BOISE, Idaho - Idaho hospitals are rationing care because of the strain from the pandemic. Some groups are questioning the use of age as one of the determinants for who gets medical attention, or how promptly.

A flood of COVID-19 patients has pushed Idaho to implement its "crisis standards of care" guidelines. In the event of scarce resources, the standards say, the focus should be on saving the most "life years." That could lead hospitals to choose to save a younger person because they're assumed to have more years left to live, said Lupe Wissel, state director of AARP Idaho.

"I understand the need for the crisis standards for care, absolutely," he said. "However, any health-care decision should be made based on individualized medical assessments of patients, their circumstances and objective medical evidence. Age should not, and should never, be used as a factor in making these very hard medical decisions."

According to the Idaho Department of Health and Welfare, ensuring patients aren't discriminated against based on age or other factors - such as race, religion or disability - is a guiding principle for patient care.

In September, the group Justice in Aging filed a civil-rights complaint against Idaho over its crisis standards of care, asking the U.S. Department of Health and Human Services to investigate Idaho's plan. Wissel said doctors make decisions based on objective medical evidence all the time.

"Every life is valuable," he said. "You should not bring how many years someone has lived or someone to assume how many years they have left, etc. No, that should not come into play."

Hospitalizations and deaths continue to rise in Idaho. The state remains one of the least vaccinated in the country, with about 53% of people age 12 and older fully vaccinated.

November is National Family Caregivers Month, and many of the 200,000 Nebraskans who help care for loved ones with a health issue or disability could use help.

Caregiving can take its toll. In one survey, almost three-fourths of caregivers said they were emotionally stressed, and over half reported financial strain.

Mike Osberg is coordinator of the Caregiver Support Program at the Eastern Nebraska Office on Aging, which provides respite, or relief, for caregivers. He said the person being cared for must be age 60 or older, unless they have a diagnosis of early dementia. And they must require help with at least two activities of daily living.

"That includes things like being able to take a bath or shower by themselves, dressing themselves, being able to manually feed themselves," Osberg outlined. "Then, do they have problems with walking and using the bathroom?"

Osberg pointed out the caregiver is actually the client and must be at least 18 years old. They can receive up to six hours a week of relief from an in-home respite provider, or they can have their loved one attend an adult day program for five full days per month.

The Eastern Nebraska Office on Aging serves Cass, Dodge, Douglas, Sarpy and Washington counties. Each of Nebraska's eight Area Agencies on Aging provide support for caregivers, although the services may vary.

Each month, they send the caregiver a "contribution request" to cover a suggested percentage of respite expenses. Osberg noted the amount is based on the care receiver's monthly income, or a couple's combined income, if the spouse is the caregiver.

"A lot of folks, their income is low, so we may only ask for them to consider 10% of what the total cost was for the month -- or 20%, or 30% or on up -- but it's strictly voluntary," Osberg emphasized.

He added no one is denied services based on income or inability to pay.

Those who choose an in-home respite provider can schedule how they use the six hours per week, and Osberg stressed the adult day program can benefit the care receiver as well as the caregiver.

"The caregiver gets a bigger chunk of time," Osberg observed. "But also, the care receiver gets to participate in activities, is going to probably eat their noon lunch and snacks there, participate maybe even in a little road trip, things like that."

He said the participating caregiving agencies are all bonded and insured, and conduct background checks on their employees.


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Idaho officials are holding an event in the capitol to recognize family caregivers during National Family Caregiver Month. Lieutenant Governor Scott Bedke is reading a proclamation signed by Governor Brad Little in the Capitol Rotunda today.

Francoise Cleveland, associate state director of advocacy, AARP Idaho, said family caregivers often don't recognize the vital role they play.

"They sacrifice their time, their health and their financial stability to provide that care and support, and often this is a labor of love," Cleveland said.

Cleveland added that family caregivers are crucial for ensuring people stay in their homes as they age, which is the option many prefer. There are about 210,000 caregivers in Idaho, according to data from AARP.

Deneice Anderson, a family caregiver in Idaho taking care of her 82 year old mother, said it can be difficult to balance the assistance her mom needs with her own needs.

"She had a gal hit her car one day and so I'm the one that's doing the insurance work for that. And I take her to her appointments - and I work full time," she explained.

Cleveland says AARP Idaho has legislative priorities for the 2024 session that could help improve caregivers' lives.

"We will be working on addressing the shortage of direct care workers in Idaho, protecting vulnerable adults from financial exploitation, ensuring health care is available through Medicaid and working to update the guardianship and conservatorship statutes," Anderson said.

The 2024 legislative session is scheduled to begin on January 8th.

November is National Family Caregivers Month and a few tips can help people with these duties.

Executive Director of the Oregon organization Aging Concerns, Vicki Schmall, said family caregivers often are called the backbone of long-term care.

But she said people performing these roles must remember to think about themselves as well.

"I often say to family caregivers," said Schmall, "taking care of yourself is really the best gift you can give to the person who needs your care."

Schmall said its critical that they be willing to ask for and accept help. She said there are local supports available for caregivers through programs such as Oregon Care Partners and the state's Aging and Disability Resource Connection.

Schmall said people also should do their research early about potential facilities in the event in-home care becomes too much. She pointed to the service Eldercare Locator as a helpful resource in this search.

"What is most important about decision making," said Schmall, "is making decisions based on what is best and not on promises I made earlier or feelings of guilt, and also not on pressures from others."

Schmall emphasized that caregivers need to pay attention to how they're doing.

"If as a caregiver you find yourself becoming socially isolated, it's a warning sign," said Schmall. "It says the importance of making some change because social isolation is not good for either the family caregiver or the person receiving care."