By Ken Burdick
Did you know loneliness poses the same health risk as smoking 15 cigarettes a day? In fact, new research indicates weak social connections and feelings of extreme isolation could shorten a person’s life by 15 years. With more than one-third of U.S. adults age 45 or older indicating they are lonely, we’ve reached a critical number of individuals who are at risk for serious health outcomes.
What makes loneliness a significant health issue?
- Loneliness can increase risk for heart failure.
- Persistent loneliness can reduce lifespan.
- Loneliness can contribute to cognitive decline.
Beyond the health-related impact, social isolation and loneliness also have enormous fiscal implications. Every month, Medicare spends $134 more for socially isolated older adults than those adults who are more connected to their communities. This additional care translates into an estimated $6.7 billion in Medicare spending annually.
What can we do as an industry to address this issue? At WellCare, we are looking at these areas:
- Care in the Home. We must leverage care at home or outside of a clinical setting with support like the Program for All-inclusive Care for the Elderly (PACE), a federal initiative offered through a combination of Medicare and Medicaid funding. The goal is to keep seniors in their homes versus a nursing home. The program also comprises 255 PACE day centers called “PACE without Walls.”
- Social Connections. We need to help members build a stronger community – being connected is one of the leading predictors of extended life.
- Caregiver Support. We must also look at programs to address the impact loneliness is having on caregivers and their ability to assist. Some of the ways WellCare supports caregivers include paid training courses, certifications to enable pay for services and care management support.
- New Technology. We should consider social media communities as an aid for those individuals with low mobility.
- Loneliness Data. We also need processes to capture data around loneliness. For example, as part of WellCare’s onboarding process, we ask members specific questions regarding loneliness and caregiver support. This practice enables WellCare to understand our members better by uncovering mitigating factors and determining more holistic care..
We see positive industry changes through the Centers for Medicare and Medicaid Services (CMS) to expand reimbursement of non-medical benefits for this growing population. Previously, CMS defined supplemental healthcare benefits under narrower guidelines. The new 2019 guidance broadens the definition, which WellCare sees as positive step in allowing health plans to offer more primarily health-related benefits that address social issues such as loneliness.
But what more should be done? Could loneliness become the rallying cry for a targeted public health campaign designed for individuals to act – similar to campaigns that address immunizations or obesity?
Please share your thoughts in the comments below.
Kenneth A. Burdick is the CEO of WellCare Health Plans
wellcarehealthplansblog.wordpress.com 
I actually developed a training for Meridian for our MI and IL teams on this very topic. I presented it back in August. It is an area where I think Population Health departments could begin to look at ways to engage and begin to measure reductions or increases of loneliness against health outcomes.
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I could not agree more. This is why our MLTSS program is so important. We provide in home care and Medical Day Care programs that are instrumental in preventing the disease of loneliness. Thank you for addressing this topic.
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Can this be reviewed by other groups? I’m with CHS and this would be relevant to our ACOs and other provider models in Medicare FFS.
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I agree that loneliness can often be a precursor or trigger for depression. I also believe it can have significant impacts on an individual’s health. However, unlike with obesity, immunizations, and other social determinants, loneliness is more difficult to identify. Even more challenging is attempting to quantify loneliness and track improvements through metrics. If WellCare moves forward with such an initiative, would be interesting to follow!
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Why is a person lonely can be the result of many causes. It appears – the question of why must be addressed to discover causes. Once we understand why or the cause, we can only then address the issue of loneliness.
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Religious communities (some more than others) are experiencing a growing awareness of the issues of social isolation. Connecting with religious communities as public health partners, offering training resources and other partnerships, is a possible strategy.
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Currently reading Senator Ben Sasse’s book, “THEM” A recommended reading for anyone, but especially those in healthcare field, regardless of whether it is hands-on delivery or via other means of communication.
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The video game Fortnight is all the range with young and mature alike. What if we piloted a Fortnight program where groups of lonely seniors are teamed up to play the game with and against others? This combines the connectivity of social media aspect with challenge of role playing video games. It would cost less than $2K to test for 6-8 weeks to see if loneliness ratings have improved.
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This is a great article, and brings to light a subject that is often left in the dark.
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PACE is a tremendous program and I know something about how it worked in NYC from a prior company. Technology can also extend connectedness, not only in telehealth/remote patient monitoring to connect members/beneficiaries with their care coordinators, but also socially with organizations and remote participation for those with mobility issues. It’s worth noting that the FCC is funding $100 million for the Connected Care Pilot Program and opened up the rural healthcare program to over $500 million. These are bringing broadband and telehealth to the ‘end of the line’ in underserved and rural communities.
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We recently put our 92-year-old aunt on hospice. She has declined greatly in the last year, and I believe mostly because she is lonely and depressed. She left her home in California to come live with us rather than go into a nursing home. She misses her old friends. We can’t give her the social interaction that she craves, and we are stressed ourselves by our inadequacy to meet her emotional support. I still work here at WellCare, and my husband is her caretaker at home. Hospice is the Medicare benefit that offered the help we need. The hospice team offers volunteers that can spend just a little time a week visiting with Gloria. They offer grief and spiritual counseling in the home. They help with her personal care needs. How wonderful it would be if Medicare could offer the same support for individuals not on hospice.
For those individuals not fortunate enough to have family support, I can see the need for social outlets, both inside the home, and in safe social settings. We need transportation to take beneficiaries to the social settings and back home safely. We need social workers that can keep the beneficiaries informed, interested, and involved. We need to make each individual feel connected, appreciated, purposeful, hopeful.
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hi Ken- this is a great topic. I am reading a book called “Lost Connections” by Johann Hari that proposes depression and anxiety are caused by a persons disconnection from meaningful work and a disconnection from others among other things as opposed to a “chemical imbalance” in their brain. Clearly a lack of connections impacts a persons life. If we were to factor in the behavioral health implications of loneliness to depression and anxiety the figures you noted would be even higher. This has significant impact on care planning for providers and our clinical teams as you noted. It can help destigmatize behavioral health care- depression is a natural response to a lack of connection, not a moral failure. What an opportunity we have to change the script for our members! Instead of telling someone they need treatment for a mental illness, we tell them they need help connecting and creating meaning in their lives. To clarify, I’m not indicating that traditional treatment for behavioral health should not occur. I am saying we need to expand the view of it and how we can help. Should the treatment plan include volunteer work or joining community organizations as a primary approach vs the immediate rush to prescribe a drug? Are volunteer organizations a new provider type for us? It’s worth evaluating and having the discussion.
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I think this would be a great campaign! Having personal relationships with family and friends that I know are lonely and not necessarily older. Being lonely can lead to depression which can also greatly affect your health. Depression also tends to lead to alcohol or substance abuse which can be detrimental to a person’s overall health. Targeting loneliness and getting involved before one gets to depression would make a great difference.
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This is a very insightful blog on the Loneliness epidemic that appears to be growing as our culture becomes more automated and continues to age. It not only impacts the United States but has also become a growing crisis in Japan and Europe. This will become a greater challenge not just to the aging baby-boom generation but to all generations. I think that WellCare can have a critical impact on helping to address the health risks associated with this crisis and improve the wellness of those that are most affected.
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I have spoken to numerous Medicare aged patients who have no one in their life to care about their needs. These patients are elderly and struggle to care for themselves physically and financially. The patients who are eligible for Medicaid have options for home health aides, but what about those patients who make too much money to qualify for Medicaid and cannot afford to hire a private agency within the home? The PACE program sounds great but again it is only for Medicare/Medicaid patients (unless I am misunderstanding this). This is a great topic that needs to be addressed. Thank you Ken!
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Great article! We don’t address loneliness enough and perhaps reframing some of our initiatives around loneliness may be effective. When I think about public health programs like the Diabetes Prevention Program, Enhance Fitness, Silver Sneakers and even for profit programs like Weight Watchers, there is a common element that leads to success — the group. That is where all the magic happens. So we may not need to create a separate intervention, but start to focus more on programs that use the group setting for improving health.
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What my NYC Medicare Outreach team does to reach out to our aging in place populations is work with building locations where seniors are. We find opportunities to host events that allow them to socialize with one another. This is especially important during the Fall and Winter months as many of our seniors are faced to deal with the holiday months alone, reminding them that their loved ones are no longer here. There is also the reality that they may struggling to cope with the seasonal affective disorder/ “winter blues”. Engaging with our senior citizens and other populations living alone, creating opportunities for interaction, education and mental and emotional stimulation is key.
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A very good topic. Loneliness often leads to depression, which leads people to withdraw and then feel more lonely! It isn’t enough to give them resources. We have to help them get there and facilitate a connection because they may lack the skills to form relationships or have burned former bridges to family etc. Loneliness is a skip away from overeating and poor nutrition, drug/alcohol addictions and internet addictions to numb the pain or pass the time. It is a multifaceted issue and needs an integrated approach to form change.
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A campaign to address the loneliness epidemic that appears to be growing as our culture becomes more automated and continues to age. This will be very interesting to see. Great idea!
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I recently heard at a Arc conference for individuals with IDD on employment that isolation is a big problem for this population and a barrier to getting employment. These individuals need more community engagement and activities designed to get people out of sheltered workshops and into competitive and integrated jobs. I believe WellCare can be leader in this area by integrating our strong service coordination with our Community Connections and community organizations to help our Medicaid IDD populations avoid isolation and gain opportunities that all of us seek.
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