Health and social service utilization patterns of Mexican American older adults

HEALTH AND SOCIAL SERVICE UTILIZATION PATTERNS OF MEXICAN AMERICAN OLDER ADULTS

DIANA J. TORREZ* University of California-San Francisco ABSTRACT: Thus qualrtatrve study examrned the servtce utdrzatzon patterns of a group of Mexuzan Amencan older adults and barrrers they may encounter when they attempt to access formal services A purposeful sample was drawn from the clients of a social service program whrch provcded assistance to older adults Interviews wrth 46 respondents revealed that (1) detenoratmg health exacerbated the needfor services (2) deficlencles m the ablhty to have health, social, and transportahon needs met as a result of economic and trme constramts of adult chrldren (3) drfficulty accessmg needed services on therr own behalf and (4) farlure to receive assistance m accessrng services and prolongahon of unmet needs adversely affected the qua&y of their lives Thefindmgs of thrs study provide msrght mto the issues faced by Mexican American older adults and are valuable m understanding why there IS an mcreasmg need for formal socral services among older Mexican American adults as has been documented by previous research

The need for social and health services by older adults has been shown m numerous studies In practice, the underutrhzation of services by Hispanics IS well documented (Enbes and Bradley-Rawles 1978, Mmdel and Wright 1982, Yeatts et al 1992) Although researchers have noted the lack of social servrce use, few studies have explored the reasons that he behind the underutrhzatron of services among Hrspamc older adults The purpose of thus qualitative study was to examme the servrce utilization patterns and access barriers to service of one Hrspamc ethmc group, Mexican Amencan older adults.

*Direct all correspondence to Dtana J Torrez, Instnutefor Health and Agmg, School of Nursmg, Unrverslty of Caltjonua-San Francisco, San Francrsco, CA 94143-0646 JOURNAL OF AGING STUDIES, Volume 12, Number 1, pages 83-99. Copyright 0 1998 by JAI Press Inc. AlI rights of reproduction in any form reserved. ISSN: 0890-4065.

84

JOURNAL OF AGING STUDIES

Vol 12INo 111998

Previous studies have often used “Hrspamc” as a catch-all phrase to Include numerous Hispanic ethnic groups However, I chose to focus on only one group because the various Hispamc ethnic groups are dtstmct and should not be grouped together for the purposes of research The participants for this study were selected from the clients of a social program which provided assistance to older adults over the age of sixty Since the Mexican Amencans m this study were already identified as a population m need of services as well as a population receiving some services, this study examined the barriers which these older adults encountered when inmally attempting to access services Moreover, because pervious research has hypothesized that underutihzatton of services by Htspamcs m general may result from the fact that their needs are met by their farmlies, this study also examined the availabrhty of informal support from the famihes of this one subgroup of Hispamcs The underutihzatton of services by Htspamc older adults has not created much response from social service agencies, because tt has often been assumed that Htspamcs experience little need for these services This assumption has been based on the belief that Hispamcs had access to other alternative support systems, spectfically the extended family, which provide assistance for whatever needs might be present (Kaiser, Gibbons, and Camp 1993) However, research studies have reported that this support may not be as extensive as previously thought These studies have documented that although Mexican American families are an important source of emotional support for then older adults, their high poverty levels, 28.9%, and time constraints (related to the types of occupations m which Mexican Americans are concentrated) limits the extent of the help that adult children can offer then elderly parents (Andrews 1989) This study therefore addressed two research questions (1) Are economtc and time constramts adversely affecting the abihty of the Mexican Amencan adult children to provide informal support to then parents? (2) What structural and cultural barriers do Mexican Amencan older adults encounter when attemptmg to access social and health services?

BACKGROUND Although this research focuses specifically on Mexican American older adults, previous studies, as noted, often have not differentiated among the various Hispanic ethnic groups As such, the fmdmgs of most research are presented under the umbrella term “Htspamc” or “Latmo” Consequently, most of the relevant literature presented here does not discuss specific Hispanic ethnic groups, but rather refers collectively to “Hispamcs” or “Latmos” older adults Hispanics experience high morbidity and mortality rates from diabetes, curhosts and chronic liver disease (Harmon 199 1) Arthritis,, hypertension and cardiovascular conditions have been the most commonly reported health complaints of the Hispanic older adults They are more likely than non-Hlspamcs to suffer hyperglycemia, cardiopulmonary problems, stroke, obesity and certain types of cancer (USDHHS 1988, 1992, Sotomayor 1993) In addition, diabetes disproportionately affects Htspamcs, Hispanics have a two to three times higher rate of diabetes than other groups If left untreated this condition may lead to complications for older adults such as blindness and amputations (Garcia 1993) Mm and Bumette’s (1994) comparative study showed that severe cognitive and functional tmpanment were increased m Hispanics relative to white or African American

Health and Social Set-me UtUation

Patterns

85

elders They also noted that Hispanics were less hkely than the other two older adults groups to report their health as excellent or good A Commonwealth study (1989) reported that 58% of poor Hispanic older adults report poor and fan health compared with 46% of those who were not poor Past studies have documented the relattonship between poverty and health, and a recent government study found that socioeconomic status was a major contributor of health status (USDHHS 1988). Although poor health and low socioeconomic status have been associated with a greater need for health and social services, Hispanic older adults, as noted, are less likely than the general population to utihze services Kamikawa (1991) reported that mmonty elders comprise fewer than three percent of participants m all poverty programs for the older adults In addition, Hispamcs’ participation m the Older American Act Program decreased from 22% of clients m 1980 to 17 5% m 1985 (Miranda and Quuoz 1990) Kamikawa (1991) reported that ethnic elders were consistently underserved by Administration on Agmg programs which were not means-tested but largely geared to and staffed by the white middle class Exammation of health service utihzation reveals a similar pattern For instance, less than five percent of Hispanic older adults have never visited a dentist as compared with less than one percent of the general older adults population (USDMMS 1988) The complex and bureaucratic nature of service agencies, isolation, language barriers, transportation problems, and high ilhteracy rates have been suggested as adversely affecting the service utihzatton patterns of Hispamcs (Aguure and Bigelow 1983, Hyde 1990, Estrada, Trevmo and Ray 1990, Garcia 1982, De Armas 1975 and LaCayo 1980) In addition, the primary source of income and health insurance coverage for Hispanic older adults, m all hkehhood, contributes to their low rate of health service utilization Hispamcs’ social security comprises a larger proportion of their total income than 1s the case for the general population, 50 9% and 40 4%, respectively, Moreover, they experience a poverty level twice that of non-Hispamcs (Andrew 1989) Sotomayor (1993) has noted that poor older adults spend nearly 20% of their income on out-of-pocket health care expenses compared with 13% of nonpoor older adults Mexican Amencan older adults are more likely than white older adults to count on Medicare as their sole source of health insurance Although Medicare is nearly universal for persons over 65, only 91% of Hispamcs were covered as compared with 96% of whites and 95% of African Americans (Garcia 1993) As discussed, the assumption that the needs of Hispamc older adults were primarily met by an informal support network influenced outreach efforts of social service agencies Although many older adults do express a preference for having their needs met by their adult children, the negative effect of contemporary economics and urbamzation on the extended family social support system have been noted (Becetra and Shaw 1984, Gratton 1987) High rates of poverty among Hispanic married couple families, more than three times that of whites, have made economic support to elders mcreasmgly difficult (Garcia 1993) Also, an increasing number of Hispanic women are entenng the labor force As a result, these women, previously the caregivers of older adults, are no longer a readily available resource Although Hispanic children continue to provide emotional support to the older adults, the various economic and social factors noted have adversely affected the abihty of Hispamc families to provide services to aged members In addition, government policies, such as reducing SSI assistance by one third for those who live m other’s house-

88

JOURNAL OF AGING STUDIES

Vol 12iNo i/1998

holds, have discouraged famihal assistance Maldonado (1989) reported that 22% of Hispanic older adults live alone, and of these, nearly half live below the poverty level An addmonal concern has been ratsed by Garcia (1991, 1993), who views structural changes m the Htspamc family as adversely impactmg the future of its members Because of a reduction m the percent of Hispanic marned famthes, from 74 1 percent m 1982 to 69 8 percent m 1989, Garcia expressed a concern that the growing number of Hispamc single-parent famihes may not be capable of provtdmg financtal and emotional support to then older adults It 1s evident from the literature that, compared with the general older adult populatton, Htspamcs are economically worse off, more hkely to rely on the government as their sole source of income and health insurance, and experience poorer health Despite this, they are less likely to use soctal and health servtces This study sought to examme some of the reasons that one group of Mexican Amencan older adults underutthze services

Methodology This study was conducted m collaboratton with a North Texas Area Agency on Aging (AAA). The AAA targets funds to areas of documented need and subcontracts with numerous local agencies for services to people, age 60 and older The data for this study were collected from one of the agencies with which AAA subcontracts for services This agency provides services to persons who have economtc, social and physical need Among the services provided are case management, transportatton services, advocacy and chore services The agency was selected as the data source for this study for two reasons (1) the agency’s stated goal and (2) the profile of older adults typically referred to the agency The goal of the agency was to assist older adults m obtammg services they needed to mamtam then independence and remam at home and part of the community A large percentage of clients were referred to the agency by friends, neighbors, or relatives because of their perceived need for services and their mabthty to secure these services on then own I believed that the agency would therefore be a useful setting from which to obtain data on service needs and service delivery for one group of Mexican Amencans I also believed that since data would be obtained from a purposeful sample, it would provide a umque opportunity to explore the service utthzation patterns and barners encountered by Mexican American older adults. As such, the informants for this study were selected from one of the North Texas AAA which was located m a predommately Mexican Amencan neighborhood

SAMPLE The case files and the personal mtervrews revealed the following profile of the agency’s clients (see Table 1) It was evident that the malortty of clients had little formal education and exist at or near the poverty level. Although 43.4% did own then homes, these homes were usually m need of major or mmor repairs The maJonty of older adults m this study lived alone and rehed on the agency to assist their independent hvmg snuatton Respondents reported infrequent interaction with then children, 87% reported contact with then children only once a week and 50% of these reported the interaction to be of short duration, usually two hours However, the malortty of mformants did report frequent phone contact with their children

87

Health and Social Serwce Utllrzatron Patterns

Selected Characterlstlcs DemoaraDh/c

TABLE 1 of E&A Mexican Amerlcan

Cllents

Value

Characteristic

Age Range Me&an Age Women EducatIonal Range Income Range Major Income SoUrCe Rented Housmg Lived Alone Median Number of Children Llvmg with Cluldren Average Personal Contact With Chddren Bnth Place Health Problems Two or More PrescrIptIon Drugs

60-90 years 75 years 73 9% 1 to 9 years $412-$800 monthly Social Secunty and Supplementary Security Income 50% 66% Five 86% Once a week 73 9% Texas, 19 6% Mexico, 6 5% Other 913% 89 1%

Health problems were common among the adults m this study The majority of respondents reported diabetes, arthntls, hearmg loss, vision problems, high blood pressure, and the need for medication to cope with these health problems Approximately seventy percent (69.6%) of the older adults also noted that the high costs of their prescription drugs created a financial hardship for them

PROCEDURE These data were collected by myself and a research assistant through personal home mtervlews with the agency’s Mexican American clients Perrmsslon for the Interviews with the agency’s clients was requested by the caseworker They were conducted m Spanish, were approximately one to two hours m length and were audiotaped Prior to beginning each interview the respondents were assured confidentiality An interview guide was developed m collaboration with the AAA director, the caseworkers, and myself (Appendix) The tool focused on (1) the types of formal services currently bemg received, (2) the barriers encountered m accessing these services or other services, (3) the mode by which these services were mltially accessed, and (4) the types of informal services received from their children Although the interview guide provided the structure for the interview process this survey instrument was used as a starting point for the discussion Through out the interview, mformants were encouraged to discuss other relevant issues such their health, families, and relevant past expenences These topics were probed since among older adults the topic of health can yield information on services being received or services needed to maintain their health status Likewise, the topic of family can yield important mformatlon on the amount and type of support their children are able to provide, Previous expenences with bureaucracies may yield mformatlon which might make older adults reticent to seek services from vmous agencies

88

JOURNAL OF AGING STUDIES

Vol 12lNo

II1998

Although this study’s intent was to mtervlew all 61 Mexican American clients of this agency, this did not prove possible Poor health was the primary reason some older adults could not be interviewed Others, however, simply chose not to be interviewed, or could not find the time as a result of then roles as careglvers to their own parents In all, 46 older adults were interviewed

ANALYSIS After completion of the interviews, the tapes were transcribed The data were analyzed using the comparative method described by Glaser and Straus (1967) The analysis consisted of two stages The first stage involved orgamzmg all the responses for each of the interview questions The responses to each question were then analyzed for patterns or conceptual categones which might be mductlvely derived from the data Observed patterns or categories for each of the interview guide questions were documented For instance, the need for transportation, difficulty accessing services, lack of knowledge about services and limited contact with family were among some of the themes which emerged The second stage involved analyzing the data from each of the interviews as one unit Each interview was analyzed for themes or categories which might be mductlvely derived from the data The major themes or categones for each interview were again documented For example, difficulty dealing with government agencies, lack of mformatlon about services, declmmg health, and inadequate assistance from their children emerged as some of the core themes Categories were established m the first stage by noting similar responses for each of the questions If a particular response emerged m more than seventy percent of the cases (32 out 46) this was documented as a pattern or a category Since this study focused on mformal support from children and patterns of and barriers to social services, only the questions which directly addressed these subjects m the interview guide were included m this analySIS These questlons mcluded m the analysis were #3, #4, #8, #ll, #13, #14, #15, #16, #17 and #18 Based on this criterion, eight patterns emerged from this analysis The same cnterlon was set for the mtervlew analysis If a theme emerged m 70% of the mtervlews, it was documented as a theme or a category As a result of the focus of this study, only those themes which were related to family support, patterns of social service use, barrlers to social services and unmet need were analyzed As a result of this criterion, five themes or categones emerged at this stage of the analysis There was a slgmflcant amount of overlap with regard to the categones which emerged at each stage of the analysis

RESULTS The eight patterns which emerged from the stage one analysis are presented m Table 2 Stage one analysis revealed that although the informants m this study did have contact with their children, this contact did not result m the assistance they needed for services Although this 1s m part a function of the study’s sample being drawn from the particular agency, this reveals that children are not a guarantee of adequate social support. In order to remain m the community and be able to access services, these older adults needed addl-

Health and Socral Serwce Utlllzatlon

Patterns

89

TABLE 2

Stage One Data Analysis of Mexican Amencan Older Adults Serwce Pattern Utilization Patterns

N

Most often Used E&A Servxes Transportation Food Supplement Referral to Other Services Remammg m Community Dependent on Services Difficulty Accessmg Servxes Alone Word of Mouth as Mode for Identlfymg Commututy Services Recelvmg Social SecurltylMeduzare SSI Me&cad LImIted Contact with Family Weekly Personal Contact Dally Phone Contact Detenoratmg Health Has LImIted Actlvltles Unable to Identify Other Servxes that Might be Needed

%

39 44 42 35 36 41

84 80 95 65 9130 76 08 78 26 89 13

40 32 33

86 95 69 56 7174

33 40 41 38

71 86 89 82

74 95 13 60

assistance They required assistance m locating mformatlon about the services, help with applying for these services, and assistance m accessing these services once they began to receive them One of the important fmdmgs at this stage of the analysis was that these older adults had perceived themselves as Independent mdlvlduals until their health begin to deteriorate It was the decline of their health which placed them m a position where they were m need of services Stage two of the analysis revealed similar findings Analysis of the interview are presented m Table 3 Stage two of the analysis again supported the needs of respondents for services as a result of declmmg health Although the interviews revealed that the majority of informants had good relationships with their children, the amount and type of contact with then children was not sufficient to provide them with the assistance they needed In addition, respondents expenenced difficulty accessing formal services wlthout assistance, and consequently they were unable to adequately meet their health, social, and transportation needs It was evident from both stages of the analysis that there was considerable overlap m the patterns which emerged from stage one analysis and the themes which emerged ttonal

TABLE 3

Stage Two Data Analysis of Themes in the Lives of Mexican American

Older Adults

Themes

N

Dlffculty Dealmg with Formal Agencies Dechne m health resulted m dependence Infrequent Personal Contact with Cluldren Lack of InformatIon about Servxes Need for Assistance m Accessmg Services

35 41 33 40 37

% 76 08 89 13 7174 86 96 80 43

90

JOURNAL OF AGING STUDIES

Vol 12iNo 111998

from stage two analysts In combmmg the results of both stages of analysts four major charactensttcs of these older adults were revealed (1) detenoratmg health exacerbated the need for services, (2) deficienctes m the abrltty to have health, soctal, and transportation needs met as a result of economtc and time constramts of then adult children, (3) difficulty accessing needed services on their own behalf, and (4) failure to receive asststance m accessing services and prolongatton of unmet needs adversely affected the quality of then lives

DISCUSSION Deteriorating Health Exacerbated the Need for Services This study’s lindmgs supported previous research which has shown that Mextcan American older adults have high rates of dtsabtlmes In this study 89 13% of the respondents stated that then declmmg health hmtted then acttvmes and consequently resulted m a need for services Despite then realized need for services, the informants’ comments implied that mmally they had been reticent to accept assistance from nonfamily sources The majority of mformants took considerable pnde m “doing for themselves” I told you I never bothered anyone never been sick

1 never needed to I have always worked and have

Well I ~111tell you one thing For me no one does anything want First I was mamed

I am used to doing what 1 But my husband died and now I do everythmg

However, as a result of deteriorating health, the mformants were forced to admit their need for assistance This reahzatton, however, was a source of considerable frustration 1 have had a lot of problems with my eyesight I cannot see with one eye [Regarding wife’s health] She 1s diabetic and at times becomes very 111It 1s like she becomes very dizzy, but it IS probably her diabetes and my legs become swollen In the morning my legs are fine, I have many problems but I believe I have vancose veins I have already been operated on, but they have returned and I have difficulty walking I have high blood pressure, diabetes and arthritis that IS very pamful For instance, nght now 1 cannot move my legs My feet are very swollen My entire body 1s m very bad condltlon

For these mformants declmmg health had limited their mob&y and consequently mdependence m home life and community activittes Health problems resulted m their need for assistance with bathing, dressing, or housework It also resulted m the need for transportation to keep doctor’s appomtments Although many of these older adults had expected that

Health and Social Servtce Utkfatlon

Patterns

91

their children would provide them with the assrstance they needed, they soon reahzed this would be drfficult.

Deficiencies in the Ability to Have Health, Social, and Transportation Needs Met as Result of the Economic and Time Constraints of Their Adult Children As the profile of the older adults presented earher revealed, the majonty of those m tins study dtd not hve with their children and approximately half did not even resrde m the same community as their children Although there was still substantral contact wrth their chrldren, this usually consisted of phone calls and short weekly visits. The respondents, however, were quick to state that their children were adults with families and responstbrhties of their own Lms hves m Cahfomla and George lives m New Jersey They are mamed and have famlhes My three daughters hve here All of them are mamed I have stayed alone They call me or wnte to me or send me cards, but It 1s not the same as a vlslt They live far away and it 1s too expensive to vlslt I have four sons, but they work and it IS very hard for them to take me to the doctor I have three chddren, but they are mamed once a week

My daughter calls me everyday and visits

Although this was not the amount of contact that the “extended famrly support system” suggests, rt 1s important to note that despite the fact that the degree of family mteractron had decreased among these respondents, the family remained a very tmportant element m their lives This was evidenced by the fact that m nearly every home, numerous family photographs were displayed on the walls, dressers and shelves These photographs depicted the history of their family-births, graduattons, weddings, family get-togethers, etc This study’s fmdmgs also revealed that economrcs, urbamzatron and changing family structure have had a negative effect on these older adults’ support system. I am very happy with the hves my children have made for themselves They have been able to take advantage of opportumtles that were never available to us I would never have thought my children would have become such Important people It, however, would have been ideal if these opportumtles would have presented themselves m our town, but the ideal rarely occurs Today’s generation IS very different from the past In the past everyone worked together You looked out for your neighbors and fnends

Although some adult children (13%) provided assistance often expressed that their actrvmes were stressful Everyone else [slblmgs] assumes that because I would be the one who took care of her. We never pened Between taking care of my family and my else. No one seems to care [reference to slblmgs], help

to their elderly parents, they

am the daughter and I live here that I sat down and discussed it, it just hapmother, I don’t have time for anything they never offer to help I need some

92

JOURNAL

OF AGING STUDIES

Vol 12iNo

l/1998

Consequently even when adult children provide some assistance, the responstbrhtres were not divided among all the children and, as a result the caregiver and the older adult were sttll m need of formal services. The adult children of Mexican Amerrcan older adults, as is true of many adult children, experienced time constramts as a result of family and Job responstbilmes (Facro 1995) In the past daughters and daughter-m-laws were available to provide services such as transportation and assistance with social service agency forms However, as Mexican Amencan women mcreasmgly enter the labor force, it has become increasingly more difficult for them to provide the type and amount of assistance that was once an important component of the extended family system (Wtlhams 1990) The majority of older adults m this study stated that then daughters held part&me or full-time Jobs Importantly, however, nearly half of the respondents also stated that they believed then children were unfamrhar with the process of accessing formal services Therefore, smce the children may not have possessed the mformation necessary to help their parents access these formal services, they could not offer assistance m accessing the system

Difficulties Accessing Needed Services on Their Own Behalf The analysis revealed that one of the mam problems m accessing services was lack of mforrnatron about exrstmg services For instance, transportation was one of the services which many older adults stated they needed, and for which they relied on the agency Many of the informants noted how detrimental it would be for them if they did not have this service It would be very dlfticult for me to go to the doctor It would be more dlfflcult for me I would have to find some one else She (the caseworker) will take me to pick up my medlcmes (at the drugstore) not take me It would be difficult for me to get there when I need to

If she did

Before (the caseworker) began to drive me to the doctor’s office, 1 would often miss appomtments, because I could not get there I count on her

Although, the respondents beheved the agency’s transportation service was essential to their ability to access other social and health services, numerous other community transportation services for older adults were available, particularly for physician’s visits This lack of awareness regarding available community transportation services was a reflection of a general lack of adequate social service mformatton Consequently, prior to becoming clients of the program, many of the older adults interviewed had not received various commumty services for which they were eligible The majority of mformants m this study had been unaware of programs which offered assistance with mmor and major home repairs, reduced health service costs, food services, or ehgibihty criteria for programs such as Food Stamps, Social Security, Medicare, and Medicaid Although an awareness of these services provides the older adults with the knowledge to begm to access these services, the older adults revealed that the most fornndable bamer to accessing these servrces was often the bureaucracy involved m the apphcatron process For many older adults the process mvolved m receiving services or

93

Health and Soctal Serwce Utllrzatlon Patterns

entitlements from federal and state agencies was perceived enough to prevent them from making an application

as complex and mtrmidatmg

I was told by my nerghbor that I could get the crty to help me repan the roof on my house I called one of the city offices to ask for mformation, but no one seemed to know what I was talkmg about It was not until (the caseworker) came, that she helped me fill out the forms for the program I had been recelvmg a lot of mall from the city about the condltlon of my home, but I did not know what to do After a few months, I became concerned and took all the mall to the Community Center My friend said they might be able to help I was having problems with my hearmg aid It was not working properly But I could not afford another one (The caseworker) helped me fill out some forms so that I hardly had to pay anything for the hearing aids It took three, but I think the doctor finally got It nght

A common barner to applying for services was the mformant’s low educational level, which resulted m difficulty completing the lengthy and complex application requrred by some of the service agencies Another barrier to completmg these forms was language For the malonty of older adults m this study, Spanish was theu first language and as a result, they had difficulty comprehending materials which were prmted m English. Moreover, as a result of limited education, approximately half of the respondents admitted to not being literate m either English or Spanish 1 get lost every time 1 have to go to those offices fused with all the papers they want me fill out

The older adults discussed past experiences of having been drscnmmated against m such social service and health care The malonty stress associated with the process of applying

When I do find them, then I get con-

with various agencies, and their perceptions areas as employment, housing, tmmrgratton, of older adults mterviewed remarked on the for services One informant noted

Everyone 1s always m such a hurry, no one has time to answer questions If you don’t speak English very well it 1s even more difficult to get answers to your questions

It was evident that for this study’s mformants, an awareness of the various social and health programs was not sufficient Consequently, the assistance of someone who was famrhar with the system and who could assist them m the actual process of applying for services was necessary to the abihty of older adults to access and utilize social and health services

Failure to Receive Assistance In Accessing Services And Prolongation Of Unmet Needs Adversely Affected The Quality Of Their Lives The analysis revealed that m the maJortty of cases, if assistance had not been received from the caseworker, these older adults would have not have been able to access services

94

JOURNAL OF AGING STUDIES

for their health, social servtce and transportation the quality of their lives

Vol 12lNo 111998

needs. This would have adversely affected

She (the caseworker) helped me receive benefits from the Veterans Administration She arranged it so that I received a check for eight months and then it was stopped because they said I received social secunty They wanted me to pay back $800 00 She helped me and made It so that I would not have to pay back the money

When I needed to fill out forms, she filled them out for me and she 1s gomg to find someone to help me with my ears because I do not hear There are times when the telephone will ring and I do not hear It She 1s going to help me this week If some forms which deal with the Social Secunty amve, we call her and she comes and take us to take care of that business At the beginning she helped us apply for food stamps and to fill out forms such as those There were many services that we were eligible for, but we did not know they existed and we did not know where to go

Krout (1983) noted that older adults often did not come forward to demand services even when they were eligible for them because of a lack of knowledge needed to complete apphcation process Chow (1994) noted that especially for older adults access to mformation alone did not ensure service utihzation The bureaucratic structure of many social and health service agencies can be extremely mtimidatmg for many mdividuals m society For elderly Mexican Americans uncomfortable with English or the complexity of the paperwork involved m applying for services, assistance IS essential to receiving entitled servtces (Williams 1990).

CONCLUSIONS reported here reveals that the study respondents were not only m need of health and social service mformation, but that they were also m need of assistance to access these services Although many of these older adults grew old with the expectations that their children would provtde them with the same types of support they provided their parents, they later discovered that this would not be the case It should be noted that though the family contmues to be an important component of the Mexican Amencan culture, the extended family support system often associated with Mexican Americans is no longer the norm (Willlams 1990, Maldonado 1989, Gil-Torres 1993) It was evident that for the older adults m this study, the avadabihty of social and family support network did not necessarily guarantee adequate support m their daily lives or the assistance they required to apply for formal social services The fmdmgs m this study are derived from a select population Nevertheless, the respondents’ characteristics as predommantly older, poor, female and Mexican Americans offer some insight mto the problems that plague other older Mexican American adults Indeed nearly 21% of all Hispanics over 65 live m poverty and of these nearly 70% are women (Sotomayor 1993) Therefore, understanding the effect of this intersection of race, class and gender on these respondents’ need for services IS beneficial to understanding the changing and growing needs of Mexican Americans elders

The research

Health and Socral Serwce Utilzatlon

Patterns

95

The family structure has been affected by changing social and economic conditions which have led to the rmgration of younger adults from their communmes of ongm This has had sign&ant impact for service access and health care (Gallegos 1991). Although some studies have noted that Hispanics have more access to mformal support systems than other ethnic groups (Greene and Monahan 1984), others studies have reported that as Hispamc children are becoming upwardly mobile they are leaving then communmes (Zumga de Martinez 1981) Also lack of financial security among Latmo children may place strain on the family, and as a result older adults are reticent to ask their children for help (Gallegos 1991) This study supports the experiences of some Mexican Amencan older adults that are finding that then children are having difficulty or are unable to provide them with support m their daily lives Another observatton by Gallegos (1991) which bears mentioning is that even if Latmo children can meet all the needs of their parents, it 1s a disservice to both the older adults and their children to expect them to do so If Hispanic older adults do not to some degree meet their needs through contact with the outside world, then dependency, which can have adverse affects on the farmly, can be the result (Rathbone-McCuan and Hashimi 1982) Gallegos (1991) further notes that the health and social service needs of Hispanic older adults have not received adequate attention Since Mexican American have tended to rely heavily on sons and daughters for assistance (Markides, Boldt, and Ray 1986), accessing health and social services on their own 1s a relatively new expertence, and older aduits are often unaware of where or how to access social services If Mexican Amencan older adults are to receive services to which they are entitled, then additional programs will need to be established to assist them m accessing social and health services m the community. It is also tmperative that admmistrators of health and social services programs be aware that older Mexican American most often receive service-related mformation on services through such mformal sources as neighbors, friends and family Therefore, making social service information available at social functions, churches, or asking current recipients of services to mform their friends and neighbors of services will facilitate the dissemination of mformation to Mexican Amencan older adults Most importantly, however, agencies must be aware that due to language barriers and past negative expenences with government agencies, Mexican Amencan older adults, more so than other groups, require asststance m accessing these services In conclusion, this study has yielded findmgs which offer insight mto the formal and informal support systems of Mexican Amencan older adults The data revealed that as a result of a changing family structure and high disease rates, the study respondents were increasingly m need of formal services However, access to services was problematic and as a result they experienced dtfficulty adequately meeting then health, social service and transportation needs The findmgs of this study were consistent with previous research which underscored the negative impact of the changing family structure on the natural system of support on which Hispanics have traditionally rehed (Gallegos 1991, Willlams 1990, Gil-Torres 1993, Zumga de Martinez 1981). This study reveals the need for further research on the factors which promote or mhibit access to services by older Mexican Americans A more representative study of this segment of the population is warranted to produce findmgs for the tmplementation of strategies by pohcymakers and local agencies

JOURNAL OF AGING STUDIES

96

Vol 12lNo l/l998

to increase the health and social service utlhzatlon of Mexican American older adults A study of this magnitude IS needed and timely m light of the rapidly increasing Mexican American population ACKNOWLEDGMENTS. This study was conducted under the auspices of the Gerontological SOCIety of Amenca’s 1992 Techmcal Assistance Program (TAP) This proJect was supported, m part, by the Tarrant County Area Agency on Agmg on award number 90AM470 from the Admml$tratlon on Aging, Department of Health and Human Services, Washmgton, DC 20201 Grantees undertaking projects under government sponsorship are encouraged to express freely their findmgs and conclusions Points of view or opmlons do not, therefore, necessarily represent official Admmlstratlon on Aging Pohcy This article was also prepared with the support of a postdoctoral trameeshlp from the Trammg Program m Soclocultural Gerontology, Umverslty of California, San Francisco, Dlvlslon of Medical Anthropology and Institute for Health and Agung (NIA Grant #T32AG00045) The author wishes to thank MaryRose Mueller for her review of earher drafts of this article

APPENDIX Health and Social Service Utilization of Mexican American Older Adults Interview Guide Demographic Data Name/Code NumberAge Sex Marital Status Education Income Llvmg Arrangement Caseworker 1 How did you hear about the Program? 2 How long have you been receiving

services?

3 What services does the caseworker

or volunteer

4 How do the services community7

provide for you?

you receive enable you to remain

5. How often does the caseworker

at home and a part of the

provide you with services?

6 How often do you have contact with the caseworker‘? 7

What do you think of your caseworker’?

The services

8 What was your situation like pnor to receiving

she provides?

services from this Program?

9 How has situation changed since you became a chent of this Program?

Health and Socal Serwce Utdrzatlon Patterns

10 Would your sltuatlon change if you suddenly 11 What additional comfortable?

97

stopped recelvmg services3

services could the Program provide that would make your life more

12 Was the process required for you to become a client of this Program a difficult one7 13 What other services do you receive at the Center7 14 What other social services do you receive? 15 Do you have regular contact with family, relatives, neighbors, do you have contact?

and friends? How often

16 What services do your friends and famdy provide for you7 17 Have you experienced certain medical condltlons that have hmlted function7 Health, nutntlonal, family problems, etc?

your ability

to

18 What other concerns do you have that the Program might be able to address’ 19. Do you have access to a telephone7 20 Do you have access to public transportatlonv

REFERENCES Andrew?, .I 1989 Pobver& and Poor Health Among Elderly Hlspatuc Americans A report of the Common Wealth Found CornmIssIon on Elderly People Llvmg Alone (September) Agun-re, B and A Blgelow 1983 ‘The Aged m Hlspamc Groups A review ” International Journal of Agmg and Human Development 17 (3) 177-20 1 Becerra, R M and D Shaw 1984 The Htspanrc Elderly A Research Reference Guide Lanham, MD Umverslty Press of America Chow, N G 1994 “Patterns and Determmants of Social Service Utlhzatlon Comparison of the Chddless Elderly and Elderly Parents Llvmg With or Apart From Their Children ” The Gerontologist 34 (3) 353-362 De Armas, E P 1975 “The Super System and the Spamsh Speakmg Elderly ” In Proceedmgc ofthe Puerfo Rtcan Conference of Human Servzces, edlted by D J Curran et al Washington, DC Natlonal Coahtlon of Spamsh-Speakmg Mental Health Orgamzatlons Enbes, R A and M Bradley-Rawls 1978 “The UnderutIlizatIon of Nursing Home Faclhtles by Mexican Amencan Elderly m the Southwest ” The Gerontologzst 18 363-371 Estrada, A L , F M Trevmo, and L A Ray 1990 “The Care Utdlzatlon Bamers Among Mexican Americans Evidence from Hhanes, 1982-1984 ” American Journal of Public Health, Supplement 80 27-3 1 Faclo, E 1995 L’nderstandmg Older Chrcanas Soclologlcal and Poky Perspectwes, Vol 14 Sage Senes on Race and Ethmc Relations Gallegos, J S 1991 “Culturally Relevant Services for Hlspamc Elderly ” In Empowenng Hlspanrc Famrhes A Crltzcal Iwue for the ‘9Os, edlted by M Sotomayor Famdy Service Amenca Milwaukee

98

JOURNAL

OF AGING STUDIES

Vol 12lNo

111998

Garcia, A 1993 “Income Security and Elderly Latmos ” In Elderly Latrnos Issues and Soluttons for fhe 21st Century, edited by M Sotomayor and A Garcia National Hlspamc Councd on Aging Washington, DC Garcia, A 1991 “The Changing Demographic Face of Hispanics m the United States ” In Empowerrng Htspantc Famtltes A Crzttcal Issue for the ‘9Os, edited by M Sotomayo Family Service America Milwaukee Garcia, G 1982 Famtlral Support Systems A Comparattve Study Among Mexican Amertcan, Black And Anglo Elderly Unpublished master’s thesis University of Texas at Arlington Glaser, B and A Strauss 1967 The Discovery of Grounded Theory New York Aldme Greene, V L and D J Monahan 1984 Comparative Utlhzatlon of Community-Based Long-Term Care Services by Hispanic and Anglo Elderly m a Case Management System Journal of Gerontology

39 730-735

Gratton, B 1987 “Famlhsm Journal

among the Black and Mexican Amencan

Elderly

Myth or Reality ”

of Aging Studies 1 (1) 19-32

Harmon, R G 1991 Testimony submitted before the Jomt hearing of the House Select Committee on Agmg and the Congressional Hispanic Caucus Hyde, J C 1990 Language Barriers and Ethnic Mmortty Elders Prepared for the National Resource Center on Mmonty Aging Population San Diego, CA Kamlkawa, L 1991 “Public Entitlement Exclusionary Beneficence ” Generatzons (Fall/Winter) 21-24 Kaiser, M A , J E Gibbons, and H J Camp 1993 Long-Term Care Development of Services for Latmo Elderly In Elderly Latmos Issues and Soluttons For The 21st Century, edited by M Sotomayor and A Garcia National Hispanic Councd on Agmg Washington, DC Krout, J A 1983 “Knowledge and Use of Services by the Elderly A Cntlcal Review of the Literature ” Internattonal Journal of Aging and Human Development 17 153-167 LaCayo, C G 1980 A National Study to Assess the Servrce Needs of Htspantc Elderly-Final Report Los Angeles, CA Asoclaclon Naclonal Pro Personas Mayores Maldonado, D 1989 “The Latmo Elderly Living Alone The Invlslble Poor” The Caltfornra Soctologtst 2 (1) 8-21 Markides, KS , J S Boldt, and LA Ray 1986. ‘Sources of Helping and Intergenerational Sohdanty A Three-Generations Study of Mexican Americans ” Journal of Gerontology 41 506-5

I1

Mmdel, C H and R Wnght Jr 1982 “The Use of Social Services by Black and White Elderly The Role of Social Support Systems ” Journal of Gerontologrcal Soctal Work 4 (3-4) 107-125 Miranda, L and J T Qulroz 1990 The Decade of the Hzspanrc An Economtc Retrospecttve Washington, DC* Pohcy analysis Center, National Council of La Raza MUI, A D 1994 “Long-Term Care Service Used by Frad Elders Is Ethmclty a Factor?” The Gerontologtst 34 (2) 190-198 Rathbone-McCuan, E and J HashIm 1982 “The Hispanic Elderly Cuban Puerto Rican and Mexican ” In Isolated elders, edited by E Rathbone-McCuan and J Hashlml Rockvdle, MD Aspen Systems Corporation Select Committee on Aging, U S House of Representatives 1989 Hzspanrc Elderly Amerzca’s Farlure to Care (Comm Pub No 101-735) Washmgton, DC US Government Prmtmg Office Sotomayor, M 1993 “The Latmo Elderly A Pohcy Agenda” In Elderly Lattnos Issues and Soluttons for the 21st Century, edited by M Sotomayor and A. Garcia National Hispanic Council on Aging Washington, DC Torres-Gil, F and V Villa 1993 “Health and Long-Term Care Family Pohcy for Hlspamc Agmg ” In Elderly Latmos Issues and Soluttons for the 21st Century, edited by M Sotomayor and A Garcia National Hlspamc Council on Agmg Washington, DC

Health and Socral Setvrce Utrlrzatron Patterns

99

U S Department of Health and Human Servtces 1992. Health ofthe Umted States and Healthy People 2000 Review Washington, DC U S Government Prmtmg Office U S Department of Health and Human Services 1988 Health Status of Mmorrtles and Low-Income Groups Thrrd Edrtlon Washington, DC U S Government Prmtmg Office Wllhams, N 1990 The Mexican .4mencan Family Tradltron and Change DIX Hdls, NY General Hall Yeatts, D E , T Crow, and E Folts 1992 “Service Use Among Low-Income Mmonty Elderly Strategies for Overcommg Bamers ” The Gerontologist 32 24-32 Zumga de Martmez, M 1981 “The Mexican Amencan Family A Weakened Support System?” In Mmonty Agmg Pobcy Issues for the ’80s (Proceedings of the Seventh National Institute on Mmonty Aging), edited by E P Stanford San Diego, CA Campanile Press