22 Jul Coronavirus: The Bay Area Seniors Who Are Left Behind by a Telehealth Tech Divide

No longer able to visit libraries or other public places to use a computer, many older adults are finding that a lack of access to technology is making it harder to access health care as well. (Pavla Pelikánová / CC 4.0 / Wikimedia Commons)

By Laurence Du Sault, CalMatters

Dan Makevich’s terrible eyesight made him retire early from his beloved job of 15 years as a tour guide in the Bay Area and Yosemite. When the pandemic hit, Makevich knew his age, diabetes and respiratory problems made him a prime target. What he didn’t know was that not owning a computer would make getting health care much harder.

“All of my doctor’s appointments started canceling,” said Makevich, 67, who now lives on a fixed income and can’t afford a computer. “‘They said, ‘We’ll do it by Zoom.’ Well, we can’t.”

Seniors make up 80% of COVID-19 deaths in the U.S. and run a greater risk than most venturing outside their homes, according to the Centers for Disease Control. But even when sheltered, some elders face a lonely, disconnected reality: Half the country’s senior population doesn’t have internet access, and one-fourth live alone, according to the Census Bureau.

Loneliness itself is a health risk for older adults, but experts and providers worry now more than ever that the technological divide is reducing seniors’ access to health care. Without a statewide effort specifically aimed at helping low-income seniors during the pandemic, existing programs and Bay Area nonprofits are trying to fill a tech gap made life-threatening by COVID-19.

“There has been so much despair around not getting to see family and, more to the bone, around not having food, or access to telehealth,” said California Department of Aging director Kim McCoy Wade.

Doctors are increasingly using telehealth as the safest, most effective means of caregiving. It’s a luxury that low-income seniors who don’t have internet, a computer, or digital skills simply can’t access. Doctors and volunteers who teach digital literacy report that clients have trouble installing apps or may have never held, much less used, a smartphone.

For immunocompromised Makevich, health care has always been a high priority. But without a computer or smartphone, he quickly piled up a sizable list of small but impossible tasks: registering online for appointments, accessing programs requiring a Google or Facebook account, getting text messages for prescriptions and emails for Medicare updates or appointment reminders.

Makevich said he wished he could have participated in the Zoom appointment his health care coverage was supposed to provide him. That way, a doctor could have taken a look at his spinal stenosis. But with no way to film himself, his back problem could only be assessed over the phone. Still, Makevich knows he’s lucky: He has a partner at home and takes digital training classes through a San Francisco nonprofit that will soon provide him with a free tablet. “People without computers are being left behind,” Makevich said. “And you can’t keep up with computers if you don’t have money.”

Of California’s 5.7 million seniors, one in three are low income, according to data from the Department of Aging. When shelter-in-place orders shut down businesses, those who went to senior centers and libraries for internet and human connection quickly lost that access. With a rising number of coronavirus cases, many at-risk elders won’t leave their homes. “It’s a crisis on top of a crisis: older adults, even before the pandemic, we’re too often isolated and excluded from communities,” said McCoy Wade.

That’s precisely why Paige Wheeler Fleury co-launched Oakland at Risk in March. The community-based website was meant to match older adults with neighbors for support during the pandemic. It became much more when medical and social workers started reaching out, worried about clients who were getting further isolated by the digital divide. Wheeler Fleury said one woman hadn’t seen anybody in three months and did not know where to turn when her best friend, infected with COVID-19, was put on a ventilator.

In four months, Wheeler Fleury said, Oakland at Risk has helped 350 elders. She remembers many vividly, including one woman who was disabled and fell twice but couldn’t access web-based health services on her own.

“Many adults have lost access to health care altogether because of this digital divide,” said Dr. Josette Rivera, a professor of medicine at UC San Francisco.

Rivera, who is also a clinician for the elderly, couldn’t recall a single patient who’d been able to set up a telehealth appointment without the help of a younger family member. “Saying that telehealth is the solution … well, not for everybody,” said Rivera. “It’s a real inequality.”

The divide isn’t only a question of age. According to the California Public Utilities Commission, of all demographic barriers to getting connected, income is the most significant. The Pew Research Center found in 2017 that 73 percent of low-income elders in the U.S. don’t have home broadband, compared with 13 percent for households earning $75,000 or more.

For 62-year-old Scott-Stephen Aiu, library computers were an essential part of life. Every day, Aiu, a San Francisco resident living alone on a fixed income, would read his email and make sure everyone was doing well back home, in Hawaii. The pandemic put a stop to those daily communications. Aiu said he contacted multiple senior centers and even city and state officials to ask how he could access the internet, without success.

McCoy Wade said the Department of Aging had been communicating with the Public Utility Commission and tech corporations, among others, to address seniors’ issues of digital access, and there have been discussions about making access to telehealth an integral part of Medicaid and Medicare. The department has also been gathering data and holding webinars, McCoy Wade said, but has yet to target the specific technological needs seniors face during the pandemic. A few statewide initiatives like Comcast’s 60 Day Free internet program or the PUC’s Emerging Technology Fund seek to close the digital gap, but many still struggle to find solutions.

Two months into shelter-in-place, Aiu was referred to Community Tech Network, a San Francisco nonprofit that partnered with others to launch programs aimed at improving access to technology for elders. Aiu was given a tablet and digital training. Being able to connect with family and make safe doctor’s appointments on Zoom has made him feel “part of the world again.”

“It was just in the nick of time because honestly, I was just going to give up,” said Aiu.

This article is part of The California Divide, a collaboration among newsrooms examining income inequity and economic survival in California.