Introduction

The United States has put legal measures of ensuring that the healthcare of the vulnerable members of the society is well taken care of.  There are various healthcare programs put in place to provide quality healthcare services to the immigrants as members of the vulnerable population. Besides, healthcare programs and policies have been established by different health organizations to make the immigrants qualify for both private and public for healthcare financing services, quality care and affordable services (Byrd & Clayton, 2015). However, the vulnerable groups are still associated with disparities such as lack of healthcare service satisfaction, higher prevalence of infectious diseases, mental and visual health and inadequate finance for these services (Hacker et al., 2015).  In this project, I will focus on the Indian immigrants in America.  Being the second most significant immigrant population in the country, it is imperative to study their healthcare system and the Federal policies in place to take care of their health. The community is still going through disparities despite the government intervention. The paper explains the health needs of the group, the required community health services, social-cultural values and how their cultural norms can affect the implementation of such policies in the community.  

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Description of the vulnerable population and why they need the assistance

Today, more than half the Indians stay in urban areas with some number of the people in the community. The government is obliged to come up policies like Indian Health Services to cater for the health of this group.  There are other healthcare states set for the Indian Health programs reservations. The Urban Indian Health Programs provides the fund for the Indian medical care and support for those in the reservations and outside the reservations. Despite the Federal policies and services that have been put in place to cater for the Immigrants in the US. The Indians in Americans still need community healthcare services majorly because of the accessibility challenges (Mirza et al., 2014). The first reason why this community still needs the services is that most of them are poor and are susceptible to many health-related problems like injuries and diabetes. Some of the medical programs like Medicaid is not expanded to the low-income immigrants leaving thousands of Indian population in America with no health coverage. There is also the inadequate management of Indian medical clinics. For instance, there is lack of data sharing between the Indian Health Programs in the City and those in reservations as compared to the hospitals of the US citizens.

 Another reason why this community still needs healthcare services is that there are gaps in the healthcare system provision. For example, the HIS is continually underfunded since the government releases approximately 2.2 million funds to cater for the Indian immigrants despite their number.  With the growing population, it is evident that these services are inadequate and accessibility is still a problem. According to research, even the budget of the US prisoners is higher than the amount set to care for the health of the Indian immigrants (Watson, 2014).  On the reservations, the available healthcare facilities do not offer adequate services like the emergency departments. Meaning the immigrants in this area would still suffer if there is no other healthcare assistance in the community. Moreover, the accessibility of these services is still a problem. These services are located miles away, and some of the vulnerable groups in the Indian population like the elderly and the disabled may find it hard to reach those places. For this reason, there is high mortality rate for most of the Indian immigrants in the US. For these reasons and more, it is clear that despite the Federal services, this vulnerable group still needs the assistance of the community.

Health service needs of the vulnerable group

            Although the American government and the Public Health system are aware of the gaps in the healthcare system of the Indian Immigrants, the healthcare needs of the population are usually excluded.  The omission reflects the lack of data sharing, mismanagement of the healthcare systems and the misinterpretation of the Indian Health Service. The problems associated with this group calls for the need of various healthcare services. First, there is a need to identify the strategies that aim at improving the accessibility of the health care services for the underserved populations especially in the reserved areas (Wagner et al., 2015). Medicaid program is one of the strategies that can cover a wide range of Indian population in urban areas and the underserved regions. The successful implementation of this program will call for the Public Health professionals dealing with the vulnerable group to ensure the eligibility of Medicaid before it is used. The individuals have to meet all the federal requirements to be given the Medicaid service. This will cater for the health of small children, those with mental impairment and the elderly. It is a cheaper healthcare strategy since it is suitable for long-term healthcare services that require home nursing.

                 Another health care need is an evaluation of how Indian Health services utilize the healthcare resources for Indian population. This will involve identification of various approaches to ensure that there is equal service distribution among the city population and those in the reserved areas. The reason for employing this approach is because the Indian people need to have enough health care facilities that will cater the entire community. Healthcare accessibility is another need that the Federal government and the Public Health department should take into consideration when making important healthcare decisions.  Making these services available will not only improve the accessibility but also reduce the mortality rates of this vulnerable group (Hacker et al., 2015).  Since most of the Indians immigrants still believe in some of the traditional medications, there is a need to offer education programs on the medical programs provided by the government and their importance in improving their health. Moreover, a dialogue between the government and the healthcare providers should be organized to inform the government on the issues associated with this group and the need to add more fiancé to support the HIS services.

Statistical data of the healthcare from Agencies who serve Indian Immigrants

                 According to the reports from the National Congress of American Indians 2013 report, the approximated amount of IHS spending was about 2,849 dollars per person while the total global healthcare spending was approximately $ 7, 717 (Mirza et al., 2014).  This statistics shows that there is a need to review how the Indian Health Service use the fund provided by the government to serve the Indian population. According to the reports from American Public Health Association 2004, Zukerman recorded that the number of insured   American Indians was lower than the one for the Americans (Byrd & Clayton, 2015).  The report demonstrated that about 48% of the low-income Indians had coverage from the insurance agencies.  It also showed a 55% of the Indians from the low-income population who earn not more than 200% of the American poverty level as compared to the Americans who were 25% for the year. From this statistics, it is imperative that the reason why there is a need of more fund from the government to support the healthcare services is that the Indians are still weak and just a few can afford some services like the Medicaid.

Community-Service Program

                 My proposed community service is home care nursing to the Indians in the reserved areas and those in town. The services will take place in their homes purposefully to offer preventative and healthcare improvements (Watson, 2014). With the increasingly high hospital bills, it would be essential to take care of the vulnerable group in the Indian population such as the old people, the disabled and those recovering from long-term diseases that require long-term care (Wagner et al., 2015). Home nursing services prevent high medical costs associated with the long-term care in the hospital.  The kind of services offered while delivering these services is the nutritional education, medication delivery, rehabilitation services, and therapeutic services.  For the patients who have not fully recovered but are released from the hospitals, the home care nurses advice the family members on the medications of the patients and other home care requirements. Treatment can also be done when the condition is taking long to stabilize. If the home care nurses do not have the authority to administer medication, he/she consults the patient’s physicians in case of a worsening condition.

                   The Indian Immigrants will benefit from this service in various ways. It would cater for the elderly who would otherwise be having chronic diseases that need long-term care services.  Organizing this community program in such population would improve the accessibility of the health care services by taking the care to their homes.  Since the immigrants are weak and may be having financial issues to cater for the long-term stay in the hospitals, the program will be cost-efficient.  With the reduced health care cost, the service will cater for many individuals in the population.  The homecare nursing will bridge the gap and provide constant care services to ensure that the healthcare services being offered are of quality.

Social and cultural norms of the Indian Immigrants in the US

                 Understanding the cultural values of Indians is an essential consideration in the delivery of healthcare services. Some of the Indian population still believes in the traditional ways of medication.  Taking care of the elderly, for instance, is associated with the understanding of their beliefs on the type of health care service to be given. Some elders still believe in the Indian way of medication known as the Ayurvedic as a means of preventing illness and curing any infection (Mirza et al., 2014). This would affect the medical care because some of the practices are not culturally accepted. Another cultural belief is Hinduism. The aspect of having Hindu religion makes the elderly in the community to have some various elements of causes of the diseases. For instance, some of the population still believes that Karma causes a disease. With these cultural norms, the intervention of the home nursing services is crucial as it would aim at improving the awareness of the diseases and the right kind of medications required.

                 Another cultural norm is that the Indians are organized as the close-knit family. They usually have to consult the family members in making the critical decisions on the type of health care needed. Another important consideration is the fact that Indians believe in high-value modesty (Watson, 2014). The American Indians would prefer the healthcare attendances from the same sexes. The healthcare providers can always pay attention to the cultural norms before arranging to give the home nursing to ensure that they maintain a culturally accepted behavior while providing the home care services. However, while delivering the nutritional advice, it will be necessary for the nurses offering these services to base their minds on the cultural diet. The program would focus on understanding the norms of the community and adjust to them to reduce the social indifference.

Community organizations to partner with

                 Immigrant Access Care is a program established by the Federal government to cater for the immigrants. All the immigrants in the US including the Indians face difficulty in the communication as some have problems with the English proficiency, familiarity with the US healthcare system and the healthcare programs (Hacker et al., 2015). This organization makes it easier for the immigrants to understand the complexity of healthcare service, to combat the challenges affecting them to access healthcare and to understand their eligibility for healthcare programs. Partnering with the organizations such as Minnesota Illinois and Arizona would be beneficial to the Indian Immigrants population especially in the under-served areas. Collaborating with Illinois will help in implementing the proposed program in that, it would ensure that there is appropriate communication with various healthcare providers, providing primary health education and accessing available financial support.

                 It would be necessary to partner with the Phoenix Alliance of the Community Health. This organization is set to offer free healthcare programs to those who are not covered by any insurance company.  It is a non-profit organization which would be helpful for the low-income immigrants as it offers education services to community health issues, free treatment for the vulnerable population and other more functions.

                 Other organizations like the Oregon, Washington, and Massachusetts would be the essential part of the program (Byrd & Clayton, 2015). These organizations have expanded their program to provide insurance covers to those eligible regardless of the immigration status of the vulnerable group. Such programs would benefit the proposed community program in that; it would offer additional services like regular checkups, sick child doctor visits, mental health, substance abuse programs and immunization services.   It provides other services like charity care and community health centers to the unauthorized immigrants.

Funding sources

United State Congress

 The United state congress is the funding source for the Indian Health Service. The IHS is programs that have been organized by the state to cater for the healthcare service for the Indian Immigrants in the US.  Since the home care nursing program is meant for assisting the Indians, most of the services would be funded by the United state Congress either directly or through the HIS. To qualify for this, one must be federally recognized, residence on tax-exempt land or active participant of tribal affairs.

Medicaid and Children Help Insurance Program

 This is a Federal-funded insurance program that caters to the low-income immigrants. To qualify for the program one has to fall under the category recognized by the Federal law as eligible.

Permanent Resident under Color of Law

 This is a public benefit that is set to cater for the immigrants who are recognized by the government and are not deported.

Write-offs and charity

 This would be a source of the fund from both private and public organizations that would be willing to support the Indian Immigrants. The eligibility of charity care would depend on the employment status, geographical area and the source of income (Watson, 2014). The write-offs cater for the uninsured who are not expected to pay bills or for the Medicaid who exceeds the limit.

Conclusion

                 The United States has legal obligations to cater for all the vulnerable population in the in the country. For the Indian Immigrants, the government has come up with programs like the Medicaid, Indian Health Service program and other programs and organizations to offer healthcare services. However, this group is still experiencing problems of accessibility, cost and the quality of service. It is therefore advisable to organize community programs like home nursing to ensure that the vulnerable part of the Indian immigrant’s population receives some additional care services at home. However, this program will only be successful if there is a partnership with other healthcare organizations. It is also imperative to note that some of the sources of finance for this program would be Medicaid, write-offs and charity, and CHIP.

References

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Hacker, K., Anies, M., Folb, B. L., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: a literature review. Risk management and healthcare policy8, 175.

Hainmueller, J., & Hopkins, D. J. (2015). The hidden American immigration consensus: A conjoint analysis of attitudes toward immigrants. American Journal of Political Science59(3), 529-548.

Johnstone, M. J., Hutchinson, A. M., Redley, B., & Rawson, H. (2016). Nursing roles and strategies in end-of-life decision making concerning elderly immigrants admitted to acute care hospitals: an Australian study. Journal of Transcultural Nursing27(5), 471-479.

Mirza, M., Luna, R., Mathews, B., Hasnain, R., Hebert, E., Niebauer, A., & Mishra, U. D. (2014). Barriers to healthcare access among refugees with disabilities and chronic health conditions resettled in the US Midwest. Journal of Immigrant and Minority Health16(4), 733-742.

Tangka, F. K., Subramanian, S., Mobley, L. R., Hoover, S., Wang, J., Hall, I. J., & Singh, S. D. (2017). Racial and ethnic disparities among state Medicaid programs for breast cancer screening. Preventive medicine102, 59-64.

Wagner, L. M., Brush, B. L., Castle, N. G., Eaton, M., & Capezuti, E. (2015). Examining differences in nurses’ language, accent, and comprehensibility in nursing home settings based on birth origin and country of education. Geriatric Nursing36(1), 47-51.

Watson, T. (2014). Inside the refrigerator: immigration enforcement and chilling effects on Medicaid participation. American Economic Journal: Economic Policy6(3), 313-38.