Accommodating Vulnerable Populations in Healthcare Within contemporary healthcare, access to healthcare services is negatively impacted by a variety of potential barriers. Typical examples of such barriers include cultural and ethnic isolation, advanced age, low income, lack of access to public transportation, and language barriers. In our healthcare agency, the two most prevalent barriers to healthcare access are advanced age, language barriers, and the particular vulnerabilities of aged populations.

Within our healthcare organization, there may be issues of the failure on the part of many staff members to empathize with the significance of these issues, largely because the staff are almost all young, well-educated individuals whose primary language is English. This project consists of several proposed methods of increasing the awareness and sensitivity among healthcare providers to the significance of these potential barriers to healthcare access. In principle, they are designed to help individuals who are not and have never been subject to any such potential barriers in American society.

The Significance of Language Barriers in Healthcare Access

One of the most significant potential barriers to access to contemporary healthcare resources is the language barrier encountered by some individuals (

Hiscock, Pearce,

Blakely, et al., 2008; Rust, Ye, Baltrus, et al., 2008). This barrier is most common among first-generation immigrants and especially by individuals who have remained within traditional foreign ethnic and other highly insular social communities (Beauchamp & Childress, 2009; Tong, 2007). Irrespective of how long they have been living in the United States, their choice to remain within their own ethnic communities (or their inability to assimilate, as the case may be) can substantially complicate their ability to access healthcare resources in the community, even when they are available (Hiscock, Pearce, Blakely, et al., 2008; Rust, Ye, Baltrus, et al., 2008).

Typically, these individuals may be completely unable to avail themselves of healthcare resources in the community, simply by virtue of their inability to understand the communications initiatives established by healthcare programs to publicize their existence. Our healthcare agency may be less accommodating in this respect in several ways. Specifically, there is no effort among the administration to recruit employees with bilingual (much less multi-lingual) abilities.

Generally, the availability of translators is a matter of pure happenstance determined by whether or not employees with the requisite language skills to assist in translation when necessary happen to be available. When they are available, they generally make an effort to be helpful, both in face-to-face encounters and in telephone inquiries. While no statistics are maintained in this regard, there is very good reason to suspect that many individuals who contact the agency but are unable to obtain the language-competency skills necessary may not make follow-up attempts thereafter. Therefore, one important concept for both employees and (especially) administrators to appreciate is how much of a barrier to healthcare services foreign-language limitations can be among this population and how much language issues can perpetuate their vulnerability.

Proposal for Increasing Awareness among Agency Healthcare Providers

There are several conceivable approaches to increasing the awareness of agency employees of the importance of accommodating foreign language translation needs to improve access to healthcare services. One possible approach would involve the assignment of field tasks that exposed personnel directly to the difficulties encountered by members of the community who cannot understand or communicate in English. Such assignments might include the assignment to obtain specific information within insular ethnic communities where the prospect of finding translators to assist the healthcare personnel is known to be low. The addition of narrow time constraints to these tasks would naturally increase the difficulty of their completion, partly by reducing the opportunity to solicit assistance. In principle, this approach relies simply on reversing the communications dynamic typically encountered by individuals in the community who cannot understand English.

Another more easily controlled approach to exposing healthcare workers to the significance of healthcare barriers encountered by members of the community who cannot understand or communicate in English might involve in-house exercises in which staff members are assigned to obtain information by a telephone campaign to members of the local community (or businesses) who do not speak English. As in the first approach, imposing time constraints would increase the difficulty of the assigned tasks. Also, as in the first approach, the participating staff members would not be aware until the conclusion and evaluation stage of the process that the assigned tasks were part of a designed awareness exercise intended to improve sensitivity to vulnerable individuals with significant language barriers in the community.

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One mechanism might be to provide them with pamphlets and other types of printed information and to assign the task of compiling a report detailing the information they are able to glean from those resources.
Intended Outcome of the Exercises

There are two principal intended outcomes of these exercises. The first intended outcome is to increase the appreciation among first-line healthcare workers of the extent to which foreign-language reliance issues can pose potential barriers to healthcare service access. More specifically, it is expected that the direct exposure to the need for translation assistance on the part of individuals who may never previously have had such an experience will increase their sensitivity to the vulnerabilities of members of communities who are dependant on such resources.

The second expected outcome is to increase the awareness of first-line healthcare workers of the crucial importance of making a genuine effort to obtain the necessary translation services in situations where the failure to do so might result in the loss of the opportunity to provide services to the individual. Specifically, in some cases, that may simply entail making the effort to find someone with bilingual capabilities. In other cases, that might entail ensuring that they at least solicit return contact information (or even simply note it from Caller-ID-type systems and then schedule the necessary follow-up contacts initiated by staff members with the requisite language skills subsequently.

Finally, perhaps the most important aspect of these exercises relates to their intended effect on agency employees in administrative positions. Specifically, it is intended to promote understanding of the need to increase the availability of bilingual (and multilingual) informational resources, outreach initiatives to local ethnic communities, and (especially) of the need to recruit, hire, and train more bilingual employees. Ideally, administration should gain a better understanding of the crucial need to ensure that all staff shifts include bilingual staff members. More particularly, these mechanisms are intended to motivate administration, at the very least, to establish the necessary procedures and protocols to ensure that individuals who are unable to obtain bilingual assistance in agency contacts are always contacted with follow-up attempts as soon as the appropriate individuals in the agency are available to make the re-contact attempts.

The Significance of Advanced Age as a Barrier to Healthcare Access

Advanced age is also a crucial area that precipitates barriers to access to healthcare and healthcare resources among another extremely vulnerable population (Hiscock, Pearce, Blakely, et al., 2008; Rust, Ye, Baltrus, et al., 2008). Specifically, members of the aged population experience increasingly serious difficulties in connection with physical mobility, eyesight, and (especially) hearing abilities (

Hiscock, Pearce,

Blakely, et al., 2008; Rust, Ye, Baltrus, et al., 2008). On one hand, it is likely that agency staff members understand this in a more general context, such as through their own extended family relationships and ordinary social awareness and interactions. On the other hand, it is equally likely that agency staff members do not fully appreciate the extent to which advanced age operates as a specific barrier to access to healthcare resources. Therefore, the following proposal is intended to increase awareness of, sensitivity to, and the inclination among agency employees to assist members of the community who are particularly vulnerable to healthcare barriers by virtue of their advanced age.

Proposal for Increasing Awareness among Agency Healthcare Providers

A viable approach for increasing awareness among agency employees of the nature of potential barriers to healthcare access and the extent to which those barriers can increase the vulnerability of the aged members of community might involve the use of learning aids designed to mimic some of the limitations posed by advanced age. Specifically, a learning exercise could rely on sight-limiting eyewear, ear plugs, and external limiters of physical mobility in the nature of soft casts and other types of wraps ordinarily used for therapeutic purposes. Staff members could participate in exercises such as traveling by public transportation and negotiating stairs and posted visual aids without the benefit of good eyesight, hearing, and physical mobility. Moreover, staff members could also be required to such exercises after a night of sleep deprivation to mimic some of the cognitive difficulties typically associated with advanced age. They might be required to perform memory-based and other cognitive tasks that would ordinarily be relatively easy for them.

Intended Outcome of the Exercises

The intended outcome of this series of exercises would be primarily to increase awareness in agency employees of the nature of the limitations posed by advanced age in the realm of potential barriers to access to healthcare…