Language barriers, what can I do?

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Language barriers, what can I do?

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I moved my Mom and Dad to an Adult Family Home two years ago. My Dad passed away in April of this year, but Mom is still in the AFH. I've always worried about the language barrier between the caregivers and the patients. The home only has caregivers from Kenya, and none of them speak english very well, and they don't understand when I ask them a question. Mom gets agitated because the caregivers don't understand her. They forced her to wear a bra, after I had instructed that they don't put one on her, but instead let her wear the undershirts.
I ask caregivers about Mom's medications, and none of them know how to go to the patients binder for information, and they don't understand the MAR. They are all nurse delegated, but most of them don't even know how to check the blood sugar levels, let alone know how to give an insulin injection.
There's no abuse or neglect, and I don't want to move Mom ever again, but the language barrier is a big concern. What can I do?
Is there any law that says the caregivers must be able to communicate and understand what is being said?

Care Decisions Caregiving Skilled Nursing Facility

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What can you do? Nothing. What if your Mom only spoke another language and they could not communicate with her at all? What could they do? Nothing. You cannot teach everyone to speak English well nor without an accent, for sure. So seems you are helpless in this. The important thing here is are they good to her. And throw all of her bras away! I am with you! At some point we need freedom from them! OK, back to real. You mention medications. I am assuming that there is a medication tech or nurse? They are usually well trained and usually do the testing? Do get together with the facility and ask for an overview of how medications are handled, who gives them, what is their training. These facilities are very very costly to run, and the rules by government are onerous in our country to be sure. The result is that workers are paid minimum wage, and often have to work two jobs to survive in our country. So some of the realities make this all MUCH less than ideal. I am wishing you so much luck, and remember that the first important thing is safety (two bad falls on forum recently, one with badly shattered legs). Right up there with that is KINDNESS as that is what will most benefit your loved one. As to language, it is low on the list in my book. Though in my own city it would behoove me to learn spanish NOW so I can communicate with the caregivers I will soon enough be dependent on. Wishing you and your Mom the best.

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In the state of Washington, the CNA's can and are nurse delegated. Which means they check the blood sugar levels, give insulin injections, administer medications, have access to all of the patients medical history. The MAR is checked by the RN that comes in once a month or less to check the meds and make sure everything is done correctly.
If my Mom spoke another language, I would have sought out a specialty care facility which could bridge the language barrier.
The caregivers are as kind as they can be when they don't understand what the patient is saying. The only way I get anything communicated effectively is by email. I don't mind the accents, but I do mind the inability to understand or speak english well enough to work in a facility which requires a lot of complicated communication.
If I were to go to another country, I would learn the language well enough to work in the field I desire. If I don't speak the language well enough, then I would need to find a class to attend so I can learn it, and also a job that doesn't require me to be as skilled in the language, until I do learn it.
When a caregiver can't differentiate He from SHE, so when they are telling me something, and refer to my Mom as "He" I think they're actually talking about someone else. Ugh!
This isn't being racist, it's being real.

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First CNAs can do nothing you have listed. They can't give Meds, they can't look at her records, they can't check sugar levels or give injections. Some CNAs can get training to be Medtechs where they can give meds. The only person who can do these things is the RN who is their boss. LPNs can do what u listed. But some states don't allow them to give injections.

If u don't want Mom wearing bras, then take them out of her room. They can't put on her what isn't there. Put a note on top of her "shirts" with "these are to be put on in place of a bra". I had a white board on Moms refrigerator where I wrote notes to the aides and they could write notes to me.

I find that its not so much there is a language barrier but that they speak too fast. Ask the RN to have them talk slower and face the person.

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I LOVE the idea of the white board.

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Okay, just read that she is in a small adult family home of 5 patients. In that situation your best bet might be learning to communicate with them.. I’d focus on a few phrases that are necessary for your mom’s needs and help your mom to speak and understand those words and phrases. There are loads of apps for phones and tablets along with translation devices you can utilize.. learning another language keeps those pathways in her brain happy, right?

No neglect by those caregivers? Fantastic!

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Mom has Alzheimer's. I would never ask nor expect her to learn another language. Not even a few words. The home gets over $5,000.00 a month to care for her. It's their job to communicate with Mom, not Mom learn how to communicate with them. She can't even use a phone or tablet now. So, no. Not an option.

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Please, stop and consider - if the caregivers are good with your mom, kind and trying to do their best - that is wonderful. Not everyone speaks English and caregiver jobs are not well paid. Employers have to be flexible to get workers - it is sort of a seller's market. Immigrants are really necessary to keep this society going. That is simply a fact So I'd be grateful that they treat your mom decently.

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I have been going over all of my options on how to get this resolved, but about the time I begin to figure out what the caregiver is saying, she's gone, and a new caregiver is there. I know that the turn over for employment is high in the homes, and I understand that they need to go orientation and training, but there needs to be communication. I have nothing against immigrants. I do have a problem with anyone that can't communicate with the patient or family. I don't care if they're immigrants or not.
What's necessary in our society is people that can communicate. This is about communication, not race. This is about my Mom being able to tell the caregiver that she's in pain, and the caregiver understanding it and knowing what to do about it.
I was a caregiver. I chose to work in that field. I knew what the pay was. None of the caregivers go into a job thinking they're going to get rich. When I go to visit Mom and talk to the caregivers about how Mom is doing, I leave exhausted. I try so hard to understand what is being said, and then I feel guilty because I had to have things repeated to me, and I have to repeat the same question over and over, rephrasing the question, and talking slowly, so maybe, just maybe, there's no misunderstanding.
The caregivers are good with Mom. I am grateful for that. They keep her clean, fed, and safe. That doesn't mean I should overlook the issue of communication.

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OMG!! FIRE THEM!!!!!!!! If you want to keep them, get a translator.

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Well, I think the employer should be responsible for helping the caregivers with their communication barrier. THEY should send the employees to a class to learn the language. I really think the owners of the home should have at least one person on staff with English as their first language.
What I THINK they should do doesn't matter. It's what I've seen the caregivers do, or not do that concerns me.

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I found the laws for Adult Family Homes. RCW 70.128.130 (17 a,b) It states;
(17) The provider and resident manager must assure that there is:
(a) A mechanisim to communicate with the resident in his or her primary language either through a qualified person on-site or readily available at a times, or other reasonable accommodations, such as language lines; and
(b) Staff on-site at all times capable of understanding and speaking English well enough to be able to respond appropriately to emergency situations and be able to read and understand resident care plans.

This law still leaves a lot of latitude so there's no undue burden on the caregiver, but it stills requires "English" to be the language spoken well enough to read and understand resident care plans.

Thanks everyone for responding to my question.

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Hmmmm. They are from Kenya? My understanding is that they speak English for school, government matters, business, etc. I had a pen pal who wrote in perfect English, and I worked with university students from all over the world. In general, people from Kenya are not difficult to understand. But then if from Kenya, perhaps they are from very rural areas where Swahili is the main language. I'm just curious.
Anyway, clear communication is essential. I would relocate my mom in such a situation, knowing that in time she would adjust.

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English speaking or not I would be concerned that they do not know how to get to patient information and that they do not know how to check basic critical information (blood sugar).
Is there someone there that could obtain the information QUICKLY if they had to call 911?
Do they know who gets what medication and when? And are they documenting when it is given?
These are things that wold be very concerning to me and I would probably report the facility and the situation to the state Ombudsman.

Now a simple solution to the bra...Remove the bras from your mothers room. That way they can not put one on her. If you need to have her wear one when you take her out you can bring one when you come get her. I would just leave the t-shirt if it is more comfortable for her.

As far as "abuse and neglect" It might be considered neglect if the person that is caring for you ignores your questions, ignores your requests and does not answer you...all these things could happen if they do not respond to your questions, requests or your moms questions and requests or if they do not answer either of you. This might be taking the definition a bit far but if your mom started to complain about pain would they understand her? respond to her? if not that would be neglect.

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In general, people from Kenya are conscientious. I cared for my mom at home for 8 yrs. before I had to put her in a nursing facility due to the level of care she needed. But before I did, I had a Polish caregiver living in to help me, and one day a fierce electrical fire broke out at a neighbor’s home a few doors down. We lived in a large city in attached wood frame homes which share a common crawl space. I am trying to explain to the caregiver why we had to get out of our building immediately and both try to get my mother ready. My mom was sharp as a tac, but her body was not mobile. Mom knew what was going on and trying to help herself while the caregiver was fighting me the whole time, due to the language barrier. It was dead of winter, and she could not understand why we had to get out. Even with the full time fire department literally two blocks away, and rapid response time, two people were taken out of that home unconscious, one of them succumbing months later, pets died, and a fireman told us the fire was so hot, it melted the shield on his helmet! Thank God it did not get as far as our house. It could have easily, though, if the fireman were not as close and ready as they were. So you see, communication and savvy are just as important as kindness, and they as caregivers, should see that, too. Had I been at work that day, and the fireman not get there within a couple of minutes, what would have happened? Especially if you cannot move fast enough?

If you still want to keep her there, and believe me, I do understand the rarity of finding good caregivers, then you, family members, and/or friends need to come up with a schedule and commit as a team to visiting throughout the week. Buy a Swahili dictionary in a bookstore or online and point to words when you cannot get a point across. It helps. They will show you words to, and you get some connection. It will also help establish a relationship with the caregivers. Kindness goes a long way. Pick your battles in this situation, but never compromise medical care and safety. Always have the ombudsman’s number on you, call the state office, and get basic info, so if you do need to contact them, you are not going trial and error in a possible crisis.

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Alvadeer, These care homes have greedy owners and that is why they pay minimum wages to the actual caregivers. It is appalling how much money they make. I would be ashamed of myself for giving the very people that make my business successful such a pittance and call it pay.

If they consistently are from Kenya is it possible to get an app for yourself that would allow you to communicate with them?

I agree that there should always be a person at the facility that can communicate with the paying customer. Have you spoken to the owners about the repercussions of something happening and no one being able to assist because of the language barriers? These are lives at stake, in AZ we had a kennel full of dogs that perished because of dereliction of duty and they are being prosecuted to the hilt, can you imagine if it was human lives that were tragically cut short? I would talk to the owner and get this addressed for everyone's sake. Those caregivers could be facing issues that they can't understand and it just sounds unreasonable all the way around.

Let us know how it works out.

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If there is such a bad language barrier that staff cannot even understand you, complete patient testing, or provide you with information about your mother's medicine/care - just those added up lean toward patient abuse because she is clearly not getting the care being paid for and cannot get them to explain things to her in a way she can understand. Your complaints are not going to change who works there. It's time to find another facility. Visit and talk to various employees working there as well as patient family members that you can find.

Imagine yourself in a foreign country where you do not speak the language and you are trying to tell someone you don't want to wear a bra...or you would like to have hot oatmeal instead of cold corn flakes. That is about the situation your mom is living in right now.

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For my own Mom, she had a language barrier even if one was born and raised in the U.S. For some reason, my Mom could not understand people from Boston or people from the deep south. Neither my Dad nor I had any problems.

The reason could be that when my Mom and her siblings were growing up, her parents only spoke their native language [eastern European]. Now, one would think my Mom would have had a better ear for people with accents. But she didn't.... [sigh].

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This is a big issue in all types of care centers, residences, nursing homes, rehabs, around the country. My experience as daughter of patient at crappy rehab--nurses and all other care-giving and administrative staff did not always understand me when I spoke, maybe even less than I understood them. I think they struggled to read and write English too. The head nurse one day could not pull up the words, "The doctor is the one in the blue shirt in the middle." She just kept pointing and yelling "Oba de-yah! Oba de-ya!" (Translation: over there). My mother could not understand what was said to her at all, but she didn't want to hurt anyone's feelings, so she pretended to be totally deaf! If nurses or staff did not want to deal with my question at the moment, they would give me a blank look and act as if they did not understand what I said, even though I knew they did understand my very basic wording. This was just the tip of the iceberg of a very dysfunctional organization that managed to limp along in a poor neighborhood. On the opposite side of the spectrum, mom is now in a wonderful memory care residence with nurses and caregivers from the Caribbean and Africa who have accents, but the accents are not as strong, their understanding of spoken English is better, and they are trained to be more customer service oriented. My stress level went way down. The residents are honest about it tho--I almost laughed out loud when at dinner, one of the men said, "I can't understand a word you're saying!"

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Kindnessandlove: That is SHOCKING that someone dosing medicine is allowed to be so reckless because they don't understand the English language. Forcing the patient to wear a piece of clothing is one thing; dosing a patient with the wrong medicine is and could be quite dangerous! For this reason, this MUST be amended immediately!!!! Think of it this way - if your LO is on say - a heart medicine THAT IS CRITICAL TO HER HEALTH - and she is given - an antidote, what could result may be catastrophic.

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Yes, you're right. It could be a catastropy. Since I've posted on here last, the owner of the home have let go of a few employees that just weren't able to communicate. The owners are also from kenya, but they have good communication skills. The caregivers that are there now, are so refreshing, with the ability to communicate. No, it's not perfect english, and there's still a few struggles, but they know what they're doing, and if they aren't sure, they call the RN, or the Supervisor.
The home now knows how important it is that all of their caregivers communicate well.
Someone stated that they thought Kenyans were required to take english in school. Yes, they are, and most do well with it. One of my favorite caregivers explained to me that it was a required course in their schools. She was excellent with the english language.
I did talk to the RN that does the nurse delegation and explained some of my concerns. She made it a point to go over the medications with the caregivers once again. The saving grace here, is that the medications are pre-packaged in doses for morning, noon and night. The only meds that the caregivers struggle with are the opiates that are a prn. I expressed my concerns about those too. The RN has assured me that she will be keeping an eye on it.
Since the other caregivers have been replaced, Mom has settled down and isn't so negative.
It doesn't matter what nationality you are, or what language you speak, you can either learn to be a good caregiver, or not. Not everyone is cut out for this kind of work.
Thank you eveyone for the feedback, suggestions, and understanding.

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