AP-NORC poll: Hispanics see barriers to nursing care
By DANIEL TRIELLI
Aug. 23, 2017
WASHINGTON (AP) — Close to one-half of older Hispanics have faced language or cultural barriers interacting with health care providers, and few have confidence in long-term care facilities to meet their needs, according to a poll by the Associated Press-NORC Center for Public Affairs Research.
And that may result in lower use of nursing care, even as Hispanics live longer than their non-Hispanic counterparts.
Fewer than 2 in 10 Hispanics age 40 and older say they are very or extremely confident that nursing homes and assisted living facilities can accommodate their cultural needs, according to the poll.
Experts cite two factors that might be contributing to the lack of confidence: social norms among Hispanic families that discourage outside care of older relatives, and a lack of high-quality providers.
"Quality is not just meeting government requirements. It's also having high engagement and a sense of community," said Jacqueline Angel, a sociology professor at the University of Texas at Austin, who has researched Hispanics and aging.
Jane Delgado, president of the National Alliance for Hispanic Health, agreed. Most nursing homes have not been attuned to the particular needs of Hispanics, she said. "Culture is not something that they are interested in."
The poll found that about half of Hispanics have had difficulty communicating with a health care provider because of a cultural (47 percent) or language barrier (45 percent).
Angel said that may result in lower use of long-term care facilities.
Hispanics accounted for 5.5 percent of all nursing home residents in the U.S. in the first quarter of 2016, according to government data. Hispanics represented about 8 percent of the population 65 or older.
Research shows current nursing home admission rates for Hispanics are far below levels for other ethnic groups, Angel said.
That happens even when taking into account that Hispanics tend to live longer. Government statistics show that Hispanics have a life expectancy of 82 years, longer than non-Hispanic white Americans (78.7 years) and non-Hispanic black Americans (75.1 years). Hispanic women have a life expectancy of 84.3 years.
"The good news is that we live longer. But that also means that we are going to need more care as time goes by and as young people move away from home," Delgado said.
To break down cultural barriers, experts say that nursing homes and assisted living facilities must invest in a more personal experience for residents.
In places such as Palm Beach County, Florida, where many people have Hispanic origins, that is practically a requirement.
At the MorseLife group, a senior health care and housing provider in West Palm Beach, half the staff is bilingual. "We have therapists who can communicate directly with the patient, not only understanding the language, but also the cultural aspects of what they are saying," said Dr. Ivan Merkelj, one of the directors.
Hispanics may also have higher expectations of what long-term care services should entail.
The AP-NORC poll showed that Hispanics are more likely than older adults as a whole to say that the typical home health aide should provide services such as shopping for groceries (75 percent to 62 percent), transportation to a doctor's appointment (84 percent to 71 percent), and making sure bills are paid (52 percent to 33 percent). Angel said this may reflect a desire to replicate the home environment.
Delgado suggested that communities adopt day care programs such as PACE, or Programs of All-Inclusive Care for the Elderly. Adopted by 122 organizations, the model establishes guidelines for senior day care programs, with a focus on listening to specific needs and demands from seniors.
Merkelj, originally from Peru, is the medical director of the Palm Beach PACE program. He said it not only allows seniors to have independence, but also eases them into contact with nursing homes and assisted living facilities for when the time comes.
"There's a belief that it's your responsibility to keep your mother and father in your home until they die," he said. "But once we establish a relationship of confidence with the family, that can change."
The survey was conducted March 2-29 by The Associated Press-NORC Center for Public Affairs Research, with funding from the SCAN Foundation.
It involved interviews in English and Spanish with 1,341 people aged 40 and older nationwide who are members of NORC's probability-based AmeriSpeak panel, which is designed to be representative of the U.S. population. The survey includes interviews with 310 Hispanics age 40 and up. Results from the full survey have a margin of sampling error of plus or minus 2.2 percentage points, and plus or minus 6.2 percentage points for the Hispanic sample.
AP-NORC long-term care polls: http://www.longtermcarepoll.org/