The invisible undocumented elderly may no longer remain invisible as their numbers grow and their healthcare needs become more critical.
Close to 4,000 undocumented seniors now live in Illinois, according to a study by Rush University Medical Center, but that number is expected to increase to 55,144 by 2030. The study also found that 16% of Illinois immigrants 55 or older live in poverty, compared with 11% of the native-born population.
In the U.S., estimates of the number of undocumented immigrants ranges from 10.5 million to 12 million. Approximately 4.95 million are from Mexico, 1.9 million from Central America and 1.45 million from Asia. It is estimated that in 2014, a million and a half undocumented immigrants were 55 years and older. This represents almost 25% of the total undocumented population.
Older undocumented immigrants are at higher risk of repeat hospitalizations, according to a 2019 University of California, Irvine study that revealed the disparities between undocumented immigrants and insured patients in California.
As a family nurse practitioner with Rush College of Nursing in Chicago, this grim reality is challenging. I recently cared for a 68-year-old patient who was born in Croatia and has lived and worked in Chicago the last 40 years.
His family was not in his life, he was experiencing homelessness, and his mental capacity was such that the healthcare team deemed him unable to safely care for himself.
He had in earlier years been a singer in a night club. He would sing songs to the staff in Croatian, and his face would light up. He would talk about his home country in his native language with pride, tears in his eyes and joy.
Patients who can’t go home
In December 2020, Illinois became the first state in the nation to begin providing health care coverage to seniors who are undocumented.
Healthy Illinois For All is a first step in providing equitable health care coverage for all. Yes, Illinois does grant Medicaid to undocumented seniors. Unfortunately, this new coverage for the elderly undocumented does not cover nursing home care, as similar health care plans do. This leads to an inability to discharge patients from hospitals if they need higher levels of care.
Because Illinois took this step, my patient had been enrolled in a health care coverage plan. This was a big step toward better health and stability. At least, I thought that was the case.
As he is undocumented and has no identification cards, he needed help navigating the health care system.
“Sorry, we need a state-issued ID to let him use his insurance plan. Does he have a social security number?” was the standard first set of questions, since health care facilities require an ID to even allow a patient to use a plan.
The health care community must be more creative to remove barriers like this.
Solutions could start with providing health care forms in multiple languages, providing more interpreters, and offering more cultural awareness and sensitivity trainings for employees. Health care institutions should accept all health insurance plans, not just the ones that reimburse to their standards.
How to cover the costs
Unfortunately, the patient we were caring for recently suffered a stroke. He was finally able to get a diagnosis that he is unable to care for himself. He has been in a hospital bed for the last six months because his health care plan does not cover nursing home care.
Adding nursing home care to the existing expanded coverage for the undocumented will add to the cost, for the health care system and ultimately taxpayers. But the undocumented are among those paying taxes; it is estimated that undocumented immigrants pay billions of dollars each year in taxes in the United States.
Granting legal permanent residence to more immigrants could bring in additional tax revenue as well: It’s estimated that granting legal permanent residence to 3.7 million undocumented immigrants who are parents or guardians of minors who are U.S citizens could results in additional revenue of $2.5 billion.
If the undocumented elderly who need nursing home care cannot get it, they risk ending up in emergency rooms and being readmitted to hospitals, which also drives up costs. Emergency room and hospital costs for chronic disease management in the U.S. is estimated at $1.1 trillion.
Every person deserves to live a dignified life as they age. Hospitals are meant to care for the acutely ill, not serve as nursing homes. By 2030, this crisis could explode.
Illinois should act now, to offer nursing home coverage for the undocumented elderly.
Christina Manheimer is a family nurse practitioner with Rush University College of Nursing and a Public Voices Fellow through the nonprofit Op-Ed Project.
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