New Study: Psychiatric Care for Seniors on Medicare May Be Hard to Find
By Don Drake, Connelly Law Offices, Ltd.
"As a society, we need to understand that mental illness is not a natural part of the aging process," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "Seniors experience mental health issues less than younger people; however, they are also less likely to seek help when needed."
"Among seniors, the most common psychiatric disorder is dementia, affecting about five million adults, according to the Alzheimer's Association. This is followed by depression, affecting about five percent of seniors, and anxiety disorders, affecting up to eight percent of seniors," said Attorney Connelly. "We also witnessed these numbers rise dramatically during the pandemic. So, although the experts cite these numbers, many seniors are living with these disorders and are not getting treatment, meaning the numbers are probably significantly higher."
Dorothy was a 72-year-old Italian immigrant living in North Providence. She moved from a home she shared with her late husband, Domenic, into a small apartment following his death. "I first met Dorothy when she and her son, Joseph, who lived in St. Louis, came to our office to discuss her husband's estate," said Attorney Connelly. "She was adamant that she did not want to go into assisted living and wanted to continue to be independent. So, we were able to find her a small apartment that fit her budget."
Her son expressed concerns about her living alone, but she said she was active in her church and the senior center, so there should be no concerns. "Joseph had his worries around this but relented to his mother's wishes, wanting to make her happy and keep her comfortable," said Attorney Connelly. "But after a few months, our office received a call from Joseph stating that she was spending more and more time in her apartment and isolating herself from her friends. He also said one of her neighbors noticed that her apartment was beginning to look very cluttered and unkempt. We met with her and decided to have a home health aide come in several times a week to provide services and companionship for her."
After the first meeting, the health aide called Connelly Law and said that Dorothy was "very depressed." "We discussed these concerns with Joseph and decided to have the health aide set up appointments with her primary care doctor," stated Attorney Connelly. "The PCP agreed with the assessment of the health aide and started Dorothy on an anti-depressant and found a therapist who would visit her weekly in her home and then move these visits to the therapist's office as a first step to getting her out of the apartment."
This strategy worked, and Dorothy returned to her church and eventually to the senior center. "Our office had a cleaning service go into her apartment and clean up the clutter for her mental well-being and for her physical protection. She told the home health aide that because of the mess in her house, she stayed on the couch because she was afraid of falling and didn't invite anyone in due to the embarrassment of the clutter."
Dorothy's case was typical of seniors who develop a mental illness. The outcome could have been much different if it were not for others who witnessed her withdrawal from social activities and expressed their concerns. Very few seniors will self-refer to psychiatric care, so it is imperative that those who care about them be aware of any emotional or behavioral changes.
Triggers for Mental Illness
Interestingly, the trend to age in place has drawbacks, especially for those living alone. Seniors may be avoiding the excessive costs of assisted living or long-term care, but they are also lonely and more apt to develop a mental illness. Lack of socialization or having someone in the home with them who may see a deterioration in their mental health is problematic.
There are also other triggers for mental illness in the elderly. According to the World Health Organization (WHO), these include:
Illness or loss of a loved one
Long-term illness (e.g., cancer or heart disease)
Physical disability or loss of mobility
Physical illnesses that can affect emotion, memory, and thought
Poor diet or malnutrition
Even if these problems are seen, there is another factor that is cause for concern about seniors with mental health issues -- a lack of treatment providers.
The Lack of Psychiatrists
"Senior mental health is an issue that needs to be addressed, but unfortunately, a new study, reported on by Drugs.com reporter, Cara Murez, said that although seniors have these needs, their access to psychiatrists is severely limited," said Attorney Connelly. "According to the report, nearly two-thirds of Medicare Advantage psychiatrist networks included less than 25% of all psychiatrists in a given service area."
The findings of the study were published in the July issue of the journal Health Affairs.
“This means that many people who have coverage through Medicare Advantage plans may not actually have access to psychiatrists, given how few are considered in-network,” said lead study author Dr. Jane Zhu, an assistant professor of medicine in the School of Medicine at Oregon Health & Science University to Drugs.com.
"But the problem may be far worse than the data reveals," said Attorney Connelly. "According to Dr. Zhu, there is a shortage of psychiatrists in the United States, and those who are in the Medicare Advantage network are usually fully booked and not accepting new patients."
Because of this, according to Zhu, patients may need to pay higher out-of-pocket costs as well as experience delays in getting care or, in some cases, not getting care at all.
“More than half of the counties for which we had data did not have a single [Medicare Advantage]-participating psychiatrist,” the authors wrote in their study. “Our findings offer upper-bound estimates of network breadth, raising concerns about MA enrollees’ access to mental health services amid the growing prevalence of mental health conditions among older adults.”
"The study suggested that insurers incentivize more mental health professionals to accept Medicare Advantage programs," stated Attorney Connelly. "Another option was to allow psychologists, counselors, and primary care physicians to expand their scope of services around mental health care for seniors. The bottom line is this, we need to work together to ensure our seniors are not ignored when it comes to their mental health and demand that the treatment resources they deserve be in place to provide adequate care for them."