Three years ago, Janet Burns felt herself sliding into depression. "I get into a slump and can't get out," she said.
Several times, psychotherapy had helped her. The pandemic has brought fresh pressures. Burns, 75, has had to largely suspend her volunteer work, and she and her husband have been unable to visit their children and grandchildren. She said she was handling it.
But, she added, it was reassuring to know that she could turn to her counselor if necessary. "It's like a safety net," she said. "I wish everybody had it."
Health experts also wish that more older adults could access psychotherapy and other kinds of mental health care, especially now as mental health problems have risen markedly. "It makes their existing issues worse," Mi Yu, a geriatric psychiatrist in Nashville, said of the pandemic's effects.
Experts have long reported that older people, particularly those older than 80, seem more reluctant to seek treatment for psychological disorders. "The greatest generation are the pull-yourself-up-by-your-bootstraps group," said Daniel Plotkin, a geriatric psychiatrist in Los Angeles.
Age bias can infect practitioners, too. Yu recalled a woman in her 80s who sought therapy. Two dozen local practices turned her away, saying they didn't accept patients her age.
"We actually find elderly patients are more open to therapy," Yu said. "They want to resolve something and they don't have time to lose."
The woman's experience demonstrates that even when older people decide to seek treatment, finding and affording therapy can prove difficult.
Traditional Medicare covers individual and group psychotherapy, with no cap on the number of sessions; beneficiaries pay 20% of the authorized amount. It also provides for free annual depression screening.
But many mental health practitioners won't accept Medicare. Yu accepts Medicare's payment of $91 for a 45-minute session, but she said many of her colleagues opt out because that is half or less than the going rate for therapy.
Researchers at George Mason University and Mathematica reported that in a national survey, only about 36% of mental health providers accepted new Medicare patients, compared with 83% of physicians.
Moreover, although Medicare covers mental health treatment by a variety of providers, it won't reimburse licensed professional counselors or marriage and family therapists.
Heidi Jelasic, 68, an administrative assistant in Royal Oak, Mich., had been seeing a licensed professional counselor. Then, in April, she lost her job in a pandemic layoff, and with it, her employer health coverage.
That meant shifting to Medicare, which would not cover her counselor. "I'm on a shoestring," she said. "I can't afford it."