Lifestyle

America is particularly terrible at taking care of its elderly

Out of 11 wealthy Western countries, the U.S. has the sickest senior citizens.

Americans 65 and older were more likely to be sick than their elderly counterparts in countries like Canada, Australia, Sweden, France and Germany, according to the 2017 Commonwealth Fund International Health Policy Survey of Older Adults, which surveyed between 500 and 7,000 people over 65 in each country. More than a third of them having three or more chronic conditions.

Older Americans also had financial hurdles in relation to their care (23 percent) and didn’t receive the help they needed because they couldn’t afford it (24 percent). Australia came in second for cost-related access issues (scoring 13 percent, and 22 percent on those two measures, respectively). Interviews were conducted over the phone and online between March and June this year.

A quarter of older Americans were concerned about having enough money for necessities, such as housing, utilities, medical needs and nutritious meals, compared with countries like Norway, where just 3 percent said the same, and Sweden, at 4 percent. “That has a lot to do with the safety nets and income disparities,” said Robin Osborn, lead author of the report and director of the international program in health policy and practice innovations at the Commonwealth Fund.

“We know that poverty, food, security, unstable housing, along with things like social isolation and mental health contribute to higher rates of chronic illnesses,” she said. More than 10 percent of respondents in France, the Netherlands, Norway and the U.K. reported living alone and said they felt “socially isolated.” Loneliness is considered as much of a public health hazard as obesity, according to research presented at the American Psychological Association conference in August.

And the prevalence of sicker, older Americans will only get worse, Osborn said, especially as health care costs continue to rise. An American couple retiring this year could expect to spend $275,000 in health care costs throughout their retirement, up 6 percent on last year, according to Boston-based financial services firm Fidelity Investments. Health care is more expensive in the U.S. than the other countries, which will make it harder for American seniors to get the care they need.

How the U.S. differs from other countries in health care:

  • The U.S.’s Medicare system provides universal health insurance to Americans 65 and older, but it comes with premium contributions and cost sharing, as well as potentially high out-of-pocket expenses for prescription drugs.
  • In other countries with universal coverage, such as Canada, the Netherlands and the U.K., there are no deductibles or cost sharing for primary care. France exempts adults with chronic conditions from cost sharing and prescription drug expenses, Sweden caps cost sharing visits at the equivalent of $120 and Germany caps its cost sharing 1 percent of the chronically ill’s income.
  • Older Americans have barriers to receiving social services for their needs, which means they may make more visits to the emergency room and have higher rates of hospitalization.
  • Alternatively, Canada recently announced an investment in home and community-based care. Australia has a program for community-based services that provides a range of services for the elderly, including home care, meals and palliative care. The Affordable Care Act had promised better access to health care and social services to people who were eligible for Medicare and Medicaid, but is currently being dismantled under the Trump administration.

In the U.S., Social Security, a government benefit most seniors are entitled to start collecting at age 62, can help pay monthly bills, though likely not all of them. Programs like Meals on Wheels, which is partially funded by the Department of Housing and Urban Development, as well as local organizations and religious institutions, help the elderly, poor and disabled afford nutritious meals, buy wholesome groceries and help them pay for housing.

But older Americans, in particular, need more: 43 percent of the elderly in the U.S. are considered “high-need,” which means they need help performing daily activities. They are most at risk of developing depression or anxiety, or falling, and yet were 15 times more likely than the elderly in Sweden to skip care because of the cost.