Leith States – The US Department of Health, Age in America and Social Determinants of Health

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Leith States - The US Department of Health, Age in America and Social Determinants of Health
Leith States – The US Department of Health, Age in America and Social Determinants of Health

As a society, we are living longer due to better living and health care. While reaching old age is something to be thankful for, there are several challenges facing the seniors that we should all be aware of. We don’t realize how much we can help our aging population until we start to age or see a loved one struggle.

Here are a few of the concerns that seniors face as we live longer: Memory loss, Dementia or Alzheimer’s disease, Parkinson’s disease; Inability to drive or travel independently; Hearing loss, Vision problems, including blindness; Falls resulting to injuries; Chronic pain, arthritis; Depression and loneliness; Social isolation; Financial insecurity; Scams and abuse. Many are the social determinants of health.

It is common for seniors to develop chronic disease as they age. But not all seniors have equal access to care. During the pandemic, there is a growing gap and disparity in care, which has exacerbated under stress. And it’s more common in medically underserved seniors than in the general population.
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Bio:

Dr. Leith States, the Chief Medical Officer in the Health and Human Services, Office of the Assistant Secretary for Health.
He has spent his career advocating for vulnerable populations and advancing social justice. Dr. States believes that everyone deserves grace, everyone deserves a second chance, and everyone is worthy of love no matter what they’ve done or had done to them. We all need truths to hold onto – as we make sense of our life experiences.

Visit Leith States on LinkedIn: https://www.linkedin.com/in/leith-states/

Transcript:

Hanh:
Hi, I’m Hanh Brown, the host of the Boomer Living Broadcast. On the show, industry leaders share information, inspiration and advice for those who care for seniors. Our expert panelists discuss senior health care, dementia, care giving and technology for seniors, affordable senior living options, and financial security, all of which address the social determinants of health. So, thank you so much for participating in today’s conversation. Check out CareString.com, our recently launched platform, where we match seniors with caregivers and guide businesses and their employees to the care giving journey. So check out CareString.com. Now, for those in the audience, we love to hear from you. We’re all learning together as we navigate in the later part of life taking care of our elderly relatives or as a profession, as a professional. So, please comment and ask questions. And thank you so much for tuning in. And I look forward to you participating. Today’s topic is COVID Aging Population and Social Determinants of Health. As a society we’re living longer due to better living and healthcare. While reaching old age is something to be thankful for, there are several challenges facing seniors that we should all be aware of. We don’t realize how much we can help our aging population until we start to age or see a loved one struggle. Well, here are just a few concerns that seniors face as we live longer. Memory loss, dementia, Alzheimer’s disease, Parkinson’s disease, inability to drive or travel independently, hearing loss, vision problems, including blindness, falls resulting in injuries, chronic pains, arthritis, depression, loneliness, social isolation, financial insecurity, scams, and abuse. Many are the social determinants of health. It’s common for seniors to develop chronic disease as they age, but not all seniors have equal access to care. So, during the pandemic there is a growing gap and disparity in care, which has exasperated under stress. And it’s more common in medically under served seniors than the general population. The U.S. department of health and human services promote sound scientific advances in medicine, public health, and social services to improve the health and well being of all Americans, especially seniors and the disabled. Well, joining me today in conversation is Dr. Leith States, Chief Medical Officer in the Health and Human Services Office of the Assistant Secretary of Health. He has spent his career advocating for vulnerable populations and advancing social justice. Dr. States believes that everyone deserves grace. Everyone deserves a second chance and everyone is worthy of love, no matter what they’ve done or had done to them. So, we all need truth to hold onto, as we make sense of our life experiences. So Dr. Leith, welcome to the show.

Leith:
Thank you, Hanh. I really appreciate that introduction in pulling a more meaningful bio that reflects some of my personal thoughts. It’s such a pleasure to be with you and to be with your listeners. As a personal note of thanks to them please add questions. I love to have a dialogue and have my boundaries expanded when I’m in these settings. So, I’m more than happy to be challenged on my thoughts, my comments. This is how we all learn. So, pleasure to be here.

Hanh:
Thank you. Thank you so much. Well, today we’re going to discuss COVID’s impact on seniors aging, population, and the social determinants of health. So I guess why don’t we get started by, why is there so much debate about vaccines despite the majority of scientists agreeing that they’re safe?

Leith:
So that, that is obviously a loaded question and I’ve wrestled with this in my background as a preventive medicine physician. I have a, I guess, a higher level of attachment to population level care to the historic victories of public health. Because that’s, you know, what my specialty is founded upon. And I by function of that, I guess starting point have to look at history as my great teacher for why we are, where we are with regards to vaccine hesitancy, mistrust, distrust. And I think, you know, even if we go back to the early days of vaccination and I mean, lady, lady Montague, and, and Edward Jenner there were anti vaccine perspectives and thoughts and concerns expressed at that time. For a variety of reasons, right? It was a challenge to thoughts about the deity about what their relation was to God going into God’s place. There are considerations on the cultural bounds of, well, you’re not from where I’m from. You don’t think like, I think so, therefore I will not subscribe to your method of medicine. Right. And I’m extrapolating a bit because. At the, what I’m referring to in history is, you know, prior observations from other cultures in south Southeast and Southwest Asia that, you know, informed European thoughts on vaccination. And now I see that with some of the there’s somewhat polarized dimensions of. Uh thoughts around autonomy and where public health where public health authorities start in end, and then how that rolls into the political spectrum of leanings and, and spectrums, I guess the, the ends of the spectrums that we’ve seen Fuel some of the increased debate. So I think it’s a matter of history. I think it’s a matter of our current state with social media, with the capacity to be informed and challenged only in our point of view and our, our thoughts. I do believe. That there are valid points across all ends of the spectrum. There was a time when, you know, we were in charge of our bodies. If I wanted a medicine, I would take that medicine. There are regulatory agencies in place. Now there are state regulations. There are local mandates. There are. Our ties on the pharma and that scene makers that allow for permit. And I would say drive the the notion that there’s in some instances, a asymmetry of power where folks could perceive that, you know what, they don’t have my best interest at heart. So I fully understand where folks may be coming from, from that stand point. And I think that is one part of the argument, the other piece. And I’ll be brief on this one, because I think this has been, this is probably a more easy to digest or at least wrap our minds around is distrust mistrust from the standpoint of longstanding wrongs in communities, racial, ethnic minorities, and persons with disabilities and otherwise disadvantaged underrepresented populations. I think that’s much more well-documented and I think it, it puts. It shifts the way we as medicine and public health providers have attempted to bridge that gap to bring people in in the past. It’s not enough to just stop and say, we have this, come take it. And if you don’t come get the vaccine. We need to acknowledge where the barriers are and what we can do to meet all to, you know, 50, 50, or maybe even a 60, 40. And I think there’s been a course correction. That’s helped blow some of that, but you know, once you start down a course with a response effort, it’s really hard to turn that back, especially from a public health standpoint. So that’s a really long answer to a really complex question. Hopefully that generates some good thought from our listeners.

Hanh:
Yeah, very complex question. I understand. So will there be an increased need for a booster vaccines in the elderly population due to COVID further booster vaccine?

Leith:
Yeah. Yeah. So I think we’ve seen a strong data that is supportive of boosters in certain settings, certain populations, More so for folks that are immune compromised have existing co-morbidities. So from that standpoint, there are blanket recommendations where it will be helpful to have boosters, utilized by aging populations. And then as a subset, I think there’s an even greater need in communities that have immune compromised state and also have com or bid conditions. Diabetes or untreated or poorly managed cardiovascular disease, existing respiratory diseases, maybe COPD, emphysema. So a shorter answer, but the take home is yes, there will be a need.

Hanh:
So do you think the elderly are being disproportionately impacted by COVID?

Leith:
Again, this is excellent. I really good question. I like this one because. It is a, I think a good picture of how COVID has been a great revealer. And by that, I mean for most issues that regard health and public health The general rule is children and the elderly are going to be more heavily impacted than other populations. For one at the early spectrum of life, kiddos don’t have a voice. They aren’t well-represented, and there’s not a lot of there’s not all the money in doing research and developing solutions in children. And the problem is they’re not young. They’re not little adults. They have their own physiology, their own makeup, their unique risk factors that get forgotten in their population very often in the aging population. I think it’s, it’s similar in that we’ve extended life and allowed for the bright, shiny. Developments in medicine, in therapeutics, in device development, procedure development in our understanding of basic science and clinical research to help extend life. Right. And on the back end of that has not been the infrastructure built in to accept that increasing population. So I do think that there’s been a widened. A widened gap. And this is demonstrated in some quality and increasing research that, you know, there are widening gaps in blind spots in care, especially for those in rural population, living in rural areas. And I would add that, you know, as a last piece with that, that it’s a matter of infrastructure. It’s a matter of literacy education from health and, and data standpoints. And there’s a variety of other things that are launching points from that, that we don’t need to extend into right now. But I think are fully worthwhile to be unpacked as reasons for our drivers, for those inequities or disparities in that space.

Hanh:
And I think out of this conversation, the goal, I think from everybody it’s really to close that gap. And it’s very important that, you know, we look beyond our role bay on our department or company’s objective and the goal. You know, first and foremost is how do we best serve the aging population. So I think it’s great that we have this conversation and hopefully open up minds and ideas in innovation. So thank you. What do you think is the long-term impact of COVID on the elderly population?

Leith:
So this is a you know, it’s a glass half full versus glass, half empty. I’d like to think I’m an optimistic person by nature. So I’ll go with the glass half full. I think it’s presented a number of opportunities. I think it’s demonstrated the capacity of disruption to happen for this community. And at the same time allow for a real time. Allow for a, a near real time demonstration of value. Which I think is important when we think of creating a value proposition for industry or health systems in general, to devote energies, personnel, economic resources, into developing the platforms that are needed to help drive outcomes for this community. And I guess, you know, they’re a good example of that would be around tele-health and that’s been something that obviously has in the past 20 years, this there’ll be a little bit hyperbolic, but it’s, it’s kind of languished, right? It, it, it developed, but it didn’t have that disruptive catalyst to create the demand signal where it would become a integral part of our care delivery system COVID has done that. COVID has allowed us to look at the human services and the healthcare delivery side to say, how do we serve aging populations, where they are, how do we best do this in a way that respects their autonomy, their dignity, that creates the sense that they are engaged in and have the self-efficacy within their care plans or within, you know, the direction trajectory of their life. That there doing it in a way that not only supports their presence in the community as a continuing to thrive individual, but also serves that value piece from the health care economy standpoint, in terms of making it a, a mix that works for Medicare, for private insurance. For the health tech investors for adventure capital, all in a way that will be a sustainable footprint, right? Because the artificial nature of funding for the American rescue plan or these repeated COVID bills is that will, you know, dry up as important as the government can be in service of initial disruption to find sustainability. I think it has to transition at some point back to the private sector. And I think that we’re seeing that more and more.

Hanh:
Thank you. Thank you for your feedback. Now, I would like to acknowledge Yan. She has a question in, perhaps you can help answer. Can you talk about some of the resources that might be available for immigrant non English speaking elderly. There is a struggle in rural areas, as you mentioned. So are there accessible resources available? Are there.

Leith:
So, thank you so much for the question. I think that that’s a, a critical consideration as we were discussing some of the subpopulations that might be falling through the cracks. And as you can imagine, I think a number of uh, Of advisory notices have come out from the HHS office of civil rights on this standpoint of what telehealth needs to provide, what providers need to include in their offerings to ensure that they’re compliant with the, the regulations set forth by HHS and the public health service act or any of the standards regulations from ONC and one of those is with limited English prevention, proficiency. So that means having interpreter surfaces at services available for, folks with a difficulty hearing, hard of hearing limited sight or blind there’s, you know, requirements on that from those angles as well. It has not worked well, by and large, one of the things I hear, and this is anecdotes because I don’t have a good published data to pull from just yet. But it has been an issue across Medicaid, Medicare in some instances and in the private sector. And partly it’s because of the lack of resources. I think another part of this is that you’re kind of building the plaintiffs. You’re flying, right? It’s that old colloquialism, but I think it’s very true in this space that there is an it’s it’s similar to what we just spoke of in terms of COVID being the great revealer for populations that had problems with accessing care prior to the pandemic, it’s become more so. So I think those populations I just mentioned are in that boat and along with LGBT communities and others that found it difficult to, access for a number of reasons, whether those were physical, whether they were stigma related or others.

Hanh:
Very true. So as we. I know we touch on many points, but I think anything that’s really, I guess, really important. Maybe we can do a deeper dive. For instance, what solutions do you think are necessary to protect the elderly from from Covid?

Leith:
That’s so, and this is where I think taking a step back right. And looking at the pandemic across. The last two plus years and assessing what the relative risk of certain interventions are, is absolutely necessary, right? Because the initial data has, you know, started to show, you know, obviously vaccination that is critical to routine public health, interventions of physical distancing of possible. The mask wearing has been, especially, protective for aging populations, even I, and this is where, you know, there’s the the issue as it relates to isolation versus a loneliness and getting to the risk assessment of how, how can we navigate that space well, to ensure that it’s not just mitigation of. COVID risk, but ensuring that the rest of life remains intact because looking at the most recent values I’ve seen in terms of excess deaths attributed to. COVID it’s as many deaths as are due to COVID itself in the United States. So problems of not seeking care for cardiac arrest. For heart attack for stroke for other chronic disease related issues, even preventive care services and preventive cancers. If we’re not retaining the access to those pipelines, I believe we’re going to do ourselves a disservice to that population and ultimately to ourselves because we’re not investing in inappropriate mix that values the entire spectrum of an individuals life. And it limits us to looking at the trees when we need to be, we need to retain focus on the forest.

Hanh:
Very true. So what is your thought on, how can we ensure that older adults receive the necessary care for any future pandemics? For example?

Leith:
So the process of ensuring care or ensuring the appropriate framework is in place. I think is something that needs to be considered as a, as a collective approach, right? You can focus or the, you know, various entities could focus on aging populations in isolation, but I think that the key is to ensure that there is recognition that. Pandemics need to be addressed as a community based at a community-based level. So by that, I mean, Aging populations play a vital role where they live, where they work, where they play. And if that is not an active consideration in a community development plan or in a community preparedness and response plan that would include pandemics. I think that’s one of the sure ways to set. Is set that population up for failure in the future. I, and I think we’ve seen that and not, not necessarily, limited to aging populations. I think all, all populations have found themselves in some way, not, not adequately prepared for, or suited to respond to what the last two years brought us. Obviously for many of us, we were probably better suited because we were well-versed with. Health it, or we had frequent contact with a tele-health already, or we knew how to navigate apps and other smart enabled platforms to ensure we remained in good contact and had our preventive care on track for those that respond or require, you know, by mail that require in-person that require a number of other means to use touch points, to ensure care. I think that’s where the problem lies. And I’m hopeful that that will change. At least at the federal level, there is a concerted effort to make sustainable, or at least have codafide what steps need to be taking next time. And. I with the audience it’s online. I am absolutely certain they’ll say, well, what happened in 2003? What happened in 2011? What happened in 2014? And I’m speaking of SARS, H one M one Ebola, every time one of these things happens, children and aging populations. Are going to be hit the hardest, but we did not take the time as a nation, as states, as communities to build those, considerations into our, into our thought process in an unintentional way. An ounce of prevention, an ounce of prevention is never as attractive as a pound of cure, but I am hopeful that that will be the case this time.

Hanh:
Thank you. Thank you so much. I’d like to acknowledge Len. He is asking about what effect, if any, have community-based health initiatives had on reducing disparities?

Leith:
Oh, Lynn. Great, great question. Thank you for for chiming in, the, the, idea that disparities could be addressed primarily from a top down federally driven. Initiatives, thoughts, ideas programs is not, not realistic. It’s not what the federal government’s for. And I don’t think anybody has any real illusions that that would be the case. So with that, I think my, my goal in that statement is to say community-based organizations, CBOs have been. Hugely important in reducing disparities when they are leveraged one, they are empowered when they have the opportunity to serve as a true representative for those communities. And then, and then use resources in a way that responds to identify gaps and opportunities. I think that’s where much of the power comes in. Th the area where I’ve seen the most, I would say dissonance between the theory and reality of that is in the way granting. But grant funding works from time to time. In that, I mean, you know, if we go through a standard grant making process, you may not have grant writers within these CVO’s again, they, they may not have private funding or existing funding from the usual operations to support these projects while waiting, you know, nine, 10 months for funding to come through from a grant that was written a year ago. So, the, the construct that has been utilized in the past is not necessarily effective to empower the people that need to be. The action officers in this. And that’s me going back to some military time, just understanding who’s going to be doing the work. Those should be the folks that are driving the bus with the funding. So I think that they are absolutely critical. I think that disruption is occurring that is allowing much of, you know our ability to characterize problems in a way that’s meaningful to, policy makers and decision makers. I think that there’s a disruption coming to CBS where they’re able to curate and and be good stewards of data in a way that they had not before. And I think that that is leading to a more a more symmetric balance of, of not power, but I’ll say symmetric representation in solving problems in a meaningful way.

Hanh:
Very complex matter. And thank you for your feedback on that. I like to acknowledge brick a previous guest on the show. So in many cases, older adults need assistance to access tele-health is money available to help older adults with this purpose?

Leith:
So Rick, that’s a excellent, excellent question. And it’s something that has continued to come up because, and this is a, another, I think fabulous opportunity to bring up one of the issues that COVID has revealed. Right. So tell a health can be a great, good when it’s equitably. Distributed. Right. So, you know, equal opportunity, not necessarily equal outcome, but if you don’t have broadband access, if you don’t have wireless, if you don’t have even, you know, like hard wire I brought gets for for other types of internet connectivity, it really. It leaves you with limited options. And though we’ve seen audio only as an option for tele-health for these populations, it’s not optimal, right? For some diagnoses, it may be, but if we already understand that there’s no, no connectivity or degraded access as a baseline, it starts things off. With an understanding that the lack of equity is a potential contributor to driving a widening disparate outcome. So in terms of what funding is available there are a number of broad federal family initiatives that are increasing access in rural communities specifically. And not just federal, but state level, local level private organizations have gotten involved in terms of providing funding to communities, to, um allow for a creative and, and novel approaches to bringing in, I guess band-aid measures while, while broadband is being brought into communities. So the organization that is the lead for federal government on that is the FCC. And to a lesser extent, HHS is engaged, but we are engaged in, in lockstep in terms of. Well, we see broadband is going into this community. What would, what can we do to drive programmatic development or scale existing organizations in their approach to getting education to providers, to patients to make sure that there’s infrastructure, in place on top of the actual broadband, when it does come in.

Hanh:
Thank you. Thank you so much. These are definitely very difficult, complex questions, and I appreciate you answering them. There’s definitely not a silver bullet solution to any of this. And I appreciate the audience asking. I would like to acknowledge Robert Bowman. I think he tagged Dwayne Dwayne Clark from ages living indicating that longevity indicating that longevity is decreasing for about 40% of Americans. Most behind. Longevity mortality, premature deaths, smoking diabetes, mental illness, obesity, and so forth, and many more are 45 to 50% found in 2,621 countries. Lois in healthcare workforce with 40% of the us population.

Leith:
So I think so what I’m reading from there is it’s a much more of a statement and I agree that the reasons that that is the case. And I think you lay out quite a few of them there. The one that I might add, especially for populations from 55 to 69 is the increasing rate of overdose deaths in, in racial, ethnic, ethnic minorities, especially black men. And this is related to that transition in the opioid epidemic where we’ve seen an increase in fentanyl analogs and. And a decrease in prescription opioid use and even decrease in heroin use. So that is an increasing area of, I think as we look at the share or the, the proportionate burden felt by emerging crises, it’s another example where aging populations do suffer more on the extremes, but I appreciate that contribution. That was a helpful.

Hanh:
Do you want to take on? I would like to acknowledge Len, did I hear you say earlier that the health care needs to count on private sector for solutions? You talked about the grant process for seeking funds. How can the private sector become engaged in providing solution.

Leith:
So Len I appreciate that. Yeah. So I believe that that’s a tried and true structure for government and private relationship. And part of what I base that on is the history of things like DARPA and ARPAE, where you have had accelerated development in areas where disruption was not prioritized either through a lack of interest, lack of perceived value or the desire to, serve as a barrier to keep disruption from happening because it’s not in the existing, in the incumbent’s best interest to move forward. So the examples I think of are, you know, internet or GPS, you know, those are the usual ones thrown around about DARPA. So what we saw was significant government investment or, or even the human genome project. So significant government interest, toss it up Once it was developed, it started to create a value proposition. Then, or a sustainable business model then, you know, private sector is able to jump back in VC is able to jump back in. I think the same thing is true for these types of solutions in the health tech area. In know where I’d see this most appropriate for private sector becoming engaged is in what we call, and your, your, some of the lessons maybe familiar with, you know, going through the valley of death. As an it developer or health tech developer, or drug developer it takes quite a bit to go from a struggling start up to make it through to regulatory pathways or in this case, if it’s a, a health tech, Altec device, could be a wearable remote patient monitoring to get through, you know, the FDA considerations for regulatory device approval, then to get through reimbursement for with Medicare Medicaid. So I think it’s a it’s an interesting relationship where private could come in and serve as a, a shepherd tempering folks through a little bit more fully. Through that valley of death, the issue is that many times, you know, you be get through their, their initial VC. And they require a little plus up and it doesn’t come and then good ideas die on the vine or they can get bought up and then not be, you know, pushed through to the people that actually need them. So I think that there are, that’s one of the touch points. The other, I think is probably, you know, working with the private sector working with private insurers because they have a bit more flexibility in how they approach things. With regards to developing in the example could be like a Medicare advantage contracting organization where they can develop their approach to treating their population, including excluding and growing maturing based on their population’s needs. And I think that’s where at times you do get that nice marriage of private, private, to private that can ultimately inform back to. Government because Medicare advantage obviously informs back to CMS.

Hanh:
Do you want to read Robert’s, further comment?

Leith:
Perfect. Okay, so let me read out. So, Robert I’ll start from the your longer comment here. “So, America is unique that we have worst health care designs as we get older, poorer, disabled, mentally ill, or need more healthcare. As we get older and therfore poorer and sicker, we can no longer afford the high cost of housing and living at high concentration counties, People health work for social supports; therefore, we must move to counties, lowering cost of living in housing. People move in with family or others, or must go to the twenty six hundred and twenty one counties lowest in healthcare workforce that are lower in cost in social supports. Internal growth in these counties is high and the immigration is high. Also retention is high. These are factors in the most rapid growth of these counties dating back 60 years. By 2060, this 40% in 2010 should be. 50% or a majority of the U.S. population, even more behind as the healthcare designs continue to pay less and close and compromise their hospitals and practices. If you understand the majority of the population most behind and what remains of their health care, you will question micromanagement innovation and other costly and meaningless attempts to improve outcomes, dating back decades. You understand that only 1965 to 78, did they get any real increases in funding. You’ll understand that reforms, since the eighties are all a tie for last place, as far as helping these counties.” That covered a lot of ground. And I thank you for those comments and I love having these kind of on these philosophical discussions around why it is what we’re doing, what we’re doing. Is it meaningless? Is there a better way? And then looking at what the historical kind of comparative. And I, you know, I agree that, you know, there’s there was a reason for where we are today and the here I’m speaking to is the observation that though poverty has decreased markedly for I for aging populations, since, you know, social security came into existence. It has certainly leveled off per Robert’s observations in terms of diminishing return on what it is we’re doing to improve quality towards aging populations in entering the end of life. So, from that standpoint, I think it’s clear to me that The U.S. and other countries, other OECD countries, we’re not apples to apples. Right. There was a decision made many decades ago that we would follow the private insurer pathway. We would prioritize medicine. We would have a market-based system and not go the path of universal care, at least in. We, we have it, but we don’t. Right. So I think it’s, it’s, it’s so difficult to compare and say, we should be doing X, Y, Z. I do believe strongly that less is more earlier in life. And I do think we’ve gotten away from that in medicine. We’ve gotten away from that in public health. And I think it’s done a disservice to how patients, how individuals view the, the power they have over their own lives. Because there was a time when there wasn’t a pill for everything. There wasn’t a solution from the doctor, right. Or from healthcare. And there was an inflection point when, you know, the. The per cap it a number of pills that we take went sky high. I mean, multiplied by thousands in the space of a decade. And I think that all that, that also corresponds is a, it was an early predictor of that, that range of the sixties to seventies that Robert mentioned. But I think that there always simple solutions. And while I agree that less should always be more. There is a place for ensuring the advancements that do take place are done. So in a way that ensure equitable access for folks that need it most.

Hanh:
Great. Thank you so much. I’d like to acknowledge Terry’s comment, Terry. He indicates at passive remote patient monitoring with local processing of data removes the need for high bandwidth, only events are sent to monitoring entities. There has been too much focus on the modern model bandwidth. Do you see RPM becoming the norm?

Leith:
Oh, Terry, that’s a really thank you for reminding me of that. A, it reminds me of a model and I can’t remember the state offhand. There’s a great vendor that is essentially providing RPM for a number of, of indices. Where It, it allows patients to drive by if they’re in a rural community, they can just drive by a cell tower it’ll ping and then B to send off to the cloud and then the provider can access it. So it doesn’t require them to have broadband in the home, but allows them to upload that via just driving in proximity of a cell tower when they go to the market or go for a drive somewhere. So I do think that RPM, as it becomes a more mature tool that can be utilized in, in provider and patient interactions and work flow in a meaningful way. It will become a good tool because you know, the 90% of life that occurs outside the clinic walls and not when we’re getting our blood pressure and heart rate taken by a clinician or staff and in Carson, Is is, you know, it’s artificial, right. I it’s always best to have that capture of people where they are and doing what they, what the rest of life contains. So I appreciate that. Thank you. Thank you, Terry.

Hanh:
There’s another one that, I don’t know if you can see the name, but I can not.

Leith:
No, just as Linkedln user.

Hanh:
Right. He’s indicating that are we seeing more fluid adoption of technology where the aging population will become more self-serving in other words, lot in the homes, wearables and so forth.

Leith:
Yeah. Yeah. And so, I think that that is certainly going to be the case. One of the interesting outgrows. In a number of Medicare advantage organizations that are attempting to drive up the utilization of health IT for their aging populations has been, you know, more standardization of RPM as a component of their integrated care delivery. So, I think it certainly will be. And as much as, and you can imagine that as these catch on, and by catch on, it will be improved outcomes from the standpoint of, you know, optimization of chronic disease management and quality of life, increased satisfaction with interaction with providers. And I think that, and I mentioned self-efficacy, but I think it’s so important to feel like you are in the driver’s seat, to feel like you have ownership, that you are in, you know, you’re in control of your life. You’re not going to the doctor to ask for permission to live a certain way. Patients, individuals are, and I said this in a class last night, you know, they know much more about clinicians than their. There’s no better teacher about you than you. And, granted, there are different ways to convey that experience, to convey what you know, but by and large, I think, you know, when I come to learning from someone that’s has lived experience in an area, I turned my ear to them before I turn it to an expert. And I have to say that knowing that I, you know, in the same boat being a provider, I don’t expect folks to listen to me before they talk to their father, their friend, there’s somebody who’s been through a similar experience. Right. So, I think self-efficacy and trust are so important.

Hanh:
You know, as you’re talking about that, perhaps this is an in parallel. I often think that taking ownership, responsibility of your health it’s it’s beyond that one, visit a year inside a doctor’s office. Okay. That’s just a short window of time, but I think throughout live day to day, you got to take ownership. ‘Cause we don’t see health as well. Well, we shouldn’t see health as the objective to achieve it’s really day-to-day goals that we have to take care of ourselves.

Leith:
Yeah. I feel that, you know, if we look at health as the end goal, we’ll get exhausted, the goal is contentment in life. Right? Being okay with who you are, where you’re at, your surroundings, your relationships and your choices and stemming from healthy, those healthy choices. I think stem from that positive place where you’re in a balanced, resilient place and that does not come from seeding your. Your autonomy to, you know, the medical providers or to anyone else in your life, right? I mean, there’s forces where you can reclaim and, and and become that and take steps towards being that version of the Brazilian self. And I firmly believe that it can start in and should, you know, especially for. Populations that have historically been on the short side of the power dynamic with clinicians, it should be incorporated in those interactions.

Hanh:
Great points. Now I like to acknowledge, I think the last comment that we read is actually from Nick Patel, from thri. WelTec. Thank you so much for your comment. So let’s see every time our try to reflect on these questions on to you. I realize how complex they are, but it’s necessary to uncover them and talk about it openly with the audience and ourselves. So what solutions do you think should be put into place to ensure that elderly are able to live healthy and productive lives? I know we touch on throughout the conversations. If you have any top tips to make sure that happens to allow that day happen?

Leith:
Well, I think you’ve heard me, go on about self-efficacy right. So I will always be a proponent of that resilience connection with, with family, with friends, with meaning in life. Right. I think there’s a, I’m getting to the age, myself where I, I’m starting to see where. The successes are where folks are continuing to thrive as they enter into the next phases stages of life. And there’s something special about being about being able to turn the page on one chapter and move boldly into a next phase without uncertainty so much goes into that. But I think as much. Folks can remain tied to who they are. And I know this sounds a little abstract, but it is, it’s so important to maintain that sense of identity over the lifespan, right. To not become a wash in the requirements of the day to day, but to be focused on what the end goal is. And that’s the contentment with who you are. So the other things all in around that, right? So we talked about self-efficacy community relationships valuing yourself, staying plugged into care as you can, whatever mechanism that takes. If you’re a veteran, don’t be too, too stubborn to go to the V. If you have opportunities for Medicaid, Medicare, and dual eligible take advantage. If there are lower cost options that allow you to be seen. At a community clinic at a public health clinic is these are things I think that we should still take it, take advantage of. And I say that, you know, having done, you know, the public health clinics growing up, or, you know, having to go, you know, being part of military medicine for so long and now being the VA patient, you know, It pays to stay engaged, but to do it in a way that you remain cognizant of what your ultimate goal is. And it’s not to make doctors happy, it’s not to be shamed into doing better, but it’s to maintain that identity, the contentment to drive towards health in a way that is just a by-product of your life, rather than the sole driving factor of your life.

Hanh:
Thank you. Thank you so much. Let’s talk about nursing homes. So what’s being done to prevent, reduce COVID like pandemics in nursing homes or other care facilities the future?

Leith:
So that’s been a real, so nursing homes have been a focus at the federal and state level. You all recall that there were quite a few missteps and controversies early on in the pandemic with or training, Lack of empathy, poor communication with family members inability test, inability to really provide for the routine needs and care due to. Real proceed you know, blow overblown concerns, or just lack of, established protocols that would otherwise have ensured appropriate care that it respected the values, the time left for some of these patients and help them retain connection. Right. And I’ll I’ll cite one program. I think that has been really really, Beneficial and leverages tele Tel a services, but not telemedicine aspect. It’s project echo in a partnership with arc, which is the agency for health, health research, and quality. Project echo is a telementoring platform where whereby you have different types of clinicians that can be sourced into a videos setting to receive education, continuing education on a topic. And there was a large initiative through art. That’s still ongoing. I believe I can’t recall the current state and how large it is, but to increase education for for. Nursing nursing home staff providers and has resulted in improved outcomes, improved quality of life, improves satisfaction and, and decreasing transmission and or outcomes and morbidity mortality from COVID. It’s a small thing. When you think about it, you think, well, why wasn’t this already being done? It’s, you know, Do continuing education. This was just a novel means to apply project echo in a setting that had not been done previously. So I think it’s served as a model to show, okay, this, this is something that is not costly, but can have big impact across the country when we administer it in the correct way. So that’s one thing that I would just highlight is a way to keep people healthy when they’re in that setting.

Hanh:
Great. Great. Thank you so much. So I’d like to wrap it up to let you know that Dr. Leith and I will have continued conversations. So finish this, and then there’s other topics that add on. So please look forward to the future. And remember with an aging population closing the care gap for all Americans is critical. So we must ensure that no senior falls through the cracks and loses health due to lack of resources and to get started or to continue to do what you’re doing, here are just a few things that you can do even more to ensure that seniors have access to quality care, regardless of their location or socioeconomic status. Well, urge lawmakers to pass legislation to protect the rights of seniors and their families. Urge politicians to pass legislation to support senior care. Lobby for regulation of unlicensed assisted living facilities. Raise awareness about the benefits of aging in place. Support local charities that provide free or low cost senior care services. Lobby for legislation that makes quality senior care more affordable and accessible. Support family caregivers by providing training and resources. Encourage employers to allow employees flexible work arrangements to care for their elderly relatives. Promote programs to provide respite care for family caregivers. Fund research on the best way to provide quality care for seniors. Promote public private partnership to increase the availability of senior housing. And of course help seniors in your community access resources that they need. Start or join a group that focuses on elder care issues. Volunteer your time at a local nursing home or assisted living facility. Donate money to organizations that provide support for seniors. Remember, speak out against agism. And finally, don’t forget to vote. Policies affecting seniors are made every day. So it’s important that your voice is heard at the polls. And we hope the ideas, the conversations and the leadership from Dr. Leith today has given you some starting points how we all can continue to do and do better. So let’s work together and close the gap in care for all Americans. So please tune in next week. There will be two topics. We’ll discuss American dementia, brain health in an unhealthy society. Humanizing dementia care for the elderly rather than focusing on the shortcomings, affirm and respond to your loved ones needs, fears, and desires. We’ll also be discussing about venture capitalist’s review on how they decide which senior care products to invest in. Remember to subscribe to our YouTube channel, Aging Media Show. And leave a review on iTune podcast Boomer Living. We thank you so much. And I thank you so much, Dr. Leith and the audience for joining in this conversation.

Leith:
Thank you.

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Episode 146

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