Why older Americans are bearing the brunt of the government shutdown
The ongoing government shutdown creates uncertainty for the more than 70 million Americans who rely on Medicaid for essential health care. At the same time, telehealth flexibilities first implemented during the Covid-19 pandemic have also expired, leaving significant gaps in access to telehealth that has been proven to help promote and sustain positive health outcomes for Americans who lack transportation or proximity to providers, especially in rural areas.
During the shutdown, federal agencies were forced to suspend non-essential operations, such as maintaining telehealth services provided through Medicare and Medicaid. This leaves many patients in a quandary, unsure of where to seek accessible and affordable care, especially those in rural areas or those enrolled in telemedicine chronic disease management programs.
Arguably the group most affected by the government shutdown, older Americans are facing particularly dire consequences. Many people rely on telemedicine to manage chronic conditions such as Alzheimer's disease and related dementias (ADRD). For these people — many of whom lack transportation or are unable to visit in person — virtual appointments are often a lifeline. While many Medicare Advantage and commercial plans or plans enrolled in the Guidance Improving the Dementia Experience (GUIDE) model remain eligible for telehealth services, countless seniors on traditional Medicare are at risk of missing critical windows for dementia diagnosis and early intervention. According to the Annals of Internal Medicine, about half of all telehealth appointments are specifically for behavioral or cognitive health. Without these appointments and timely care, many memory-related conditions may go untreated until it is too late. Today, ADRD affects more than 7 million Americans—a number expected to rise dramatically as the government shutdown drags on and the baby boom generation continues to age.
Many people with ADRD, regardless of disease progression, have difficulty traveling safely to a clinic due to disorientation, mobility issues, and anxiety in unfamiliar surroundings. There, telemedicine clinicians are able to conduct remote cognitive assessments, monitor disease progression and oversee treatment without waiting for an in-person visit, ensure vital signs are strong, medications and treatments are being followed, and track daily activities before emergencies occur. It’s these telehealth appointments that can prevent more falls, malnutrition, or avoidable hospitalizations.
Not only is telemedicine critical to patient health, but telemedicine appointments are also an essential tool for caregivers. As the number of baby boomers and older adults with ADRD continues to increase, we are ushering in a new generation of caregivers and we need to be prepared to support them. In fact, research shows that one in three people in the United States is affected by dementia, either through diagnosing it themselves or becoming a caregiver. While some platforms and services include programs that provide caregivers with dementia-specific support, training, and guidance, the most important thing the healthcare industry can offer caregivers is increased access to support and care for their loved ones.
My grandmother has dementia and I have seen firsthand how my family navigates this journey and process and how we have to make many adjustments. Not only is it difficult to get an initial diagnosis, but we are also witnessing a general lack of experts. Technologies such as telehealth services are an important step in helping caregivers and people with dementia more effectively, improving their care journey, extending their independence and improving health outcomes.
For people with cognitive disabilities, time is of the essence. The loss of telehealth flexibility, coupled with the disruption to Medicaid, could have devastating consequences for millions of patients suffering from dementia and other cognitive and behavioral issues. Despite the shutdowns, the healthcare industry has a responsibility to the millions of Americans living with ADRD that must not only continue, but enhance care through accessible hybrid models that incorporate virtual and in-home care services.
The consequences of a lack of medical care cannot be ignored. Policymakers must act quickly to restore telehealth flexibilities, Medicaid coverage and funding gaps—dementia is a bipartisan concern.
At the same time, healthcare innovators must redouble their efforts to develop hybrid care models that combine virtual and in-home care services to serve patients with a focus on screening and early detection, diagnosis, treatment and care management to make brain health more accessible to patients. Without it, there is a two-year wait to see a neurocognitive specialist return, leaving ADRD patients without support for ongoing symptoms and complications.
Photo: delihayat, Getty Images
Julius Bruch is CEO and co-founder of Isaac Health, a scalable brain health and dementia care platform that partners with leading healthcare organizations to provide expert screening, assessment, treatment and care management for people living with dementia and their family caregivers. His background includes serving as a consultant to McKinsey’s Healthcare practice, leading value-based care and digital health efforts in the United States, Europe, Asia and Africa. Julius holds a PhD in the molecular mechanisms of neurodegenerative diseases and studied medicine at the University of Cambridge in the UK. At Isaac Health, he works to create more partnerships with health plans across the country to make dementia care more accessible to vulnerable populations.
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