COVID-19 and 2021: Looking into the Crystal Ball

Published in the Pawtucket Times on December 28, 2020

Novel coronavirus (COVID-19) cases continue to surge across the nation.  Yesterday, nearly 18,986,236 Americans have contracted COVID-19 with over 331,930 dying, says the John Hopkins Coronavirus Research Center. Projection models say that deaths may spike to over 500,000 by March 2021.

As 2021 approaches, the Centers for Disease Control and Prevention (CDC) has announced that 1.9 million people throughout the nation have gotten a dose of COVID-19 vaccine.  CDC also warned that a new variant COVID can be more rapidly transmissible than other circulating strains of SARS-COC-2.

Even with the dissemination of a safe and effective COVID-19 next year, many experts say that COVID-19 will around for a long time.  We are now seeing New Year predictions being made about COVID-19’s future impact on the delivery of care to seniors. The New York-based Aloe Care Health, one of the world’s most advanced voice-activated medical alert and communication service for elder care, recently brought seven experts together, to make predictions as to how COVID-19 pandemic will impact the provision of healthcare, insurtech, caregiving services and aging services in the upcoming year.  

Predictions from Health Care Experts

According to a statement released by Aloe Care Health on Dec. 22, these invited experts see a ‘Better Year Ahead.”  Here are some of their insightful predictions: 

Jay H. Sanders, M.D., CEO, The Global Telemedicine Group, member of the Aloe Care Advisory Board, observed: “The best examination room is where the patient lives, not where the doctor works. And, any variant of the following: telemedicine is to healthcare as Amazon is to shopping; as Netflix is to the movie theater, and as on-line banking is to your local bank.” 

“While 2020 turned the world upside down, it also revealed the massive gaps and deficits that exist in caregiving and senior care. I think 2021 will be the ‘Year of the Caregiver’ as companies, the senior care industry, and leading service organizations come to terms with how to best serve these underpaid and undervalued everyday heroes,” stated Amie Clark, Co-Founder and Senior Editor at the Clackamas, Oregon-based The Senior List.  

Donato Tramuto, Author, Chairman and Founder of Health eVillages, noted: “After a year highlighted by the devastating impact of COVID-19, vaccinations and other measures bring us hope to combat the virus in 2021. However, it is also important that we pay attention to the unintended consequences of COVID-19. As we safely social distance to decrease exposure risk, we must find ways to intervene and deal with the social isolation and loneliness caused by the lack of connection. I expect the next decade to bring innovations in business and healthcare to help us rebuild our community of connections and address the loneliness epidemic.” 

“Aging-in-place will continue to gain traction. Remote patient monitoring, personal emergency response technology, and other health matters will be addressed in-home. Health Insurance companies will redouble efforts to advance digital care management, using data to prevent acute health episodes. Covid19 will accelerate the digital adoption of remote patient care and communication. Masks will be required or desired in many public forums for much of 2021. Sadly, social distancing may be here to stay,” predicted Bob Hurley, Executive Advisor in Digital Health, eHealth; member of the Aloe Care Advisory Board. 

“COVID has demonstrated the power of telehealth to support health care workers, the older population and caregivers. It is amazing to see the adoption rate grow amongst all ages and the importance it addresses for the safety and independence of vulnerable populations. I expect innovative concepts to grow and expand in 2021 that will further empower providers and the population as a whole to live healthier and fulfilling lives,” anticipates Vicki Shepard, Health and Aging Expert, co-founder of Woman Business Leaders (WBL): Women Leading Healthcare 

“The last several months have given every one of us a dose of radical empathy for people who are isolated and alone. My profound hope is that this translates into better care for one another, especially older adults, in 2021 and beyond. And as our population ages overall (more than 10,000 of us reach 65 every day), I hope too that we collectively evolve beyond so many limiting, false, and often unconscious preconceptions about aging. This starts with products that are more thoughtfully, more beautifully designed, and extends right through to our everyday interactions.” Says Ray Spoljaric, CEO and Co-Founder, Aloe Care Health  

Finally, Jordan Mittler, Director and Founder of Mittler Senior Technology, adds: “In 2021, older adults will continue to rely on simple technology to interact with friends and family, as well as to function independently. Normalcy will take time to resume, and senior communities need to use home devices to function in society. Online shopping, online healthcare, online banking, and virtual communication will be major components of the lives of elders as we go into 2021.”  Jordan leads an inspiring group of teens teaching elders how to use technology to improve communication and daily activities. 

Predictions from a Rhode Island Physician

Over the months, Michael Fine, M.D., Chief Health Strategist, City of Central Falls, says that the COVID-19 pandemic made seniors to feel isolated and vulnerable. “As people get vaccinated it will let people feel more comfortable about moving around.  But January and February will be very hard month,” he warns. 

As we move into 2021, Fine predicts that “many people will think twice before moving to congregate settings of any sort, and we will live with new and burdensome precautions for a long time.”  He thinks that Rhode Island will lose some of its assisted living facilities and nursing homes due to the ongoing pandemic.  

Next year, Fine recommends that older Rhode Islanders stay close to home until they are vaccinated and use food delivery services where possible.  “The best way to cope is to use the telephone a lot and go out walking as much as possible, and to listen to lots of music and read a lot,” he says.   

“COVID-19 has changed how we live our lives.  Wearing a face mask and social distancing are the new normal. “I think we will go back to life as it was.  But it will take 3 to 5 years,” says Fine.   

Fine, who formerly served as the state’s Director of Health, has some thoughts about combating the COVID-19 surge in the Ocean State.  “My advice continues to be to shut bars and restaurants for indoor dining and to keep schools open, until we drop to below 2 new cases/100,000 population per day.  Everyone who works outside their homes should be tested twice a week, and every employer should make sure that’s happening, and everyone positive should be isolated for 10 days, and all contacts go into quarantine. We need employers to take the lead on this, because government has not been able to get it done,” states Fine.

Spotlight on Government Action

“It is time we all look hard at our political leadership, which has chosen to keep factories, bars and restaurants open, at the cost of hundreds of lives and a robust economy, while the virus is spreading in our communities, hitting people of color hardest.  We need to look at ourselves and our faith communities as well, allowing this to happen instead to speaking up for the sanctity of human life,” says Fine. “Democracy depends on the consent of the governed.  We all went along.  This response represents the most fundamental kind of institutional racism, the kind that puts profit in front of the lives of people of color and the communities in which people of color live,” he adds.

“All level of government failed.  SARS-CoV-2 is a cold virus.  We remain completely unprepared for a truly dangerous virus, which is evolving somewhere around the world, and will hit elders and people of color hardest again,” warns Fine. 

Keynote: Fine Calls for Community Health Stations Across Rhode Island

Published in the Woonsocket Call on May 20, 2018

Last week, the Rhode Island Minority Elder Task Force (RIMETF) held a Health and Wellness Fair at the Cape Verdean Progressive Center in East Providence to put a spot light on minority health care needs.

Dr. Michael Fine, a primary care physician who formerly was the state’s Health Director, and now serves as Senior Population Health and Clinical Officer at the Blackstone Valley Community Health Care, Inc., gave the keynote address, calling for an overhaul of America’s ailing health care delivery system.

Although RIMETF’s primary mission is to raise money and seek grants to provide limited emergency assistance to low-income seniors in crisis situations, the organization also promotes the advancement of inclusive programs for minority elders, says Susan Sweet, the nonprofit’s founder, a former state official who advocated for, developed and operated programs and services provided to the state’s vulnerable populations, including elders. She continued that work after retirement from the state. “During the last two decades, RIMETF provided more than $53,000 in grants,” she said.

According to Sweet, RIMETF’s $200 grants help low income seniors to pay utility costs, rent, food, medications, clothing, furniture, personal healthcare items and other necessities of life. She says that 80 grants are given out annually, about half going to minority applicants.

But, the decision to host a Health and Wellness Fair on May 11, 2018, was tied to minorities having a lack of access to health care services and to have Dr. Fine outline a better way of providing care to Rhode Island’s minorities, adds Sweet. “To this day the state’s diverse minorities continue to remain in the dark about health care programs and services that they can access and that lack of information has a detrimental impact on their health and well-being,” says Sweet.

Health Disparities in Rhode Island

During his thirty-minute keynote, Dr. Fine, a primary care physician who formerly was the state’s Health Director, and now serves as Senior Population Health
and Clinical Officer at the Blackstone Valley Community Health Care, Inc., provided the details as to how lack of access to health care adversely impacts the health and life expectancy of Rhode Island’s minorities.

According to Dr. Fine, infant mortality in the African American population is about three times as high than in the white population. Diabetes is about two times more common in the African-American population than it is in the white population. He also noted that life expectancy in the United States is 4.5 years less among the African American population than it is among the white population.

Zeroing in on Cape Verdeans, Dr. Fine noted that the Rhode Island Department of Health does not track the health of this minority group separately from other groups. The state’s primary care practices and community health centers don’t have a good way to decide who counts as a Cape Verdean for health tracking purposes, he said. But about half of the Cape Verdean community in Rhode Island live in Pawtucket and Central Falls, so that health information collected using the electronic medical record by Blackstone Valley Community Health Center (BVCHC), Inc, provides the first ever look at the health status of Cape Verdeans in Rhode Island.

It’s difficult to know if that data is complete, because it doesn’t allow us to count all Cape Verdeans at the BVCHC, but only those people who speak Cape Verdean Creole or those who identify themselves as having been born in Cape Verde. “Because we have no complete way to identify the health status of the Cape Verdean population, we have no certain way to identify specials needs and opportunities to provide better health care to this minority group,” says Dr. Fine. In addition, because Cape Verdean Creole is not a written language, “we have no way to certify Cape Verdean medical translators” which means some of the health care needs of Cape Verdeans go unaddressed, he adds.

But, there are better ways to improve the health care of Rhode Island’s Cape Verdeans, says Dr. Fine. “We must make sure that all Cape Verdeans are enrolled in a primary care practice or community health center,” he says, noting that electronic medical systems can provide better measures of the health of this population.

Dr. Fine called for Cape Verdeans to be appointed to boards of health care organizations to represent them in decision of allocation of resources, to demand better translation services, and to improve delivery of health care to Rhode Island’s Cape Verdeans.

As to Rhode Islanders, Dr. Fine noted that 25 to 45 percent don’t get primary care and prevention. As a result, there are 1,200 unnecessary deaths a year from heart disease and stroke. There are 200 unnecessary deaths a year from colon cancer and 65-70 unnecessary cases of HIV. Up to 200,000 Rhode Islanders remain smokers, he says.

Dr. Fine continued to detail the negative impact on the health of Rhode Islanders if they did not visit a primary care physician. More than 1,500 babies are born to teenagers, more than a third to minorities. Not to mention that there are 330 to 400 avoidable deaths from influenza every year due lack of immunization (500,000 Rhode Islanders are currently not immunized every year). And there are 330 deaths a year from prescriptions and other drug overdoses, he says.

It’s Time for a Change

Dr. Fine warns that major changes must be made to the nation’s health care delivery system to reduce spiraling health care costs and to provide better access. This solution can be modeled after his Central Falls Neighborhood Health Station (CFNHS), he says. It’s a multi and interdisciplinary approach, bringing a wide variety of health care professionals together, from physician, nurses, physician assistants, mental health workers, nutritionists, substance abuse workers and midwifes, to rehabilitation professionals, CFNHS’s must also provide urgent care and primary care services, be open on weekends and have “sick today access appointments.” Says Dr. Fine.

Fine has documented early successes in the CFNHS’s delivery of health care. Adolescent pregnancy was been reduced by 24 percent in 2016 and emergency medical service runs were reduced by 5 percent in just 12 months.

Dr. Fine envisions a Neighborhood Health Station in every community of 10,000 persons. When up and running, “we’ll increase life expectancy, reduce infant mortality and revitalize the local economy,” he says, by reducing health care costs.

Concluding the Health and Wellness Fair, Director Charles J. Fogarty, of the Rhode Island Division of Elderly Affairs, who will be retiring next month, was recognized by RIMETF for his 40 years of public service and his support for the work of the Minority Elder Task Force.

For more details regarding the work of the RI Minority Elder Task Force or to make a donation, write RIMETF, 5 Leahy Street, Rumford, RI 02916 or call Lori Brennan Almeida, Chairperson, at 401-497-1287.

Tips on Finding an Age-Friendly Fitness Center

    Published on November 16, 2012, Pawtucket Times

           With the cold frigid weather approaching, that 30 minute daily walk around the block may well fall by the wayside in the winter months. While this activity is just what the doctor ordered to help keep you physically fit and feeling good, many aging baby boomers and seniors ‘look inward’ by turning to a local gym, by bringing their regular exercise indoors.

Seeking that Perfect Age-Friendly Fitness Center

            According to the Vancouver, British Columbia-based International Council on Active Aging (ICAA),aging baby boomers and seniors are joining health and wellness facilities faster than any other age group today, however many of these facilities are ill-prepared or not equipped to serve those in their later years.

While older “adult-focused” small gyms like ‘Nifty After Fifty’ are available, “even the large 24 Hour Fitness chains seek to attract older adults”, says Patricia Ryan, ICAA’s Vice-President of Education, noting that “over 70 percent of YMCAs had older adult programs according to a stat cited in ICAA Active Aging in America, Industry Outlook 2010.

Ryan recommends that when shopping around for a fitness center that caters to older baby boomers and seniors, always compare and contrast information gathered, using the following checklists, created by ICAA, to identify age-friendly fitness center.

            Become a savvy shopper when touring your local fitness center, by making sure it gears its amenities and organizational philosophies towards your needs – those age fifty-something and beyond.  ICAA, the world’s largest senior fitness association, has created a check list to help older persons to rate and compare local fitness facilities so they can choose one that meets their age-specific needs.

Some specific questions to consider can ultimately ensure that the center you choose meets your specific physical needs:

  1. Are the locker rooms clean, accessible and monitored by staff?
  2. Do you feel comfortable in the atmosphere of the facility?
  3. Are the membership contracts and marketing materials available in large print?
  4. Are signs visible and easy to understand?
  5. Does the facility’s cardiovascular equipment have the following age-friendly features – a display panel that is easy to read, easy to change and easy to understand?
  6. Is the music acceptable and set at a reasonable level?
  7. Do the facility’s treadmills start slowly, at 0.5 mph?
  8. Do the recumbent bikes or steppers have a wide and comfortable seat with armrests?
  9. Does the facility’s strength-building equipment have instructional placards that have simple diagrams, easy-to read text and font, and correct usage information.
  10. Does the facility’s strength-building equipment have a low starting resistance, less than five pounds?
  11. Does the facility offer programs designed to meet the needs of those with a variety of chronic conditions (specifically osteoporosis, cardiovascular, disease, diabetes, balance abnormalities, muscular weakness)?
  12.  Do the group exercise classes have different levels of intensity, duration and size?
  13.  Is there an extensive screening and assessment process (for balance, functional   abilities, osteoporosis)?’
  14.  Is the staff certified by a nationally recognized organization to work with people who have various health issues that may arise with age (specifically osteoporosis, hypertension, arthritis)?
  15. Is the staff knowledgeable about the impact that medication can have on exercise?

To download the complete checklist, visit the ICAA website,  www.icaa.cc/checklist.htm.

Getting Healthy, Building Closer Relationships   

It’s no secret to Maureen Wilcox, 45, of the need to cater to an aging population.  Wilcox,  a certified Personal Trainer at the Attleboro YMCA located across from the City’s Public Library on South Main Street in Attleboro, MA estimates that 30 percent of the nonprofit group’s membership is age 50 and over.  Many of these members are seeking advice on how to better manage or prevent age-related health concerns, the most common being: arthritis, high blood pressure, diabetes, cardiac health and obesity.

Wilcox notes that this large constituency finds value in the Attleboro YMCA’s wide variety of programs that are geared towards baby-boomers and seniors.  These programs include resistance and strength training, aqua classes, Zumba classes, chair exercises, yoga and Tai Chi. “These classes will help you to manage a healthy body weight, stimulate your immune system, increase strength, improve posture, increase your flexibility and balance and help prevent chronic illnesses”, she adds. 

             According to Wilcox, a fitness center can also be a place to build friendships among older persons.  “A supportive community can enhance camaraderie among the participants, keeping them motivated and committed to meeting their exercise goals,” she says, adding that commitment to an exercise regime may well be more important than pushing weights around..

Over the years working, Wilcox has seen many new members in their later years forge new friendships at the Attleboro YMCA.  “Seeing people regularly allows them to develop meaningful relationships where they ultimately become an extended family,” she says.

“Relationships developed by participating in exercise classes also builds a small community among the senior age group members,” Wilcox notes, adding that they often participate in social trips and group outings outside of the Attleboro YMCA.  She notes, some seniors while exercising on their stationary bikes, read a big print book, To Kill Mocking Bird, adding health and wellness to an already established community literacy initiative.

Finally, in addition to personal training, various group exercise classes, including a running club,  LIVESTRONG is also offered at the Attleboro YMCA, says Wilcox.  It’s a free 12-week personal training program that provides a place where cancer survivors can come together.   Along with specially-trained staff to safely work in small groups,  participating members receive one-to-one attention while working toward maintaining or regaining their independence, everyday fitness, and overall health & wellness.  These participants share a bond that only cancer survivors can relate to.  “This is an inspirational program and one which we are all proud to be a part of,” prides Wilcox.

Getting to the Bottom Line

             Outdoor walking or the gym? That depends on personal preference and time availability.  “Brisk walking is beneficial, emphasizing ‘brisk,’ “says ICAA’s Ryan. “Faster walking to increase intensity has been reported in several studies in ICAA Research Review, to enhance your health, rather than the frequency,” she noted.

In addition, Ryan adds that scheduled classes in a fitness center help a person plan physical activity into their days and there should be equipment and classes for variety. There is expertise available in many (but not all) cases, especially in gyms targeting older adults and medically integrated fitness centers, a.k.a hospital wellness programs. There is recognition among most fitness clubs that older adults are not only a huge population to attract, but also a very good customer because of expendable income, she says.

“Exercise plays a vital role in healthy aging,” says Michael Fine, MD, Director of the Rhode Island Department of Health.  “Regular exercise is an important weapon in the battle against chronic diseases, such as heart disease and diabetes.  Exercise also helps us maintain flexibility, balance and mobility.  It isn’t necessary to join a gym or buy expensive equipment; a brisk walk around the block is a great place to start if you’ve been sedentary. The key is to find an activity you enjoy and to make time for it each day.”

Ryan strongly agrees with Dr. Fine. “The most important message for those late in life is to MOVE, and to add physical activity into each day.  Physical activity is the magic pill. Whether walking, raking and hauling leaves, playing soccer or even going to a fitness club, it’s the right thing to do for healthy aging.

Herb Weiss, LRI ’12,  is a Pawtucket-free lance writer who covers aging, medical and health care issues.  He can be reached at hweissri@aol.com.