Hidden poor among older adults: Health outcomes and barriers to care

Background: The Federal Poverty Guideline Level (FPL) is a single national level based on 1950s standard of living and is used widely in planning and program eligibility. However, in California, the FPL grossly underestimates those who are economically insecure. The Elder Index is an alternative measure of economic security that better reflects California's higher cost of living and sheds light on the hidden poor among the elderly. Objectives: To analyze and compare the health characteristics and barriers to care for older adults with incomes below the Elder Index. Methods: Using data from the California Health Interview Survey and the 2011 Elder Index, we identify older adults with incomes below the Elder Index, those with incomes above the FPL but below the Index, and those below the FPL. We assess and compare overall health status, disability, prevalence of psychological distress, chronic health conditions, and access to care. Results: The health and access to care among the hidden poor, as identified by the Elder Index, is more similar to those identified as poor by the official FPL (<100% FPL) than to those above the Index, who they are usually combined with. Conclusions: The hidden poor have health care needs similar to older adults identified as poor by the FPL, yet, due to program eligibility criteria based on the FPL, the hidden poor are overlooked and have less overall access to care than better-off seniors. Public policy therefore needs to include the hidden poor in program planning and eligibility to address this population.