Article of the week: Have a policy for treating patients who speak foreign languages

Rehab Regs, April 18, 2008

Laws require medical facilities to provide translators to those in need

Every day in many areas of the country, rehab providers treat patients who speak a variety of languages. But whether your facility treats limited English proficiency (LET) patients on a regular basis or a few times per month, it’s important that you are always ready to provide medical interpreters.

Congressional law requires facilities to provide an interpreter to any patient who requests one, and in most cases, healthcare organizations are responsible for the cost of the interpreter. The Joint Commission on Accreditation of Healthcare Organizations also requires facilities to have a policy in place for treating LET patients (see p. 3 of the PDF of this issue for sample policies).

If you don’t have a system set up to acquire the services of translators, you’re putting yourself at legal and financial risk.

But the question of how you will provide these translator services depends on how often you see patients of a particular language and what services are available in your area, according to Deb Salhus, OT, director of medical rehabilitation at the Courage Center in Golden Valley, MN. “If you have a large Spanish-speaking population in your area, it might not be too tough to find a Spanish-speaking interpreter,but if you have a patient who only speaks Japanese and you’re in a rural area, that could be a different story.”

Found in translation

What makes the process easier is that several options exist for finding a translator, including

  • hiring a staff interpreter
  • hiring bilingual therapists
  • using an interpreter agency
  • calling a language interpreting phone service
  • using a patient’s family member

Each of the choices have their pros and cons, and no matter which you choose, you will most likely have to use one or more of the other options at some point.

You’re hired

The ideal situation for most facilities is having an interpreter on staff, whether that person is a full-time interpreter or a therapist who can speak a second language commonly found in your area.

Hiring a staff interpreter is common and often a necessity in urban hospitals, but is too costly for small private practices or rural facilities that don’t see LET patients regularly, Salhus says.

If your facility has a regular—but not constant—need for an interpreter of a specific language, you could consider hiring an interpreter as part of your office staff and make translating one of his or her responsibilities.

The downside to this is that you will rarely find an interpreter who speaks every language that you’ll encounter. Hiring a bilingual therapist is difficult when you can’t maintain minimum staffing levels.

Also, never use a bilingual therapist or staff member who is not a trained interpreter to translate, Izabel Arocha, MEd, cultural and linguistic educator with Cambridge (MA) Health Alliance says. A bilingual therapist can treat a patient who speaks the language with which he or she is familiar, but the therapist should not translate if he or she is not qualified to do so.

Door-to-door service

The most common way to find a translator, especially for smaller facilities, is by using a service that contracts out interpreters on a per diem basis, according to Arocha. “Interpreter services are the best option for finding qualified interpreters of almost any language you can think of,” she says. “You’ll have to work with them to make the scheduling work, but the interpreters you get will have experience in healthcare and understand what you’re trying to accomplish.”

One major downside of using these services can be the cost. It will cost you typically in the range of $50–$100 per hour for a translator through these services, which sometimes is less than what you will receive in reimbursement from that patient. And because it’s rare that you will be reimbursed for the interpreter—some states, Minnesota being one, pay for interpreters through Medicaid programs—that could result in you losing money by treating a patient.

Because the law requires you to provide a translator, you have little choice but to pay up. “It’s obviously not ideal, but if you schedule things right, you don’t have to lose money,” says Salhus. Consider bunching several patients who speak the same language in back-to-back appointments or treat patients for longer sessions less frequently when appropriate.

When using an interpreter service, ensure that the interpreter and the agency sign a business associate agreement to comply with Health Insurance Portability and Accountability Act of 1996 regulations. You also might want to have the patient sign a consent form acknowledging that the translator will be privy to some of his or her medical information, Salhus says.

Calling for help

Although it’s certainly not ideal for rehab services because of its hands-on nature, a telephone translation service may be useful to many providers at one time or another. The most common of these phone translators is Language Line, although others (e.g., Cyracom, Language Link Communications, and Pacific Interpreters) provide similar services.

They typically give you the option of just about any language in the world and charge you by the minute. They work well if a patient calls up trying to make an appointment or walks in off the street unexpectedly.

“In some ways they are the easiest to use, because they’re convenient and you don’t need to plan . . . as much,” says Arocha. “However, with rehab, they cause a lot of issues.”

For example, if a therapist is trying to demonstrate an exercise, a phone translator won’t be able to see what’s going on and thus may have a harder time interpreting the exercise.

Also, because continuity of care is so important in rehab, having a different interpreter for each patient’s visit can be problematic.

Because of the convenience and the low cost—ranging from $1.50 to $2 per minute—the use of over-the-phone interpreters is on the rise, according to Arocha.

Family troubles

Enlisting a patient’s family member or friend is seemingly the cheapest and most convenient option, although it is also the most problematic option, says Arocha.

Family members as translators work well for making appointments or relaying quick reminders, but for regular treatments, they present barriers.

For one, you cannot force any LET patient to use a family member, and you must at least offer him or her the use of an outside translator. And even when the patient wants to use a family member, it’s often not ideal.

Tests show that bilingual people who aren’t trained translators can miss a lot of what is said and don’t give accurate translations, according to Arocha.

“Patients have the right to use family and [turn down] an interpreter, but I’d recommend that you have any patient who does so sign a consent form waiving the [facility’s] liability.”

Sample policies

Communicating with people of limited English proficiency

Editor’s note: Use this example to create a policy and procedure at your facility for dealing with people who primarily speak a language other than English.

It is the policy of [facility name] to provide communication aids at no cost to the Limited English Proficient (LET) persons whom it serves, including current and prospective patients, clients, family members, interested persons, etc., to ensure them a meaningful opportunity to apply for, receive, participate in, and benefit from the services offered. The procedures outlined below will reasonably ensure that information about services, benefits, consent forms, waivers of rights, financial obligations, etc., are communicated to LET persons in a language that they understand. Also, the procedures will provide for an effective exchange of information between staff/employees and patients/clients/families while services are being provided.


1. The [facility name] will designate [employee’s name] to be the administrator responsible for implementing methods of effective communication with LET persons.

2. The administrator will maintain and routinely update a list of all bilingual persons, organizations, and staff who can provide bilingual services develop written instructions on how to gain access to these services (e.g., contact names, telephone numbers, addresses, languages available, hours available, fees, and conditions under which the contacts are available)

3. To ensure effective communication and protect the confidentiality of patient information and privacy, the patient will be informed that the services of a qualified interpreter are available to him or her at no additional charge. Only after having been so informed, the patient may choose to rely on a family member or a friend in a particular situation. Document the choice of the patient and presence of an interpreter after every visit.



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