Meeting the Health Care Needs of an Older Hispanic Population
By Simmons, Jeff | |
Proquest LLC |
Community-based care is at the core of CHN's mission. The organization believes in offering health care services in locations that are easily accessible to its patients. To better serve those individuals, who are not as likely to visit a health center, CHN offers confidential educational outreach and sexual health services through its medical mobile van weekly throughout
During these health care visits, counselors and physicians say they encounter an increasingly aging and diverse population confronting higher rates of obesity, heart disease and diabetes.
"An aging and increasingly diverse population requires that health care organizations and institutions take heed and respond to patients' individualized needs," says
"The growth in the Hispanic population of patients should be a signal to all health care providers that they should take steps now, and not wait until it's too late, to improve access and care."
As the country's Hispanic population continues to steadily escalate, medical providers are establishing ways to improve their services, to draw more Hispanics into the health care system and inevitably strengthen access. Hispanics represent the largest ethnic group without insurance in the country.
It's estimated that nearly 1 in 3 Latinos living in the country does not have insurance or has poor access to quality care - the largest "minority" group by far (recent research noted that 1 in 8 white individuals are uninsured, by comparison). Experts further dispel perceptions that undocumented immigrant Hispanics are primarily among the uninsured, pointing out that nearly a third of U.S.-born Hispanics and more than a third of Hispanic American citizens are uninsured.
The debate over access escalated amid the extended period to enroll for insurance under the Affordable Care Act (ACA). In mid-April, the
The debate aside, experts agree an aging population that is increasingly Hispanic should warrant long-term efforts to improve the public's understanding about proper health care, and to address issues earlier before they become life-threatening.
According to the federal
Among other troubling concerns: Hispanics face higher rates of the risk factors that can lead to heart disease such as obesity and diabetes; Hispanic women have steeper rates of cervical cancer, which they contract at 1.6 times the rate of white women, according to HHS department reports; and, only 46.5 percent of Hispanics had a colorectal cancer screening in 2010, significantly less than the 59-9 percent rate of non-Hispanics.
"With the Latino community, we know there are access issues," says
"There was massive misinformation, a complete lack of knowledge about what this meant," Martinez said. "There was so much information and fear about what it meant, and people were not enthused about enrolling."
"Latinos are very family-oriented, and many adult children are still living with their parents," she said. "What impacts one member of the family really impacts them all. Getting them information that will help them prevent diabetes or high cholesterol or heart conditions is important."
She added, "Keeping our community educated and healthy is really what's important."
One creative campaign designed to connect with older - and younger - Hispanics was a digital outreach effort in which mothers would email or post on
NHCOA has developed a Hispanic Aging Network of community-based organizations across the country, the
"As the U.S. population grows older, an increasingly larger share of our older Americans are Hispanic," said Dr.
"Through this demographic shift we are confronting several realities that need to be addressed, particularly in the area of health. Hispanic older adults are disproportionately affected by chronic diseases and illnesses. In addition, we know that lack of health literacy is an added burden that impacts Latinos, as well as other Americans."
In early April, NHCOA launched a new health literacy elearning platform - Portal e-Comunidad - for lay community health workers to promote health literacy among Hispanic seniors with chronic diseases. The platform features five modules of 20- to 40-minute lessons on narrated PowerPoint presentations, including instructions on managing medications at home and how to get the most out of a doctor's visit.
When Hispanics do have access to health care, linguistic and cultural gaps between the health care provider and patient or a lack of cultural competency can result in misunderstandings and poor communication - a driving force behind the health literacy movement.
Dr.
Noting the Spanish word "once" for the English word "eleven," he said: "One of the classic health literacy stories is about the medication bottle that says take once a day, but someone with limited English proficiency takes 11 pills instead of one."
While elderly patients comprise about 7 percent of its current patient population, CHN anticipates a growth in that number due to higher life expectancy rates, along with the increasing amount of people who now qualify for affordable health insurance.
Often, he said, elderly patients are receiving care from multiple medical providers, and receiving multiple medications.
"Without the oversight of one qualified primary care doctor, it's very easy for patients to have their health worsen," he said. "And for Spanish-speaking patients, this care model is critical since English is not their first language and they may not know what questions to ask or understand all of the directions for taking medications and improving their own health conditions."
'We want to make sure they follow a provider's directions," he said. "We hire as many bilingual staff as possible. These are people from the community who are able to understand the language and culture of our patients."
Additionally, CHN ensures that it has a language line available so its patients can communicate with translators via phone, and the nonprofit is now readying to launch a video translation service to allow translators to notice nonverbal gestures to better assess conditions.
'We suspect it's going to enhance the translation process, and allow people to see each other, use gestures and read lips," Weissman said.
NHCOA reports that steep costs may often be prohibiting older adults from seeking medical care. While
For many Hispanic older adults,
In fact, NHCOA reports that Hispanics were the racial and ethnic group most likely to not see a doctor in the past year - because of cost. This has spurred nonprofits to strengthen their efforts to bring greater numbers of older Hispanics into the health care fold.
That trend is evident at the 10-year-old
Chronic illness, diabetes, high blood pressure, high cholesterol, asthma, and obesity rates were significantly higher in the community as well - and six of the top 10 causes of death in East Harlem resulted from complications of chronic disease.
As a result, the clinic is navigating new initiatives to connect with a community often without access to care earlier. In
Although EHHOP provides comprehensive primary care, some patients require specialty services and before this program was established, these patients encountered a number of barriers to specialty care. Language and health literacy barriers were particularly challenging for many of the most vulnerable patients to overcome - and led to long delays in effective treatment.
Patient ambassadors are medical and graduate students who help patients with the logistics of referral appointments. They walk them to appointments, greet front desk staff, help them sign in and ensure payments proceed smoothly. They also help to coordinate follow-up care.
EHHOP launched a chronic care program in which thirdyear students are paired with patients with complex chronic disease for one to two years to ensure they have a stable medical provider who can effectively tackle their health needs rather than the discordant care that comes with multiple providers. EHHOP also is regularly staffed with social workers and nutritionists - all in an effort to knit more comprehensive services together.
'We train all of our students at the clinic to be very proactive about educating their patients," said Nickerson, "and to make sure whatever they tell their patients is appropriate and understandable."
Establishing stronger inroads in the older Hispanic community is a key, she said.
"Once people have diabetes or high blood pressure, diseases that could be prevented or improved through earlier lifestyle changes and education, it is harder to treat them," she said. "The main reason we need to focus on this group of people is that they are at high risk. Some of it is genetic, some of it is because of the environment they live in, but there is a lot we can do. This is really important and meaningful to focus on."
Copyright: | (c) 2014 The Hispanic Outlook in Higher Education |
Wordcount: | 2200 |
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