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Position:
Healthcare providers should use trained interpreters for non-English proficient (NEP) or limited English proficient (LEP) patients during clinical encounters in geriatric care. Healthcare providers should not rely on family members and friends, and especially minor children, to function as interpreters.

Rationale:
Healthcare providers caring for older adults should be aware of language barriers among patients and their caregivers during clinical encounters. Quality geriatric care necessitates removal of impediments to communication such as language barriers. In 2000, the United States Census Bureau Report revealed that about 7 percent of persons 65 years or older did not speak English, and in some ethnic populations, over 70% of elders speak little or no English.^1,2 Projected demographic changes of increasing diversity among older Americans will lead to even greater language diversity and concomitant challenges for non-English proficient (NEP) or limited English proficient (LEP) patients while they navigate the healthcare delivery system.

In caring for NEP/LEP patients, healthcare providers should be aware of recent federal requirements regarding appropriate language assistance options and interpreters, which should be accessed during clinical encounters.^3,4 The National Standards on Culturally and Linguistically Appropriate Services in Health Care (CLAS) guidelines state that "health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation." The Office for Civil Rights (OCR) policy discusses acceptable language assistance options that can be used when caring for LEP patients. Using family members and friends and especially minor children as interpreters can pose unique problems and is highly discouraged. Serious clinical omissions or mistakes can result from: incomplete or inaccurate translations due to the family member's insufficient vocabulary in one of the languages or to censoring of personally uncomfortable or culturally inappropriate material; differing opinions between the provider and the family member about the importance of particular information; emotional involvement of the family member with the health of the elder; and confidentiality, fear, modesty or cultural norms which impede the discussion of health issues such as genito-urinary problems or elder abuse in the presence of a family member. With respect to interpreters, providers should be aware of the recent guidelines for The National Standards of Practice for Healthcare Interpreters.⁵ These guidelines discuss tasks and skills the interpreter should be able to perform which include; accuracy, confidentiality, impartiality, respect, cultural awareness, role boundaries, professionalism, professional development, and advocacy.

Geriatric providers are encouraged to be advocates for competent language access for older LEP and NEP patients in their clinical settings. Model hospital policies have been developed by the California Health Care Safety Net Institute⁶. In cases where there can be no trained interpreters available in person for a specific language, health care organizations need to provide clinicians technology allowing remote access, such as telephonic language banks, video interpreting, or remote simultaneous intepreting⁷.

Credits: Prepared by members of the Ethnogeriatrics Committee: Fred Kobylarz, Toni Tripp-Reimer, Rita Hargrave, Marianne Tanabe, Arun Rao, and Gwen Yeo.

1. Census Report Language Use and English-Speaking Ability: Census 2000 Brief C2KBR-29. October 2003. http://www.census.gov/prod/2003pubs/c2kbr-29.pdf
   
   
2. U.S. Census Bureau, Census 2000 Summary File 4.
   
   
3. Federal Register. National Standards on Culturally and Linguistically Appropriate Services in Health Care. Office of Minority Health. Vol 65:80865-80879. Washington DC; December 2000. Available at http://www.omhrc.gov/clas.
   
   
4. Federal Register. Policy guidance on the prohibition against national origin discrimination as it affects persons with limited English proficiency. Office of Civil Rights. Vol 65:52762. Washington D.C.: August 30, 2000. Available at http://www.hhs.gov/ocr/lep/guide.html.
   
   
5. National Standards of Practice for Health Care Interpreters September 2005. Available at http://www.ncihc.org/sop.htm
   
   
6. Paras, M. Straight Talk: Model Hospital Policies and Procedures on Language Access. California Health Care Safety Net Institute; California Association of Public Hospitals and Health Systems, 2005. Available at http://www.calendow.org/reference/publications/pdf/cultural/SNI%20CAPH%20Model%20Hospital%20Policies%20and%20Procedures.pdf
   
   
7. Roat, CE. Addressing Language Access Issues in Your Practice: A Toolkit for Physicians and their Staff Members. California Academy of Family Physicians and CAFP Foundation. 2005. Available at http://www.calendow.org/reference/publications/pdf/cultural/CAFP%20Language%20Access%20Toolkit.pdf.