July 27, 2018; US News & World Report (AP)
The NORC (National Opinion Research Center) at the University of Chicago recently issued a report listing the barriers that Latinx persons face in considering long-term care. Those barriers include communication, addressing cultural distinctions, and cost.
The study reports that nearly six in 10 Latinx adults have had a difficult time communicating with a long-term healthcare provider because of a language or cultural barrier, and when they do, they often turn to outside sources for help. (NORC offers an infographic illustrating the problems and complexity of the issue.) Half of those who have faced these barriers turned to a family member or to another healthcare provider for assistance. More than one in four looked to a translator, public resources in their community, or online sources for help. While Spanish translators may play a significant role in bridging communication gaps, they do not take the place of healthcare providers forming relationships with older adults and their families and listening to their stories.
As Emily Swanson and Russell Contreras write for the Associated Press, while translation is important, it does not always ensure understanding. For instance, Swanson and Contreras interviewed Antonio Torres, 53, of Orlando, Florida, who is bilingual and legally blind. Torres said, “When I tell them I don’t understand them, they’ll bring someone over to speak to me in Spanish and I don’t understand them, either. We didn’t grow up speaking that formal Spanish, so I have no idea what they are saying.”
A large proportion of elderly Latinxs have concerns about long-term care facilities’ ability to address cultural differences. Less than three-in-10 have confidence that these facilities will be aware of and responsive to cultural norms regarding diet and religious or spiritual beliefs.
Yet another major barrier is cost. Many Americans believe that Medicare and Medicaid will fund long-term care. In fact, Medicare does not cover the cost of this kind of care, although Medicaid does for those who qualify. This is compounded by demographic disparities, particularly as they relate to ability to pay; just 15 percent of older Latinx people are “very confident” they will be able to pay for their future long-term care needs.
Fortunately, some government offices, universities, and foundations are stepping up to the plate. South Carolina is a state with a small but growing Latinx population, presently estimated by the Census Bureau at 5.7 percent. The South Carolina Department of Health and Human services has established the Division of Community Long-Term Care to centralize access to care. It works to avoid unnecessary home placement and premature admission to nursing care facilities. South Carolina’s Medical University of Nursing (MUSC) has established the Hispanic Health Initiative, which coordinates community collaborations to that allow older adults to stay in their homes as long as possible. Funding received from federal agencies, national and local foundations, and private donors support their innovative programming that is culturally and linguistically appropriate.
The SCAN Foundation, whose mission is centered on care to provide dignity and independence for old adults, has conducted research on healthcare delivery to Latinxs. It works to bridge care and financing for older adults. The Henry Kaiser Foundation, which focuses on health and healthcare disparities, reports that a number of groups—Latinxs, Blacks, and American Indians/Alaska Natives as well as low-income individuals—are at disproportionate risk of being uninsured, lacking access to care, and experiencing worse health outcomes. Low-income individuals and people of color also face increased barriers to accessing care, receive poorer quality care, and ultimately experience worse health outcomes.
A few years ago, NPQ’s Rick Cohen called health disparities “the new frontier for civil rights.” As Cohen noted at the time, “much of the story of closing healthcare and health insurance disparities, like the history of the civil rights movement as it fought to break down local barriers in schools and other accommodations, will involve local activists and local nonprofits.”—Meredith Betz