HCA 480
April 24, 2016
Asians and Language Barriers in Long Term Care Facilities
There are many long term care patients who speak English as a second language or are not able to speak English at all. One of the many ethnic groups who are not proficient in speaking English is the Asian ethnic group. The Asian ethnic group is estimated to increase in the next years and is becoming the largest foreign born group by 2055 ( Zong and Batalova, 2016). In 2014, the total population of the Asian Ethnic group was 12,750, 000. It was also reported in 2014, that approximately 46 percent of Asian immigrant were limited in English proficiency, compared to 50 percent of all immigrants in America (Zong and Batalova, 2016). There were 76 million US baby boomers reported in 2011, and out of those the elderly Asian ethnic group increased from 0.8 million to 3.8 million (Feng, Fennell, Tyler, Clark, and Mor, 2011). This means that Asians are one of the fastest growing minority groups in long term care facilities.
Having non-English patients can cause a serious issue for the long term care facilities that have patients who do not understand English, since it is the primary language in the United States. Language barriers in long-term carriers are not only difficult because the patient cannot communicate with the staff, but because most of their patients suffer from mental disorders such as dementia. It’s also hard for a long term care facility to provide services to different cultures because the caregiver trusts the facility to understand and most importantly respect the patient’s cultural values and acculturations. The Asian Ethnic group not only faces language barriers, it also faces food preferences and cultural norm that can interfere with the facilities process of care. For the Asian culture nursing homes are the last resort for long term care, family members always step up and provide care giving. In a study by Esme Fuller-Thomson and Monica Chi on the use of Activities of Daily living on 55 and older Asian Americans, they found that out of 43,218 Chinese Americans only 5,718 (13.2%) were institutionalized, out of 22,460 Vietnamese Americans only 680 (5.5%) were institutionalized, out of the 14, 148 Korean Americans only 1,240 were institutionalized, out of the 17, 258 Japanese Americans only 2,659 (16.4%) were institutionalized, out of the 32, 102 Filipino Americans only 2, 827 (9.2%) were institutionalized, and out of the 18, 671 Asian Indians only 872 (4.7%) were institutionalized (Fuller-Thomson, E., & Chi, M. (2012).
In order for long term care facilities to have good overall quality of care they need to resolve the issue of language barriers. Some of the solutions that long term care facilities have come up with are having translators, interpreters, dual-role staff, bilingual providers, translated documentation, Interprecare System, phone interpreters, and Ad hoc interpreters. It really depends on the client to pick what type of language service they want to use while receiving their care.
| Weighted estimates according to ethnicity | ||||||||
|---|---|---|---|---|---|---|---|---|
| Characteristic | Chinese | Pacific Islander | Vietnamese | Korean | Japanese | Filipino | Asian Indian | Non-Hispanic White |
| N = 43,218 | N=5,966 | N = 22,460 | N = 14,148 | N = 17,258 | N = 32,102 | N = 18,671 | N = 4,915,191 | |
| Institutionalization | ||||||||
| Not Institutionalized | 37,500 | 5,286 | 21,220 | 11,489 | 14,431 | 29,159 | 17,799 | 3,743,339 |
| (86.8%) | (88.6%) | (94.5%) | (81.2%) | (83.6%) | (90.8%) | (95.3%) | (76.2%) | |
| Institutionalized | 5,718 | 680 | 680 | 1,240 | 2,659 | 2,827 | 872 | 1,171,852 |
| (13.2%) | (11.4%) | (5.5%) | (18.8%) | (16.4%) | (9.2%) | (4.7%) | (23.8%) | |
| Gender | ||||||||
| Male | 16,780 | 2,764 | 9,991 | 4,740 | 6,256 | 10,636 | 6,733 | 1,712,285 |
| (38.8%) | (46.3%) | (44.5%) | (33.5%) | (36.2%) | (33.1%) | (36.1%) | (34.8%) | |
| Female | 26,438 | 3,202 | 12,469 | 9,408 | 11,002 | 21,466 | 11,938 | 3,202,906 |
| (61.2%) | (53.7%) | (55.5%) | (66.5%) | (63.8%) | (66.9%) | (63.9%) | (65.2%) | |
| Age | ||||||||
| 55–64 | 6,316 | 1,990 | 5,167 | 1,697 | 1,919 | 6,400 | 4,333 | 1,060,053 |
| (14.6%) | (33.4%) | (23.0%) | (12.0%) | (11.1%) | (19.9%) | (23.2%) | (21.6%) | |
| 65–74 | 8,346 | 1,462 | 6,351 | 3,251 | 2,244 | 6,150 | 5,416 | 909,278 |
| (19.3%) | (24.5%) | (28.3%) | (23.0%) | (13.0%) | (19.2%) | (29.0%) | (18.5%) | |
| 75–84 | 16,081 | 1,776 | 7,166 | 6,132 | 5,983 | 11,463 | 5,470 | 1,481,325 |
| (37.2%) | (29.8%) | (31.9%) | (43.3%) | (34.7%) | (35.7%) | (29.3%) | (30.1%) | |
| 85+ | 12,475 | 738 | 3,776 | 3,068 | 7,112 | 8,089 | 3,452 | 1,464,535 |
| (28.9%) | (12.4%) | (16.8%) | (21.7%) | (41.2%) | (25.2%) | (18.5%) | (29.8%) | |
| Marital Status | ||||||||
| Not Married | 23,476 | 3,524 | 10,774 | 8,611 | 9,561 | 16,598 | 8,655 | 3,086,557 |
| (54.3%) | (59.1%) | (48.0%) | (60.9%) | (55.4%) | (51.7%) | (46.4%) | (62.8%) | |
| Married | 19,742 | 2,442 | 11,686 | 5,537 | 7,697 | 15,504 | 10,016 | 1,828,634 |
| (45.7%) | (40.9%) | (52.0%) | (39.1%) | (44.6%) | (48.3%) | (53.6%) | (37.2%) | |
| Education (Highest completed) | ||||||||
| Primary School | 19,642 | 2,353 | 9,404 | 3,773 | 2,782 | 8,834 | 7,895 | 854,930 |
| (45.4%) | (39.4%) | (41.9%) | (26.7%) | (16.1%) | (27.5%) | (42.3%) | (17.4%) | |
| High School—No Diploma | 4,191 | 857 | 4,295 | 2,076 | 2,737 | 3,043 | 2,201 | 771,061 |
| (9.7%) | (14.4%) | (19.1%) | (14.7%) | (15.9%) | (9.5%) | (11.8%) | (15.7%) | |
| High School Diploma | 13,508 | 2,580 | 6,941 | 5,551 | 8,639 | 12,377 | 4,658 | 2,661,023 |
| (31.3%) | (43.2%) | (30.9%) | (39.2%) | (50.1%) | (38.6%) | (24.9%) | (54.1%) | |
| Bachelors’ Degree | 3,670 | 76 | 1,322 | 1883 | 2,293 | 6,557 | 2,216 | 390,941 |
| (8.5%) | (1.3%) | (5.9%) | (13.3%) | (13.3%) | (20.4%) | (11.9%) | (8.0%) | |
| Graduate Degree | 2,207 | 100 | 498 | 865 | 807 | 1,291 | 1,701 | 237,236 |
| (5.1%) | (1.7%) | (2.2%) | (6.1%) | (4.7%) | (4.0%) | (9.1%) | (4.8%) | |
| Poverty Level 1 | ||||||||
| Under poverty line | 7,498 | 996 | 4,910 | 3,052 | 1,444 | 3,511 | 2,590 | 610,078 |
| (20.0%) | (18.8%) | (23.1%) | (26.6%) | (10.0%) | (12.0%) | (14.6%) | (16.3%) | |
| 100–199% | 10,218 | 975 | 4,465 | 3,700 | 2,539 | 6,236 | 2,984 | 1,057,774 |
| (27.2%) | (18.4%) | (21.0%) | (32.2%) | (17.6%) | (21.4%) | (16.8%) | (28.3%) | |
| 200–299% | 4,993 | 1,298 | 4,343 | 1,319 | 2,301 | 2,944 | 2,606 | 713,717 |
| (13.3%) | (24.6%) | (20.5%) | (11.5%) | (15.9%) | (10.1%) | (14.6%) | (19.1%) | |
| 300–399% | 4,410 | 291 | 2,210 | 637 | 2,491 | 4,882 | 2,976 | 462,692 |
| (11.8%) | (5.5%) | (10.4%) | (5.5%) | (17.3%) | (16.7%) | (16.7%) | (12.4%) | |
| 400–499% | 2,870 | 623 | 1,762 | 479 | 904 | 3,559 | 2,210 | 297,961 |
| (7.7%) | (11.8%) | (8.3%) | (4.2%) | (6.3%) | (12.2%) | (12.4%) | (8.0%) | |
| 500%+ | 7,511 | 1,103 | 3,530 | 2,302 | 4,752 | 8,027 | 4,433 | 601,117 |
| (20.0%) | (20.9%) | (16.6%) | (20.0%) | (32.9%) | (27.5%) | (24.9%) | (16.1%) | |
| Cognitive Problems | ||||||||
| No Problems | 14,440 | 2,196 | 5,854 | 4,272 | 5,192 | 12,894 | 7,095 | 2,086,130 |
| (33.4%) | (36.8%) | (26.1%) | (30.2%) | (30.1%) | (40.2%) | (38.0%) | (42.4%) | |
| Some Cognitive Problems | 28,778 | 3,770 | 16,606 | 9,876 | 12,066 | 19,208 | 11,576 | 2,829,061 |
| (66.6%) | (63.2%) | (73.9%) | (69.8%) | (69.9%) | (59.8%) | (62.0%) | (57.6%) | |
| Citizenship | ||||||||
| American by birth or naturalization | 35,177 | 5,023 | 16,954 | 10,272 | 16,428 | 26,096 | 10,455 | 4,856,583 |
| (81.4%) | (84.2%) | (75.5%) | (72.6%) | (95.2%) | (81.3%) | (56.0%) | (98.8%) | |
| Not a citizen | 8,041 | 943 | 5,506 | 3,876 | 830 | 6,006 | 8,216 | 58,608 |
| (18.6%) | (15.8%) | (24.5%) | (27.4%) | (4.8%) | (18.7%) | (44.0%) | (1.2%) | |
| Language spoken at home | ||||||||
| Speaks English at home | 3,409 | 2,629 | 2,346 | 556 | 9,212 | 3,464 | 3,535 | 4,519,002 |
| (7.9%) | (44.1%) | (10.4%) | (3.9%) | (53.4%) | (10.8%) | (18.9%) | (91.9%) | |
| Doesn’t Speak English at home | 39,809 | 3,337 | 20,114 | 13,592 | 8,046 | 28,638 | 15,136 | 396,189 |
| (92.1%) | (55.9%) | (89.6%) | (96.1%) | (46.6%) | (89.2%) | (81.1%) | (8.1%) | |
Table retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499866/
The InterpreCare System is a fast, easy, and more convenient language service not only because it’s easy for the client, but because it’s easy for the staff to communicate as well. Although there is not much information on the InterpreCare System, it is another great way to help the language barrier among the patients and providers. The interpreCare System is able to change words and phrases for specific long-term care staff and residents, it can translate the residents native language into English so the staff can understand it, and provides a training manual with accompany videotapes and audiotapes (Sterns, 2015). This system has had strong interest in long-term care facilities such as Menorah Park and Montefiore Homes in Cleveland, Ohio, Hillside Hospital in Glen Oaks, New York and Menorah House in Southfield, Michigan, since it is lightweight, portable, and adaptable (Sterns, 2015). This approach is also very convenient for the staff because they will save their time and energy instead of trying to learn another language in a short amount of time. The staff will also not have to carry folders and translated sheets everywhere they go. This system is also helpful for the patient because they will recognize wording in their native language, which will help them point out what it is they need so the staff member can provide good care. The staff and patients will be able to depend on this approach and not worry about communication, that way the staff can focus on what’s important and that is to give the patient the best quality care and the patient can calmly receive it.
Another approach long term care facilities have is providing interpreters, translators, phone interpreters, and translated documentation. Long term care interpreters and translators provide their services to the patient whenever it is needed, such as during admission, examination, consultation, procedures, and other provider-patient interaction. Communication among patients and healthcare providers is important for the safety and comfort during the patients stay, yet 24 million Americans do not speak enough English to communicate effectively with their healthcare provider. Professional interpreters are able to insure that the patient and healthcare provider communication is accurate and satisfactory including the understanding the patients cultural background (Alobaidy, 2015).Long term care facilities make sure the Interpreters or translators are qualified and credited. It’s important for the interpreter or translator help communicate effectively and efficiently, whether it be in person, through text or by the phone, so the provider can give the patient great quality health care.
(Siu Williams (left) is a certified medical interpreter who is translating for patient Son Van Vo.) Photo from: www.sfchronicle.com
Having dual-role staff and bilingual providers is another approach long term care facilities are doing to solve the issue of language barriers. This approach is a little more complicated in the sense that it’s hard to find staff and providers that already have the skill of speaking another language. Although it may be hard to find dual-role staff or bilingual providers, when they do work in the facility it does increase physician-patient communication and safety. It also builds trust between patient and staff, which is very important in long term care facilities. It is priority for Long term care facilities hire dual-role staff because the ability to communicate effectively is crucial to the delivery of high-quality health care to patients, especially culturally and ethnically diverse patient populations.
An Ad hoc interpreter is also used in long term care facilities to insure the staff and patient can communicate. An Ad hoc is a person who is not trained in medical interpretiation or medical fluency, such as a family member or friend or even a bilingual staff member (Regenstein, 2008). Ad hoc interpreters should only be used to interpret or translate non-medical issues. Long term care facilities only use Ad hoc interpreters if the patient refuses the offer of a translator hired by the facility and signs a waiver (Professional translation services in the ED can reduce errors and prevent adverse events). There are patients that will prefer to have their family member or friend to translate because of the trusting relationship they already have. Long term care facilities prefer to use an Ad hoc interpreter to translate non-medical issues because sometimes the interpreter will summarize in their own way or make assumptions.
References
Alobaidy, M. (2015, December 16). How to Become a Hospital Interpreter. Retrieved from http://www.innerbody.com/careers-in-health/how-to-become-a-hospital-interpreter.htmlFeng, Z., Fennell, M. L., Tyler, D. A., Clark, M., & Mor, V. (2011, July). Growth Of Racial And Ethnic Minorities In US Nursing Homes Driven By Demographics And Possible Disparities In Options. Retrieved from http://content.healthaffairs.org/content/30/7/1358.full
Fuller-Thomson, E., & Chi, M. (2012). Older Asian Americans and Pacific Islanders with Activities of Daily Living (ADL) Limitations: Immigration and Other Factors Associated with Institutionalization . International Journal of Environmental Research and Public Health, 9(9), 3264–3279. http://doi.org/10.3390/ijerph9093264
Professional translation services in the ED can reduce errors and prevent adverse events - www.strategiesfornursemanagers.com © 2016. (2016). Retrieved from http://www.strategiesfornursemanagers.com/ce_detail/280720.cfm
Regenstein, M. (2008, September 01). Language Barriers in Health Care. Retrieved from http://www.rwjf.org/en/library/research/2008/09/language-barriers-in-health-care.html
Sterns, R. S. (2015). The Interprecare System: A Language Intervention Product. Retrieved from http://grantome.com/grant/NIH/R44-AG014317-03
Zong, J., & Batalova, J. (2016, January 06). Asian Immigrants in the United States. Retrieved from http://www.migrationpolicy.org/article/asian-immigrants-united-states
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