By Tibisay Zea. This story originally ran in El Planeta. To read the original article in Spanish, click here.
On every warm and sunny afternoon, Pedro Arellano, 68, sings Mexican boleros and rancheras accompanying himself with the guitar at an emblematic park in Boston. He seems to camouflage himself under the foliage, but there he is, in the shade, where many Bostonians have heard him, for years–yet very few know who he is, or would be able to recognize him.
Arellano arrived in the United States in 1991. He left his wife and six children in Puebla, his hometown in Mexico, and put himself in the hands of a coyote to cross the border, running away from a debt and hoping to send money to his family. He settled in New York, where he began to do construction work and found himself without enough money to at least pay for his own accommodation.
“We were about 20 people living in a one-bedroom apartment, sleeping on mats over the floor, one next to the other,” he said. One day Arellano went to Boston to visit friends and he decided to stay, hoping for better results. Nevertheless, the situation was not very different.
After working in the construction industry, restaurants, shops and mariachi ensembles, Arellano began doubting whether he could find what he was looking for. He was alone, working three shifts a day, living in a cramped apartment, and reaching his golden years. This is how he fell into alcoholism and depression. Finally he contracted tuberculosis and was hospitalized on the verge of death at the Boston Medical Center.
Today, he lives on to tell the story, and the circumstances have forced him to slow down. “I used to make a lot more when I worked for construction, but that job is just for young people. I cannot make it anymore,” he said.
After he recovered, Arellano was lucky enough to live with a friend, who does not charge him rent. He said he earns his living by playing music in the park during the warm months and doing day labor in the winter. Without savings, he spends all his daily earnings: “If I stop, I will die.”
For the poorest seniors in the United States, about 70 percent of their income comes from comes from Social Security, according to federal statistics. But undocumented seniors, who do not qualify for this benefit and are twice as likely as the general population to live in poverty, continue to depend on their day-to-day earnings.
Pablo Buitrón, a primary care physician from Ecuador who works at the Boston Medical Center, treats many Hispanic patients, some of them undocumented. “Their most common problems are chronic diseases, such as hypertension, heart problems, obesity, heart attacks, diabetes … and this is often a consequence of their lifestyle,” Buitrón said.
“The undocumented who are getting older present socioeconomic problems that are reflected in their health,” he continued. “To survive, many of these seniors keep working low-wage, often physically demanding jobs — cooking, cleaning houses, street vending or working as home caregivers at 70 or 75 years old –- or for the rest of their lives.”
Additionally, Buitrón explained, the majority of undocumented patients bring some psychological or psychiatric problem, either anxiety, depression or traumas due to being away from the family, or some shocking experience they suffered as immigrants, or to discrimination.
In the Boston area, he went on, “There are not enough therapists who speak Spanish, and it is far from ideal to undergo mental therapy with the help of a translator instead of a doctor who speaks your language or understands your culture.”
Furthermore, the anxiety produced by the uncertainty and fear of deportation has grown in the Trump era, he observed.
Some lawmakers and others argue that undocumented immigrants are draining public services without paying their share. In fact, though, analysis by the Social Security Administration reveals that unauthorized immigrants pay paid $13 billion into the program in 2010 alone while only taking $1 billion in in benefits. That is, unauthorized workers contributed $12 billion or more to Social Security each year more than they take out. Other research has found similar trends for Medicare.
Who Pays the Bills?
Although undocumented people cannot access health insurance throughout the U.S., Massachusetts has a resource called Health Safety Net, known as MassHealh Limited. This aid package includes preventive visits and emergency assistance for people who do not qualify for health insurance.
“The biggest difference between standard health insurance and MassHealh Limited is that the person can only attend community health centers or public hospitals,” explained Hannah Frigand, associate director of the Help, Registration and Education program of Health Care For All.
She continued, “In addition, ambulance services and long-term care or nursing centers are not covered by the health safety network and patients can only obtain medications in certain specified pharmacies.” Frigand’s program is responsible for educating and helping people navigate the health insurance system in Massachusetts. A 10-minute ambulance ride in Boston can cost about $850.
Although Pedro Arellano, the Mexican immigrant, has MassHealh Limited, the system only covers preventive visits in community centers and emergencies in public hospitals. But after his illness, Arellano was hospitalized in a rehabilitation center for 10 months, an expense that was not included in the coverage, and which he was supposed to pay out of pocket. Of course, he had no way to covering it; even though the hospital tried to charge him, he was unable to pay.
Hospitals typically try to charging those unable to pay their debt. As a result, collection agencies are more likely to contact uninsured people who face problems paying medical and non-medical bills. A 2008 study by the National Bureau of Economic Research, in Cambridge, Mass., found that those entering a hospital without health insurance double their chances of filing for bankruptcy over the next four years.
Even though a 1985 federal law requires emergency departments of clinics and hospitals to receive anyone who arrives, regardless of their ability to pay, that care is limited.
“We have heard recent stories of people with cancer and what it means to them when they only qualify for the Health Safety Net,” said Health Care For All’s Frigand. “Someone who needs personal assistance does not have access to homecare, and that makes them more prone to being hospitalized for longer, an expense which is not included in the coverage either.” Elders and those who are very sick are the people most affected by these limitations in coverage.
In Massachusetts, it is common for private hospitals not to accept patients with MassHealth (the state’s low-income Medicaid program) or Medicare only without additional private MediGap coverage. “Although in theory they should not discriminate, some health centers have ways of evading such patients, for example, by using an insurance system for practices for profit that do not admit MassHealth patients, or orienting their marketing strategy to target people with money.”
Most hospitals are nonprofit organizations and are exempt from federal, state and local taxes, if they provide a benefit to the community, such as charity care. But private nonprofit facilities often say government allocations fall short of their costs for their uncompensated care for the poor.
Therefore, said Boston Medical Center’s Dr. Pablo Buitrón, the burden falls on public hospitals, which assume the financial weight of treating these patients. “If the effort were distributed among all the hospitals, it would be better, incentives would be created so that everyone in the world,” he said.
Access to Housing
Before being admitted to the hospital, Pedro Arellano lived in an apartment in East Boston, an immigrant neighborhood, with 1 bedroom and 1 bathroom, along with five other families. “We slept on the floor on mats, wherever we could find room,” he said.
This situation seems to be quite common. “In immigrant neighborhoods like East Boston, this happens because accommodation costs simply cannot be afforded,” explained Andrés Del Castilllo, community organizer of the City Life/Vida Urbana, an organization dedicated to promoting fairer and more inclusive public housing policies in Boston.
In the United States, only New York City and San Francisco have higher rental prices than Boston, where a 1-bedroom apartment costs, on average, $ 2036, according to Reis Inc., which monitors rent costs.
According to the Elder Economic Security Standard Index, a formula created at UMass Boston and used around the country to estimate the costs of living for people age 65 or older, a healthy older adult living independently in Massachusetts needs $27,742 to cover such basic needs as housing, food and health care expenses. For couples, the cost is $38,976. The largest share of this expense (about one-third of seniors’ incomes) goes to housing, according to the 2015 Consumer Expenditure Survey data.
The waiting list for elders to find affordable housing averages about 9 months, a tolerable period considering that waiting for a younger family can be from 8 to 10 years. However, undocumented immigrants simply do not have access to subsidized senior housing. “These programs are funded with money from the federal government and there is a restriction that prevents the undocumented from participating. They just do not qualify,” Castillo noted.
Peruvian sisters Maria Yolanda and Vicenta Aleman, ages 75 and 73 respectively, received a notice that their rent for an apartment in East Boston would increase by 40 percent. If they did not agree, they would have to leave within 30 days. Fortunately, they attended a meeting of the City Life / Vida Urbana organization that helped them fight in court, and in the end they negotiated with the owner and did not have to move.
Many others in the Latino community are not as fortunate. “Right now the most difficult struggle for the elderly population is the lack of access to information and education. Then there are other barriers such as language,” explained Andrés del Castillo.
He added, “But now in Boston the problem of forced displacement is very serious. Such displacement is not only from your home, or from your neighborhood, but from the whole region, because the high prices will force them to move far away from where they are currently living. The sisters are used to going to their doctor, taking local transportation, attending certain local programs or meeting with their neighbors or relatives in the area. So moving away brings side effects such as isolation and physical and mental deterioration.”
Discrimination is another factor mentioned by Del Castillo as a serious threat for the undocumented. Laws in Massachusetts prohibit discrimination. But in practice. Those without a Social Security number taxpayer identification number learn that “the owner will not in most cases take their rental application seriously because they assume they are undocumented. We are now building the argument that all these mechanisms have a disproportionately negative impact on our community.”
A Growing Population
We have seen the proliferation of interesting and moving stories focused on the young beneficiaries of the Deferred Action for Childhood Arrivals (DACA) program or, most recently, Temporary Protected Status (TPS). But not much is known about the plight of undocumented older adults. They, unfortunately, have little to contribute to the productivity arguments commonly used to persuade lawmakers that undocumented can add to the economy if allowed to stay.
Overall, undocumented seniors are currently a very small group. According to the Center for Migration Studies of New York, only 76,753 (0.7 percent) of the 11 million undocumented people living in the United States are over 65 years old. Most of the immigrants who came illegally in the 1960s legalized their status after the Immigration Reform and Control Act of 1986, during the presidency of Ronald Reagan. That law offered a path to citizenship to almost 3 million unauthorized immigrants who had entered the United States before January 1, 1982.
In the 1990s, there was another wave of migration. The Migration Policy Institute estimates that more than 6 million undocumented immigrants entered the U.S. during that decade, and a considerable number are approaching senior status.
Almost 2.5 million people in the United States without documents are between 45 and 64 years old, according to 2015 figures from the Center for Migration Studies. This means that the older population will grow sharply in the coming years unless the U.S. government implements a new way to legalize their immigrant status.
Tibisay Zea wrote this article with support from a journalism fellowship from the Gerontological Society of America, New America Media and the Silver Century Foundation.
The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.