Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Jane M. Georges, PhD, RN; Patricia A. Roth, EdD, RN; Dorothy Crummy, PhD, RN


elderly, Medicaid, Medicare, nursing, older adult community, southern California


Access to care represents a leading health indicator for meeting the complex healthcare and social needs of an exploding population of older adults living in the United States. This qualitative study was undertaken to discover the essence of access to care by community-dwelling older adults with Medicare and Medicaid. Participants were recruited from a metropolitan area in Southern California. Thirteen women and men aged 65 to 91 described their experiences with accessing care during a face-to-face, audio-recorded interview. The study aimed to: describe experiences of access to care, identify facilitators and barriers to care, and describe the effects of facilitators and barriers to care with regard to the participants perceptions of health. Situated in a Husserlian phenomenological approach, in-depth descriptions lead to discovering the concepts that gave common meaning and understanding to the phenomenon, access to care. Five major theme categories illuminated the essential structure: navigating the system; negotiating the system; "it was just too difficult"; "it costs money to be ill"; and "I'm just thankful for everything." The themes depicted the human experience as evidenced by real, lived situations. Eleven sub-themes further illustrated the various perspectives and unique understandings of accessing healthcare. The themes developed add to the paucity of available information about older adults with similar demographic characteristics. They reflect and support some of the barriers described in the literature that can limit access to healthcare, those being financial, structural, and personal barriers. The findings generate important insight into understanding what it is like to get healthcare services as an older adult receiving government-subsidized health insurance. Limited economic resources and their relationship to decision-making for healthcare spending are a critical area for future research. Examination of the decision-making process for healthcare used by older adults with no family or significant other is indicated. A stronger focus is needed towards investigating access to medications, health information, transportation, safe housing, and nutritious food and their relationship to increasing quality and years of healthy life. Nurses and other health professionals identified as people who make the system work deserve further exploration in their role as facilitators to accessing care.

Document Type

Dissertation: Open Access



Included in

Nursing Commons