The case focuses on addressing the risks in the discharge process in patients whose opportunities are limited by the language barrier. The patient is a 90-year-old female who experienced shortness of breath and frequent falls, significantly increasing the risks of adverse health outcomes in non-compliance with the recommendations. The presence of the patient’s family members increases the chances of conveying health and medication recommendations to the patient. Lastly, there is a low probability that the patient will fully adhere to health recommendations if they cannot afford the medication. Thus, the patient’s immediate needs include resolving the housing issue to ensure long-term care and solving the financial problem through the application of Medicare/Medicaid to cover the costs of long-term care. Therefore, the services required for preparation of discharge include interpreter and translation services and social care services to assist with applying for Medicare/Medicaid and ensure the patient’s follow-up visit.
Understanding the necessary information about their condition presents an important factor in patients’ adherence to medical recommendations. Thus, assessing the patient’s health literacy ensures their safety and prevents potential adverse health outcomes. Common short health literacy assessment methods include tests that measure the patient’s reading comprehension in the medical context. Considering that the discharge process will use help from an interpreter, the assessment of the patient’s understanding of her medical condition can use a teach-back method. The method suggests asking the patient to describe their medical condition and retell the specified health recommendations to ensure that the information heard was processed and accepted by the patient. The assessment can be applied to the patient’s caretaker to ensure their understanding of the patient’s needs. Next, assessing the patient’s options to care can take the form of sequential questions. The assessment will define whether the patient has a permanent place of residence and acquire next of kin information. With the help of social workers who have the necessary documentation about the patient’s movements, the hospital can assess the patient’s available options to care.
The case details identified that the patient experienced shortness of breath and frequent falls. The symptoms can be linked to chronic obstructive pulmonary disease (COPD), which significantly affects patients’ quality of life. Comorbidities significantly contribute to the severity of the disease and its mortality. Therefore, the management of COPD patients should also include the treatment of comorbidities (Argano et al., 2021). According to Brown et al. (2019), homeless people experience falls more frequently due to environmental exposures and develop functional impairment due to a loss of confidence in physical movements. Thus, understating the patient’s family’s financial situation and living arrangements is important to ensure positive health outcomes. Lastly, it is important to consider the patient’s culture and potential beliefs that may present barriers to treatment.
Understanding the family’s communication style and culture can enhance the relationships with the patient, even in cases where language barriers limit communication. Active listening methods allow the professional to convey to the patient the idea that despite misunderstandings, the professional is ready to help and give full attention to the patient’s problems. Next, encouraging the patient to continue speaking by showing reactions can increase the patient’s trust in the professional’s competence. Lastly, the professional can intelligibly convey essential concepts to the patient through paraphrasing to develop patient’s understanding of the treatment process.
The patient faces significant negative effects in the social determinants of health. Firstly, the housing problem adds complications to the patient’s discharge process and potentially can eliminate the positive effects of treatment. Next, the patient’s financial situation makes it difficult to schedule the follow-up visit and reduces the chances of the patient’s adherence to medical recommendations. Lastly, the language barrier and low health literacy make it difficult for the patient to seek help from the healthcare system.
The clinical care for the patient is highly dependent on community resources. Without cooperation with community resources, clinical care cannot provide the necessary services and have a significant positive effect on the patient’s health. Thus, the Care Coordinator and Social Worker can coordinate to help the patient and her daughter find the financial assistance required for long-term care and resolve the housing problem. For example, they can help the patient and her daughter file applications for government assistance programs such as Supplemental Nutrition Assistance Program (SNAP), Medicaid, or Medicare.
There are two prominent strategies of engaging with community resources that can be applied to support the patient in this scenario. Firstly, the hospital social workers who represent the main stakeholders assist patients and their families in dealing with emotional pressure and financial struggles. The hospital social work team can assist care coordinators with finding long-term care placement for the patient and transportation, as well as acquiring vital resources for the patient’s family, such as nutrition and food. Furthermore, the second strategy suggests partnering with stakeholders, such as local pharmacies, to offer prescription coverage for the patient.
The national standards of Culturally and Linguistically Appropriate Services (CLAS) require health care organizations to provide effective and respectful quality care to fulfill diverse cultural needs. The first standard applicable to the patient’s health disparities in the scenario requires the health organization to provide language assistance to patients with limited English proficiency (U.S. Department of Health & Human Services, n.d.). Thus, the hospital must provide translation services for all patient appointments. Furthermore, the standards require organizations to provide printed and multimedia materials in the patient’s native language or common languages for the population in the area (U.S. Department of Health & Human Services, n.d.). Therefore, the hospital must provide printed materials for the patient and her daughter translated into their native language.
The recommended evidence-based intervention that includes community involvement and cultural considerations and improves the identified health disparity is placing the patient in a long-term care facility. The intervention will improve the safety of the patient’s living conditions and allow the elimination of health disparity. Community involvement will be shown in support from social workers, while cultural considerations can be presented by the cultural sensitivity of nursing staff engaged in patient care.
Positive lifestyle changes can significantly improve a patient’s health after discharge. Local community resources can help with transportation of the patient to follow-up visits. Furthermore, help from such programs as Meals on Wheels can assist in maintaining a nutritious diet for the patient. Elderly people often struggle with social isolation and loneliness, which affects their mental health (Donovan & Blazer, 2020). Thus, finding a community with the same cultural beliefs will increase the patient’s communication circle and connect with local community.
The community resources that might be accessed to support and sustain the hospital’s cultural intelligence development include webinars and in-service sessions. Many resources offer affordable options for the development of employees’ cultural intelligence. For example, the Cultural Intelligence Center organization provides virtual webinars that discuss the importance of emotional and cultural intelligence for representatives of all professions which involve contacts with people from different nationalities and ethnicities.
Cultural intelligence is required in professional healthcare standards, such as the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Cultural intelligence presents one of the primary requirements for accreditation of Certified Community Behavioral Health Clinics (CCBHCs). The requirements emphasize that clinic employees must show cultural competence when treating people with limited English proficiency.
References
Argano, C., Scichilone, N., Natoli, G., Nobili, A., Corazza, G. R., Mannucci, P. M., Perticone, F., & Corrao, S. (2021). Pattern of comorbidities and 1-year mortality in elderly patients with COPD hospitalized in internal medicine wards: data from the RePoSI Registry. Internal and Emergency Medicine, 16(2), 389–400.
Brown, R. T., Guzman, D., Kaplan, L. M., Ponath, C., Lee, C. T., & Kushel, M. B. (2019) Trajectories of functional impairment in homeless older adults: Results from the HOPE HOME study. PLoS ONE, 14(8), 1-16.
Donovan, N. J., & Blazer, D. (2020). Social isolation and loneliness in older adults: Review and commentary of a national academies report. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 28(12), 1233–1244.
U.S. Department of Health & Human Services. (n.d.). CLAS Standards. Think Cultural Health. Web.