Topics in Health: Lessons From The Field
Reporting on Aging: Health Reform, Ethnicity and Income In The Mix
"If you have your health, you have everything." My grandmother's refrain, and maybe yours, too, might well have been the prime cliché of the baby boomers' youth.
As the United States heads toward the 2012 presidential election, however, concerns about the health of our large and rapidly aging population are colliding with ongoing federal and state budget battles more visibly than ever. Not only are Medicare and Medicaid under fire, but recession-battered state budgets are shrinking safety-net programs that low- and moderate-income elders and their families depend on.
Journalists increasingly need to understand the complexities of how seniors are affected by the Affordable Care Act and other major health policy shifts. Too few reporters have questioned lawmakers about how they would protect lower-income Americans, especially older women and minority elders. Those groups, experts in aging say, will be disproportionately harmed by such measures.
Mainstream Media's "Happy Talk" on Aging
As former New York Times reporter Jane Gross notes in her new book, A Bittersweet Season: Caring for Our Aging Parents-and Ourselves, when she became immersed in caring for her mother, she found herself asking such questions as, "What do you mean Medicare doesn't cover the cost of home care or assisted living or a nursing home?"
The failure of many Americans to understand that Medicare does not cover long-term care is a fundamental failure of communication shared by U.S. media.
Gross, who created and now contributes to the Times' New Old Age blog, lays considerable blame on a national press mired in age denial for leaving the public ill-informed about dealing with the "serial humiliations of advanced old age."
Until recently, Gross writes, mainstream media "offered little or no information to help two generations [elders and their adult children] through this unprecedented and arduous passage. Why is the coverage of old age mostly happy talk-wizened mountain climbers or marathoners; nursing homes that permit, even celebrate, consensual sex?"
Health reporters wishing to get a jump on one of the major stories in aging should heed the prediction of the late social historian Theodore Roszak. In his 2009 book, The Making of an Elder Culture he predicted that the longevity revolution will foment an "elder insurgency." He believed there will be a national rebellion that will begin with "women in their 50s who are getting stuck with elder care for no money," as well as with little help and few ways to cover the often-crushing costs of such care.
Prudent health reporters may well be skeptical about an uprising of the aged, but they'd be wise to listen carefully to Roszak and many others who have stressed that aging is very much a woman's issue. The National Alliance for Caregiving is an excellent source of research on the subject, such as their June 2011 study, Double Jeopardy for Baby Boomers Caring for Their Parents.
Certainly, journalism has seen its own double-dip recession in recent years with the collapse of traditional media business models that preceded the current national economic malaise. So it may seem too much to ask journalists to focus on the policy implications of the health stories they cover. For some, the wonky stuff doesn't come easily. But articles that blandly describe this or that potential cut in Medicare or Medicaid without noting that cutting individual elements of those programs will make little difference to overall health care inflation simply reinforces the wrong message for the public: "Gee, we have to cut somewhere, right?"
As Theodore Marmor, Yale emeritus professor of health policy and author of the essential text, The Politics of Medicare, told me, "The United States has a health care cost problem across all systems, not a Medicare cost problem."
Connecting the Policy Dots
Too often, excellent reporting on the struggles of families and communities to deal with eldercare or elder abuse, for example, fails to connect the dots to legislative or regulatory decisions that might shed light on why these issues persist. That leaves politicians and lobbyists to dominate health care debates with arguments not about appropriate care but about how much to cut this or that budget.
The alarming rise in Medicare and Medicaid budgets that is amplified weekly in national and local media is, frankly, beside the most important point. Reporters need to keep their eye on the medicine ball – the actual quality of health care.
The United States should be improving health care – not restricting it more – by gaining more control over health inflation and establishing a system of continuity of appropriate care for everyone. That includes prevention, acute care, chronic palliative care and long-term care.
Politicians and health policy experts across the political spectrum agree on this goal, although they fervently disagree on how to achieve it. But true continuity of care, not our system of atomized cost and profit centers, is what people care about. It needs to be at the heart of every story, explicitly or implicitly.
Gray in the Rainbow
In addition, a crucial and greatly under-covered aspect of national health security for our aging population lies in America's growing diversity, the basis for important stories crying out for continuing coverage from different angles.
Because most 20thcentury immigration to the United States was reduced to a trickle until 1965, about 80 percent of the huge and aging baby boomer generation is white. On the one hand, that means the heavily ethnic population of younger generations in the U.S. may well balk at being called on to care for white seniors, if American policymakers continue shutting off access to an American Dream that includes health coverage and good careers, not just low-level service jobs like in-home care.
On the other, the proportion of U.S. elders from ethnic backgrounds will double by 2050, from two in 10 now to four in 10 ethnic older adults, according to Steven P. Wallace, of the UCLA Center for Health Policy Research.
For example, Wallace notes one area that has not received much attention: the decreasing family size of the baby boomer and more recent generations. Wallace, a leading researcher for the NIA-funded Resource Centers on Minority Aging Research, says:
A lot of our social policy assumes that there will be plenty of family members around to care for older adults as they begin to need assistance, but families from all races and ethnicities are becoming smaller. Plus, in some communities (especially African American), fewer older adults are still married in old age, which makes support systems even less secure since the first place you turn for help is to your spouse.
Adding to the strain on ethnic elders, Wallace said, is that they are "less likely to have the financial resources to buy the help they need."
Income insecurity was the focus of a report issued in August 2011 by the Greenlining Institute, based in Berkeley, Calif. "The Economic Crisis Facing Seniors of Color", notes:
Currently, disparities pervade healthcare to the point that healthcare is fundamentally unequal. For seniors of color, language and cultural barriers form distinct challenges for a population that often needs complex, intensive healthcare services; and adequate force of healthcare workers with appropriate language and cultural skills will be essential.
Many health reporters in their communities also are well-positioned to give voice to those most directly affected by policy decisions. As Columbia Journalism Review (CJR) health and aging blogger Trudy Lieberman told me, "I'm not seeing enough kitchen-table stories. Health reporters still need to get out there and talk to people. Stop just talking to elites."
General Aging Reporting Resources:
Current Awareness in Aging Research (CAAR) is an email newsletter from the Center for Demography of Health and Aging at the University of Wisconsin-Madison. It includes headlines and titles with hyperlinks to articles, government reports (international), academic and nonprofit research.
Public Policy & Aging E-Newsletter comes from the Gerontological Society of America and its National Academy on an Aging Society. It highlights key developments and viewpoints in the field of aging policy, including articles and reports circulating in the media, academy, think tanks, private sector, government and nonprofit organizations.
Ethnic Aging Reporting Resources:
National Caucus and Center on Black Aged, Karyne Jones, president and CEO. Also, Peggye Dilworth-Anderson, University of North Carolina-Chapel Hill, immediate past president, Gerontological Society of America, E-mail: dilworth [at] email [dot] unc [dot] edu.
National Asian Pacific Center on Aging, Seattle,Wash., Christine Takada,President and CEO, 206.838.8168; Christine [at] napca [dot] org.
Latinos and Economic Security project based at UCLA's Center for Policy Research on Aging [.] A collaboration with USC's Andrus Gerontology Center and other organizations, the project focuses on how public policy will affect Latinos in terms of income, healthcare and related areas. Contact its director, Fernando Torres-Gil, a former head of the U.S. Administration on Aging. Also, Carmela G. LaCayo, President/CEO, National Association for Hispanic Elderly/Asociación Nacional Pro Personas Mayores, Pasadena, Calif. Contact: (626) 564-1988, e-mail: micasact [at] aol [dot] com.
International Association for Indigenous Aging: Dave Baldridge, executive director, and Director, National Indian Project Center, Albuquerque, N.M. (conducts national and international projects related to American Indian health). He is a former consultant to the CDC's Native Diabetes Wellness Program. Contact: dave [at] nipcinfo [dot] com. Also, the National Indian Council on Aging [www.nicoa.org], Albuquerque, N.M, Randella Bluehouse, executive director; (505) 292-2001 ext. 25, e-mail: rbluehouse [at] nicoa [dot] org.
Ethnic Health Care Disparities: Besides Steven Wallace, contact Carmen R. Green, MD, director, Healthier Black Elders Center, Michigan Center for Urban African-American Aging Research, professor, University of Michigan, Ann Arbor. Contact: carmeng [at] med [dot] umich [dot] edu, 734-936-4240.
Reporting Resources on Medicare, Medicaid and Long-Term Care Policy:
Jennie Chin Hansen, CEO, American Geriatrics Society [www.americangeriatrics.org], jhansen [at] americangeriatrics [dot] org, a former national president of AARP and had of On Lok Senior Services, the model of the PACE long-term care programs under Medicaid.
Theodore Marmor, professor emeritus, Yale University, and current adjunct professor, Harvard's Kennedy School of Government, author of The Politics of Medicare. Contact: theodore [dot] marmor [at] yale [dot] edu.
V.J. Periyakoil, director, Palliative Care Education and Training, Stanford University , an expert on chronic illness among multicultural elders. Contact:periyakoil [at] stanford [dot] edu.
Maya Rockeymoore, president and CEO, Global Policy Solutions and former program and research director, Congressional Black Caucus, maya [at] globalpolicysolutions [dot] com.
Jeanette C. Takamura, dean, Columbia University School of Social Work, New York, N.Y., Phone: 212-851-2289; e-mail: jtakamura [at] columbia [dot] edu, former head of the U.S. Administration on Aging.
Larry Polivka, executive director of the Claude Pepper Center at Florida State University, Tallahassee, and a consultant to state and federal agencies nationally.
Joshua M. Wiener, director of the Aging, Disability, and Long-Term Care Program at RTI International.