On Twitter, NCLR joined @SaludToday for a #SaludTues Tweetchat on the power of promotores, who increasingly play an important role in promoting community-based health education and services for Latinos. See highlights from yesterday’s lively chat.
By Elizabeth Carrillo, MPH, Project Coordinator, Institute for Hispanic Health, NCLR
November is National Diabetes Month, a time to bring attention to diabetes and how it affects nearly 30 million Americans. Latino adults are disproportionately affected by this disease, being nearly twice as likely as non-Latino White adults to be diagnosed. Many factors contribute to this disproportionate risk, including age, obesity, family history, and ethnicity.
Diabetes is a serious chronic disease that can lead to additional complications. The good news is that it’s manageable, and those who have better access to health care and community resources tend to be more likely to receive treatment. Adopting a healthier lifestyle is a key step to reducing one’s risk for developing diabetes. One way to better understand risk factors and learn about preventing or managing diabetes is by participating in culturally sensitive classes. They’re often free and led by peer facilitators or promotores de salud (community health workers).
In his presidential proclamation declaring April 6–12 National Public Health Week, President Obama said, “Public health is the foundation for a brighter tomorrow.” He urged all Americans to take action to improve the health of our country.
In that spirit, earlier this week close to 60 public health experts from across the country gathered at NCLR’s headquarters in Washington, DC, to discuss how peer support provided by community health workers, or promotores de salud, and other nontraditional health workers can improve primary care in the U.S.
— Peers for Progress (@Peers4Progress) April 7, 2015
The conference, “Peer Support in the Patient-Centered Medical Home (PCMH) and Primary Care,” was co-hosted by Peers for Progress, the Patient-Centered Primary Care Collaborative, and NCLR. Its objective was to identify and promote effective models of peer support as a way to engage individuals to become more involved in the health prevention and chronic disease management activities of their primary care center. Substantial research points to the benefits of peer support as a way to engage people (including those for whom care services too often fail to reach), educate them on how to prevent and manage disease, and cut down on unnecessary, costly care. Peer support is also effective because it incorporates patients’ perspectives, as well as those of their families, homes, and communities. Ten model programs were featured at the conference.
— APHA CHW Section (@APHACHWSection) April 7, 2015
One program, Alivio Medical Center’s Mi Salud es Primero, was able to reach 90 percent of all patients with type 2 diabetes with peer support. The promotores de salud provided emotional and social support, taught one-on-one and group educational sessions, and linked patients to resources in the community. As a result, HbA1c blood sugar levels declined from 8.26 percent to 8.10 percent across the entire population, which was a very positive finding.
These model programs demonstrate how peer support can serve even more people. Lessons learned and challenges overcome were discussed and will be published in a conference report later this month.
NCLR applauds the many experts in the health care field who promote peer support programs that serve patients well throughout our nation. We can strengthen public health and help bring about a brighter tomorrow by continuing to integrate peer supporters with primary care teams for the benefit of patients everywhere.
By David Castillo, New Media Manger, NCLR
The thing to understand about Affordable Care Act (ACA) navigators is that they are busy people doing an important job: shepherding consumers through the enrollment process and helping them complete and file the application for financial assistance for lower insurance premiums. Navigators receive training from the Centers for Medicare and Medicaid Services and are then officially certified to provide impartial, in-person assistance. They offer a personal touch to a process that many find daunting, especially those who may have never had insurance before.
To get a sense of what these people do every day, we caught up with Cliff Clark, Program Director for NCLR Affiliate MHP Salud, which offers navigator assistance to the Rio Grande Valley. MHP Salud is a community-based organization that specializes in community health worker programs. It is currently in its second year of offering navigator services.
Together with his team, Clark serves a four-county area of more than one million people. Since open enrollment began in November, Clark has been busy traveling the massive region doing all he can to enroll as many as possible. He took me through an average day for a navigator in his area. “They might report to our offices in Weslaco, but they might also report to an off-site community partner that has made space available to enroll folks,” said Clark.
When a consumer arrives, the first thing the navigator does is begin an assessment that involves questions about family size, who in the family needs insurance, and what the consumer is looking to achieve. Based on this information, they begin creating an online profile for the enrollee and start the process of applying for financial assistance. This assistance comes in the form of a monthly tax credit, so navigators first collect information on income estimates to see if the enrollee qualifies. If the enrollee does, they can begin the process of selecting the right plan for their circumstances.
It is a lengthy process that depends on the customer’s understanding of insurance and often requires several visits. Helping people take the time to make the right decisions, however, is a top priority for Clark, and it’s something he stresses to his staff. “It’s not something you should rush,” he said. “You’re not going to buy a car with no wheels on it because it’s no use to you. It’s the same with insurance.”
One thing that sets MHP Salud apart is its use of community health workers, or promotores de salud, as navigators. In the Rio Grande Valley, providing culturally competent services is paramount, and promotores make folks much more comfortable. Clark notes that among those he serves, 85 percent of whom prefer to speak Spanish, the face-to-face contact is far more preferable to telephone assistance or online service, since technology can be a barrier to many of his customers.
“They’re more approachable, they’re a trusted part of our community,” said Clark of the promotores. “They live in the community, they know the challenges, and they understand the culture. That’s an extra layer of comfort that consumers have with our promotores.”
Also a boon this year is the outreach MHP Salud and many other groups have done to inform the public about what they need to enroll. As a result, Clark has found that many more clients now arrive with the documents needed to begin enrolling. It was a far cry from the first year, in which they often had to tell folks to return with the proper documentation.
“Before, they didn’t have anything with them because they just didn’t know. They were confused, perhaps a little frustrated because they felt obligated to do it,” said Clark. “People are coming in much more prepared this year.”
Of course, having all the documents needed to begin the process isn’t always a guarantee that people will receive coverage. This is especially true in Texas, which has failed to extend Medicaid coverage to low-income families, putting them in the “Medicaid coverage gap” because they make too much to qualify for Medicaid and too little to qualify for a subsidy. For Clark, it’s one of the more challenging aspects of the job.
He notes that only about 20 percent of the applicants MHP Salud assists actually qualify for a subsidy because their income level is between the eligibility limits. In such cases, consumers in the coverage gap receive an exemption to the law so they won’t be fined for not having insurance. But it also means they won’t have access to affordable insurance.
“Trying to explain the Texas Medicaid coverage gap to those who are terminally ill and why they can’t have access to health care has been very difficult,” said Clark. “It’s quite a bad situation.”
For the millions who fall into the coverage gap, many of them will do what they were doing before. “They’ll go to Mexico to see a doctor or go to a cash clinic, which is only $40,” said Clark. “Some will go to federally qualified health centers, which offer services to families with no insurance.”
He says he’s hopeful Medicaid will be expanded in Texas, or that at least an alternative solution will be offered, as it’s sorely needed in the area he serves.
Of course one of the more rewarding parts of Clark’s job is the flip side of that “bad situation.” He recalled one story of an elderly couple who received a 90 percent subsidy. It allowed one of them to receive long-needed cataract surgery, which they had put off because they had no insurance.
“Sometimes people come to tears of happiness because they have just been enrolled. They may be sick and really, really need it but didn’t think they could get insurance,” he said. “They are very pleasantly surprised when they find out they can start taking care of some things they need to take care of. It’s changing people’s lives.”
Cliff Clark and his ACA navigators at MHP Salud may be extremely busy people, especially with the enrollment deadline on the horizon, but they are performing a service vital to improving public health. And for that, we thank them.
The deadline to sign up for health care is Feb. 15. Don’t delay! Sign up today before it’s too late!
By Elizabeth Carrillo, Project Coordinator, Institute for Hispanic Health, NCLR
Decreased judgment, difficulty completing familiar tasks, and unusual changes in behavior or personality are all-too-familiar signs of someone living with Alzheimer’s disease. For National Alzheimer’s Disease Awareness Month, we want take a moment help you better understand this terrible ailment.
Alzheimer’s currently affects more than five million Americans. Experts estimate that by 2050 the number of individuals age 65 and older with Alzheimer’s will reach between 11 million and 16 million people—more than double today’s rate. For various reasons, including family history and prevalence of heart disease and diabetes, Hispanics are at least 1.5 times more likely than Whites to suffer from Alzheimer’s and other forms of dementia. Hispanics also have a higher life expectancy than other groups which, coupled with greater risk for developing Alzheimer’s, means the disease will continue to increase among Hispanics.
A concern in our community is that Latinos lack an understanding of the disease’s signs and symptoms, often confusing them for normal signs of aging. In fact, Latinos are diagnosed an average of seven years later than Whites, which suggests that the signs are less likely to be recognized. Earlier this week NCLR conducted a text quiz to assess general awareness of the prevalence of Alzheimer’s among Latinos, and the results showed that only 35 percent of people are aware that Latinos are 1.5 times more likely to develop this disease. It’s a signal that there is still much work to be done around raising awareness of the disease among the Latino community.
We must begin by understanding the normal signs of aging versus the signs of Alzheimer’s. While there is still no cure for the disease, early diagnosis can lead to treatment that is more effective at slowing down its progression. Reducing one’s risk for Alzheimer’s—by practicing these five tips for maintaining a healthy brain—is an important step toward fighting the disease.
Increasing awareness of this disease begins with all of us. With support from the MetLife Foundation, NCLR has implemented Mantenga su Mente Activa (Keep Your Brain Active), an Alzheimer’s education program led by promotores de salud (community health workers), for the last five years. The program has been implemented across 20 communities via our Affiliates in the West, Southwest, and Midwest regions of the country. Since 2010, Mantenga su Mente Activa has reached more than 4,500 Latinos through face-to-face programming, mainly via a tool kit used during charlas, or small educational sessions. It has also reached an estimated 16 million Latinos through digital media efforts of NCLR and participating Affiliates. These include tools such as a bilingual awareness video and a Spanish language public service announcement. The program has been effective at increasing awareness across specific areas, but we hope this is only the start of what will become a national effort to educate Latinos about the disease. Join us in our efforts—pass along this information to your friends and family.