Alzheimer’s Disease and Relate Dementia Reform Health Care

Executive Summary

The “model minority” stereotype and lack of disaggregated data, emulate inaccurate representation of the Asian Americans and Pacific Islander (AAPI) community, causing older adults, in particular, with Alzheimer’s disease and related dementias, to experience language and cultural discriminatory barriers, impacting the accessibility of appropriate health care services. Advocating for linguistically and culturally appropriate health care services will aid in achieving the health needs of AAPI older adults, by health care providers’ implementation of in-language resources and by educating mainstream aging providers on the cultural differences within the AAPI subpopulations. On the contrary, some debate that in-language services such as professional interpreters create additional communication barriers and culturally competent services lead providers to make inappropriate patient assumptions, that can result in adverse consequences. Therefore, a language and cultural policy must, in addition to, providing aging AAPIs with individual quality care and direct services but, also combat potential contradictions and diminish latent negative effects.

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Background

The aging population in the United States is only increasing, anticipating for the first time in history, that residents sixty-five years or older will exceed the fifteen years and younger demographic (AARP, 2015). Almost half of AAPIs’ 10 percent of the total U.S. population, 4.64 percent, are calculated within the national aging population (Ong, 2016). National longevity parallel to the AAPIs increasing population trajectory impacts the rapid demographic shift that projects that the AAPI older adult population will increase by 145 percent, between the years 2010 and 2030, becoming one of the fastest-growing aging minorities (U.S. Census Bureau, 2010). However, even as the population of AAPI older adults escalate, due to the affixed “model minority” stereotype and aggregated data under the homogenous Asian category, there is a lack of language and cultural services; for instance although the funding from the Older Americans Act (OAA) serves more than 2.7 million older adults, in 2013 they only served little over 3 percent of AAPIs, in addition to only 3 percent of provided caregivers were AAPI juxtaposed to 53 percent being Caucasian (Administration for Community Living, 2013).

The problem of insufficient language and cultural services has its cause in AAPIs ability to receive equitable access to health care resources that can provide earlier information, diagnosis, assistance, and understanding to both AAPI patients and families on Alzheimer’s disease and related dementias. The total U.S. population increases by 18 percent in comparison to Asian Americans’ 74 percent increase and Native Hawaiian and other Pacific Islanders’ 52 percent increase, causing both the expanding AAPI demographic and its’ seniors to experience negative disseminating generational affects if health care providers fail to improve linguistic and cultural policy, that will evidently impact the future of AAPI health care (Ong, 2016). The growing issue of absent AAPI language and cultural services, experience considerable research by the National Asian Pacific Center on Aging (NAPCA), in collaboration with the White House Initiative on Asian American Pacific Islanders (WHIAAPI), investigating and highlighting the diverse needs of the aging AAPI population, in efforts to promote accessible public services, while addressing the extensive prevalence of health care issues.

Discriminatory barriers of language and culture impact all low-income and communities of color, making it difficult for patients and families with Alzheimer’s disease and related dementias to receive the proper health care accommodations and resources. Unable to communicate with health care providers, impose further implications for both the physician and patient to issue proper services, recommendations, and caregiving. Existing Older Americans Act and Affordable Care Act are provided for AAPI older adults however are not implemented in a way that best serves the AAPI community with health insurance, funding, and or language and cultural applicable resources.

Due to already expanding access to health care services, by developing the 1998 Minority AIDS Initiative and current legislation to expand health services for diabetes, cancer, and Alzheimer’s diseases patients, your experience will serve as a tremendous asset in helping advocate for the improvement of linguistic and cultural policies, to further contribute to your existing efforts. In the Congressional District 43, CA, with a population of 745, 656, race and ethnicity census data reports Asian to be 13 percent of the population, while about 90 percent of the rate in California is 14 percent, it is more double the 6 percent rate of the entire United States population (Census Report, 2017). Furthermore, under the category place of birth, out of the 31.3, residents recorded as apart fromthe foreign-born population, 25 percent are accounted as Asian, which is about two-thirds of California’s rate of 38 percent and about 80 percent of the 30 percent in the United States. This data, however, neglecting to disaggregate the category Asian into subpopulations as well as adhere to OMB Directive 15, revised standards that require the separation of Asian into the two categories “Asian” and “Native Hawaiian or Other Pacific Islander”. Therefore, if the data was to be collected and recorded based on subpopulations, could provide further insight into District 43’s current AAPI demographic. Despite the data’s flaws, it does, however, highlight the prevailing amount of Asians and foreign-born Asians that would benefit from proponents for linguistically and culturally appropriate health care services.

Evidence

A comprehensive search was done by using the AAPI Nexus Journal database, including quantitative testimony from publication by other advocacy organization such as National Asian Pacific Center on Aging, AARP Executive Summary, Centers for Disease Control and Prevention, and National Standards for Culturally and Linguistically Appropriate Services in Health Care.

Problem

Despite of the recent push by NAPCA and WHIAAPI for greater language and culturally appropriate services, for aging AAPIs with Alzheimer’s disease and related dementias, many AAPIs still faced with the “model minority” stereotype and aggregated data collection, hinder the momentum for the inauguration and implementation of improved funding, language assistance, and cultural competence of health care providers. Advocacy must preserve in collecting disaggregated data on AAPI older adults with Alzheimer’s disease and related dementias, that can be used to build a defense around long-term service and support systems for California, particularly, the Congressional District 43, to help organize and understand the unique health services and resource trends among AAPI subpopulations. Many AAPI older adults experience stigma and misperceptions surrounding Alzheimer’s disease and relate dementia, causing many AAPIs to either not seek or fully understand current resources and services, that can be resolved by increased funding, education, and holding health care providers accountable for supplying preferred language services and cultural competency.

Policy Options

Increase funding for in-language resources and cultural competency: Available funding for linguistically and culturally accessible information will be an imperative implementation for AAPI older adults to achieve maximum health security and care. By increasing the funding for language and cultural services, health care provides can allocate more fiscal investments in supplying in-language interpreters proficient throughout the diverse language needs of each AAPI subpopulation. This policy option will result in a high monetary demand, however, the negotiation with different health care providers and data researchers can allow for an equitable determinant that financially adheres to both currently established projects or requirements while allocating resources to support the linguistic and cultural finances. Funding from influential statewide organizations or higher-level individuals, like the Workforce Development Aging and Community Services or Kerio, will facilitate a stronger health care equity amongst AAPI older adults and contribute to available services, aiding in the communicative understand of Alzheimer’s disease and relate dementias. Fiscal support for in-language resources will include but are not limited to the hiring of a bilingual staff, interpreter services, and in-language programs, services, and resources to patients with limited English proficiency or languages barrier.

Providing ongoing health care education and training on culturally and linguistically appropriate service: Instituting and facilitating the continuation of educating and inculcating health care providers and staff on AAPI cultural differences will endeavor to ensure the reliable accessibility to educated professional translators and staffing across all levels and disciplines, knowledgeable in cultural and linguistic appropriate services. Most AAPIs value physical family unity and employ family or informal caregivers as translators, with 54 percent communicating with health providers versus 36 percent of the total population (AARP, 2014). However, due to the complexity of medical information and diction, culturally and linguistically educated interpreters and aging providers are of compulsory importance to ensure each patient understands and receives quality life care. Supplementary, due to lack of public education, AAPI families experience delusions surrounding Alzheimer’s disease and related dementias, due to the topics’ inability to be properly translated, therefore, aging AAPI are unable to receive and or understand the necessary resources available. Higher cost for implementation may manifest; however, will benefit the long-term ramifications if health care providers do not stress the importance of persistent linguistic and cultural education. Support from the National Council on Interpreting in Health Care and demographic information and health-related facts from U.S. Department of Health and Human Services, Office of Minority Health, to promote efforts of understanding communities and each unique culture.

Assure health care providers supply preferred language service and diverse competence of cultural health practices: Developing regulating standards for language and cultural health care services that require all health care providers to follow a systemized format and report on currently employed services. By recording and holding health care providers accountable, for which languages were most commonly administered and analyzing the effects of how cultural competency resources and additional services impact overall understanding and security, will visibly aid in the implementation of such systemic language and cultural services. Health care organizations and providers must dispense patients with their preferred language both verbally and through written notices, to ensure the full understanding and correct translation of the medical information. Expressing concerns on the cultural assumptions brought on by health care providerscan be eliminated by ensuring their responsibility for in providing equitable and accessible health care resources and enforcing the importance of language and cultural diversity.

Recommendation

The Congressional District 43, CA, should increase the funding, education, and hold health care providers accountable for the diverse language and cultural needs of different AAPI older adults and families with Alzheimer’s disease and relate dementias, in addition to significantly expanding the collection of disaggregated data on AAPI subpopulations. Given the above policy options, which correspond intersectionality, it would of the utmost importance, in efforts to build a unified voice among AAPI older adults and others community members within Congressional District 43, CA, to begin corresponding with external AAPI organizations, such as NAPCA, as well as with community-based AAPI-serving organizations, on implementing linguistically and culturally appropriate health care services. The problem of lack of linguistic and cultural services can be resolved through increased funding to improve current data on AAPI older adults. Disaggregated data will illustrate to policies makers, the diverse subpopulation demand within the category of Asian, for in-language and cultural competency resources that will provide patients with professional translators and health care providers with knowledge regarding the varying medical strategies and beliefs within each serving AAPI subpopulation. The second policy option will resolve this problem by requiring all health care providers to enforce the continuation of education and training on AAPI cultural and linguistic differences. For example, with 42 percent of AAPIs care for elders, versus 22 percent of the general population; many, AAPI families due to traditional cultures, value family closeness over health care providers, therefore resistant in, assistance, submitting their elders into institutional facilities (AARP, 2014). Thus, guaranteeing health care providers will supply the preferred language service and a diverse competence of cultural health practices will expedite the policies implantation. While the new policy may appear timely, costly and resource demanding, the policy recommendation of implementing in-language services and cultural competence education, due to the growing size of the AAPI community, will serve the best interest of future generations. Investing in a language and cultural policy, will unit the Congressional District 43, CA, community with the AAPI community, and together pursue this policy recommendation.

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