Community groups step in to help immigrant elderly people access health care
When all people have access to health care, it is better for the entire health care system
The health care system in the United States is complex for most people, and those who are not fluent in English or do not have documented residency status have additional barriers to overcome. However, as the immigrant population ages, so does the demand for services, and community and cultural groups across the country are stepping in to help.
These groups try to overcome linguistic, cultural, trust and bureaucratic barriers to connect with elderly immigrants and their families for whom assistance is available.
“As you get older, you have more medical needs, and it can be more difficult for you to visit specialists.”
There are also efforts in some states to extend Medicare to people who are undocumented – many of whom have been in the US for decades, work and pay taxes.
In South Philadelphia, home to a large number of Asian immigrants, there Wellness Center Hansjoerg WyssA partnership between the Jefferson Health Provider Chain and the Southeast Asian Mutual Aid Association (SEAMAAC) Alliance.
The center, which opened in 2021, provides primary health care and social services to immigrants in the area. About 25% of Wyss’ clients are from the Latino community, most of whom are in the country without documents, said center director Dr. Mark Altschuler.
needs of the elderly population
He said the center also provided services to more than half of the 600 Afghan refugees resettled in Philadelphia last year. This year, Ukrainian refugees have added to the mix.
The growing senior population is a major focus of the centre. “As you get older, you have more medical needs, and it can be more difficult to visit specialists,” Altschuler said.
“We wanted to try to bring all the services people need in one place.” He said this includes a pharmacy, physical and occupational therapists, and social workers.
“The problem is that families often don’t want to bring someone who doesn’t know the language.”
“The health care system is a challenge for people who were born in this country, where English is their primary language,” Altschuler said. He said the staff at Wyss, many of whom are fluent in other languages, spend time with patients and caregivers and “do a little more than you would in your typical facility.”
According to Altshuler, it would be “impossible” to have staff fluent in every language, but interpretive services such as laptop iPads are available at the front desk so everyone can be taken care of.
“Wyss provides a ‘safe space’ for individuals without documents and offers services on a sliding fee scale for those who can pay,” Altschuler said. He advised anyone who comes to the center without insurance to see a social worker to determine if insurance is available.
The uninsured rate among undocumented immigrants is nearly five times higher than that of U.S. citizens, according to an April 2022 report from Illinois Health Campaign. The report said that “confusion, fear and panic” resulting from threats of detention and deportation beginning in 2016 led to many being completely denied healthcare.
a Kaiser Family Foundation The report found similar results. About four in 10 undocumented immigrants were uninsured in 2020, compared to less than one in 10 for citizens. Moreover, Trump-era immigration restrictions and the pandemic have likely increased the burden on non-citizens.
caregiver burden
The growing number of elderly immigrants places additional pressures on family members as they take care of caregiving responsibilities, from managing appointments and medications to giving intravenous fluids and emptying catheter bags.
Efforts to restrict immigration are not helping the market for paid home care services, an area that relies heavily on immigrants. One in four direct care workers is a migrant, according to PHI’s Robert Espinosa.
“For in-home care, that number is one in three,” he said in an interview at Columbia’s Age Boom Academy.
Post-Brexit, “it becomes very difficult to get access to the kinds of people who are often in caregiving positions,” said John Baird, director of International Longevity Center At Columbia University, to reporters at the Age Boom conference.
Without good interpretation services, “the elderly may go home without understanding the doctor’s instructions.”
The paid-care delivery crisis places an additional burden on families, which are predominantly immigrant and community-marginalized, which “tend to exacerbate economic instability,” said Jason Resendez, president and CEO at The National Caregiving Alliance and 2020 Next Avenue Effective in agingto reporters at Age Boom.
Even if outside help is available, migrant families may not be exploited, said Donna Backouis, the program coordinator SEAMAAC The Elders Roots of Happiness Program, which directs participants to the Wyss Center and other resources.
“The problem is oftentimes families don’t want to bring someone who doesn’t know the language,” Packouz said. “They feel vulnerable bringing in a stranger.”
variety of barriers
Bacquis said the lack of insurance is also a “huge handicap” for many. She said language is a problem even for those who are insured and able to see a doctor. Without good interpretation services, she said, “elderly people may go home without understanding the doctor’s instructions.”
Moreover, she added, many are “afraid of being a nuisance” and don’t want to ask for clarification, so they’ll “leave” without enough information. Those who do not have younger family members living close by are the ones who suffer the most.
“The reason SEAMAAC is here is because many do not have a family to help them navigate the health care system,” Packouz said. Health service providers can make things easier by highlighting important information in handouts so the person can take it to a family member or other person who is fluent in English for interpretation.
said Lauren Bongan, national director of The Diverse Elders Alliance.
“Caregivers who are relied upon to perform a cultural task experience four times more experience than other caregivers,” she told a group of American Geriatrics Association Fellows for Journalists in Geriatrics at the association’s annual meeting in Indianapolis in November 2022.
“A program that relies on high-quality medical translation or has forms available in multiple languages in which care recipients can take initiative is an example of cultural adaptation.”
“A program that relies on high-quality medical translation or has forms available in multiple languages in which care recipients can take initiative is an example of cultural adaptation” to make medical information more accessible, Bongan said.
Didier Trinh, the coalition’s director of policy and advocacy, said residential facilities also need to be culturally responsive. He told the story of his Vietnamese grandmother, who came to the United States “late in life” and in her 90s had to go to a nursing home.
“It was difficult for her to communicate with her caretakers, and as a result she ‘lost her light,'” he told reporters at the GSA meeting. He shared such a simple thing as a familiar meal – The facility didn’t serve the Vietnamese food she’d cooked for herself her entire life – they could have helped.
“If doctors are going to work in an area with a large immigrant population, they need to be prepared to do so,” Packouz said. Too often, “the front desk is a major roadblock.”
For example, she points out that overworked employees may sigh when they see an elderly person who doesn’t speak English well, making the person feel like a burden.
Packouz said clinics also have to be within walking distance of their clients, because transportation is a barrier for many seniors.
Pennsylvania provides emergency medical assistance to anyone who needs it most, regardless of immigration status. The temporary program should expand its coverage to eye care, Packouz said, citing the case of an undocumented elder with diabetes who was unable to have surgery to save his eyesight and was therefore unable to administer insulin and later died.
“The fact that he couldn’t see was life threatening, and they didn’t cover that up,” she said. In Pennsylvania, as in most states, undocumented residents are not entitled to federally subsidized health insurance programs like Medicare and Medicaid, and are prohibited from purchasing insurance in the state-run Affordable Care Act markets.
States expand coverage
In Illinois, undocumented immigrants have access to health coverage thanks to a 2020 law that provides a Medicaid-esque program for low-income seniors regardless of their immigration status.
These policy changes were the result of communities organizing, telling their stories, and demanding access to healthcare.
However, the program does not include coverage for home and community services or long-term care, something Healthy Illinois is working to change, said Tuvia Siegel, the group’s campaign manager.
However, barriers remain. They include language, the complexity of the system, and the “cultural competency of service providers,” Siegel said. “There is an understandable level of reluctance and fear about sharing information with any government agency and receiving government programmes,” she said.
“The way we dealt with that and overcame it was through community outreach,” Siegel said. She added that using “trusted messengers” to spread the word can help, though “there is definitely fear and mistrust.”
According to Siegel, “Coverage for undocumented individuals is being expanded nationwide.” She noted that California, New York, Washington and Colorado are among the states that have begun to expand coverage.
“It has to happen at the state level because the federal government hasn’t changed” its policy, she said. “States fill the gap.”
“These policy changes were a result of communities organizing, telling their stories, and demanding access to health care, which we believe is a human right. When people get access to health care, it’s better for the entire health care system.”
