GBONEWS: Mental Health Research May 2; Minority Aging Impact Video; Unhoused Seniors; Indian Elders in U.S.; Medicare and Long-COVID; Surviving End-Stage Poverty; Geriatrician Shortage; Assisted Living’s Bad Algorithms; & MORE


E-News of the Journalists Network on Generations.  

April 23, 2024 — Volume 31, Number 4

EDITOR’S NOTEGBONews, e-news of the Journalists Network on Generations (JNG), publishes alerts for journalists, producers and authors covering generational issues. If you have difficulty getting to the full issue of GBONews with the links provided below, simply go to to read the latest or past editions. Send your news of important stories or books (by you and others), fellowships, awards or pertinent kvetches to GBO News Editor Paul Kleyman. []. To subscribe to at no charge, simply sending a request to Paul with your name, address, phone number and editorial affiliation or note that you freelance. For each issue, you’ll receive the table of contents in an e-mail, so just click through to the full issue at GBONews does not provide its list to other entities. NOTE ALSO: Some news links below hit paywalls and are inaccessible without subscriptions, although a number of those do allow free access to the first few stories.

In This IssueIt’s Shakespeare’s Birthday With Sound & Fury Signifying Nothing But Orange.

1. GOOD SOURCES: *** The National Council on Aging to host 7th Older Adult Mental Health Awareness Day Symposium online, May 2.

2. THE STORYBOARD: *** Over the Threshold: America’s Unhoused Older Adults,” (Part 1) by Katie Scarlett Brandt, Chicago Health Magazine/Caregiving Magazine, *** “Over the Threshold: Women and Homelessness,” (Part 2);

*** “Asian Indian Elders Yearn For ”Apnapan’ (Belonging) As They Age In America,” (Part 1, Aging in America Series) by Meera Kymal, India Currents, Part 2 “Leaving A Legacy Like A Dewdrop On A Lotus Leaf’ – Asian Indians Redefine Aging In America”;

*** “Does Medicare Cover Long COVID?” (Part 1) by Kate Ashford, NerdWallet, (Part 2) “How Does Long COVID Affect Your Retirement Planning?”;

*** “Research finds older adults with creative outlets may age better,” by Kristen Senz, (Bloomington, Ind.) Herald-Times;

*** “California Seeks to Address the Needs of the LGBTQIA+ Community as They Age,” by Christina Nooney, KALW Public Radio;

*** “Study finds treating self-neglect among older adults can prevent later abuse,” by Rose Lundy, The Maine Monitor

*** “Ageism Unveiled: Embracing Authentic Beauty in the Era of Anti-Aging,” by Anjana Rajbhandary, NepYork(Nepali media news);

*** “Biden and members of Congress work to reduce cost of diabetes medication for all,” (Part 1) by Deborah BaileyAFRO News

3. EYES ON THE PRIZE: *** Deadline to Apply for the 2024 Elections Journalism Fellowship of the National Press Foundation (NPF), May 27; 

4. MORE STORYBOARD: *** “Many Patients Don’t Survive End-Stage Poverty,” Op-Ed by Lindsay Ryan, MDNew York Times

*** “Assisted living managers say an algorithm prevented hiring enough staff,” by Douglas MacMillan and Christopher RowlandWashington Post;

*** “Green Houses: A communal approach to elder care,” by Liz Seegert, (Association of Health Journalists “Aging” blog);

*** “Finding a doctor who specializes in senior care is hard. Here’s why.” by Carly Stern, Washington Post;

*** “The Burden of Getting Medical Care Can Exhaust Older Patients,” by Judith Graham, KFF News.


*** The National Council on Aging will host the 7th annual Older Adult Mental Health Awareness Day Symposium, May 2, from 10 a.m. to 5 p.m. Eastern/7 a.m. to 3 p.m. Pacific Time – with session recordings to be sent to registrants post-conference (good for non-early risers out West).

The event is free to all. Substantive sessions will cover the latest research and best practices on such compelling issues as food insecurity among elders, substance abuse, and recent studies on “what works” in suicide prevention. A session on grandparents raising their grandkids – will spotlight “key findings from Generations United’s 2023 report, “Building Resilience: Supporting Grandfamilies’ Mental Health and Wellness.” There’s much more, so check out the day’s full Agenda.

The morning will start at 10:00 a.m. EST with a conversation between keynoter, Jenifer Lewis, a star of TV’s innovative show Black-ish and many others, with NCOA President & CEO Ramsey Alwin. Lewis wrote the bestselling memoir, The Mother of Black Hollywood (Harper Collins) named “2018 Book of the Year” at the National Book Club Convention. 

Gen Beat reporters can send questions or contact speakers through Laura Plunkett, Associate Director, Center for Healthy Aging: (571) 527-3915; Co-sponsoring the conference with NCOA are the U.S. Administration for Community Living, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration.

*** “Minority Aging: Major Impact” is a video 1-hour recording of the expert webinar produced by the Journalists in Aging Fellows Program as part of our ongoing educational series for reporters in aging.  It was held on April 16, 2024, for current and past fellows and is now available to all via YouTube. 

The SpeakersFernando Torres-Gil, PhD, FGSA, Professor Emeritus of Social Welfare and Public Policy, UCLA Luskin School of Public Affairs; and former Assistant Secretary for Aging, U.S. Administration on Aging. VJ Periyakoil, MD, Stanford Medical School Associate Dean of Research (Geriatrics and Palliative Care); Founding Director, Stanford Palliative Care Education & Training Program; and Founding Director, Stanford Resource Center for Minority Aging Research. Joseph Betancourt, MD, MPH, President, The Commonwealth Fund; Associate Professor of Medicine, Harvard Medical School; Founding Director, Disparities Solutions Center, Boston. 

The Context: “People over age 65 will soon outnumber those under 18 and in just a few decades, the nation will have more non-white than white residents, according to U.S. Census Bureau predictions. The aging population, especially minority aging, holds huge implications for health care, retirement and policy issues, such as Medicare and Medicaid. Older minorities tend to have more chronic conditions, less regular access to care, and a smaller nest egg. There will also be fewer caregivers available for our elders, which will impact broad concerns from end-of-life planning to social services and supports.”


Following are stories by some of the reporters selected for this year’s Journalists in Aging Fellows Program, the collaboration between publisher, the Journalists Network on Generations, and the Gerontological Society of America. For this 14th year, the program is being supported by grants from the Silver Century FoundationJohn A. Hartford FoundationArchstone Foundation, the Commonwealth Fund and the NIHCM Foundation, plus a generous contribution from John Migliaccio. 

* * * Over the Threshold: America’s Unhoused Older Adults,” (Part 1 of 4) by Katie Scarlett BrandtChicago Health Magazine/Caregiving Magazine (April 4, 2024): The DekOlder adults face an increased risk for homelessness across the U.S. As many people search for solutions, they’re also asking themselves what it means as a society when we can’t care for our most vulnerable.”

The Lede: “Angel doesn’t need the scars to remind him. He remembers the day it happened, how the man pulled up along Humboldt Park one morning seven years ago, asking if anyone wanted to make a few bucks by helping him move. Angel was in his early 50s at the time, living on and off in the park. He readily agreed to help and hoped to earn enough to get something to eat that day. . . . The man asked Angel to dispose of a box of unwanted items in the alley garbage bins. . . . When Angel stepped on the edge of a pothole instead of on flat ground, he pitched forward. His knee snapped. . . . Angel’s brother and sister-in-law took him in while he recovered, but as happens with many people who live on the streets, follow-up care falls by the wayside against competing demands for basic needs like food, shelter, and water.”

The Stats: “Angel is one of 653,104 people experiencing homelessness in the U.S., according to the 2023 Homeless Assessment Report. The U.S. Department of Housing and Urban Development (HUD) released the report in December. . . . Their findings show that from 2022 to 2023, homelessness increased by 12% in the U.S. . . . Of all people experiencing homelessness in the 2023 count, 138,089 were over age 55. The 2023 report showed overall that older Americans were, in many places, becoming the fastest growing segment of the homeless population. In Chicago, however, their numbers remain steady at about 5% — or 800 people.”

Seniors: “Beth Horwitz is vice president of strategy and innovation at nonprofit All Chicago Making Homelessness History — the central coordinating body around homelessness in Chicago. She sees access to affordable housing as a key challenge. . . .  Older adults . . . tend to be on fixed incomes. ‘So as their housing costs change, they’re at risk of not having enough income to change their costs,’ Horwitz says. ‘You can imagine that if you get an unexpected bill or raised rent, that is imperiling to seniors’ . . . . A triggering event can leave older adults vulnerable to homelessness, too.”

*** “Over the Threshold: Women and Homelessness,” (Part 2 of 4) by Katie Scarlett BrandtChicago Health Magazine/Caregiving Magazine (April 13, 2024): The Dek: Women now make up a larger portion of unhoused Americans — and their role as caregivers plays a part in that risk.” 

The Lede: “For Jill (name changed for privacy), homelessness happened quickly. She and her husband had owned a small wallpapering business in the Boston area. But they moved in with Jill’s mother, who had dementia, so Jill could care for her. Over time, Jill’s husband was diagnosed with cancer. . . They died within three weeks of each other. And three weeks after that, Jill’s cat died. Jill eventually lost their home and ended up at a homeless shelter for the first time in her life.”

The Research: “[Jill] shared her story with Judith Gonyea, PhD, professor at the Boston University School of Social Work. Gonyea has worked for decades towards helping people achieve “secure old age” — adequate retirement income, quality healthcare, and affordable housing. Unhoused women today make up 38% of the homeless population, up from 5% in 1980. The population overall is growing older, too. In 1990, for example, the average age of the homeless adult population was 35. Today, it’s 50.”

Quotes: “‘A lot of the women’s stories speak to this caregiving role. The loss of a caregiving relationship — this social connection and bond — becomes the unraveling of their lives,’ Gonyea says. . . . ‘We think of women as the ones who maintain the home and who are the nurturers. So when we see women not maintaining this ideal, they’re stigmatized, marginalized, seen as deviant.’ Gonyea says that while the big-picture causes of poverty tend to be the same for men and women, women find themselves in those circumstances more frequently.”

The Risks: “ ‘A lot of women who have never been poor in their lives become poor,’ says Cindy Hounsell, JD, president of the nonprofit Women’s Institute for Secure Retirement (WISER). Hounsell has dedicated her work to setting women on a course to protect their financial future.”

Options: “Hounsell says one option women have is to stay in the workforce for longer. ‘That’s going to give you money. I don’t like it as a solution, and some people can’t do that.” However, she sees at least one added benefit: “A lot of times the women who keep working aren’t isolated’. . . . Yet, for people currently retiring at 65, Social Security predicts they will live 20 more years. And while Social Security pays the average retiree about $1,800 a month, the average household of someone over age 65 spends upwards of $4,300 monthly.”

*** “Asian Indian Elders Yearn For ”Apnapan’ (Belonging) As They Age In America,” Part 1–Aging in Americaby Meera KymalIndia Currents (April 12, 2024): The Dek – “Asian Indian elders seek a place to call home as America faces a looming caregiver gap.” 

The Lede: “Anyone who knows Seetha Appana calls her feisty. In her lifetime she’s carved out a successful career in hospital administration, run a single-parent household – no easy feat in conservative 1960s India, and survived several health threats of her own, including heart failure. Today, at 96, she is the beloved core of her family unit in upstate New York. . . Thirty-one years ago, [she] arrived in the U.S. from Chennai, India, to live with her daughter and family. . . . In Eastern collectivist societies, older parents reunite with adult children.” 

A Quote: “‘For elders of Indian origin, finding Apnapan –  a sense of belonging – is a key component of ensuring wellbeing as they age,” says Annapurna Pandey, an anthropologist at the University of California, Santa Cruz. . . . Her study “Getting Old in North America: The Dilemmas of Diasporic Indians” in Culture Change in India (March 2024), analyzed two waves of Indian immigrants – the generation that arrived as students in the late 1960s and early 70s and, the later life immigrant parents like Appana, who after retirement or death of a spouse, joined their adult children in the U.S. . . . According to Pandey, . . . the professionals who moved to the U.S. in the 1960s showed more competency in leading a life in America, while those who came later relied more on their adult children in learning to acculturate to an American lifestyle.”

More Research: “Another study on Asian Indian American Older Adults edited by VJ Periyakoil, MD, Stanford University School of Medicine, describes these later-life Indian immigrants who join U.S.-based adult offspring  as ‘followers of children.’ It reports that almost 14,000 individuals older than 60 immigrated to the U.S. from India in the late 1980s and early 1990s to live with their grown-up sons and daughters. . . . ‘The grandparents’ role in raising the children is highly respected, and they form the linkage to the Asian Indian culture, religion, and heritage,” reports the . . . study, describing the intergenerational setting common to many Asian-Indian immigrant families, where family members pitch in to provide care.”

The Stats: “Indians, one of the fastest-growing ethnic groups in the U.S. today, represent the second-largest U.S. immigrant group with a current population of  4.8 million.  Thirteen percent of Asian-Indians are over the age of 65, reflecting the demographic trends and needs of the aging American population.”

A Solution: “Few families can afford the exorbitant price tag of private health care. The lack of culturally competent caregivers and associated high costs puts an exhausting burden of care back on families. . . . ‘We know there’s a shortage of caregivers,’ says Mahesh Nihalini, who suggests that one solution is for the U.S. to tap into the global labor force and give visas to trained caregivers from other countries.”

* Also read Meera Kymal’s  Part 2– “Leaving A Legacy Like A Dewdrop On A Lotus Leaf’ – Asian Indians Redefine Aging In America” (April 18, 2024): The Dek“Asian Indians are shaping a cross cultural view of successful aging in America.”

Findings: “Anthropologist Annapurna Pandey from the University of California, Santa Cruz, offers insights into the changing life experiences of older Asian Indian immigrants. Her study “Getting Old in North America: The Dilemmas of Diasporic Indians” in Culture Change in India (March 2024), found that attitudes and expectations were shifting away from the traditional views of the Indian philosophy of life towards a new vision of better aging.”

A Quote: “ ‘My research shows they don’t want to admit they are old,’ says Pandey. Instead, changing attitudes among aging Asian Indians blend the collectivist values of the East with a Western individualist view for a more challenging, but less passive path into the future.”

*** Does Medicare Cover Long COVID? (Part 1 of Series) by Kate AshfordNerdWallet (March 14, 2024): The Dek: Medicare covers the symptoms of long COVID, but your access to specialists may vary.”

The Lede: “Nearly 1 in 4 adults age 65 and over who have had COVID-19 have experienced long COVID symptoms afterward, according to data from the U.S. Census Bureau. Long COVID includes a wide list of lingering health problems that may occur at least four weeks after being infected with COVID-19, according to the Centers for Disease Control and Prevention.” 

The Rub: “If you have Original Medicare, you can see any specialist anywhere in the country who accepts Medicare coverage. . . On the flip side, Medicare Advantage, which is sold by private health insurance companies, usually requires members to get their care from providers and facilities within a network, which may be restricted to a geographic area. . . For this reason, it’s important to check a Medicare Advantage plan’s network before you sign up so you can make sure your doctors — and any specialists you want to see — are included.”

Options: “If you have a plan that allows you to see out-of-network providers, such as a PPO plan, you may be able to see a specialist who isn’t in-network and pay more out of pocket. If you have an HMO plan that doesn’t allow you to seek care out-of-network, you may be able to request a prior authorization or gap exception from your insurer to have the medical provider billed at in-network rates. Take note: This is a high bar to clear. . . In the end, it may be easier to switch to a plan that includes that doctor in-network, enroll in a PPO plan that allows you to go out-of-network, or return to Original Medicare.”

Medigap:If someone with long COVID is signing up for Medicare for the first time, . . . consider Original Medicare with a Medicare Supplement Insurance, or Medigap, plan. ‘It is market specific,’ says [Garrett Ball, owner of Secure Medicare Solutions, an independent Medicare insurance agency]. ‘You still have to weigh the premiums versus the benefits of different types of plans.’” 

* Kate Ashford’s Part 2 — How Does Long COVID Affect Your Retirement Planning? (April 1, 2024): The DekLiving with long COVID reinforces that a successful retirement plan must hold up to unexpected illness.” (See Part 1: Does Medicare Cover Long COVID?”.)

A Key Stat: “Almost 1 in 5 adults age 50 and over say they’ve had symptoms of long COVID, according to a 2023 survey from AARP. Common effects include fatigue, brain fog, difficulty breathing, anxiety, depression and gastrointestinal issues, and 39% have had symptoms for a year or more.”

A Quote“ ‘So many people got infected with COVID, you have a much bigger number of people who are infected with a significant chronic disease,’ says Carolyn McClanahan, a physician-turned-certified financial planner in Jacksonville, Fla. At the heart of the matter, long COVID isn’t unique in the way it impacts your retirement strategy — but it does reinforce that a successful retirement plan must hold up to unexpected illness.”

Be Prepared: Ashford’s article outlines six proactive measures retirees should take in case of an unexpected long illness. For example: 1) ‘You may want to have as much as six to 12 months of savings set aside.’ And 2) “A basic estate plan . . . helps ensure that if you’re incapacitated or unable to speak for yourself, your health and your affairs will be handled the way you want them to be. . . . [Also] write a letter of intent that puts their wishes down on paper, such as the goals behind their estate plan or how they’d like the end of their life to go.” 

*** “Research finds older adults with creative outlets may age better,” by Kristen Senz, Bloomington, Ind. Herald-Times (April 19, 2024): 

The Lede: “Throughout his music career, Ray Major played traditional music for fun and to make a buck. He never intended to preserve German American cultural heritage or insulate himself against the downsides of aging. But with his harmonica and his curiosity, he ended up doing both. . . . Jon Kay, an Indiana University professor and director of Traditional Arts Indiana (TAI), chose Major to record the latest installment of TAI’s Elder Music Series.”

Research to Practice: “Kay, a folklorist and associate professor in IU’s folklore and ethnomusicology department, works in the fast-growing field of creative aging. He studies how creative expression helps people as they age. . . . Research points to creative practice — not just art and music, but also hobbies like gardening, knitting, and cooking — as important tools for staving off isolation, boredom, and helplessness later in life. ‘I tell people it’s kind of like saving for retirement. The best time to start is when you’re 18; the second-best time is today,’ Kay said. ‘We need to invest in ourselves.’”

Practice to Production: “As part of the state-funded Elder Music Series project, Kay produces several hundred CDs of each recording and hosts a release party where CDs are given away to friends and community members. Major’s release party will be part of Strassenfest in Jasper, Ind., this summer. Through these events, and the creative aging summits he hosts around the state, Kay hopes to highlight creative expression as an important component of resilience.”

California Seeks to Address the Needs of the LGBTQIA+ Community as They Age,” by Christina NooneyKALW Public Radio (March 26, 2024, 28-minute listen): The Dek: “What does it mean to grow old in California when you are LGBTQIA+? We’ll discuss a California survey designed to understand and address the needs of this community as they age with Susan DeMarois, Director of the California Department of Aging and Openhouse Executive Director Kathleen Sullivan.” Link to SurveySurvey of LGBTQIA+ Older Adults in California: From Challenges to Resilience.”

*** Study finds treating self-neglect among older adults can prevent later abuse,” by Rose LundyThe Maine Monitor (March 24, 2024): The Dek — “Researchers point to an advocacy program in Maine that works with AdultProtective Services as one solution to preventing exploitation.”

The Lede: “A few years ago, Adult Protective Services put Polly Madson Cox in touch with an older woman who was neglecting herself. She lived alone, struggled to meet her basic needs and was on the verge of eviction. Madson Cox, who was an advocate with the Elder Abuse Institute of Maine, worked with the woman to try and find a way to stay in her apartment. . . . Madson Cox soon learned this person was exploiting her, controlling her medications, ability to leave the house and her finances.”

Research: “A recent study found this is a common problem. An analysis of Maine APS [Adult Protective Services] investigations published online . . . by the Journal of the American Geriatrics Society found that older adults who neglect themselves often experience other mistreatment at the same time and are at risk of further abuse.”

A Quote: “Said the study’s lead author, Dr. Stuart Lewis, an associate professor at Dartmouth’s Geisel School of Medicine. ‘Self-neglect is a huge unmet need in elder mistreatment.’ Self-neglect, which makes up half of APS investigations nationally, occurs when someone no longer has the capacity for self-care. Often this means failing to eat appropriately, care for their home, maintain good hygiene or manage their financial affairs, according to the 2021 Adult Maltreatment Report by the U.S. Department of Health and Human Services.”

More Stats: “To examine how self-neglect relates to other forms of mistreatment, researchers analyzed nearly 18,000 Maine APS investigations . . . The study found that . . .  almost 40 percent of elder mistreatment cases began with self-neglect. . . , Lewis said.”

National Approach: “The study was conducted using Maine APS cases collected during a pilot program of the RISE model. . . . is a new national approach . . . that reduces harm while respecting the individual’s autonomy.”

***  Ageism Unveiled: Embracing Authentic Beauty in the Era of Anti-Aging,” by Anjana RajbhandaryNepYork (Nepalese media news, March 18, 2024): 

The Lede: “As a beauty writer focusing on skincare, I cannot count the number of times I have used the term ‘anti-aging’ automatically in all my articles because it’s the most popular and commonly used word that is synonymous with describing fewer fine lines and wrinkles on smoother, brighter, and firmer skin—basically meaning younger-looking skin. Recently, there’s been a lot of discussion on accepting aging because celebrities are speaking up about it. . . . Still, the popularity of anti-aging products is growing exponentially because the global anti-aging market will hit $83.2 billion by 2027 (per Globe Newswire). 

A Quote: “I attended a talk by Dr. Tracey Gendron on “Ageism” at the 2023 Gerontological Society of America (GSA) Annual Scientific Meeting . . . In Gendron’s book “Ageism Unmasked: Exploring Age Bias And How To End It,” she describes ageism as ‘thoughts, beliefs, and attitudes’ we have about people based on their age that can lead to stereotyping, prejudice, and discrimination. . . Attending Gendron’s talk and reading her book made me question my views and biases on aging.” 

Research: “In a 2019 study, “Ageism and Health in Patients Undergoing Cosmetic Procedures,” over 30% cited age for daily discrimination, . . . Those who felt discriminated against on the basis of age also had ‘worse self-rated health, lower self-esteem, and greater anticipated age-based discrimination.’”

Practice: “I spoke with facial plastic surgeon Dr. Sarina Rajbhandari, and she said the most common cosmetic procedure in Kathmandu, Nepal, is rhinoplasty between the ages of 18 and 30. “Most patients come in because they spend too much time on social media where filters set up unrealistic expectations and people are too aware of their appearance,” she said. Sometimes, Dr. Rajbhandari gets parents who bring their children or husbands who bring in their wives for surgery, and she turns them away. . . Dr. Rajbhandari concluded, “It’s important for people to have realistic expectations so they do not get too carried away by what they see online.” 

*** “Biden and members of Congress work to reduce cost of diabetes medication for all, (Part 1 of Series)by Deborah Bailey, AFRO News (“The Black Media Authority,” Washington-Baltimore, April 2, 2024): 

The Lede: “Diabetes remains at the top of the list as the White House and members of Congress fight to lower prescription drug costs for all diabetic patients. For the second year in a row, President Joseph Biden used this month’s State of The Union address to emphasize his administration’s vow to cap insulin prices at $35 per month.” 

The Cost: “Spending on insulin in the US rose astronomically in the past decade, from $8 billion in 2012 to $22.3 billion in 2022,” said Charles “Chuck” Henderson, CEO of [the American Diabetes Association (ADA)] . . . Professional policy advocates like Henderson have combined forces with patient advocates and everyday citizens . . . Together, they have pushed the Biden administration and Congress to move toward insulin affordability for the 8.4 million Americans who need it each day to survive.   

A Quote: “ ‘Instead of paying $400 a month for insulin, seniors with diabetes only have to pay $35 a month. And now I want to cap the cost of insulin at $35 a month for every American who needs it,’ Biden said [in the State of the Union], referring to the $35-a-month cap made possible through the Inflation Reduction Act (IRA).”

But: “Last year, the IRA capped insulin prices at $35 per month for Medicare part D [prescription drug plan] enrollees in January 2023. Medicare Part B enrollees began receiving the benefit in July 2023. Pharmaceutical corporations began stepping up as well to announce their own price caps on insulin. In March 2023, Eli Lilly was the first major pharmaceutical firm to announce a program to reduce the listing price for insulin and expand a $35 price cap. . . Patients will still pay more than the $35-a-month price cap without insurance reductions or other discounts.”

For Whom: “More than 38 million Americans are diabetic with 90 percent of those cases being Type 2 Diabetes, according to the Centers for Disease Control and Prevention (CDC).  This is one in 10 Americans.”

For Black Americans: “Black adults develop diabetes at nearly twice the rate of our White counterparts with the greatest disparity being between Black women and White women who develop Type 2 Diabetes. ‘Type 2 Diabetes has become America’s quiet epidemic,’ said Erika Walker Williams, assistant professor and diabetes specialist in the department of internal medicine at University of Texas, Southwestern in Dallas. Black adults are hospitalized due to complications with diabetes at more than twice the rate of Whites; three times more likely to be diagnosed with end-stage renal disease, and twice as likely to die from the illness as our White Counterparts, based on data from the U.S. Department of Health and Human Services Office of Minority Health.”


*** Deadline to Apply for the 2024 Elections Journalism Fellowship of the National Press Foundation is May 27. NPF stresses, “States are scrambling to guard their operations against cyberattacks and disinformation campaigns. Local election administrators and poll workers – the increasing targets of harassment and threats – are bracing for a new storm as November draws near. The election also represents a decisive moment for journalism, facing a public confidence crisis of its own. To help meet the challenge, the National Press Foundation will hold a training conference in Detroit, Mich., July 28-30. This three-day training will be a deep dive on covering elections themselves, not horse-race politics.” 

NPF adds that they “particularly seek applications from local and nonprofit news organizations, Black, Indigenous and other journalists of color; and those who do public interest reporting in undercovered areas.” Also, “The foundation will cover airfare, hotel costs and most meals.” 


*** “Many Patients Don’t Survive End-Stage Poverty,” Op-Ed by Lindsay Ryan, MD, New York Times (April 11, 2024): The Dek:“Ryan is an associate physician at the University of California, San Francisco, department of medicine.” 

The Lede: “He has an easy smile, blue eyes and a life-threatening bone infection in one arm. Grateful for treatment, he jokes with the medical intern each morning. A friend, a fellow doctor, is supervising the man’s care. We both work as internists at a public hospital in the medical safety neta loose term for institutions that disproportionately serve patients on Medicaid or without insurance. You could describe the safety net in another way, too, as a place that holds up a mirror to our nation.”

The Upshot: “With a clear voice, he tells [the doctor] that if his arm must be amputated, he doesn’t want to live. She doesn’t understand what it’s like to survive on the streets. . . . With a disability, he’ll be a target — robbed, assaulted. He’d rather die, unless, he says later, someone can find him a permanent apartment. In that case, he’ll proceed with the amputation. The psychiatrists evaluate him. He’s not suicidal. . . . In San Francisco far more people need long-term rehousing than the available units can accommodate. . . .He transitions to hospice and dies. A death certificate would say he died of sepsis from a bone infection, but my friend and I have a term for the illness that killed him: end-stage poverty. . . . So many of our patients die of the same thing.”

The Media: “I love reading about medical advances. I’m blown away that with a brain implant, a person who’s paralyzed can move a robotic arm and that surgeons recently transplanted a genetically modified pig kidney into a man on dialysis. . . . But breakthroughs like these won’t fix the fact that despite spending the highest percentage of its G.D.P. on health care among O.E.C.D. nations, the United States has a life expectancy years lower than comparable nations—the U.K. and Canada— and a rate of preventable death far higher.”

“The Solution to that problem is messy, incremental, protean and inglorious. It requires massive investment in housing, addiction treatment, free and low-barrier health care and social services. It calls for just as much innovation in the social realm as in the biomedical, for acknowledgment that inequities — based on race, class, primary language and other categories — mediate how disease becomes embodied. If health care is interpreted in the truest sense of caring for people’s health, it must be a practice that extends well beyond the boundaries of hospitals and clinics.”

*** “Assisted living managers say an algorithm prevented hiring enough staff,” by Douglas MacMillanand Christopher RowlandWashington Post (April 1, 2024): The Dek:  “The nation’s largest assisted-living chain uses a staffing algorithm; some managers say they quit or were fired after they complained it left facilities dangerously short-handed.”

The Lede: “Two decades ago, a group of senior-housing executives came up with a way to raise revenue and reduce costs at assisted-living homes. Using stopwatches, they timed caregivers performing various tasks, from making beds to changing soiled briefs, and fed the information into a program they began using to determine staffing.”

The Consequence: “Brookdale Senior Living, the leading operator of senior homes with 652 facilities, acquired the algorithm-based system and used it to set staffing at its properties across the nation. But as Brookdale’s empire grew, employees complained the system, known as ‘Service Alignment,’ failed to capture the nuances of caring for vulnerable seniors, documents and interviews show. . .

“In emails and phone calls to Brookdale executives, building managers repeatedlycomplained that the company’s algorithm underestimated the amount of labor they needed to meet resident needs, according to court records, internal company documents reviewed by The Washington Post and interviews with more than 35 current and former Brookdale employees.”

In Court: “In two civil lawsuits against Brookdale — one in Tennessee, one in California — a dozen residents or relatives of residents claim they suffered due to short-staffing caused by an overreliance on algorithms. . . . Brookdale spokeswoman Jackie Dickson disputed the allegations in the lawsuits and saidthat Brookdale empowers local facility managers to set staffing levels as they see fit. Last year, a federal judge denied class-action certification for some of the claims in the California lawsuit, in part because plaintiffs failed to show that facilities are ‘similarly staffed.’”

The Gap: “There are no federal laws regulating assisted-living facilities, and only 13 states require staffing minimums. . . . The problems of understaffing and questionable levels of care pervade the assisted-living industry. Since 2018, more than 100 residents died after wandering away from such facilities or being left unattended outside, a Postinvestigation found.

Brookdale, Sunrise and Atria Senior Living, another top chain, were questioned as part of a congressional committee inquiry into concerns about the costs and quality of care at senior living facilities raised by The Post’sreporting. A spokesman for Sen. Bob Casey (D-Pa.), chairman of the Senate’s Special Committee on Aging, said the companies provided some responses to the lawmakers’ questions but the committee has declined to make them public.”

A Quote: “ ‘Such rigid systems canfail for tasks with wide variability,’ said Carri Chan, a Columbia Business School professor who researches health-care management and operations. ‘When you are taking care of patients, all of whom have unique needs, there is going to be a lot of variation,’ she said.”

WaPo’s Ongoing Coverage: “The Washington Post is continuing to report on the assisted-living industry, and we want to know your experiences with elder care, assisted living and dementia care. Tell us about your experience here.” Doug MacMillan is a corporate accountability reporter for The Washington PostChristopher Rowlandpreviously covered health care for the Globe in Boston.

*** “Green Houses: A communal approach to elder care,” by Liz Seegert, (April 2, 2024, Association of Health Journalists “Aging” blog): 

The Lede: “Most older adults don’t want to live out their days in a traditional nursing home. But when an elder with serious health issues needs 24/7 care, it might be the only option. Family caregivers may not have the wherewithal to cope, and the monthly median cost of around-the-clock home care services — 168 hours per week — tops $24,000. Another long-term care option is gaining popularity: Green Houses. These elder-centered, long-term care residences are smaller than most long-term care facilities and designed to look like and feel a typical residential home. Green House homes support about a dozen residents at a time, but units are often grouped together, so people feel like part of a community.” 

Effectiveness: “Since their launch in 2003, Green Houses have generated greater resident and family satisfaction, lower staff turnover, better overall clinical outcomes, improved quality of life, and lower mortality rates during the first two years of the COVID-19 pandemic, according to a report from the AARP Public Policy Institute. There are nearly 400 Green Homes in 35 states and Australia. . . . As the AARP report noted, “residents can get what is essential for them and what is important to them.” 

Findings: “Green Houses are licensed as either stand-alone nursing facilities, or they can be part of an established, traditional long-term care institution, wrote Charles Sabatino, former director of the American Bar Association Commission on Law and Aging, in an April, 2023 article in Health Affairs. Staff, particularly certified nursing assistants, are cross-trained, and are empowered to work as a team to help residents reach their personal goals, he wrote. Not only does this approach give residents a greater sense of control over their lives, but it helps reduce staff turnover and boost job satisfaction.”

*** “Finding a doctor who specializes in senior care is hard. Here’s why.” by Carly SternWashington Post(March 17, 2024): The DekResearch suggests geriatricians more effectively manage older patients’ care, but several factors dampen interest in the field.”

The Lede: “Pat Early, 66, has lived with the autoimmune disease Sjogren’s syndrome since her 30s. She must rely on a stable of specialists — a rheumatologist, gastroenterologist, endocrinologist, ophthalmologist and the like — to manage the fatigue, muscle pain and other complications of the disease, all helmed by her longtime primary-care doctor. When that doctor started cutting back his staff, she began searching for someone new and stumbled across a medical practice of geriatricians — doctors who specialize in patients over age 65. Early didn’t consider herself old, so ‘it never even crossed my mind that that’s something I should be looking at,” she said. But she’s grateful for the switch.’”

The Limits: “People over 65 use more health care than other age groups and make up nearly half of hospital admissions. But there are just 7,300 board-certified geriatricians in the United States, which is fewer than 1 percent of all physicians, according to the American Geriatrics Society. By contrast, more than 60,000 pediatricians were practicing in 2021, according to the Association of American Medical Colleges (AAMC).”

The Stats: “Yet research suggests that geriatricians more effectively and efficiently manage older patients than doctors without such training — leading to lower inpatient death rates, shorter hospital stays and reduced patient costs. Right now, the United States has roughly 1 geriatrician for every 10,000 older patients. Only 41.5 percent of geriatric medicine fellowship positions were filled in late 2023, down from 43 percent in 2022. Meanwhile, the number of people over 65 is expected to grow by nearly 40 percent within the decade.

A Quote: “ ‘The vast majority of older people are getting care from people who have little to no training in the care of older adults,’ said Louise Aronson, a professor of geriatric medicine at the University of California at San Francisco and the author of [the 2020 Pulitzer Prize Finalist]  Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life.”

How Come? “This shortage stems from negative stereotypes about aging, lack of exposure to the field among doctors and lower pay than many other medical specialties, experts say, and can lead to doctors misdiagnosing symptoms or overprescribing drugs that can cause cognitive impairment or other issues in older patients. ‘It is dire,’ Aronson said.”

*** “The Burden of Getting Medical Care Can Exhaust Older Patients,” by Judith GrahamKFF News (March 27, 2024): The Dek: “Susanne Gilliam, 67, was walking down her driveway to get the mail in January when she slipped and fell on a patch of black ice. Pain shot through her left knee and ankle. After summoning her husband on her phone, with difficulty she made it back to the house. And then began the run-around that so many people face when they interact with America’s uncoordinated health care system.”

The Real Cost: “The toll the American health care system extracts is, in some respects, the price of extraordinary progress in medicine. But it’s also evidence of the poor fit between older adults’ capacities and the health care system’s demands.”

A Quote: “Ishani Ganguli, an associate professor of medicine at Harvard Medical School:

‘It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests,’ she said. . . Ganguli is the author of a new study showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms, or spending time in the hospital or rehabilitation facilities.’”

The Burden: “Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minn., has for many years raised an alarm about the ‘treatment burden’ that patients experience. . . .

Four years ago — in a paper titled “Is My Patient Overwhelmed?” — Montori and several colleagues found that 40% of patients with chronic conditions such as asthma, diabetes, and neurological disorders ‘considered their treatment burden unsustainable.’”

The Journalists Network on Generations (JNG), founded in 1993, publishes Generations Beat Online News ( JNG provides information and networking opportunities for journalists covering generational issues, but not those representing services, products or lobbying agendas. Copyright 2024 Paul Kleyman. For more information contact GBO Editor Paul Kleyman. 

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