| Appendix A: Qualitative
Findings
Senior Health
senior health
senior
health issues
Seniors are another
population given special consideration in the community panels. First, participants
mentioned the difficulty seniors of all social and economic backgrounds have finding
quality medical services.
"We do just as much
episodic care on seniors as we do almost for uninsured. They don’t get out or
schedule routine visits as they get older …"
— Physician
"Seniors, they have some of
the same challenges as the rest of the community as it relates to access to services
around cultural and linguistic appropriateness. Worse than that, they have a lot of
pride."
— Social Services Representative
"I’d say the health
care issue for elderly, even those with resources, is a difficult area. Each of us finds
that when we get to that stage of taking care of our parents. Until you actually go
through it, you think of yourself as a competent person who can access things, but when
that comes upon you, it is a difficult process."
— Community Leader
These physicians indicated they
are seeing senior health problems, such as falls, resulting from a kind of social
abandonment because seniors no longer have family members who are close by who will look
out for them.
"In the emergency room, the
other extreme of the age is that we’re seeing an increasing amount of senior citizens
come in, a virtual epidemic of falls, it’s just age-related. Every year we have more
seniors who seem to be socially abandoned. We have to have our social service come down
and try to make arrangements for home care or visiting nurses. They never seem to have
that initiated on their own. I don’t know if that’s pride that they don’t
want to, or they just don’t want to give up their homes. There just seems to be a
real need in the community for education or dissemination of information to the senior
citizens about what’s available."
— Physician
"I think that’s
occurred because of a social change, too. I’ve been very disappointed sometimes
taking care of some very aged patients who live alone or as a couple [who] have children
living somewhere in the community, but having nothing to do with their care or even taking
very close responsibility for them. So this puts the aging population out on its own.
It’s inevitable that they are going to have a lot more trouble and they do take a lot
more services."
— Physician
"We don’t have very
good senior outreach services. In fact, I don’t know if we have them at all. You take
care of somebody, they have a hip fracture or something and they’re fine, but
they’re living on the edge… they’re barely able to take care of themselves,
then something happens to them, not some huge major disability, but something that takes
them away for 3 or 4 weeks. They often can’t go back to their house. If they were
integrated earlier into some kind of senior program when a crisis happened, they
wouldn’t be nursing home bound necessarily. And nursing home bound in this community
is usually self-pay because it’s not covered by insurers. That creates a huge
financial burden for the whole family. Maybe early intervention, senior outreach, the home
health aides, things like that would allow them to return to the natural
environment."
— Physician
"I live in the area, if [my
mother] didn’t have any relatives that lived in the area, I don’t know what
would have happened to her. She wouldn’t have known what to do, and the neighbors,
pretty much, wouldn’t have done anything. I think there are a number of people like
that in our county that just are left to languish on their own. Unless you have some
relative, as a person ages, they live longer, they do sink into dementia and
Alzheimer’s."
— Community Leader
Other factors contributing to the
isolation of seniors are losing the freedom to drive and lack of adequate public
transportation.
"We actually have three
major residential areas for seniors downtown, which is wonderful, but still most of our
seniors don’t live downtown. They live out in residential areas far removed from
public transportation. Often they’re perfectly healthy, they just may be old and
frail and they’re isolated in their homes."
— Business Leader
"I think one of the
problems is that we have so many people living longer and they’re not living close to
downtown as they do in metropolitan areas where seniors have access to public
transportation. Instead many of them are scattered up in the hills where they really
become isolated and one of the reasons many of them can’t remain at home is because
of that isolation. They don’t have a family member or someone who can drive them when
they can’t drive themselves, and also there are many people who can’t afford to
drive and rely on the bus."
— Business Leader
"With our seniors we see
more accidents, and they literally can’t afford to lose their driving
privileges."
— Business Leader
Furthermore, several saw the need
for more in-home care to allow the aging to remain in their own homes longer.
"I think there’s too
much money in institutional care and not enough money spent on keeping people in their
homes as long as possible. In-home care is very expensive, but there’s a tremendous
amount of resources tied up in institutions and it seems like bureaucracies – state
and federal – are really invested in maintaining this."
— Community Leader
"Actually I do see a need
for in-home supportive services. The county is really good about providing the
supplemental, emergency care. We call in-home supportive services for the Medicare
eligible seniors and it’s working, but it isn’t working really well because it
doesn’t meet the need of those seniors at home who live so long. They may not even
have relatives or children living in the state, so they’re all by themselves. They
don’t have money to go for private workers to provide services at home and the county
is only for emergency."
— Social Services Representative
"I worry about older people
in East Palo Alto being able to get quality care attendants because people don’t want
to go there. I know some of the taxis won’t go in to East Palo Alto. Some of the
pizza places won’t go into there. There’s a perception way beyond reality."
— Social Services Representative
Other issues concerning seniors
include overmedication, fear, chronic diseases, and women’s health.
"There is overmedication of
seniors because they don’t understand ‘overmedicate,’ or take the wrong
medication. So we have to find ways of developing mechanisms for them… these boxes
with ‘Monday,’ ‘Tuesday,’ ‘Wednesday,’ you’d be
surprised how for some seniors that makes a difference in them remembering what they have
to take. I guess that speaks to us understanding that we have to think of non-traditional
ways of helping certain people help themselves."
— Social Services Representative
"The other big thing that
happens a lot [with seniors] is that the doctors prescribe anti-anxiety medication, which
is to deal with the depression or to deal with the anxiety. [But] it messes with their
mobility…"
— Social Services Representative
"My boy’s grandmother,
she’s 78 years old, she’s scared to go just to any market. She only goes to the
big Safeway, only during the morning hours, during the days because she’s scared. And
that’s not good that some of our senior citizens are scared of walking out to get a
sandwich."
— Business Leader
"The chronic diseases that
come with age, and prevention, and the isolation… it just reinforces the conditions
of seniors, particularly those who have not worked, have not gone out of their home."
— Social Services Representative
"The whole women’s
health piece for the older adults, it’s a hidden kind of issue for so many older
women. Everything from the issues around breast cancer, the incidence of osteoporosis
– again stuff that is preventive – but without a real focus on it before they
get into that situation, and their resources are just minimal."
— Social Services Representative
On another note, physicians
discussed the need to develop guidelines on health care limitations when care is futile.
"How much care should a
senior really get when they get into a crisis? We don’t have as much talk in this
county as we do in some other progressive states in the union, about health care
limitations for older people. We have people who come to our hospital 80 or 90 years old
and get as much care as someone who came in when he was 50 years old. And then when they
go back into the health care system or go back home or there is no home, the costs are
horrendous. There probably should be some discussion in this county…"
— Physician
"Those issues are being
talked of more and more in hospitals with some tremendous resistance. When you talk about
rationing… but some of it’s not appropriate, some of it’s futile."
— Physician
"When you do that though,
you also have to involve the public. There’s not a broad sweep of education to the
public of what can be expected and should be expected when they’re elderly
patients."
— Physician
"It’s not just elderly
patients, it’s any patient to which you’re delivering futile care. There’s
a huge discrepancy about what constitutes futility. Stopping care or foregoing care when
the situation is not going to come out well is something that’s not very well
addressed."
— Physician
"At least in California we
have this Natural Death Act, in which people are encouraged to write out their wishes for
their care at any stage in life. And I think what we find though is that not many people
who enter into the hospital system actually have that. When they do, it isn’t very
clear, and it’s very difficult to get families to act rationally in those situations.
If the person had a directive that said under these circumstances I do or don’t want
this sort of thing, that’s binding, and it’s binding on the family as well. Even
though it has certainly been publicized, it really isn’t very well known."
— Physician
"Part of the issue, too, is
we’re talking about a countywide system, but do those guidelines apply to someone
who’s a Santa Clara County resident? You have to start with individual counties, but
what is preferable is regionwide, or statewide."
— Physician
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