by Thin Rati Oo and Jessica McCann
Introduction
According to the U.S. Census Bureau, in 2018, about eight percent of the 44.8 million immigrants in the United States were age 65 or older, a figure projected to reach 22 million in 2060. These older immigrants bring diverse cultures and perspectives, enriching our American society. However, their transition to a new country presents distinct health care access challenges, including language, socioeconomic constraints, and policy barriers, that require focused attention and support. Below, we outline these barriers and offer solutions to improve access to health care and health outcomes for older immigrants.
Barriers to Care
Language Barriers and Health Care Access
Navigating the U.S. health care system can feel like navigating uncharted waters without a compass for older immigrants. Limited English proficiency becomes a significant barrier, making it challenging to communicate with health care providers and understand medical instructions. These issues can lead to medical errors, and research shows that the medical errors experienced by persons with limited English proficiency can be even more dangerous than those involving English speakers. Moreover, immigrants with limited English proficiency often face additional barriers to care including lack of insurance, discrimination and not having a usual source of health care. While people of all ages with limited English proficiency face these barriers, they are particularly challenging for older immigrants. Importantly, community health centers often fill this gap, with about 40% of individuals with limited English proficiency receiving care, which is often “linguistically and culturally appropriate,” at a community health center.
Mental Health and Socioeconomic Constraints
Challenges extend beyond language for many immigrants, especially refugees who have fled conflict or persecution. These experiences often lead to chronic mental health issues like depression and post-traumatic stress disorder, compounded by the loss of independence and social status in their new environment. Socioeconomic constraints worsen these challenges, as many lack the resources needed to maintain their health and well-being. For instance, a significant number of older immigrants have lower levels of education and face financial instability compared to native-born Americans, affecting their health literacy and access to health care services.
Structural and Policy Barriers
Older adult immigrants encounter significant structural barriers. Policies like the 1996 Personal Responsibility and Work Opportunity Reconciliation Act restrict access to social services for non-citizens, adding hurdles for those seeking health care. Many older immigrants lack adequate insurance coverage, which limits their access to essential medical care and preventive services. Moreover, the Biden administration is continuing to navigate the complex landscape of immigration policy, complicated by widespread anti-immigration sentiments.
Policies like the Migrant Protection Protocols initiated during the Trump administration continue to spark debate and influence current administration decisions regarding asylum seekers. Ongoing legal battles surrounding Deferred Action for Childhood Arrivals (DACA) and Temporary Protected Status further highlight the complexity and contentiousness of these issues. Recent court rulings, such as overturning the Chevron decision in Loper Bright Enterprises v. Raimondo, are reshaping policy directions and future pathways for immigrants entering the U.S. These legal shifts are expected to significantly influence how immigration policies evolve, reflecting broader uncertainties heightened by upcoming elections. Outcomes of these policies, and upcoming elections, will surely have repercussions for the health of older immigrants.
Cultural Misunderstandings
Approximately three out of ten immigrant adults seeking care in the United States report facing challenges receiving culturally competent health care. Health care providers often misunderstand the health care needs of older adult immigrants due to cultural differences and a lack of training in cultural humility. For instance, traditional health beliefs and practices, which many immigrants uphold, may not be fully understood or respected within the conventional United States health care framework. This misunderstanding can lead to inadequate care and feelings of exclusion among immigrant patients.
Solutions
Traditional Medicine
Bridging this gap requires health care systems to not only provide language support but also integrate culturally relevant health education and practices. Research shows that traditional medicine practices, when used safely and with health care provider guidance, facilitate culturally competent care that benefits both immigrant and non-immigrant populations alike. For example, studies show that acupuncture aids in managing cancer-related pain, while Chinese herbal medicine shows promise in treating conditions like cardiovascular disease and ulcerative colitis. Health centers such as Asian Health Services in Oakland, CA have successfully integrated traditional medicine into their services by offering acupuncture, herbal medicine, and other practices.
Moreover, more federal investment in research on the integration of traditional health practices into community clinics is essential. While global research shows positive outcomes are associated with traditional health practices in the primary care setting, there is a research gap here in the U.S. Evidence-based insights gained from this research can inform policies and practices, thereby better addressing the health care needs of immigrant communities in the United States.
Provider Training and Patient Language Supports
Equally important is empowerment through education and resources. Health care providers must undergo cultural competence training. Promoting health literacy and supporting older adult immigrants in advocating for their health care needs will also ensure they can make informed decisions about their health. Additionally, making health care accessible to those with limited English proficiency, as outlined in the U.S. Department of Health and Human Services Language Access Plan, will reduce barriers to care and improve health outcomes among older immigrants. Community health centers are already bridging this gap with enabling services, which provide non-medical supports like translation, enrollment assistance, and outreach to all patients, including older immigrants.
Adequate Funding
Adequately funding or expanding existing programs like health centers, Medicaid, Medicare, and community health initiatives is key toward addressing the health care needs of older adult immigrants. Increased funding through HRSA grants, CDC grants, and private and non-profit sources could bolster these programs, improving services such as language support, cultural competence training, and traditional medicine integration.
Conclusion
Meeting the health care needs of older adult immigrants in the United States goes beyond mere policy—it is a fundamental moral obligation that speaks to our societal values. As the United States grapples with shifting demographics, prioritizing the health and well-being of these immigrants isn’t just about fairness; it’s about embracing our shared humanity.
To truly tackle health inequities, our health systems must consider and address how cultural influences impact patients’ health care decisions. This is essential even when the treatments they value may not be grounded in conventional evidence. By investigating and considering these practices, we can design and facilitate safe, effective, culturally sensitive, and coordinated care for all patients and communities across the country.
Moreover, the ripple effects of these changes will extend beyond our communities. The integration of traditional medicine and culturally competent care into our health care systems can also serve as a model for other nations facing similar demographic shifts. It demonstrates that a health care system capable of adapting to diverse cultural needs not only meets the immediate needs of its population but also sets a global standard for inclusive care regardless of age and cultural background.
By confronting their distinct challenges with empathy, cultural awareness, and concrete policy changes, we can guarantee that every older adult, regardless of where they were born, can grow old and flourish in the land they call their “new home.”