One of the most crucial tools of elder abuse prevention is access to quality, affordable, health care. In 2010 the Affordable Care Act (ACA) expanded health care access to over twenty million people across the country including many older adults. This includes increased access to wellness visits; long term supports and services (LTSS); substance abuse treatment; increased access to behavioral health services; and much more. The Republican controlled Congress, along with President Trump, have made it their mission to repeal the ACA and to radically change Medicaid. While there is great uncertainty about how or when any changes will take place, there is no doubt about the positive impact that increased access to affordable healthcare has on the lives of older adults.
How Does Access to Healthcare Intersect With Elder Abuse Prevention?
Access To Medical Professionals – The ACA greatly increased access for older adults to healthcare providers. This means they now receive routine monitoring for physical, cognitive, and functional problems – all of which can assist in identifying and preventing elder abuse.
The Opioid Crisis – I have written several prior posts on how the opioid crisis has adversely affected so many older adults in Massachusetts and their younger family members as well. One Republican plan would end substance abuse and mental-health coverage that’s now used by at least 1.3 million Americans in the expanded Medicaid program. This is a huge mistake – treatment options are already difficult to come by and this particular change will only increase the costs of the epidemic for some of our most vulnerable citizens.
Self Neglect/Behavioral Health Services – Many older adults who suffer from self neglect are at great risk of losing their home, their income, or face increased risks to their safety or health. Often at the root of self neglect situations are untreated mental health issues. It is difficult now for many older adults to receive quality, accessible, behavioral health services. The threatened cuts would greatly exacerbate this problem and leave many very vulnerable elders with inappropriate, unsafe, and much more costly options such as homeless shelters, nursing home placement, or hospitalization.
LTSS – An accessible LTSS system is critically important in preventing elder abuse. LTSS are often what allows an older adult to stay in their home safely, to receive needed help such as chore services or home care services, and to keep them out of more costly institutions like nursing homes. Medicaid is the primary payer of LTSS, covering approximately two-thirds of all LTSS costs nationwide. Proposed changes to the Medicaid program would put access to LTSS at risk and inevitably lead to less healthy and much more costly outcomes for many older adults.
Expanded access to healthcare through the ACA, along with the many other positive changes to improve the quality of healthcare and produce better outcomes for patients, has been an essential link in promoting elder justice. We don’t know what future changes to the ACA and Medicaid will entail, but it is clear that decreasing access to basic health care services will have a devastating impact on older adults and hinder ongoing efforts to prevent elder abuse.