In December 2000, the Office of Minority Health published the National Standards on Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards). These standards provide a framework for building the cultural and linguistic competence of home health care agencies. This article describes each of the 14 standards and suggests strategies for meeting the cultural and linguistic needs of home health care patients.
If your agency provides care to patients whose culture or language is different from yours or that of your staff, you need to be aware of the recently issued federal standards for culturally and linguistically appropriate services. In December 2000, the U.S. Department of Health and Human Services' (DHHS) Office of Minority Health (OMH) issued a group of standards to "ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner" (Federal Register, 2000, p. 80872).
The National Standards for Culturally and Linguistically Appropriate Services in Health Care, commonly referred to as the CLAS Standards, were developed to:
* Improve outcomes, patient satisfaction, and costefficient health care services for culturally and linguistically diverse patient populations
* Provide guidance to health care providers on how and when to provide culturally and linguistically appropriate services
* Correct inequities that currently exist in providing services to culturally and linguistically diverse populations
* Improve the health of all Americans of all racial, ethnic, and cultural groups, no matter what language they speak
In this article we will first briefly review the origin and development of the CLAS standards and their relationship to the Office of Civil Rights' Policy Guidance on Title VI of the Civil Rights Act of 1964 (Federal Register, 2000). We will then analyze the intent of each standard and suggest strategies that home health care administrators can adopt to meet the standards.
ORIGIN AND DEVELOPMENT OF THE CULTURALLY AND LINGUSTICALLY APPROPRIATE SERVICES (CLAS) STANDARDS
In 1997, aware that census statistics and projections showed that America's population was becoming ethnically, culturally, and linguistically more diverse with each passing year, and also aware that there were no national standards of when and how to meet the needs of these diverse populations, the Office of Minority Health contracted with two agencies?Resources for Cross Cultural Health Care and the Center for the Advancement of Health?to draft national standards to meet the health care needs of culturally and linguistically diverse populations. Drawing on current state and federal regulations, policies, research, and input from healthcare providers and advocacy groups, these draft standards were published in the Federal Register in December 1999 (Federal Register, 1999, pp. 70042-70044).
A public comment period and several public meetings resulted in a revision of the standards based on an analysis of the data from the comment period. The final version of the CLAS standards were published on December 22, 2000. Since that time, health care providers and advocacy groups continue to respond to the CLAS Standards. In general, advocacy groups are concerned that many of the standards are guidelines rather than regulations, and health care providers are concerned about the cost of complying with the standards. The linguistic standards, which require interpretation and translation services for limited English proficient (LEP) persons, are a particular concern. Health care providers fear that complying with these standards?securing interpreters and translating written patient materials?is prohibitively expensive.
RELATIONSHIP TO THE OFFICE OF CIVIL RIGHTS' LANGUAGE ACCESS GUIDELINES
At the same time that the OMH was working on the CLAS Standards, the Office of Civil Rights (OCR) developed a parallel document that addressed the needs of LEP persons in health care and social service encounters. …