Low Health Literacy in the Older Adult: Identification & Intervention power point 2.1.15

Communication Strategies for the Home Health Care Medical

Professionals

Low Health Literacy in the Older Adult: Identification & Intervention

Jeanne M. Baus, RN, BSN, MS, RCFE, Alumnus CCRN

February 2015

What is Health Literacy?

Definition, “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (HSS:HealthyPeople, 2010, p.1).

What is Health Literacy?

The National Health Education Standard (NHES) states, “The capacity of an individual to obtain, interpret, and understand basic health information and servicers and the competence to use such information and services in ways which are health-enhancing”(1997, p.5).

What Does Health Literacy Include?

• Health Literacy includes being able to read and understand instructions on a prescription bottle, read medical brochures, understand medical instructions and consent forms (ICE, A-06-04).

• Health Literacy encompasses (HSS, 2012):– The ability to listen.

– The ability to follow directions.

– The ability to fill out forms.

– The ability to calculate using basic math.

– The ability to interact with health professionals.

– Locating health information.

Low Health LiteracyFactors That Directly Impact Health Literacy

Factors That Reduce Cognition:• Hearing Impairments: One in three older adults over the age of 65 have

hearing deficits, by 85 years old it is 50%. Leads to misunderstanding & information being repeated (ACN, 2009 & HHS, 2012).

• Visual Impairments: Do they have glasses?, Is the prescription current? Always have magnifier on hand during a visit. Tape recording the instructions in additional to written material may be needed (ACN, 2009 & HHS, 2012).

• Medication: Pain, antipsychotics, cardiac, antianxiety meds all can impair mental clarity (ACN, 2009).

• Stress: Illness and self-care may result in being tired (ACN, 2009). • Fatigue: Fatigue is related to an increased error rates and poor

judgment (ACN, 2009) .• Inadequate Sleep: Poor sleep quality is related to decreased levels of

concentration and learning abilities. • Lack of Nutrition: Poor nutritional status is linked to decreased

performance in abilities to comprehend and learn new skills.

Low Health LiteracyFactors That Directly Impact Healthy Literacy

• Cultural Differences: Different cultures do not always share the same knowledge, education or expectations of healthcare services. Culture impact communication styles and response to health education (ACN, 2009 & HSS, 2012).

• Educational Levels: Low educational levels directly correlate to low literacy (ACN, 2009).

• Language Barrier: Non-English speaking or English as a second language directly impact learning barriers (ACN, 2009 & HSS, 2012).

• Behavioral Barriers: Stress, ADD, ADHC, psychiatric conditions, dementia, autism, medications directly impact ability to concentrate and learn (ACN, 2009).

Low Health LiteracyChronic Conditions Impact Health Literacy

• 80% of older Americans 65 and older have a minimum of one chronic condition (CDC, 2010).

• 50% of older adults have multiple chronic conditions.

• Almost 7% of older adults have 5 or more chronic conditions (CDC, 2010).

• 50% of men over the age of 65 are more likely to have four or more multiple chronic conditions (CDC, 2010).

• CDC reports, “The risk of having five or more chronic conditions almost triples, from 8% for those ages 50-64 to 21% for those ages 85+” (National Health Survey, 2010, p.2).

Low LiteracyFactors That Directly Impact Health Literacy

Each chronic condition forces the older adult to navigate the medical system on a more frequent basis. Increased chronic conditions is related to higher rates of misunderstanding, error and noncompliance (CDC, 2010).

Comparison between Sex, Number of Conditions between 2001 and 2010. Note the rise in chronic conditions over the ten year period. CDC (2010). National Health Interview Survey.

Low LiteracyFactors That Directly Impact Health Literacy

Chronic Conditions among older Americans. Retrieved from http://assets.aarp.org/rgcenter/health/beyond_50_hcr_conditions.pdf

Graph source: Medicare Beneficiaries 65+. John Hopkins Bloomberg School of Public Health analysis of Medical Expenditure Panel Survey, 2005

The most common medical conditions older adults must learn how to navigate safely and consistently include high blood pressure, high cholesterol, diabetes, cancer, mental illness and back problems. Note the increases of chronic conditions between 1997 and 2006.

Health Literacy Statistics

The Institute of Medicine reports…

“Nearly half of all adult Americans – over 90 million people- have difficulty understanding and acting upon healthcare information.” (2004, p. 1)

National Literacy Statistics• Nation wide, the National Assessment

of Adult Literacy (NAAL) (2004)reports, “More than 77 million U.S. adults have basic or below basic health literacy skills” (p. 1).

• The National Assessment of Adult Literacy (NAAL) found that older adults over the age of 65 had the lowest literacy scores compared to all other age groups surveyed (2004).

Health Literacy Scores by Age

National Centers for Education Statistic (NCES) (2003). The health literacy of America’s adults: Results from the 2003 National assessment of adult literacy. Retrieved from http://nces.ed.gov/pubs2006/2006483_1.pdf

Note: Adults are defined as people 16 years of age and older living in householdsor prisons. Adults who could not be interviewed because of language orcognitive or mental disabilities are excluded from this figure.

Health Literacy Statistics

The National Network of Libraries of Medicine

(NNLM) reports…

• 36% of adults in the U.S. have limited health literacy.

• 22% have ‘Basic’ health literacy.

• 12% have ‘Below Basic’ health literacy.

• 53% have ‘Intermediate’, health literacy.

• 14% of the total population has a ‘Proficient’ health literacy level(2012, p. 1) .

Distribution of Health Literacy Performance Levels from 2003 NAAL Literacy Levels

Low health literacy: Implications for National health policy (2011). Health literacy by race and ethnicity, U.S. Population.

Retrieved from http://www.npsf.org/wp-content/uploads/2011/12/AskMe3_UConnReport_LowLiteracy.pdf

Health Literacy is separated into four levels: “proficient”, “intermediate”, “basic”, and “below basic” (NAAL, 2004).

Health Literacy StatisticsNAAL below basic and basic literacy skills

Literacy Statistics: Los Angeles County

• Adults in Los Angeles have the lowest literacy rate when compared to other major U.S. metropolitan areas.

• Low literacy rates are 65% on the Eastside and 84% in South Los Angeles (In our own backyard, San Fernando Valley).

• The city of Los Angeles ranks highest for low-literacy numbers: 1,670,000.

Literacy Network of Greater Los Angeles & United Way (2004). Low literacy in Los Angeles. Retrieved from http://unitedwayla.org/wp-content/uploads/2011/11/LiteracyatWorkSum_Sep2004.pd

Literacy Statistics: Los Angels County

Literacy Network of Greater Los Angeles & United Way (2004). Low literacy in Los Angeles. Retrieved from http://unitedwayla.org/wp-content/uploads/2011/11/LiteracyatWorkSum_Sep2004.pd

Low health literacy: Implications for National health policy (2011). Health literacy by race and ethnicity, U.S. population. Retrieved from http://www.npsf.org/wp-content/uploads/2011/12/AskMe3_UConnReport_LowLiteracy.pdf

The Cost of Health Literacy

• Vernon, Trujillo, Rosenbaum & DeBuono report…

“Low health literacy is a major source of economic inefficiency in the U.S. health care system” (2012, p.1).

• Vernon, Trujillo, Rosenbaum & DeBuono report, “Future costs of low health literacy that result from current actions (or lack of action), the real present day cost ranges from $1.6 trillion to $3.6 trillion”(2012, p.5).

Low Health Literacy is Expensive

• Low literacy reduces patients to seek preventative care.

• Low literacy levels result in a higher frequency to the emergency room.

• This group is twice as likely to be hospitalized and stay longer periods.

• Average one or more outpatients visits annually.

• Are hospitalized for more day for each admission (Vernon, Trujillo, Rosenbaum & DeBuono, 2012).

Health Literacy & Hospitalization

American Public Health Association (2002, August). Health literacy. Am J Public Health, 92(8): 1278-1283. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447230/figure/f1/

Percentage of study participants hospitalized once (black)

or 2 or more times (white), by functional health literacy.

Low Health Literacy & Medical Costs

One Medicare study followed 3,260 enrollees around the country. People with limited health literacy levels were found to have higher costs for emergency room visits, and inpatient care (Howard, Gazmararian, & Parker, 2005).

Algorithm for Use of Health Care Services

Agency for Healthcare Research and Quality (2011, March). Health literacy interventions and outcomes: An updated systematic review. Figure A. Logic model for analyzing studies of health literacy. Retrieved from http://www.ahrq.gov/research/findings/evidence-based-reports/literacyup-evidence-report.pdf

Low Health LiteracyThe Impact on Home Health Care Services

Who Do We Serve?Home Health Care Patient Demographics

The HSS: National Health Statistics Report (HSS)(2011)

published the following home health statistics…

• 68.7% are older than 65 years.

• 64.0% are women.

• For the older adult who is 65+, the average length of service is 242 days.

• For the oldest-old, 85+, the average length of service is 270 days.

• Average number of admitting diagnose is 4.2

• 68% of older adults live with family or nonfamily members.

Most Common Admitting DiagnosesHome Health Care Patient

The most frequent admitting diagnosis for the home health care patient during the initial interview. HSS: National Health Statistics Report (2007).

Low Health Literacy Home Health Care Providers Need Family Support

Health literacy is connected to being able to advocate for themselves or include an individual or family caregiver on a consistent basis (IOM, 2012).

Home Health Care PatientsDifficulty With Understanding

• 71% of older adult have challenges understanding printed health education materials (AMA, 2007).

• 68% older adults have difficulties understanding numbers and completing calculations (AMA, 2007).

• 80% of older adults have difficulty completing medical forms or understanding charts (AMA, 2007).

Low Health Literacy & Medication

The AMA reports, “People over 65 and older make nearly twice as many physician office visits per year than 45 to 65. However, estimated two-thirds of older people are ‘unable’ to understand the information given to them about their prescription medications” (2007, p. 4).

Low health literacy leads to medication and treatment errors, under dosing and over dosing, missed doses and noncompliance. These errors directly relate to increased medical costs, emergency room visits and hospitalization.

Health LiteracyIs Health Literacy Related to Education?

• Older adults who have completed high school may stillhave challenges navigating health care instructions.

• Adequate functioning older adults who live at home or still work may have inadequate health literacy (ICE, A-06-04).

• Health literacy is also connected to the older adults ability to listen, speak, and have an adequate background of their health condition(s) regardless of educational backgrounds (HSS, 2012).

Risky BehaviorsLow Health Literacy: Impact on the Home Health Care Patient

• More likely to not use their inhalers correctly and at prescribed times.

• More confused about symptoms and medical/dietary interventions for low or high blood glucose levels.

• Less likely to understand correlation between obesity, salt, diet & lack of exercise in relationship to hypertension.

• Less likely to remember physical symptoms of high or low blood pressure (Weiss, 2007, p. 13).

Weiss, B.D. (2007). Health literacy and patient safety. Retrieved from http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

Home Health Care ProviderGeneral Communication Tips: Initial Greetings

• Initial greetings set the tone –Always address the older adult by their last name. Ask “How they would like to be addressed?” (ICE, A-03-04).

• Begin conversation with general questions (i.e. the weather, what was their last meal?).

• Pay attention to the patient’s speech patterns. Match your volume and speed to that of the patient (ICE, A-02-04).


• Eye contact is interpreted differently by many cultures, do your homework before the appointment.

• Pay attention to the patient’s level of comfort with direct eye gazing. Never force the patient’s to maintain direct eye contact if they appear uncomfortable (ICE, A-02-04).

• Physical gestures mean different things to different cultures. Follow the lead of the patient.


• Be conservative in your body gestures.

• Always ask permission prior to touching the patient (i.e. taking vital signs, listening to heart and breath sounds)(ICE, A-02-04).


• Ask open ended questions. Avoid “yes” or “no” type questions.

• Reduce background noise (turn off TV or radio).

• Stick to one topic at a time (avoid switching from topic to topic quickly).

• Keep sentences short, questions short (American Speech-Language-Hearing Association, 2012).


• Avoid hurrying their answer, all extra time for them to respond.

• Tolerate pauses or gaps between questions and answers.

• Engage in ‘active listening’ techniques (American Speech-Language-Hearing Association, 2012).

Home Health Care ProviderTeaching Patients with Low Health Literacy Skills

• Avoid medical terminology.

• Avoid technical words.

• Use simple words.

• Use short simple sentences.

• Speak slowly, repeat when needed.

• Avoid shouting.

• Use pictures, videos, brochures in theirlanguage to improve comprehension.

• Give information is small segments, assess comprehension prior to proceeding (ICE, B-02-04).


• Avoid teaching for longer than 30 minutes at a time. Observe for fatigue and pain (ACN, 2009) .

• Present one ‘key’ idea at each visit.

• Observe for facial and body language indicating confusion or frustration. Repeat with new strategy when necessary (ACN, 2009).

• With each visit, review information presented on last visit, prior to proceeding with a new skill or topic. Review…assess… teach…review…assess…teach…etc.


• All essential information will be taught first.• Present material in a step-by-step format (HSS,

2012).• Avoid mixing ‘positive & negative’ information

(HSS, 2012). • Repeat ‘key’ information, use visual aides

whenever available.• Be consistent with choice of word. Avoid

interchanging words (ACN, 2009 & HSS, 2012). • Confirm understanding by asking for a repeat

demonstration (ICE, B-2-04 & Parkland Patient Education, n.d.).


Make Reading Material Easy To Read

• Provide written material in large print (16 or 18-point) (HHS, 2012).

• Always choose easy to read font (Serif).

• Organize the logical flow of information.

• Provide clear headings with subheadings.

• Allow a lot of space between each idea or topic, at least ½ inch between each line (HSS, 2012).

• Sentences should remain simple and short (Parkland Patient Education, 2013).


Women 65+ Men 65+

Arthritis/Hypertension 63.0% Arthritis/Hypertension 49.3%

Diabetes/Hypertension 25.4% Diabetes/Hypertension 29.5%

Arthritis/Diabetes 20.4% Cancer/Hypertension 27.6%

Cancer/Hypertension 21.8% CHD/Hypertension 24.8%

Arthritis/Cancer 21.0% Arthritis/Diabetes 21.2%

Five Most Prevalent Chronic Condition Dyads for US Adults With 2 or More Chronic Conditions, by Sex and Age. CDC (2010). National Health Interview Survey

Most Common Teaching Topics For Field Staff

Home Health Care ProviderChallenges of Literacy, Culture & Language

The United States Department of Health and Human Services (HHS) acknowledge, “Culture affects how people communicate, understand and respond to health information” (Health Literacy Basics, 2012).

Home Health Care ProviderChallenges of Literacy, Culture & Language

Dr. Regina Benjamin from the 2010 Surgeon General’s Perspective reported, “HHS reports that the cultural and linguistic differences among patients directly impact their health literacy levels, which in turn contribute to an increased prevalence of health disparities…more so in vulnerable populations” (2010, p. 784)

Home Health Care Provider Challenging Language Barriers

• Identify patient’s under agency service with Limited English Proficient (LEP). Any patient’s with language barriers or patient’s that have difficulty processing (understanding) health information should be provided in their native language (ICE, B-02-04).

• Utilize color coded stickers on office charts indicating when interpreter services are needed (ICE, B-02-04).

• Ask the patient’s/family preference in the spoken language. • If no staff or family are available for interpreting service, a

telephone interpreter service should be utilized to acquire accurate information or to give vital medical instructions.

• Provide brochures or educational material in the language the patient speaks.

Home Health Care ProviderInterpreter Services

When and How to Utilize the Interpreter:

• When agency staff is unable to communicate with the patient.

• When family/caregivers are unavailable.

• The interpreter should meet the patient’s needs. Some patient’s may prefer a specific sex due to personal information being shared.

• Allow extra time when working with an interpreter.

• Avoid speaking loudly or too fast. Allow time for the interpreter to communicate all your questions and instructions.

• Avoid technical terms, medical terminology.

• Face the patient, not the interpreter.

• Avoid interrupting the interpreter.

• Observe the patient’s body language, look for signs of confusion, comprehension, disagreement or agreement (Industry Collaboration Effort (ICE), 2004, B-03-04).

Interpreter ServicesTelephonic Companies

• All companies provide training materials, including specific reports and equipment.

• There is a start-up cost and some charge a low monthly service fee.

• Rates depend on language requested.

Medical Interpreter Services (ICE, B-05-04):• CyraCom International 800-713-4950

• Interpreting Services International, Inc. 818-753-9584

• Pacific Interpreters 800-311-1232

• Tele-Interpreters 877-835-3468

Home Health Care ProvidersAlternative Patient Teaching Tools

• Use of Graphic Illustrations:

Pictures, Pictographs, Models

• Audiotapes and compact discs: Focus on one topic at a time. Use plain/simple language.

• Videotapes: The Internet has thousands of commercial and noncommercial sources.

• Information-only computer modalities

• CD-ROM, Downloadable Internet sites

American Medical Association, Health Literacy Resources (2013). Health literacy. Retrieved from http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/health-literacy-program.page

Home Health Care ProvidersPaying Attention to Non-Verbal Behaviors

Low Health Literacy ‘Behaviors’ :

• Not completing forms, always having an excuse (avoiding needed paperwork).

• Not taking medications as prescribed.

• Consistently arriving to appointments late.

• Calling for instruction clarification.

• Not filling prescriptions as directed (Joint

Committee on National Health Education, 1995).

Industry Collaboration Effort (ICE) (2004). Tips for identifying and addressing health literacy issues (A-06-04). Retrieved from http://www.iceforhealth.org/library/documents/ICE_C&L_Provider_Tool_Kit.10-06.pdf

Home Health Care ProvidersPay Attention to What is Not Being Stated

Low Health Literacy ‘Verbal’ Comments:

• A) “What does this say?”

• B) “I don’t understand this?”

• C) “I will have my family explain it to me.”

• D) “I will have my neighbor explain it to me.”

• E) “I don’t know where my glasses are.”

• F) “My eyes are tired now, I will read it later.”

Industry Collaboration Effort (ICE) (2004). Tips for identifying and addressing health literacy issues (A-06-04). Retrieved from http://www.iceforhealth.org/library/documents/ICE_C&L_Provider_Tool_Kit.10-06.pdf

Words that Avoid Confusion

Weiss, B.D. (2007). Health literacy and patient safety: Help patients understand. Manual for clinicians(2nd ed.) Retrieved from http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

FreeHealth Literacy Government Resources

• National Institute of Health (2013). MedlinePlus: How to Write Easy-to-Read Health Materials. Available for download at http://www.nlm.nih.gov/medlineplus/etr.html* (A 5-page paper on education techniques considering reading level,

cultural background and English as a second language).

• The Council of State Governments (2002). State Official’s Guide to Health Literacy. Available for download at http://adph.org/ALPHTN/assets/060110literacyguide.pdf * (This is a 136-page document discusses Medicare costs, impact on each

state an is full of excellent statistics and graphs).

• U.S. Department of Health and Human Services: Center for Disease Control and Prevention (2009). Improving Health Literacy for Older Adults: Expert Panel Report. Available for download at http://www.cdc.gov/healthliteracy/pdf/olderadults.pdf* (A 47-page brochure aimed at improving health literacy for older adults).

FreeHealth Literacy Government Resources• U.S. Department of Health and Human Services. Office of Disease Prevention and

Health Promotion (2010). National Action Plan to Improve Health Literacy. Available for download at http://www.health.gov/communication/HLActionPlan/pdf/Health_Literacy_Action_Plan.pdf* (This is a 73-page document that provides examples for restructuring the

way medical professional provide health care information of patient tosustain a health literate Nation).

• U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality (AHRQ). Health Literacy Universal Precautions Toolkit. Available for download at http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html* (This is a 227-page document that provides step-by-step guidance and

tools for assessing patients for all literacy levels).

• U.S. Department of Health and Human Services: Centers of Disease Control. Simply Put: A guide for creating easy-to-understand materials. Available for download at http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf

* (This is 43-page brochure for strategic and proactive community outreach).

FreeHealth Literacy Government Resources• Health Industry Collaboration (ICE) (2004). Better communication, better care:

Provider tools to care for diverse populations. Retrieved from http://www.iceforhealth.org/library/documents/ICE_C&L_Provider_Tool_Kit.10-06.pdf

(This is a 56-page tool kit for healthcare professionals. The packet addresses communication with diverse patient populations, language barriers and the impact of cultural background).

• The Gerontology Society of America (2012). Communicating with older adults: An evidence-based review of what really works. Retrieved from http://www.agingresources.com/cms/wp-content/uploads/2012/10/GSA_Communicating-with-Older-Adults-low-Final.pdf

(This is a 40-page document that covers all aspects of improving communication between the caregiver or medical professional. The material is all evidence-based and has a long list of references and more reading material that is very helpful).

Home Health Care ProvidersStaff Educational Training Resources

• American Medical Association, Health Literacy Resources. Content: This Health Literacy kit includes DVD, CD-ROM or VHS, online material, hand-outs and an in-depth teaching manual. Cost: Varies depending on course and materials chosen. Available at http://www.ama-assn.org//ama/pub/about-ama/ama-foundation/our-programs/public-health/health-literacy-program/health-literacy-kit.page

• Health Literacy MissouriContent: Online Training, workshops and diagnosing health literacy weaknesses in staff.Cost: Varies depending on course and materials chosen. Available at https://www.healthliteracymissouri.org/our-services

FreeStaff Educational Training Resources

• Centers for Disease Control and Prevention (CDC). Health Literacy for Public Health Professions. This offers 1 free CEU upon completion. Course ID WB185.

Available at: http://www.cdc.gov/healthliteracy/gettrainingce.html.

• U.S. Department of Health and Human Services (2011). Effective Communication Tools for Healthcare Professionals. Course ID 101508. This course is free. It does not offer CEU’s. Takes 5 hours to complete.

Available at: http://www.cdc.gov/healthliteracy/gettraining.html

FreeStaff Educational Training Resources

• University of Minnesota. School of Public Health (2013). Culture and Health Literacy Modules. This course is free. Offers no CEU’s. Available at: http://cpheo1.sph.umn.edu/healthlit/#a

* (This is a two-course offers case studies in culture andhealth literacy).

• Public Health Training Center (2013). Health Literacy & Public Health: Introduction. This course is free. This course offers 1.5 CEU’s credit. Course ID 7WDQEL-PRV-10-219. Available at http://www.empirestatephtc.org/learning/pages/catalog/phlit01/credits.cfm* (This course provides excellent examples of health literacy in the field. All references are evidence-based).

Home Health Care ProvidersField Staff Communication Resources

• “On The Spot Communication Tool Kit” is a valuable tool for home health care providers who require simple-to-use tools that assist in communication difficulties related to low reading & reading skills, language difficulties or hearing challenges.

• The tool kit provides products that can enhance provider/patient communication.

Augmentative Communication News (ACN) (2009, August). Communication “On the Spot”. ACN, 21(2):1-15. Retrieved from http://www.augcominc.com/newsletters/index.cfm/newsletter_129.pdf

Home Health Care ProvidersField Staff Communication Tools

• Dry erase board: For writing and drawing messages.

• Picture communication board: Allows the patient to point to specific areas of the body, pain scale numbers and simple messages.

• Pocket talker: This device increases hearing in when a hearing aid is unavailable.

• English/Spanish: Flash cards for the most common phrases and words.

Pressman, H. & Newman E. (2009). Communication access within healthcare environments: A call for action. Patient Provider Communications. Retrieved from http://www.patientprovidercommunication.org/article_3.htm

Home Health Care ProvidersField Staff Communication Tools

• Vidatak E-Z Communication Boards (Multiple Languages and Picture Boards). Vidatak,LLC(877) 392-6273

• Critical Communicators/Pocket Communicator/Picture Communicator (Multiple Languages)

Interactive Therapeutics. (800) 382-8622

• PockeTalker (for hearing impaired). Williams Sound products from ‘A Bridge Between Nations’. (888) 432-0874 or (982)526-1596

• Chattervox (voice amplifier)

Asyst Communications Co., Inc. (847) 816-8580Patient Provider Communications (2012). Communication access within healthcare environments. Retrieved from http://www.patientprovidercommunication.org/article_3.htm

Home Health Care ProviderA Review of Points…

• Health care literacy can be improved. • As a health care provider, have all staff become aware of this

critical issue with the older adult patients in your agency. • Begin with general staff education focusing on communication

with the older adult. • Schedule all staff to complete all free on-line tutorials about

developing plain language materials and messages. • Print-out free governmental agency support training manuals

and use them as reference guides for future health literacy in-services.

• Provide written support materials for all staff.• Purchase and create patient educational materials that have

visual content. communication skills, techniques and support materials for the low health literate patient.

Home Health Care ProviderA Review of Points…

• Review the various cultures in your agency, develop a culturally competent staff.

• Create common health related topics in a number of languages.

• Awareness of health literacy and implementing proactive steps will improve patient communication. These steps will result in improved patient outcomes and reduced ER visits and hospitalizations.

• Remember: Creating effective health literacy communication is a human right. It should remain accessible and achievable for all patients regardless of age, gender, language or culture.

Bibliography• American Medical Association, Health Literacy Resources (2013). Health

literacy. Retrieved from http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/health-literacy-program.page

• American Speech-Language-Hearing Association (2012). Health literacy. Retrieved from http://www.asha.org/SLP/healthliteracy/

• Augmentative Communication News (ACN) (2009, August). Clinical News, 21(2):1-16. Retrieved from http://www.augcominc.com/newsletters/index.cfm/newsletter_129.pdf

• Benjamin R.M. (2010, Nov.-Dec.). Improving health by improving health literacy. Public Health Rep, 125(6):784-785.

• Centers for Disease Control and Prevention (CDC) (2010). Prevalence of multiple chronic conditions among US adults: Estimates from the National Health Interview Survey, 2010. Retrieved from http://www.cdc.gov/pcd/issues/2013/12_0203.htm

Bibliography• Eldercare Workforce Alliance (2012). Care coordination. Retrieved from

http://www.eldercareworkforce.org/research/issue-briefs/research:care-coordination-brief/

• Howard, D.H., Gazmararian, J., & Parker, R.M. (2005). The impact of low health literacy on the medical costs of Medicare managed care enrollees. Am J Med.,118:371-377.

• Joint Committee on National Health Education (1995). Barriers to literacy. Retrieved from http://www.cdc.gov/HealthyYouth/SHER/standards/

• Industry Collaboration Effort (ICE) (2004). Partnering with diverse patients: Tips for office staff to enhance communication (A-03-04). Retrieved from http://www.geneticcounselingtoolkit.com/pdf_files/ICE_Booklet.pdf

• Industry Collaboration Effort (ICE) (2004). Telephonic interpreting companies (B-05-04). Retrieved from http://www.geneticcounselingtoolkit.com/pdf_files/ICE_Booklet.pdf

Bibliography• Industry Collaboration Effort (ICE) (2004). Ten Tips for working with

interpreters (B-03-04). Retrieved from http://www.geneticcounselingtoolkit.com/pdf_files/ICE_Booklet.pdf

• Industry Collaboration Effort (ICE) (2004). Tips for communicating across language barriers (B-02-04). Retrieved from http://www.geneticcounselingtoolkit.com/pdf_files/ICE_Booklet.pdf

• Industry Collaboration Effort (ICE) (2004). Tips for identifying and addressing health literacy issues (A-06-04). Retrieved from http://www.geneticcounselingtoolkit.com/pdf_files/ICE_Booklet.pdf

• Industry Collaboration Effort (ICE) (2004). Working with diverse patients: Tips for successful patient outcomes (A-02-04). Retrieved from http://www.geneticcounselingtoolkit.com/pdf_files/ICE_Booklet.pdf

• Institute of Medicine (IOM) (2004, April). Health literacy: A prescription to end confusion. Retrieved from http://www.iom.edu/Reports/2004/Health-Literacy-A-Prescription-to-End-Confusion.aspx

Bibliography• National Assessment of Adult Literacy (NAAL) (2003). The health literacy of

America’s adults: Results from the 2003 national assessment of adult literacy. Retrieved from http://nces.ed.gov/pubs2006/2006483_1.pdf

• National Health Education Standard (NHES)(1997). Definition of health literacy. Retrieved from http://opi.mt.gov/PDF/Health/NHES.PDF

• National Network of Libraries of Medicine (NNLM) (2012). Health literacy. Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html

• National Women’s Health Report (2004, Oct.). Average health literacy skills compared with poor health literacy skills. Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html

• Joint Committee on National Health Education Standards (1977). National health Education standards: Achieving Health literacy. Retrieved from http://opi.mt.gov/PDF/Health/NHES.PDF

Bibliography• Parkland Patient Education (2013). Guidelines for teaching patients with low health literacy.

Retrieved from http://www.parklandhospital.com/patients_visitors/health_information/pdf/gdl%20teaching%20ll.pdf

• Rhode Island Health Literacy Project (2013). Introduction to health literacy. Retrieved from www.RIHLP.org

• United States Department of Health and Human Services (HHS) (2012). Health literacy and older adults. Retrieved from http://www.health.gov/communication/literacy/olderadults/literacy.htm

• United States Department of Health and Human Services (HHS) (2010) . Healthy People: Health Literacy. Washington, DC: U.S. Government Printing Office. Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html

• U.S. Department of Health and Human Services: National Health Statistics Report (HSS)(2011, April 27). Home health care and discharge hospice care patients: United States, 2007 and 2007. Retrieved from http://www.cdc.gov/nchs/data/nhsr/nhsr038.pdf

• United States Department of Health and Human Services (HHS) (2012). Quick quick to health literacy fact sheet: Health literacy basics. Office of Disease Prevention and Health Promotion. Retrieved from http://www.health.gov/communication/literacy/quickguide/factsbasic.htm

Bibliography• United States Department of Health and Human Services (HHS) (2012). Quick quick to health

literacy and older adults: Cognitive Challenges. Office of Disease Prevention and Health Promotion. Retrieved from http://www.health.gov/communication/literacy/olderadults/cognitive.htm

• United States Department of Health and Human Services (HHS) (2012). Quick quick to health literacy and older adults: Hearing impairment. Office of Disease Prevention and Health Promotion. Retrieved from http://www.health.gov/communication/literacy/olderadults/hearing.htm

• United States Department of Health and Human Services (HHS) (2012). Quick quick to health literacy and older adults: Visual Impairment. Office of Disease Prevention and Health Promotion. Retrieved from http://www.health.gov/communication/literacy/olderadults/visual.htm

• Vernon, J., Trujillo, A., Rosenbaum, S. & DeBuono, B. (2012). Low health literacy: Implications for national health policy. Retrieved from http://www.pfizerhealthliteracy.com/asset/pdf/Low-Health-Literacy_Implications-for-National-Health-Policy.pdf

• Weiss, B.D. (2007). Health literacy and patient safety: Help patients understand. Manual for clinicians (2nd ed.) Retrieved from http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

Low Health Literacy in the Older Adult: Identification & Intervention power point 2.1.15

Health & Medicine

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