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Baker M, Campagna V, Mitchell E. SDOH and Immigration Status: Offering Advocacy and Adhering to Ethical Practice Across the Care Continuum. Prof Case Manag 2024; 29:47-53. [PMID: 38251941 DOI: 10.1097/ncm.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
PURPOSE Social determinants of health (SDOH), the environmental, economic, and social factors that influence people's health outcomes, are widely recognized across health and human services. In addition, there are other factors that can exacerbate SDOH; among them is immigration status. Its influence is so profound that it has been suggested that immigration be considered an SDOH in and of itself (National Academies of Sciences, Engineering, and Medicine, 2018). Across the continuum, case managers need to be aware of the immigration status of their clients (the individuals for whom they advocate and provide services). This is particularly important when addressing the care needs and discharge plans for clients in acute care, community-based health, and workers' compensation. With workers' compensation, when an individual is undocumented and severely injured, immigration status directly impacts the services they may receive under state mandates. Moreover, such limitations can present ethical dilemmas for case managers, including what happens to workers if they are returned to their home countries. PRIMARY PRACTICE SETTINGS SDOH and immigration status can impact individuals in acute care, subacute care, community-based care, and workers' compensation. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE SDOH and immigration status highlight the disparities that exist within health and human services. Although equity is a core value of case management practice, the case manager's ability to provide equal access to care and resources can be severely limited because of the individual's immigration status. At all times, case managers must practice within their licensure and certifications. By recognizing that immigration status should be an SDOH, case management professionals and health and human services organizations can elevate the discussion of how to care for individuals with catastrophic injuries and illnesses who are undocumented.
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Affiliation(s)
- Michelle Baker
- Michelle Baker, BS, RN, CRRN, CCM, is a commissioner and a former chair of the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists with its CCM and CDMS credentials. She is also Director, Clinical Network Operations, for Paradigm, where she manages workers' compensation catastrophic nurse case managers
- Vivian Campagna, DNP, RN, CMGT-BC, CCM, ICE-CCP, is the Chief Industry Relations Officer of the CCMC. With more than 30 years of case management experience, Vivian spent much of her professional career in acute care case management, before joining the Commission
- Ellen Mitchell, MA, RN, CCM, is the Director for Industry Relations for the CCMC. She has more than 25 years of experience in the field of hospital case management and holds a master's degree in acute care nursing
| | - Vivian Campagna
- Michelle Baker, BS, RN, CRRN, CCM, is a commissioner and a former chair of the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists with its CCM and CDMS credentials. She is also Director, Clinical Network Operations, for Paradigm, where she manages workers' compensation catastrophic nurse case managers
- Vivian Campagna, DNP, RN, CMGT-BC, CCM, ICE-CCP, is the Chief Industry Relations Officer of the CCMC. With more than 30 years of case management experience, Vivian spent much of her professional career in acute care case management, before joining the Commission
- Ellen Mitchell, MA, RN, CCM, is the Director for Industry Relations for the CCMC. She has more than 25 years of experience in the field of hospital case management and holds a master's degree in acute care nursing
| | - Ellen Mitchell
- Michelle Baker, BS, RN, CRRN, CCM, is a commissioner and a former chair of the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists with its CCM and CDMS credentials. She is also Director, Clinical Network Operations, for Paradigm, where she manages workers' compensation catastrophic nurse case managers
- Vivian Campagna, DNP, RN, CMGT-BC, CCM, ICE-CCP, is the Chief Industry Relations Officer of the CCMC. With more than 30 years of case management experience, Vivian spent much of her professional career in acute care case management, before joining the Commission
- Ellen Mitchell, MA, RN, CCM, is the Director for Industry Relations for the CCMC. She has more than 25 years of experience in the field of hospital case management and holds a master's degree in acute care nursing
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Nouri S, Tan CH, Rangel M, Wertz M, Sanchez A, Alvarado A, Arreola E, Quinn M, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "Advocating for what we need": A CBPR approach to advance care planning in the Latinx older adult community. J Am Geriatr Soc 2023; 71:2601-2614. [PMID: 36651685 PMCID: PMC10352463 DOI: 10.1111/jgs.18236] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Advance care planning (ACP) is low among Latinx older adults. We used community-based participatory research (CBPR) to identify ACP barriers/facilitators and design community-based ACP events. METHODS In partnership with community-based organizations, clinicians, and local government, we formed a Latinx Community Committee (n = 13 community members). We then conducted 6 focus groups with Latinx-identifying, English or Spanish-speaking older adults (age ≥ 55), caregivers, and community leaders to assess ACP barriers/facilitators. We analyzed transcripts using thematic analysis and, based on these learnings, designed and implemented community-based ACP events. Using a validated survey, we assessed acceptability and pre-to-post-event ACP readiness (4-point scale; 4 = most ready; 0.2 change considered meaningful) with Wilcoxon signed-rank tests. RESULTS Focus groups included 10 Spanish-speaking older adults, 8 caregivers, and 10 community leaders. Themes highlighted the importance of ACP (e.g., means of advocacy), barriers (e.g., how to start conversations), and facilitators (e.g., trusted community spaces) in the Latinx community. Ninety-seven people attended 5 events targeting 3 Latinx populations (LGBTQI+, intergenerational, and older adults broadly). Overall pre-to-post-event ACP readiness increased (2.62 (SD 0.97) to 2.95 (SD 0.93); p = 0.05). Readiness to document wishes increased significantly (2.44 (SD 1.0) to 2.98 (SD 0.95); p = 0.003). Most reported being comfortable attending events (85%) and would recommend them to others (90%). CONCLUSIONS This study describes a feasible, acceptable, and effective CBPR ACP intervention. Co-developed community events represent a promising approach to reducing disparities in ACP among the Latinx population.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Charissa H. Tan
- John A. Burns School of Medicine, University of Hawai’i at Mānoa, Honolulu, Hawaii
| | | | - Molly Wertz
- Molly Wertz Consulting, San Francisco, California
| | | | | | | | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Steven Z. Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Courtney R. Lyles
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rebecca L. Sudore
- Division of Geriatrics, Department of Medicine, University of California San Francisco
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Quach BI, Qureshi D, Talarico R, Hsu AT, Tanuseputro P. Comparison of End-of-Life Care Between Recent Immigrants and Long-standing Residents in Ontario, Canada. JAMA Netw Open 2021; 4:e2132397. [PMID: 34726744 PMCID: PMC8564577 DOI: 10.1001/jamanetworkopen.2021.32397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Recent immigrants face unique cultural and logistical challenges that differ from those of long-standing residents, which may influence the type of care they receive at the end of life. OBJECTIVE To compare places of care among recent immigrants and long-standing residents in Canada in the last 90 days of life. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used linked health administrative data on individuals from Ontario, Canada, who died between January 1, 2013, and December 31, 2016, extracted on February 26, 2020. Individuals were categorized by immigration status: recent immigrants (since 1985) and long-standing residents. Data were analyzed from December 27, 2019, to February 26, 2020. EXPOSURES All decedents who immigrated to Canada between 1985 and 2016 were classified as recent immigrants. Subgroup analyses assessed the association of region of origin. MAIN OUTCOMES AND MEASURES The main outcome was place of care, including institutional and noninstitutional settings, in the last 90 days of life. Descriptive statistics were used to compare characteristics and health service utilization among recent immigrants and long-standing residents. Negative binomial regression models estimated the rate ratios (RR) of using acute care and long-term care in the last 90 days of life. RESULTS A total of 376 617 deceased individuals (median [IQR] age, 80 [68-88] years; 187 439 [49.8%] women and 189 178 [50.2%] men) were identified, among whom 22 423 (6.0%) were recent immigrants; recent immigrants were younger than long-standing residents (median [IQR] age, 76 [60-85] years vs 81 [69-88] years; P < .001), more likely to be living in lower income neighborhoods (12 357 immigrants [55.1%] vs 166 017 long-standing residents [46.9%] in the lower 2 income quintiles; P < .001), and had a higher Charlson Index score (score ≥5, 6294 immigrants [28.1%] vs 74 809 long-standing residents [21.1%]; P < .001). In the last 90 days of life, recent immigrants spent more days in intensive care units than long-standing residents (mean [SD], 2.64 [8.73] days vs 1.47 [5.70] days; P < .001), while long-standing residents spent more days using long-term care than recent immigrants (mean [SD], 19.49 [35.81] days vs 10.45 [27.42] days; P < .001). Being a recent immigrant was associated with a greater likelihood of acute inpatient care use (RR, 1.21; 95% CI, 1.18-1.24) and lower likelihood of long-term care use (RR, 0.66; 95% CI, 0.63-0.70), after adjusting for covariates. CONCLUSIONS AND RELEVANCE These findings suggest that at the end of life, recent immigrants were significantly more likely to receive inpatient and intensive care unit services and die in acute care settings compared with long-standing residents. Further research is needed to examine differences in care preference and disparities for immigrant groups of different origins.
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Affiliation(s)
- Bradley I. Quach
- Faculty of Sciences, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | | | - Amy T. Hsu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- ICES, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Gray NA, Boucher NA, Cervantes L, Berlinger N, Smith SK, Johnson KS. Hospice Access and Scope of Services for Undocumented Immigrants: A Clinician Survey. J Palliat Med 2020; 24:1167-1173. [PMID: 33351728 DOI: 10.1089/jpm.2020.0547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To characterize clinician experiences of hospice access and scope of services for undocumented immigrants. Background: The 10.5 million undocumented immigrants in the United States are not covered by Medicare's hospice benefit and are at high risk for being uninsured. Limited data are available regarding hospice services for this population. Setting/Subjects: Two hundred ninety-four interdisciplinary palliative care clinicians from across the United States. Measurements: Participants completed a web-based survey regarding hospice access and scope of services for undocumented immigrants in their location. We used simple frequencies to report clinician responses and chi-square analysis to evaluate associations between response and location. We performed rapid qualitative analysis of free-text responses to identify common limitations in scope of services. Results: A majority of clinicians (68%) perceived that access to hospice was limited or unavailable for undocumented immigrants in their location, and among respondents who provided data regarding hospice scope, 38% reported that services provided to undocumented immigrants were limited compared to those provided to other patients. Reports of restricted access and scope varied by region, and those in large metropolitan areas were more likely to report restricted scope of care than those in smaller towns (43% vs. 28%; p = 0.03). In our qualitative analysis of free-text responses, common limitations in hospice scope included reduced access to medications and equipment, inability to access inpatient hospice, inadequate translation services, reduced staffing, and restricted duration of services. Conclusions: Undocumented immigrants may face barriers in accessing comprehensive hospice services. Public policy changes that improve access to hospice may improve end-of-life care for undocumented immigrants.
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Affiliation(s)
- Nathan A Gray
- Duke Palliative Care, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nathan A Boucher
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health System Health Services Research and Development, Durham, North Carolina, USA.,Duke University Sanford School of Public Policy, Durham, North Carolina, USA.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Lilia Cervantes
- Division of Hospital Medicine and Office of Research, Denver Health, Denver, Colorado, USA.,Division of Hospital Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA.,Division of General Internal Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | | | - Sophia K Smith
- Duke University School of Nursing, Duke University, Durham, North Carolina, USA
| | - Kimberly S Johnson
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA.,Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, USA
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The Need for Cultural Inclusivity in Global Palliative Nursing: Caring for Selected Underserved Populations in the United States. J Hosp Palliat Nurs 2020; 21:E1-E8. [PMID: 31033646 DOI: 10.1097/njh.0000000000000575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is estimated that 11.1 million people in the United States are living with serious illness, and most people with serious illness need palliative care. Quality palliative care incorporates culturally sensitive care, and with the increasing diversity in the United States, it has become even more critical that nurses and health care professionals be prepared to meet the unique needs of those living within the diverse and underserved populations of this country. Advocating for access to palliative care for the seriously ill, culturally respectful care at the end of life, and honoring values, practices, and beliefs are essential roles of the nurse. This article presents 4 examples of individuals from diverse and potentially vulnerable US populations who face unique challenges as they deal with their life-limiting diseases and face end of life.
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Seto Nielsen L, Goldstein Z, Leung D, Lee C, Buick C. A Scoping Review of Undocumented Immigrants and Palliative Care: Implications for the Canadian Context. J Immigr Minor Health 2019; 21:1394-1405. [DOI: 10.1007/s10903-019-00882-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Linke C, Heintze C, Holzinger F. 'Managing scarcity'- a qualitative study on volunteer-based healthcare for chronically ill, uninsured migrants in Berlin, Germany. BMJ Open 2019; 9:e025018. [PMID: 30904858 PMCID: PMC6475233 DOI: 10.1136/bmjopen-2018-025018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES In Germany, healthcare for people lacking legal residency status and European Union citizens without health insurance is often provided by non-governmental organisations. Scientific studies assessing the situation of the patients with chronic diseases in this context are scarce. We aimed to characterise medical care for chronically ill migrants without health insurance and outline its possibilities and limitations from the treating physicians' perspective. DESIGN Qualitative semi-structured interviews; qualitative content analysis. SETTING Organisations and facilities providing healthcare for uninsured migrants: free clinics, medical practices and public health services. PARTICIPANTS 14 physicians working regularly in healthcare for uninsured migrants. RESULTS Delayed contact to the healthcare system was frequently addressed in the interviews. Care was described as constrained by a scarcity of resources that often impedes adequate treatment for many conditions, most pronounced in the case of oncological diseases or chronic viral infections (HIV, hepatitis). For other chronic conditions such as cardiovascular diseases or diabetes, some diagnostics and basic medications were described as partially available, while management of complications or rehabilitative measures are frequently unfeasible. For the patients with mental health problems, attainability of psychotherapeutic treatment is reported as severely limited. Care is predominantly described as fragmented with limitations to information flow and continuity. Which level of care a patient receives appears to depend markedly on the respective non-governmental organisation and the individual commitment, subjective decisions and personal connections of the treating physician. CONCLUSIONS Restrictions in medical care for uninsured migrants have even more impact on chronically ill patients. Volunteer-based care often constitutes an inadequate compensation for regular access to the healthcare system, as it is strongly influenced by the limitation of its resources and its arbitrariness.
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Affiliation(s)
- Charlotte Linke
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
| | - Christoph Heintze
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
| | - Felix Holzinger
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
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Periyakoil VS, O'Mahony S, Elk R, Quill T. Our Differences Make Us Stronger. J Pain Symptom Manage 2018; 55:1398-1399. [PMID: 29481962 DOI: 10.1016/j.jpainsymman.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Vyjeyanthi S Periyakoil
- Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Palo Alto, California.
| | | | - Ronit Elk
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Timothy Quill
- University of Rochester Medical Center, Rochester, New York
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