Guest Column by Nathan Boucher
A global pandemic at a scale unseen in our lifetimes, the COVID-19 threat has turned what we know upside down and added both real and perceived levels of risk to our daily lives in a short time. This risk and turmoil are magnified if you are an older adult and more so if you have multiple chronic illnesses and/or disabilities.
On March 18, the President signed into law the Families First Coronavirus Response Act after its relatively speedy — but not speedy enough — pass through the House and Senate. The act is large and far-reaching, dealing with everything from employee assistance to medical care and health insurance to aid for vulnerable populations in our country.
The document is located here https://www.congress.gov/bill/116th-congress/house-bill/6201 in its entirety, but it needs some rounding up with regard to those key pieces focused on supporting older Americans — our large and growing population that also happens to be at greatest risk of dying from COVID-19.
Ironically, we are amid an important census count. However, available 2010 data indicates that in Chapel Hill, approximately 9 percent of the population is 60 years old or older and 30 percent of those are living alone. Nineteen percent of residents 60 and over received food stamps in the last year prior to data collection, indicating further vulnerability.
Concerning this older group, Title V of the Families First Coronavirus Response Act focuses on aging and disability services through the Administration for Community Living. These services will be enhanced with $250 million for activities authorized under the Older Americans Act of 1965. This includes 160 million for Home-Delivered Nutrition Services (programs like Meals on Wheels); $80 million for Congregate Nutrition Services (i.e., for those living in supportive residential homes); and $10 million for Nutrition Services for Native Americans, another vulnerable population with its complement of older Americans.
Mobility impairments, fears of exposure to the virus and severely constrained family caregiving efforts have made a large and vulnerable older population more vulnerable still. Many of our older Chapel Hill neighbors are facing a harrowing reality compounded by actual increased risk of dying from the virus if contracted.
Also under Title V of this new act, is a public health and social services emergency fund that will add $1 billion to reimburse health care providers for provision of health services aimed at SARS–CoV–2 (the virus) or COVID–19 (the disease caused by the virus) if the patient is uninsured by federal or group insurance coverage programs. With this fund, our UNC-affiliated and other area medical providers will be paid for their time and great efforts caring for older, uninsured Chapel Hill residents.
Approximately 20 percent of Chapel Hill older adults are veterans. Under Title VI of the act, the Veterans Health Administration will get an additional $60 million to use on medical care for patients who are veterans and medical community care (those providing the care). This is important because a little-known requirement of the VHA is that they act as additional care facilities and services for civilians in times of crisis.
Durham VA Healthcare System serves a large catchment area, including Chapel Hill and Orange County veterans. If virus-related health care utilization progresses beyond the resources of our local hospitals some of us may end up receiving services provided by the VA.
The new act also seeks to reduce out-of-pocket costs to us here in Chapel Hill and across the US. The act states there will be no deductibles, copayments and coinsurance for individual care provided during health care provider office visits, including in-person visits and telehealth visits, urgent care center visits and emergency room visits if care is SARS–CoV–2 or COVID–19 related.
We are all facing threats to our health, our finances and our social networks. Older adults in Chapel Hill and beyond may be experiencing this ten-fold. These new congressional provisions, coupled with our neighborly concern and effort can support and encourage our most vulnerable Chapel Hill residents.
Nathan Boucher is an assistant research professor at the Duke University Sanford School of Public Policy and the Duke School of Medicine as well as a Research Health Scientist at Durham VA Health System’s Center of Innovation to Accelerate Discovery and Practice Transformation.