Language Barriers in the Healthcare Realm

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Language Barriers in the Healthcare Realm

• Presentation by Lori King, RN, BSN
• Multicultural Education
• Dr. Christian
• October 17, 2006

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Importance of the Issue

• Appropriate medical care is a necessity in
  todays society. Many Americans do not
  experience proper medical care due to ineffective
  communication practices and language barriers in
  our healthcare community.
• Hospitals, doctors offices, and medical staff
  should employ superior medical care by ensuring
  that supplementary interpreter services are
  utilized to grant a higher standard of care for
  non-English speaking patients and their families.

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Abstract

• This presentation evaluates the language
  barriers experienced in the healthcare realm.
  Federal and state statues are provided to enable
  readers to comprehend the laws positioned to aid
  non-English speaking citizens. Authentic accounts
  of miscommunication and life changing events are
  mentioned to engage others to grasp the veracity
  of this issue. This publication also looks at
  ways to combat the dilemma at hand and construct
  concrete transformations to permit non-English
  citizens with the equal opportunities they
  deserve.

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Primary languages

• America is home to an abundance of immigrants
  from around the globe. Many immigrants living in
  the United States do not verbalize English as
  their primary language.
• Virtually 47 million people speak a language
  other than English at home. Somewhere from 11 to
  21 million people have a restricted capability to
  speak English.
• ACORN, 2004

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Percentage of Americans Who Speak Non-English
Languages or With Limited English Proficiency

• Flores, 2006
• (Data obtained by
  the U.S. Census Bureau)

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Census Information

• According to the 2000 Census, over 18 percent of
  the United States population speaks a language
  other than English at home.
• The population of America recently sky rocketed
  to 300 million. Based on the percentages stated
  by the Census Bureau, almost 54 million people in
  our population speak a non-English language.
• Kaiser, 2003

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Major Risks

• Hospital patients who speak little or no English
  are at greater risk of
• Medical errors
• Misdiagnosis
• Possible death
• Kaiser, 2002
• Many immigrants are unable to maneuver through
  the complicated landscape of hospitals because of
  language complexity. Often they do not receive
  the care they warrant. Many studies have revealed
  that this lack of suitable communication is an
  obstruction to receiving satisfactory healthcare.
  
• ACORN, 2004

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Deleterious Effects of Language Barriers

• Patients who experience language barriers are
  less likely than others to have a usual source of
  medical care, receive preventative services at
  reduced rates, and have an increased risk of non
  adherence to medication.
• Flores, 2006

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Satisfaction Survey

• According to a study conducted by Newsday,
  patients who did not obtain interpreter services
  reported
• Twenty-seven percent of patients said they left
  the hospital incapable of understanding how to
  administer their medications.
• One-third of the patients devoid of an
  interpreter stated that they would not come back
  to the facility.
• More than fifty percent of those lacking an
  interpreter said the hospital staff on no account
  asked them if they required help to pay for
  medical care.
• Kaiser, 2002

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Tragic Consequences

• Case no. 1
• A Spanish-speaking 18 year old staggered into a
  friends room and collapsed, after saying he was
  intoxicado. The non-Spanish speaking paramedics
  thought this word meant intoxicated the
  tangible meaning of the word is nauseated.
  After almost 36 hours in the hospital the patient
  was worked up for a drug overdose, the comatose
  patient was reevaluated and identified to have
  intracerebellar hematoma with brain-stem
  compression and a subdural hematoma secondary to
  a ruptured artery.
• This case led to deferred patient care and
  unnecessary quadriplegia.
• Flores, 2006

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Tragic Consequences Continued

• Case no. 2
• A Spanish speaking mother told a resident that
  her two year old hit herself when she fell off
  her tricycle the resident misunderstood the two
  words. He believed that the fracture was a
  product of abuse, so he contacted The Department
  of Social Services (DSS). DSS sent a worker
  devoid of an interpreter. The mother then signed
  over guardianship of her children.
• This circumstance occurred because of an initial
  miscommunication between the doctor and the
  mother. This could have been prevented with the
  use of interpreter.
• Flores, 2006

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Federal Statutes

• There are many federal and state statues that
  prohibit the behavior mentioned in the previous
  examples.
• Title VI of the 1964 Civil Rights Act states
  Refusal or delay of medical care because of
  language barriers is considered discrimination
  (Kaiser, 2006).

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Federal Statutes

• In 1998, the Office for Civil Rights of the
  Department of Health and Human Services issued a
  communication regarding the exclusion, under
  Title VI of the 1964 Civil Rights Act. This
  provision affects persons with inadequate English
  aptitude.
• The memorandum states that the refutation or
  hindrance of medical services due to language
  barriers represents discrimination and entails
  that recipient of Medicare or Medicaid funds
  afford language aid to persons with limited
  English aptitude.
• Flores, 2006

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State Statues

• Many states have laws on the books to remedy this
  tragic situation regarding the language barriers.
  
• Rhode Island law as of 2002 requires hospitals to
  offer interpreter services as a stipulation for
  continued licensure.
• Massachusetts Emergency Services Interpreter Law
  of 2001 commands that all acute care facilities
  that provide emergency room services, must
  provide interpreter services for every patient.
• ACORN, 2004

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Remedy the Situation

• As evidenced by the previous examples, it is
  obvious that these laws are not being followed
  adequately.
• In order to better serve the non-English speaking
  population, the following steps should be taken
• The federal government must take stronger action
  to enforce Title VI of the Civil Rights Act.
• State officials must develop laws requiring
  better language services and extend a plan to
  reimburse providers for language services.
• ACORN, 2004

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Remedy the Situation

• Hospitals must develop programs to teach staff
  cultural competence and also aid them in
  developing their language skills.
• Health departments could also develop campaigns
  to educate non-English speaking people about
  health issues.
• Medical and nursing schools could also offer
  special courses so that these healthcare
  professionals will better understand and
  interpret the cultures of their clients.
• 
  
  ACORN, 2004 Healthcare Coverage, 2004

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For More Information Visit These Websites

• Kaiser Family Foundation
• http//www.kff.org
• The Henry J. Kaiser Family Foundation focuses on
  health care issues, mainly policy, public
  education, and health and development in South
  Africa.
• This information can be useful for the general
  public, by aiding them in making decisions based
  on the health care policies noted. This is also a
  great source of information for medical
  professionals as well.
• The New England Journal of Medicine
• http//content.nejm.org/cgi/content/full/355/3/229
  
• This article published in the NEJM discusses
  language barriers to health care in the United
  States.
• This information can be useful to healthcare
  professionals, teachers, and American citizens as
  a whole. It provides an eye opening account to
  the reality that these immigrant groups
  experience.
• ACORN
• www.acorn.org
• The Association of Community Organizations for
  Reform Now enables people to voice their views
  and organize positive change in the community.
• ACORN is a useful site for anyone that longs to
  make a change or a difference in their
  neighborhood.

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For More Information Visit These Websites

• Hablamos Juntos
• http//www.hablamosjuntos.org/mediacenter/default.
  todays_stories.asp
• Hablamos Juntos strives to improve communication
  skills between healthcare professionals and their
  patients with limited English proficiency.
• This website is especially useful for healthcare
  professionals. But, Hablamos also offers
  education classes teaching Spanish for many other
  professions, such as business experts, teachers,
  and public figures.
• The National Center for Cultural Competence
• http//www11.georgetown.edu/research/gucchd/nccc/
• The National Center for Cultural Competence
  serves to increase the ability of health and
  mental health programs to devise, execute, and
  assess culturally and linguistically competent
  service delivery systems.
• This site includes conceptual frameworks and
  models, tools and processes for self-assessment,
  and policies currently being enforced. I believe
  that teachers, medical professionals, and our
  general community can utilize the information and
  tools provided to better understand the
  non-English speaking realm.

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Useful Journal Articles

• Healthcare Coverage Language is top barrier for
  Hispanics to receiving medical care in the South.
  
• Author Unknown
• This article describes the language barriers that
  are keeping the souths Hispanic community from
  receiving much needed medical care and
  interpreters. It lists some possible remedies for
  the situation as well.
• This is useful for teachers, medical
  professionals, and the southern citizens. It can
  aid people in understanding the barriers that are
  posed and help them work to correct the
  barricades.
• Healthcare Access The Language barrier
  negatively impacts health care for 50 million
  U.S. residents.
• Author Glenn Flores
• This article was published in the New England
  Journal of Medicine. It highlights healthcare
  communication in the United States and gives
  examples to aid in the fixation of the problem.
• This journal writing is particularly useful for
  medical and auxiliary staff, but can be utilized
  by other professions as well.

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Conclusion

• It is apparent in todays society that language
  barriers are a major blockade to better
  understanding and healthcare for non-English
  speaking individuals.
• As a society, we must work together to better
  understand, develop relationships, and utilize a
  sense of cultural competency to convey our nation
  as one with freedom and opportunity for all.

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References

• ACORN (2004). Speaking the language of care
  Language barriers to hospital access in Americas
  cities. Retrieved from http//acorn.org/fileadmin
  /Additional_Accomplishments/National_report.pdf
• Flores, G. (2006). Healthcare Access The
  language barrier negatively impacts health care
  for 50 million U.S. residents. Obesity, Fitness
  Wellness Week, 1350.
• Flores, G (2006).Language barriers to health care
  in the United States. The New England Journal of
  Medicine. 355, 229-231.
• Kaiser Family Foundation (2002). Language
  barriers greatly increase medical error for
  hospitals, study says. Retrieved from
  http//www.kaisernetwork.org/daily_reports/print_r
  eport.cfm?DR_ID10842dr_cat3
• Kaiser Family Foundation (2003). Immigrants
  health care coverage and access. Retrieved from
  www.kff.org
• Kaiser Family Foundation (2006). Daily health
  policy report. Retrieved from http//www.kaiserne
  twork.org/daily_reports/rep_index.cfm?hint3DR_ID
  38611
• Unknown, (2004). Healthcare Coverage Language is
  top barrier for Hispanics to receiving medical
  care in the South. Obesity, Fitness Wellness
  Week, 666.