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Schooling Me


Last week, I wrote about a study that revealed an astonishing fact:  Poor, Black people have worse home health outcomes.   I surmised that we really didn’t have time to do a full literacy assessment; nor did we have the skills to do so.  Oops.  A reader, Kyandra commented that there is a Single Question Literacy assessment and that prompted a day long journey into Health Literacy on the internet.  Some of the information I found truly was surprising – and frankly, embarrassing to us as a nation.

The statistics are wide and varied.  One study estimates that one in three adults does not have the literacy skills to understand written health materials. Most health materials are written at an 8th grade level but the average reading level of adults is closer to the 5th grade level.  Older Americans (i.e. Medicare Beneficiaries) are more likely to be unable to read or comprehend written materials.  Accidents happen, hospitalizations increase and preventative care decreases with an increase in health literacy skills that are basic or less than basic.

Should health literacy statistics bore you, know that effective January 1, you are mandated to have a working knowledge and use it.

From the new Conditions of Participation:

The agency must provide information about rights and responsibilities verbally and in writing in a manner the patient can understand. There must be documentation that the agency has complied in the chart.

This is not new.  It has always been a part of the Civil Rights Act section 504 which applies to all government contractors (yes, you are a government contractor ever since your agency entered into a provider agreement with CMS).  Now it is part of the CoPs.

Finally, patients and/or their families have sued successfully when they were unable to understand consents or other forms given to them.  Judges think that a patient who cannot understand the information cannot give informed consent.  I agree.

During my rambling search, I found one video by the AMA that explains the problem much better than I do and also offers solutions.  If I ran an agency, I would play this video at a mandatory inservice for all employees.

After watching the video, consider using a single question literacy screen that has been proven to be fairly accurate in determining health literacy in adults as suggested by Kyandra.

 “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?”

  1. never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always

Although the assessment is determined to be only moderately effective in research, there’s a good chance that a patient admitting to having difficulty reading medical instructions needs more than a standard teaching guide and I’m pretty sure that creative nurses will be able to accommodate those needs.

Nicole White from Chicago commented that she used a sheet of paper handed to her patients.  It had several goals written in a font similar to that found on medication bottles.  She asked them to choose a couple of goals they would like to achieve.  If they couldn’t read the sheet, she asked if she could fetch their reading glasses from another room.  She assessed patient specific goals, vision and literacy without adding time to her assessment.

Nobody is in a better position to dance around problems with literacy than home health employees.  We are in the homes where patients are typically more comfortable.  We get to the know the patients (which may suggest the need for a second screening after a few visits).  We may have more than one person to teach and we can truly give the patient our full attention watching for indications that they are not understanding.  And we can solicit questions.

Agencies can lower hospitalizations, prevent medication and other errors, save a life or two, comply with the new CoP’s, reduce risk and save Medicare millions of dollars when they take health literacy seriously.  And it only costs the time it takes to play a YouTube video and let your nurses and therapists loose to find creative, patient specific solutions.  If nurses can devise a plan to use pool noodles in their care, I’m pretty sure they can use those same skills to meet the needs of their patients.

Please share how you work with patients with limited English proficiency or literacy skills by commenting below or emailing me.

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