Older people without invisible papers may no longer remain invisible as their numbers increase and their health care needs become more critical.
Nearly 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 immigrants to the Illinois 55 or older live in poverty, compared with 11% of the nation-born population.
In the United States, estimates of the number of undocumented immigrants range from 10.5 million to 12 million. About 4.95 million come from Mexico, 1.9 million from Central America and 1.45 million from Asia. It is estimated that in 2014, 1.5 million undocumented immigrants were 55 and over. This represents almost 25% of the total undocumented population.
Older undocumented immigrants are at a higher risk of repeat hospitalizations, according to a 2019 study from the University of California, Irvine that found disparities between undocumented immigrants and insured patients in California.
As a family nurse practitioner at Rush College of Nursing in Chicago, this grim reality is challenging. I recently treated a 68 year old patient who was born in Croatia and who has lived and worked in Chicago for the past 40 years.
His family was not in his life, he was homeless, and his mental capacity was such that the healthcare team deemed him unable to safely take care of himself.
Previously, he had been a singer in a nightclub. He sang songs to the staff in Croatian and his face lit up. He spoke of his homeland in his native language with pride, tears in his eyes and joy.
Patients who cannot return home
In December 2020, Illinois became the first state in the country to begin offering health care coverage to undocumented seniors.
Healthy Illinois For All is a first step in providing equitable health care coverage for all. Yes, Illinois grants Medicaid to undocumented seniors. Unfortunately, this new coverage for undocumented older people does not cover nursing home care, as similar health care plans do. This leads to an inability to get patients out of hospitals if they need higher levels of care.
Because Illinois took this step, my patient had been enrolled in a health care coverage plan. It was a big step towards better health and stability. At least I thought it was.
As he is undocumented and does not have an ID card, he needed help navigating the health system.
“Sorry, we need state issued ID to allow him to use his insurance plan.” Does he have a social security number? was the first set of standard questions, as healthcare facilities require ID to even allow a patient to use a plan.
The healthcare community needs to be more creative in breaking down barriers like this.
Solutions could start by providing healthcare forms in multiple languages, providing more interpreters, and providing cultural awareness and sensitivity training to employees. Health care facilities should accept all health insurance plans, not just those that reimburse according to their standards.
How to cover the costs
Unfortunately, the patient we are caring for recently suffered a stroke. He was eventually able to get a diagnosis that he is unable to take care of himself. He has been in a hospital bed for six months because his health care plan does not cover nursing home care.
The average cost to keep a person in a hospital bed overnight is $ 2,653.00. The average nursing home bed for one night is $ 290.00.
Adding nursing home care to the existing expanded coverage for undocumented migrants will increase costs, for the health system and, ultimately, for taxpayers. But undocumented migrants are among those who pay taxes; undocumented immigrants are estimated to pay billions of dollars each year in taxes in the United States.
Granting permanent legal residence to more immigrants could also generate additional tax revenue: it is estimated that granting permanent legal residence to 3.7 million undocumented immigrants who are parents or guardians of minor U.S. citizens could generate additional revenues of $ 2.5 billion.
If undocumented elderly people who need nursing home care cannot get it, they risk ending up in the emergency room and being readmitted to hospital, which also increases costs. Emergency room and hospital costs for chronic disease management in the United States are estimated at $ 1.1 trillion.
Every person deserves to live a life of dignity as they age. Hospitals are meant to care for the critically ill, not to serve as nursing homes. By 2030, this crisis could explode.
Illinois should act now to provide nursing home coverage to undocumented seniors.
Christina Manheimer is a Family Nurse Practitioner at Rush University College of Nursing and Public Voices Fellow in the non-profit Op-Ed Project.
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