Health care programs changing

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Local health care facilities are serving an increasing number of Spanish-speaking patients, requiring program development to accommodate them.

Laura Willems, self-sufficiency manager for Moffat County Department of Social Services, said she's seen a significant rise in the number of immigrants, mostly Mexican, in her office during the past three years.

Area hospitals do not carefully track such demographic information, officials said. Yampa Valley Medical Center in Steamboat Springs does not track the number of Hispanic clients it serves, and The Memorial Hospital in Craig asks patients to declare their nationality but makes the decision optional.

However, Beka Warren, a registered nurse and patient-care planner at TMH, said statistics regarding use of the hospital's interpretation service indicate the number of strictly Spanish-speaking clients TMH serves has grown from 8 percent to 13 percent during the past few months.

As a result, communication has become a concern for health care facilities. At many locations, Spanish speakers must provide their own interpreters.

The staff at TMH does what it can to provide adequate solutions for patients.

The hospital discourages family members from interpreting, Warren said, because medical terminology literally can be lost in translation by a layperson. Instead, the hospital uses a telephone language line that connects personnel with a medically certified interpreter in any of 158 languages. YVMC uses a similar system.

Both facilities will provide in-person interpreters for patients with long-term or specialized needs.

Maria Sandoval, a Women, Infant and Children program counselor at the Northwest Colorado Visiting Nurse As--sociation, dedicates two days a month in Craig and Steamboat for WIC. She also interprets for two women's health clinics each month and during immunizations for Spanish-speaking patients.

The office has hired another part-time interpreter, Rosa Tarango, to keep up with the volume of clients.

Dollars and cents

A larger problem than translation, Warren said, is the number of uninsured people who come to the emergency room for treatment, which significantly taxes the hospital.

"That really impacts our time and our effort," she said. "A lot of people come to the ER because that's their first choice. We cannot turn away anybody."

At least 15 percent of Moffat County's residents are uninsured, Warren said, but the increase in uninsured patients is not necessarily correlated with the growing immigrant population. However, many of the uninsured patients are Spanish speakers.

"(For the) people who are buying insurance, it ultimately drives up their costs," Warren said.

Plus, she said, TMH has to be careful how it spends money.

"There's been a lot of small hospitals who have closed because they couldn't handle their community's changes," Warren said.

She does not foresee TMH having to close, but she acknowledges that Medicare and Medicaid do not pay back 100 percent of the hospital's costs. Even those who are eligible for such programs put a strain on the facility's budget.

Sandoval says the answer isn't as easy as telling immigrants to get health insurance.

"It can get complicated and expensive," she said. "Anyone can get private insurance, but we cannot afford it. People, they live check to check. They're not going to get insurance and not pay the rent."

As a start, YVMC uses a sliding scale based on income, and it offers payment plans and a financial assistance program.

"We do have means to work with our patients who are not insured," said Karl Gills, YVMC's chief executive officer.

The next step

The VNA uses a similar income-based sliding scale, and WIC is offered free of charge. Sandoval, who immigrated here from Tabasco, Zacatecas, Mexico, knows first-hand the struggles immigrants face after they cross the border.

So, services such as WIC are important to her because they give immigrants a leg up. WIC clients receive a number of grocery items for pregnant women and young children.

"We teach them ways to improve their nutrition and healthy habits," Sandoval said. "(In Mexico), you can't buy the milk you need. There, it's basically beans and tortillas. I can say that because I lived that."

Pregnant women are one of the only illegal immigrant populations that can receive government support for health care.

Emergency Medicaid covers the costs of delivery, but not prenatal care, for documented or undocumented immigrants. The baby then continues to be eligible for the program, but the mother does not.

Just this month, however, the state Legislature reinstated Medicaid presumptive eligibility, allowing pregnant women who are documented aliens or U.S. citizens to receive medical care while waiting for their Medicaid application to be approved, which takes 45 days on average.

The women can get full coverage on prescriptions and regular checkups with their physician, said Carrie Godes, director of community care with the VNA.

The program requires pregnancy verification, and recipients must be at 133 percent or lower of the federal poverty level. The individual's citizenship will be checked through the application process.

Children, regardless of nationality, can get insurance coverage through the Children's Health Plan Plus, which offers medical, dental, vision and mental health coverage for a low co-pay.

The only requirement is an income at 200 percent of the poverty level, which recently changed from 185 percent.

"We're really excited because it becomes more inclusive," Godes said.

She encourages anyone who thinks they might qualify to come into the VNA to apply. The application is strictly income-based and does not ask about assets, such as cars and homes.

The Social Services Office offers resources to help people however it can, but many times, immigrants do not qualify for assistance programs.

"Whether they're here legally or illegally, their benefit doesn't change," Willem said.

To help with lack of assistance, Warren said an effort is under way to start a rural health facility aimed at indigent populations.

"We have a good collaborative effort between Routt and Moffat counties on this issue," she said.

Gills said YVMC has no programs geared toward Spanish-speaking patients, at least not yet. But as the needs increase, so will the facility's efforts.

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