Medicare eligibility doesn’t guarantee a spot in the doctor’s office for many older Houstonians.
A new report by the Kinder Institute’s Center for Community and Public Health shows 1 in 7 Harris County adults age 65 or older needed medical care but did not receive it in the prior year, increasing their risk of poorer health at an already vulnerable stage of life.
This translates to nearly 100,000 older adults in the county going without physical healthcare, mental health treatment, dental services, prescription refills and other medical needs. That figure could grow in the coming years, as the Houston area’s older adult population continues to live longer and the last wave of baby boomers approaches the 65-year threshold.
“Even if the 1 in 7 figure doesn’t sound striking, given how many older adults are in our region, the sheer number of people affected is alarming,” said Hannah Ballard, associate director of the Center for Community and Public Health and a co-author of the brief.
For decades, Medicare has served as the nation’s premier medical service for older adults, providing the vast majority of them with low-cost health insurance and a base standard of care once they hit their 65th birthday. But persistent holes in the safety net leave some local residents — particularly those in lower-income households — unable to afford or access timely medical care.
Not all Houstonians qualify for Medicare, including non-citizens and people who haven’t paid Medicare taxes for 10 years. About 3.4% of Harris County residents age 65 and older lack health insurance, according to the Census Bureau’s 2024 American Community Survey.
Some services also aren’t covered by Medicare — including many dental, vision and prescription costs — and routine medical care comes with some out-of-pocket costs.
“If an older adult on a fixed Medicare income has to choose between paying copays for four different medications or buying food, they will buy food,” said Rafael Samper-Ternent, director of the clinical research and innovations core at UTHealth Houston’s Institute on Aging. “They might delay scheduling a follow-up until they run out of medications.”
Technical, logistical and cultural hurdles also can lead to older adults forgoing care.
Reliance on digital portals and text reminders presents a technological barrier that disproportionately affects lower-income older adults, Samper-Ternent said. Transportation also remains a challenge, particularly for older adults who rely on family members with full-time jobs, can’t easily access public transportation or struggle to navigate ride-sharing services.
In addition, some older adults avoid seeking help due to historical mistrust of the healthcare system and stigmas surrounding mental healthcare, he said.
The findings of the Kinder Institute report draw on a spring 2024 Greater Houston Community Panel survey of more than 5,200 residents. Researchers analyzed responses from about 700 Harris County adults age 65 and older. The survey did not ask why respondents missed care or differentiate between emergency and routine appointments.
Who’s missing out
A large majority of older adults in the survey — roughly 80% to 90% — described their physical and mental health as “good,” “very good” or “excellent.” Self-reported rates of cardiovascular conditions (40%) exceed the national average, while rates of metabolic conditions (20%) are slightly below average.
These conditions require early and consistent access to healthcare providers, which makes it critical to understand the barriers to reaching them, Ballard said.
In Harris County, rates of missed care varied by demographics and type of medical need.
Older adults with an income of less than $25,000 were five times more likely to report not receiving needed care (26%) compared to residents with a household income of $100,000 or more (5%).
Missed dental services ranked as the top type of needed care not received (8% of all older adults), followed by physical health (6%), mental health (3%) and prescriptions (2%).
People in worse health also were more likely to miss out on care. Roughly 20% of older adults who rated their physical health or mental health as “poor” or “fair” said they hadn’t received services for their respective needs.
By contrast, only 4% of respondents who rated their physical health as “good,” “very good” or “excellent” said they hadn’t gotten needed care. About 2% of those giving the same ratings to their mental health hadn’t received necessary help.
System-level improvements
A web of resources in Houston helps older adults access medical care.
For example, community-based organizations such as Amazing Place and CarePartners offer healthcare system navigation and older-adult day programs as a service. The Area Agencies on Aging assist older adults in scheduling appointments and connecting with providers. The Houston Gerontological Society and the Center for Healthy Aging at UTHealth Houston provide additional support, such as access to elder law attorneys and social workers.
At Senior Rides and More, trips to doctor’s appointments are the most-requested service used by older adults in the Houston-based nonprofit's 71 ZIP code service area.
“When older adults stop driving, it is going to hinder their healthcare,” Senior Rides and More Executive Director Debby Posso said. “If we can get them to their appointments and get their prescriptions, it delays that trip to the emergency room that could result from delayed care.”
Still, Kinder Institute researchers said additional improvements to Houston’s healthcare support systems are needed.
Ballard said more patient care navigators and caregiver education programs could help older adults better understand available resources and how to reach them. Researchers also recommended reducing scheduling delays, offering more same-day or walk-in options, and providing more transportation or telehealth alternatives.
“There is low utilization of the resources that are already there because of a lack of awareness or difficulty navigating complex systems,” Ballard said.
Samper-Ternent noted that in his geriatric practice, effective care typically requires a nurse, social worker and community health worker working alongside the physician to help patients navigate the system. That model, he said, remains the exception rather than the rule.
"Unfortunately, there isn't a lot, despite a big need," he said. "The sicker and more functionally limited a person is, the harder elder care becomes. We're improving access to these services, but there is still a huge gap.”
