When you don’t speak English, the U.S. can be a perplexing place. While there are large communities of non-English speakers throughout the country, much of the government and work life is conducted entirely in English.
For older adults who don’t speak English, this can only compound the age-related challenges they face. Health and mobility issues can be isolating, and a language barrier can further exacerbate that isolation. And when even asking for translated documents is a challenge, it can be tough to access necessary services.
Unfortunately, that’s the situation that all too many U.S. seniors today are facing. According to the 2010 U.S. Census, 14.2 percent of people over 65 in the U.S. don’t speak English at home. What’s more, those older Americans who don’t speak English at home tend to be less proficient in English than younger people: only 36.3 percent of Spanish speakers over 65 are proficient in English, and only 27.8 percent of people who speak an Asian or Pacific Island language are proficient.
Legal Rights for Seniors with Limited English
But, as Justice in Aging staff attorney Denny Chan points out, seniors with limited English skills have legal rights -- it’s just a matter of exercising them.
Chan points out that the Affordable Care Act, the healthcare reform law passed in 2010 and widely known as Obamacare, includes a mandate for any healthcare provider receiving federal dollars not to discriminate on the basis of national origin. That means providing interpretation and translations services when needed.
Limited English speakers are also entitled to receive translated documents from their health care provider, and providers are required to notify consumers of their rights. However, patients don’t always know about their rights or how to go about exercising those rights by asking for an interpreter or a translation.
“The absence of a translation means that someone can't participate in the program itself, that's where you run into problems,” Chan says. “These rights are only as good as when people assert them and know when to ask for those services.”
Translation services are more necessary than you might think. Sometimes, families might ask a child to translate, or rely on their own limited knowledge of English. In other cases, staff members at their healthcare provider’s office with a casual knowledge of a second language might attempt to translate. But in these cases, the translator often lacks a professional knowledge of the language, particularly a medical knowledge.
“One thing that the federal law lays out is that the interpretation service has to be by someone who is qualified,” Chan says.
Of course, access to translators will vary by where the service provider is located and what language needs translation. While Spanish translation might be easy to come by in California or Texas, it will be considerably more difficult to translate Tagalog in North Dakota.
Language Assistance Options in Health Care or Long-Term Care Settings
Technology offers a solution to that problem. Free translation services are available via phone or Internet and that can get a qualified translator on the line in minutes. Chan says that a lot of healthcare providers, and especially the larger ones, contract with these services.
“Improvements to technology have really helped a lot of healthcare providers to comply with the law and help a lot of people get the access that they need,” Chan says.
Chan also points out that anyone seeking interpretation has the right for the services to be free and timely. He notes that while people may be afraid to ask because of the potential cost, the law states that they should be provided for free.
Interpretation services should also be provided quickly under federal law. Chan says a healthcare provider's staff shouldn't take a long time to find the person who can translate, and that these services should be readily available.
“The law is supposed to give people who don't speak English proficiently the same level of access [as those] who do speak English proficiently,” Chan says. “If you don't have to wait if you do speak English, you shouldn't have to wait if you don't speak English.”
How One Senior Care Provider is Tackling The Challenge
In ethnically diverse areas, translation can be a constant challenge for senior care providers. At On Lok Lifeways, a California-based organization that operates adult day care centers and clinics as well as providing in-home care and other services for seniors, social workers say their participants speak at least six different languages.
On Lok operates at several different locations in the San Francisco Bay Area, a region with a large immigrant population, particularly from Mexico and Asia. The mix of languages spoken by clients depends on the surrounding neighborhood, according to Chau Lam and Szu-Ning Chen, social workers at the San Jose location. In their facility, there are many Spanish, Vietnamese, Mandarin and Cantonese-speaking clients as well as some who speak Hindi or Tagalog.
Social workers at On Lok turn to a variety of methods to communicate with their clients, including telephone services, contract interpreters and even a picture book so seniors who are just arriving to the center can point at illustrations of what kind of service they might need.
“We do have staff available for all the participants with different languages,” Lam says.
Of course, the adult day care program can only provide limited medical services and must partner with other health care providers for any specialists, like cardiologists or ophthalmologists. But, through its attention to language access, the organization has been able to remove a major barrier to healthcare access for local seniors.
The diverse community that congregates at their centers can even help seniors find new community connections, On Lok representatives say. Growing old can be an isolating experience, particularly when it means lost mobility, and being disconnected from the surrounding culture through limited English skills can only worsen the situation.
At On Lok, participants usually can find other seniors or staff who share a similar background, helping to overcome that isolation, and leading to confidence while engaging with the rest of the community.
Possible Changes to Protections for Non-English Speakers on the Horizon
While the rights of foreign-born people seeking healthcare are protected under federal law, the future of those rights is murky, as there have already been efforts to repeal the Affordable Care Act by the Republican Congress and President Donald Trump’s administration.
State laws can offer even greater protections than federal law, however, so Justice in Aging recommends that people get to know what the law says in their state.
“It's an anxious time for people who don't speak English as their primary language because there’s been a number of efforts to chip away at the protections they have,” Chan says. “We’re going to do whatever they can to make sure those protections stay as strong as possible.”