Cao, Xuemei. 2026. “Assigning (Un)Deservingness: How Institutional Gatekeeping Stratifies Older Chinese Immigrants’ Service Access through Competing Deservingness Frames.” Journal of Social Issues 82(4):e70087. https://doi.org/10.1111/josi.70087.
Abstract: Older Asian Americans are the fastest-growing segment of the US aging population, with a majority of them being foreign-born and underserved by formal services. Existing scholarship largely draws on the health behavior model and the immigrant assimilation literature to explain this underutilization, treating service access as an individual decision shaped by help-seekers’ characteristics, resources, and cultural preferences. While this demand-side approach identifies important barriers, it leaves unexamined how frontline service workers regulate access and how broader institutional forces shape their discretionary decisions. Drawing on ethnographic fieldwork conducted between 2020 and 2022 in the Greater Boston Chinese immigrant community, I argue that service access is stratified through workers’ gatekeeping organized around two competing deservingness frames. Within the aging-healthcare system, workers enact a medicalized vulnerability frame that positions older immigrants as at-risk populations deserving of proactive care. In the immigration-welfare system, workers employ a citizenship performance frame that evaluates claimants based on evidence of integration and compliance. These competing frames are produced through the interaction of macro-level policies, meso-level organizational factors and professional norms, and micro-level interpersonal comparisons. Their coexistence generates contradictory expectations for claimants and stratifies access to services depending on how closely individuals align with institutionally constructed ideals of deserving recipients. By shifting analytical attention from individual help-seeking to institutional gatekeeping, this article demonstrates how moral evaluations embedded in service systems reproduce inequalities and stratify access to care among older immigrants.
Xuemei Cao is an Assistant Professor of Sociology at Bentley University. Her research focuses on immigration, aging, health, family, social networks, and qualitative research methods.
