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Out of the Blind Spot


“There are more older adults in California sitting just above the poverty line than below it, and their health and access to care look more like the ‘officially’ poor.”

USING THE TRADITIONAL STANDARD of the federal poverty level, 259,000 Californians age 65 and older are considered poor. But a study released this year by the Fielding School-based UCLA Center for Health Policy Research reveals that many more elders in the state are struggling with severe economic insecurity, despite having incomes above the poverty line. These additional 655,000 older adults, the “hidden poor,” don’t qualify for public assistance, yet are unable to make ends meet on their own.

Twenty-four percent of California’s 65-and-older adults living alone or only with their spouse/partner are part of the hidden poor as defined by the Elder Index, a measure of poverty refined and expanded by the FSPH center that considers the true cost of living in each California county. The study found that the hidden poor are almost twice as likely to identify themselves as being in poor or fair health, to feel depressed, and to report that they can’t get timely health care compared to older adults who have higher incomes.

“There are more older adults in California sitting just above the poverty line than there are sitting below it, and their health and access to care look more like the ‘officially’ poor than the non-poor,” says Dr. Steven P. Wallace, professor and chair of the Fielding School’s Department of Community Health Sciences, associate director of the UCLA Center for Health Policy Research and lead author of the study. “They have financial troubles and health issues that may be related to their economic situation, but outdated poverty measurements keep them in the blind spot of planners and policymakers.”


Source: 2013-14 California Health Interview Survey

Despite not qualifying for most public services, the elders in the hidden poor category tend to struggle economically in ways that can affect their health, Wallace says, whether it’s living in substandard housing; skipping meals or forgoing healthy but more expensive foods that meet their dietary needs; or splitting costly pharmaceutical pills in half to make them last longer. Even with Medicare coverage, he notes, over 10 percent of all older adults’ spending nationally is on health care.

“The high cost of housing in California is one of the biggest drivers in an older adult’s budget,” adds Imelda Padilla-Frausto (MPH ’07), an FSPH doctoral student and UCLA Center for Health Policy Research graduate researcher who co-authored the study. “Policies addressing the shortage of decent affordable housing for our elders will enable them to allocate more of their limited income to taking care of their health through proper nutrition and adequate health care.”

The Elder Index, which enabled Wallace and Padilla-Frausto to identify an all-too-easily overlooked group in the hidden poor study, is becoming an increasingly valuable tool for researchers, public health planners and policymakers in California and beyond. The method to calculate the federal poverty guidelines that are used to determine income eligibility for programs such as Medicaid and food stamps hasn’t been updated since it was created in the early 1960s, despite significant changes in consumer spending patterns and the standard of living during that time. Moreover, the federal poverty level fails to take into account the local cost of living, which is a significant disadvantage in high-cost states such as California.

In response, gerontology experts sought to devise a more accurate measure of poverty using widely accepted national and state data sources such as the U.S. Census Bureau and the U.S. Department of Housing and Urban Development. The UCLA Center for Health Policy Research and the Oakland-based Insight Center for Community Economic Development have partnered to refine the tool for California – calculating the location-specific costs for older adults to meet basic needs and examining the implications for those who fall below the index.

Currently, for example, the federal poverty level counts a single person as poor if his or her annual income is under $11,770. But in high-cost areas of California, people with incomes much higher than that may still struggle to make ends meet. In 2013, the average cost of basic living expenses in California as measured by the Elder Index was $23,112 for single older renters.

The Elder Index is now widely used in California by organizations that work with low-income older adults, as well as by local health departments in their planning efforts. In 2011, California became the first state to institutionalize the Elder Index through legislation that made it the standard of measurement for gauging income security among the state’s elders.

“Poverty isn’t generally associated with older people because we assume that their needs are being addressed by Social Security and Medicare, but that’s not always the case, at least in Los Angeles,” says Laura Trejo, general manager of the City of Los Angeles Department of Aging and a major proponent of the state legislation. Trejo uses the index both for planning and to educate policymakers and others on the challenges confronting older people with limited means, often seeking assistance from Wallace to obtain numbers specific to the city.

“If you think people are taken care of, you don’t necessarily view assisting them as a priority,” Trejo says. “The Elder Index gives us the scientific backing when we educate and advocate for older people who are in fact struggling.”