School of Public Policy, University of California Riverside, 900 University Way, Riverside, CA, 92521, USA.
School of Social Work, University of California Berkeley, Berkeley, USA.
J Immigr Minor Health. 2020 Oct;22(5):996-1009. doi: 10.1007/s10903-019-00966-7.
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.
据估计,美国有 1050 万无证移民;其中 10%年龄在 55 岁以上。尽管许多无证老年人纳税,但他们没有资格享受医疗补助或社会保障福利。该研究考察了无证老年成年人对自己健康状况的看法以及他们获得医疗保健的经验。采用深入的半结构化访谈,方便与年龄在 55-63 岁之间的 30 名无证老年成年人(N=30)进行对话(M=61.67,SD=5.50)。大多数参与者为墨西哥人(n=26,87%),平均在美国生活了 21 年(SD=8.78)。在完成初始、集中和轴向编码时使用了恒定比较方法。参与者被分为五类典型人群,这些人群涵盖了感知健康状况/需求与获得医疗保健之间的交集:(1)高需求,有获得医疗保健的机会;(2)高需求,机会不明确;(3)未确诊需求,无法获得医疗保健;(4)感知健康状况,无法获得医疗保健;(5)健康状况,有获得医疗保健的机会。报告高健康需求的参与者经历了一系列慢性和退行性健康状况。参与者通过自掏腰包(每次就诊的咨询、实验室工作和药物费用在 100 美元至 300 美元之间)获得医疗保健。有机会获得医疗保健的高需求参与者通过永久居住在合法身份或医疗贫困服务计划下获得医疗保健;鉴于他们的无证身份和政策变化,获得医疗保健的机会不确定。参与者在获得医疗保健方面面临多种障碍,主要是费用高和身份不明。有限的医疗保健机会导致了一些不利后果,如健康状况恶化、情绪负担和经济不安全。老年无证成年人是一个弱势群体,他们有很大的健康需求。医疗保健费用高昂且获取途径有限,对老年无证成年人造成了沉重的负担。研究结果突显了为老年无证成年人提供政策倡导和实践的许多机会。