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Improving Outcomes for Limited-English Speaking Home Health Patients

The latest numbers show that 4.5 million patients receive care in their homes. For limited-English speakers, a lack of adequate language support has negative implications on the outcome of their care.

Recent studies show that most home health caregivers do not have the diverse language skills required to work with limited-English proficient (LEP) patients. Here's a closer look at the risks this poses for home health patients with limited-English skills, plus tips for improving care outcomes for this vulnerable segment of the population.

The Demand for Language Diversity in Home Health Is on the Rise

Language barriers have been a target of concern for the last several years across all spectrums of healthcare. The population continues to become more diverse, with as many as one out of every five U.S. households speaking a language other than English at home. That number is sure to rise in the future — between 1980 and 2014, the number of people who spoke a language other than English at home tripled.

The need for language support in home health cannot be ignored. While the movement toward improving health equity through language access has gained traction in most healthcare settings, home health organizations have traditionally operated outside the realm of traditional in-office or in-facility care. That's why until recently, the language gaps in home healthcare have been largely overlooked. This can be deemed as an even greater point of vulnerability for the safety of LEP patients enrolled in home health programs.

Language Support Is Widely Lacking In Home Health Care

A recent effort carried out by the New York University Rory Meyers College of Nursing (NYU Meyers) was designed to harness more insight into language support availability in home health. The study looked at home health care visit patterns in terms of language concordance, or visits in which the care provider either spoke the patient's language or had the support of an interpreter. Their findings included:

  • Only about 18% of home health registered nurse (RN) visits were language concordant across all language demographics
  • Only about 26% of physical therapy visits were language concordant across all language demographics
  • Only 13.1% of RN visits with Spanish-speaking individuals were language concordant

With Spanish being the most common language spoken in the U.S. other than English, it's easy to speculate that language concordance would be more likely than with other languages...but that wasn't the case. Korean, Russian, and Chinese home health patients were all more likely to have a language concordant visit with a home health RN than those who spoke Spanish.

A Closer Look at the Implications of Lacking Language Support in Home Health

Quite a few studies have worked to clarify the health disparities that exist for LEP patients. The AMA Journal of Ethics states that LEP patients, in general, may face greater risks of medical errors and worse clinical care outcomes. In asystematic review of the implications of language barriers for healthcare, language barriers were found to affect overall satisfaction of care for both patients and care providers. In addition, the review found that implementing even rudimentary translation tools improved the quality of care and enhanced the safety of LEP patients.

Unfortunately, there have been few studies to look at the implications for LEP home health patients specifically, though a recent study published in 2022 in the International Journal of Nursing Studies did offer a great deal of insight. Overall, patients who need home health care are far more likely to have a positive experience if they speak English. From a sample of more than 87,000 home health patients, researchers determined that patients with non-English language preferences faced a higher risk ofreadmission for facility care within 30 days.

Why Language Support May Be Lacking in Home Health Care

There may be a series of factors associated with the fact that language support is lacking in home health. One factor is that testing and certification to become a home health care aid in the United States is primarily offered in only the English language. This is the case in Washington, D.C.. though one in four D.C. area residents may be LEP, with nearly half of those people speaking primarily Spanish.

Another factor is that home health agencies are often privately operated entities not affiliated with larger care organizations. This places the burden of adopting language support and cultural diversity protocols on the organization itself. Some organizations fail to recognize the need for language support, while others simply struggle to know where to start or don't find room in their operational budgets to implement language support.

How to Improve Outcomes for LEP Home Health Patients

Most home health care professionals recognize that language barriers influence both the safety and quality of the care provided. The key to improving care outcomes for LEP home health patients requires a three-step approach for care providers:

  1. Providers must understand the health disparities that exist for their patients
  2. Providers must strive for cultural competence across the entirety of their operation, so home health aides have a good understanding of how cultural differences need to influence how care is provided
  3. Providers must take advantage of quality medical interpreting and language support services to improve patient experiences and the care provided

Working Toward Health Equity in Home Health for LEP Patients

The more we understand how language barriers create health disparities for LEP patients, the more important it is that providers take the initiative to make changes. To find out how language support can improve the care provided by your home health organization, reach out to GLOBO for more information about our language support services and how we can help start improving the experience for your LEP patients today.

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