Census Bureau estimates people over 65 years (77 million) will outnumber those under the age of 18 years (76.5 million). This will place an increased demand on our country’s strained eldercare resources. I have over a decade of eldercare experience, as a nurse, nursing home manager, and nurse practitioner. Public awareness and legislative action are urgently needed to address the issues our seniors face before the situation becomes catastrophic.  

Legislative gaps in our current system include:

  • enforcement of elder abuse laws
  • transparency in healthcare pricing
  • support for legislation that improves healthcare staffing

The rising cost of healthcare and increased out-of-pocket (OOP) expenses accentuate the woes of our aging population along with others. Seniors are most affected by these increased OOP costs due to dependence on a monthly fixed income from retirement savings and/or social security. 

Skipped Doses, Healthcare Visits

A high burden of OOP costs for seniors may lead to skipped healthcare visits and procedures or medication rationing. Despite Medicare coverage for those over 65 years, annual OOP costs average $2,000. In 2021, high healthcare costs led to:

  • One in twelve Americans over 65 years to skip a needed procedure or physician visit
  • Nine percent of Americans over the age of 65 not filling a prescription
  • One in six older adults not receiving dental care 

In the state of Michigan where I practice, seniors living in the community and in senior living facilities are facing dire circumstances. Seniors in the community are grappling with medication costs, rising insurance premiums, transportation challenges, and poverty. The biggest issues that I witness in my office practice are their inability to afford personal care and housework assistance that will maintain their independence, and the skyrocketing cost of assisting living and nursing home care. 

The Cost of Senior Housing

Despite substandard living conditions with poor staffing, senior living facilities and nursing homes charge high rates. A study by the American Action Forum estimated that by 2030, long term care (LTC) costs may reach 2.5 trillion. The cost of a private room in a nursing home is currently over $100,000 a year. Forty percent of seniors will pay approximately $50,000 a year for in-home health care. However, most in-home care is unpaid labor provided by family members, an average of 17.8 hrs per week, which places a financial strain on the family by taking them out of the workforce.  

In my practice, many medications are unaffordable for my patients. An elderly male patient suffered a stroke because he could not afford his blood thinner and blood pressure medications.  This has rendered him unable to use one side of his body, he relies on a cane, and can no longer drive. Having to choose between losing his home or paying for his medication, he will soon require nursing home care.  

The Ambulance Bill

Another expense that causes seniors in America great concern is the ambulance bill. My grandmother was cared for by family members for the last two weeks of her life at the age of 98 in hospice care. However, my grandmother initially refused to leave the hospital to return home because she was afraid of being unable to afford the ambulance bill. In the past, when my frail elderly grandmother had fallen and needed hospitalization, I had to carry her out of the house, as she refused to call the fire department and pay the bill. 

My grandmother is not alone in her refusal to call the EMS due to cost concerns. In our state of Michigan, the average cost of an ambulance is $150-$450 depending on the distance and type of insurance coverage. The No Surprise Medical Bill Act signed into law in October 2021 by Michigan Governor Gretchen Witmer does not address ambulance transportation. In my experience as an emergency room nurse, many patients came in critical conditions via private vehicle. One tragic case was of a young man who brought his deceased grandfather laying across  the back of his vehicle. Emergency room personnel frantically attempted resuscitation, but it was too late. The patient lost his life because he was afraid to call an ambulance out of financial concerns.

Elder Abuse

Many of our elderly citizens are unable to care for themselves in their homes but cannot afford the cost of personal care assistance. My late grandmother did not have the resources to pay for in-home care assistance in her elderly years and wanted to remain in her condo. Laws that prevent elder abuse had failed her–a family member with a gambling issue was able to withdraw most of her life savings, leaving her ineligible for Medicaid for five years, and without the financial assets to care for herself. Adult protective services were contacted several times, with no resolution.  

However, this situation is not unique to my grandmother. Elder abuse—physical, sexual, emotional, neglect, or financial—occurs in ten percent of seniors over the age of sixty, usually by someone well-known to them. While laws to protect seniors from this abuse are in place, their enforcement is the problem. As a nurse practitioner and advocate in the area of elder reform, I would like to see enforcement of existing elder abuse laws. Cases like my grandmother’s are all too common, and enforcement of existing elder law is the solution to stopping this cycle of elder abuse in America.

Legislative Changes Vital

The solution is legislation at the state and federal level that addresses the issue of healthcare affordability. The Inflation Reduction Act, signed into legislation in 2022, puts a $35 cap on insulin prices and begins to phase-in negotiations between Medicare and drug companies to limit the cost of high-cost drugs. This is a small step in the right direction, because for a senior citizen living at the federal poverty level, $35 is still unaffordable. The best solution might be to advocate for legislation that makes life-saving medication free for our disabled and senior Americans. 


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Starr Burke is Nurse Practitioner with experience managing a nursing home and working in geriatrics & internal medicine. She is a trained Senior Care Advocate, a classically trained Opera Singer (Italian, French and German), a pandemic ER/ICU Nurse, and a baker.

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