“We’re Still Going”: A Critical Ethnography of Independently-Living Elders’ Healthcare Utilization to Maintain or Regain Their Health and Autonomy.

Elders becoming eligible for Medicare are projected to reach 72.1 million by 2030 (U.S. Census Bureau, 2011). Their numbers will challenge the healthcare system (HCS) and Medicare’s ability to provide equitable, quality, elder-specific, and cost-effective healthcare (HC). The literature suggests that factors related to elders themselves, the HCS, and elder-healthcare provider (HCP) interactions impact Independently-living elders’ (ILEs’) experiences with and their ability to utilize the HCS. ILEs are a hidden demographic in the literature; their experiences with the HCS are not well understood because little research specifically examines ILEs for these purposes. Critical Ethnographic methodology (Thomas, 1993) was utilized to explore the research question, “What are independently-living elders’ experiences utilizing the healthcare system?” Twelve men and women over 65 were recruited using purposeful and snowball sampling. Study data consisted of semi-structured interviews and field observations. Study findings revealed that ILEs cultivated and could draw upon a wealth of personal resources including themselves and their support system to deal with their lives and to access and utilize the HCS so they could maintain or regain their health and autonomy. ILEs first had to acknowledge their need for HC and then decide from whom to seek care. ILEs’ access to care could be constrained by HC procedures and HCPs themselves. ILEs were willing and capable people, they provisionally entrusted their care to providers in the hope that HCPs would be suitable and willing to partner with them in their HC. ILEs expected their HCPs to treat them as equal partners and to be good stewards of their trust by treating them well, providing them with quality care, and acting on their behalf. The success of ILEs’ partnerships with their HCPs determined whether they chose to sustain their relationships with their HCPs; it also impacted the ILEs’ HC outcomes and wellbeing. ILEs gained valuable experiences that they made public; they shared their experiences with members of their support system, as part of their reciprocal relationships, in order to facilitate their access and ability to utilize the HCS to meet their HC needs.