Language, cultural differences are barriers to care
The American health care system is bewildering to many immigrants from Southeast Asia who once lived in villages and often had to walk a full day to get to a clinic for health care and who have a limited understanding of English.
That’s why UCare Minnesota, a Minneapolis-based HMO, employs people who understand the culture and needs of the Hmong population, says Chue Xiong, RN, care coordinator for UCare’s Minnesota Senior Health Options, (MSHO) a state-supported program for members age 65 and older who are eligible for Medicaid, with or without Medicare.
Xiong joined UCare as a case manager in January.
In addition to case management, UCare has Hmong employees in customer service and transportation and provides interpreters at no cost to members.
The outreach to the Hmong population was one of eight UCare Minnesota programs spotlighted by The American Association of Health Plans (AAHP) in its national report "Innovations in Medicaid Managed Care: Health Plan Programs to Improve the Health and Well-Being of Medicaid Beneficiaries."
The Hmong originally were from China and migrated throughout Southeast Asia, including Laos, Thailand, and Vietnam. Many ended up in refuges camps in the late 1970s and early 1980s and were relocated all over the world, including Australia, Canada, France, and the United States. California has the highest population of Hmong in the country, but Minnesota is second, Xiong says.
Xiong, herself a Hmong, relocated to Duluth, MN, in 1980 as part of the United Nations Refugee Resettlement Program.
Many of the Hmong refugees are older and have not been able to learn English.
"Even if they have been here for 20 years, English is just too difficult for them. They have enough stress in their lives without trying to learn another language," Xiong says.
The language barrier is complicated by the fact that younger Hmong generations often do not speak Hmong anymore and are unable to translate for their older family members.
"I try to bridge that gap," Xiong says.
Most of UCare’s MSHO members in the Hmong community go to two family practice physicians who are Asian and understand the Hmong culture.
When Xiong is notified of a new enrollee, she visits them within 10 days, goes over the coverage, and explains what it’s about.
She assesses whether the members need other community services, such as meals on wheels and adult day care, and if they need durable medical equipment.
After the assessment, she puts the patients in four risk categories. Those who are at lowest risk may get an occasional phone call and a visit every six months.
If the member has complex medical or social needs, Xiong follows up with repeated home visits, arranges for home health care, physical therapy, occupational therapy, or whatever else the member needs.
She typically gets more involved when the members are hospitalized or need to see a specialist.
When Hmong UCare members are referred to specialists, Xiong often accompanies them.
"If they have medical problems and need to see a specialist, I handle the referral, arrange for transportation, and schedule interpreters if I cannot go. When they go to the specialty clinic, they often don’t know how to tell the doctors why they were referred. I talk to the clinic and explain the situation," she says.
Xiong is notified when a patient is admitted to the hospital. She makes an appointment to visit the patient to find out what is happening and to help with communication between the patient and the physician.
"If the case gets complicated, I schedule frequent care conferences to prevent misunderstandings and miscommunication. This usually includes the doctors, nurses, social worker, patient, family members, and myself," she adds.
If members have to go to a skilled nursing facility for rehabilitation, Xiong works with the nursing home to make sure they get the appropriate level of care and to get them discharged as soon as possible.