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Latinx Undocumented Older Adults, Health Needs and Access to Healthcare

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Abstract

An estimated 10.5 million undocumented immigrants reside in the U.S.; 10% are 55 and older. Undocumented older adults do not qualify for Medicaid or Social Security benefits even though many pay taxes. The study examines undocumented older adults’ perceptions on their health status and their experiences in accessing health care. In-depth semi-structured interviews were used to facilitate dialogue with undocumented older adults (N = 30) ages 55–63 (M = 61.67, SD = 5.50). Most of the participants were Mexican (n = 26, 87%) and had lived in the U.S. on average 21 years (SD = 8.78). A constant comparative approach was used while completing initial, focused, and axial coding. Participants were classified into a five-group typology that captures the intersection of perceived health status/need and access to health care; (1) High need, with access to care; (2) High need, with ambiguous access; (3) Undiagnosed need, with no access; (4) Perceived healthy status, with no access; (5) Healthy status, with access to care. Participants who reported high health needs experienced a range of chronic and degenerative health conditions. Participants accessed care by paying-out-of-pocket (between $100 and 300/visit for consultation, lab work, and medications). High need participants with ambiguous access have been able to access care through permanently residing under color of law status or Medically Indigent Services Programs; access is uncertain given their undocumented status and changes in policies. Participants faced multiple barriers to accessing health care—mainly high cost and documentation status. Limited access to care leads to several detrimental consequences such as debilitated health, emotional burden, and economic insecurity. Older undocumented adults are a vulnerable population that experience great health needs. The high cost for health care and limited access to care takes a toll on undocumented older adults. The findings highlight many opportunities for policy advocacy and practice with older undocumented adults.

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References

  1. Passel JS, Cohn D. Mexicans decline to less than half the U.S. unauthorized immigrant population for the first time. Washington, DC: Pew Research Center; 2019.

    Google Scholar 

  2. Wiltz T. Aging, undocumented and uninsured immigrants challenge cities and states. 2018. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/01/03/aging-undocumented-and-uninsured-immigrants-challenge-cities-and-states. Accessed Apr 2019.

  3. Christensen Gee L, Gardner M, Hill ME, Wiehe M. Undocumented immigrants’ state and local tax contributions. Washington, DC: The Institution on Taxation and Economic Policy; 2017.

    Google Scholar 

  4. Kaiser Family Foundation. The health coverage of immigrants. 2019. https://www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants/. Accessed Apr 2019.

  5. Ku L, Jewers M. Healthcare for immigrant families: current policies and issues. Washington, DC: Migration Policy Institute; 2013.

    Google Scholar 

  6. Angel JL, Rote SM, Brown DC, Angel RJ, Markides KS. Nativity status and sources of care assistance among elderly Mexican-origin adults. J Cross Cult Gerontol. 2014;29(3):243–58. https://doi.org/10.1007/s10823-014-9234-9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. NBC News. Old, poor, and undocumented: immigrants face grim golden years. 2014. https://www.nbcnews.com/feature/in-plain-sight/old-poor-undocumented-immigrants-face-grim-golden-years-n116791. Accessed Apr 2019.

  8. Torres A, Munoz JA, Becerril R. Elderly undocumented Latinos and their retirement strategies. 2016. https://scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1000&context=sociology-publications. Accessed Apr 2019.

  9. Parmet WE. Immigration and healthcare under the Trump administration. Health Aff. 2018. https://doi.org/10.1377/hblog20180105.259433/full/.

    Article  Google Scholar 

  10. Chesler ER. Denying undocumented immigrants access to medicaid: a denial of their equal protection rights. Boston Univ Public Interest Law J. 2008;17(2):255–88.

    Google Scholar 

  11. Kaiser Family Foundation. Key facts about the uninsured population. 2018. https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/. Accessed Apr 2019.

  12. Wallace SP, Torres J, Sadegh-Nobari T, Pourat N, Brown RE. Undocumented immigrants and healthcare reform. Los Angeles: UCLA Center for Health Policy; 2012.

    Google Scholar 

  13. National Immigration Law Center. Public charge. 2019. https://www.nilc.org/issues/economic-support/pubcharge/. Accessed Apr 2019.

  14. Zenlea S. Straight talk for seniors: what proposed changes to the “public charge” rule could mean for senior immigrants and their families. 2018. https://www.ncoa.org/blog/straight-talk-for-seniors-what-proposed-changes-to-the-public-charge-rule-could-mean-for-senior-immigrants-and-their-families/. Accessed Apr 2019.

  15. Ramakrishnan KS, Colbern A. “California package” of immigration integration and the evolving nature of state citizenship. Policy Matters. 2015;6(3):1–20.

    Google Scholar 

  16. Ulloa J. Legislature declares California will be a ‘sanctuary state’. 2017. https://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-california-lawmakers-take-final-action-1505534909-htmlstory.html. Accessed Apr 2019.

  17. California Legislative Information. California senate bill 75. Pub. L. No. 75. 2015. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB75. Accessed Apr 2019.

  18. Galeano C, Valdez M. Health4All: full-scope medical for undocumented adults. Sacramento: California Immigrant Policy Center; 2018.

    Google Scholar 

  19. Lucia L. Towards universal health coverage: expanding medical to low-income undocumented adults. Berkeley: UC Berkeley Labor Center; 2019.

    Google Scholar 

  20. Families USA. Latino health inequities compared to non-Hispanic Whites. 2018. https://familiesusa.org/product/latino-health-inequities-compared-non-hispanic-whites. Accessed Apr 2019.

  21. Hummer RA, Hayward MD. Hispanic older adult health & longevity in the United States: current patterns & concerns for the future. Daedalus. 2015;144(2):20–30.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Larson K, Mathews HF, Torres E, Lea CS. Responding to health and social needs of aging Latinos in new-growth communities: a qualitative study. BMC Health Services Research. 2017;17(1):601–9. https://doi.org/10.1186/s12913-017-2551-2.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tinker B, Gupta S. Undocumented immigrants on dialysis forced to cheat death every week. 2018. https://www.cnn.com/2018/08/02/health/kidney-dialysis-undocumented-immigrants/index.html. Accessed Apr 2019.

  24. Monga P, Keller A, Venters H. Prevention and punishment: barriers to accessing health services for undocumented immigrants in the United States. Laws. 2014;3:50–60. https://doi.org/10.3390/laws3010050.

    Article  Google Scholar 

  25. Vasquez T. For undocumented people seeking healthcare, ‘The barriers can seem endless’. 2016. https://rewire.news/article/2016/03/22/undocumented-health-care-barriers-endless/. Accessed Apr 2019.

  26. Hoffman J. Sick and afraid, some immigrants forgo medical care. The New York Times. 2017. https://www.nytimes.com/2017/06/26/health/undocumented-immigrants-health-care.html. Accessed Apr 2019.

  27. Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: a literature review. Risk Manag Healthc Policy. 2015;8:175–83. https://doi.org/10.2147/RMHP.S70173.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cristancho S, Garces DM, Peters KE, Mueller BC. Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use. Qual Health Res. 2008;18(5):633–46. https://doi.org/10.1177/1049732308316669.

    Article  PubMed  Google Scholar 

  29. National Conference of State Legislatures. Immigrant eligibility for healthcare national alliance on mental health. 2017. https://www.ncsl.org/research/immigration/immigrant-eligibility-for-health-care-programs-in-the-united-states.aspx. Accessed Apr 2019.

  30. Batalova J. Senior Immigrants in the United States. Washington, DC: Migration Policy Institute; 2012.

    Google Scholar 

  31. Vidaeff AC, Kerrigan AJ, Monga M. Cross-cultural barriers to health care. South Med J. 2015;108(1):1–4. https://doi.org/10.14423/SMJ.0000000000000221.

    Article  PubMed  Google Scholar 

  32. Derose K, Bahney BW, Lurie N, Escarce JJ. Immigrants and health care access, quality, and cost. Med Care Res Rev. 2009;66(4):355–408.

    Article  PubMed  Google Scholar 

  33. Hilfinger Messias DK, McDowell L, Estrada RD. Language interpreting as social justice work: perspectives of formal and informal healthcare interpreters. ANS Adv Nurs Sci. 2009;32(2):128–43. https://doi.org/10.1097/ANS.0b013e3181a3af97.

    Article  PubMed  Google Scholar 

  34. Ku L, Flores G. Pay now or pay later: providing interpreter services in health care. Health Aff. 2005;24(2):435–44.

    Article  Google Scholar 

  35. Suleiman LP. Beyond cultural competence: language access and Latino civil rights. Child Welf. 2003;82(2):185–200.

    Google Scholar 

  36. Ayón C. Economic, social and health effects of discrimination on Latino immigrant families. Washington, DC: Migration Policy Institute; 2015. http://www.migrationpolicy.org/research/economic-social-and-health-effectsdiscrimination-latino-immigrant-families. Accessed 27 Dec 2019.

    Google Scholar 

  37. Ortega AN, McKenna RM, Pintor JK, Langellier BA, Roby DH, Pourat N, Vargas Bustamante A, Wallace SP. Health care access and physical and behavioral health among undocumented Latinos in California. Med Care. 2018;56(11):919–26. https://doi.org/10.1097/MLR.0000000000000985.

    Article  PubMed  PubMed Central  Google Scholar 

  38. National Immigration Law Center. Issue brief: the consequences of being uninsured. 2014. https://www.nilc.org/wp-content/uploads/2015/11/consequences-of-being-uninsured-2014-08.pdf. Accessed Apr 2019.

  39. Albert SM, Raviotta J, Lin CJ, Edelstein O, Smith KJ. Cost-effectiveness of a statewide falls prevention program in Pennsylvania: healthy steps for older adults. Am J Manag Care. 2016;22(10):638–44.

    PubMed  Google Scholar 

  40. Szanton SL, Alfonso YN, Leff B, Guralnik J, Wolff JL, Stockwell I, Gitlin LN, Bishai D. Medicaid cost savings of a preventive home visit program for disabled older adults. J Am Geriatr Soc. 2018;66(3):614–20. https://doi.org/10.1111/jgs.15143.

    Article  PubMed  Google Scholar 

  41. Towne SD Jr, Li Y, Lee S, Smith ML, Han G, Quinn C, Du Y, Benden M, Ory MG. Physical activity and associated medical cost savings among at-risk older adults participating a community-based health & wellness program. PLoS ONE. 2018;13(6):e0198239. https://doi.org/10.1371/journal.pone.0198239.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Carande-Kulis V, Stevens JA, Florence CS, Beattie BI, Arias I. A cost-benefit analysis of three older adult fall prevention interventions. J Saf Res. 2015;52:65–70. https://doi.org/10.1016/j.jsr.2014.12.007.

    Article  Google Scholar 

  43. Gassoumis ZD, Wilber KH, Baker LA, Torres-Gil FM. Who are the Latino baby boomers? Demographic and economic characteristics of a hidden population. J Aging Soc Policy. 2010;22(1):53–68. https://doi.org/10.1080/08959420903408452.

    Article  PubMed  Google Scholar 

  44. Ku, L. Why immigrants lack adequate access to health care and health insurance. 2006. https://www.migrationpolicy.org/article/why-immigrants-lack-adequate-access-health-care-and-health-insurance. Accessed Apr 2019.

  45. Health Access. Profiles of progress: California counties taking steps to a more inclusive and smarter safety-net. https://health-access.org/images/pdfs/2016_Health_Access_Profiles_of_Progress_County_Report_5_31_16.pdf. Accessed Apr 2019.

  46. Insure the Uninsured Project. County medically indigent care programs. 2017. https://www.itup.org/wp-content/uploads/2017/08/2017-County-Medically-Indigent-Care-Programs-Chart-Final-1.pdf. Accessed Apr 2019.

  47. Riverside University Health System. Medically indigent services program. nd. https://www.ruhealth.org/en-us/medical-center/patients-visitors/billing/Pages/Medically-Indigent-Services-Program.aspx. Accessed Apr 2019.

  48. Mental Health Advocacy Services. Immigrant access to medical. 2014. https://mhas-la.org/government-benefits/immigrant-access-to-medi-cal/. Accessed Apr 2019.

  49. Aguilera D. Little-known state provision gives some undocumented immigrants full medi-cal. Valley Public Radio; 2015. https://www.kvpr.org/post/little-known-state-provision-gives-some-undocumented-immigrants-full-medical. Accessed Apr 2019.

  50. Mental Health Advocacy Services. Immigrant access to Medi-Cal. 2014. https://mhas-la.org/government-benefits/immigrant-access-to-medi-cal/. Accessed Apr 2019.

  51. Lessard G. Access to healthcare for undocumented (and some other) immigrants. Los Angeles: National Immigration Law Center; 2015.

    Google Scholar 

  52. Bronfenbrenner U. The ecology of human development. Cambridge, MA: Harvard University Press; 1979.

    Google Scholar 

  53. Menjívar C, Abrego L. Legal violence: immigration law and the lives of Central American immigrants. Am J Soc. 2012;117(5):1380–421. https://doi.org/10.1086/663575.

    Article  Google Scholar 

  54. Abrego L, Lakhani SM. Incomplete inclusion: legal violence and immigrants in Liminal legal statuses. Law & Policy. 2015;37(4):265–93.

    Article  Google Scholar 

  55. Newman SD, Andrews JO, Magwood GS, Jenkins C, Cox MJ, Williamson DC. Community advisory boards in community-based participatory research: a synthesis of best processes. Prev Chronic Dis. 2011;8(3):1–12.

    Google Scholar 

  56. Artiga S, Diaz M. Health coverage and care of undocumented immigrants. 2019. https://www.kff.org/disparities-policy/issue-brief/health-coverage-and-care-of-undocumented-immigrants/. Accessed Apr 2019.

  57. Mather M, Scommegna P, Kilduff L. Fact sheet: aging in the United Sates. 2019. https://www.prb.org/aging-unitedstates-fact-sheet/. Accessed Apr 2019.

  58. Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks: Sage; 2006.

    Google Scholar 

  59. Morrow SL. Quality and trustworthiness in qualitative research in counseling psychology. J Couns Psychol. 2005;52(2):250–60. https://doi.org/10.1037/0022-0167.52.2.250.

    Article  Google Scholar 

  60. Saloner B, Polsky D, Kenney GM, Hempstead K, Rhodes KV. Most uninsured adults could schedule primary care appointments before the ACA, but average price was $160. Health Aff. 2015;34(5):773–80. https://doi.org/10.1377/hlthaff.2014.1258.

    Article  Google Scholar 

  61. Rodriguez N, Paredes CL, Hagan J. Fear of immigration enforcement among older Latino immigrants in the United States. J Aging Health. 2017;29(6):986–1014. https://doi.org/10.1177/0898264317710839.

    Article  PubMed  Google Scholar 

  62. Page KR, Polk S. Chilling effect? Post-election health care use by undocumented and mixed-status families. N Engl J Med. 2017;376(12):e20. https://doi.org/10.1056/NEJMp1700829.

    Article  PubMed  Google Scholar 

  63. Perreira KM, Yoshikawa H, Oberlander J. A new threat to immigrants’ health—the public-charge rule. N Engl J Med. 2018;379(10):901–3. https://doi.org/10.1056/NEJMp1808020.

    Article  PubMed  Google Scholar 

  64. Vargas ED. Immigration enforcement and mixed-status families: the effects of risk of deportation on medicaid use. Child Youth Serv Rev. 2015;57:83–9.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Watson T. Inside the refrigerator: immigration enforcement and chilling effects in medicaid participation. Am Econ J Econ Policy. 2014;6(3):313–38.

    Article  Google Scholar 

  66. World Health Organization. Health is a fundamental human right. 2017. https://www.who.int/mediacentre/news/statements/fundamental-human-right/en/. Accessed Apr 2019.

  67. Sass HM. Justice, beneficence, or common sense? The president’s commission report on access to health care. J Med Philos. 1983;8(4):381–8.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the participants for sharing their lived experiences with the research team. We would also like to thank the community advisory board members for their continued efforts to ensure the success of the study.

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Correspondence to Cecilia Ayón.

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Ayón, C., Ramos Santiago, J. & López Torres, A.S. Latinx Undocumented Older Adults, Health Needs and Access to Healthcare. J Immigrant Minority Health 22, 996–1009 (2020). https://doi.org/10.1007/s10903-019-00966-7

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