The greatest challenge in our healthcare system: engaging with the “forgotten patient”

On July 30, 1965, the U.S. Congress passed legislation establishing Medicare because seniors often went without necessary medical care.  The beginnings of the movement that eventually led to the passage of the law can be traced to President Theodore Roosevelt in the 1910s, who believed that for America to be strong and prosperous, we needed to ensure health among the population.1

Before the passage of Medicare, the elderly (those 65 and over) were half as likely to have hospital coverage, and almost three times more likely to be poor than those 18-64 years of age.  Within ten years of Medicare’s inception, the improvement in healthcare access helped cut poverty rates among the elderly in half.  Today, the poverty rates among the elderly are lower than those 18-64 years of age.2-5

A key impetus for the creation of Medicare was to address the “forgotten” population – seniors who had trouble providing for themselves, and often had nowhere to turn to for help.  However, Medicare was designed at a time when we lived shorter lives – and were more likely to live with family.  Life expectancy has increased by approximately 4 years since 1960, and the proportion of seniors living alone has increased by roughly 50% during that time (helping to increase the total number of seniors living alone from about 3 million to just under 15 million).6-9  

Loneliness and social isolation are on the rise in America.  The negative impacts are so significant that the U.S. Surgeon General wrote a formal advisory on “Our Epidemic of Loneliness and Isolation”, pointing to harmful consequences in our schools and workplaces, and comparing the mortality risk of the individual to smoking up to 15 cigarettes a day.10-12, Figures 1-2

This epidemic has compounded what is perhaps the greatest challenge facing our healthcare system today: how to help the rising number elderly patients who in many ways continue to be “forgotten.”  Most seniors have health insurance, and have medical providers they can go to.  Yet, many patients do not receive necessary care because our healthcare system is designed to be transactional and impersonal.  

Finding the nearest emergency room is easy enough, but understanding how to prevent serious illness, navigate care coordination complexities and plugging into available community resources –that is the challenge.  Our healthcare system works best for patients who can:

  • Understand basic healthcare (i.e. patients who are health literate)
  • Speak English
  • Pay for supplemental services
  • Physically get to the healthcare resource(s)

What if a patient can’t do one of the above?  What if the patient can’t do any of the above?

It is precisely these patients that are being “forgotten.”  Healthcare cannot just be for those who are health literate, can speak English, afford supplemental services, and physically get to healthcare resources.  The solution is multi-factorial, but it is also simple.  By following four steps, we can make a world of difference in the lives of patients:

  1. Offer medical services that patients want and need (such as holistic treatment for arthritis and behavioral health services) in the home or other accessible setting;
  2. Provide these services using age and culturally specific content;
  3. Connect patients to integrated medical care delivery to ensure medically necessary and preventive services are completed;
  4. Proactively address those at highest risk with specialized care management programs to optimize health outcomes

Patients simply need a reason to plug-in – they need a reason to engage.  If there’s a service that allows them to have a better quality of life, support their families, or pursue their passions they are much more likely to take advantage of it.  We must innovate to bring those services to patients, and make it easy and affordable for them to access them.  Moreover, patients must feel wanted and understood by the clinical practitioner, so that they can better understand their healthcare options and how to navigate our complex healthcare system.

All patients, indeed all people, need two things for happiness: health and companionship.  Offering one without the other is inherently limited.  Therefore, optimal patient engagement occurs when there’s a medical service with proven value to the patient, explained and delivered by a clinician (or health system) who understands the needs of the patient, and focuses on connecting with the patient on a personal level – rather than transactionally doing a service.

And when patients experience even limited benefit from an initial service, they are much more likely to integrate into broader medical care delivery and the community.  It is a positive feedback loop which grants us the opportunity to assess patients who have specialized care needs and proactively intervene to improve their quality of life and prevent complications.

When the forgotten patient is welcomed back, the benefits accrue not just to the patient – the benefits also accrue to their families, their communities, and the healthcare system.  Given the millions of senior patients being left behind, countless lives, and billions of dollars can be saved.

While the societal benefits are clear, I ask you this: isn’t this the kind of healthcare you would want for our country? Isn’t this the kind of healthcare you would want for your loved one? Isn’t this the kind of healthcare you would want for yourself?

About the Author

Marlow Hernandez, D.O., M.P.H., F.A.C.P.

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