Opinion | The Challenges of Health Care for the Elderly

Opinion | The Challenges of Health Care for the Elderly

To the Editor:

Re “The Decline in Geriatric Care Hurts Us All,” by Pamela Paul (column, Jan. 17):

The blame for the relegation of geriatricians to the bottom of the medical specialty hierarchy resides with ourselves. We are a consumer society, after all. Where there is demand, a wealth of choice reigns.

But as Ms. Paul writes, elder care is seen as profoundly unglamorous, even repellent. The helplessness of babies and the old are similar, but how starkly different are the reactions. We do not rush to nursing homes as we do to maternity wards. As a modern society, as human beings, we have far to go to realize the gift of being with our elderly as the joy it is.

Deborah Plumer
Brooklyn

To the Editor:

There is much to be done to give all of us access to quality medical care as we age.

The government can increase Medicare reimbursement rates to ensure fair compensation for geriatric services, to encourage more providers to accept older patients. Private funders can support medical schools to provide scholarships, loan repayment and grants to encourage specialization in geriatrics. Medical and health professional schools can infuse geriatrics into their required curriculums. The National Institutes of Health can increase funding for research into the basic biology of aging and new approaches to age-related chronic diseases.

Finally, we must fight inaccurate, ageist and all-too-common views in health care about older adults. That will provide the foundation for delivering the kind of care to allow all of us, as we age, to make needed contributions to our families, communities and nation.

Stephanie Lederman
James Appleby
Ms. Lederman is executive director of the American Federation for Aging Research in New York. Mr. Appleby is chief executive officer of the Gerontological Society of America in Washington.

To the Editor:

There are just not enough providers who want to treat elders. It is the same with psychologists: Less than 1 percent are interested in working with geriatric patients. It’s so important and critical that Medicare continues to cover mental health care in a variety of settings, including telehealth and home visits that my older clients use.

My passion for the emotional well-being of older adults began by chance. In 1978 at the first community mental health center where I worked, the federal government was offering free training on mental health care for the elderly to only one therapist at each center. Since I was the only therapist to raise my hand, saying, “I like my grandparents,” I was selected to attend the training and fell in love with counseling older adults.

Working with the aged has been richly rewarding. I am fascinated with people’s long lives and the complexity of their issues. Connections with clients are real and strong and appreciated. And surprise: Now I am an elder.

Miki Paul
Benicia, Calif.
The writer is a licensed psychologist.

To the Editor:

Even if medical education and practice in the United States were more sensibly financed, the need for elder care would be overwhelming. There are about 7,300 doctors board certified in geriatrics in the country, and currently about 57.8 million Americans over 65. Each geriatrician can care for about 700 patients. Do the math: Most seniors do not get any geriatric care at all.

What if we formed geriatric centers that provided care by not only physicians, but also a broad array of nurses, physician assistants, dental assistants, physical therapists, dietitians, etc.? Not only would such “geri-centers” provide multidisciplinary medical care, they would also offer opportunities for continued socialization for our elders, who often are isolated.

Who would pay for all this? The younger generations, whom we worked so hard to raise and who will age into benefiting from these services themselves.

Herbert Rakatansky
Providence, R.I.
The writer, 90 years old, is emeritus clinical professor of medicine at Brown University.

To the Editor:

Re “Zuckerberg’s Macho Posturing Looks a Lot Like Cowardice,” by Zeynep Tufekci (column, Jan. 16):

While Ms. Tufekci’s column on Mark Zuckerberg’s metamorphosis is spot on, it can be summed up simply in two of its sentences: “Flattery and obeisance are how powerful people keep themselves in favor with strongman regimes. Cash works, too.”

Most striking of all, however, is what Mr. Zuckerberg’s conversion represents. Like the actions of Elon Musk, Jeff Bezos, Jamie Dimon and their ilk, it is part of the final element of Donald Trump’s impending ideal government: an authoritarian president, an obedient administration, a subservient legislature, a compliant Supreme Court and a controlled oligarchy providing him access to unlimited wealth in exchange for their own access to vast power and increased profit. It is the mirror image of Russia, his model, and China as well.

This is not at all speculative. It is here and it will be unchallengeable for at least two years (if and when Democrats gain control of the House), possibly four. If any of us need convincing of the enormous power Mr. Trump will have, try to think of the last time any of the branches of government or the economic titans of their countries defied President Xi Jinping in China or President Vladimir Putin in Russia. I believe the answer is never.

Jay Adolf
New York

But we believe that the plan will unduly incentivize demolition of historic buildings and further erase fashion manufacturing jobs, which have already declined by 60 percent in the past decade.

The Historic Districts Council is proud to have partnered with the New York Fashion Workforce Development Coalition as part of our 2024 Six to Celebrate program to protect both the physical fabric and manufacturing businesses of the garment district.

MSMX currently does not include incentives for retaining fashion manufacturing jobs. It should fulfill the unkept promises from the Bill de Blasio administration’s 2018 support package for fashion production.

The plan should also incentivize residential conversion over new construction. The Landmarks Preservation Commission must designate key sites and blocks in the area.

These changes to MSMX would allow the garment district and the Midtown South area to house thousands of residents while protecting the manufacturing jobs that are a livelihood for so many workers.

Frampton Tolbert
New York
The writer is executive director of the Historic Districts Council.

To the Editor:

These days I don’t want to get out of bed, turn off the warm shower, read the newspaper or head out the door.

But I must fight against authoritarianism, racism, sexism, homophobia, inequality, religious intolerance, xenophobia, denial of L.G.B.T.Q. rights, war, environmental destruction and any of the other manifestations of ignorance and hatred that continue to exist and thrive in our societies.

I’m 76, I can’t do as much as I used to, but I will get up, dry off, read the paper and head out the door.

We must stand up, and speak up, together. Now and always.

Elizabeth Davidson
Bainbridge Island, Wash.

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