- Just ahead on Black Issues Forum, concerns surrounding elder care continue within the Black community and seem to stay from generation to generation.

Some speculate that decades of economic racism and lack of health advocacy play large roles in why.

Stay with us.

[upbeat music] ♪ Welcome to Black Issues Forum.

I'm Kenia Thompson.

Lack of proper pain management for Blacks and decreased access to medical care seem to be a direct result of racial biases and inequitable healthcare options.

We keep facing the same questions about our health and, more importantly, the health of our aging loved ones year after year.

To discuss those issues that keep prolonging the conversation, I welcome my panelists, Dr. DeLon Canterbury, CEO of GeriatRx, therapist and author of "You Can Keep Your Parents At Home," Margo Arrowsmith, and Carmen Williams, CEO of the Troubull Company.

Thank you all.

Welcome for being here.

- Thank you.

- Thank you.

- Thank you.

- Numerous studies have noted that Black Americans have worse health than their white counterparts, including chronic diseases and disabilities leading to shorter and sicker lives than white Americans.

Studies show that four in ten Black men 20 years of age or older have high blood pressure.

This rate is 30% higher than that of white men.

Additionally, Black men's risk of a stroke is twice that of white men.

When we look at our Black female population, 45% of those 20 and older have high blood pressure, that rate 60% higher than white women.

As a result, we've seen an increasing amount of people of color who are on prescription medications to combat these ailments.

However, there are some out there who argue that not all prescriptions are good.

Dr. Canterbury, tell us what you're seeing in respect to this and how has your work in deprescribing changed the lives of your patients?

- Absolutely be happy to and unfortunately this is an ongoing epidemic in our country.

Over-prescribing is rampant and it is a public health issue and it hurts more for those who may be a minority or those who may be in rural settings who don't have access to care.

I have seen countless times where senior citizens are unnecessarily put into nursing homes or put into the hospital or, worse yet, die because of prescription.

And I'm not just talking about opioids.

I'm talking about legally prescribed prescriptions intended to help the patients out.

In fact, it happened to me, it happened to my family.

My grandmother Mildred was given an inappropriate medication that actually spiraled her dementia out of control and this was actually completely avoidable!

This happened while she was in a nursing home, so you would think they would have the best care, people are looking, but this led to her being eventually kicked out of the very same nursing home that wrote the prescription.

And this story isn't the only one.

This is the reason why I started my company GeriatRx.

Our very first patient was on 36 medications.

I mean, ridiculous amount of medications.

And this is a 70 year old frail Black woman.

Didn't need any of this stuff.

And we were able to find, unfortunately, that her family was debating between forcing her into her nursing home or fighting to keep her at home so she can age gracefully in her own comfort and space.

The beauty about our medication review of getting people deprescribed and safely taking them off of medications led to this woman, not only improving in her health conditions, reducing her dementia symptoms, but she was able to be able to stay at home, keep her house, and not be forced into a nursing home, which can cost anywhere from $100,000 to $150,000 just a year.

So it's costly and with more cost rising with housing, with everything else going on, this is more of a blight for people within minority communities to combat.

So we have to start talking about the problem of overprescribing.

We have to start leveraging pharmacists to really get people to the best, safe, and honestly the least amount of medications as possible.

And I don't care how long you've been on it.

That's the problem.

As we age, our bodies change.

The way we absorb medications change, the way medications are cleared change, and they can lead to tons of side effects that can cause confusion, constipation.

Unfortunately it could lead to death, hospitalization, falls.

All of these can worsen their outcomes and lead to mortality rates increasing.

And it's worse when you are a minority or low income.

- Yeah, well, I'm glad you're here doing that work, but how are you working with the doctors?

Are they aware how certain medications can affect elders differently like you just mentioned?

- So some geriatricians are especially trained in this and understand the need to stop, but the overwhelming majority have no clue.

The first point is medical providers maybe get four to six weeks of pharmacology within their training, so really they don't quite know the side effect profiles, the interactions, unless it's within a small scope of their practice.

So that's number one.

Number two, we aren't, again, understanding how the body ages.

Most medicines that are out there and approved are honestly derived from young adult white males from the '70s.

That's old data.

We're all different, we all have different bodies, we all respond differently and so when it comes to aging, we're literally just kind of guessing that they had the same side effect profile as a younger adult.

So it's a multi-layered issue.

- It is, and aging is a fact of life that the majority of our society will experience and the level of quality in that experience, however, is not always up to our control.

Carmen, in your advocacy for elder care through the Troubull Company, how would you suggest that we address the process of aging in elder medical care on the local legislative level?

- Well, first of all, what we have to do is have very real conversations with legislation in terms of what it means to age and to age in place and the disparities that have been there for numerous years.

These aren't new issues, needs to be revisited just like we have to revisit medications and we have to revisit treatments.

We have to revisit the different aging populations, because the people who are 70 now will be 80 later and their needs will not be the same.

We have to educate caregivers.

We have to be advocates for a lot of different communities and be in a process of understanding.

We have to have very real conversations, because nobody knows what it's like to be a caregiver until you are one.

So having the conversations up front to educate and prepare people for what it's like to become advocates, having conversations with independent qualified individuals to represent families, because I do understand that it is a lot.

It can be a lot to care for a loved one, especially at home.

Alzheimer's, dementia, cancer, various different avenues that pop up if you will.

And being able to have a conversation with the legislature that puts financial backing behind the individuals that have to care for their loved ones is where the conversation has to begin.

Holding medical facilities, holding long term care facilities, doctors accountable is where legislation has to start, outside of just backing the individuals with finances.

- Indeed, indeed.

And unfortunately though, there are times when physical and medical conditions just make it difficult for elders to advocate for themselves like you're saying, Carmen.

But Margo, what happens when an elderly person is unable to advocate for their own medical health?

- Well, as Carmen was saying, one of the most important things is that they have people around them who will do it.

But one of the things people have to do as they're getting older and perhaps their memory's starting to fail is to not panic and to not assume, therefore there's something wrong with me.

I'm gonna do whatever somebody else tells me to do.

Dementia is not a thing per se.

Dementia is a cluster of symptoms that can in fact be a lot of different things.

As Dr. Canterbury and Carmen both have said, it could be from too much medication.

It can be from a UTI because again, as we age, you know we can get UTIs when we're born.

But as we age, UTIs have symptoms that in fact resemble dementia.

The problem is that as we get older, people start to assume or doctors start to look at us and assume, oh, it's dementia.

One of the things that I tell people to do and they can do it, but is to say to the doctor, all right, you're telling me I have dementia or you're telling me my loved one has dementia.

If I or my loved one were 45 years old, what other things would you be looking for?

Because very often, again it might be something else.

You know, it might be depression.

It might be again, medication issues.

When my father was in his late eighties, he got a very bad case of aspiration pneumonia.

We sent him to the hospital, they told me to come and get him and take him home.

He was, when I got there he was strapped to a chair, floridly hallucinating.

And of course I refused to take him home, because what, and he couldn't take anything by mouth.

But the doctors, it was a Sunday.

So they wanted me to take him home.

And I spent the day fighting.

The doctor said to me, "Look, you know, they're old.

When they're someplace they're not, you know, not used to, they get confused."

- Right.

And I said, "Well, number one in the last, between my mom and my dad, they've been here seven times in the last year.

This is not a new place.

And number two, he is not confused because he's old.

He's hallucinating because he has pneumonia."

- Right.

- So in fact, but again, of course he could not advocate for himself.

I needed to be there.

People like Carmen are gonna do such a great job, because they're gonna be teaching people how to advocate.

If I hadn't been in the field that I'm in, I might have accepted what the doctor said.

- Yes, yes.

- So the training as both Dr. Canterbury and Carmen are doing the training of people, both us older people, because I'm one of them and their families is so important.

- It is very important.

And so back to you Dr. Canterbury.

When we talk about discrediting these patients, right.

The doctors aren't necessarily taking the issues at hand maybe as strong as they should, right.

And so when we look at the mental conditions such as Alzheimer's, how significant a role do those play in discrediting those patients and then the work that you do to try to de-prescribe the medications that may have been provided to them?

- Yeah, it's a real issue.

The lack of, I feel appreciation for the caregiver perspective is poorly just not really respected or received within the medical community, I feel as much as it should.

And that leads to ageism.

That leads to stigmas, that leads to more problems, and honestly disconnect in alignment and patient goals.

And so when this happens, we're putting our patient in more harm.

We're burning out more of our caregivers.

We aren't doing justice the way we should.

And frankly, most providers are not trained in the field of senior care.

It's just a blatant truth.

So they're going off of what they may know.

In addition to the fact that they already have a running task list of unnecessary things they have to do on the back end for prior approvals or insurance claims or all these things that are put on the doctor, when we're not truly fully utilizing people who may be social workers or geriatricians or people who work like Carmen and Marco, who are in this space to be that voice.

So you really do have to have that caregiver.

You really do have to also come as a patient with your guns loaded.

You gotta know what you're coming in with.

You gotta have your list.

You need to be organized and you need to demand, if you're seeing anything wrong with your loved one, what you want and what aligns with your goals for your family and what's best for your family, because it's a cutthroat system and I can't lie.

This is not healthcare.

This is sick care.

- Yes it is.

And knowledge is power.

It's no secret that African Americans have endured generations of economic racism.

We've seen the results of this through low wages, low home ownership, and little to no savings or investments for Black men and women and their families.

The impact of these economic inequities have reverberated into multiple generations of poverty further impacting living decisions for our latter years, alarmingly.

Reports indicate that black families generally have lower incomes than white families which makes it more difficult to save for retirement in a federal reserve survey of consumer finances, right before the pandemic, numbers show white families had a median family wealth of about $188,000.

The median wealth of black families was less than 15% of white families, coming in at approximately $24,000.

Historically, black families have taken care of their elders themselves at home but some found that they weren't equipped financially or physically to do so.

Carmen, in your work aiding this community, are you finding that black families are still doing this or is there more of a shift to seek assistance from external service providers?

- There's definitely a shift in order to seek existence well assistance from external providers mainly because as people age, we have to work#.

People my age, I'm in my forties and we are working still.

Families take a priority so we're not present.

We feel like, okay, well, I don't have time for this.

Let me put my parents somewhere.

So there's definitely a shift in terms of where our priorities should be.

We don't look at well when I buy a home whether or not I need to have a bedroom or a space in order to care for my loved one.

We don't look at what's going to be required in the short term.

We're only looking at, well, maybe somebody will come in and they'll take care.

This is what healthcare is for.

So a lot of times you find that Medicare or Medicaid is not, is not strong enough so then we just deal with whatever we're told.

We're not doing the research.

We're not being accountable for our parents that took care of us.

We're shifting that responsibility to someone else.

And unfortunately, there is a massive trend of 'I don't know what to do, somebody else do it.'

And that is a very dangerous place to be.

Because then you have situations where people don't have advocacy as what Margo was saying and what Dr. Canterbury, they're overmedicated because now you can cram a lot of people in a small space and this is a handicap pardon upon, but this is a handicap that is crippling the African American and minority community, because there's just not enough education out there or advocacy to represent.

Hey, we need to be taking care of the ones that took care of us.

- Well, when we look at the financial conditions of our black families, would you say, Carmen back to you, that they have the same options for retirement as others, without that savings - They don't and this is something that we don't plan for because a lot of persons my age are not invested in planning for ourselves not to mention having to take care of an elder.

So the disparities are there.

Some of it is self-inflicted.

However, a lot of it is not encouraged with wage gaps and it's not being addressed with the ability to plan for aging in place.

And it's not also something that we discuss with employers of what it would look like to have to take care of a loved one, with benefits, with opportunities, with long term care, even putting policies in place so that we can take on the burden of caring for ourselves once we get to the point where we are in that situation so that that burden is not passed on to those who were now in our situation when that time comes.

So yes, the financial disparities can be addressed with employers and with benefits if they're going to be true benefits and it is across the board, it is it's devastating - Good points.

And without retirement and savings it's just really hard to map out a plan for long term living scenarios for many minority elders.

However, with the proper planning and considerations of lifestyle, there are options.

Margo, tell me about the long term living options out there for elders and their families.

- Well, they can go anywhere from a person staying in the home they've lived in their whole life to moving to a small apartment, to going to one of these communities.

I'm told to call them, you know, four or five stories buildings.

However, what people need to look at is not so much where they're gonna go, but what, who is the person that's gonna go there?

I mean, I have, I'm very familiar with several of the senior communities here.

I've worked in them.

There's a handful of people who are very happy there but there're also very profitable.

So there's a lot of marketing trying to convince everybody that everybody should go there.

But you look at the person, you look at the lifestyle that they want and one of the things to remember is is that assisted living, number one, you get three meals a day, somebody vacuums once a week and they check to make sure you're alive once a day.

That's it?

Anything else is extra.

So when people think, oh, look, it'll just be cheaper there.

It's really not 'cause they're very expensive.

Sometimes if, sometimes churches will help you keep your parents at home.

I know there's a lot of elderly people in the churches, but there's ways of being creative.

But one of the concerns is as this has become so profitable and it is, the marketing push to put more and more and more people in senior communities.

Again, some people are happy there, but I know a lot of them aren't.

You know, I had a woman call me.

You know, she put her mother in the best home possible.

She's depressed, go fix her.

So I go, the woman's not depressed.

She's angry 'cause her daughter made her leave her home.

She made me go back three times to undepress her mother.

Her mother was actually quite lovely, but very angry.

So it's, it's really looking at the person and where it would be best for them.

Not the, but you're gonna have a lot of people your doctor marketing to you.

And again, you know, as your income grows and that's great, you're gonna get more pressure to spend that money in places that might not be the best for this particular person.

- Indeed, indeed.

It's all about listening too, right?

Often while making those long term living decisions it's not just the elder that's making the decisions.

Kind of like what you mentioned Margo.

Many times we have children and other loved ones who are there for the journey as well.

Margo back to you.

How does boundary setting, let's talk about boundary setting, how does that play a role for both the elderly and the families that help take care of them?

- I've been getting these emails from marketing companies.

Well, from home health companies and the headline is it's about this 40, 70 rule.

And I read it.

And when they peeled me off the ceiling, what it basically says is, is that when you're 40, you know more than your parents in their 70s and we will teach you how to manipulate them into doing what we think you should have them do, because it's a very profitable business and that's what they do.

So I say, this is not a rule, this is a marketing gimmick.

So be careful of it, but there's so much out there.

They want the dollars and they're happy to, by the way, build little cheap ones for people who don't have as much money.

I mean, 'cause there's still a lot of money to be made in giving somebody a $5,000 a month, three room apartment.

With two meals a day, there's a lot of money in that.

I'm with Carmen, I really would like to work to have this regulated better because it's eating everybody up.

- You make good points and something that needs to be considered is the position that we need to be in to be able to make some of these important next steps and decisions.

Our health should obviously be a priority.

Dr. Canterbury, is there a cultural understanding of our health conditions and how we can manage them more effectively?

- Hmm, now that is a multi-layered question.

I believe there is a common understanding of what may be going on.

However, we truly fail in making healthcare equitable.

And what that means is if you don't even have the resources or you don't even have a community support network or a church group or a caregiver support group, you may not know what you can possibly do.

And frankly, seeing my parents have to go through taking in my grandma when they were full-time, a teacher and accountant and maneuvering all this, no healthcare background, it's expensive and difficult.

So trying to take care of her in their home, they tried a couple months, expensive, failed, ended up going to having a home health aid, didn't work for too long.

We had to put her into another home.

All of these layers affect the process of care.

So when it comes to a cultural understanding, we have to start using more people who are like community health workers who are educated and trained people, who are in the streets, people who are there who know these people in churches to represent and be that healthcare advocate.

It's easy to say, Hey, you're diabetic, so you need to work out and do this.

We know what we gotta do.

The problem is how are we addressing the root cause?

How are we addressing the social determinants of health that truly drive impact?

How are we talking about housing, transportation, food resources?

I can't tell you how many times I've been able to just advocate for patients only by saying, hey, because of your income, you apply for SNAP benefits.

Have you applied?

That saved them $700 a month.

So, my point is I think people do know what may be going on.

And yes, there may be a general lack of education, not everyone knows, but the question is where do we go from here?

How do we use people who care?

How do we use systems that can provide pretty cost effective solutions around improving your health and wellbeing?

It's not always diet and exercise as nice as it sounds, it does help but culturally, we still see disparities.

Like we said before, there's always gonna be a disparity.

And the issue at the root cause is frankly inequities.

- Yeah and I know that Carmen's doing a lot of advocacy work with her company and Margo's doing the same advocacy work with her clients and with you, you're de-prescribing.

- Yeah.

- Last question.

We're gonna pitch back to you.

How has de-prescribing impacted long term health in the black community and what do you see that outcome looking like?

- So the ugly truth is this.

As you age and take multiple medications, your risk of harm increases.

And we know for fact that if you have less income or of a minority group, your outcomes will even be more worse.

And so when we're able to start talking about patients who may be on 10, 20, 30 medications, our work with geriatrics and as a pharmacist is to make sure patients can live gracefully at home with as little medications as possible, that is what de-prescribing is all about.

And so the impact we've had is shown by keeping a family from having to pay $150,000 a year just for putting someone into a memory care unit.

I still see that patient and talk to them and they're doing well.

So the impact is there.

And I'm saying this to stress that one medication, one medication can send a senior to the hospital or kill them, one.

Your health condition could be diabetes, hypertension, dementia, there are certain medications that you just have to completely avoid.

So a really good low hanging fruit is to leverage your community pharmacist, ask what can I get my loved one safely off of, so that they're not being forced into another nursing home which we were able to prevent from our service.

So over-prescribing is a huge problem.

We gotta talk about it.

And it starts with the patient first knowing what can we do to get my grandma or my loved one off of this?

- Yeah, so bottom line is we have to advocate for ourselves and we have to be vigilant about the health that we carry til' in term.

- Absolutely, yes.

- Thank you.

I want to thank today's guests for joining us.

We invite you to engage with us on Twitter or Instagram using the hashtag #blackissuesforum.

You can also find our full episodes on pbsc.org/blackissuesforum, or listen at any times on Apple iTunes, Spotify, or Google Podcast.

For Black Issues Forum, I'm Kenia Thompson.

Thanks for watching.

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