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DiversityNursing Blog

Insuring Undocumented Residents Could Help Solve Multiple US Health Care Challenges

Posted by Erica Bettencourt

Mon, Mar 30, 2015 @ 10:36 AM

Source: University of California - Los Angeles

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Latinos are the largest ethnic minority group in the United States, and it's expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers. Latinos' low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.

Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA: The consequences of not covering undocumented residents. The growth of the Latino population in states that are not participating in the ACA's Medicaid expansion program. The heavier demand on public and private health care systems serving newly insured Latinos. The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.

"As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels," Ortega said. "Resolving these four key issues would be an important first step."

Insurance for the undocumented

Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.

For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA's expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.

For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA's exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.

In addition, previous research has shown that undocumented people often delay seeking care for medical problems.

"That likely results in more visits to emergency departments when they are sicker, more complications and more deaths, and more costly care relative to insured patients," Ortega said.

Insuring the undocumented would help to minimize these problems and would also have a significant economic benefit.

"Given the relatively young age and healthy profiles of undocumented individuals, insuring them through the ACA and expanding Medicaid could help offset the anticipated high costs of managing other patients, especially those who have insurance but also have chronic health problems," Ortega said.

The growing Latino population in non-ACA Medicaid expansion states

A number of states opted out of ACA Medicaid expansion after the 2012 Supreme Court ruling that made it voluntary for state governments. That trend has had a negative effect on Latinos in these states who would otherwise be eligible for Medicaid benefits, Ortega said.

As of March, 28 states including Washington, D.C., are expanding eligibility for Medicaid under the ACA, and six more are considering expansions. That leaves 16 states who are not participating, many of which have rapidly increasing Latino populations.

"It's estimated that if every state participated in the Medicaid expansion, nearly all uninsured Latinos would be covered except those barred by current law -- the undocumented and those who have been in the U.S. less than five years," Ortega said. "Without full expansion, existing health disparities among Latinos in these areas may worsen over time, and their health will deteriorate."

New demands on community clinics and health centers

Nationally, Latinos account for more than 35 percent of patients at community clinics and federally approved health centers. Many community clinics provide culturally sensitive care and play an important role in eliminating racial and ethnic health care disparities.

But Ortega said there is concern about their financial viability. As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.

"These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time," he said. "So it remains unclear how these clinics will continue to provide care for them."

Need for diversity in health care workforce

Language barriers also can affect the quality of care for people with limited English proficiency, creating a need for more Latino health care workers -- Ortega said the proportion of physicians who are Latino has not significantly changed since the 1980s.

The gap could make Latinos more vulnerable and potentially more expensive to treat than other racial and ethnic groups with better English language skills.

The UCLA study also found recent analyses of states that were among the first to implement their own insurance marketplaces suggesting that reducing the number of people who were uninsured reduced mortality and improved health status among the previously uninsured.

"That, of course, is the goal -- to see improvements in the overall health for everyone," Ortega said.

Topics: US, study, UCLA, clinic, diversity, health, healthcare, hospital, care, residents, undocumented, language barrier, health centers, Insuring

Interpreter Services | UCLA Health (Video)

Posted by Erica Bettencourt

Fri, Oct 17, 2014 @ 11:56 AM

The UCLA Health Interpreter/Translation and Deaf Services program provides services to all UCLA Health inpatients, outpatients, and their relatives at no cost. Every attempt is made to provide services in any language. The service will be provided by an in-person interpreter, video conference or by telephone.

Source: Youtube

Topics: UCLA, interpreter, diversity, nursing, health, video, health care, hospital, YouTube

A nurse who is healing patients and himself

Posted by Alycia Sullivan

Fri, Nov 01, 2013 @ 11:31 AM

He was riding in his aunt's sedan, a kid in elementary school, watching senior citizens walk in and out of the Lynwood retirement home where his mother worked. Then she emerged in scrubs.

That's it.

David Fuentes holds on tightly to that simple memory: his mother at work. It's easier than recalling many other parts of his childhood — "a blur," as he calls it.

Like the time when he was little and his father, drunk, socked his mother. She remembers the blood gushing from her face and her child standing in the bathroom saying, "Mom, Mom."

Or the times when he was older and his mother had fallen into addiction. He would stay awake fearful of what might come when she went out looking for a fix.

Or the times he took care of his siblings when no one else would.

"Just like the basic things. That's all I really remember," Fuentes says, "kind of helping to make sure they got fed, and just keeping them company, making sure they were OK."

His face tightens slightly with some questions about the past. But he knows he doesn't need to remember everything.

He has his one simple memory. His mother, a nurse.

She always dreamed of becoming a registered nurse, but life got in the way.

"There's a huge family dynamic," says Fuentes, 26. "I wanted to fulfill for my mom what she envisioned for herself, but could never do."

This summer, he graduated from nursing school at UCLA and landed a job in the intensive-care unit at UCLA Medical Center, Santa Monica.

Beyond being a trailblazer in his family, Fuentes is among a group of men redefining the nursing industry. Although the profession is still dominated by women, the number of men is on the rise.

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David Fuentes attends the morning huddle before the shift change in the intensive care unit at UCLA Medical Center, Santa Monica on April 11.

The percentage of male registered nurses more than tripled from 2.7% in 1970 to 9.6% in 2011, and the proportion of licensed male practical and vocational nurses increased from 3.9% to 8.1% over the same period, according to the U.S. Census Bureau.

Researchers cite various reasons for the shift, including diminished legal barriers, increasing demand for nurses as the U.S. population ages, and middle-class pay.

But for Fuentes, a main motivation is the solace he finds in being a caretaker.

"Everything is left behind," he says. "That's why I love it so much."

"It's like therapy ... kind of our way of dealing with our issues."

The sturdy curve of his biceps, the gauge in his left ear, the lip ring and tongue ring might seem intimidating if it weren't for the delicate way Fuentes presses on the legs of a 99-year-old patient to check her blood flow, or how he cups his hands and drums on her back to help her breathe more easily.

It is 45 minutes into his first shift as a registered nurse, and Fuentes and another RN are caring for the elderly woman, who had been in septic shock.

She is blind and mostly unresponsive, but Fuentes asks politely, his voice soft but direct: "I'm going to take your temperature ... OK?"

Another nurse says the woman's family stayed for 15 minutes earlier in the day. But Fuentes will be there the whole night standing guard — giving her medicine and monitoring her pain and breathing on his 12-hour overnight shift.

His black curly hair is pulled back into a ponytail and he's wearing navy blue scrubs, the color of the uniform defining his new rank.

"This is the first day of the rest of my life," Fuentes said before his shift started.

Fuentes thinks it's only natural that some patients feel more comfortable with nurses of the same gender, but mostly, he says, it doesn't come up.

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David Fuentes examines Russell Sherman, 87, a patient being treated for a pulmonary embolism. Sherman says he remembers when all nurses were women in white uniforms.

A couple of months earlier, during his training, he was checking the oxygen flow into patient Russell Sherman's nostrils when the 87-year-old looked him over admiringly and said he remembered when the only nurses at hospitals were women in white.

"They were always girls," Sherman said. "It doesn't faze me at all. I think it's a good thing for men to be able to do a job without shame."

One of Fuentes' heroes is UCLA School of Nursing Dean Courtney Lyder, the nation's first male minority dean of such an institution.

Lyder, 47, said his own dean at Rush University Medical Center in Chicago, Luther Christman, was the first male dean of a school of nursing in the country. Tall and muscular, he "debunked a lot of preconceived myths about nursing."

Decades later, Lyder said, stereotypes about men in nursing are fading and the experience he had in nursing school — one of five men in a class of 200 — is becoming more uncommon. Although he says "we still have a long way to go" as an industry, 11% of students at UCLA's nursing school during the 2012 - 13 academic year were men.

"Men are seeing that this is a viable option that pays well, you have a good lifestyle, you give back to society," Lyder said, adding that nursing groups such as the American Assembly for Men in Nursing have also surged on college campuses.

"Nursing doesn't have a gender. Society and media have portrayed nursing as feminine," Lyder said. "It's not."

But there are nuances, some more subtle than others.

Huddled around sack lunches at a table outside the hospital, a group of undergraduate students — about eight women and one man squeezed in at the far end — took turns saying that they wanted to become nurses because they want more meaningful relationships with patients, not just because it's a good career.

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David Fuentes makes the rounds with registered nurses Pamela Helms, center, and Heather Alfano in the intensive care unit at UCLA Medical Center, Santa Monica.

But they struggled to respond when the conversation shifted to pay grades, and the fact that even though men are far less represented in the field, census data show that women earn less on average, 91 cents for every $1 earned by a man.

"I think men obviously are more stronger than women, so maybe," one of the female students said, grasping for a reason. "I don't know, I'm trying to justify it."

The group packed up a few minutes later and went back to work.

Fuentes says that he decided to go into nursing in his freshman or sophomore year of high school, but his mother says his instinct for caretaking goes back much further than that.

"Sometimes I feel that maybe he grew up a little bit too fast because he wanted to make things easier for me," said Guadalupe Perez, 44. "Always got the impression that he kind of knew what was going on, like he just understood.... You could see the sadness in his eyes."

She's proud of her son, even when he chose to live with his aunt and only saw her on weekends.

"He has a good heart, he was always there for his little brother," she says. "Maybe it's just something that ... got into him, always being there to help someone."

But Fuentes is already thinking much bigger than his first love and about the role that nurses can play in the national debate over healthcare and the changes to the healthcare system.

Even though his past is painful, he doesn't want to put it behind him. "It's made me who I am," he says.

Late one night before graduation, Fuentes scribbled his thoughts about the nursing industry and then read them aloud as if his fellow graduates were listening.

"I am sure every single one of you in those seats, pre-license and licensure students alike, can attest to the roller-coaster ride that your respective nursing journey has taken you on," he wrote.

"There have been lots of ups and downs, unexpected turns this way, that way, every which way you could and never would have fathomed, but look at us now, we made it!"

Source: LA Times

Topics: male nurse, UCLA, Santa Monica, David Fuentes, nursing

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