WASHINGTON, Oct. 13 (UPI) -- Hospitals want to offer more language services for patients who do not speak English well -- but that is easier said than done.
"It's like the wild west out there," Don Schinske, executive director of the California Healthcare Interpreting Association, told United Press International. "There is a lot of confusion."
Technically, hospitals have had a legal obligation to provide interpretation services of some kind to patients with limited English ability for decades, but services were largely provided on an ad hoc basis by family members and bilingual staff.
Now, with immigrant populations in many areas growing at an exponential rate, hospitals are looking to beef up their services not out of obligation but out of necessity. But the path to adequate language services is not well-defined.
There is no clearly identified game plan for hospitals to decide what mix of language services to provide, by whom, and how.
Sixty-three percent of hospitals report seeing patients with limited English proficiency either daily or weekly, according to the first national survey of hospital language services, released by the American Hospital Association this week. For hospitals with more than 300 beds, that number increases to 96 percent.
When those patients cannot communicate effectively, it has negative effects on the quality and efficiency of care including decreased use of primary care and increased use of expensive diagnostic tests and emergency rooms, previous studies have found.
Almost 90 percent of the hospitals surveyed were coping using a mix of bilingual staff, telephone interpretation services and full-time translators to serve the needs of patients speaking more than 80 different languages.
Because hospitals are prohibited by federal law for charging for language services, and Medicare and private payers do not provide reimbursement, hospitals must find ways to pay for the service they provide with existing funding.
Only 3 percent of hospitals surveyed said they receive direct reimbursement, almost exclusively in the handful of states that pay for language services through Medicaid.
And there is no set game plan for developing a language program.
After the Hispanic population in the area grew by more than 500 percent in 10 years, WakeMed Hospital in Raleigh, N.C., decided to stop relying on stop-gap measures and start a formal language services program -- but the facility was essentially required to design that program from the ground up.
It started as an effort to translate signs and consent forms but eventually ballooned into a hospital-wide effort. A task force formed to spearhead the changes eventually decided to hire a full-time manager of interpretation and translation services, 20 staff Spanish interpreters and three translators. Employee volunteers proficient in less common languages were given training as well.
The hospital also hired contract interpreters for less frequently encountered languages and a telephone service for patients who are deaf and blind.
All staff were required to attend training workshops for dealing with patients with limited English proficiency, and nurses were asked to complete online modules.
The end result was an overall cultural shift at the hospital, Cristina Krasny, language services manager, said at a panel discussion Wednesday. "Our program really aims at helping staff meet the challenges on a daily basis and a constant basis."
Now, the hospital helps smaller hospitals design their own programs, Krasny said.
There is also little agreement on what level of training is sufficient for a medical interpreter, Schinske of the healthcare interpreters association said.
Many interpreters are hired based simply on their perceived ability to speak English and another language, but they are not evaluated to see if they have the specialized vocabulary and communication skills needed to be effective in a hospital setting.
In addition, he said, there are other best practices -- repeating information back to patients for accuracy and giving doctor's instructions in first person, for example -- that untrained interpreters may not be familiar with.
Depending on how valuable an employer finds those skills, the length of training deemed necessary to work as a medical interpreter can also vary widely. Community colleges offer yearlong courses, while many employers send their employees to weeklong training sessions.
"There is not yet consensus about what constitutes adequate basic training," Schinske said.
Only one state, Washington, offers an official certification for the field, a "quality bar that most professions have," he added.
Discussions have taken place at both state and federal levels about measures that could be taken to add more uniformity, but in the meantime many hospitals do not have the luxury of waiting for them to be put in place.
Between 1990 and 2000 the non-English-proficient populations more than doubled in 15 states, and providers are "starting to deal with the issue of language access issues for the first time," said Mara Youdelman, staff attorney at the National Health Law Program.
"It's an issue that's not going to go away."
