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Elder Care Centers Try To Bridge Language Gap

By Gary White
Published: Saturday, August 20, 2011 at 11:29 p.m.

LAKELAND | Maria Cruz, a frail yet elegant woman of 96, sat in a wheelchair Thursday afternoon in a room at Highlands Lake Center, a skilled nursing facility in Lakeland. Across from her, speech therapist Madeline Magrina unpacked an array of communication aids — laminated papers with images of such common items as a sweater and a radio with corresponding words in English and Spanish.

Cruz has been diagnosed with dementia, and her speech therapy sessions are intended to bolster her cognitive ability. The sessions offer an extra challenge for Magrina, the therapist: Cruz, a native of Brazil, speaks Portuguese, while Magrina, a Puerto Rico native, speaks English and Spanish.

Cruz's daughter, Wilma Carrillo of Lakeland, was on hand Thursday to help with translation. She said the staff at Highlands Lake Center does everything possible to give her mother ways of communicating her needs.

Cruz illustrates a growing challenge for elder-care facilities.

As the state's foreign-born population continues to rise, nursing homes and assisted-living facilities accept more residents who don't speak English, creating challenges for the administration and staff.

Examples of facilities struggling to accommodate patients who don't speak English can be found throughout the state, said Diane Carpenter, regional manager for the Long Term Care Ombudsman Program, a state agency that advocates for residents of assisted-living facilities and nursing homes.

"I would say there's a facility in every one of our 17 districts that has that problem," Carpenter said.

State regulations require nursing homes to inform residents of their rights and to communicate with them about medical treatments and other important matters. That communication, both oral and written, must take place in a language the resident understands, said Michelle M. Dahnke, director of communications for Florida's Agency for Health Care Administration.


The most common scenario involves residents who speak only Spanish, but Carpenter said myriad language barriers can be found in Florida's adult-care facilities. It's not difficult to find nurses and certified nursing assistants fluent in Spanish, but nursing homes also accept residents who speak more obscure languages.

Terry Tressler, administrator at Highlands Lake Center, said the facility has had residents whose native languages were Polish and various Indian dialects.

Residents at Spring Lake Rehabilitation Center in Winter Haven include Haitian-born Creole speakers and people from Vietnam, said Anna Morris, the facility's admissions coordinator. Morris said Spring Lake has enough staff members who speak Spanish and Creole to have at least one working for each shift.

Likewise, Tressler said Highlands Lake Center, a 179-bed facility, has Spanish-speaking employees working every shift.

"If we have them as customers, then we're required to have the ability to communicate with them," Tressler said. "It's a broad requirement, but it has a very practical impact. If we're required to communicate, then it's our job to figure out how to do that."

Grievous problems are less plentiful in Polk County than in some other areas, said Tresa Johnston, the ombudsman program's district manager for Polk, Hardee and Highlands counties. But Johnston said she has seen facilities in Polk that didn't have enough Spanish-speaking employees to accommodate residents with no English skills.

Johnston cited the case of a resident at a Polk facility who was supposed to receive medication on an as-needed basis but didn't get it because the staff lacked Spanish speakers who could understand her requests. Johnston said she worked with the staff to create a picture board, giving the resident a way to convey her desire for medication.

Conversely, Carpenter said she has also visited some nursing homes with predominantly Spanish-speaking staffs and some residents who speak only English.

"I've gone up to (staffers) who only speak Spanish and said, ‘I'm having a heart attack. Can you help me?' and the staff member smiles and says, ‘Si, si, señora,' " Carpenter said.

Carpenter's agency doesn't have the authority to cite facilities for violations. In extreme cases, she said, her staff reports problems to the Agency for Health Care Administration, which has enforcement powers.

That agency maintains an online directory of nursing homes that includes languages spoken by staff members. Haines City Health Care Center is listed as able to accommodate speakers of Creole, Filipino, French and Spanish, a fact confirmed by the center's administrator, Tom Glass.

The directory says the Groves Center, a 120-bed facility in Lake Wales, has employees who speak Filipino, German and Spanish. The facility's administrator was not available Friday, but an employee said she knew of no staffers who speak German.


There may be no single solution to the challenge, but Johnston said elder-care centers should not admit residents who don't speak English unless they can provide at least one employee on each shift who speaks the resident's language.

That may be a realistic expectation for accommodating Spanish-speakers but a more formidable task in handling speakers of other languages. Aside from relying on family members to translate, facilities have other options.

The Alzheimer's Association, a nonprofit organization, offers a free, 24-hour translation hotline with access to some 80 languages, said Nancy Parente, senior bilingual program specialist for the Florida Gulf Coast chapter.

Private companies also offer interpretation services by phone. The largest, California-based Language Line, has trained interpreters in more than 170 languages, spokesman Dale Hansman said. The company charges $1.50 to $2.50 per minute, Hansman said.

Communication challenges can be particularly acute for elderly people with dementia, even in its early stages. As memory loss advances, people for whom English is not the primary language often lose their ability to speak it, Carpenter said.

"So you might have a Spanish-speaking individual who's learned to speak English, but as the disease progresses they lose the ability to speak English and revert back to their first language, whatever it is," Carpenter said. "They become isolated, and there's nothing that will put a person into depression and decline quicker than not being able to communicate. ‘Nobody hears my cries. Nobody wishes me good morning. No one cares about me.'?"

A similar example can be found at Grace Manor at Lake Morton, a Lakeland nursing home catering to residents with Alzheimer's disease. Administrator Kathy Claar said the population includes a man who learned Chinese and Japanese in childhood and later adopted English. Claar said the man, diagnosed with dementia, often lapses into one of his original languages.

"He'll start preaching in Japanese or preaching in Chinese, and we have to remind him, ‘You need to speak in English,'?" Claar said. "Sometimes when he gets agitated, he won't flip back to English. He'll stay in Chinese or Japanese for a while. It's been challenging, but we've always worked it out. He has very supportive family."

Tressler, the administrator at Highlands Lake Center, said his facility prides itself on meeting residents' needs, including the need to communicate and be understood. Part of the solution is creating "communication boards," pictorial aids like the ones the speech therapist used in her session Thursday with Maria Cruz.

One of the laminated sheets bore six images on each side, including a cartoon of a tense, frowning man accompanied by the Spanish word dolor and the phrase, "I am in pain."

If any residents are in pain — or hungry or cold or in need of a restroom — Tressler said his staff wants to be sure the message is transmitted.

"I'm not saying it's not a challenge, but usually it's a challenge we can solve," Tressler said.

"We can find some common ways to communicate."


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