Language Barriers in Home Health Put Patient Outcomes at Risk

A lack of diverse language skills among the home care workforce is putting patients with limited English proficiency at risk, according to a recent study.

Language gaps with their caregivers put some people at higher risk of adverse events, higher risks of 30-day readmissions, and longer length of stay in both inpatient and emergency room settings, research from the New York University Rory Meyers College of Nursing (NYU Meyers) shows.

These language gaps between patients who have limited English proficiency (LEP) and those that take care of them are widespread throughout the health care system, but may be the “most pervasive” in home health care settings, NYU Meyers found. Additionally, there is little research on the impact of language barriers on patient outcomes.


“This is an ongoing challenge for health care providers,” Penny Feldman of the Center for Home Care Policy and Research at the Visiting Nurse Service of New York (VNSNY) said in an article on the research.

The study, “An Exploratory Analysis of Patient Provider Language-Concordant Home Health Care Visit Patterns,” looked at language concordance—a private duty call where the provider spoke the same language as the patient or was accompanied by an interpreter—for registered nurses (RNs) and physical therapists (PT).

Only 18.1% of RN visits and 26.7% of PT visits with LEP patients were language concordant across dominant immigrant demographics—English, Chinese, Italian, Greek, Korean, Russian, Spanish, Yiddish and others.


“Despite the fact that Spanish is the second most spoken language in the U.S., only 13.1% of RN visits with Spanish speaking patients were language concordant,” the article states.

Korean speakers had the highest level, 31.3%, of these language-concordant visits, followed by Russian speakers—22.4%—and Chinese speakers— 18.7%—the study found.

As the makeup of the United States continues to shift, with one if five U.S. households speaking a language other than English at home, the demand for language-concordant home health care services is likely to rise. The lack of language concordant home health visits also opens the door to other potential pitfalls, such as cultural competence, unconscious bias and discrimination in heath services, the study found.

“The broader significance of these findings is that as societies diversify through immigration, the demand for language-concordant health services will rise,” said researcher Allison Squires.

Testing and Certification Limitations

A potential obstacle for workers who wish to become certified home health care aides is that the testing, at least in the Washington, D.C. area, is only offered in English, according to Marla Lahat, executive director of Home Care Partners, an in-home care services provider in the D.C. area.

Home Care Partners currently staffs just one Spanish-speaking caregiver in the D.C. city proper. The provider does have a group of Spanish-speaking caregivers and clients in the D.C. metro area. While in demand, Home Care Partners has not found a significant need for more Spanish-speakers in the city proper, according to Lahat. However, that may be because of who the organization serves.

Home Care Partners provides home care services within a niche—funded through neither Medicare nor Medicaid. Instead, the provider is mostly grant-funded, according to Lahat.

“We fill a different niche for generally [those with] low incomes that don’t qualify for Medicaid or Medicare services,” Lahat said. “These are low-income individuals who would have difficulty affording private duty care but don’t qualify for Medicare.”

Much of the need for Spanish-speaking caregivers may be siloed within Medicaid, according to Lahat. However, with recent anti-immigration positions and rhetoric throughout the country and within the new Trump administration, fewer immigrants may want to receive services through federal programs like Medicaid, Lahat speculated.

“I think some people are worried if their immigration status is not what they want it to be, they don’t want to get involved in many programs that could make them vulnerable,” she said.

If fewer people in the D.C. area end up turning away Medicare and Medicaid services on these fears, Home Care Partners could potentially see an increased demand in services and possibly for Spanish-speaking caregivers.

To boost the number of Spanish-speaking caregivers, standards should be changed, with certifications, testing and classes available in other languages, Lahat said.

“[Caregivers] should have some English proficiency for an emergency, but there is a place for workers of a particular background, culture and language to work with clients in that same population and provide them with appropriate, culturally sensitive services,” Lahat said. “No one is saying a Spanish-speaker has to be placed with a Spanish-speaker, but if we want to bring in more workers and people with diverse language skills, we need to be able to accommodate them.”

Written by Amy Baxter

Photo Credit: “NYU” by Lars Kiesow

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