OUR BLOG

Life at the Intersection: Older Adults Need a Response to COVID-19 Grounded in Equity

By | BLOG, Health Equity, Home & Community Based Services

Dorothy is in good spirits, but tired and growing increasingly impatient. In January – well before life for most Americans had been dramatically disrupted by COVID-19 with stay at home orders and the shut down of non-essential businesses – the 72-year-old Chinese American living in Seattle, Washington’s Chinatown began to see signs that her community’s life was slowing down. She’d been reading the daily headlines in the Chinese newspaper about the virus in Wuhan and other parts of China. But when the dim sum parlor across the street was only about a quarter full on a normally busy Saturday afternoon, and her building’s annual Lunar New Year celebration was cancelled, it all became real.

Dorothy’s story, and the stories of her community, highlight the importance of intersectionality in our response to the coronavirus. An intersectional framework considers the ways that various forms of inequity operate together, exacerbate each other, and sometimes create unique challenges. It can lead to better policies that recognize the different ways the older adults in our communities are experiencing the crisis.

During the period described above, Dorothy was heart-broken to learn that her neighbor, Mr. Zhang, had been attacked while riding a local bus. Mr. Zhang was riding the bus home after doing some errands, while wearing a face mask, not because he was sick but because he was aware of the asymptomatic nature of the virus; he wanted to protect himself and others. Several passengers on the bus began harassing him and threatening him. They told him to go back where he came from and threw garbage at him. Others in the Asian American Pacific Islander (AAPI) community have reported a surge in verbal and physical assaults in the wake of what President Trump has repeatedly labelled the “Chinese virus.”

Considering all the circumstances, Dorothy – like many of her neighbors – decided to self-quarantine beginning in early February. She stopped going to the nearby temple, and her local bakery in Chinatown has suspended business operations through the end of April. In the wake of the pandemic, AAPI seniors are experiencing unprecedented levels of loneliness and isolation. But the implications for older adults like Dorothy extend far beyond social – even the home and community-based services (HCBS) that keep her healthy and living in the community are affected. She has asked her caregiver to stop coming and avoids her local adult day health center.

Adding to her fears, getting local and accurate information about the pandemic has been difficult. Aside from her Chinese newspaper, information about the coronavirus in Dorothy’s native language has been limited, particularly local news with Washington-based resources and guidance. Many AAPI older adults across the country are language-isolated, which further debilitates their ability to fight the virus. Like many older adults, Dorothy is not on social media and does not regularly use mobile technology, so information is even more limited.

Supporting older adults who may be isolated, experiencing discrimination (or even hate crimes), who may be limited English proficient (LEP), in addition to being low-income, and whose cultural background is not reflected in the mainstream requires a comprehensive and intersectional COVID-19 response strategy. For Dorothy and other older adults in her community, such a strategy begins with acknowledging that her experiences and needs during the pandemic may look different from other older adults or other AAPI individuals, and is informed by her life at the intersection of multiple identities.

At a minimum, an intersectional response should:

  • Denounce Racism. Importantly, intersectionality-informed policies identify the racism and xenophobia spurred by the coronavirus and require local, state, and federal leaders to denounce it and couple their statements with providing ample support to hate crime prevention resources. For a community that lives with the trauma from the experiences of Vincent Chin, Joseph Illeto, Navrose Mody, and others, efforts to curb hate crimes and xenophobia are crucial. In response to a problematic rise of hate crimes in the wake of the virus, the New York Attorney General created a hotline to report coronavirus hate crimes and xenophobia.
  • Acknowledge Heightened Needs. COVID-19 policies must recognize Dorothy and others like her may have already started self-quarantining well in advance of any state or federal directive, and that accordingly, their needs for socialization, food security, and home and community-based services are perhaps heightened relative to those who began staying at home much later.
  • Be Culturally Competent. Policies have to be created with all communities in mind. For example, even calls from our nation’s health experts to not buy and wear masks fails to recognize the ways in which such a message may be received in AAPI communities, informed by their experiences with Severe Respiratory Syndrome (SARS) less than 20 years ago. Another example of cultural competency is around food. During this outbreak, while the need for home-delivered meals to older adults has skyrocketed, it is just as important that those meals are prepared using culturally familiar ingredients and cooking methods.
  • Include Outreach Strategies for Various Language and Cultures. At a minimum, intersectionality requires in-language resources to reach LEP older adults like Dorothy. In 2020, government agencies cannot rely solely on Google translate, tweets via social media, or employ a one-size-fits-all approach. Outreach to AAPI older adults and other communities must include partnerships with local community-based organizations and ethnic media who have the expertise to communicate with these populations.

For those older immigrants, language-isolated older adults or older adults of color, the harms of the coronavirus will undoubtedly be compounded. Dorothy, Mr. Zhang, and so many others like them are not adequately served by policies that only partially address their lived experiences. If they are going to survive this pandemic and in order for them and their communities to thrive, our response to the coronavirus must be intersectional.

*Dorothy and Mr. Zhang are not real people but their stories are based on real accounts from on-the-ground advocates, the media, and loved ones.

Medicaid’s Built-in Solution to Protect People from Crushing Debt

By | BLOG, Medicaid

Medicaid Retroactive Coverage: A Safeguard against Crushing Medical Debt & Key to Accessing Care

Carol was hospitalized after an accident in August. Although she did not apply for Medicaid until October, Medicaid’s retroactive coverage protection ensured that the Michigan Medicaid agency covered her medical bills totaling nearly $50,000 dating back to August.

John experienced a major medical crisis requiring him to stay in the hospital for 86 days. The total charges for his care exceeded $1 million. Because John was uninsured and low-income, the hospital’s staff prepared a Medicaid application, a process which took 65 days to complete. The Florida Medicaid agency approved the application and covered bills for the previous 90 days.

In both of these situations, Medicaid’s retroactive coverage protection filled in gaps for people who neither had nor could afford private health insurance. Without it, Carol and John would have been saddled with unaffordable bills, and likely been caught in medical debt and perhaps even bankruptcy.

Many people like Carol and John turn to Medicaid when they face significant or unexpected health care costs. In fact, the program is uniquely designed to respond to this need—federal law requires state Medicaid agencies to pay for care and services that an eligible person received before they formally applied for coverage. Congress created this 90-day retroactive coverage period because it recognized that people cannot always apply for Medicaid as soon as they become eligible and often do not even know they might be eligible. Medicaid applications are complicated, and it often takes states several weeks or months to determine eligibility, especially when the applicant needs long-term services and supports.

Retroactive coverage is a key financial protection for older adults and other people who are low-income, uninsured, and underinsured. It is the only safeguard against debt and bankruptcy if these individuals experience a health emergency, need long-term services and supports following an illness, or have other unexpected high-cost health care needs. Medicaid retroactive coverage also opens the door to accessing necessary care and helps lessen the uncompensated care burden on providers, particularly nursing facilities and hospitals that serve a large percentage of low-income patients, making it possible for them to stay open and continue to serve their communities.

Despite the importance of this protection, a growing number of states are eliminating retroactive coverage through waivers of federal Medicaid law. Our issue brief takes a deep dive look at some of these states and how their waivers harm older adults, providers and even the state itself. Bottom line: neither older adults and their families nor our healthcare system can afford to lose this protection.

Medicaid Work Requirement Red Tape Threatens Coverage for Family Caregivers

By | BLOG, Uncategorized
More and more states are moving to restrict Medicaid coverage by requiring low-income adults to report that they are working. In fact, the list of states that are in the process of designing or implementing these so-called “community engagement” or work requirement policies has grown to seventeen. Unfortunately, these harmful policies are especially dangerous for family caregivers because they create so much red tape and ignore the stressful and often complex situations these individuals face.

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Talking Taxes Over Turkey

By | Affordable Care Act, BLOG, Economic Security, Health Care, Long Term Care, Medicaid, Medicare, Safety Net Defense
This week marks an important milestone for my wife and me – our first time hosting Thanksgiving. We’ll be bringing together three generations of family: our parents and some of their siblings, our siblings, and a growing crew of little ones. There will be good food, lots of laughs and, if my nephews can convince my daughters, some family football. Read More

Unnatural Disaster: Seniors Hit Hardest in Floods and Fires

By | BLOG, Health Care, Medicaid, Medicare, Nursing Homes
The heartbreaking stories from our recent spate of natural disasters just keep coming. The hurricanes in Houston, Florida and Puerto Rico; the wildfires in Northern California. Stories of destruction, panic, fear and – sadly – death. And there is one disturbing through line: the victims of these disasters, especially those who lose their lives, are overwhelmingly older adults. Read More

What Advocates for Older Adults Need to Know About the Budget Resolution

By | Affordable Care Act, BLOG, Economic Security, Safety Net Defense
If you work with older adults (or have older adults in your life), you have a sense of what we all need as we age. The burden of high health care and housing costs on low-income seniors is growing, and fewer seniors can meet these basic needs: hot meals and enough food to eat, a stable home in the community, and quality health care. Unfortunately, Senate Republicans passed a budget resolution that would make this vision of aging more and more rare. The budget resolution would allow Congress to significantly cut taxes for the wealthiest Americans by cutting funding for critical programs needed by all other Americans. Here’s what advocates for older adults need to know. Read More

Graham-Cassidy ACA Repeal & Replace Proposal: New Name, Same Attacks on Older Adults

By | Affordable Care Act, BLOG, Health Care, Health Care Defense, Medicaid, Uncategorized
Senators Graham and Cassidy recently released the lone remaining proposal to repeal and replace the Affordable Care Act (ACA). The Graham-Cassidy plan once again takes direct aim at Medicaid to pay for tax cuts and provisions that primarily benefit the wealthy and makes even more harmful changes to the ACA than the bills the Senate voted on in July. Any of its provisions alone or in combination would be devastating for older adults, people with disabilities and anyone with limited income and are counter to the current bipartisan efforts to improve the ACA. Read More

Older Adults & the ACA Health Insurance Marketplace: What’s at Stake for 2018

By | Affordable Care Act, BLOG, Health Care, Health Care Defense
Among its many achievements, the Affordable Care Act (ACA) has made great strides in covering more older adults who previously had no access to health care. Before the ACA, many low-income older adults who did not have employer-based coverage had no affordable coverage options to address their growing health care needs prior to becoming eligible for Medicare. Insurance companies were allowed to effectively price lower-income older adults out of the individual market or deny them coverage altogether based on pre-existing conditions. These insurance practices posed significant barriers for the 84 percent of people ages 55 to 64 estimated to have at least one pre-existing condition. Read More

Social Security is 82 today!

By | BLOG, Social Security, Supplemental Security Income
On August 14, 1935, President Franklin Roosevelt signed the Social Security Act. Today, Social Security continues as a bedrock program that provides millions of older adults with the income they need to meet a basic standard of living and to avoid falling into extreme poverty as they age. Without Social Security, 15.1 million Americans over age 65 would live in poverty. The addition of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) as part of the Social Security program has ensured that even more people are protected from the risks of destitution and homelessness if they experience a disability before they reach retirement age, or are not otherwise eligible for significant benefits. Read More

Aging as LGBT: Two Stories

By | BLOG, Health Equity, LGBT, SENIOR POVERTY

Tina and Jackie were born in the same town in 1947. Despite similar beginnings, their lives take very different turns. In 1967, Tina meets Frank. And Jackie meets Frances. As a same-sex couple, Jackie and Frances couldn’t marry, were denied spousal benefits, and experienced a lifetime of discrimination and lost wages. Fast forward to today, and Jackie, like so many other older adults, struggles with financial insecurity, social isolation, and overall lack of health and well-being, simply because they are lesbian, gay, bisexual, or transgender (LGBT). Read More

Senate ACA-Repeal Knocks Down House, Builds Shack

By | Affordable Care Act, BLOG, Health Care, Health Care Defense, Home & Community Based Services, HOMEPAGE
Over 90% of older adults say that they want to remain in their homes as they age, rather than going into a nursing home. A successful and popular program, Community First Choice (CFC), lets people do just that.

The revised Senate health care bill brings an idea that should be a hard sell for the over 3 million older adults and people with disabilities who rely on Medicaid for in-home care. On top of a massive almost $800 billion cut to Medicaid that guarantees shrunken programs and eliminated services, the Senate bill kills CFC and replaces it with an inferior version that provides fewer services for a limited time only.

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The Republican Health Care Bill is Bad News for Your Grandparents. And Your Parents. And You.

By | Affordable Care Act, BLOG, Health Care Defense, Medicaid, Medicare, Nursing Homes
Who needs Medicaid? Probably someone you know. Medicaid is the backstop government program that provides coverage when someone can’t afford necessary health care. Historically, Medicaid coverage focused on children, older adults, and persons with disabilities, although 2010’s Affordable Care Act expanded Medicaid coverage to some low-income adults without disabilities. The Better Care Reconciliation Act, which Senate Republicans just released, not only aims to take away the expanded coverage, but also makes deep cuts to the core Medicaid program that inevitably will lead to health care rationing. Read More