Access for vulnerable older adults seeking health care
By Jay Nachman
David J. Johnson is on the front lines of helping older adults, vulnerable and otherwise, who are seeking needed health care.
The barriers to receiving health care are many, including affordability, transportation inaccessibility and complicated insurance issues. As the CARIE LINE Supervisor, Johnson provides resources and information that assist older adults to become more healthy and independent.
Johnson can, for example, explain that Pennsylvania has prescription assistance programs to help pay for medicines. He provides referrals for other benefits, programs and subsidies. He can also help people work through issues related to receiving Medicare and Medicaid benefits that can be enormously complex.
“Older adults often feel overwhelmed with just how many different people are involved to resolve, on paper, fairly simple issues,” Johnson explains. “They say, ‘I need to go see the doctor, but I need to be able to afford to see the doctor.’ I would encourage people that reaching out for help is perfectly okay and validating. Many people first try to resolve these issues on their own, but they may need an advocate to help them through the process.”
Hikma Elmi, a health programs manager at the African Family Health Organization (AFAHO), also provides information about access to health care for the African and Caribbean immigrants and refugees the organization serves. (For information, call 215-546-1232 or visit AFAHO.org.)
“It all comes down to knowledge,” Elmi said. “A lot of people are unaware of the services that are available to them, whether they are documented or undocumented. For all our clients who need health care, we connect them to the different health care institutions in the city of Philadelphia.”
Often, undocumented immigrants are afraid of jeopardizing their immigration status, Elmi said, but the health centers operated by Philadelphia’s Department of Public Health serve people who are uninsured and undocumented. (For more information, call 311 or visit phila.gov/services/mental-physical-health/city-health-centers.)
AFAHO also has cultural health navigators who provide language assistance and ensure that their immigrant clients receive culturally appropriate care. Prior to the pandemic, the navigators would accompany the clients to doctors’ offices and advocate for them.
“There’s a strong trust in the relationships that we have built with our clients,” she said. “They know whether they are documented or not, and they have this language barrier, our cultural health navigator is there to accompany them, and assist them and advocate for them. They feel a lot more comfortable going to these city health centers and getting evaluated when it comes to their health and getting the treatment that they need.”
Rose Ann DiMaria-Ghalili, Ph.D., the associate dean for interprofessional research and development at Drexel University’s College of Nursing and Health Professions, offers a big picture look at barriers to health care. She co-authored the study, “Disrupting Disparities in Pennsylvania: Retooling for Geographic, Racial and Ethnic Growth,” which showed that “health inequities are most acute among those living in rural and low resourced areas of the state, and among underrepresented populations (particularly Black/African American and Latino), who lack access to health care, experience digital divide and face persistent local healthcare workforce shortages.”
The report estimated that 14% of Pennsylvanians live in a medically underserved area, and 22% live in an area that is both medically underserved and designated as a health professions shortage area. Further, in the state, 11% report not seeing a doctor because of cost, and 15% of those living in Philadelphia reported not being able to see a doctor in the past year because of cost.
One small start to address these issues would be for all health care providers to be trained in providing care for older adults. “We think about health care only as going to see your provider but there’s a lot we can do to remain healthy and to age in place, to help older adults get the resources they need to live in the community,” DiMaria-Ghalili said.
Local area agencies on aging, such as Philadelphia Corporation for Aging, offer services to help older adults remain functional in their homes, such as personal care, home-delivered meals, minor home adaptations, and caregiver support. For more information, call the PCA Helpline at 215-765-9040 or Click Here>>.
The Center for Advocacy for the Rights and Interests of the Elderly (CARIE) can assist with Medicare/health insurance, health resources, nutritional support and more at 215-545-5728 or CARIE.org.
Jay Nachman is a freelance writer in Philadelphia