Immigration Status Trips Up Forgotten Seniors

Anemona Hartocollis of the NY Times reports on abandoned elders who are having trouble getting health care.

"There's this layer of fog that lays over this area of people who become elderly and incapacitated who are not citizens, or who become incapacitated without ID, and then they're stuck in nether land," said Edward H. Tetelman, New Jersey's acting public guardian.

Others lose their forms of identification to the hardships of life on the street, said Susan Hollander Whitman, a state social worker who counts the Hagedorn Jane Doe among her clients. "It's not the kind of thing a transient person is going to keep on them or keep anywhere," Ms. Whitman explained. "You have to go back to square one to try to figure out where they came from - what state, what country, whatever, and try to get all the documents that you need in order to get the Medicaid."

. . .

[S]ince 2006, federal regulations have required that Medicaid recipients provide proof of citizenship or legal residency to receive long-term coverage, and some illegal immigrants in grave conditions have been returned to their homelands, not by the government but by hospitals (Debra A. Smith, Hagedorn's chief executive, said the hospital would not do that). Social workers suspect that some of the unidentified hospital patients may be undocumented immigrants abandoned by relatives desperate to get them needed care.

And as a result of this suspicion, apparently shared by Congress, many of these abandoned elders--even citizens or permanent residents--will not get the care they need.  The government would rather throw them under the bus than risk providing health care to undocumented immigrants.  (There's no question we'll throw elderly undocumented under the bus, regardless of how long they've been in the U.S.)  They've not just been abandoned by their families, but by all of us.

But even when identity is known, sometimes the problems remain. 

I can vouch that there are many elderly citizens and permanent residents in the nursing homes and care facilities of New York City who are in danger of getting the boot because they can't prove their immigration status.  I worked with some of them.  Those are difficult cases.

As I wrote a while back:

There are a lot of elderly and sick New Yorkers languishing in nursing homes, care facilities, hospitals, and on the street who may have lawful status in this country but don't have the documentation to receive the care they need, or to do things like get a job or open a bank account. Let's say a naturalized citizen falls on hard times, loses his home and job, doesn't have much family in this country, and ends up on the street for a time, losing in the process every shred of paper that ever once identified him as a member of the human race. It happens more often than you might expect. Let's say he wants to start things over and try to pick up the pieces of his life. It can be nearly impossible for such a person to navigate on his own the bureaucratic maze needed to recover the documentary foundation upon which modern life is built.

At the employment office: "You need two forms of picture ID and proof of citizenship to start work."

At the DMV: "You can't get a state-issued ID unless you have proof of birth that we accept: birth certificate, passport, non-expired permanent resident card."

At the Department of Health: "You can't get a birth certificate without a government-issued ID." Doesn't matter in our case anyway, since our guy was born abroad. That's even worse-just try getting a birth certificate from another country with no valid form of identification.

At Citizenship and Immigration Services: "No more walk-ins today. Use the kiosk in the hall to make an InfoPass appointment." Our guy soon discovers that an InfoPass appointment requires a government-issued ID.
"But that's what I need to talk to somebody about."
"Call our 1-800 number."
After 45 minutes on hold, our guy is transferred and then told to make an InfoPass appointment.

Can't work, can't eat, can't pay rent. But can't receive public benefits either, since he can't prove he exists to the satisfaction of any of the government agencies tasked with keeping track of him. He may as well not exist.

So maybe he gives up and stays on the street. Maybe he dies.

It happens more than we might like to admit.

[Image: James Estrin/The New York Times]