The Healthcare Paradox of Seniors: Greatest Need but Least Access to Physicians

Our seniors are caught in a healthcare paradox.  They have enormous healthcare challenges, and yet many have the least access to physicians because they have so much trouble getting to them.  By 2030 seniors will represent 20% of our population, and they are the largest subgroup of our citizens.  It would be logical to believe that they would be a major focus of attention of the medical community, but this is not happening.  As a result, our seniors are underserved, overprescribed, and under-represented in healthcare delivery and research.

There are intriguing new developments in electronic access to healthcare, but most seniors don’t or can’t use electronic gizmos and are therefore left behind (

Physician medical practices seem to spring up everywhere, but the physicians themselves maintain their traditional business model and force seniors to either come to them for their care or do without.  Too often our cumbersome medical system causes seniors to delay needed healthcare until it’s too late, resulting in an ER visit or hospitalization.  And when they are discharged from the hospital, seniors are given a ream of paperwork with myriad vague and often conflicting instructions which they are then forced to try to disentangle and assimilate, all while they are still weakened and recovering from their illness.

Seniors have the highest number of chronic medical conditions, are the highest consumers of our healthcare dollars, and yet are at the point in their lives where they are least able to financially contribute to the cost of their healthcare.  And yet approaching senior healthcare in the traditional manner does nothing to reduce their overall healthcare costs.

So, what is the solution?  Well, there is no single solution that will solve this paradox, and looking for a magic bullet that doesn’t exist might explain why there has been such little progress in this arena.  And it blinds us to creative approaches that can be identified that can have real and immediate, tangible benefits.  If we make it our goal to “bite off a little chunk” of this problem rather than the impossible task of conquering the entire monstrosity, and if we get creative, we can make a difference in the lives of our seniors NOW…not a year from now, not 5 or 10 years from now, but NOW!

Here’s an example of a “new” and deceptively simple approach.  A “House Call.”  A simple, old fashioned House Call.  A physician bringing full primary care to the home of a senior.   This opens up a world unseen and unknown by most physicians, because what happens in a patient’s home is often VERY DIFFERENT from what the physician imagines from his remote perspective in the hospital or his office.  And here’s the best part of this approach and where the benefit really lies:  once the physician is in the senior’s home, this allows on-site, realistic physician leadership and management of the senior’s healthcare, where the physician sees things the way they really occur and not just the way he imagines they occur.

There are only a few working models of House Calls across the United States, and among the most successful are those providing care in Retirement Communities (Independent and Assisted Living) which are a popular alternative for many aging seniors.  It is here where physicians can schedule a group of patients to be seen in a ½ day clinic, most closely imitating a ½ day in the doctor’s office.

But this approach needs the partnership and mutual support of both the physician and the Retirement Community.  When this occurs, the benefits of an on-site House Call are just what you’d expect them to be:  more appropriate care directed to the reality an individual patient faces at home, healthcare that is actually provided rather than avoided due to the difficulty or impossibility of accessing a physician, and adjusted expectations of achievable results resulting from a better knowledge of the patient and his preferences.  Applied on a broad scale, the House Call would almost certainly contribute to reducing overall healthcare costs.

We must encourage and foster creative approaches to improving the healthcare of seniors.  Everyone who interacts with seniors is a stakeholder.  So I encourage you to think outside of the traditional healthcare box, think creatively, and then innovate by picking just a small “chunk” of this issue and applying your contribution TODAY!

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