The PDF for this issue which includes footnotes and endnotes can be found at here.
Hector is in his late 80s. Recently widowed, his only source of income is Social Security. He’s struggling to keep up with his utility bills. Hector’s hip and knee pain make it difficult for him to do things that he used to do, like shovel the sidewalk or cut the grass. Paying for a landscape company to handle these tasks is not affordable. Without a ramp, it is difficult for Hector to get in and out of the house. Hector sticks to a strict budget on groceries. His refrigerator and cupboards have few items, and they are sometimes out of date. Hector has a toothache that has been bothering him for weeks, but he cannot afford to see a dentist.
Is Hector showing signs of diminished capacity? Or is he simply one of the many older adults living in poverty? This article will examine how poverty and aging masquerade as incapacity for older adults. We will examine why it matters, and most importantly, what we can do as practitioners in the law and aging community.
How Poverty and Aging Masquerade as Incapacity
Older adults living in poverty must contend with the dual prejudices of society. One result of ageism is assuming that older adults are incapable of handling their own affairs and need to be stripped of independence and autonomy for their own protection. Likewise, society places harsh value judgments on people living in poverty and how they spend their money. Combined, these prejudices combine to treat low-income older adults as incapable of handling their own affairs, and morally incorrect in their attempts to do so.
When we consider the “hallmarks” of incapacity that are frequently used to restrict the independence and autonomy of older adults, the “hallmarks” can look a lot like living in poverty. To an outsider, it may look like Hector is dealing with dementia. He’s an older adult with unpaid bills, a home that’s unmaintained, expired food, and unaddressed medical issues. To people who are more familiar with poverty dynamics, Hector’s situation can be seen for what it is: an older adult who is living in poverty and must make difficult—sometimes impossible—decisions about his financial priorities.
Many older adults are living in poverty or close to it, and race and gender play a role. Racial minorities and women are more likely to live in poverty than other demographics. Adults aged 65 or older had an overall poverty rate of approximately 10.3% in 2021, and the subset of adults aged 80 or older have a poverty rate of about 12.9%. The 2021 poverty rate for Hispanic adults aged 65 or older is 18.7%, Black adults aged 65 or older is 17.8%, and white adults not identifying as Hispanic at 8.0%. Women aged 65 or older in 2021 were more likely than their male counterparts to live in poverty.
Why this Matters
For those of us in the aging and law community, we know that judgments about capacity can lead to restricting independence and autonomy. We make life changing decisions based on our perceptions of capacity—and we might be wrong in those perceptions. By addressing the poverty issues, those “hallmarks” of incapacity may vanish.
For Hector, a well-meaning family member or adult protective services worker might conclude that Hector needs restrictions instead of support. The first thought may be that Hector needs to move into a more restrictive setting, perhaps with a guardian or power of attorney making choices for him. After all, Hector would be fed, receiving the medical attention that he needs, and would no longer need to maintain his home.
But all of this comes at a tremendous cost to Hector, particularly when there is no indication that this is a capacity issue—simply a poverty issue. Hector could connect with social service organizations that can provide utility assistance and help with the sidewalks and lawn. Hector may be eligible for Supplemental Nutrition Assistance Program, Commodity Supplemental Food Program, meals on wheels, or other food programs. Because Medicare does not cover dental benefits, Hector may need information on community dental clinics that will provide him with the care he needs. Finally, a ramp may allow Hector to participate in the community more easily. All of this would keep Hector in his home, and in charge of his own affairs.