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Technology Divide Between Senior ‘Haves’ and ‘Have-Nots’ Roils Pandemic Response

Judith Graham

Family gatherings on Zoom and FaceTime. Online orders from grocery shops and pharmacies. Telehealth appointments with physicians.

These have been lifesavers for a lot of older adults staying at dwelling throughout the coronavirus pandemic. But an unprecedented shift to digital interactions has a draw back: Large numbers of seniors are unable to take part.

Among them are older adults with dementia (14% of these 71 and older), listening to loss (practically two-thirds of these 70 and older) and impaired imaginative and prescient (13.5% of these 65 and older), who can have a tough time utilizing digital units and packages designed with out their wants in thoughts. (Think small icons, difficult-to-read typefaces, insufficient captioning among the many hurdles.)

Many older adults with restricted monetary sources additionally might not be capable of afford units or the related web service charges. (Half of seniors residing alone and 23% of these in two-person households are unable to afford primary requirements.) Others aren’t adept at utilizing know-how and lack the help to be taught.

During the pandemic, which has hit older adults particularly arduous, this divide between know-how “haves” and “have-nots” has severe penalties.

Older adults within the “haves” group have extra entry to digital social interactions and telehealth companies, and extra alternatives to safe important provides on-line. Meanwhile, the “have-nots” are at higher danger of social isolation, forgoing medical care and being with out meals or different vital gadgets.

Dr. Charlotte Yeh, chief medical officer for AARP Services, noticed difficulties related to know-how this 12 months when attempting to remotely educate her 92-year-old father the right way to use an iPhone. She lives in Boston; her father lives in Pittsburgh.

Yeh’s mom had at all times dealt with communication for the couple, however she was in a nursing dwelling after being hospitalized for pneumonia. Because of the pandemic, the house had closed to guests. To discuss to her and different relations, Yeh’s father needed to resort to know-how.

But varied impairments obtained in the best way: Yeh’s father is blind in a single eye, with extreme listening to loss and a cochlear implant, and he had hassle listening to conversations over the iPhone. And it was tougher than Yeh anticipated to search out an easy-to-use iPhone app that precisely interprets speech into captions.

Often, relations would attempt to organize Zoom conferences. For these, Yeh’s father used a pc however nonetheless had issues as a result of he couldn’t learn the very small captions on Zoom. A tech-savvy granddaughter solved that downside by connecting a pill with a separate transcription program.

When Yeh’s mom, who was 90, got here dwelling in early April, physicians treating her for metastatic lung most cancers needed to rearrange telehealth visits. But this might not happen by way of cellphone (the display screen was too small) or her pc (too arduous to maneuver it round). Physicians might study lesions across the older girl’s mouth solely when a pill was held at simply the suitable angle, with a telephone’s flashlight geared toward it for further gentle.

“It was like a three-ring circus,” Yeh mentioned. Her household had the sources wanted to resolve these issues; many don’t, she famous. Yeh’s mom handed away in July; her father is now residing alone, making him extra depending on know-how than ever.

When SCAN Health Plan, a Medicare Advantage plan with 215,000 members in California, surveyed its most susceptible members after the pandemic hit, it found that about one-third didn’t have entry to the know-how wanted for a telehealth appointment. The Centers for Medicare & Medicaid Services had expanded the use of telehealth in March.

Other boundaries additionally stood in the best way of serving SCAN’s members remotely. Many individuals wanted translation companies, that are troublesome to rearrange for telehealth visits. “We realized language barriers are a big thing,” mentioned Eve Gelb, SCAN’s senior vice chairman of well being care companies.

Nearly 40% of the plan’s members have imaginative and prescient points that intrude with their skill to make use of digital units; 28% have a clinically vital listening to impairment.

“We need to target interventions to help these people,” Gelb mentioned. SCAN is contemplating sending neighborhood well being employees into the properties of susceptible members to assist them conduct telehealth visits. Also, it might give members easy-to-use units, with important capabilities already arrange, to maintain at dwelling, Gelb mentioned.

Landmark Health serves a extremely susceptible group of 42,000 individuals in 14 states, bringing companies into sufferers’ properties. Its common affected person is almost 80 years previous, with eight medical situations. After the primary few weeks of the pandemic, Landmark halted in-person visits to properties as a result of private protecting tools, or PPE, was in brief provide.

Instead, Landmark tried to ship care remotely. It quickly found that fewer than 25% of sufferers had applicable know-how and knew the right way to use it, in accordance with Nick Loporcaro, the chief govt officer. “Telehealth is not the panacea, especially for this population,” he mentioned.

Landmark plans to experiment with what he calls “facilitated telehealth”: nonmedical employees members bringing units to sufferers’ properties and managing telehealth visits. (It now has sufficient PPE to make this potential.) And it, too, is know-how that it can provide to members.

One various gaining consideration is GrandPad, a pill loaded with senior-friendly apps designed for adults 75 and older. In July, the National PACE Association, whose members run packages offering complete companies to frail seniors who dwell at dwelling, introduced a partnership with GrandPad to encourage adoption of this know-how.

“Everyone is scrambling to move to this new remote care model and looking for options,” mentioned Scott Lien, the corporate’s co-founder and chief govt officer.

PACE Southeast Michigan bought 125 GrandPads for extremely susceptible members after closing 5 facilities in March the place seniors obtain companies. The units have been “remarkably successful” in facilitating video-streamed social and telehealth interactions and permitting nurses and social employees to deal with rising wants, mentioned Roger Anderson, senior director of operational assist and innovation.

Another various is know-how from iN2L (an acronym for It’s Never Too Late), an organization that makes a speciality of serving individuals with dementia. In Florida, beneath a new program sponsored by the state’s Department of Elder Affairs, iN2L tablets loaded with dementia-specific content material have been distributed to 300 nursing properties and assisted residing facilities.

The purpose is to assist seniors with cognitive impairment join just about with family and friends and have interaction in on-line actions that ease social isolation, mentioned Sam Fazio, senior director of high quality care and psychosocial analysis on the Alzheimer’s Association, a associate within the effort. But due to price range constraints, solely two tablets are being despatched to every long-term care neighborhood.

Families report it may be troublesome to schedule sufficient time with family members when only some units can be found. This occurred to Maitely Weismann’s 77-year-old mom after she moved right into a short-staffed Los Angeles reminiscence care facility in March. After seeing how arduous it was to attach, Weismann, who lives in Los Angeles, gave her mom an iPad and employed an aide to make sure that mom and daughter have been in a position to discuss every evening.

Without the aide’s help, Weismann’s mom would find yourself unintentionally pausing the video or turning off the machine. “She probably wanted to reach out and touch me, and when she touched the screen it would go blank and she’d panic,” Weismann mentioned.

What’s wanted going ahead? Laurie Orlov, founding father of the weblog Aging in Place Technology Watch, mentioned nursing properties, assisted residing facilities and senior communities want to put in communitywide Wi-Fi companies — one thing that many lack.

“We need to enable Zoom get-togethers. We need the ability to put voice technology in individual rooms, so people can access Amazon Alexa or Google products,” she mentioned. “We need more group activities that enable multiple residents to communicate with each other virtually. And we need vendors to bundle connectivity, devices, training and service in packages designed for older adults.”

Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially unbiased program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.

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