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The gaps in our social safety net


When it takes up its next bill to combat the coronavirus raging across the U.S., Congress should include measures to combat a second epidemic that is spreading in COVID-19’s wake: social isolation.

Social isolation has long been a threat to Americans’ health, and especially to the elderly who are so vulnerable to the novel virus. One in four community-dwelling elderly Americans lives alone. Many have outlived spouses and friends, and live at great distance from remaining family in our dispersed, highly mobile society. Not all are technically savvy and nearly half don’t have a home internet connection.

Under the best of circumstances, these conditions can lead to loneliness, and now in this period of forced distancing, it is even more likely and more dangerous. When isolation becomes loneliness, individuals are at significantly increased risk from many of the common cripplers and killers in modern society: heart disease, cancer, stroke, dementia, and other chronic maladies. 

Now that the community lockdowns that are essential to interrupt the spread of the novel coronavirus are severing social links, addressing social isolation may be as important to health as the most powerful medicines we need to ultimately develop for COVID-19. 

The good news is that there are ways to help with loneliness and blunt its negative health impacts and policymakers could employ some of them to nip this new social epidemic in the bud.

The Medicare program should provide more generous coverage of mental health benefits, including a temporary elimination of copays and deductibles for mental health services until lockdowns are lifted. Medicare should also require its prepaid health plans, in its Medicare Advantage program, to offer services to combat social isolation. 

In particular, allowing Medicare to provide digital solutions and support so people can engage in telemental health and other digital activities that could help them stay socially connected during lockdowns.

Congress should fund the Department of Health and Human Services to support the nation’s extensive, but underfunded, a network of Area Agencies on Aging or AAAs.

These agencies already run many programs to support the elderly in their homes through food and transportation assistance, as well as programs to combat social isolation. Their work has been shown to reduce nursing home admissions and costs — doubly important in the age of COVID19.

Congress should also increase support for state and local public health departments to combat social isolation. These agencies were stretched thin before the pandemic, and need assistance to expand pre-existing programs to care for vulnerable elders.

Congress should provide funds for eligible non-profits with a track record of combating social isolation.  New legislation might also support the development and distribution of a growing suite of mobile applications for those elders who are connected. These apps provide opportunities for chats, remind elders to check in with existing friends and families, and connect users to conversational coaches. 

The current pandemic is shining a merciless light on many of the gaps in our social safety net. The isolation of many of our most vulnerable citizens is one of those. If the response to the pandemic creates a more robust set of supports for socially isolated elderly, it could help many survive this pandemic and have lasting positive effects on the health of Americans for generations to come.

David Blumenthal, M.D., MPP is the president of The Commonwealth Fund. Gretchen Jacobson, Ph.D., is the vice president of medicare at The Commonwealth Fund. Tanya Shah, MBA, MPH, is the vice president for Delivery System Reform at The Commonwealth Fund. The Commonwealth Fund is a nonprofit foundation supporting research on health care issues and making grants to improve health care practice and policy. 


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