Working with Hispanic Elderly

1. Working with Hispanic Elderly

2. America was once envisioned as “themelting pot” U.S.A.

3. Health Care

4. “In a complicated health care system where there are rulers …, the needs of vulnerable populations suffer” (55). Christina Aguierre-Molina Health Issues in the Latino Community

5. Immigration from Mexico to the United States In 2000, Latino population in the U.S. was 66.1% Mexican (Aguierre-Molina 4). “Mexican Americans have been more persistent than any other ethnic group in maintaining their language and culture” (172). Sybil Lassiter Multicultural Clients: A Professional Handbook for Health Care Providers and Social Workers

6. Learning Outcomes • Following this presentation we hope that you will have a clearer understanding of: • Who are Latinos? • What are the various barriers which Latinos face in obtaining health care? • c. How Latino culture and health care provider culture impact health care services.

7. For the Latino Community,barriers to health care include, but are not limited to: Lack of understanding of U.S. health care system Lack of transportation to facilities Exorbitant health care costs Lack of health insurance Limited knowledge of English language Cultural Conflicts

8. Health Insurance Many Latinos lack health insurance because of the language barrier, but MOST lack health insurance because: they work in low-paying, less stable, often hazardous jobs that do not offer employee benefits. “Latinos are the most likely to be uninsured” (Aguierre-Molina 50).

9. The Language Barrier Spanish-speaking community is: one of the largest minority groups in the U.S. However, there are few Spanish-speaking deliverers of health care. “One way to sensitize young students to the severity of the language barrier is to have them present a health problem to a person who does not speak or understand a word of English. It’s often difficult and embarrassing.” Rachel Spector Cultural Diversity in Health and Illness

10. “I can’t understand what the doctor and nurses are saying! They speak a foreign language!”

11. A hospital can be a frightening place … Non-English-speaking patients can feel intimidated and vulnerable.

12. Interpreter Services Families often use children or friends to interpret. Chicago Study: 84 hospitals surveyed about interpreter services Results: 71 said they do not hire interpreter services (utilize staff, housecleaning persons, clerks) 20 hospitals request that patients bring their own interpreters 2 hospitals require patients to bring their own interpreters or go elsewhere for treatment. J. Dunlap and Faye Hutchinson America’s Newcomers: Health Care Issues for New Americans

13. While Interpreters are helpful, the use of interpreters is not without its problems: Interpreters can often … construe their own meaning of certain words or phrases:ahora = “now” or “at this time” (most Spanish-speaking countries) ahora = “24 hours from now” (Mexico) be a hindrance in obtaining information that a Latino patient feels is very personal or sensitive. interpret incorrectly if the interpreter is a child.

14. Potential Consequences of the Language Barrier: Patient dissatisfaction; Poor comprehension and understanding of messages from providers; Non-adherence to physician instructions; Lower quality of patient care; Poorer health outcomes.

15. Latino Cultural Values • Preferred personality • Time orientation • personalismo • familismo • machismo • curanderismo

16. personalismo “formal friendliness” or personalized approach Value is placed on how individuals work together as a group versus individual accomplishment. Often refer to health care workers by name rather than by job title or name of institution. Individuals should be kind, agreeable, flexible, loyal, honest, generous, willing to help others. Mary

17. Through personalismo … Latino patients often expect to form a personal, friendly relationship with their health care provider. Some bring food as a personal gesture, and expect the provider to graciously accept it.

18. familismo • Places goals of the family above those of the individual. • Family placed at the CENTER of daily life: family ties close-knit unity dependence upon each other family extended family

19. Latino patients often view their illness and treatment as a FAMILY MATTER. Include family in decisions regarding treatment. Western Culture Illnesses as well as decisions about treatment are often kept private and away from family and friends. Through familismo…

20. machismo “macho”= male, one who carries great honor, responsibility and respect • Male considers himself the sole provider and back- bone of the family. • Responsible for well-being of family … will often sacrifice his own medical needs to make sure those of his family are met first.

21. The “downside” of machismo • For most Latino males, succumbing to illness is not considered “macho.” • Often seen as “weak” by others if a man cannot work due to illness. • Latino culture views “illness” as something one simply must endure. • Illness often reflects moral and physical weakness. • Often results in physical abuse of spouse.

22. Due to fear of Western medical practices along with a feeling of intimidation of large medical institutions, many Latinos turn to: curanderismo curandero“ Aztec Holistic Healer Spanish Spiritualistic

23. Who is the curandero? Religious figure or specialist who receives his/her gift of healing in 3 ways: 1. Born to heal 2. Learn through apprenticeship 3. Through a trance or dream during adolescence or midlife.

24. In curanderismo, rituals include (but are not limited to) • Laying on of hands • Performing massages • Lighting candles • Going to confession • Doing penance

25. curanderismo OR doctor?? curanderismo Westernized Care versus Close, personal relationships De-personalized care

26. “Culture” of the Health Care Provider Just as a certain race or ethnicity lives according to its own cultural beliefs, providers of health care follow a set of rules and principles from which they carry out specific practices, habits, and norms. What happens when providers of health care from one culture encounter recipients of health care from another culture?

27. Health care providers often expect Latino patients to willfully submit to invasive testing without prior discussion or verbal preparation. Often ask outright explicit and often embarrassing questions with minimal preamble. CultureClash! The results are often…

28. Health Care Providers include:(but are not limited to) • Physicians • Nurses • Social workers • Dietitians • Lab professionals

29. Latino Health Practices According to the American Public Health Association (APHA), Hispanics and Latinos are commonly distrustful of physicians and modern medical practices. About 33% of Latinos believe that home remedies are more effective at treating illness than prescribed medications.

30. Home remedies often include: Different forms of alcohol Honey Various teas

31. Bridging the Gap Between HCP Culture and Latino Culture By integrating home remedies with prescribed treatments, health care providers can often win the trust of the patient which can then increase patient compliance to treatment. American Public Health Association

32. Type I: Type II: Deficiency in pancreatic secretion of insulin: < 5% of diabetes cases in the United States. Insulin deficiency and/or insulin resistance: > 90% of diabetes cases in the United States. Diabetes and I.D.E.A.L. Latino Patients Diabetes Fifth cause of death for Latinos

33. I.D.E.A.L.(Initiative for Diabetes Educational Advancement for Latinos) • Intensive and Expensive. • Requires frequent trips to health care facilities. Main obstacle to treatment: Language barrier

34. How Do We Resolve Linguistic and Cultural Differences? “… identifying the differences among people will enable better understanding of one’s own culture, as well as the ethnic culture of others” (77). Rachel Spector

35. In conclusion The most important things to note: Confianza Fatalismo El Cliente