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As COVID vaccines roll out all over Los Angeles County, people who care for their elderly immigrant relatives are navigating barriers to getting them inoculated.

Language, culture and technology all can keep people in the highest-risk groups for COVID-19 from getting their vaccines, USC experts say. Barriers include teaching seniors how to use computers to sign up for appointments, debunking misinformation and even convincing skeptical parents to get the vaccine in the first place.

Sheila Salinas Navarro, a doctoral candidate at the USC Leonard Davis School of Gerontology, studies elderly immigrant communities. She has seen the barriers to seeking health care firsthand. “My dad is the toughest one to get through to,” she said.

Before her father could even get the vaccine, he developed COVID-19 in January. He initially refused to go to the hospital because of a “fake news” video he saw online that said people who go to the hospital end up dead. Salinas Navarro and her sisters had to convince him to go to the hospital after tea and vitamins didn’t make their dad feel better. He ended up being treated for pneumonia as well as COVID-19.

In Los Angeles County, only people age 65 and older, health care and nursing home workers, and certain others with underlying health conditions are eligible to receive the vaccine. While Salinas Navarro’s father isn’t old enough yet, he is a skeptic, and she said the entire family is trying to convince him that the vaccine won’t kill him.

Immigrants in L.A. especially exposed to COVID-19

The USC doctoral student sees this theme play out in her own research with immigrant populations, particularly Latinos, who have seen higher rates of COVID-19 infections and deaths than other groups. Latinos are more likely than most other groups to be exposed to the virus because higher percentages of them work essential jobs and live in multigenerational homes. They also have higher prevalence of underlying health conditions like diabetes, Salina Navarro said, which puts them at higher risk for COVID-19 complications.

“Some Latinos live in communities where people do not have the option of working from home,” she said. “They have to bag groceries or clean houses for lawyers and doctors. They have to commute on the bus because that is their means of transportation, so their exposure is higher.”

Data show that low-income households and people of color have been most heavily impacted by the pandemic.

In Los Angeles County, the COVID-19 mortality rate for Latinos — 284 per 100,000 — was nearly three times higher than that of whites, which was 98 per 100,000 as of Feb. 17, according to the county’s Department of Public Health.

The mortality rate for Black Angelenos was 158 per 100,000.

“COVID-19 has exposed numerous inequities in our system, where low-income residents and people of color have a higher risk of death from COVID-19 than whites and areas of low poverty,” according to the agency.

USC faculty, staff focus on removing barriers to vaccine access

Keck Medicine of USC has held vaccine clinics and is engaged in community outreach — along with USC government and community relations — to increase vaccination rates on the Eastside, which is heavily Latino.

Felipe Osorno, the executive administrator of continuum of care operations and value improvement at Keck Medicine, said immigration status may play a part in COVID-19 vaccine hesitancy among some immigrants. Although people don’t need to be U.S. citizens to receive a vaccine, they must be California residents. When schedulers or websites ask for ID to confirm residency, that may cause fear among undocumented immigrants.

“There are a lot of people who don’t have an ID who are in these roles, so it might give them some pause,” Osorno said. “There might be some immigration status nervousness.”

Staff members have gotten multiple phone calls from people asking what they should write on forms if they don’t have an ID, he added.

Osorno also noted that technology may be a barrier to vaccine access, with digital access and literacy posing particular problems. He has heard from people who are struggling to book vaccination appointments because scheduling is done online.

“We’re hearing that more and more because the only way to get an appointment right now is a website,” he said.

Caregivers to elderly immigrants are often on call as their IT advisers, trying to book appointments online for them. Research suggests that elderly patients are less likely than other patients to be able to use online medical patient portals for scheduling and communicating with physicians, as well as telehealth. And the caregivers do this all while taking care of their own children, jobs and errands.

During COVID, caregivers for immigrants act as advocates, translators

These relatives and friends also often have the burden of serving as impromptu translators during medical visits and trips to get the vaccine, Salinas Navarro said. And translating a doctor’s medical information from English to Spanish is much more stressful than translating in more mundane situations like shopping for groceries.

“It’s really difficult when you’re trying to translate medical terms, especially for children or someone who speaks the language but doesn’t have a medical background,” she said, adding that some caregivers have anxiety over mistranslating a technical medical term and causing more harm.

Language also plays a role in debunking misinformation about COVID-19 and the vaccine, as many immigrants consume media from their country of origin and in their native language. Caregivers might struggle to find reliable sources of information for their relatives in those other languages.

Cesia Rojas, one of the family care navigators with the USC Family Caregiver Support Center, said she goes out of her way to find reliable news sources to debunk misinformation her clients see online.

“Unfortunately, a lot of that information is in English and not available in different languages,” she said. “Some folks say they trust Univision, so I try to look for articles on Univision with credible research.”

Apart from translating languages, caregivers to immigrants also have to account for cultural differences.

For example, immigrants who come from countries where respect for authority is highly valued may not feel comfortable asking questions. So it’s important for caregivers to serve as patient advocates. In the case of a vaccine for COVID-19 or any other disease, recipients must read paperwork acknowledging risks for an allergic reaction. If they have concerns, they need to be able to ask questions.

“They may not question authority,” Salinas Navarro said. “They sit and nod, ‘yes, yes,’ even if they don’t understand, and they don’t ask questions or ask for clarification.”

COVID-19 pandemic weighs particularly heavily on caregivers

These added burdens — on top of everything caregivers have had to deal with during the pandemic — are taking their toll.

Social workers from the USC Family Caregiver Support Center have seen the pandemic’s impact on caregivers firsthand. The resource center is 1 of only 11 in California and is housed within the USC Leonard Davis School. Their caregiver navigators help more than 1,100 Angelenos care for their loved ones by connecting them to different services.

“We’ve definitely noticed an increase in need around housing, mental health and legal services,” said Lucila Torres, senior family care navigator with the USC Family Caregiver Support Center. Caregivers feel burned out by the combination of work and isolation. They’re also struggling to pay bills.

When it comes to actually getting their elderly loved ones the vaccine, social workers say caregivers are struggling to schedule appointments. Rojas, one of the family care navigators, said only a quarter of her clients have gotten an appointment. One of them did it by staying up until 2 a.m., and another was able to get help from a relative who works in the medical industry.

The rest of them have tried calling or signing up online but have had no luck. They ask Rojas for help, assuming she has some sort of vaccine fast pass. But she doesn’t. So Rojas squeezes time into her workday to try to book their appointments online.

She hasn’t been able to find time slots for them yet, so she understands caregivers’ frustration.

Caregivers wonder when they’ll be eligible for COVID-19 vaccines

Apart from overcoming all of these barriers, some caregivers find themselves ineligible for the vaccine they’re helping their loved ones receive.

At-home caregivers aren’t eligible for the vaccine in Los Angeles yet, even though they provide health care to their loved ones. Currently, health care workers with a professional license or paystub from a health care provider are eligible. That doesn’t include relatives who informally take care of loved ones.

“Independent caregivers hired by people in their homes are not eligible at this time,” Osorno said.

However, caregivers caring for someone with certain conditions like cerebral palsy, Down syndrome or epilepsy — or someone who depends on a ventilator — are eligible for the vaccine. They can use a letter from the California Department of Developmental Services to request a vaccine.

To help caregivers cope with these added stressors, it is important for them to find a supportive community. That can be family, school, work, counseling or support groups like the USC Family Caregiver Support Center.

“I think support groups are very helpful and very important,” Salinas Navarro said. “Caring for an older adult can be burdensome, and navigating the system can be a challenge. But community organizations are good places where people can reach out for help.”

This story first appeared on USC News on February 24, 2021.

Top: Richard Dang, right, of the USC School of Pharmacy prepares a COVID-19 vaccine during a mass-vaccination event at Dodger Stadium. (Photo/Irfan Khan, Los Angeles Times via Getty Images)

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