The Morning Call (Sunday)

You’re Not Too Old to Talk to Someone

The aging may do as well in psychother­apy as younger people. But finding and affording therapy can prove difficult.

- By Paula Span

THREE YEARS AGO, Janet Burns felt herself sliding into depression, a too-familiar state. Ms. Burns, a retired federal worker living in Rockville, Md., grew up in a home she described as abusive, with an alcoholic father. Sometimes, she said, “I get into a slump and can’t get out.” Several times, psychother­apy had helped her regain her equilibriu­m.

Then her father died. “It brought up a lot of stuff I thought I had dealt with,” she said. Experienci­ng guilt and relief, and feeling responsibl­e for her mother, she began to suffer from anxiety, insomnia and exhaustion. Sometimes she found it hard to get out of bed.

Ms. Burns, 75, found a new counselor and saw her weekly for a couple of months, then every other week. “She helped me put this in perspectiv­e and lift the burden I was putting on myself,” Ms. Burns said. “She gave me some tools, mental exercises to do.”

The coronaviru­s pandemic has brought fresh pressures. Ms. Burns has had to suspend her volunteer work, and she and her husband have been unable to visit their children and grandchild­ren. She’s handling it, she said. But, she added, it was reassuring to know that she could turn to her counselor again if necessary, “It’s like a safety net.” She said, “I wish everybody had it.”

Health experts and practition­ers also wish more older adults could access psychother­apy and other kinds of mental health care, especially now. Mental health problems have risen markedly during the pandemic, the Centers for Disease Control and Prevention has reported.

Although younger people are much more apt to report such ailments, one in four over age 65 said they had experience­d anxiety or depression in August 2020, according to a Kaiser Family Foundation analysis — more than twice the figure in 2018. Loneliness and isolation have taken a toll on older people, and geriatric psychiatri­sts anticipate an increase in grief disorders.

“It makes their existing issues worse,” Dr. Mi Yu, a geriatric psychiatri­st in Nashville, said of the pandemic’s effects. “All my patients seem to have experience­d more distress and anxiety and they’re requiring more frequent sessions,” which lately are conducted by video or phone, she said.

Experts have long reported that older people, particular­ly those over 80, seem more reluctant to seek treatment for psychologi­cal disorders. Acknowledg­ing psychologi­cal problems still carries a stigma.

Age bias can infect practition­ers, too, said Dr. Daniel Plotkin, a geriatric psychiatri­st in Los Angeles. “The unfortunat­e attitude that most people have, including doctors, is that older people can‘t change, that they’re stuck in their ways.” In fact, he noted, studies have shown that older people do as well in psychother­apy as younger ones.

Practition­ers may prefer to treat younger clients because they still have decades ahead during which to reap the benefits. Dr. Yu recalled a woman in her 80s who sought therapy after her husband suffered a heart attack. Two dozen local practices had turned her away, saying they didn’t accept patients her age.

“I was dumbfounde­d,” Dr. Yu said. “We actually find elderly patients are more open to therapy. They’re more reflective. Realizing that they have limited time left in life gives them a sense of urgency; they want to resolve something and they don’t have time to lose.”

Dr. Yu worked with the woman for about a year, also prescribin­g anti-depressant­s, until “she gradually was back to herself.”

But the woman’s experience demonstrat­es that even when older people decide to seek treatment, finding and affording therapy can prove discouragi­ngly difficult.

Traditiona­l Medicare covers individual and group psychother­apy, with no cap on the number of sessions; beneficiar­ies pay 20 percent of the authorized amount. It also covers treatment of alcohol and drug abuse and provides for free annual depression screening. Co-payments for Medicare Advantage beneficiar­ies vary from plan to plan.

But many mental health practition­ers won’t accept Medicare, in part because the reimbursem­ent is so low. Dr. Yu, for example, accepts Medicare’s payment of $91 for a 45-minute session, but because that is half or less than half of the going rate for therapy in Nashville, many of her colleagues opt out.

Researcher­s at George Mason University and Mathematic­a reported last year that in a national survey, only about 36 percent of mental health providers accepted new Medicare patients, compared to 83 percent of physicians.

Moreover, although Medicare covers mental health treatment by a variety of providers (including doctors, clinical psychologi­sts, clinical social workers, nurse practition­ers and physician assistants), it won’t reimburse licensed profession­al counselors or marriage and family therapists.

With only 1,526 board-certified geriatric psychiatri­sts practicing nationwide in 2019, that pool of 200,000 licensed counselors and marriage and family therapists could go a long way toward meeting the demand for care.

“They comprise about 40 percent of the

‘We actually find elderly patients are more open to therapy. They’re more reflective.’

mental health work force, but they’re not eligible under Medicare,” said Matthew Fullen, a counselor educator and researcher at Virginia Tech. “That’s a pretty heavy disincenti­ve to getting the help you need.”

He and his colleagues surveyed 3,500 practicing licensed counselors and found that half had turned away patients because of the Medicare coverage gap. Almost 40 percent had to refer existing patients elsewhere once they became Medicare eligible.

Heidi Jelasic, 68, an administra­tive assistant in Royal Oak, Mich., had been seeing a licensed profession­al counselor after a traumatic event and felt she was making good progress. Then, in April, she lost her job in a pandemic-related layoff, and with it, her employer health coverage.

That meant shifting to Medicare, which would not cover her counselor, and she could not afford to pay out of pocket. “I’m on a shoestring,” she said. “I can’t afford it.”

In short order, she has endured job loss, pandemic fears and, in September, her mother’s death in a nursing home that had barred visitors, for fear of spreading infection. “These are some of the most challengin­g months I’ve had in my whole life,” Ms. Jelasic said. “And I was unable to turn to my therapist.”

Medicare has not updated eligibilit­y rules for practition­ers since 1989, Dr. Fullen noted. Legislatio­n to add licensed profession­al counselors and marriage and family therapists has passed in both the House and Senate, but not in the same year.

Practition­ers also hope that Medicare’s temporary coverage of telemedici­ne — helpful when older clients can’t easily make in-person visits — will become permanent after the pandemic, although some seniors struggle to afford or use the necessary technology.

Ms. Jelasic counts herself fortunate that she grew up with a grandfathe­r who was a psychiatri­st. He often told his family that needing help from a mental health profession­al should be no more shameful than consulting a dentist for a toothache, and she believed him.

 ?? CYDNI ELLEDGE FOR THE NEW YORK TIMES ?? Heidi Jelasic had been seeing a counselor when the pandemic hit, and she lost her job and her health coverage. “I was unable to turn to my therapist,” she said.
CYDNI ELLEDGE FOR THE NEW YORK TIMES Heidi Jelasic had been seeing a counselor when the pandemic hit, and she lost her job and her health coverage. “I was unable to turn to my therapist,” she said.

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