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The Impact of Section 1557 Final Rule on Healthcare

Written by Corliss Collins, BSHIM, RHIT, CRCR, CSM, CCA, CBCS, CPDC and Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS    

The 2024 Final Rule for Section 1557 of the Affordable Care Act (ACA) was issued by the Department of Health and Human Services (HHS) on April 26, 2024. The effective date was July 5, 2024. The American Institute of Healthcare Compliance (AIHC) Volunteer Education Committee has written this article in response to several requests for more information on the Final Rule, which aims to ensure that all people have non-discriminatory access to healthcare. It applies to health programs and activities that receive federal financial assistance, known as covered entities.

Introduction

The Final Rule applies to all health insurance issuers that are recipients of federal financial assistance, which includes Medicare Parts C and D payments, as well as state Medicaid agencies and the health insurance federal and state Marketplaces (and all plans offered by issuers that participate in those Marketplaces that receive federal financial assistance).

Those covered by the rule may include hospitals, health clinics, health insurance issuers, state Medicaid agencies, community health centers, physicians’ practices, and home health care agencies.

Section 1557 makes it unlawful for health care providers, including doctors' practices and hospitals that receive federal financial assistance, to refuse to treat—or to otherwise discriminate against—an individual based on a number of characteristics, including:

  • Race
  • Color
  • National origin
  • Age
  • Disability
  • Sex, which includes sexual orientation and gender identity

Effective date is July 5, 2024.

Most of the implementing regulations in the new rule are effective 60 days (July 5, 2024) after publication in the Federal Register, which was on May 6, 2024. Some provisions impacting health insurance plan design won’t become effective until the plan year beginning after January 1, 2025, and other provisions where entities might need additional time to amend current practices also have later effective dates.

  • The Final Rule does not apply to employment practices, including the provision of employee health benefits.

Overview of the 2024 Final Rule for Section 1557 legislation

1. Strengthening Anti-Discrimination Protections

  • Expanded Protections: Include protections against discrimination based on gender identity and sexual orientation.
  • Clarification of Existing Protections: Clearly define what constitutes discrimination in health care settings.

2. Improving Access to Health Care Services

  • Equitable Access: Ensure that all individuals can access health care services without discrimination.
  • Language Access Requirements: Mandate language assistance services for individuals with limited English proficiency.

3. Enhancing Patient Rights

  • Empowerment of Patients: Provide clear mechanisms for individuals to report discrimination and seek remedies.
  • Informed Consent: Ensure patients are fully informed of their rights and available services.

4. Data Collection and Transparency

  • Demographic Data Collection: Encourage the collection of data to monitor health disparities and promote health equity.
  • Reporting Requirements: Establish guidelines for reporting discrimination and health outcomes.

5. Promoting Inclusive Health Care Environments

  • Cultural Competency Training: Require training for health care providers to better serve diverse populations.
  • Creating Safe Spaces: Implement policies to foster welcoming environments for all individuals, especially marginalized groups.

6. Clarifying Responsibilities for Covered Entities

  • Defining Obligations: Clearly outline the responsibilities of health care providers and insurers under the law.
  • Guidance for Compliance: Provide resources and guidance to help entities comply with the updated regulations.

7. Addressing Current Health Care Challenges

  • Response to Emerging Issues: Adapt the regulations to address current challenges, including those highlighted by the COVID-19 pandemic.
  • Focus on Health Equity: Tackle systemic inequalities in health care access and outcomes.
  • Artificial Intelligence (AI) and Nondiscrimination 

The government recognizes the potential impact of artificial intelligence (AI) in health programs and activities. Therefore, the rule clarifies that nondiscrimination in health programs and activities continues to apply to the use of AI, clinical algorithms, predictive analytics, and other tools. This clarification serves to support the October 30, 2023, Executive Order on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence. Specifically, the rule:

  • Applies the nondiscrimination principles under Section 1557 to the use of patient care decision support tools in clinical care.
  • Requires those covered by the rule to take steps to identify and mitigate discrimination when they use AI and other forms of decision support tools for care.

However, as of January 2025, this Executive Order has been rescinded.

How Covered Entities Must Comply

According to guidance issued by OCR, covered entities should:

  • Provide services and programs in the most integrated setting appropriate to the needs of the qualified individual with a disability
  • Ensure that programs, services, activities, and facilities are accessible
  • Make reasonable modifications in their policies, practices, and procedures to avoid discrimination on the basis of disability, unless it would result in a fundamental alteration of the program
  • Provide auxiliary aids to persons with disabilities, at no additional cost, where necessary to afford an equal opportunity to participate in or benefit from a program or activity
  • Designate a responsible employee to coordinate their efforts to comply with Section 504 and the ADA
  • Adopt grievance procedures to handle complaints of disability discrimination in their programs and activities
  • Provide notice that indicates:
    • That the covered entity does not discriminate on the basis of disability
    • How to contact the employee who coordinates the covered entity's efforts to comply with the law
    • Information about the grievance procedures

Consequences for Violating a Patient’s Rights under Section 1557

The Office for Civil Rights (OCR) enforces Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. 42 U.S.C. 18116.

Section 1557 has been in effect since the enactment of the ACA in 2010. Since that time, the OCR has been receiving and investigating discrimination complaints under Section 1557.

If an individual believes s/he has been subject to discrimination in health care or health coverage, they may file a complaint with OCR under Section 1557. OCR has a toll-free number and will guide individuals through the complaint process. OCR’s complaint forms are available in a variety of languages. Individuals can file a complaint online via OCR’s Complaint Portal.

If OCR determines that it has jurisdiction, OCR will investigate the complaint or, in some cases, refer the complaint to an agency with joint jurisdiction. When OCR identifies a violation or compliance concern, it will work with the recipient to achieve compliance with the law. Depending on the scope of the changes required, complaints can be resolved through voluntary compliance letters or agreements requiring the recipient to develop policies, monitoring, notification, and training, which also resolve the specific incidents alleged in the complaint. If voluntary compliance cannot be achieved, OCR can issue a formal findings letter and refer the case to DOJ or begin administrative proceedings to revoke federal funds.

In the News - Imaging Network Violates Section 504 and Section 1557

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) recently announced a settlement with the New Jersey Imaging Network (“Network”) to resolve a civil rights complaint from an individual who uses a wheelchair, and was denied mammography because of her disability, based on Section 504 of the Rehabilitation Act (Section 504) and Section 1557 of the Affordable Care Act (Section 1557), which prohibit discrimination on the basis of disability. Together, these laws protect people with disabilities from discrimination in any program or activity receiving funding from HHS. The Network has only 45 calendar days to modify policies and procedures to comply, and in addition:

Document requests for mobility assistance or other reasonable accommodations; provide patients with a description of available accommodations; and notify patients of their rights under the law.

  • Develop a process for individualized assessment of patients who may require reasonable accommodations.
  • Train its staff on the new policies to ensure employees understand practices and procedures for interacting with and accommodating individuals with disabilities, techniques for safely assisting individuals with limited mobility to ensure their safe access to and use of medical equipment and examination tables, and The New Jersey Imaging Network’s various non-discrimination and non-retaliation obligations.
  • Notify patients, staff and the public of rights and protections afforded them by federal law and how to file a discrimination disability-based complaint with HHS.

OCR is monitoring the settlement action for the next 2 years. Click Here for the OCR & New Jersey Imaging Network Resolution Agreement. 

Conclusion

This 2024 Final Rule for Section 1557 legislation aims to bolster anti-discrimination measures in health care, ensuring equitable access to services, protecting patient rights, and promoting a culture of inclusivity within health care settings. This rule reflects a commitment to address health disparities and improve the overall quality of care for all individuals. 

View the Final Rule “Nondiscrimination in Health Programs and Activities” in the Federal Register – a Rule by the Centers for Medicare & Medicaid Services posted 05/06/2024.

About the Authors

Corliss Collins, BSHIM, RHIT, CRCR, CSM, CCA, CBCS, CPDC is Principal & Managing Consultant, P3 Quality LLC, Founder and serves on the AIHC Volunteer Education Committee.

Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS serves as the Board Chair of AIHC and oversees the Volunteer Education Committee.

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Reporting Elder Abuse on the Claim

Part 4 in a series of articles to support World Elder Abuse Awareness 

Written by Joy Rose, MSA, RHIA, CCS, CHA, CHPS     

ICD-10-CM Rules for Coding Abuse

World Elder Abuse Awareness Day was June 15.  Adult and child abuse, neglect and other maltreatment is unfortunately prevalent in society, and many believe that these cases are underreported (refer to the June 2024 article “Detecting Abuse of the Elderly” Part 2 in a series of AIHC Elder Abuse Awareness Training for your Workforce articles).  It is not uncommon for providers to evaluate suspected or confirmed cases of elder abuse.  Please feel free to repost, print and make this article available to your workforce members.

ICD-10-CM CODING RULES FOR ELDER ABUSE

When it comes to medical coding, there are specific codes that cover many types of abuse and exploitation.  These codes should always be assigned when appropriate. 

As a medical coder, when reviewing the medical record for appropriate documentation, one can only assign the codes when they are documented by the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient's diagnosis). Do not interpret the physician narrative without the physician’s confirmation.

When assigning codes to a medical record that has suspected, confirmed or sequelae effects from abuse, one should follow the coding guidance as found in the conventions of the ICD-10-CM book, the Official Coding Guidelines for ICD-10-CM, as published by the National Center for Healthcare Statistics and The American Hospital Association, Coding Clinic©.  The ICD-10-CM diagnosis codes applicable to a case of confirmed or suspected elder abuse can be found in the section, Coding of Injuries, Burns, Poisoning, and Complications of Care, CHAPTER 19 Injuries, in ICD-10-CM.

CODING AXIS OR PLACES IN ICD-10-CM

Remember the axes of ICD-10?  In coding abuse, the first axis is abuse, neglect or other maltreatment of an adult and whether the abuse is confirmed (category T74) or suspected (category T76).  Only select these categories when it is documented by the patient’s provider in the record.

CODE EXAMPLE OF SUSPECTED ELDER FINANCIAL ABUSE CODE:

  • A suspected case of adult financial abuse code would start with the first axis abuse, suspected =T76
  • The fourth character would indicate the type of abuse – financial T76.A (Financial)
  • The fifth character specifies adult as the victim  T76.A1 (Adult)
  • The sixth character indicates suspected – T76.A1X (Suspected)
  • The 7th character indicates the episode or encounter in this case initial.  T76.A1XA (episode)

EXAMPLE

Extra digit codes for T76.A

T76.A1XA

Adult financial abuse, suspected, initial encounter

T76.A1XD

Adult financial abuse, suspected, subsequent encounter

T76.A1XS

Adult financial abuse, suspected, sequela

For confirmed cases of abuse, be sure to assign the appropriate external cause codes from the assault section (X92-Y09) to identify the cause of physical injuries.  The perpetrator, when known, should also be added as a code from the Y07 category.

LOOK UP CONVENTION FOR ABUSE ICD CODES: 

  • To find the code use the search term ‘maltreatment’, ‘abuse’, ‘exploitation’ as a start. When using an encoder, it may provide a code when entering a full term such as “financial abuse”. 

SEQUENCING:  

  • Follow the coding guidelines for coding of injuries in Section 1, Chapters 19, 15, and 20; as well as the conventions of ICD-10 in the codebook.


WHAT ABOUT SUSPECTED CASES?

The assignment for suspected cases is slightly different. If suspected abuse is ruled out during a visit, assign code Z04.71-Encounter for examination and observation following alleged physical adult abuse, ruled out.   

  • The “Z” category codes for ruled out, should be used, not a code from T76.
  • If a suspected case of alleged rape or sexual abuse is ruled out during an encounter code Z04.41,
  • Encounter for examination and observation following alleged adult rape or code Z04.42.
  • If a suspected case of forced sexual exploitation or forced labor exploitation is ruled out during an encounter, code Z04.81, Encounter for examination and observation of victim following forced sexual exploitation, or code Z04.82

CODING SCENARIO

An elderly woman presents at the emergency department for pain in her left wrist.  Upon examination and x-ray, it is discovered she has a closed radial styloid process fracture. She relates the story as her wrist being grabbed and twisted by her adult daughter as the elderly woman attempted to keep the daughter from obtaining her debit card. The friend who brought the woman in witnessed the encounter and agrees with the story.  A police report has been filed. The physician documents the abuse as confirmed.

The codes assigned based on documentation in the patient’s medical record would be:

S52515A  Nondisplaced fracture of left radial styloid fracture, closed

T7411XA  Adult physical abuse, confirmed initial encounter

T74A1XA  Adult financial abuse confirmed initial encounter

Y042XXA  Assault by strike against or bumped into by another person, initial encounter

Y0744  child perpetrator of maltreatment and neglect

A coder should also code the social determinants of health for this encounter, if any. In this case, Z62820 Parent-biological child conflict, might be used.

References:

About the Author

Joy Rose, MSA, RHIA, CCS, CHA, CHPS is a member of the American Institute of Healthcare Compliance (AIHC) and serves as a subject matter expert on the AIHC Volunteer Education Committee.

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Spotting Financial Fraud & Exploitation of the Elderly

Part 3 in a series of articles to support World Elder Abuse Awareness    

Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS of the American Institute of Healthcare Compliance (AIHC), a non-profit healthcare education organization.    


AIHC is sharing this information in support of World Elder Abuse Awareness Day.  The information below is not all-inclusive or comprehensive, but it is a good start to increase awareness to educate your workforce, patients, caregivers and family members.  Please feel free to repost, print and make available to your workforce members. 

Criminals are getting smarter every day and using advanced technology, such as Artificial Intelligence to scam the elderly.  Loneliness also creates situations for vulnerable adults leading to romance scams.

Understanding Elder Abuse and Financial Exploitation Statutes

The federal government, states, commonwealths, territories and the District of Columbia all have laws designed to protect older adults from elder abuse and guide the practice of adult protective services agencies, law enforcement agencies, and others. Basic definitions associated with elder abuse are provided below for clarification. These laws vary considerably from state to state. 

  • Please check on the U.S. Department of Justice (DOJ) “State Elder Abuse Statutes” for easy reference for definitions, rules applying to institutional settings, Native American elder justice and more.

Abuse

According to Title 8 Public Health and Welfare § 192.2400 of the Department of Health and Senior Services, “Abuse”, the infliction of physical, sexual, or emotional injury or harm including financial exploitation by any person, firm, or corporation and bullying.

Extortion

Extortion happens when someone threatens harm to scare the individual into giving them money or items. This can be threat of harming a pet or loved one or threaten nursing home placement, etc.

Financial or Property Exploitation

This means illegal or improper use of an elderly or adult with a disability's money, property, or other resources for monetary or personal benefit, profit or gain. This includes, but is not limited to, theft, misappropriation, concealment, misuse or fraudulent deprivation of money or property belonging to the elderly or adult with a disability. 

According to the DOJ, this is typically committed by someone the patient knows, such as Power of Attorney (POA) abuse, credit or debit card use, lawyers or brokers abusing the patient’s trust. 

Financial exploitation refers to 2 types of financial crimes committed against older adults:

  • Financial abuse (committed by someone you know)
  • Financial fraud (committed by a stranger)

Both result in serious financial, physical, and emotional harm to older adults.

The Transnational Elder Fraud Strike Force provides the following list to warn and educate the public about trending elder fraud threats. The Strike Force encourages use of the scheme names listed below to enable those combating financial exploitation to speak a common language in discussing and reporting incidences of elder fraud. 

  • These scams are outlined in more detail below.
  • Social Security Administration Impostor Scam
    • Tech Support Scam
    • Lottery Scam
    • IRS Impostor Scam
    • Romance Scam

Spotting a Scams Targeting the Elderly

Romance Scams are launched by criminals online perhaps through a dating website, online game or even social media.  These scammers pretend to be someone they are not so they can gain trust and then ask for money. The scammer will say they’ve fallen in love, but have some reason they can’t meet in person. The scammer will start asking for money so they can travel to meet the victim or they need money to deal with an emergency, start a business, or help get the victim started with an “investment”, sometimes in cryptocurrency.

Imposter Scams is when the criminal pretends to be from the government (such as the Social Security Administration, IRS, or the police), or a company (such a bank or online company). Scammers will state that there is a serious problem with the victim’s account or benefits, or that the victim is a suspect in a crime. They may warn that benefits are being stopped, that there is a warrant for the victim’s arrest, or that the victim’s money is not safe. A scammer will offer fix this problem which involves paying money or moving money to a “safe” account the scammer provides.

Grandparent Scams prey on the elderly where the criminal pretends to be a family member.  This is easier now with Artificial Intelligence being used.  The victim receives a call pretending to be a family member in trouble (often arrested or seriously injured) and needs money right away.  Scammers often demand that the phone call be kept a secret.

Investment Scams happen when the victim is offered a once in a lifetime investment chance.  Scammers trick the victim into putting money in stocks, cryptocurrency, real estate, or many other things. Scammers promise big returns on investment with little or no risk. At times, a scammer may even show a fake statement that makes it look like the victim’s investment is doing well or even send some money to get the victim to pay more.

Lottery/Sweepstakes Scams happen when the victim is told they have won a sweepstakes, lottery prize or gift.  At times, scammers will even pretend to be a government agency helping to make sure the victim receives their winnings. The catch?  The victim must pay a fee to obtain the winnings, and then never receive that prize or gift.

Phantom Hackers & Technical Support Scams are more frequent due to savvy seniors having better computer skills and using technology.  These scams start as a computer pop-up, phone call or email saying there is a problem with the computer.  The scammers may pretend to be from a well-known company and ask to “remote” into the victim’s computer, meaning they can access and control the computer. Scammers will say there is a problem that needs fixing immediately and tell you to pay a fee. At times, scammers will also pretend to offer you a refund. They will pretend to refund you too much money ($4500 instead of $450) and ask you to return the difference.

The information below is from an FBI Public Service Announcement entitled Increase in Tech Support Scams Targeting Older Adults and Directing Victims to Send Cash through Shipping Companies.

THE SCAM

  • Tech support scammers usually initiate contact with older adult victims through a phone call, text, email, or pop-up window purporting to be support from a legitimate company. The scammer informs the victim of fraudulent activity or potential refund for a subscription service.
    • Subsequent emails, pop-ups, and texts contain a phone number for the victim to call for assistance. Once the victim calls the number, a scammer tells the victim they have a refund for the victim, however, the only way the money can be sent is by connecting to the victim's computer and depositing it into the victim's bank account.
  • The scammer tells the victim they can assist with the refund and convinces the victim to download a software program allowing the scammer remote access to the victim's computer.
    • Once a connection is established, the victim is convinced to log on to their bank account. The scammer then supposedly transfers an amount to the victim's bank account but "accidently" deposits a much larger amount than intended.
    • The scammer points this "error" out and tells the victim to return the extra money or the scammer will lose their job.
  • The scammer instructs the victim to send the money in cash, wrapped in a magazine(s), or similar method of concealment, via a shipping company to a name and address provided by the scammer.
    • Most recently, scammers have instructed victims to ship packages containing money to pharmacies and retail businesses that are equipped to receive shipping company packages.

“Phantom hacker” scams are an evolution of tech support scams, a type of cybercrime.  As of August 2023, losses from tech support scams were up 40% during the same period in 2022, according to a recent FBI public service announcement. It didn’t disclose the total dollar loss during that period. Information from that announcement is reproduced below.

"Phantom Hacker" Scams Target Senior Citizens and Result in Victims Losing their Life Savings

The FBI is warning the public of a recent nationwide increase in "Phantom Hacker" scams, significantly impacting senior citizens. This Phantom Hacker scam is an evolution of more general tech support scams, layering imposter tech support, financial institution, and government personas to enhance the trust victims place in the scammers and identify the most lucrative accounts to target. Victims often suffer the loss of entire banking, savings, retirement, or investment accounts under the guise of "protecting" their assets. Between January and June 2023, 19,000 complaints related to tech support scams were submitted to the FBI Internet Crime Complaint Center (IC3), with estimated victim losses of over $542 million. Almost 50% of the victims reported to IC3 were over 60 years-old, comprising 66% of the total losses. As of August 2023, losses have already exceeded those in 2022 by 40%.

THE SCAM

Phase 1 - Tech Support Imposter

  • A scammer posing as a tech or customer support representative from a legitimate company contacts the victim through a phone call, text, email, or a pop-up window on the victim's computer and instructs the victim to call a number for "assistance."
  • Once the victim calls the number, a scammer directs the victim to download a software program, allowing the scammer remote access to the victim's computer. The scammer pretends to run a virus scan on the victim's computer and falsely claims the computer has been or is at risk of being hacked.
  • Next, the scammer requests the victim open their financial accounts to determine whether there have been any unauthorized charges - a tactic the scammer uses to determine which financial account is most lucrative for targeting. The scammer chooses an account to target and tells the victim they will receive a call with further instructions from the fraud department of the respective financial institution hosting that account.

Phase 2 - Financial Institution Imposter

  • A scammer posing as a representative of the financial institution mentioned in phase 1, such as a bank or a brokerage firm, contacts the victim. The scammer falsely informs the victim their computer and financial accounts have been accessed by a foreign hacker and the victim must move their money to a "safe" third-party account, such as an account with the Federal Reserve or another US Government agency.
  • The scammer directs the victim to transfer money via a wire transfer, cash, or cryptocurrency, often directly to overseas recipients. The scammer may instruct the victim to send multiple transactions over a span of days or months.
  • The scammer tells the victim to not inform anyone of the real reason they are moving their money.

Phase 3 - US Government Imposter

  • The victim may also be contacted by a scammer posing as an employee at the Federal Reserve or another US Government agency.
    • If the victim becomes suspicious of the government imposter, the scammer may send an email or a letter on what appears to be official US Government letterhead to legitimize the scam.
  • The scammer continues to emphasize the victim's funds are "unsafe" and they must be moved to a new "alias" account for protection until the victim concedes.

Report Financial Fraud of the Elderly

Fraud and romance scams aimed at older adults resulted in losses of more than $184 million in 2018.

Many crimes go unreported because victims are scared, embarrassed, or don’t know who to call. That’s why DOJ created the hotline.

Call the Elder Fraud Hotline at 1-833-372-8311 (Monday-Friday, 10:00 a.m.-6:00 p.m. ET. or contact your local police or sheriff.

Report to the FBI

The Internet Crime Complaint Center, or IC3, is the Nation’s central hub for reporting cybercrime. It is run by the FBI, the lead federal agency for investigating cybercrime.

The FBI requests victims report these fraudulent or suspicious activities to the FBI Internet Crime Complaint Center and be sure to include as much information as possible:

  • The name of the person or company that contacted you.
  • Methods of communication used, to include websites, emails, and telephone numbers.
  • The address where the cash was shipped and the recipient’s name(s).

Don’t Turn a Blind Eye – Be Part of the Solution

If you see something, say something to your Compliance Officer, Manager or someone in authority.  Ignoring a potentially harmful situation is to neglect our duty of care to our patients. Financial extortion can financially devastate an elderly patient which contributes to psychological and physical problems.

Duty of care is a requirement that a person act toward others and the public with the watchfulness, attention, caution and prudence that a reasonable person in the circumstances would use. If a person's actions do not meet this standard of care, then the acts are considered negligent, and any damages resulting may be claimed in a lawsuit for negligence.

This article is sponsored by the American Institute of Healthcare Compliance (AIHC), a non-profit healthcare compliance training organization. Please re-post this article or print and distribute to your workforce for educational purposes.  Locate more information from your State, local law enforcement, medical society and use this link for additional information from the U.S. Department of Justice.  For more information to obtain online training in corporate compliance, click here.

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Detecting Abuse of the Elderly

Part 2 in a series of articles to support World Elder Abuse Awareness   

Warning Signs of Elder Physical, Sexual, Psychological Abuse, Abandonment and Neglect   

Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS of the American Institute of Healthcare Compliance (AIHC), a non-profit healthcare education organization.   

Elder Abuse Awareness for the Healthcare Workforce

The Department of Justice lists the following information that can be used by nurses, physicians and healthcare workforce members.  AIHC is sharing this information in support of World Elder Abuse Awareness Day.  The information below is not all-inclusive or comprehensive, but it is a good start to increase awareness to educate your workforce.

Please feel free to repost, print and make available to your workforce members.  This information can be useful when completing a Social Determinants of Health (SDOH) risk assessment and any time a health care professional determines it is necessary to gain a deeper understanding of presenting problems which are warning signs of elder physical, sexual, psychological abuse, abandonment, neglect and financial extortion.

Detecting Physical Abuse

Warning Signs can present as:

  • Bruises, black eyes, welts, lacerations, or rope marks
  • Bone fractures, broken bones, or skull fractures
  • Open wounds, cuts, punctures, untreated injuries in various stages of healing
  • Sprains, dislocations, or internal injuries/bleeding
  • Broken eyeglasses/frames, physical signs of being subjected to punishment, or signs of being restrained
  • Laboratory findings of medication overdose or under-utilization of prescribed drugs
  • An elder's report of being hit, slapped, kicked, or mistreated
  • An elder's sudden change in behavior
  • The caregiver's refusal to allow visitors to see an elder alone

Consider Asking –

  1. Has anyone hit, kicked, bit, slapped, or thrown things at you?
  2. Has anyone held or tied you down, or locked you in a room or building?
  3. Has anyone shaken, pinched, or burned you?
  4. Has anyone physically hurt you so that you suffered some injury, such as cuts, bruises, or other marks?
  5. Has anyone pushed, shoved, or grabbed you?
  6. Has anyone used a knife or gun on you?
  7. Has anyone not allowed you to go to the bathroom?     
  8. Has anyone given you too much or too little medication?

EXAMPLES: Stories as told by the DOJ regarding physical abuse cases of the elderly

  • Abuse by Guardian/Conservator
    • Blair, 65, had no close relatives. Because of early-onset dementia, he was placed in a nursing home and required guardianship. Chris, Blair’s guardian, came to Blair’s nursing home every few months to see how Blair was doing.
    • During the last visit, Chris began slapping Blair to wake him up. Joan, a care attendant rushed to the room when Blair began crying out for Chris to stop. Joan noticed marks on Blair’s face and asked what had happened. Blair was unable to tell Joan what had happened but Chris quickly left the room.
    • Joan reported the incident to her supervisors who helped her make a report to Adult Protective Services (APS). The report triggered involvement by the state ombudsman and local law enforcement.
  • Abuse by Long-Term Care Aide
    • Monica, 79, was placed in a long-term care facility when her ALS became severe and her family could no longer care for her. Her family became concerned when they saw bruising on her arms and back. Monica was not able to speak and could not tell her family how she got the bruises.
    • Monica’s family asked the staff about the bruising but was not satisfied with the explanation. The family also noticed that when a certain aide helped bathe her, Monica became upset and agitated. They suspected that the aide was hitting Monica and called local law enforcement.
  • Abuse by Disabled Adult Son
    • When George, 79, lost his wife of 50 years to cancer, his son, Lawrence, came to live with him. Lawrence was on disability due to a traumatic brain injury. The brain injury caused behavior changes, including difficulty with self-control and verbal and physical outbursts. The injury also caused violent mood swings.
    • Occasionally, Lawrence went to a neighbor's apartment and got drunk. One night when Lawrence returned home, George asked him if he was drunk. Lawrence yelled "NO" and punched his father in the face. Because George was afraid of further violence, he called 911 to get help from the police.
  • Abuse by Adult Grandsons
    • Katherine, 82, raised two grandsons, Joel and Kent. They had physically abused her since they were teenagers. After 12 years in prison, Joel returned to his grandmother's home because he had nowhere to go. One night Joel came home and was drunk. He banged on the door but Katherine told Joel to go away.
    • After he entered the house through a back window, Joel beat his grandmother. Katherine went to a neighbor’s house and called 911. Joel was arrested and Katherine was taken to the hospital. The police contacted Adult Protective Services (APS).
  • Abuse by Spouse
    • After 58 years of marriage, Virgil and Ella, both 83, knew each other's habits well. Sometimes, when they argued they became physically violent. Nevertheless, they said they loved each other and had never considered divorce. Violence was unfortunately a part of their relationship. As Ella aged, she developed osteoporosis. She began to worry that if she fell down when they were fighting each other she might end up with a broken bone. She confided this to a friend, and her friend suggested calling the local domestic violence hotline to speak with a counselor.

Detecting Abandonment/Neglect

Warning Signs can present as:

  • Dehydration, malnutrition, untreated bed sores, and poor personal hygiene
  • Unattended or untreated health problems
  • Hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no heat, or no running water)
  • Unsanitary and unclean living conditions (e.g., dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing)
  • An elder's report of being neglected
  • The desertion of an elder at a hospital, a nursing facility, or other similar institution
  • The desertion of an elder at a shopping center or other public location
  • An elder's report of being abandoned

Consider Asking – 

  1. Has the person who is supposed to take you to the grocery store, shopping, or to a place of worship stopped taking you there?
  2. Has the person who is supposed to help with household chores or cooking or eating stopped helping you?
  3. Has the person who is supposed to help get you to the doctor, or take medicines at the right times or amounts, or get glasses or dentures stopped helping you?
  4. Has the person who is supposed to help you bathe or shower, or get in and out of bed, or get dressed, or go to the toilet stopped helping you?
  5. Has the person who is supposed to help you pay bills or manage your money stopped helping you?
  6. Has anyone left you alone or deserted you at home or elsewhere for a long period of time?

EXAMPLES: Stories as told by the DOJ regarding abandonment & neglect of the elderly.

  • Neglect by Daughter and Son-in-Law
    • Kofi, 84, was diagnosed with Alzheimer’s disease and moved in with his daughter's family. Sometimes Kofi had trouble sleeping, had physical and verbal outbursts, and began wandering. His daughter and son-in-law were afraid that Kofi might wander out of the house if they left him alone.
    • They locked the doors to the house so that Kofi could not get out and wander around when they left for work. A neighbor noticed Kofi trying to get out of the house. She contacted the local police and Adult Protective Services (APS).
  • Neglect by Son and Daughter-in-Law
    • Tamara, 76, lived alone but had trouble getting around. Her son and his wife asked Tamara to move in with them. Tamara had her own bedroom on the second floor and stayed there most of the time. She could not use the stairs easily.
    • Her son and daughter-in-law both traveled frequently for work and sometimes neglected to give her adequate food and water. They also failed to groom her or to clean her room consistently.
    • One day Tamara became dizzy, weak and disoriented so her daughter took her to the hospital. The hospital staff discovered that she was dehydrated, disheveled and obviously unwashed. They asked about her care, but Tamara said she was well cared for. 
    • Nevertheless, as required by law, the hospital staff reported suspected neglect to Adult Protective Services (APS).
  • Neglect by Sons
    • Clarence, 79, invited his two adult sons to move in with him so he would not be alone after his wife died.
    • The sons soon sent Clarence out to live in the shed and locked him out of the house. Sometimes his sons put food out for him. Occasionally they gave him a basin of cold water with a washcloth.
    • When one of Clarence’s neighbors noticed that Clarence seemed to be living in the shed, she called Adult Protective Services (APS) anonymously and reported what she had seen. She then decided Clarence may need immediate help so she called the police to do a welfare check.
  • Abandonment by Adult Daughter
    • Juliette, 87, lived with her daughter, Nanette, for the past three years. Nanette helped Juliette with daily activities, such as getting her meals, bathing, and cleaning the house.
    • Nanette decided to move in with her boyfriend in another state and left her mother alone in the home.
    • About a week later, Juliette’s niece happened to be in town and stopped by to visit her aunt. She saw that the inside of the house was in very bad condition and found Juliette in poor health. Juliette’s niece contacted Adult Protective Services (APS) and the State Area Agency on Aging.
  • Abandonment by Guardian/Conservator
    • Henrietta, 88, required a court appointed guardian due to combined physical and mental disabilities that left her partially incapacitated. Her niece, Roberta, was appointed as Henrietta’s guardian.
    • Roberta visited Henrietta in her home a few times but then never came back and made no further arrangements for her care.
    • A neighbor noticed the lack of activity at Henrietta’s house. The neighbor knocked but couldn’t get Henrietta to answer door, so she called law enforcement for a welfare check and Adult Protective Services (APS).
  • Another Abandonment by Guardian/Conservator
    • June, 73, suffered a severe brain injury. At first, she was able to care for herself but as she got worse, a court appointed Sam as her legal guardian to assist her. He saw June two times in the first six months but did not return to see June and did not arrange for her care.
    • He falsified reports to the court stating that he saw June every three months. As a result, no one knew that June was living on her own without Sam’s help.
    • June was unable to remember to clean her house and the trash had not been taken out in many months. Due to the deterioration of her house, June received a visit from a county health officer who discovered that June was very frail.
    • The county health officer was a mandatory reporter and called Adult Protective Services (APS). APS petitioned the court for a new guardian.

Detecting Signs of Psychological Abuse

Warning Signs can present as: 

  • Being emotionally upset or agitated
  • Being extremely withdrawn, non-communicative or non-responsive
  • Unusual behavior, such as sucking, biting, rocking
  • An elder's report of being verbally or emotionally mistreated
  • Witnessing a caregiver controlling an older adult or isolating an older adult
  • Exhibiting a change in sleeping patterns or eating habits
  • Personality changes, such as apologizing excessively, or depression or anxiety

Consider Asking –

  1. Has anyone verbally attacked, scolded, or yelled at you so that you felt threatened or intimidated, or afraid for your safety?
  2. Has anyone made you feel embarrassed by calling you names such as “stupid,” telling you that you or your opinion was worthless or blaming you for things that you did not do?
  3. Has anyone talked to you so that you felt that they were talking to a child?
  4. Has anyone forcefully or repeatedly asked you to do something so that you felt forced into doing something against your will?
  5. Has anyone close to you completely refused to talk to you or ignored you for days at a time, even when you wanted to talk to them?
  6. Has anyone kept you away from family, friends, or regular activities against your will?
  7. Has anyone close to you looked at you in such a way that you felt afraid that they were going to hurt you?
  8. Have you felt that someone was watching your every move to try to control you or that that person was stalking you?
  9. Has anyone you know made unwanted phone calls to you or left messages or sent unwanted emails, texts, or instant messages to you?

EXAMPLES: Stories as Told by the DOJ regarding psychological abuse of the elderly

  • Psychological Abuse by Stranger
    • Rosie, 75, lived alone in an independent senior housing community. Her next-door neighbor, a disabled retiree, repeatedly emailed her rude messages and sent vulgar and threatening messages to her cell phone.
    • Fearing her neighbor might harm her if she told him to stop, Rosie contacted local law enforcement and filed criminal charges as well as a petition for a civil restraining order. She also notified housing management.
  • Psychological Abuse by Son
    • Jane had not seen her friend Harry, 87, at Mass for weeks. This was not like her friend since Harry went to Mass almost every Sunday. Jane stopped by Harry’s house. Harry answered the door and Jane was shocked.
    • Her friend had lost weight, looked terrible, and had obviously been crying. Harry told Jane in a hushed voice that since his son had moved in, he would not let him go to church, the senior center, or even out of the house.
    • Harry said that his son was now controlling everything including his money. Before Jane could say anything, Harry’s son started yelling and Harry quickly closed the door. Jane decided to make an anonymous report to Adult Protective Services (APS).
  • Psychological Abuse by Spouse
    • Sarah, 75, had been married for over 50 years to Saul who was abusive. The abuse had a pattern. Her husband would start following her around watching her every move. Then he would make comments under his breath. Finally, he would start pointing his finger in her face and pushing her around.
    • Since Saul’s retirement, this pattern seemed to be getting worse and happening more often. Sarah picked up a pamphlet on Domestic Violence at her synagogue and decided to make her first call for help.
    • From her conversation with the domestic violence advocate, she learned about resources in her area and steps she could take to be safe.
  • Psychological Abuse by Daughter
    • Zoe, 79, was healthy, independent and lived with her unmarried daughter, Trish, to share expenses. Zoe believed they had a good relationship. Nevertheless, Trish sometimes yelled at Zoe, calling her horrible names and telling her she was worthless.
    • Trish began threatening to put Zoe in a nursing home. Zoe tried to ignore these rants because she was grateful to live with her daughter.  However, she thought she deserved to be safe from such comments.
    • Zoe eventually told a close friend about Trish’s yelling and threats. The friend suggested that Trish and Zoe seek counseling and that Trish get respite help from a local Agency on Aging.
  • Psychological Abuse by Guardian/Conservator
    • Mark, 75, had Alzheimer’s disease and was beginning to have severe memory loss and trouble walking around the house.  Mark’s paid caregiver, Yolanda, asked the court to appoint a guardian.
    • Each time the guardian, Mrs. McKee, visited with Mark, she made fun of his memory problems and inability to remember where he was or even who Yolanda was. Yolanda became worried about Mark and the fact that Mrs. McKee, the court appointed guardian, did not seem to take Mark’s condition seriously.
    • Yolanda called Adult Protective Services (APS) and the probate court to review Mark’s guardianship.

Detect Warning Signs of Sexual Abuse

Warning Signs can present as:

  • Bruises around the breasts or genital area
  • Unexplained venereal disease or genital infections
  • Unexplained vaginal or anal bleeding
  • Changes in an older adult's demeanor, such as showing fear or becoming withdrawn when a specific person is around
  • Evidence of pornographic material being shown to a older adult with diminished capacity
  • Blood found on sheets, linens or an older adult’s clothing
  • An elder's report of being sexually assaulted or raped

Consider Asking –

  1. Has anyone forced you to have sexual intercourse or oral sex if you did not want to?
  2. Has anyone touched you in a sexual way or forced you to touch them in a sexual way against your will?
  3. Has anyone made you undress or expose yourself when you didn’t want to?
  4. Has anyone taken pictures of you with your clothes partially or completely off when you didn’t want them to?
  5. Has anyone talked to you in a sexual way that made you feel uncomfortable?
  6. Has anyone made you watch pornography against your will?

EXAMPLES: Stories as told by the DOJ regarding sexual abuse cases of the elderly.

  • Sexual Abuse by Nursing Home Aide
    • Margaret, 77, lived in a nursing home that was known for good residential care. One day, a nursing aide noticed that Margaret appeared anxious, but Margaret would not explain why.
    • While preparing her for a bath, the nursing aide saw multiple bruises on Margaret's arms, neck and back and asked what happened. Initially, Margaret did not say anything. Subsequently, the director of nursing learned from another resident that a new aide had sexually assaulted Margaret.
    • As required by law, the director of nursing reported the sexual assault to Adult Protective Services (APS), and APS initiated an investigation, involving the Ombudsman and local law enforcement.
  • Sexual Abuse by In-Home Caregiver
    • Eduardo, 80, had a stroke. His family hired an in-home caregiver to assist with his daily needs such as bathing and going to the toilet. One day his daughter stopped by to help see her dad.
    • As she helped him get dressed, he winced, and she noticed that his genital area was red and irritated. Her father started to cry and mumbled something about the caregiver hurting him there.
    • The daughter immediately called Adult Protective Services (APS) to make a report. She also called the agency where the caregiver worked, made a complaint, and ended services. APS alerted the law enforcement.
  • Sexual Abuse by Family Member
    • Pearl, 70, took her nephew in when his mother could not handle his behavior problems. The nephew began viewing pornography on the TV that he shared with his aunt. Pearl was uncomfortable about this and told her nephew to stop.
    • One day, the nephew came home and was high on drugs. He forced himself sexually upon his aunt. Pearl called 911 for local law enforcement and went to the hospital where she met with a sexual assault victim specialist.
  • Sexual Abuse by Guardian/Conservator
    • Angela, 71, required guardianship because of her continued alcohol and drug abuse. The court appointed Richard as her guardian.
    • Soon after his appointment, he gave Angela more drugs, sexually assaulted her, and threatened her with prison for her drug use if she reported him.
    • Angela summoned the courage to go to the local police and contacted a lawyer to obtain a new guardian.

Don’t Turn a Blind Eye – Be Part of the Solution

If you see something, say something to your Compliance Officer, Manager or someone in authority.  Ignoring a potentially harmful situation is to neglect our duty of care to our patients. 

Duty of care is a requirement that a person act toward others and the public with the watchfulness, attention, caution and prudence that a reasonable person in the circumstances would use. If a person's actions do not meet this standard of care, then the acts are considered negligent, and any damages resulting may be claimed in a lawsuit for negligence.

This article is sponsored by the American Institute of Healthcare Compliance (AIHC), a non-profit healthcare compliance training organization. Please re-post this article or print and distribute to your workforce for educational purposes.  Locate more information from your State, local law enforcement, medical society and use this link for additional information from the U.S. Department of Justice.  For more information to obtain online training in corporate compliance, click here.

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Community Healthcare

Elder Abuse Awareness for the Healthcare Workforce

Part 1 in a series of articles to support World Elder Abuse Awareness   

Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS   


Please feel free to repost, print and make available to your workforce members.

Detecting elder abuse can be difficult.  AIHC is publishing a series of articles to help providers and workforce members detect potential abusive situations in support of World Elder Abuse Awareness Day which is recognized on June 15th.

  • Please feel free to repost, print and make available to your workforce members.  This information can be useful when completing a Social Determinants of Health (SDOH) risk assessment and any time a health care professional determines it is necessary to gain a deeper understanding of presenting problems which are warning signs of elder physical, sexual, psychological abuse, abandonment, neglect and financial extortion.

Time to Stand Up for the Elderly

Victimization and abuse of older adults is an important subset of crime. People age 65 and older experience the same crimes as the rest of the population, including financial victimization, neglect, and physical, sexual, or emotional abuse. However, older adults may be less likely to recover from their victimization and are often sought out because of their age and decreased likelihood of reporting.

Researchers estimate that approximately 10% of older adults over age 60 experienced some form of elder

abuse in the past year. However, studies have also shown that crimes against older adults are highly underestimated.

People with degenerative diseases or cognitive disabilities, which include dementia, Alzheimer’s, and Parkinson’s, or those living in institutional settings such as nursing homes, are often not included in surveys. Additionally, while studies demonstrate that older adults are most commonly maltreated by family members or acquaintances, roughly half of violent victimizations are perpetrated by strangers.

Maltreatment is not always a criminal offense, but the intimate nature of many of these victimizations means that older victims are less likely to report offenses committed by someone they know.

Elder abuse can have several physical and emotional effects on an older adult. Victims are fearful and anxious. They may have problems with trust and be wary of others. Many victims suffer physical injuries. Some are minor, like cuts, scratches, bruises, and welts. Others are more serious and can cause lasting disabilities. These include head injuries, broken bones, constant physical pain, and soreness. Physical injuries can also lead to premature death and make existing health problems worse.

When an elderly person is mistreated, they may hesitate to admit the incident due to the desire to have autonomy and control.  The victim may fear that admitting the mistreatment could remove what little autonomy they have left.  Therefore, it is important for health care providers and loved ones to be aware of signs that a patient or loved one has been abused or exploited.


What It Is

Elder abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult. An older adult is someone age 60 or older. The abuse occurs at the hands of a caregiver or a person the elder trusts. Common types of elder abuse include:

  • Physical abuse is when an elder experiences illness, pain, injury, functional impairment, distress, or death as a result of the intentional use of physical force and includes acts such as hitting, kicking, pushing, slapping, and burning.
  • Sexual abuse involves forced or unwanted sexual interaction of any kind with an older adult. This may include unwanted sexual contact or penetration or non-contact acts such as sexual harassment.
  • Emotional or Psychological Abuse refers to verbal or nonverbal behaviors that inflict anguish, mental pain, fear, or distress on an older adult. Examples include humiliation or disrespect, verbal and non-verbal threats, harassment, and geographic or interpersonal isolation.
  • Neglect is the failure to meet an older adult’s basic needs. These needs include food, water, shelter, clothing, hygiene, and essential medical care.
  • Financial Abuse is the illegal, unauthorized, or improper use of an elder’s money, benefits, belongings, property, or assets for the benefit of someone other than the older adult.

Elder Abuse is a Serious Problem

According to the Centers for Disease Control (CDC) and other government agencies (DOJ, FBI), elder abuse is a serious problem in the United States. The available information is an underestimate of the problem because the number of nonfatal injuries is limited to older adults who are treated in emergency departments.  

  • The information doesn’t include those treated by other providers or those that do not need or do not seek treatment. Additionally, many cases are not reported because elders are afraid or unable to tell police, friends, or family about the violence.
  • Victims have to decide whether to tell someone they are being hurt or continue being abused by someone they depend upon or care for deeply.

The CDC reports that elder abuse is common. Abuse, including neglect and exploitation, is experienced by about 1 in 10 people aged 60 and older who live at home. From 2002 to 2016, more than 643,000 older adults were treated in the emergency department for nonfatal assaults and over 19,000 homicides occurred.


Some groups have higher rates of abuse than others.

  • Compared with women, men had higher rates of both nonfatal assaults and homicides.
  • The rate of nonfatal assaults increased by more than 75% among men (2002–2016) and more than 35% among women (2007–2016).
  • The estimated homicide rate for men increased by 7% from 2010 to 2016.
  • Compared to non-Hispanic Whites, non-Hispanic Black or African American persons, non-Hispanic American Indian/Alaskan Natives, and Hispanic or Latino persons have higher homicide rates (2002–2016).

Overall firearm-specific older adult homicide rates increased between 2014 and 2017.

  • Of the 6,188 victims, 62% were male.
  • The perpetrator was an intimate partner in 39% of firearm homicides and 12% of non-firearm homicides.
  • Common contexts of firearm homicides were familial/intimate partner problems, robbery/burglary, argument, and illness-related (e.g. the homicide was perpetrated to end the suffering of an ill victim, both victim and perpetrator had an illness, or the perpetrator had a mental illness).

An article was published on April 30, 2024 by CBS News entitled Criminal schemes targeting U.S. seniors account for $3.4 billion in reported losses, FBI says.  The article states that Americans over 60 years of age fell victim to so-called elder fraud crimes more frequently last year than during any other year and accounted for an estimated $3.4 billion in total reported losses.

Be Part of the Solution

If you see something, say something to your Compliance Officer, Manager or someone in authority.  Ignoring a potentially harmful situation is to neglect our duty of care to our patients. 

Duty of care is a requirement that a person act toward others and the public with the watchfulness, attention, caution and prudence that a reasonable person in the circumstances would use. If a person's actions do not meet this standard of care, then the acts are considered negligent, and any damages resulting may be claimed in a lawsuit for negligence.

This article is sponsored by the American Institute of Healthcare Compliance (AIHC), a non-profit healthcare compliance training organization. Please re-post this article or print and distribute to your workforce for educational purposes.  Locate more information from your State, local law enforcement, medical society, the Department of Justice as well as the FBI. For more information to obtain online training in corporate compliance, click here.

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Community Healthcare

Primary Care Community Health Workers: Roles and Functions

Written by:  Dr. Ali Khan, MD, MPP, FACP  


Primary care is the cornerstone of a functioning healthcare system. Community health workers (CHWs) are an invaluable resource to communities worldwide. They are on the front lines of providing care, education, and support services to meet the needs of vulnerable populations.

These passionate professionals play a vital role in helping patients navigate their own healthcare pathways and ensure they receive comprehensive, tailored services along the journey. From outreach to case management to health promotion activities, there’s a lot that health workers can do in primary care settings.

From providing information and support to connecting people with appropriate medical care and services, let’s explore how primary care community health workers are making a difference in our communities—and why we should be investing more in their incredible roles.

Who Are Primary Care Community Health Workers?

Primary care community health workers play a vital role in bridging the gap between patients and the healthcare system. They are frontline public health workers. They are trained to provide culturally and linguistically competent care.

A Community Health Worker brings an invaluable set of capabilities to the table when it comes to interacting with disadvantaged populations and linking them to support services in their area. With a focus on providing quality care, the responsibilities of a Community Primary Care Doctor change depending on the needs of those they are caring for and the communities they serve.

No matter their specific setting, healthcare workers go about working to improve healthcare services for all.

Healthcare workers can act as patient advocates, educators, case managers, or outreach workers. Additionally, they may provide direct services such as health screenings or blood pressure checks.

If you are interested in becoming a primary care community health worker, there are several things you should keep in mind, like:

  • You must have a genuine desire to help others.
  • You should also be comfortable working with diverse populations.
  • You have good communication skills.
  • You must be able to work independently and be organized in your work
  • Finally, being bilingual is often a plus in this field.

The Roles of Primary Care Community Health Workers

Primary care community health workers play an important role in improving the health and well-being of individuals and communities. They are often the first point of contact for people seeking healthcare services. They play a key role in connecting people to the care they need.

Healthcare workers typically work in primary care settings, such as community health centers, clinics, and doctor’s offices. They may also work in public health departments, schools, or other community-based organizations. Some may even be self-employed.

CHWs typically have a close relationship with the communities they serve. They are familiar with the resources available in their area.

Primary care community health workers perform a variety of tasks, including:

  • Providing direct patient care.
  • Conducting outreach and education activities.
  • Coordinating referrals to other health and social services.
  • Bridging the gap between patients and physicians.
  • Providing support to patients with chronic conditions or those who are at risk for chronic diseases.
  • Providing home visits to patients who are unable to come to a primary care facility for appointments.

The roles of CHWs vary depending on the needs of the individual patient or community. However, all primary care doctors share a common goal: to improve the overall health and well-being of their patients and communities.

Listed below are some of the functions carried out by community healthcare workers in society:

  1. First Point of Contact
    Primary care community health workers play a vital role in supporting patients and families in the primary care setting. Serving as a vital link to the health care system, they are the frontline for patients and their loved ones. They provide a range of services that support the delivery of high-quality, patient-centered care.
  2. They Are Health Educators
    CHWs typically have a broad knowledge of community resources. They can connect patients and families to needed services.
    They also serve as “health coaches” or “patient navigators,” providing education and guidance to help patients manage their health conditions. They ensure you make healthy lifestyle choices, adhere to their treatment plan and navigate the complex healthcare system.
  3. Direct Services
    CHWs may provide direct services such as blood pressure screening or blood glucose testing, and conduct home visits. They can help coordinate care among a patient’s various providers.

How to Become a Primary Care Community Health Worker?

Becoming a Primary Care Community Health Worker (PCHW) is a rewarding role that can make a meaningful impact on the health and wellbeing of your community.

In this role, PCWHs provide services such as health education, screenings, health risk assessments and other health services to help their patients manage their diseases or avoid illnesses.

They work in a variety of settings, from clinics to homes, to ensure quality care for all patients. To become a PCHW, you will need to complete training courses and certification requirements, as well as gain experience in general healthcare topics such as nutrition and psychology.

As a PCHW, you will need to be committed to helping people improve their health. Your dedication and knowledge will also help promote effective health policies in your community.


Conclusion

Primary Care Community Health Workers are essential partners in transforming our health care system and improving the well-being of communities.

Through their roles in providing direct care, advocacy, education, and service coordination, they can make an invaluable contribution to helping individuals and families achieve improved health outcomes.

By understanding the important roles and functions of Primary Care Community Health workers, we can empower them to bring about positive change in communities around the world.


FAQs

What Is the Job Prospect for Primary Care Community Health Workers?

Community healthcare workers are in high demand. It is estimated that the job percentage will continue to increase over the next decade. If you have a tertiary education and you are bilingual, the job prospects are high for you.

Do I Need a Certification to Become a Primary Care Community Health Worker?

Many employers prefer you hold a degree in healthcare-related programs. But, for some, it may not be required.

How Long Does It Take To Complete a CHW Certification Program?

It depends on your availability for school and the kind of courses you choose. A certification program can be finished in two semesters if you pace yourself correctly.


About the author:

Dr. Ali Khan, MD, MPP, FACP is Chief Medical Officer for Value Based Care Strategy at Oak Street Health, a national network of primary care centers for adults on Medicare.  A board-certified internist, Dr. Khan completed his residency at Yale-New Haven Hospital, where he serves on the clinical faculty. He is a graduate of the Harvard Kennedy School and VCU’s Medical College of Virginia, earning joint MD and MPP degrees as a Harvard Public Service Fellow. As part of Virginia Commonwealth University’s joint BS/MD program, Dr. Khan graduated magna cum laude with University Honors in print journalism.

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