Language barriers and healthcare access for vulnerable aging populations

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.

Finally, the most controllable approach to this issue would be an exercise announced to the staff with its intended purpose. 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.

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 and healthcare resources. By mimicking the physiological limitations associated with advanced age, the exercises would increase understanding and empathy among agency employees. More particularly, it is hoped that this program would help young and physically healthy individuals responsible for delivering healthcare and healthcare informational services to make a better connection between what they already know about aging more generally and its specific relevance in terms of healthcare access barriers.

Finally, it is hoped and expected that this approach to increasing the understanding of the barriers faced by members of this vulnerable community would motivate administrative personnel to consider the needs of aged members of the population in designing programs, informational resources, and in recruiting, hiring, and training personnel to better meet the needs of members of this population in ways conducive to mitigating the impact of these age-related barriers to quality healthcare. .