Ageism Jeopardizes Community and Provider Health
By Joy Stephenson-Laws, Managing Partner
There is a very subtle bias that can impact all populations regardless of race or gender. This bias is commonly known as “ageism”, and it refers to the discrimination of patients because of nothing more than their age. This bias can, and often does, negatively impact both the emotional and physical health of older patients by contributing
to cognitive decline, more hospital stays, and disability. It also carries a price for providers as well.
As the nation’s population continues to age, opportunities for ageism to occur in healthcare will continue to increase as well. If you consider that the U.S. Census bureau estimates that by the year 2060 almost 25 percent of Americans will be 65 or older with the number of 95-plus individu-
als tripling, you have a good idea of the potential scope of this challenge. In fact, credible research suggests that one in five adults over the age of 50 have experienced discrimination in a healthcare setting. If nothing changes, this population will continue to be at risk for stereotyping, prejudice (implicit or explicit) and substandard practices in all areas of healthcare.
Various studies bear this out. One, for example, showed that younger patients tend to wait less time in the ED for assessments than older and frailer patients, who wait longer for the same attention and care. This delay in delivering care was attributed to no other reason than the age or frailty of the patients. Given that seniors have a greater number of ED visits than their younger counterparts, the potential negative impact on their health of having to wait for care cannot be underestimated.
In addition to risks to their physical health, their receiving often-dehumanizing treatment in the ED and other areas of healthcare can also cause emotional damage to older patients. This behavior includes infantilizing seniors through “elderspeak” (such as calling an older patient “dear”), discounting or disregarding their opinions and input, or simply dismissing them outright because “they are old.” You can see this in the following examples reported by patients and caregivers:
The doctor said to me, “Well, you know, she’s old.” And then I blew up. I said, “Her age has nothing to do with this. She is in pain, she can’t walk, she hurts.” CAREGIVER
When you’re older, they don’t expect you to know anything ... and they discount you immediately. PATIENT
Talked down to you as if you’re a child. That’s right, yes. You’re a responsible adult. You understand perfectly well what’s going on. They should treat you as such. PATIENT
There’s a stigma to dealing with older seniors ... that we’re going to die anyway. So, minimal service. PATIENT
Provider staff can also create an environment that implicitly tolerates age discrimination by having attitudes such as “every patient over the age of 65 should be an automatic no code” or “we should be saving the resources for the young”.
One impact of ageism in a provider setting is that it can influence the range of diagnostic tests and treatments offered and/or provided to seniors. It also can lead to providers making assumptions such as an older person with poor hearing being cognitively impaired or chronic conditions such as neuropathy being dismissed as “it’s part of being old.” On the other hand, some conditions may be overtreated, which can cause unnecessary harm and emotional distress. It also may increase the probability that they will engage in risk-taking behaviors that could further negatively impact their health. And last, but certainly not least, age
bias has been associated with an earlier death – by some estimates over seven years on average. Older people are often left out of clinical trials, which can make it more difficult for researchers to identify the benefits and risks of medications that may be marketed to seniors (and their doctors). Providers are not immune to the financial and operational impact of ageism. A study by the Yale School of Public Health found that this bias led to excess costs of $63 billion for a broad range of health conditions during one year in the United States. The researchers also found that ageism was responsible for 17.04 million cases of the eight most expensive health conditions in one year among those 60 and older. Among the health conditions examined were cardiovascular disease, mental disorders, and chronic respiratory disease.
What health care providers can do
Most experts agree that trying to eliminate all bias would be akin to trying to “get people not to breathe”. Providers can, however, adopt approaches and techniques to achieve positive outcomes in addressing age and other biases. Some of these include the following:
Include potential bias factors as part of a provider’s morbidity and mortality conferences to better identify when, how, and what could have prevented the bias and its influence on treatment decisions
Make the effort – and train staff – to always practice evidence-based medicine and how to better recognize when their unconscious bias and stereotypes about age and other factors (often multiple biases are present, for example race and age) may be a factor in treatment or diagnostic decisions
Take time to see the patient as an individual rather than as a member of a group prone to generalizations and try to understand their
point-of-view, life experience and day-to-day stresses
Adapt communications to compensate for the fact that many seniors have reduced hearing and visual acuity or may need additional time to process information being given them about their condition and treatment plan – this includes being sure to ask the right questions
Learn to recognize when verbal or body language during provider-patient interactions may be giving subtle cues of bias – these include “elder-speak” and talking to a caregiver rather than to the patient when also in the room
Develop and implement an ongoing continuing education module on working with elderly patients (if a provider does not already have one)
Identify and correct individual provider and staff misconceptions that contribute to age bias — these include such false beliefs such as older patients can’t understand as well as younger ones or that older ones may not follow through on after-care plans
Audit the ED and other treatment areas to identify ways to make them more “elder friendly” such as offering patient advocates or other volunteers (especially important if no family members are present), having larger type materials, and ensuring areas are well-lit It is important to recognize the existence of age and other biases and avoid taking a “not at my hospital” approach to dealing with this important issue. Admitting that any type of bias exists in a healthcare setting is neither easy nor comfortable. But doing so on an ongoing, objective basis is critical to the health and well-being of patients across the country.
Their lives literally depend on it.
This quarter’s Spotlight is on Attorney, Tami Seekins.
What is your area of expertise within SAC?
While, I assist clients in California in resolving their reimbursement disputes, my practice is focused primarily in Arizona regarding managed care and commercial insurance disputes. Issues vary, but revolve around improper exclusion of benefits, breaches of contract, contract interpretation, and authorization and medical necessity denials. In addition, I focus on noncontracted carrier reimbursement disputes in Arizona under the umbrella of unjust enrichment and implied in fact contract. Our mission at SAC is near and dear to my heart. I believe what we do is vital in helping our clients to not only maintain and grow but also to ensure our clients can continue providing quality medical services for everyone.
What one piece of sage advice can you offer to our clients that can help them in the future?
The best piece of advice I can offer our clients is to document. Proper documentation is vital to successfully resolving a reimbursement dispute, breach of contract, or contract interpretation dispute. The more detailed information I have, the better I can successfully argue our position to the court, an arbitrator, or opposing counsel. Good documentation can also save clients fees and costs because I can seek an early resolution with great supporting documentation.
Can you talk about a recent success story of yours? What was the challenge and how were you able to overcome it?
For the last 14 years, Arizona noncontracted insurance carriers have used a 2010 court decision to justify underpaying providers the reasonable value of their medical services. Insurance carriers have used this case to justify paying what they uni-
laterally decide is the reasonable value of services – which is generally just above government rates such as Medicare or Medicaid. Up until now there has been very little recourse because these carriers have had no reason or incentive to negotiate or alter their reimbursement practices.
SAC is the first firm to successfully challenge the insurance carriers’ application of this law and the defense counsel who established it. We have been tirelessly fighting on behalf of Arizona providers and have overcome two (2) motions for summary judgment in which two (2) workers’ compensation carriers asked courts in two different counties in Arizona, to rule as matter of law, that their interpretation and application of this case law was not only correct, but the only application permitted. Based on SAC’s well-reasoned arguments, the courts denied defendants’ motion and we are proceeding towards trial. With our expertise and years of experience, we are confident that the courts will understand that paying providers government reimbursement rates is unjust, inequitable, and unsustainable.
The denial of these two motions sends a clear signal to insurance carriers that they can no longer unilaterally force a hospital to accept whatever amount it wants to pay.
Do you have any hobbies or interests outside of work?
My hobbies include hiking, yoga, dance, kayaking/ paddle boarding, gardening, cooking and baking. I’m a very active person and I refresh my body and mind by staying busy. Being from Alaska originally, I really enjoy nature, so I spend a lot of time outdoors, and I have a particular interest in knowing the flora and fauna around me.
Over the last few years, I’ve also dabbled in cheese making and now make five (5) different kinds of cheese. Often when I cook, I like to experiment, so my friends and family are my lifelong guinea pigs (fortunately or unfortunately).
Do you have any charitable causes that interest you and events you have participated in recently?
I am still recovering from an extensive surgery this spring so I have not been able to participate in any charitable events recently, but my charitable interests involve social welfare issues, animal rescue
groups, conservation efforts, and volunteering with the state bar association.
Do you have family and/or pets you’d like to tell us about?
I have three (3) amazing adult children that I could discuss for days. My oldest son is named Christian. He is an electrical engineer with GM Motors and currently works on their battery storage designs. He lives in Detroit, Michigan with his wife of two (2) years.
My middle son, Caleb, is twenty-one (21) years old and earned early admission into medical school. He currently attends the University of Arizona Medical School. If you read any medical journals, you might see him. He recently was published in two (2) medical journals for research related to pain.
At 20 years old, my daughter Larissa is the youngest of the bunch. She is also in the medical field. She will be taking her boards to receive her license as an ultrasound technician specializing in prenatal ultrasounds soon.
Do you have any guilty pleasure television shows, movies or other activities to tell us about?
I don’t watch a lot of TV, but when I do, I like watching reality TV. It’s a little embarrassing to admit, but I find it oddly entertaining. So, there you have it: my no longer secret guilty pleasure.
What are your favorite foods? Colors? Other favorites?
I eat a lot of fruit. At almost any given moment of the day my desk looks like a charcuterie board. Thankfully, I live where there is an abundance of great fruit. Generally, what I’m eating a lot of rotates with the season, but I eat a lot of watermelon, berries, and cherries.
Being from Alaska, I have been spoiled with fresh wild Alaska seafood. It is really hard to beat Alaskan king crab, king salmon, or halibut that was in the water less than 12 hours earlier. I’m also partial to game meat (moose, caribou, bison, elk etc.) having eaten it as my primary meat source for many years. I am always “game” to try exotic meat (meaning not farmed) and have tried quite a few unusual items.
MISSION :POSSIBLE
UNLOCKING THE CODE TO POST-APPEAL RECOVERY SUCCESS
Location: Double Tree Hotel, Pleasanton Date:
Thursday, August 15, 2024
Join the Law Offices of Stephenson, Acquisto & Colman (SAC) at our final stop in the roadshow as we unlock the complexities of the legal landscape, empowering healthcare providers with strategies for unparalleled financial victories. Dive into the dynamics of successful post-appeal recovery and discover how our blend of expertise, innovation, and tenacity has secured over $1.5 billion in recoveries.
This seminar will equip your healthcare facility with crucial insights to transform post-appeal challenges into opportunities, ensuring that with SAC, every recovery mission is a resounding success.
To register for the event visit: www.eventcreate.com/e/sac-education-series-2024
All articles are written by the SAC Litigation team. The SAC Litigation team includes attorneys, nurses and physicians with extensive experience in all areas of law related to healthcare matters. Additionally, SAC partners hold legal advisory positions with healthcare organizations and sit on the boards of numerous healthcare-related organizations, and monitor all outgoing SAC client marketing materials and related content.
We would love to hear from you! If you have questions, comments or feedback, please email us at SACReview@sacfirm.com.
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