language services and accessibility - elliot hospital · • no other elliot staff may be used to...

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Language Services and Accessibility

Daphne Martinez-CedresElliot Health System Interpreter - Spanish



Non-Discrimination StatementElliot Health System complies with appropriate Federal and State civil rights laws and does not discriminate on the basis of age; race; color; ethnicity; ancestry; national origin; citizenship; language; religion; creed; culture; sex; gender identity or expression; sexual orientation; marital status; military service; veteran status; educational background; socioeconomic status; source of payment of care; physical, developmental, or intellectual disability; genetics; or any other class protected by law


Laws Insuring the Rights of Patients with Disabilities or Limited English Proficiency (LEP) • American’s with Disabilities Act (ADA) Title III,

Sec. 36.303 Auxiliary aids and services (equal access to services)

• Title VI of the Civil Rights Act of 1964, and Executive Order 13166 (anti-discrimination)

• Affordable Care Act – Section 1557 (must provide qualified interpreters and translated documents to patients at no cost – no minors may interpret)


AccessibilityAccommodations for Patients with Physical

Challenges: • Handicap accessible parking• Ramps • Door openers• Accessible bathrooms (stalls and sinks)• Elevators• Flooring/carpeting appropriate for wheelchair use• Patient registration counters at appropriate level for wheelchairs • Lever-like door handles


AccessibilityAccommodations for Patients who are Blind or

Visually Impaired• Large print documents• Documents can be read to patients.• Magnifiers (in Communication Box)• Braille and raised lettering on elevators and room signage• Under the ADA service animals are allowed in medical settings. • Signage in patient rooms to help staff identify a patient with vision

loss:


AccessibilityAccommodations for patients who are Deaf or Hard of Hearing

Patients who are Hard of Hearing • Face patient when you are

speaking with them• Slow down your rate of speech• If the patient doesn’t understand –

rephrase your question• Use open ended questions (not

yes/no)• Provide an assistive listening

device from the Communication Box

Patients who are Deaf • Ask “What works best for you for

communication?”• Schedule an American Sign

Language (ASL) interpreter or use the Stratus Video Remote Interpreting Device

• When working with an ASL interpreter speak in a normal tone at a normal rate (no need to yell or speak at a slow pace). ASL interpreters will sign while you are speaking - different than working with a spoken language interpreter.

• Assistive Technology (closed captioning, videophones, TTYs)


Accommodations for Patients with Limited English Proficiency (LEP)

85 languages used by patients within the Elliot Health System in 2016

• Most diverse patient population in NH• Highest number of requests for

interpreters of New Hampshire health systems• Over $500,000 spent by Elliot Health System on

interpreting costs in 2016


Top Languages for Interpreting Requests in 2016 Within Elliot Health System (consistent over last 5 years)

1. Spanish (about 50% of interpreter requests)2. Arabic (fastest growing LEP patient population) 3. Nepalese4. Bosnian5. American Sign Language (higher cost than spoken

language interpreters)6. Vietnamese


Patient’s Right to an InterpreterPatients and companions (friend or family member, as per the patient’s request) have a right to a qualified interpreter at no cost to the patient.


What is a “qualified” interpreter?• Completed all the pre-employee screenings such as background and

drug screenings, immunizations, flu shot, etc. • Both written and verbal fluency in the target language has been

tested and determined to be proficient via formal testing measures by a qualified agency

• Successful completion of a 45-60 hour course for Medical Interpreters, including knowledge in • HIPAA• Anatomy and Physiology• Medical Terminology (in the target language)• Cultural mediation in medical settings• Structure of a health care system and roles of health care team

members


Interpreting services available Elliot Staff Interpreters• American Sign Language (ASL)• Spanish• No other Elliot staff may be used to interpret,

even if you are bilingual

In-person, contracted agency interpreters

Telephonic interpreting• Available 24/7

Stratus Video Remote Interpreting device• Video remote interpreters in ASL and 17 other spoken languages

(like Skype/Facetime) • Quick connections – sometimes used until in-person interpreter arrives.• Can also be used for audio only interpreting


Use of Family Members or Friends as Interpreters

• Must be as per request of patient – cannot be requested/suggested by Elliot staff

• Friend or family member must be over 18 yrs. (no under age children interpreting for parents)

• Patient must sign waiver releasing hospital of liability when they choose to use a friend/family member.

• Must inform patient in their preferred language of the availability of interpreters at no cost to them before signing the waiver (usually explained via telephonic or Stratus, not through the family member they are requesting to use as the “interpreter”

Elliot staff will often request a staff/contracted interpreter in addition to the friend/family member.


Benefits of using a qualified interpreter instead of a friend/family member:

Professional Interpreter

• Adhere to a Professional Code of Ethics

• Neutral • Must practice confidentiality• Must interpret accurately and

without bias• Allows family members to

remain in their role and support patients

• Trained in medical terminology in the target language

• Trained as cultural mediators

Friend/Family Member as “interpreter”

• May edit or withhold information (from provider to patient or from patient to provider)

• May answer for the patient instead of interpreting for the patient

• May not keep the information confidential within their community

• May present information in a biased way

• May not know the medical terms in their language


Interpreter’s Role as Cultural Mediators • A patient’s culture can greatly impact how they view their

medical care• Qualified interpreters work with medical staff to help

explain how cultural beliefs impact patient care and treatment

• Religion/spiritual beliefs• Gender roles• Family member roles• Cultural taboos • Beliefs about illness and death• Cultural view of medical

profession

• Homeopathic/alternative medicine

• Past traumas• Refugee experiences • Body image and boundaries


InterpretersTips for working with an interpreter• Speak to and face the patient, not the interpreter• Speak to the patient in the first person• Allow the interpreter to do their job – this is not the time to “practice”

your Spanish/French/Italian/Portuguese/etc. skills• Speak in relative short segments – pause to allow time for the

interpreter to convey the message and for the patient to reply – don’t interrupt the process

• Be aware that anything said in the room will be interpreted – side conversations to staff, comments, etc. Do not ask the interpreter not to interpret something.

• Engage the interpreter for the entire interaction – don’t just use the interpreter to “summarize” after you’ve done a series of tests, assessments, etc.


InterpretersMore tips for working with an interpreter• You may have done this procedure hundreds of times, but for the

patient often it is their first time. Ex: “I don’t need the interpreter because I really don’t need to talk to them when I …..” Remember communication is a two way street – what if they have a question or concern they would like to raise during that time?

• Allow time for questions – check in with the patient to insure they are understanding – use the “teach back method” ( ex: “tell me how you understand what we’ve just discussed”)

• Schedule additional time for appointments – communication takes longer with the use of an interpreter

•


Elliot Health System provides equal access to our services for LEP patients and patients with disabilities in support of our mission statement to:

INSPIRE wellnessHEAL our patientsSERVE with compassion in every interaction


Questions?


Manager – Language Services & Accessibility

Kimberlee Pelkey, MSW NHICSOffice: 663-2780 Pager: 385-7127Email: [email protected]

For more information contact:

INSPIRE wellness HEAL our patients SERVE with compassion in every interaction.