The Health Needs of Undocumented Older Adults: A View on Health Status, Access to Care, and Barriers
An estimated 3 million undocumented immigrants reside in the state of California. Undocumented older adults do not qualify for public benefits, including health care, even though many pay taxes. Health for All aims to provide comprehensive, affordable, and accessible care by expanding coverage to undocumented adults whose incomes are at or below 138% of the federal poverty level. If coverage was expanded to include adults regardless of immigration status, it is estimated that 25,000 older adults (65+) would qualify for full scope Medi-Cal. This report focuses on Latinxs who represent approximately 70% of the undocumented population.
As undocumented Latinxs elders age, they will be subjected to the same illnesses that afflict other senior citizens, often among the most expensive to treat: chronic diseases, cognitive disorders, and physical injuries. Diabetes, tuberculosis, and kidney failure are the most common illnesses among the older undocumented community. While undocumented older adults may experience high health needs as they age, their precarious status and other barriers precludes them from accessing care.
The study, UndocuElders in the IE, aimed to shed light on the experiences of undocumented older adults’ health status and process of accessing 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) (Download the report below for the full executive summary)
El Señor Manuel (61 years old, AD 60, SD 31)
Hay veces que he pensado en matarme [There have been moments when I have thought about committing suicide]
El señor Manuel continues to be haunted by his hospitalization from diabetic complications in 2018, which nearly killed him and led to his current depressive state. Although he felt agitated and his foot became swollen, he decided against seeking medical care; this decision ultimately caused him to lose consciousness and become hospitalized after being found on the floor by his housemates. He remained in the hospital for nearly a week. El señor Manuel currently struggles with diabetes, high blood pressure, and diminishing eye sight. He is also on dialysis and waiting for a kidney donation. His access to health insurance is in flux as he recently lost his job. After working for two decades in the same mattress factory he was fired as he was deemed a liability due to his dialysis treatment. Subsequently, he lost his employment sponsored insurance plan.
La Señora Antonia (65 years old, AS 60, SD 31)
Mi vida es puro llorar, yo creo que es depresión. [My life is all about crying, I think it’s depression]
La señora Antonia has been told by a doctor her depression has likely contributed to her health issues. Depression is a disease that affects more women than men, especially women ages 45 to 64 (John Hopkins Medicine). La señora Antonia revealed that she often cries as she thinks about her and her husband’s current financial struggles, and her deteriorating health. La señora Antonia was hospitalized four months ago and underwent open heart surgery. Prior to this surgery, she had been reluctant to seek care repeatedly because she lacked the financial resources to pay what she believed would be an expensive intervention. She chose to tolerate her symptoms despite repeatedly feeling que se me desmayaba todo el cuerpo [she lost feeling in her whole body]. It was not until she saw a cardiologist who refused to let her leave because she had been running a fever for over 72 hours. It was also during this time that she received surgery on her left leg that was infected due to her diabetes.
Don Ignacio (70 years old, SD 31, AD 60)
Lo que yo le tengo miedo es depender en mis hijos. Yo no quiero depender de nadie [I fear becoming dependent on my children. I don’t want to be dependent on anyone]
Don Ignacio suffers from several debilitating health issues. He underwent heart surgery 15 years ago and had part of his intestine removed during another procedure. He suffers from glaucoma for which he must use eye drops daily on both eyes. In addition, he has had surgery on his lymph nodes that left him vulnerable to cold weather and his kidneys are failing him. He experiences pain on his shoulder that prevents him lifting most things and feels pain when he walks. Don Ignacio is obligated to seek healthcare and take medications, but this is becoming burdensome and increasingly more expensive.
La Señora Fabiola (55 years old, AD 47, SD 20)
If I had insurance, I might still have my eyesight.
La señora Fabiola has high blood pressure, high cholesterol levels, and diabetes. Accessing care for these health conditions has been difficult as she is undocumented and has experienced ambiguous access to health insurance. Due to her undocumented status and economic limitations, she went undiagnosed and untreated for a prolonged time. As time persisted, she started losing her sight in both eyes. During periods when she felt most despondent, she could only see up to 5 inches in front of her. She needed someone to lead her when walking as she could not see if there were steps in front of her. La señora Fabiola has stated that her eye condition has caused her to feel mal y me deprimi [felt bad and depressed].
El Señor Andres (56 years old, AD 52, SD 20)
Tenía yo aseguranza y no me quisieron atender [I had health insurance, but they denied me care]
El señor Andres relocated to the United States in 1986 for more prosperous opportunities as he persistently experienced poverty and challenges acquiring work in his country of origin. Like many other undocumented immigrants, he must work considerable hours in order to sustain his family. He works 46 to 52 hours a week, but is still left short of being able to seek healthcare for himself. He is happy to have access to a CA driver’s license and pays his taxes every year hoping that one day there will be an opportunity for him to change his status.