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Some providers, however, are working to make a difference. Mobile optometrist Dr. Matt Broberg based in Kansas City, Missouri, and Lafayette County Community Health Worker (CHW) Shelly Harden prioritize patient needs and continuously connect people to resources. Both providers, one providing care to seniors living in urban areas and the other serving seniors in rural communities, highlighted the specific challenges senior patients face when accessing healthcare and their suggestions to reach future solutions. Affordable Accessibility Transportation is a main concern for many elderly patients, especially during the COVID-19 pandemic as seniors fear higher chances of catching the virus while in public. While Dr. Broberg originally focused solely on homebound patients, the increase in demand due to COVID-19 closures and fears led him to take home visits starting in March for the comfort of his patients not wanting virus exposure. While public transportation options may be available, they are not always realistic. Buses and the free Kansas City streetcar are helpful, but still pose logistical problems for seniors when pick-up locations are not within walking distance. He also pointed out that in some of his patients' experience, public transportation options aren't reliable and may make someone late to their appointment or miss it altogether, which can cause fees to pile up due to offices' late/cancellation policies. He has seen multiple people diagnosed with glaucoma stop treating themselves because of how much they accrued in extra fees simply from transportation issues. Glaucoma, a disease in the back of the eye, can lead to blindness and irreparable loss of peripheral vision if untreated. While he makes a point to immediately halt damage, start treatment, and closely monitor progress, "there is definitely going to be irreversible damage no matter what if they go that long untreated." Harden, who has worked with the Health Care Collaborative (HCC) of Rural Missouri for three years and been in social work for 25 years, sees how transportation causes access barriers to care for seniors. While Medicaid provides a transportation service for patients, sometimes they will drop a ride and patients are left to find their own replacement, which may not provide enough time to find a ride before late or cancellation fees accrue. Harden has also noticed patients avoiding routine care simply due to fear of COVID- 19 and worries what this could mean for their health in the future, fearing it could "cause more issues than not." Loss of Insurance A third of Dr. Broberg's patients have insurance benefits for glasses that need to be used by the end of December, and likely can't afford glasses out of pocket, but are refusing to be seen out of fear. He has continued to refill glaucoma drops and other prescriptions and even considered contacting insurance companies to see if there were alternatives to provide extended patient benefits. Harden, a certified application counselor for the Affordable Care Act, said finding patients insurance is the first thing she does as a CHW. "That way they can get the medical attention they need – a lot of the time that's what hinders them getting to a doctor or their medications." If patients come into one of HCC's Live Well Community Health Centers seeking care and do not have insurance, she first screens them for Medicaid, then the marketplace, and finally checks HCC's sliding pay scale to find the best option. According to Harden, there are also issues with insurance throughout home healthcare, including difficulty finding someone Medicaid will pay to help with daily chores and care. Some agencies require patients to find the home care individual themselves, which can be daunting if they don't know anyone in the area. While providers like Dr. Broberg are working to expand care to homebound patients, advocates such as ombudsmen help long-term care facility residents know and understand their rights, empower them to resolve complaints, and help ensure they are receiving the best possible care. Seniors considering or currently staying in long-term care facilities are encouraged to connect with an ombudsman and ensure their care meets their needs. Advocacy for the Elderly One of the greatest issues seniors face when accessing healthcare, according to Dr. Broberg and Harden, is a lack of advocacy for their comfort and well-being throughout the whole process. "You look at how the country is handling coronavirus and everyone is saying 'if people over 65 are affected, who cares' – that's kind of how we're treating seniors in health care, too," Dr. Broberg said. "They don't have money, they're older, who cares. It's a trend across everything – people don't care about seniors, especially poor seniors." Recently, a group of doctors who help homebound patients in the KC metro area closed, leaving their patients with little more than a letter with a phone number to call with questions. "These 600-plus patients have no idea where to go, just because they weren't given the resources." While Dr. Broberg has either helped serve these patients or directed them to another physician, these patients will likely face delays in scheduling appointments because of the overwhelming demand and a stark lack of providers. To help combat this and other barriers, he and other providers formed a group called Resources Unlimited. The group has about 10 members who provide services to seniors, including someone who helps provide telephones, an occupational therapist, a home health nurse who performs blood pressure checks, an insurance broker who helps with Medicare plans, and more. Prior to COVID-19, Resources Unlimited visited HUD housing to play bingo and other games with seniors and give them goodie bags with resources, "just to let them know that there are all these people who care about them and are here to help them." Harden also advocates for seniors by connecting patients with basic needs such as a bed, heat, and running water – necessities that can negatively affect health if left unmet. "In order to help them get better, you need to work with them on some of the basics that a lot of us take for granted. A lot of times and especially through COVID-19 with income decreasing, having food stamps can help out in that area and they can use whatever money they have on other needs like utilities." As a CHW, she helps patients with food stamp and health insurance enrollment, connecting them with resources to help with utility bills, and a variety of other personal and social care support. One of the best ways Harden believes providers can better advocate for senior patients is to "work with them from where they are" – especially if they are homebound or do not have anyone around to advocate for them. If a patient is not comfortable speaking up or asking questions, especially if they do not agree with or understand the doctor, they may simply choose not to take medication or may take it improperly. "Health literacy instruction is needed basically for anyone, but especially the elderly if they don't have anyone to support them, be with them, help explain care or walk them through it," Harden said. "When you're talking to a client, it's always good to know if they're understanding everything the way it was presented to them. What we may think is important to them or what we may think is their immediate need may be different than what their view is." HCC provides support with transportation, food stamp and health insurance enrollment, as well as health care and mental healthcare services. To learn more, visit hccnetwork.org , livewellcenters.org, or call 660.259.2440. For help comparing nursing homes, to speak with an ombudsman, or to learn more about elder abuse, call Care Connection at 800.748.7826, visit goaging.org, or email information@goaging.org. PAGE 05 January 2021

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