Hosted by Renee Shaw, this program explores barriers to health care for senior citizens in the state and the factors that contribute to poor health among those individuals. This special report is funded in part by the Foundation for a Healthy Kentucky.
- 1. While most elderly Kentuckians qualify for either Medicare or Medicaid, rising health care expenses – including prescription drug costs – remain burdensome for many, and accessing benefits is challenging.
According to America’s Health Rankings, persons over age 65 in Kentucky pay roughly double the amount of out-of-pocket expenses for health care compared to adults ages 45 to 54. These expenses, coupled with high food and housing costs, have contributed to an increase in the percentage of Kentucky seniors living in poverty since 2018, based on data from the United States Census Bureau.
The high costs of care can cause seniors to skip appointments and/or medications. Logan County resident Teresa Hudson, who is in her 60s and has COPD, asthma, and diabetes, had to ration her medications for these ailments because her cumulative out-of-pocket costs exceeded her monthly income.
“I used to go without some of my inhalers,” Hudson says, “because some of them cost $50 to $75, and that was after insurance. You go without them if you can’t afford them.”
After some trying times, Hudson found help from the Barren River Agency on Aging and Independent Living. There are 15 of these agencies located across the commonwealth, serving specific area development districts, and they exist as one-stop shops for senior information and resources. In Hudson’s case, the Barren River Agency connected her with programs that helped defray some of her monthly medication expenses.
Many seniors on Medicare or Medicaid need help navigating complicated applications and policies. Kentucky’s Cabinet for Health and Family Services offers a State Health Insurance Assistance Program (SHIP) online or by phone (at 1-877-293-7447) where qualified counselors are available to answer questions about Medicare and Medicaid, and instruct Kentuckians on how to obtain benefits.
“One of the most important benefits we try to help people access is called Medicare Extra Help,” says Angela Zeek, SHIP coordinator with Legal Aid of the Bluegrass. This program lowers monthly Medicare Part D prescription drug costs for qualifying individuals by paying the monthly premium and also part of the pharmacy bill. “It’s a very important benefit and saves about $5,000 per year in medication costs,” she says.
Another option for assistance is the Medicare Savings Program. Zeek says this program pays the monthly premium for Medicare Part B, which covers physician and clinic visits. In 2024, this program cost enrollees $174.70 per month. “That is typically deducted from the Social Security check before seniors receive it,” she explains. “If we can get them access to this program, then they retain their entire Social Security allotment.”
Victoria Elridge, commissioner of the Kentucky Department for Aging and Independent Living, says her agency operates a division called the Aging and Disability Resource Center that provides counseling to seniors facing health and financial problems. When Kentuckians call in, Elridge says a counselor will determine how best to address their issue, exploring all options available for assistance. “Last year, our SHIP counselors saved older Kentuckians $3.5 million alone in prescription expenses,” she says.
Seniors burdened by high prescription drug costs will get some relief in 2025, says Gary Adkins, volunteer state president of AARP Kentucky. As part of the Inflation Reduction Act passed by Congress and signed by President Joe Biden in 2022, a cap on out-of-pocket prescription drug prices of $2,000 per year will apply to all Medicare Part D enrollees starting this year. “I think the estimate right now for Kentuckians is about 76,000 people are going to be positively affected with this,” he says.
- 2. Many seniors in Kentucky, in both rural and urban areas, don’t have reliable transportation to medical appointments. In addition to making it difficult to receive quality health care, lack of transportation can contribute to social isolation and loneliness.
According to the U.S. Federal Transit Administration, once adults over age 65 stop driving, they make 15 percent fewer trips to the doctor. Seniors in rural areas that have stopped driving often have to rely on family and friends to visit their doctor’s office or a hospital, since public transit is scarce to non-existent.
In Carter County located in northeastern Kentucky, Regina Shockley takes her husband, Martin, to his medical appointments. It’s a difficult, time-consuming process as Martin is confined to a wheelchair due to an autoimmune disease. For longer trips to Lexington, the Shockleys are grateful to use a transportation program offered by the Northeast Kentucky Community Action Agency.
“It’s like our own chauffeur,” Regina says. “I get to relax when they come and take us – it’s just more of a carefree trip.”
Victoria Elridge with the Kentucky Department for Aging and Independent Living states that there are over 200 senior centers in Kentucky that can assist with transportation to medical appointments – at least one in each of the state’s 120 counties. But even with these centers, far too many seniors struggle to find someone that can take them to and from appointments on their schedule, says Barbara Gordon, director of community engagement at the University of Louisville’s Trager Institute Optimal Aging Clinic.
“We must do some things differently to make sure that all citizens, and particularly our most vulnerable, have access to transportation, especially to get to and from their medical appointment, but also for those social needs,” she says. “I know there are some creative things happening at many of the different agencies on aging and at the department level, trying to think of other ways to make transportation available like using Uber and ride sharing or volunteer-type programs. But we really need to do more – it is a necessary service.”
When older adults reduce or stop driving, they become more socially isolated. According to the National Institute on Aging, loneliness in the elderly is connected to an increased risk of dementia, functional decline, and even death.
“We certainly do see changes in dynamic brain imaging, and blood flow to different regions of the brain being restricted in folks who are socially isolated,” says Dr. Greg Jicha, a neurologist with the Kentucky Neuroscience Institute. “Geographical isolation becomes more impactful as we age.
“Inside each of us, we may begin to develop chronic diseases, forms of early memory loss that make us a little more reticent to get out (into society),” he adds. “Simultaneously, as we get older, our friends move to get closer to their children and grandchildren, and our social circles begin to shrink.”
Just as the Northeast Community Action Agency helps the Shockleys with long-distance transportation, other branches around the state offer companion programs that enable older folks with special needs to venture out and be involved in their communities. In Breckenridge County, the Central Kentucky Community Action Council runs a Senior Companion Program that recruits volunteers among the senior population to assist peers in a higher age range with limited vision or mobility. The program serves an eight-county region and is funded by AmeriCorps.
Through the program, Lynn Williams, who is 74, volunteers to help 85-year-old Gayle Sturgeon go on trips to the pharmacy, senior center, thrift stores, and many other destinations that Sturgeon, who has lost most of her vision, could not make alone. The program, which has operated around a six-county area for over 20 years, has approximately 25 active volunteers, many of whom get as much out of the program as those they help.
“This is not a job – it’s something you volunteer to do out of your heart,” says Williams. “It gives yourself a chance to get out and do something good for somebody – and it always comes back good for yourself. I’m telling you, it really does.”
- 3. There is a shortage of geriatric medical providers in Kentucky, from physicians to home health aides. Boosting the workforce and introducing innovative programs to provide comprehensive care will help more Kentucky seniors achieve their goals of living independently and in their homes.
According to the Bureau of Labor Statistics, Kentucky has 29 home health workers for every 1,000 seniors age 65 and older, compared to 61 per 1,000 in the United States.
“I think the estimates are that just under 20 percent of the population Kentucky is in the 65-and-older category, and that continues to grow over time,” says Sam Cotton, an assistant professor at the University of Louisville’s Department of Family and Geriatric Medicine. “We just don’t have the infrastructure for this type of support of individuals in their own homes, and that’s so unfortunate because it’s such a critical aspect of their care.
“We’ve really not done a great job of highlighting how needed home health aides are and home health workers are, because often times there’s a lot of stigma attached with those types of careers,” Cotton continues. “We’ve not done enough in terms of creating career ladders for individuals to be able to move up in that profession, so a lot of times individuals are leaving the field.”
In addition to an insufficient number of home health workers, Kentucky also has a need for more geriatric physicians, although the number of these doctors focusing on elder patients has increased from 16.8 per 100,000 seniors in 2018 to 27.5 per 100,000 in 2023, according to the U.S. Centers for Medicare and Medicaid Services. That number is still lower than the national average of 38 geriatric physicians per 100,000 patients in the U.S.
According to Dr. Laura Morton, a geriatric physician with the University of Louisville’s Trager Institute, a primary cause of this shortage is lower reimbursement rates provided to geriatric physicians through Medicare and Medicaid as compared with reimbursement through private insurance companies.
“Another barrier for people going into this field is that the patients are complicated,” she adds. “They take longer (to care for), so it’s hard to squeeze them into a traditional practice where you get maybe 15 to 20 minutes per patient. But the rewards are immense... We can help older adults thrive and really function independently for as long as possible.”
The Trager Institute at U of L has started a geriatric workforce enhancement program grant that is directed toward training physicians, nurse practitioners, and other medical workers who don’t have a background in geriatrics about the basics of caring for older adults. The goal, says Morton, is “transforming primary care practices so they have better tools and are better prepared to take care of this population.”
One recently introduced initiative designed to help seniors remain in their homes is PACE (Program for All-Inclusive Care for the Elderly). The program is offered through Kentucky’s Cabinet for Health and Family Services and provides comprehensive services to qualified recipients at a central location. Participants must be age 55 or older, on Medicaid or Medicare, and need a nursing home level of care as defined by statute.
“When you describe it to someone that’s never heard of it before, it almost seems to be too good to be true,” says Chad Helton, with Bluegrass Care Navigators in Lexington. That nonprofit was the first organization to offer PACE in Kentucky, starting in 2022. “With PACE, we know (participants) are doing it safely, and they’re getting health care, and we’re looking after them.”
Services provided by the program include primary care physicians, social services, physical therapy, and nutrition counseling. PACE also provides enrollees a sense of community engagement that alleviates social isolation. “People watch a person kind of transition within six months down the road to a brand new person – they’re active, they’re moving around, they’re making friends, they’re smiling,” Helton says. “They’re out of that isolation.”
