Providing Health Care for Seniors and Persons with Disabilities Cultural Sensitivity Training Agenda Goals for Providers Who Are Seniors and Persons with Disabilities Cultural Awareness & Etiquette Regulations & Requirements Community Coordination Tools & Resources Questions 2 1
Goals for Providers Improve quality of care and satisfaction for members with disabilities Understand unique issues and barriers to care for people with disabilities Understand what the Americans with Disabilities Act requires of health care providers Improve awareness of community resources Increase awareness of SFHPs role in helping providers address issues 3 SFHP Enrollment Estimates Month San Francisco Estimate SFHP Estimate SFHP Cumulative Jun 1,655 1,175 1,175 Jul 1,722 1,223 2,398 Aug 1,751 1,243 3,641 Sep 1,751 1,243 4,884 Oct 1,730 1,228 6,112 Nov 1,663 1,181 7,293 Dec 1,718 1,220 8,513 Jan 1,746 1,240 9,753 Feb 1,548 1,099 10,852 Mar 1,641 1,165 12,017 Apr 1,548 1,099 13,116 May 1,602 1,137 14,253 4 2
SF County Seniors and Persons with Disabilities Aid Code Summary Aid Code Aid Code Description Count % of County Total 60 SSI/SSP 12,024 71% 14 Medically Needy- Aged 2,171 13% 64 Medically Needy- Disabled 1,237 7% 6H FPL Program- Disabled 520 3% 6V Department of Developmental 238 1% Services (DDS) Waiver 20 SSI/SSP Cash Blind 185 1% 1H FPL Program Aged 149 1% 6E Continued Eligibility for 141 1% Disabled 10 Aged 84 0.5% Others (6N, 6G, 6J, 66, 24, Each <80 6C, 1E, 2E) Each <0.5% 5 Non-Dual Seniors and Persons with Disabilities by Language Compared to Current SFHP Members Language Count % age Current SFHP membership English 8,683 51% 33% No valid data 3,389 20% 5% (Other) Cantonese 2,141 13% 36% (Chinese) Spanish 982 6% 20% Russian 565 3% Tagalog 421 3% 3% Vietnamese 285 2% 2% Mandarin 274 2% American Sign 3 0% Language (ASL) 6 3
Non-Dual Seniors and Persons with Disabilities by Ethnicity Compared to Current SFHP Ethnicity Count %age Current SFHP enrollment White 4,597 27% 7% Black 4,064 24% 11% Chinese 2,133 13% 28% Hispanic 1,651 10% 21% Other API 1,374 8% 9% No response 1,182 7% 12% Other 1,065 6% 4% Filipino 488 3% 5% Vietnamese 189 1% 3% 7 Defining Disability The World Health Organization calls disability an "umbrella term for impairments, activity limitations or participation restrictions, " conceiving "a person's functioning and disability... as a dynamic interaction between health conditions (diseases, disorders, injuries, traumas, etc.) and contextual factors," including environmental and personal attributes. Disabling conditions are nearly universal, relevant to almost all persons at some point in their lives. 8 4
Defining Disability About 30% of people living in the United States experienced either some difficulty with basic movement, or cognitive, sensory, or emotional problems The most common problems relate to basic physical actions such as walking, bending, and reaching (as reported by > 20% of those surveyed) A little over 13 % reported problems with vision or hearing, and about 3% reported emotional or cognitive difficulties 9 Defining Disability About 14% of people experience complex activity limitations in their ability to participate fully in social roles including maintaining a household, working, pursuing hobbies, visiting friends, and going to the movies or sporting events. 10 5
Health and Health Care Disparities Among Persons with Disabilities About 30% are overweight or obese compared to 19% of general population 40% smoke compared with 22% of general population Lower participation in health promotion and disease prevention programs Health self-rated as fair or poor as compared with excellent or good for general population 11 Snapshot of Women with Disabilities About 20% of women in the US report disability Fewer Pap tests and mammograms than women w/out disability 30% to 34% - overweight or obese Difficulty getting reproductive care 12 6
Snapshot of People Who Are Deaf or Hard-of-Hearing 37,000,000 (16.2%) adults experience some degree of hearing loss, ranging from a little trouble hearing to deafness Hearing impairment is the 6th most common chronic condition in the civilian population About 3.3% of adults in the US are deaf or hard of hearing Health disparities include: Hypertension Diabetes Smoking behavior Barriers to care: Effective communication 13 Snapshot of People Who Are Blind/Have Vision Impairments Diabetes is the leading cause of blindness among adults aged 20 74 Between 12,000 and 24,000 new cases of blindness attributed to diabetes are reported annually 10% of the population aged 18 and older experience difficulty seeing even when using glasses or contact lenses Among these, 0.7 million people (0.3%) are blind More than 2/3 of adults who have vision impairments are over age 65 Health disparities include: Diabetes Obesity Smoking behavior Barriers to care Lack of accessible diabetes care 14 7
Snapshot of People with Developmental Disabilities About 4.5 million people with developmental disabilities in the United States About 1/2 of the estimated 2.3 million people with intellectual t l disabilities are also considered d people with developmental disabilities many experience functional limitations Health disparities include: Overweight or obesity Lack of physical activity Inadequate dental hygiene Barriers to care Poor coordination of services between agencies Lack of physician training on management of developmental disabilities 15 Communication barriers Snapshot of Seniors in Medi-Cal About 2/3 of seniors without Medicare ( non non-dual eligibles) have a disability Most non-dual seniors are likely to have some type of activity limitation 30% of seniors with disabilities receive treatment for mental health conditions annually 16 8
Snapshot of Medi-Cal Beneficiaries Disability and chronic conditions coexist and cut across age groups among Medi-Cal beneficiaries 70% who have disabilities live with two or more chronic conditions 16% of these have diabetes (compared with 7% in generation population) About 25% have four or more chronic conditions 17 Communication Tips Communication skills are vital in developing relationships with people with and without disability Relax Mistakes are human, just be willing to learn from them Most importantly, if you don t know what to do or what something means, ask kthe person They are the experts on their needs and how to best meet them 18 9
Communication Tips Treat people with respect BE PATIENT and listen attentively People may be afraid (think about how your mother, father, sister, brother may feel) Allow someone more time to speak if they need it Be prepared to explain something more than once Speak with people using your normal volume and pace, UNLESS they ask you to speak louder or slower Don't attempt to speak for, or finish a sentence for the person you are speaking to 19 Etiquette Tips Never make assumptions about what people can/can t do Never speak about the person as if they are invisible, can t understand what is being said or can t speak for themselves Never ask, What happened to you? Don t be embarrassed to use common expressions like I ve Ive got to run or See you later People with disabilities use these phrases even if they can t run or see 20 10
Etiquette Tips Avoid words that have a negative tone: Cripple or crippled, mentally retarded Unfortunate, victim, suffer or suffering from, afflicted with, disease, illness, patient, in a vegetative state, invalid Dwarf, Paraplegic, Epileptic,Deaf and dumb, Brain damaged, Handicapped Insane, lunatic, maniac, mental patient, neurotic, psycho, psychotic, schizophrenic, unsound mind, crazy, mad Terms beginning i with the, such as the disabled or the blind Cerebral palsy sufferer 21 Words to use A guide to help 22 11
The ADA: Setting the Stage for Culturally Competent Health Care The Americans with Disabilities Act is a civil rights law enacted in 1990 Like other civil rights laws, it protects people with disabilities from discrimination The ADA ensures that people with disabilities have an equal opportunity to participate and applies to: States and cities, and their contractors such as SFHP The facilities and services of health care providers 23 The ADA: Setting the Stage for Culturally Competent Health Care The ADA requires: Building and facility accessibility Effective communication Programmatic accessibility including modifications of policies and accommodations Delivery of services in a way that ensures that all people have an equal opportunity to achieve the full benefit of those services and programs 24 12
Facility Accessibility Improving Healthcare Services for Persons with Disabilities Accessibility required for: New construction Alteration Modifications of existing facilities Some access modifications required by small health care providers if they can be accomplished without too much difficulty or expense Tax incentives available 25 26 13
Communication Access A way of ensuring that communications with people with disabilities are as effective as communications with others ASL -- a visual-gestural language used by millions of Americans of all ages. ASL is a rich and complete language that has a different grammatical structure than the English language Sign Language Interpreters Like any other language interpreters, translate English and American Sign Language (ASL) 27 A TTY is a special device that lets people who are deaf, hard of hearing, or have a speech disability use the telephone to communicate, by allowing them to type messages back and forth to one another instead of talking and listening Communication Tools Relay Service -- A person who is deaf, hard-of-hearing, deaf-blind, or has a speechdisability uses a TTY to type his/her conversation to a Relay Operator who then reads the typed conversation to a hearing person. The Relay Operator relays the hearing person's spoken words by typing them back to the TTY user. 28 14
Print materials in alternative formats: Braille Audio formats CD Cassette Communication Tools LARGE PRINT Assistive Listening Systems/Devices 29 More Examples Communication Tools Communications Access Realtime Translation (CART) Communication Access Realtime Translation (CART) is the instant translation of the spoken word into English text using a stenotype machine, notebook computer and realtime software. Written notes Qualified readers Text message Email Captioning Faxing Simple language/pictures 30 15
Take 3 times a day with meals 1997 United States Pharmacopeia (USP) 31 32 16
Programmatic Access Ensuring all people have the same opportunity to achieve the full benefit of a program or service This may require: Modifying policies, practices or procedures Providing accommodations Accessible medical equipment examples Accessible radiological equipment Height adjustable exam tables Adjustable mammography equipment 33 Programmatic Access Ophthalmology chair Wheelchair accessible weight scales Hoyer Lift Upright & Open MRIs 34 17
Programmatic Access Modification of standard policies and procedures Flexible appointment time Longer appointment time Providing assistance filling out forms Providing lifting/transferring assistance Providing print materials in alternative, ti accessible formats Providing interpreter services Allowing service animals 35 Programmatic Access More Examples Helping someone with a cognitive impairment to fill out an application form and gather required documentation Setting an appointment in the afternoon for someone whose medication has sideeffects in the morning Providing drop-in hours instead of appointment times for people whose mental impairments make appointments difficult 36 18
Service Animals A service animal is any animal individually trained to do work or perform tasks for the benefit of a person with a disability. Do not touch without permission Do not feed A service animal is not considered a pet but rather an animal trained to provide assistance to a person because of a disability. Guide Dog Mobility Dog Hearing Alert Seizure Alert/Seizure Response Medical Alert/Medical Response 37 Things to remember about people who have disabilities or activity limitations Not all people who are labeled l as having a disability need coordinated care Some will need coordination of services only during health status changes, such as surgeries, infections, or acute health situations, which may or may not be related to the identified disability 38 19
Things to remember about people who have disabilities or activity limitations Some people with cognitive processing or memory imitations may need preventive care reminders by care coordinator Others may only need support services such as transportation, print info in alternative formats, sign language or language services Some will want to be in charge of all decision making with care team to advise them Most will want to be involved in decision making process 39 Triple Aim: Improved Healthcare, Improved Experience, Lower Cost Enrollment of new Medi-Cal population p is a tremendous opportunity The transition to managed care may create initial angst and frustration Benefits will become evident to members over time: Primary care Coordinated care Advocacy Customer Service SFHP thanks our providers for working together to ensure a smooth transition! 40 20
Questions, Comments, Feedback? provider.relations@sfhp.org 41 21