by Joseph Nowinski, PhD and Abigail Jeffries
Should seniors be able to choose a health insurance plan that covers companion care? Might supplementary health insurance vouchers be used to pay either for non-critical medical tests and elective medicines (such as additional diagnostic tests for non-life threatening conditions or prescription sleep aids), or for daily companion care (to include light housekeeping, showers, and food preparation)? Which choice would lead to better quality of life as well as longevity?
Each of us probably can name more than one senior whose lifestyle consists mainly of keeping track of medical appointments and sitting alone in front of the TV rather than engaging regularly in social interaction. At a distance, their wall calendars appear full, implying a busy lifestyle and plenty of contact with others. But up close, the engagements turn out to be dates with a variety of healthcare specialists, or reminders to refill prescriptions.
A major health risk
Whether a result of children growing up and moving away, loss of a spouse, shyness, physical disability, or a combination of factors, loneliness can creep into an elder’s life and accelerate the deterioration of physical and emotional health. In her 2013 New Republic article, “The Lethality of Loneliness,” science editor Judith Shulevitz wrote:
Psychobiologists can now show that loneliness sends misleading hormonal signals, rejiggers the molecules on genes that govern behavior, and wrenches a slew of other systems out of whack. They have proved that long-lasting loneliness not only makes you sick; it can kill you. Emotional isolation is ranked as high a risk factor for mortality as smoking. A partial list of the physical diseases thought to be caused or exacerbated by loneliness would include Alzheimer’s, obesity, diabetes, high blood pressure, heart disease, neurodegenerative diseases, and even cancer—tumors can metastasize faster in lonely people.
Furthermore, Loneliness and boredom can lead to poor self-care behaviors, such as bad eating habits or the consumption of more alcohol than is healthy.
Loneliness is a mounting problem. We know that the population of older Americans is growing rapidly. We also know that many among this growing population live alone.
The U.S. Department of Health and Human Services reports:
The population of persons 65 and over has increased from 35.9 million in 2003 to 44.7 million in 2013 (a 24.7% increase) and is projected to more than double to 98 million in 2060.
About 28% of non-institutionalized older persons live alone.
Almost half of women age 75+ live alone.
We also have data on how little time each day older members of society spend socializing. According to the Bureau of Labor Statistics’ 2014 American Time Use Survey, civilian, non-institutionalized persons age 55 and older spent only 39 minutes (about 10% of their leisure time) of a typical day socializing or communicating. Their main activity was watching TV, which they did nearly 4 hours a day (about 58% of their leisure time).
The companion care gap
Unless they are fortunate to have attentive family members, or are able to take advantage of community volunteer-provided services, many lonely seniors either cannot afford or do not qualify medically for companion care as it exists today. They are left to face what Mother Teresa called “the most terrible poverty,” that of “loneliness, and the feeling of being unloved.”
In September, the New York Times ran a story about what it termed an “epidemic of loneliness” among seniors in the U.S. and Great Britain. The article describes how one 24-hour telephone helpline organization in England receives 10,000 calls each week from isolated elders who call in simply to converse with another human. (“Researchers Confront an Epidemic of Loneliness” by Katie Hafner, Sept. 5, 2016).
Private companion care organizations offer services to alleviate loneliness as well as perform necessary home maintenance tasks, but such services carry an out-of-pocket cost of around $18 per hour. Visiting nurse agencies offer household assistance, but this is intended for home-bound medical patients, and the help ends when the patient is discharged.
Although Medicare pays for medical expenses such as skilled nursing, it does not pay for companion care. Some long-term care insurance may cover companion care services; however, this type of insurance is expensive and may be out of reach for many as they plan financially for their elder years.
More telephone helplines and local volunteer organizations would be welcome supports for lonely seniors, but might we also seek ways to leverage the existing healthcare system to lift elders out of the companion care gap?
Food for thought
In addition to being the concern of a compassionate society, loneliness among the elderly has been demonstrated to pose direct and serious health risks. As we re-examine the Affordable Care Act and look for ways to improve our healthcare system in general, should we consider requiring insurance plans to add an option for seniors that would cover at least a portion of companion care, treating it as any other preventive care service? Might elders be better served, happier, and healthier (thus needing fewer costly procedures and medications) if they simply spent less time feeling lonely?
Joseph Nowinski, PhD is a psychologist and author. For more information visit www.josephnowinski.com
Abigail Jeffries is a freelance writer with a special interest in health and mental health issues. She can be reached at firstname.lastname@example.org