With the start of the New Year, people across the country started coverage on insurance plans selected through the Health Insurance Marketplace. For racially and ethnically diverse and LGBT older adults, the Affordable Care Act (ACA) and the Marketplace pose both the opportunity for better health and the challenge of possibly being left behind by a new program. The Diverse Elders Coalition (DEC) is now working to improve the health of the populations that it serves and to empower them to fully participate in the ACA.
A recent article by Kaiser Health News identifies some of the opportunities and challenges California’s Hispanic population face. The article highlights the tremendous help the Health Insurance Marketplace has been to Maria Garcia, who worked with a community health center to enroll herself and her husband in an insurance policy costing $36 per month after subsidies. The article also describes the need for culturally and linguistically appropriate enrollment assistance. Many Hispanic older adults enrolling in the Marketplace like to enroll with the help of a person that they trust. Health Care Navigators can also help diverse older adults overcome barriers such as lower levels of internet connected home computers and fear of putting personal information online.
Every year, the National Asian Pacific Center on Aging (NAPCA) receives over 9,500 phone calls through a national, toll-free, Asian language Helpline from limited and non-English speaking seniors needing help understanding benefit programs for which many are eligible but unable to access.
Mrs. Pang and Mrs. Taduran (not their real names) represent thousands of immigrant seniors in the United States, who are legal permanent residents but have little or no work history in this country and go without adequate healthcare because they cannot access affordable insurance. Many are eligible for Medicare or Medicare Savings Programs but are unaware of their eligibility.
Mrs. Pang, a Chinese grandmother living in Seattle, was worried that Medicaid would not cover her health care costs while visiting her grandchildren in Los Angeles. She was right to be worried because as a Washington State resident, her Medicaid was issued by Washington State and so she had no Medicaid coverage outside of the state.
Mrs. Taduran emigrated from the Philippines with her daughter and her family so she could care for her grandchildren while her daughter and son-in- law worked. Mrs. Taduran had no health insurance because her household income was too high to qualify for Medicaid yet far too low to afford private health insurance premiums. A few years later she began to have blurred vision but didn’t tell anyone since she knew her family couldn’t afford a doctor. Read More
As we advance in life it becomes more and more difficult, but in fighting the difficulties the inmost strength of the heart is developed. Vincent van Gogh
W., 66, a former journalist and man about town, entered the meeting on LGBT issues a little late and his gait was slower than usual. When the meeting ended, he asked for a ride to the subway. As we rode, he talked about why he was late: not knowing the bus routes for this part of the city, the bus being late and the neighborhood being less than desirable. He hadn’t been feeling well and almost didn’t come to the meeting. It occurred to me that this African American elder continues to “fight the good fight” to beat the isolation that can plague us as we age and attended the meeting anyway.
Isolation is one of the great robbers of an enriched quality of life for older adults across the spectrum of race/ethnicity, class, religion, national origin, familial status, disability, gender identity, or sexual orientation. Self-imposed isolation related to aging can include an unwillingness or inability to drive, limited transportation options, chronic ailments and disabilities, lack of events for their peer group, the lack of compatriots and a youth oriented culture. Read More
Deporting Americans: A Community United Against Deportations
A couple of weeks ago, I posted a piece entitled “Caught in the Deportation Machine …” about how deportation affects elders – both those who are detained and deported, and those who suffer trauma from losing children or grandchildren. This photo montage, “Deporting Americans,” was created in Philadelphia by 1Love Movement when the tight Cambodian American community in that city was hit by a deportation crisis. Dozens of Cambodian folks with green cards, including Chally Dang and Mout Iv, were suddenly rounded up because of old convictions. Many had been rebuilding their lives for years after making the mistakes that had originally made them deportable. Many left behind U.S. citizen children, parents, and grandparents. Entire neighborhoods were devastated. Read More
At the start of October, the National Hispanic Council on Aging (NHCOA) held a Capitol Hill advocacy day as part of its 2013 NHCOA National Summit. During the advocacy day, groups of seniors met with members of Congressional staff and told them about the lives of Hispanic older adults and the issues they faced in their communities. The staff members and Congressional offices were happy to meet with the older adults and gave them a warm welcome. Overall, everyone that took part in the event agreed that it is important to all people to have access to their elected officials.
As the advocacy day continued, walking from office to office in Capitol Hill became difficult for the seniors. While the people we met with were accessible, the places themselves were not. Many of the seniors taking part in the advocacy struggled with physical limitations to their mobility, and the distances between Congressional offices posed a challenge. As the population of older adults increases as a percentage of the population, the places where we live and work will have to adapt.
Older woman with a walker unable to access stairs from the Equal Rights Center’s “Visitability” Quiz
October 15 marked the start of the Medicare Open Enrollment period. It will end on December 7, 2013. During this time, all people with Medicare are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage and benefits that will take effect next year, and decide whether they would like to change their coverage.
Webinar Opportunity: Please join Dr. Cara James, Director of the Office of Minority Health at CMS on December 5, 2013 at 2:00pm EST for a webinar that will highlight how the Affordable Care Act strengthens Medicare and provide an overview of the Health Insurance Marketplace for older Americans of color: https://12-5acaandmedicare.eventbrite.comRead More
Latinos are the largest and fastest growing ethnic group in the U.S., and comprise 17% of the population. They are often viewed as a monolithic group by mainstream culture. However, the term Latino, referring to people of Mexican, Central American, and South American origins, encompasses great diversity with regard to nationality, immigration history, language use, educational and occupational opportunities, and socio-economic position. These aspects of diversity also serve as indicators of social-structural determinants of health disparities (or differences in how often a disease affects people). How these social-structural determinants of health affect the lives of older Latino adults help us to better address the needs of this population. Understanding health disparities also provides insight into challenges faced by diverse elders from a variety of racial, ethnic and cultural backgrounds who deal with many of these same issues. The intersection of HIV/AIDS and depression among older Latinos will be used to illustrate how these social-structural determinants affect the health and well-being of a diverse aging population.
Double Jeopardy: HIV and Depression
Latinos are disproportionately affected by HIV/AIDS. The overall HIV prevalence rate for Latinos is nearly three times the rate for whites. Further, Latinos are the most likely to be classified at Stage 3 (i.e., AIDS) at the time of their HIV diagnosis (48%), as compared with whites (42%) and blacks (39%). Due to successful anti-retroviral therapy, by 2015 more than half of those with HIV in the U.S. will be 50 years or older, a proportion that will rise to 70% by 2020. The disparity in HIV prevalence is amplified among older people with HIV/AIDS. Among Latinos who are 50 and older, HIV prevalence is five times that of older non-Hispanic whites. In addition, older Latinos have a 44% increased risk for major depression and are more likely to present with clinically significant depressive symptoms compared with older whites. This syndemic (convergence of two disorders that magnify the negative effects of each) of HIV and mental distress among Latino older people with HIV (“OPWH”) is an important public health concern since the most consistent predictor of HIV treatment non-adherence is depression, and only 26% of Latinos with HIV achieve the clinical goal of viral suppression.Read More
The health coverage expansions under the Affordable Care Act (ACA) will affect you, your loved ones and your communities. The Diverse Elders Coalition represents millions of diverse older people age 50+ who are among those affected: they include the Health Insurance Marketplace, the Medicaid expansion, new benefits for elders 65+ on Medicare, and a range of protections that make health care more accessible for lesbian, gay, bisexual and transgender (LGBT) older people and older people of color. The number of uninsured older adults age 50-64 continues to rise—from 3.7 million in 2000 to 8.9 million in 2010. In addition, people of color make up more than half of uninsured people in the U.S.— and research shows that people of color, across the age span, face significant disparities in physical and mental health. Additionally, many people of color delay care because of potential medical costs and out of fear of discrimination or cultural incompetence from medical providers. This webinar highlights both national and state-specific examples on what is being done to ensure that older people know about the changes that are taking place under the ACA and how it affects them.
Speakers: Yanira Cruz, President and CEO, National Hispanic Council on Aging; Michael Adams, Executive Director, Services and Advocacy for GLBT Elders (SAGE). Special thanks to our co-sponsors, The John A. Hartford Foundation and The California Wellness Foundation.
Original Webinar date: Wednesday, November 6, 2013.
Who: Cara V. James, Director, Office of Minority Health, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services (Bio below)
What: Please join CMS and the Diverse Elders Coalition for a webinar that will highlight how the Affordable Care Act strengthens Medicare and provide an overview of the Health Insurance Marketplace for older Americans of color.
Background: October 15, 2013 marked the start of Medicare open enrollment. It will end on December 7. During this time, all people with Medicare are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage and benefits that will take effect next year, and decide whether they would like to change their coverage.
Presenter Biography: Cara V. James is the Director of the Office of Minority Health at the Centers for Medicare and Medicaid Services (CMS). Prior to joining the Office of Minority Health at CMS, Dr. James was the Director of the Disparities Policy Project and the Director of the Barbara Jordan Health Policy Scholars Program at the Henry J. Kaiser Family Foundation, where she was responsible for addressing a broad array of health and access to care issues for racial and ethnic minorities and other underserved populations, including the potential impact of the Affordable Care Act, analyses of state-level disparities in health and access to care, and disparities in access to care among individuals living in health professional shortage areas. Prior to joining the staff at Kaiser, she worked at Harvard University and The Picker Institute. Dr. James is a member of the Institute of Medicine’s (IOM) Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities and has served on several IOM committees including the Committee on Leading Health Indicators for Healthy People 2020. She has published several peer-reviewed articles and other publications, and was a co-author for one of the background chapters for the IOM Report Unequal Treatment. Cara received her Ph.D. in Health Policy and her B.A. in Psychology from Harvard University.
November is Native American Heritage Month and November 29, 2013 is Native American Heritage Day. What does this mean to me? I am American Indian of Navajo descent. I was raised on the Navajo Nation all my life. Since I grew up on the Navajo Nation I thought the world was like me. I was taught in school that I am American and I accepted that. I was taught at home to be a good and capable person.
I had inadequate preparation in our public school so I never contemplated going off to college. My mother on the other hand had other dreams for me. She filled out my paperwork to attend the local community college. It was there that I began to consider going away to attend University, and of course, mother helped me to apply. Fortunately, I was able to graduate from the University with dual degrees in the discipline of human services. Today I am using the educational skills I acquired to help create better opportunities for Older Indians.
I know that many America Indian people gave up land, resources, language, culture and complete sovereignty in the name of the English colonization westward. Many atrocities were committed against American Indian People in the taking of the land and cultural livelihood. Read More
Thanksgiving is a time for gratitude, reunions, and celebrations with family. However, many of us have ambivalent feelings about these family interactions. Our mixed feeling can range from the joy of re-connecting to anxiety around different values and expectations that exist within the family, especially between generations. This ambivalence may be experienced every day in multigenerational families, and statistics indicate that immigrant seniors are more likely to live in multi-generational households. Contrary to the stereotypical picture of a large, tight-knit immigrant family surrounding their elders with relevance and constant caregiving support, the nature of intergenerational relationships within immigrant families is more complex. Older immigrants interviewed in the research conducted by the Temple University Intergenerational Center (the “Center”) shared their sense of isolation within their family and community due to lack of time for meaningful interactions, language and value differences, and the acculturation of younger generations.
A Vietnamese senior from Philadelphia expressed his sense of disconnect.
“In Asian culture…parents take care of children, then children take care of parents when they are old…but in America, …[your adult children are] busy spending time working, their children go to school…so these things separate the family…you have to compete with these things [and] there is no room [for elders] to teach about culture.”
The role loss and the decreasing value of elders’ wisdom in American society are major barriers to the well-being of immigrant seniors. As one Somali community leader in Minneapolis explained, “Elders as advisors….that concept is lost here.”Read More
This year, the Obama administration will surpass the 2 million mark – this is, it will have deported 2 million people since 2008, more than any other administration in history. The largest numbers of people being deported are those without legal status, but many Green card holders are also among the 2 million deportees. Since 1998, over 13,000 Southeast Asians (from Cambodia, Laos, and Vietnam) have been deported, including many Green card holders who arrived in the U.S. decades ago as refugees fleeing war and genocide. The majority of those deported are under the age of 35, but many elders also get caught in the deportation machine. Even more elders who remain in the U.S. suffer emotionally and financially when their adult children are taken away.
Despite official Immigration and Customs Enforcement (ICE) guidance that agents should not “expend detention resources” on those who are elderly, many immigrant elders are detained and deported. According to information gathered through a Freedom of Information Act (FOIA) request by the NYU School of Law Immigrant Rights Clinic, the Immigrant Defense Project, and Families for Freedom, between 2005 and 2010 the New York City ICE Field Office apprehended 1,275 noncitizens over the age of 55, and of these, at least 141 were subject to mandatory detention. Seniors struggle more than most in detention – they are more likely to be Limited English Proficient, and are more likely to suffer from health problems and dementia.
Huyen Thi Nguyen, an elderly Vietnamese woman, was detained in an immigration detention center for 16 months after serving her sentence for cash-for-food stamp fraud. She continues to fight her deportation, while suffering from mild dementia. Claudette Hubbard escaped LGBT violence in Jamaica in 1973 and became a U.S. Green card holder. She has been detained by ICE for over two years because of a 20-year-old conviction from a drug charge, even though she has fully rehabilitated and is mother and grandmother to U.S. citizens.
Claudette Hubbard with her U.S. citizen daughter and granddaughters
MY IMMIGRANT MOTHER sits silently in a room the size of a small kitchen. Earlier this year, she survived multiple failures of the heart, kidneys, and limbs over the course of six weeks. She is seventy-three, uses a wheelchair, and for the first time in her life is surrounded by white people who do not speak Spanish, in the only nearby nursing home my parents can afford. In turn, my father drives through the days confronted by three omnipresent realities: hour-long daily visits with my mother, a night shift to keep him mentally and financially afloat, and a mailbox flooded with health care bills, insurance disputes and the complexity of navigating Medicare, Medicaid, and private insurers. When I speak of health reform, queer rights, or racial and economic justice, he gazes at me solemnly. He survived a lifetime of racial discrimination, fought in two wars and lived through the ensuing decades with a cacophony in his psyche. At seventy-eight, nearly blind and deaf, he will hear nothing of systems and reform. More often than not, these days we sit in silence.
This silence haunts me as an advocate who works at the intersection of aging and lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights. The aging and LGBTQ advocacy fields often propose policy solutions that are too narrow to address the complexity of how all marginalized people — including heterosexual people of color such as my parents, members of the LGBTQ community, and more — experience the process of aging. We need social transformations that address the intersecting forms of oppression that older people face — and that can make sense of the chaos and silence that shroud my parents. This has become especially clear to me through my work as the director of a national policy program devoted to improving the health and well-being of LGBTQ older people.
A closer look at the lives of aging LGBTQ people reveals how deeply identity politics and class politics are entangled. Here, an older protester rallies for marriage equality in Pasadena, California.
For the full essay, which originally appeared in Tikkun Magazine click here
When our nation talks about Asian Americans, it often groups together people from different cultures and those who speak different languages. Someone from China faces different challenges than a refugee from Cambodia, yet research typically wouldn’t show this. As a group, Asian Americans and Pacific Islanders (AAPIs) are the fastest growing population in the United States. Despite the large and rapidly growing population, research and data on AAPI elders is limited and often presented in aggregate (i.e. grouped together). Aggregate data belies the diversity and the challenges faced within the AAPI older adult population.
The National Asian Pacific Center on Aging (NAPCA) recently published five reports that paint a fuller and more accurate picture of the challenges many APPI older adults face. The reports divide the population into three groups (aged 55 & older, aged 55-64, and aged 65 & older) and highlight the language, economic, and employment characteristics of AAPI elders. NAPCA used publically available sources from various government agencies, and disaggregated (or separated) the data to better depict the realities of the AAPI older adult population (55+). See an example below.
Source: U.S. Census Bureau, 2006-2010 American Community Survey, 5-Year Estimates
Demystifying the “Model Minority” StereotypeRead More