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Service Delivery Innovation Profile

Agency Enhances Access to Culturally Competent Home Care by Providing Trained Aides to Asian American Seniors With Limited English Proficiency


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Snapshot

Summary

Penn Asian Senior Services, Inc. trains and places culturally competent certified nurse aides and home health aides to provide home health services to frail, elderly Asian Americans who have limited English proficiency. The program has enhanced access to culturally sensitive care by serving hundreds of frail seniors who otherwise would not have had access to such care and by expanding culturally competent home-care services to the underserved Asian population in the Philadelphia region.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the number of Asian-American seniors served and the number of home health providers trained by the program.
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Developing Organizations

Penn Asian Senior Services
Philadelphia, PAend do

Use By Other Organizations

  • As noted, The Asian Women's Christian Association Home Care Agency in Teaneck, New Jersey, trains certified home health aides to provide care within the Korean and Chinese communities. To learn more, go to: http://awcanj.org/blog/?page_id=46.

Date First Implemented

2004
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Patient Population

Race and Ethnicity > Asian; Vulnerable Populations > Frail elderly; Non-english speaking/limited english proficiencyend pp

Problem Addressed

Asian-American seniors lack access to home health services from individuals fluent in their culture and language. This gap in cultural competence is especially problematic for seniors with limited English proficiency and presents a persistent barrier to their access to appropriate health care.
  • Cultural and language barriers affecting quality care: As of January 2009, 81 percent of Asian seniors in the United States were born outside the country, compared to just 12 percent of seniors in the general population. Almost one-third (31 percent) of Asian-American seniors live in linguistically isolated households where everyone over the age of 13 has difficulty speaking English. About three in five Asian-American seniors (60 percent) have limited English skills, compared to 8 percent of all seniors.1
  • Limited access to care: Research indicates that Medicare beneficiaries with limited English proficiency had less access to a usual source of care and were less likely to receive preventive cancer screening tests.2

What They Did

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Description of the Innovative Activity

Penn Asian Senior Services, Inc. provides culturally competent home health care services to elderly Asian Americans who have limited English proficiency. Through its vocational training institute, PAVI, the organization trains bilingual immigrants to become certified nurse aides and home health aides who can provide culturally and linguistically tailored home health care.
  • Training culturally competent aides: Established in 2006, Penn Asian's vocational training institute, PAVI, offers training for bilingual immigrants to become certified nurse aides and home health aides and also offers a vocational English as a Second Language course for health care workers. The majority of graduates serve Asian-American seniors at home and in local health institutions.
  • Responding to requests for services: When Penn Asian receives a request for services, a bilingual social worker or staff member gathers general information that includes the potential client's health condition(s) and health insurance status. The organization refers current Medicaid recipients directly to the Area Agency on Aging (AAA) for screening and an assessment to enroll in home-care services. Elderly persons with Medicare, individual health insurance, or private resources are referred to a Penn Asian registered nurse (RN) Care Manager for a free assessment and a care plan, if desired.
  • Conducting needs assessments, developing care plans: For Medicaid eligible seniors, care managers from AAA assess the hours per day and frequency of needed care and develop a detailed care plan. The care plan identifies specific activities of daily living where assistance is needed (e.g., cooking, cleaning, personal hygiene, dressing). The AAA then generates a Service Order that is sent to Penn Asian for fulfillment. For those with Medicare or private resources, a Penn Asian RN care manager conducts the assessment and, subsequently, develops the requisite care plan. Penn Asian home health clients receive approximately 18 hours of home care per week, although the number of weekly hours can range from 6 to 52 per client.
  • Providing culturally and linguistically tailored home health care: Penn Asian home health aides speak a variety of languages, including Cantonese, Cambodian, Korean, Mandarin, Vietnamese, and English. All aides are required to complete an 80-hour training course taught by certified RN instructors as a condition of employment. Penn Asian matches clients and aides from the same cultural and linguistic background, thus improving comfort for the elderly client. Because both have similar backgrounds, the aide can provide culturally tailored services to the client, such as cooking traditional dishes for those who cannot eat or do not like American food. They also understand cultural expectations, such as knowing to remove shoes before entering a living area and understanding how cultural norms affect their interactions with female clients during bathing and hygiene activities.
  • Supporting those wanting to select own caregiver: For those who want to select their own caregiver, Penn Asian serves as a fiscal agent, managing the financial requirements of home-care delivery, including payroll and year-end tax filings.

Context of the Innovation

Penn Asian Social Services, Inc., operates as a nonprofit organization that serves frail Asian-American seniors with limited English proficiency in the Philadelphia region. The impetus for the program came from Ms. Im Ja Choi, who created Penn Asian in April 2004 in response to the difficulty she experienced trying to find a Korean-speaking home health aide to care for her 88-year-old mother who had stomach cancer. Established in April 2004, the agency originally catered only to frail Korean seniors but later expanded to serve the entire Asian community. The organization is now the largest home care agency in Pennsylvania specializing in the care of frail Asian seniors and other individuals with disabilities who have limited English proficiency.

Did It Work?

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Results

The program has enhanced access to culturally sensitive care for Asian-American seniors with limited English proficiency by serving hundreds of clients and by expanding the number of culturally competent home-care providers available to serve the local Asian community.
  • Hundreds of clients served: Between 2005 and 2010, the program served approximately 700 clients of various ethnic backgrounds, including Korean, Vietnamese, Chinese, Cambodian, and other Southeast Asian groups. Few of these clients would have had access to culturally sensitive home health care in the absence of this program.
  • Expanded pool of culturally competent aides: The vocational institute has increased the pool of culturally competent home health aides in the community. Between 2006 and 2010, 139 individuals graduated from the nurse aide program. In 2010 alone, 43 certified nurse aides and 86 home health aides from diverse backgrounds graduated, most of whom speak two or more languages. Between 2006 and 2010, roughly 75 percent of nurse aide program graduates passed the Pennsylvania State certification exam.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the number of Asian-American seniors served and the number of home health providers trained by the program.

How They Did It

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Planning and Development Process

Key steps included the following:
  • Establishing business structure and designing preliminary program: Ms. Choi had previously founded a nonprofit organization dedicated to promoting business opportunities for women. This organization became the business structure through which she established Penn Asian. To prepare for initial program design, Ms. Choi studied the structure, programs, and services of the Homecare Agency of the Asian Women's Christian Association in Teaneck, New Jersey, which trains certified home health aides to work with Korean and Chinese American families. She also spent time learning about State and local Medicaid regulations and regulations governing other insurance coverage for home health care.
  • Obtaining support from state and county champions: Ms. Choi contacted a colleague from the Pennsylvania legislature to obtain support. Through this relationship, she identified an opportunity to apply for a grant from the State Department of Economic and Community Development to start her business. She also received support from the county commissioner, who helped secure additional grant funding.
  • Establishing board of directors, hiring staff, promoting program: Ms. Choi established a board of directors and an advisory board comprised of leaders from the fields of aging, health care, human relations, and other disciplines ancillary to the needs of homebound seniors. She also hired a RN of Korean descent to serve as program coordinator. To promote the program, she ran ads in local Korean print media, gave interviews to all Korean media outlets, and networked within the Korean community.
  • Expanding to serve greater Asian community: As noted, the program initially catered only to Korean Americans. In October 2005, 1 year after starting the program, Ms. Choi determined that other Asian-American seniors faced similar challenges and, with the board's approval, expanded the program to serve all Asian-American communities.
  • Creating vocational institute: In 2006, Ms. Choi established the Penn Asian Vocational Institute, a privately licensed vocational school that provides job training for immigrants to become certified nurse aides. Ms. Choi viewed the institute as a means to educate qualified bilingual Asian-American immigrants to meet the increasing demand from local health institutions for bilingual workers.
  • Obtaining license for personal assistance services: In 2007, Penn Asian obtained a state license through which the organization can help people select and employ their own caregivers.

Resources Used and Skills Needed

  • Staffing: Penn Asian currently has 13 full-time staff, 2 part-time administrative staff, and 7 registered nurses under contract. In 2011, they placed over 270 full- and part-time home health aides in homes throughout the greater Philadelphia area.
  • Costs: The program's first-year budget was approximately $500,000 in 2005. Approximately 89 percent of the 2011 annual operating budget was for home care, 10 percent for vocational training, and 1 percent for other costs. The 2012 annual operating budget is about $4.4 million. 
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Funding Sources

U.S. Department of Labor; Medicaid; United Way of Southeastern Pennsylvania; Philadelphia Foundation; Philadelphia Workforce Development; Montgomery County (PA) CADCOM; Greentree Community Health Foundation; Margaret A. Cargill Foundation; Patricia Kind Family Foundation
Penn Asian services often qualify for reimbursement through numerous fee-for-service contracts with state and county agencies. In 2011, 87 percent of the organization's income came from fee-for-services contracts from those government agencies. Some clients pay for services on their own, either out-of- pocket or through private insurance that covers home health care. In addition, numerous individuals and public and private organizations have made financial contributions to Penn Asian Senior Services, Inc. In September 2010, Penn Asian received a 3-year grant from the U.S. Department of Health & Human Services to provide support to Asian-American students who attend the vocational institute. The grant provides $250,000 per year or $750,000 total for home health aide and certified nurse aide training, as well as funding for vocational English as a Second Language classes.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Learn about relevant regulations: Successful implementation and operation requires knowledge of State and county payment policies and other regulations that influence the provision of home care for seniors. Policies often vary by county.
  • Recognize need for upfront investment: Program startup entails multiple expenses, including advertising, recruiting employees, and various overhead costs. Initial outlays can be as high as $100,000 during the first year. 
  • Hire staff representing communities served: Hiring staff who are representative of the various ethnic communities served enhances trust and credibility within the community. When the program expanded beyond the Korean community, Ms. Choi hired an outreach coordinator who spoke Chinese and Vietnamese (along with English), which greatly increased participation from these communities.

Sustaining This Innovation

  • Provide training and maintain care management oversight: Provide ongoing training to aides, and monitor the quality of care provided. Penn Asian requires all home health aides to attend continuing education sessions six times a year. In addition, supervisory field nurses monitor the quality of care by visiting clients when they start receiving services and every 90 days thereafter while services continue.
  • Continue publicity/outreach efforts: Consistent advertising helps to maintain a community presence. Penn Asian regularly places advertisements and runs feature stories in Korean, Chinese, Cambodian, and Vietnamese newspapers in the Philadelphia Metropolitan area. Ms. Choi regularly speaks on radio programs about Penn Asian services, and maintains community connections by offering translation and social work services in the greater Asian-American community.
  • Expand program to meet client needs: Client needs will evolve over time, and services should change accordingly. For example, once adequate funds have been raised, Penn Asian plans to open a senior day care center that will offer hot meals and a variety of social programs.

Use By Other Organizations

  • As noted, The Asian Women's Christian Association Home Care Agency in Teaneck, New Jersey, trains certified home health aides to provide care within the Korean and Chinese communities. To learn more, go to: http://awcanj.org/blog/?page_id=46.

More Information

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Contact the Innovator

Im Ja Choi
Executive Director, Penn Asian Senior Services
420 York Road
Jenkintown, PA 19046
(215) 572-1234
E-mail: imja.choi@verizon.net

Innovator Disclosures

Ms. Choi has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

Footnotes

1 Profile of Asian American Seniors in the United States. Asian American Federation Census Information Center. Asian American Federation. 2009 Edition.
2 Ponce NA, Ku L, Cunningham WE, Brown ER. Language barriers to health care access among Medicare beneficiaries. Inquiry. 2006;43(1):66-76. [PubMed]
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Original publication: April 11, 2012.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: April 03, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.