Community Groups Step In To Help Immigrant Elders Get Health Care

The U.S. health care system is complicated for most people to navigate, and those who aren't fluent in English or have no documented residency status have extra barriers to overcome. Nonetheless, as the immigrant population ages, the demand for services is growing, and community and cultural groups around the country are stepping up to help.

Those groups are trying to overcome language, cultural, trust and bureaucratic barriers to communicate to aging immigrants and their families that help is available. 

There are also efforts in some states to expand Medicare to people without documentation — many of whom have been in the U.S. for decades, working and paying taxes.

In South Philadelphia, home to a large population of Asian immigrants, there's the Hansjörg Wyss Wellness Center, a partnership between provider chain Jefferson Health and the Southeast Asian Mutual Assistance Association Coalition (SEAMAAC). 

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 documentation, said center director Dr. Marc Altshuler. 

He said that the center also provided services to more than half of the 600 Afghan refugees who resettled in Philadelphia last year. This year, Ukrainian refugees added to the mix.

The growing senior population is a significant focus for the center. "As you get older, you have more medical needs, and it may be more challenging to get around to see specialists," Altshuler said.

"We wanted to try to bring all the services individuals needed to one place." He said that includes a pharmacy, physical and occupational therapy, and social workers.

"The health care system is challenging to navigate for individuals who were born in this country, where English is their primary language," Altshuler said. Wyss staffers, many of whom are fluent in other languages, spend time with patients and caregivers and "do a little more handholding than you would get at your typical facility," he said.

According to Altshuler, it would be "impossible" to have staffers fluent in every language, but interpretive services such as mobile iPads are available at the front desk so everyone can be taken care of.

"Wyss provides a 'safe space' for individuals without documentation and offers services on a sliding fee scale for those who can pay," Altshuler said. He advised anyone who comes to the center without insurance to meet with a social worker to determine whether insurance is available.

The uninsured rate among undocumented immigrants is almost five times higher than that of U.S. citizens, according to an April 2022 report from the Healthy Illinois Campaign. "Confusion, fear, and panic" resulting from threats of detention and deportation beginning in 2016 have resulted in many going without health care entirely, the report said.

A Kaiser Family Foundation report found similar results. About four in 10 undocumented immigrants were uninsured in 2020, compared with fewer than one in 10 citizens. Further, Trump-era immigration restrictions and the pandemic likely added to the burden on non-citizens, the report said.

The growing population of aging immigrants puts added pressure on family members as they take on caregiving responsibilities, from managing appointments and medications to administering IV fluids and emptying catheter bags.

Efforts to restrict immigration aren't helping the market for paid home care services, a field heavily dependent on immigrants. One of every four direct care workers is an immigrant, according to PHI's Robert Espinoza. 

"In-home care, that figure is one in three," he said in an interview at Columbia's Age Boom Academy.

After the U.K.'s Brexit, "it became a lot harder to access the sorts of people who often fill caregiving roles," John Beard, director of the International Longevity Center at Columbia University, told journalists at the Age Boom conference.

The crisis in paid caregiving puts an added burden on families, predominantly immigrant and marginalized community families, which "tends to intensify economic instability," Jason Resendez, president and chief executive officer for the National Alliance For Caregiving and a 2020 Next Avenue Influencer in Aging, told the Age Boom journalists.

Even if outside help is available, immigrant families may not take advantage, said Donna Backues, coordinator of SEAMAAC's Roots of Happiness Elders Program, which directs participants to the Wyss center and other resources. 

"The problem is a lot of times families don't want to bring in somebody who doesn't know the language," Backues said. "They feel they're vulnerable bringing in someone who's a stranger."

Lack of insurance is also "a big barrier" for many, said Backues. She said that language is a problem even for those insured and able to see a doctor. Without good interpretive services, "elders might go home not understanding the doctor's instructions," she said. 

Moreover, she added that many are "afraid of being a bother" and don't want to ask for clarification, so "they'll walk away" without sufficient information. Those without younger family members living close by are the ones who suffer the most. 

"The reason SEAMAAC is here is many don't have a family to help them navigate the health care system," Backues said. Health providers can make things easier by highlighting important information in handouts so the person can take it to a family member or someone else fluent in English for interpretation.

"Cultural tasks" such as interpretation and translation also add to the burden for caregivers, said Lauren Pongan, national director of the Diverse Elders Coalition. 

"Caregivers who are relied upon to perform a cultural task experience four times more strain than other caregivers," she told a group of Gerontological Society of America's Journalists in Aging fellows at the society's annual meeting in Indianapolis in November, 2022.

"A program that builds in high-quality medical translation or has forms available in multiple languages that care recipients can take the lead on is an example of cultural adaptation" to make medical information more accessible, Pongan said.

Residential facilities also need to be culturally responsive, said Didier Trinh, the coalition's director of policy and advocacy. He recounted the story of his Vietnamese grandmother, who came to the U.S. "late in life" and in her 90s, needed to go to a nursing home. 

"It was difficult for her to communicate with her caretakers," he told journalists at the GSA meeting, and as a result, "lost her light." He shared that something as simple as a familiar meal — the facility didn't serve the Vietnamese food she had cooked for herself all her life — could have helped.

"If doctors are going to work in an area where there's a large immigrant population, they need to be set up to do that," Backues said. Often, "it's the front desk that's a major barrier." 

For example, she noted that overworked staffers might sigh when they see an aging person who doesn't speak English well, making the person feel like a burden.

Clinics also should be within walking distance of their clientele, as transportation is a barrier for many elders, said Backues.

Pennsylvania provides emergency medical assistance to anyone in dire need, regardless of immigration status. Backues said the temporary program should expand its coverage to include eye care, citing the case of an undocumented elder with diabetes who couldn't get surgery to save his sight and, therefore, couldn't see to manage his insulin and later died.

"The fact that he couldn't see was life threatening, and they didn't cover that," she said. In Pennsylvania, as in most states, residents without documentation are ineligible for federally subsidized health insurance programs like Medicare and Medicaid and are barred from buying insurance on state-run Affordable Care Act marketplaces.

In Illinois, immigrants without documentation have some access to health coverage thanks to a 2020 law that provides a Medicaid-esque program for low-income older adults regardless of their immigration status. 

Yet, the program doesn't include coverage for home- and community-based services or long-term care, something Healthy Illinois is working to change, said Tovia Siegel, the group's campaign director.

Even so, barriers remain. They include language, the complexity of the system, and the "cultural competency of providers," said Siegel. "There's an understandable level of reluctance and fear around sharing information with any government entity and receiving government programs," she said. 

"The way we have addressed and overcome that has been through community outreach," Siegel said. Using "trusted messengers" to spread the word can help, though "absolutely, there is fear and mistrust," she added.

According to Siegel, "Coverage expansion for undocumented individuals is happening around the country." 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 are filling the gap."

"These policy changes have been the result of communities organizing and 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."

Editor’s note: This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and The Commonwealth Fund.