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The onging government shutdown has created uncertainty for more than 70 million Americans who depend on Medicaid for essential healthcare. At the same time, the telehealth flexibilities that were first put in place during the Covid-19 pandemic have also expired, leaving critical gaps in access to telehealth, which has proved to be instrumental in promoting and sustaining positive health outcomes for Americans lacking transportation or proximity to providers, especially in rural areas.
During a shutdown, federal agencies are forced to suspend non-essential operations, like maintaining telehealth services offered through Medicare and Medicaid. This leaves many patients in limbo, unsure of where to seek accessible and affordable care – especially those in rural areas or those enrolled in telehealth chronic condition management programs.
Older Americans are arguably the most impacted by the shutdown and are facing particularly dire consequences. Many rely on telehealth to manage chronic conditions such as Alzheimer’s disease and related dementias (ADRDs). For these individuals – many of whom lack transportation or the ability to attend in-person visits – virtual appointments are often a lifeline. While many Medicare Advantage and commercial plans or those enrolled in the Guiding an Improved Dementia Experience (GUIDE) Model continue to be eligible for telehealth services, countless seniors on traditional Medicare risk missing the critical window for dementia diagnosis and early intervention. According to the Annals of Internal Medicine, about half of telehealth appointments were dedicated to behavioral or cognitive health. Without these appointments and timely care, many memory-related disorders may go untreated until it’s too late. Today, ADRDs affect more than 7 million Americans – a number expected to rise sharply as the shutdown drags on and the Baby Boomer generation continues to age.
Many with ADRDs, regardless of the progression of the disease, struggle to travel safely to clinics due to disorientation, mobility issues, and anxiety in unfamiliar environments. It’s there that telehealth clinicians are able to perform remote cognitive assessments, monitor disease progression, and supervise treatments without waiting for in-person visits, ensuring that vital signs are strong, medication and treatments are being followed, and daily activities are being tracked before emergencies occur. It’s these telehealth appointments that make it possible to avoid more falls, malnutrition, or avoidable hospitalizations.
Not only is telehealth crucial for the health of the patient, but telehealth appointments are also necessary tools for the caregiver. As the number of baby boomers and seniors with ADRDs continues to rise, we’re ushering in a new generation of caregivers, and we need to be prepared to support them. In fact, research points to one in three people in the U.S. being impacted by dementia, either by being diagnosed themselves or by becoming a caregiver. While some platforms and services include programs for caregivers to support, training, and guidance tailored to those with dementia, the most important thing that the healthcare industry can offer caregivers is increased support and access to care for their loved ones.
Having a grandmother with dementia, I saw firsthand just how my family navigated this journey and process, and how we had to make many adjustments. Not only was it difficult to get to an initial diagnosis, but we also witnessed the general lack of specialists. Technology, like telehealth services, is a major step in helping caregivers and those with dementia more effectively, improving their care journey, prolonging their independence, and improving health outcomes.
Time is of the essence for those with cognitive conditions. The loss of telehealth flexibilities, combined with disruptions to Medicaid, could have devastating consequences for millions of patients with dementia and other cognitive and behavioral conditions. Despite the shutdown, the healthcare industry has a responsibility to the millions of Americans with ADRDs and must not only continue but bolster care through accessible, hybrid models that blend virtual and in-home care services.
The consequences of this lack of access to care are too steep to ignore. Policymakers must act quickly to reinstate telehealth flexibilities and Medicaid coverage and funding gaps – dementia is a bipartisan issue.
At the same time, healthcare innovators must double down on hybrid care models that combine virtual and in-home care services to patients, with a focus on screening and early detection, diagnosis, treatment, and care management to make brain health more accessible to patients. Without it, the two-year wait time to see a neurocognitive specialist returns, leaving those with ADRDs without support for ongoing symptoms and complications.
Photo: delihayat, Getty Images
Julius Bruch is the CEO and co-founder of Isaac Health, a scalable platform for brain health and dementia care that partners with leading healthcare organizations to provide expert screening, assessment, treatment, and care management for people living with dementia and their family caregivers. His background includes working as a consultant in McKinsey’s healthcare practice, where he led work in value-based care and digital health across the U.S., Europe, Asia, and Africa. Julius holds a PhD in the molecular mechanisms of neurodegenerative diseases and studied Medicine at the University of Cambridge, UK. At Isaac Health, he works to secure additional partnerships with health plans across the nation to make dementia care even more accessible for vulnerable populations.
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