Staying Healthy In A Sick Economy

Each day, Joyce Traina works with seniors who are straining to make ends meet while staying healthy — struggling with impossible life choices, like whether to fill this month’s prescription or stock up on nutritious foods.

Seniors all across the country are suffering the blows of the economic recession, and some are facing such detrimental decisions regarding their personal health and welfare.

Out of work and often physically unable to return, the elderly American population must survive on personal savings, meager pensions, government aid and family assistance when available. But Medicaid is only available to New Yorkers whose annual incomes fall below $13,800, often leaving those just above the poverty line scraping for alternative solutions, according to experts at local Jewish agencies. Andduring a recession, they note, younger family members who have lost their jobs may no longer be able to provide financial assistance to their parents and grandparents.

“Most of the people that we’re seeing are the near-poor clients,” said Traina, who is director of Health Care Services at the Metropolitan Council on Jewish Poverty. “These are the ones who fall through the cracks.”

Amy Chalfy, director of programs at Jewish Association for Services for the Aged, agrees. “Those above Medicaid level are at the most risk because Medicaid does provide a cushion,” she says. “Having that kind of access to health services because it’s completely paid for is really important. If you’re just above the line, you’re in no man’s land.”

Unable to qualify for government benefits, these seniors are lost as to how they can continue to cover their necessary expenses and local Jewish service organizations have seen an influx in clients – both Jewish and not — whose situations have become dire.

“In many cases seniors are forced to choose between paying for their meds and paying for their food,” Traina said. “I’ve heard of seniors eating cat food because the cat food is so cheap.”

But in today’s economy, even such drastic sacrifices are often insufficient.

“We are hearing that people aren’t filling their prescriptions,” Chalfy said.

“We get calls all the time that people can’t afford the $20 co-pay for the medicine, they can’t afford to see the doctor,” agreed Sanford Gruenfeld, a social worker with HomeFirst, a Medicaid-managed long-term care program at Metropolitan Jewish Health System.

And even when patients seem to be filling prescriptions properly, they’re often using dangerous cost-cutting measures like chopping pills in half to save money, noted Leah Ferster, chief services officer at JASA, which operates 24 senior centers and has five Meals on Wheels Contracts.

Until the recession really took hold in the past year, Ferster explained, many senior retirees still had personal investments they could rely upon, despite lacking a regular salary or access to Medicaid benefits.

“For the oldest of the old, if they were lucky enough to have investments they don’t have the luxury of time to build up those finances again,” Chalfy said. “We are anticipating that we will see increasing need.”

Chalfy predicts that Fiscal Year 2011 — beginning July 1, 2010 — will actually be even worse for organizations like JASA and their senior clients, due to the loss of tax revenue that helped support senior health programming. While the oldest Americans will not have enough time to rebuild their finances, Chalfy predicts, the younger portion of seniors is hardly free from worry, in part because of increased years of good health from modern medical technology.

“People are fearful that they’re going to outlive their resources,” Chalfy said. “They didn’t necessarily anticipate that they would live this long. The anxiety about outliving your resources and the potential need of going into a nursing home, that is a big fear.”

This fear is intensified by the thinning support network that many have grown to trust, namely family members who once funded their medical needs but now have lost their jobs or taken pay cuts.

"When they lose their jobs, it infringes upon the mom and dad because they’re usually helping them get through their expenses,” Traina said.

“Obviously there’s a ripple effect,” Gruenfeld agreed. “If family members are either not working or see their incomes not picking up they’re not able to provide this assistance.”

Ferster said she has noticed many more clients than usual coming into JASA’s health center to ask for money for medical expenses, but she must refer people to external agencies like Food Stamps and Medicaid — if they qualify. Independently, JASA is able to provide homecare programs with nurses and social workers at Naturally Occurring Retirement Communities, like the Co-op City high-rise buildings in the Bronx.

Met Council similarly operates several inexpensive homecare agencies, including a free housekeeping program for Holocaust survivors, but Traina has noticed that more and more seniors are canceling even such minimally priced services due to economic restraints. HomeFirst, on the other hand, works with seniors to help get them on Medicaid, and provides what Gruenfeld calls a “one-stop shop” for medical care, equipment and food stamps.

But at all three organizations, the staff members have very little optimism for the immediate future of senior healthcare.

“All we’re seeing and all we’re anticipating is that the turn around will take a while, and many of these people are anxious,” Ferster said. “They’re aging and they don’t know how they’re going to manage. They don’t know whether they’ll be able to be fiscally responsible for themselves.”