Journal of General Internal Medicine

, Volume 34, Issue 9, pp 1744–1750 | Cite as

Caregiving for Older Adults with Limited English Proficiency: Transitioning from Hospital to Home

  • Wagahta Semere
  • Anna María Nápoles
  • Steven Gregorich
  • Jennifer Livaudais-Toman
  • Leah KarlinerEmail author
Original Research



Although the family caregiver workforce is increasingly diverse, little is known about culturally and linguistically diverse caregivers and patients for whom they care. Caregiver roles include communicating with health care teams on behalf of patients with language barriers.


Our objective is to describe characteristics and experiences of caregivers for patients with limited English proficiency (LEP) immediately following hospital discharge.




Primary informal caregivers for Chinese- and Spanish-speaking patients with LEP discharged from a large academic medical center’s orthopedic surgery, general surgery, and cardiovascular inpatient floors from June 2012 to August 2013.

Main Measures

Bilingual-bicultural research assistants conducted baseline structured interviews with patients or surrogates in the hospital, and 3 weeks after discharge, gathering demographic and health information. They then interviewed by phone informal caregivers, identified by patients, to determine caregiving experiences.

Key Results

One hundred fifty-eight caregivers were interviewed post-discharge. Two-thirds (69.0%) were adults caring for parents or grandparents, and 20.9% were spouses or partners. Sixty-nine (43.7%) caregivers had LEP themselves, yet only 12% of patients reported having access to professional interpreters at the time discharge instructions were provided. Ninety percent reported performing three or more caregiving roles for the patient (helping at home, helping with medical decisions, helping with medical forms, helping communicate with medical staff, and talking with doctors about medical care). Forty percent reported moderate/high levels of perceived stress (some, most, or all of the time) caring for the patient. Multivariate regression revealed caregivers for Chinese-speaking patients, and those for patients discharged to another hospital were most likely to report moderate/high levels of perceived stress.


Culturally and linguistically diverse caregivers perform multiple roles caring for patients with LEP, often have LEP themselves, and experience notable levels of stress. These results also demonstrate an opportunity to expand the use of professional interpreters at hospital discharge to avoid communication errors.


caregiving care transitions limited English proficiency geriatrics 



Study concept and design: Karliner and Napoles; acquisition of subjects and/or data: Karliner; analysis and interpretation of data: Livaudais-Toman, Semere, Karliner, and Gregorich; and preparation of the manuscript: Semere, Karliner, Livaudais-Toman, Napoles, and Gregorich. No other individuals contributed substantially to this research or to the preparation of this manuscript.


Dr. Nápoles’ contribution was supported partially by the Division of Intramural Research, National Institute of Minority Health and Health Disparities; National Institute on Aging. This study was funded by a grant from the National Institute on Aging (R01AG038684), National Institute of Health.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The NIH had no role in the data collection, analysis, or writing of the manuscript. The contents and views in this manuscript are those of the authors and should not be construed to represent the views of the National Institutes of Health.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Wagahta Semere
    • 1
    • 2
  • Anna María Nápoles
    • 3
  • Steven Gregorich
    • 1
    • 4
  • Jennifer Livaudais-Toman
    • 1
    • 4
  • Leah Karliner
    • 1
    • 4
    • 5
    Email author
  1. 1.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Zuckerberg San Francisco GeneralSan FranciscoUSA
  3. 3.National Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaUSA
  4. 4.Multiethnic Health Equity Research CenterSan FranciscoUSA
  5. 5.UCSFSan FranciscoUSA

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