Tag Archives: digital divide

The New Digital World Can Give Seniors A Hard Time

Family gatherings on Zoom and FaceTime. Online orders from grocery stores and pharmacies. Telehealth appointments with physicians.

These have been lifesavers for many older adults staying at home during the coronavirus pandemic. But an unprecedented shift to virtual interactions has a downside: Large numbers of seniors are unable to participate.

Among them are older adults with dementia (14% of those 71 and older), hearing loss (nearly two-thirds of those 70 and older) and impaired vision (13.5% of those 65 and older), who can have a hard time using digital devices and programs designed without their needs in mind. (Think small icons, difficult-to-read typefaces, inadequate captioning among the hurdles.)

Many older adults with limited financial resources also may not be able to afford devices or the associated internet service fees. (Half of seniors living alone and 23% of those in two-person households are unable to afford basic necessities.) Others are not adept at using technology and lack the assistance to learn.

During the pandemic, which has hit older adults especially hard, this divide between technology “haves” and “have-nots” has serious consequences.

Older adults in the “haves” group have more access to virtual social interactions and telehealth services, and more opportunities to secure essential supplies online. Meanwhile, the “have-nots” are at greater risk of social isolation, forgoing medical care and being without food or other necessary items.

Dr. Charlotte Yeh, chief medical officer for AARP Services, observed difficulties associated with technology this year when trying to remotely teach her 92-year-old father how to use an iPhone. She lives in Boston; her father lives in Pittsburgh.

Yeh’s mother had always handled communication for the couple, but she was in a nursing home after being hospitalized for pneumonia. Because of the pandemic, the home had closed to visitors. To talk to her and other family members, Yeh’s father had to resort to technology.

But various impairments got in the way: Yeh’s father is blind in one eye, with severe hearing loss and a cochlear implant, and he had trouble hearing conversations over the iPhone. And it was more difficult than Yeh expected to find an easy-to-use iPhone app that accurately translates speech into captions.

Often, family members would try to arrange Zoom meetings. For these, Yeh’s father used a computer but still had problems because he could not read the very small captions on Zoom. A tech-savvy granddaughter solved that problem by connecting a tablet with a separate transcription program.

When Yeh’s mother, who was 90, came home in early April, physicians treating her for metastatic lung cancer wanted to arrange telehealth visits. But this could not occur via cellphone (the screen was too small) or her computer (too hard to move it around). Physicians could examine lesions around the older woman’s mouth only when a tablet was held at just the right angle, with a phone’s flashlight aimed at it for extra light.

“It was like a three-ring circus,” Yeh said. Her family had the resources needed to solve these problems; many do not, she noted. Yeh’s mother passed away in July; her father is now living alone, making him more dependent on technology than ever.

When SCAN Health Plan, a Medicare Advantage plan with 215,000 members in California, surveyed its most vulnerable members after the pandemic hit, it discovered that about one-third did not have access to the technology needed for a telehealth appointment. The Centers for Medicare & Medicaid Services had expanded the use of telehealth in March.

Other barriers also stood in the way of serving SCAN’s members remotely. Many people needed translation services, which are difficult to arrange for telehealth visits. “We realized language barriers are a big thing,” said Eve Gelb, SCAN’s senior vice president of health care services.

Nearly 40% of the plan’s members have vision issues that interfere with their ability to use digital devices; 28% have a clinically significant hearing impairment.

“We need to target interventions to help these people,” Gelb said. SCAN is considering sending community health workers into the homes of vulnerable members to help them conduct telehealth visits. Also, it may give members easy-to-use devices, with essential functions already set up, to keep at home, Gelb said.

Landmark Health serves a highly vulnerable group of 42,000 people in 14 states, bringing services into patients’ homes. Its average patient is nearly 80 years old, with eight medical conditions. After the first few weeks of the pandemic, Landmark halted in-person visits to homes because personal protective equipment, or PPE, was in short supply.

Instead, Landmark tried to deliver care remotely. It soon discovered that fewer than 25% of patients had appropriate technology and knew how to use it, according to Nick Loporcaro, the chief executive officer. “Telehealth is not the panacea, especially for this population,” he said.

Landmark plans to experiment with what he calls “facilitated telehealth”: nonmedical staff members bringing devices to patients’ homes and managing telehealth visits. (It now has enough PPE to make this possible.) And it, too, is looking at technology that it can give to members.

One alternative gaining attention is GrandPad, a tablet loaded with senior-friendly apps designed for adults 75 and older. In July, the National PACE Association, whose members run programs providing comprehensive services to frail seniors who live at home, announced a partnership with GrandPad to encourage adoption of this technology.

“Everyone is scrambling to move to this new remote care model and looking for options,” said Scott Lien, co-founder and chief executive officer of the company, which is headquartered in Orange County, California.

PACE Southeast Michigan purchased 125 GrandPads for highly vulnerable members after closing five centers in March where seniors receive services. The devices have been “remarkably successful” in facilitating video-streamed social and telehealth interactions and allowing nurses and social workers to address emerging needs, said Roger Anderson, senior director of operational support and innovation.

Another alternative is technology from iN2L (an acronym for It’s Never Too Late), a company that specializes in serving people with dementia. In Florida, under a new program sponsored by the state’s Department of Elder Affairs, iN2L tablets loaded with dementia-specific content have been distributed to 300 nursing homes and assisted living centers.

The goal is to help seniors with cognitive impairment connect virtually with friends and family and engage in online activities that ease social isolation, said Sam Fazio, senior director of quality care and psychosocial research at the Alzheimer’s Association, a partner in the effort. But because of budget constraints, only two tablets are being sent to each long-term care community.

Families report it can be difficult to schedule adequate time with loved ones when only a few devices are available. This happened to Maitely Weismann’s 77-year-old mother after she moved into a short-staffed Los Angeles memory care facility in March. After seeing how hard it was to connect, Weismann, who lives in Los Angeles, gave her mother an iPad and hired an aide to ensure that mother and daughter were able to talk each night.

Without the aide’s assistance, Weismann’s mother would end up accidentally pausing the video or turning off the device. “She probably wanted to reach out and touch me, and when she touched the screen it would go blank and she’d panic,” Weismann said.

What’s needed going forward? Laurie Orlov, founder of the blog Aging in Place Technology Watch, said nursing homes, assisted living centers and senior communities need to install communitywide Wi-Fi services — something that many lack.

“We need to enable Zoom get-togethers. We need the ability to put voice technology in individual rooms, so people can access Amazon Alexa or Google products,” she said. “We need more group activities that enable multiple residents to communicate with each other virtually. And we need vendors to bundle connectivity, devices, training and service in packages designed for older adults.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Back To The Future At School

Can schools safely reopen though the pandemic shows little sign of waning and educators stumble towards the first day of school in the absence of a clear cut strategy?

The answer is uncertain.

In early July President Trump demanded that schools “open quickly, beautifully, in the fall” for normal, in-person instruction.

The CDC responded with guidelines instructing school districts to build supportive community infrastructures to counter the onslaught of COVID-19 as schools reopened. They urged school officials to implement hygiene and social distancing practices and develop ‘proactive’ plans with health departments, parents and caregivers to deal with potential outbreaks.

A snapshot of the ‘new normal’ for K-12 schools.

Keeping active kindergartners apart; keeping their masks on; fewer students on school buses; limited class sizes; keeping staff safe; sanitizing; PPE; social distancing; online SATs; remote learning; iPads or computers for all.

For many schools, adjusting to the new normal would be a complicated and expensive endeavor.

School systems which struggled with pandemic restrictions would face even greater logistical and financial burdens meeting the new CDC requirements, leaving them with no other option than to continue with virtual classes moving forward.

President Trump tweeted his displeasure at the “very tough and expensive guidelines for opening schools,” and, under pressure, the CDC retracted its message, effectively relinquishing the decision making to school administrators. At the behest of the White House, the CDC emphasized the “importance of reopening America’s schools this fall,” and warned that extended school closures would “be harmful to children.”

This mixed messaging starkly reflects the reality that the CDC’s mission to reopen schools is at odds with the Trump administration’s intent to open at all odds, said Dan Domenech, Executive Director of the School Superintendents Association (AASA).

The Cost of Reopening

What is certain however, is that a safe return to in-person school comes with a hefty price tag – a whopping 200 billion dollars or more, or about $490 per K-12 student. At a panel discussion on how to safely reopen schools hosted by Ethnic Media Services on July 31, Domenech explained that the costs would cover laptops for students and an array of preventive measures that include sanitizers, masks, PPE and safe busing, before schools could consider opening their doors to staff and students. The expense would place an unprecedented financial burden on overstretched school district budgets in the next academic year.

So, a safe reopening would need a huge injection of federal funds (that the Council of Chief State School Officers projected would cost between $158.1 billion and $244.6 billion,) but the government is threatening to cut funds for schools that don’t fully reopen.

Many school districts cannot afford the expense, so policymakers at state and local levels are choosing to wait before making a decision on whether to reopen schools, based on assessments of COVID-19 threats in their region.

Is it safe to go back to school?

In a press briefing, the White House pushed the idea that the greater risk right now is to children’s learning, rather than to their health and wellbeing, announcing that, “We don’t think our children should be locked up at home with devastating consequences when it’s perfectly safe for them to go to school.”

Till recently, the common belief was that young children were not affected by COVID-19 and were unlikely to spread the virus. In fact the CDC reiterated that children pose no risks, stating that, “The best available evidence from countries that have opened schools indicates that COVID-19 poses low risks to school-aged children, at least in areas with low community transmission, and suggests that children are unlikely to be major drivers of the spread of the virus.”

However, new research from a pediatric hospital in Chicago that published its findings in JAMA, indicates that children carry high levels of the virus in their upper respiratory tracks and may efficiently spread infection by sneezing, coughing or shouting.

“In several countries where schools that have opened prematurely, such as Israel, we have seen a rise in cases,” said Pedro Noguera, Dean, USC Rossier School of Education.

As findings like these make parents and educators uncertain about reopening schools in a pandemic, it may be prudent for school districts to first assess the threat of COVID-19 infections in their area before making plans to send children back to school, suggested by Dr. Anthony Fauci, the nation’s top infectious disease expert, in recent interviews with PBS and the Washington Post.

Inequities in K-12 Education

As schools juggle in-person classes versus online learning and hybrid models, some wealthy families are resolving their uncertainty by creating private learning pods or ‘micro-schools,’ with hired tutors to educate their children. It’s an arrangement that reflects the inequities experienced by less privileged students from special needs, disadvantaged and low income backgrounds. Without tutors or pods, and limited access to internet and laptops, these children are likely to fall further behind and “experience tremendous learning loss,” noted Noguera.

The current education crisis stems froma  lack of leadership, said Noguera, adding that “The real questions facing the US is when will leadership emerge that can provide the guidance that schools need on how to manage instruction…safely … and how to reopen appropriately, in a manner that does not place lives at risk.” He called on local and community leaders to step up in the interim. It will be up to local and community leaders to create innovative ways to deliver education and support children and families, in the short term, said Noguera.

Moving forward into the future will be challenging for schools because the scope of funding required to make changes is not forthcoming from the federal purse . Without adequate funding for health and safety measures in place, Noguera stated that school districts will have to contend with, for example, teacher unions who recently announced they will go on strike over unsafe conditions.

Eleven million children do not have the laptops they need for remote learning, said Domenech. So, even though technology offers valuable learning platforms, it can be a double edged sword, when teachers are ill prepared to use it effectively and students who have little or no access to technology lose out on their learning.

Schools will have to show teachers how to close the “digital divide,” advised Noguera, by training them “to use the technology to deliver meaningful instruction to kids.” But, whatever devices students use for learning, without access to reliable Internet and Wi-Fi, low income and disadvantaged students would face inequities of digital access, warned USC Professor Shaun R. Harper. In LA, school districts have invested in making screens and hotspots available within communities so children can access learning; but children in rural areas have even less connection and risk being left behind.

Noguera suggested that instead of trying to adapt curricula to cell phones, another option would be to go back to “old school approaches to education” using pencil and paper, adding that “they worked before technology, and could work again.”

“For now, whether our education looks like mini learning pods, pandemic pods, micro schools, or collaborative tutoring with college students….that’s still going to provide inequity in our educational system.” cautioned Eddie Valero, Supervisor for District 4, Tulare County Board of Supervisors. He was referring to economist Emily Oster’s prediction that clusters of home schooling families are going to happen everywhere regardless, and “that will create an economic divide.” 

Re-envisioning the future of schooling

Panelists offered several perspectives on when and how schools should reopen.

In working with school superintendents on reopening of schools based on CDC guidelines, said Domenech, the future could feature one of three options – the popular hybrid model, with students on weekly shifts between online learning and in-person classes seated 6 feet apart, total remote learning, or returning to school full-time as before.

However, the continuing rise in infections across the country means that most schools may open remotely. It may be possible for students to return to school only in areas where the rate of infection is below 5%, advised Noguera, suggesting that less risky, outdoor learning may be one way to address the problem. However, places experiencing a surge in cases such as the Imperial Valley in southern California, will have “to rely on community organizations like non-profits to support families and deliver education to children in concert with the school district,” he said.

Noguera’s view was echoed by Mary Helen Immordino-Yang, USC Associate Professor at the Brain and Creativity Institute and Rossier School of Education, who suggested tapping into the “huge cohort of college-ready high school graduates” and using their skills as a resource for tutoring younger students. Engaging young people as a ‘brigade  of community tutors” could help solve the shortage of people in teaching and learning, and give them a sense of purpose,” said Yang.

Professor Harper, who leads the USC Race and Equity Center warned that ‘raceless’ reopening policies from school districts  would “yield racially disparate outcomes”. He suggested that more consultation with communities of color was needed to “racialize input” into the K-12 reopening strategy. That would involve considerations like providing proper PPE, testing and contact tracing for essential workers in schools who are more likely to be employees of color and are disproportionately exposed to infection, as well as trauma and grief support  for staff and students of color, who are more likely to have experienced loss of a family or community member to the virus.

The panelists called on the private sector, specifically high tech companies and philanthropists, to step up and help avert the crisis.

Big tech firms like Amazon said Noguera, which have accumulated huge profits during the pandemic, have a responsibility to assist.

Harper described this timeframe as an opportunity for philanthropists and foundations who want to close racial equity gaps by helping finance “accessibility to learning pods for poorer students who cannot afford it.” There is also a role, he suggested, for nonprofits, youth organizations and college access providers to add to their agendas and recreate pod-like experiences for disadvantaged youth during the pandemic.

Schools are relying on Congress to pass funding that will get K-12 education back on track safely, and Domenech predicts that the majority of schools in America will start the school year with remote learning because, ‘in order to bring any children into school, dollars will be required.”

Valero closed out the discussion by inviting policymakers to re-envision what school should look like for the future by thinking “in creative ways that disrupt our everyday normalcy for something different,” but he urged, “honestly it begins with access, opportunity and fairness for all students.”

“We need to model our classrooms with our most struggling students in mind.”

Meera Kymal is a contributing editor at India Currents 

Image by Katherine Ab from Pixabay; Image by Bob Dmyt from Pixabay