Finding assisted living or nursing care for a parent is never easy. The situation is further complicated when the individual in question is not fluent in English because he or she either never became totally versed in the language or aging has introduced difficulties.
“Patients with dementia often revert to their mother language,” explains Dr. Ivan Merkelj, medical director for Palm Beach PACE at MorseLife Health Systems. “The part of the brain that stores a learned language is different than the mother language, and they feel more comfortable with their mother language.”
According to Justice in Aging, approximately 5 million older Americans are limited English proficient (LEP), meaning they do not speak English as their primary language or they have a limited ability to read, speak, write, or understand it.
Many have lived independently for decades, relying on the proximity of family or friends or residing in a culturally dominant community. But when moved to a residential care facility, access to others who understand their language can become a challenge.
Understand Your Rights
All family members and caregivers involved should be aware of the rights granted to all non-English speaking individuals. Protection against discrimination due to race, color or national origin was established in 1964 by Title VI of the Civil Rights Act, and was taken further in 2000, when President Bill Clinton signed an executive order to improve access to services for LEP residents.
“Any recipient of federal funds is required to take reasonable steps to ensure meaningful access to programs by LEP individuals,” according to Justice in Aging, which advocates for low-income adults.
Denny Chan, staff attorney for Justice in Aging in Los Angeles, explains that this includes recipients of Medicare or Medicaid, including nursing homes.
“In addition, state laws can do even better,” he adds. “The federal law sets the minimum, but the states can add rights which may provide additional protection at a state level.”
Chan encourages family members and caregivers to do their research — a local older adult advocacy agency or Justice in Aging can help you get started — and to be ready to take advantage of these rights when the need arises.
“When asked on the spot to interpret, family caregivers tend to ‘cave.’ They’re so used to helping and doing things for their loved one, they’ll agree,” he says. “But these discussions should be left to someone who has mastery in both languages. A family member may lack a professional vocabulary or the names of medical conditions.”
Your request doesn’t have to be confrontational or assertive. “A friendly reply [such as] — ‘I’m not super comfortable interpreting, what can you provide for us?’ — may help,” he says. “The facility won’t deny you the right, but they may present barriers. You may have to wait or start a process. But [professional services] are best.”
Rethink Location for an Older Adult
The United States is a culturally diverse nation with many ethnically strong pockets and regions. Consider this when choosing care for your loved one: Would he or she prefer to be close to family or in a more culturally accommodating region?
Chan remembers when, after suffering a fall, his grandmother had to be moved from her home in Chicago’s Chinatown to a skilled nursing facility in Michigan, near family members. The move was culturally challenging for her, in her 90s and speaking primarily Cantonese.
He recalls that the staff tried to make accommodations on a day-to-day basis. “They put up a white board, where they tried to ‘Romanize’ her common sayings — they wrote some of her frequent phrases out phonetically. It helped some, but it was a one-way channel,” says Chan.
Food was another problem; the menu was unlike what his grandmother had been eating all her life, so family members did their best to bring in familiar meals.
Language accommodations are really just one element. Comfort with the menu, ability to join in activities and simply having someone to converse with all combine to help your loved adapt to their new community.
For example, in his facility in southern Florida, Merkelj says a large percentage of the residents are Hispanic or Creole.
“In our recruitment process, we try to balance staff members who are bilingual. We also try to integrate culture into activities, not only with conversation but in activities such as movies, music, dancing,” he says, adding that they see a favorable response.
Small Efforts Can Help
Formal language accommodations do have to be facilitated, but it is unlikely these services will be accessible around the clock. Family members can take some simple steps to help their loved one on a daily basis.
Merkelj says one thing he’s seen useful is a communication board — a simple, visual aid to help the patient communicate basic needs such as pain, hunger or a desire to make a phone call.
“You can make it with a computer. Families can help, which is valuable because many languages have different dialects or colloquial expressions,” he says.
A similar strategy is a flash card system, also something that families can create using index cards equipped with both a visual cue and the written equivalent, in both languages.
If appropriate, helping your family member learn to use a digital translator can be another form of assistance. In a study in a hospital setting, non-English-speaking patients were given iPads equipped with a multilingual assistance tool for six weeks and hospital workers concluded the tools helped support communications.
Find Common Ground
Finally, family should try to help their loved one be viewed as an individual with the staff or other residents by seeking ways to share his or her interests, background or true personality. Finding common ground can create a connection that breaks through language challenges.
“Communication is not just verbal; there’s body language, and the way things are expressed,” adds Merkelj.
It’s not easy for anyone to be uprooted from a home and for an older adult with minimal or no English, it can be especially challenging. But planning ahead, researching your rights and stepping in to assist can help create the best outcome.
Debbie Swanson () is a freelance writer living north of Boston. She often writes about pet care, senior living and family topics.
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