Cultural Competency 2010

Document Sample
Cultural Competency 2010 Powered By Docstoc
					Pinal/Gila Long Term Care
Cultural Competency Plan
   Contract Year 2010

                            Page 1 of 32
                     CULTURAL COMPETENCY PLAN
                           November 2006 - 2011
                     STRATEGIC PLAN TO PROVIDE
                         Annual Update CYE 2010
                October 1, 2009 through September 31, 2010

In its efforts to provide high quality, accessible services in a culturally competent
manner, Pinal/Gila Long Term Care (P/GLTC) moves into year four of its five year
strategic plan to fully implement the Culturally and Linguistically Appropriate Services
(CLAS) standards. The initial plan was submitted and approved in 2006. Under the
direction of the Chief Executive Officer, P/GLTC continues this plan to guide the
organization through the process of implementation.

This is the annual update to the plan and includes progress and accomplishments in the
following areas:

      Full implementation of basic competency training requirements to all staff
      Spanish bilingual translation implemented on website
      Increased the recruitment hiring and retaining of staff to more closely reflect our
       member demographics
      Implemented new strategy to increase the response to provider surveys
      Increased the level of community involvement and outreach efforts
      Created partnership with to make culturally competent reading
       and training materials available to staff
      Identification of bilingual staff and subsequent notification to all staff of those
       willing to translate in print, in person or via telephone
      Continued progress toward culturally responsive service delivery
      Continued progress toward full implementation of the CLAS standards
      Continued progress in availability of printed translation materials

Evaluations for improvement from this past year’s goals are as follows:

      Provider training sessions need to be increased
      Utilization of the Language Line™ by members needs to increase

Based on the evaluation and assessment, goals for the upcoming year are:

      Move toward full implementation of the Cultural Competency Curriculum
      Continue system-wide interventions to heighten cultural and linguistic awareness
       and sensitivity
      Expand partnership efforts with who facilitated the
       acquisition of easy-to-access cultural reference and informational material for
      Further the Spanish bilingual translation offerings on website
      Continuous translation efforts with printed member materials
      Continued support and reinforcement from senior leaders with cultural
       competency efforts

                                                                                Page 2 of 32
      Continued recruitment hiring and retaining staff that demonstrate the necessary
       skills to achieve the standards

Conceptual Framework

P/GLTC utilizes the following conceptual framework in moving toward full
implementation of the CLAS standards. The two main components driving the
conceptual framework are the National CLAS standards and the Practical Guide for
Implementing the National Standards for Culturally and Linguistically appropriate
Services (CLAS) in Health Care. Both of these components have been researched and
published by the United States Department of Health & Human Services, Office of
Minority Health.

There are fourteen CLAS standards which are organized by themes: Culturally
Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and
Organizational Supports for Cultural Competence (Standards 8-14). Within this
framework, there are three types of standards of varying stringency: mandates,
guidelines, and recommendations as follows:
    CLAS mandates are current Federal requirements for all recipients of Federal
       funds (Standards 4, 5, 6, and 7).
    CLAS guidelines are activities recommended by OMH for adoption as mandates
       by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10,
       11, 12, and 13).
    CLAS recommendations are suggested by OMH for voluntary adoption by
       health care organizations (Standard 14).

National Standards
In 1997, the U.S. Department of Health and Human Services (HHS) Office of Minority
Health (OMH) asked Resources for Cross Cultural Health Care and the Center of the
Advancement of Health to review and compare existing cultural and linguistic
competence standards and measures in the national context, propose draft national
standard language where appropriate, assess the information or research needed to
relate these guidelines to outcomes, and develop an agenda for future work in this area.

The National CLAS standards are the result of this work. They are the collective set of
culturally and linguistically appropriate services (CLAS) mandates, guidelines, and
recommendations issued by the United States Department of Health and Human
Services Office of Minority Health intended to inform, guide, and facilitate required and
recommended practices related to culturally and linguistically appropriate health
services (National Standards for Culturally and Linguistically Appropriate Services in
Health Care Final Report, OMH, 2001). Following are the fourteen CLAS standards:
Standard 1. Health care organizations should ensure that patients/consumers receive
from all staff members effective, understandable, and respectful care that is provided in
a manner compatible with their cultural health beliefs and practices and preferred
[Status: Partial implementation.]
[Demonstrated by: Education, training.]

                                                                               Page 3 of 32
Standard 2. Health care organizations should implement strategies to recruit, retain,
and promote at all levels of the organization a diverse staff and leadership that are
representative of the demographic characteristics of the service area.
[Status: Partial implementation.]
[Demonstrated by: Successful recruitment efforts.]
Standard 3. Health care organizations should ensure that staff at all levels and across
all disciplines receive ongoing education and training in culturally and linguistically
appropriate service delivery.
[Status: Partial implementation.]
[Demonstrated by: Basic competencies attained by all staff and ongoing for new
recruits. Half of intermediate competencies fulfilled.]

Standard 4. Health care organizations must offer and provide language assistance
services, including bilingual staff and interpreter services, at no cost to each
patient/consumer with limited English proficiency at all points of contact, in a timely
manner during all hours of operation.
[Status: Full implementation.]
[Demonstrated by: Providers and members are advised of language services
available through Language Line™ via newsletters, website and lobby posters.]

Standard 5. Health care organizations must provide to patients/consumers in their
preferred language both verbal offers and written notices informing them of their right to
receive language assistance services.
[Status: Full implementation.]
[Demonstrated by: Members are advised of language services available through
Language Line™, translated documents via contracted provider for written
translations, available bilingual staff.]

Standard 6. Health care organizations must assure the competence of language
assistance provided to limited English proficient patients/consumers by interpreters and
bilingual staff. Family and friends should not be used to provide interpretation services
(except on request by the patient/consumer).
[Status: Partial implementation.]
[Demonstrated by: Language Line™ employs individuals certified in over 200
languages. Bilingual staff identified at all provider offices.]

Standard 7. Health care organizations must make available easily understood patient-
related materials and post signage in the languages of the commonly encountered
groups and/or groups represented in the service area.
[Status: Partial implementation.]
[Demonstrated by: Signage posted in member areas, ongoing translation of
documents into Spanish, Spanish bilingual translation of information and content
on website.]

Standard 8. Health care organizations should develop, implement, and promote a
written strategic plan that outlines clear goals, policies, operational plans, and
management accountability/oversight mechanisms to provide culturally and linguistically
appropriate services.
[Status: Partial implementation.]
[Demonstrated by: Fourth year implementation of a five year plan.]
                                                                                Page 4 of 32
Standard 9. Health care organizations should conduct initial and ongoing organizational
self-assessments of CLAS-related activities and are encouraged to integrate cultural
and linguistic competence-related measures into their internal audits, performance
improvement programs, patient satisfaction assessments, and outcomes-based
[Status: Partial implementation.]
[Demonstrated by: Annual self-audits and plan updates.]

Standard 10. Health care organizations should ensure that data on the individual
patient's/consumer's race, ethnicity, and spoken and written language are collected in
health records, integrated into the organization's management information systems, and
periodically updated.
[Status: Full implementation.]
[Demonstrated by: Ongoing data collection efforts.]

Standard 11. Health care organizations should maintain a current demographic,
cultural, and epidemiological profile of the community as well as a needs assessment to
accurately plan for and implement services that respond to the cultural and linguistic
characteristics of the service area.
[Status: Full implementation.]
[Demonstrated by: Current demographic data and profiles.]

Standard 12. Health care organizations should develop participatory, collaborative
partnerships with communities and utilize a variety of formal and informal mechanisms
to facilitate community and patient/consumer involvement in designing and
implementing CLAS-related activities.
[Status: Partial implementation.]
[Demonstrated by: Community involvement and collaboration by Community
Relations & Outreach Coordinator with outside agencies.]

Standard 13. Health care organizations should ensure that conflict and grievance
resolution processes are culturally and linguistically sensitive and capable of identifying,
preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.
[Status: Full implementation.]
[Demonstrated by: Complaint process and tracking mechanism.]

Standard 14. Health care organizations are encouraged to regularly make available to
the public information about their progress and successful innovations in implementing
the CLAS standards and to provide public notice in their communities about the
availability of this information.
[Status: Full implementation.]
[Demonstrated by: Sharing of cultural competency efforts at initial intake
meetings. Entire plan document is available on website.]

Practical Guide
The second component driving P/GLTC’s conceptual framework for implementing the
National Standards for Culturally and Linguistically Appropriate Services is the Practical
Guide for Implementing the National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health Care. This guide is assisting P/GLTC to create a
                                                                                  Page 5 of 32
health care environment that will meet the needs and expectations of an increasingly
diverse member population. This guide contains nine sections that are cross referenced
with the fourteen CLAS standards; they are as follows:

Section 1. Compelling Rationale for Cultural and Linguistic Competency
Section 2. Conducting and Interpreting the Institutional Audit (CLAS
Standards 2, 9, 11, 12)
Section 3. Strategic Plan (CLAS Standard 8)
Section 4. Patients/Consumers receive effective, understandable and respectful care
provided in a manner that is compatible with their cultural health beliefs and referred
language (CLAS Standard 1)
Section 5. Promoting diversity throughout the organization (CLAS Standard 2)
Section 6. Providing the language access services mandated by the Civil Right Act
(CLAS Standards 4, 5, 6, 7)
Section 7. Staff and provider training (CLAS Standard 3)
Section 8. Strengthening ties with communities through contacts with grass root
organizations (CLAS Standard 12)
Section 9. Annual self-assessment and evaluation

                                 Practical Guide Status

Section 1 – Compelling Rationale for Cultural and Linguistic Competency
This section of the Practical Guide outlines the fundamentals of cultural and linguistic
competency within an organization and the need for establishing processes for the
organization. The organization’s executive management team will continue to
demonstrate their full support through their continued commitment to the Diversity
Committee, which meets on a monthly basis to discuss issues and report on items
relevant to the plan.

P/GLTC realizes the influence of linguistic and cultural access to care as major
components to successful outcomes of medical treatment. It will continue to focus on
making cultural and linguistic care a part of its organizational culture in order to achieve
cultural competence at all levels and maintain this standard on a daily basis.
Encouraging change in employee’s core assumptions and communication styles will
continue to be an emphasis of the organization.

Section 2 – Conducting and Interpreting the Institutional Audit
The intent of the self-audit is to determine whether the current program, in terms of
cultural competence, may require additional efforts. A baseline audit was completed and
this is the fourth annual audit. The audit revealed two areas of concern that would
benefit from improvement. This year’s audit revealed a need for more focus on provider
training efforts. A calendar of training topics is being created for the upcoming year.

In addition, it was learned that the Language Line™ is not being more fully utilized by
members despite current efforts to educate providers, staff and members about the
service. A Language Line™ demonstration (including video) was performed at a
Member/Provider Council meeting. Community outreach presentations include detailed
information about Language Line™ as a service.

                                                                                  Page 6 of 32
Section 3 – Strategic Plan
This document shall serve as the strategic plan. P/GLTC has set and articulated cultural
competence goals that fit into the organizational mission statement, operating principles
and service focus. P/GLTC is moving into its fourth year of a five-year plan, it is
important to continue formalizing information gathering, analysis, and performance
improvement strategies.

As part of its commitment to diversity, P/GLTC has developed and will continue to
maintain the necessary policies and procedures that are required to administer its
diversity programs and serve as a role model for providers who provide direct care to
our members.

Section 4 – Effective, Understandable and Respectful Care

P/GLTC collects, trends, and analyzes member utilization information. This information
assists the Medical Management and Quality Management Departments by:

      Determining educational needs of members and providers regarding disease
       management and appropriateness of medical services
      Validating the effectiveness of disease management activities and

Concerning the effectiveness of care, P/GLTC provides information via mailings,
newsletters and website links regarding the prevalence of particular ethnic/racial groups
to certain diseases (e.g. Prevalence of Diabetes in Hispanics, Hypertension in African
Americans and Nicotine and Alcohol Addictions in Native Americans).

Culturally specific educational materials are provided to staff and shared via an
informational bulletin board, e-mails and website links. Information is also provided on
culturally appropriate rules of etiquette. A collaborative agreement was made with (a leader in cultural diversity issues) to provide free access to all
staff to online newsletters and articles that pertain to cultural awareness and diversity.
These staff communications have become a part of P/GLTC’s ongoing efforts to
educate staff.

      Top Five Diagnoses for Inpatient Admissions for P/GLTC Membership 2009
                                            Congestive Urinary       Bronchitis
                         Renal                  Heart       Tract       with       P/GLTC
 Racial/Ethnic Group    Failure Diabetes       Failure    Infection Exacerbation   Members
 Caucasian              41.64% 51.96%          72.37%      62.52%     80.21%        62.71%
 Hispanic               45.50% 36.45%          20.56%      22.62%     15.10%        25.96%
 African American        4.54%      4.86%       3.95%       6.62%      2.60%         6.46%
 Native American        4.77%       2.06%       0.82%       2.26%      1.56%         1.85%
 Asian/Pacific Islander 2.42%       0.37%       1.48%       0.81%      0.52%        1.30%
 Other                   1.14%      4.30%       0.82%       5.17%      0.00%         1.72%
 TOTAL Admissions         2642       2140        1824        1238       960           1456

                                                                                   Page 7 of 32
Findings in 2009 from the Medical and Quality Management database indicate that
renal failure is the number one diagnosis for hospital inpatient admissions among
P/GLTC members while complications from diabetes is number two. Only one of the
diagnosis categories continues to remain the same as last year; congestive heart
failure. Nearly one-quarter of the admissions in 2009 were related to diabetes and one-
third of those were Hispanic members. Educational efforts for members were revised to
address and emphasize diabetes awareness. A Quality Management Task Force was
set up to create a resource library for case managers that houses materials related to
diabetes both in English and Spanish. The Task Force is cross-functional consisting of
nurses and case managers. The initial purpose was to create a system that provides the
case managers more resources as well as an ongoing system to encourage members
to complete their preventative screens. This information is disseminated during the
regularly scheduled review visits.

Racial/Ethnic                                           % of Emergency Room               % of Inpatient
                       % of P/GLTC Membership
Group                                                           Visits                    Admissions
                          Pinal             Gila          Pinal          Gila          Pinal          Gila
Caucasian                59.19%           80.97%         56.68%        73.16%         59.98%        69.23%
Hispanic                 27.89%           15.49%         30.44%        24.74%         27.96%        19.87%
African American          7.56%            0.44%          7.19%         0.00%         6.43%          3.21%
Native American          2.03%            0.88%           2.33%         0.00%         2.25%          1.28%
Islander                 1.46%            0.44%           1.68%         0.52%          2.37%         0.00%
Other                    1.87%            1.77%           1.68%         1.58%          1.01%         6.41%
TOTAL                   100.00%          100.00%         100.00%       100.00%        100.00%       100.00%
                          1230             226
# of Visits/Admits      Members          Members        1071 Visits   190 Visits    887 Admits    156 Admits

Other findings indicate that of those members who used the emergency room in both
counties, the percentage of inpatient admissions is about the same (83%). There is a
small percentage of Caucasian members in Pinal County who are being admitted to the
hospital directly and not from the emergency room. An information flyer has been
created to educate members about appropriate utilization of the emergency room. This
is being translated into Spanish.

                     P/GLTC Members          P/GLTC             Census Data 2008
Age                  Pinal     Gila          Members             Pinal         Gila
Under 5 yrs old      0.24%    0.00%           0.21%                    8.10%    6.60%
Under 18 yrs
old                  2.68%      1.77%         2.54%                   26.10%       22.90%
65 yrs or over       64.29%     76.55%        66.19%                  13.10%       21.90%
Under 65 yrs         35.71%     21.68%        33.81%                  86.90%       78.10%

                      P/GLTC Members         P/GLTC          P/GLTC Staff        Census Data 2008
Gender                Pinal     Gila         Members             Staff            Pinal     Gila
Male                 35.80%    30.53%         34.98%            0.00%             52.30% 48.70%
Female               64.20%    69.47%         65.02%            0.00%             47.70% 51.30%

Hyper link to US Census Quick Facts by Counties
                                                                                            Page 8 of 32
The majority of P/GLTC membership in both counties is within the elderly population
age 65 years and older. Gila County has no members under the age of five. Women
make up the majority (2/3) of membership in both counties.

Staff has been educating members that they have options when it comes to
interpretation and that they do not have to rely on family unless they prefer to. The fact
that more than two-thirds of members never use a family member to interpret could be
evidence that educational efforts are working. More than half of the provider offices
have interpreters that can help, again, reminding providers that they should match their
staff to the makeup of the population served and reminding them of the availability of
the Language Line™ will help increase those numbers.

To ensure that P/GLTC members receive information on its cultural competency efforts,
P/GLTC provides information to members in the following ways:

      When Case Management makes the welcome call and helps the member choose
       their PCP, P/GLTC takes into account any cultural preference(s).
      At the time of the initial visit, case managers provide members with a member
       handbook. The handbook contains information on P/GLTC’s cultural competence
       program, describes the Language Line™ interpretation system and encourages
       members to contact their case manager with questions.
      P/GLTC includes articles on cultural competence in its member newsletters.
      Language Line™ placards listing interpretation services have been furnished to
       contracted providers.
      During member telephone calls or assessment visits, case managers discuss
       member’s culturally relevant needs and authorize appropriate services.

To assess member needs adequately in home, community and institutional settings,
P/GLTC case managers consider member’s demographic information including
language, religious preference, ethnic affiliation etc. when examining the provider
network in order to ensure appropriate placement. Providers also consider member
language, food choice and other preferences when planning and coordinating culturally
competent member care.

Particular attention is paid to members’ needs as they relate to culturally competent
care when the member is requesting placement in either a Nursing Home or an
Assisted Living Facility. This type of placement, in essence, becomes the client’s home.
It is imperative that their needs be met in a comfortable respectful manner with which
they can live every day. The most important factors considered are:

      Language – both primary and competency with English as a second language. It
       is vital that the member understand and be understood when conveying
       information regarding their needs of everyday life.
      Location of the facility with regards to the member’s family and community with
       whom they would have the strongest cultural ties.
      The member’s perception of who is qualified to provide appropriate care.
       Perhaps caregivers younger than 40 years old or males would not be an option
       when assistance is required with personal care needs. This year the Self-

                                                                                Page 9 of 32
       Directed Attendant Care program was instituted. Members now have even more
       freedom to choose their caretaker.
      Religious preferences
      The resident composition of the facility, especially if it is co-ed.
      The cultural heritage of the facility staff. This became very apparent when a
       World War II veteran who had served in the South Pacific was receiving care at
       the most vulnerable time of his life from caregivers of Asian descent.
      Facility Menu - Food preferences such as “comfort foods” seem to be more
       important to an individual as they grow older. Dramatic cultural changes in a
       member’s routine menu have the potential for substantial impact on both the
       member’s mental well being but also their health.

Section 5 – Promoting Diversity throughout the Organization

P/GLTC is committed to maintaining a diverse workforce which reflects the members we
serve. The following steps are ongoing attempts P/GLTC utilizes to increase job
satisfaction and retain diverse employees:

      Ongoing educational and training opportunities
      Utilization of the expertise of local resources and qualified providers for cultural
       diversity and competency education.

The following tables list current member, general and staff populations:

Current Member Ethnic Demographics (as of 10/19/2009)
                                        P/GLTC Members                  P/GLTC Staff
 Racial/Ethnic Group                Pinal           Gila                All Locations
 Caucasian                          59.2%           81%                      71.6%
 Hispanic                            28%            16%                     18.18%
 African-American                   7.6%            .4%                      6.81%
 Native-American                    1.9%            .9%                      1.14%
 Asian/Pacific                      1.6%            .4%                      2.27%
 Prefer not to answer                1.7%           1.3%

Current Service Area/General Population Ethnic Demographics According to U.S.
Census Bureau 2008 estimates
                                       General Population               P/GLTC Staff
 Racial/Ethnic Group                Pinal             Gila              All Locations
 Caucasian                          58.3%            66.7%                   71.6%
 Hispanic                            30%             17.1%                  18.18%
 African-American                    4%                .7%                   6.81%
 Native-American                     6%              14.8%                  1.14%
 Asian/Pacific                      1.7%               .7%                   2.27%

The results of the 2009 audit showed the following notable changes in demographics:

      Decrease in Caucasian membership in Pinal County, while increasing in Gila
      Increase in minority staffing in all categories
                                                                                Page 10 of 32
Based on the information shown above, the staff minority demographics have increased
over last year’s results in all minority categories while minority membership decreased
in Gila County. These changes have contributed to P/GLTC’s efforts to demonstrate the
skills necessary to achieve the standards that have been established. (refer to the
following chart) P/GLTC will continue to reinforce its efforts to recruit, hire, train and
promote staff in all job classifications without regard to race, color, religion, sex, or
national origin.

    Racial Mix Charts and Graphs – Pinal/Gila Long Term Care Staff
                        as of September 2009

                                                                              P/GLTC Staff













                             r ic


Analysis of this demographic comparison leads us to the following conclusions:

      P/GLTC’s member population is closely representative of the service area
       demographics with a four exceptions.
          o The Caucasion member population in Gila County is larger than the
             general population.
          o The African-American member population in Pinal County is larger than
             the general population.
          o Conversely, the Native-American and Asian/Pacific Islander member
             population is smaller than the general population.
      The disparity in P/GLTC’s Native-American member population versus the
       general population could be explained by tribal program contractors.

                                                                                 Page 11 of 32
P/GLTC will continue to monitor staff and member makeup to ensure that populations
are adequately represented. Strategies have been identified to work with Pinal County’s
Human Resources department to enhance recruitment efforts by developing a
mechanism to train and certify staff that translate and interpret on the job and to offer
language differentials for this certification. However, due to the economic downturn, this
strategy has been temporarily suspended. P/GLTC will advertise open positions in
association publications and/or websites as a means of recruiting diverse employees.

When promotional opportunities become available, they are announced via
organization-wide e-mails, section meetings, management team meetings and all-staff
meetings. Staff is alerted of job vacancies and promotional opportunities. Positions are
also posted on the County’s employment website, which reaches a much wider hiring
pool than previous employee recruitment efforts. P/GLTC’s policy on promoting open
positions from within is to do so when it is determined that it is in the best interest of the
organization and the candidate is the most qualified. At that point departmental
promotional hiring procedures will be followed.

Educational opportunities have been available in the past to assist employees who are
seeking job advancement. Once again due to the economic decline Pinal County has
temporarily suspended the tuition reimbursement policy. In the future as things improve
we foresee that this policy will be reinstated. Minorities within the organization will be
able to improve their qualifications for higher-level positions by pursuing these
opportunities, applying for promotional positions and discussing their desires for
advancement with their supervisors. Staff survey results which are located in the
appendix indicate that the education levels, language fluency, and language proficiency
have remained relatively similar to last years results.

New Hires
Cultural Background       Administrative       position        Supervisor
Caucasian                       6                 0                3
Hispanic                        3                 1                0
African-American                1                 0                1
Native-American                 0                 0                0
Asian/Pacific                   0                 0                1

Cultural                     Higher         Promotion
Background                  ranking            to          Supervisor to      Manager to
                 Total      position        Supervisor       Manager         Administrator
Caucasian         0             4               1               0                 1
Hispanic          0             1               0               0                 0
African-          0             0               0               0                 0
Native-            0            1                0                 0                 0
Asian/Pacific      0            0                0                 0                 0

                                                                                  Page 12 of 32
Hiring strategies to increase minority representation were considered to be successful
this year. Of the sixteen new hires this year, six (38%) were minorities. Of the eight
people promoted at P/GLTC, two were minorities.

Section 6 – Providing Language Access Services

P/GLTC has provisions in place to assist non-English speaking callers. When calls go
through the front desk, if necessary, staff utilizes other employees to assist with the call.
Staff are advised which individuals to call on for assistance with interpretation. For new
staff, a Language Directory has been created to help identify internal resources. The
Language Directory lists the names and phone numbers of staff members who are
willing to assist with translation and the languages they speak. It also lists the
preferences they choose to assist such as; by phone, on the job only, in case of
emergency only, or any time. Staff is also available to assist with walk-in traffic that may
require interpretation services.

The Language Line™ is another option for staff to use both inside and outside of the
office. This service offers the translation of an oral transmittal from one language into
another language. The Language Line™ interpreters analyze an incoming original
message, regardless of the country of original or level of education of the speaker, and
match it with the words that most accurately convey the true meaning of what is being
said. This service is available to all P/GLTC members. Despite ongoing dissemination of
this information to members as well as providers, the service is rarely utilized. Please
refer to past year’s invoices in attached document.

A number of documents were translated into Spanish in order to meet member needs
and requests. Many additional documents are currently in the process of being
translated. Following is a list of documents that were translated into Spanish this past

2008 Fall Provider Newsletter                  Member Handbook
Notice of Privacy Practices                    ALF Placement Agreement
ESPD – Attachment F                            ESPD – Attachment E
ESPD – Attachment D                            Revised Service Plan Form
AC Worksheet Template                          Cultural Competency Member Survey
Spouse Attendant Care                          2009 Spring Member Newsletter
SDAC Brochure                                  Diabetes Practice Guidelines
P/GLTC Practice Guidelines                     2009 Summer Member Newsletter
Member Survey                                  Flu Insert
Transportation Insert                          Letter to Members on Flu Season

All materials shall be translated when the Contractor is aware that a language is spoken
by 3,000 or 10% (whichever is less) of the Contractor’s members who also have limited
English proficiency (LEP) in that language. All vital materials shall be translated when
the Contractor is aware that a language is spoken by 1,000 or 5% (whichever is less) of
the Contractor’s members who also have LEP in that language. Vital materials must
include, at a minimum, notices for denial, reduction, suspension or termination of
services, vital information from the member handbook and consent forms.

                                                                                 Page 13 of 32
P/GLTC attempts to match member language preferences with those of its provider
network. P/GLTC gathers this data through cultural competency surveys. Provider
services staff conducts surveys via the telephone.

      Reinforcing the use of the Language Line™ to minimize the reliance on family
       and friends for interpretation and translation to ensure members receive culturally
       and linguistically competent care and services.
      Translation of all routine member documents into Spanish. Additional languages
       identified are translated as needed.
      Posting of language posters in the lobby and providing language posters/signs to
       providers to create a change in the physical environment to make it more
       appropriate and inviting to member populations served.
      Offering Language Line™ interpretation services free of cost to providers and

P/GLTC matches member language preferences with those of its provider network.
P/GLTC gathers this data through cultural competency surveys for both members and
providers. Provider services staff conducts provider surveys via the telephone and case
management staff conduct the member surveys. This year concerted efforts were made
to survey Primary Care Physicians. As illustrated from the chart above, the responses
received were substantially higher than previously mailed surveys. This information will
continue to be collected during physician office site visits.

This year’s survey results with primary care physicians indicated the following
languages are spoken by staff personnel for Pinal/Gila Long Term Care contracted

 Albanian       German          Irish             Nigerian       Serbian
 Arabic         Gujarati        Italian           Pakistani      South Indian
 Chinese        Hindi           Kenyan            Phillipino     Spanish
 Croatian       Hindu           Kishwell          Pima           Tagalog
 English        India           Korean            Punjabi        Vietnamese
 Farsi          Indian          Latvian           Romanian
 French         Irdu            Mandarian         Russian

Of the three primary preferred languages, the availability of linguistically competent care
far exceeds the need for both those members in placement and those in general
membership who may have a potential need. Again, the availability is not concentrated
with a few providers, but is adequately spread across the network. Of note, P/GLTC
requires that all providers and their staff have the ability to communicate proficiently in
English, both verbally and in writing. This is an essential skill to provide medically
necessary information to providers and to receive medical instruction both verbal and

Language Access Efforts
On the topic of linguistic and conceptual comprehension, P/GLTC has staff available to
interpret as needed (see Language Directory in the Appendix). Members are informed
of their right to language assistance either through the assistance of P/GLTC personnel
or via telephone. Additionally, members may use interpreters that are family or friends.
                                                                                Page 14 of 32
P/GLTC uses its contracted translator to translate documents into other languages as
necessary and when identified by staff. P/GLTC has recently begun tracking the
preferred written language of members. Members are alerted of their right to translated
materials and interpreter services via initial phone calls and at intake. P/GLTC has
identified languages spoken by members and has translated documents into Spanish,
which is the predominant language requiring translation. Language Line™ usage is
tracked as shown in the attached document, but continues to reflect no usage. This will
be addressed through ongoing provider education and demonstrations on the topic.

A poster of interpreter languages available is posted in the P/GLTC lobby waiting area.
These informative posters were provided by P/GLTC for display in all providers’ offices.
In instances when members or their representatives present to the P/GLTC offices,
P/GLTC staff are utilized to provide interpretive services.
Language translation efforts consist of bilingual staff and a contracted language line.
Staff and providers are offered trainings periodically on the usage of the Language
Line™ and necessary equipment to ensure that the resource is used appropriately.

Section 7 – Staff and Provider Training

Staff: P/GLTC continues to build on its education and training program for staff by
formalizing a curriculum. This past year, Basic Competence training (as identified in last
year’s plan) was introduced to existing staff and completed by June 30, 2009, fulfilling
the Base Competence training requirement. New hires will receive the Basic
Competency training as part of their orientation. They are required to submit a
completed certification of the training and submit to their supervisor, which is to be kept
in their personnel file. On September 2, 2009 all existing staff participated in a training
session, “Cultural Competence for Health Professionals in Geriatric Care” which fulfilled
the Intermediate Competence requirement. Staff participated in an aging simulation
exercise and received two presentations regarding; cancer treatments for seniors and,
management for end of life issues. One more Intermediate Competence topic and eight
Advanced Competency topics will be covered in 2010.

Team building exercises presented to all employees at monthly meetings. Multicultural
foods were incorporated into potlucks, with the topics of discussion covering different
cultures and traditions.

On May 7, 2009, a section titled “Diversity Factors” was introduced on the care team
staffing agenda. Care team meetings are held weekly and the section allows employees
to discuss any cultural factors regarding their members. Cultural and demographic
factors are identified such as language, religious preference and ethnic affiliation. Also
considered are member language, food choices and other preferences when planning
and coordinating culturally competent member care. This information is gathered and
addressed at new member assessments when the Member Handbook is distributed. At
that time, P/GLTC’s Cultural Competence program is discussed and members are
informed of the Language Line™ translation system. Members are also informed that
materials can be provided in other languages if needed.

Awareness Boards were created this year to provide staff with frequent reminders on
the subject of cultural competency and how it affects our lives both personally and
professionally. There are two such boards in the Florence office, one in the Payson
                                                                                Page 15 of 32
office and one in the Globe office. The information is changed every three months with a
new section team at P/GLTC being responsible for the content. The first set of
information discussed characteristics of different cultures such as the traditions of
Norway. The second set related to the cultural diversity of those within the P/GLTC
workforce as well as within Pinal County as a whole. The third set will address the
various holidays that occur near the end of the year and how they are celebrated across
the world.

P/GLTC’s Diversity Committee developed a comprehensive training approach that
included determining which staff were required to achieve basic, intermediate and
advanced competencies. Following are the levels, staff requirements, topics, focus
area, and time commitment.

                                                                             Page 16 of 32

 Basic Competence (All Staff)
                TOPIC                                       FOCUS                   TIME
Cultural Competency Plan                   Information on the Organization’s       1 hour
Ethnicity and Race                         Introduction to the Nature of Social    1 hour
                                           Group Differentiation and Inequality
What is Cultural Competency?               Everyone is uniquely multicultural      15 min
Cultural Competency – Basic Concepts       Awareness and appreciation of           30 min
and Definitions                            differences
Conceptual Frameworks/Models, Guiding      How workplace behavior contributes      15 min
Values and Principles                      to or detracts from compliance
Culture Crossing – Guide to Cross-         Self-awareness of one’s own beliefs,    45 min
Cultural Etiquette and Understanding       stereotypes, biases
National Standards on Culturally and                                               30 min
Linguistically Appropriate Services
  TOTAL                                                                   4-5 hours

  Intermediate Competence (Provider Services, Nursing)
               TOPIC                                    FOCUS                       TIME
Unified Health Communication:        Improve patient communication skills;         5 hours
Addressing Health Literacy. Cultural increase awareness and knowledge of
Competency and Limited English       communication; implement patient
Proficiency                          centered communication practices
Cultural Competence for Health       Examine cross-cultural interaction with       1 hour
Professionals in Geriatric Care      older adult patients and patients at the end
                                     of life.
  TOTAL                                                                     5-6 hours

  Advanced Competence (All Case Management)
                   TOPIC                                      FOCUS
Health, Illness and Prevention Beliefs and Understanding other culture’s beliefs
Caring, Access to Care, Job Performance    Lack of innovation or compliance
and Work Relationships
Language as a Factor                       Lack of a common language and
Race and Genetic Predisposition            Medical treatment must be tailored
Impact of Culture and Language             Appreciation, acceptance, tolerance of
Member Population                          Understanding, sensitive to member’s desire
Toxic Practices                            Avoidance of stereotyping and assumptions
Religious/Cultural Taboos                  Respecting contrary beliefs

                                                                             Page 17 of 32
   P/GLTC's training goals are as follows:
       Consider the needs of new employees to ensure they reach their basic
        competency within initial 6-month job probationary period.
       Ongoing training efforts for new staff at their required level.
       Secure trainers from outside sources and utilize internal staff to conduct training
       Complete training calendar topics by end of 2010 plan.

   The evaluation of the prior year’s plan identified a weakness in provider training efforts.
   Cultural Competency is included in the provider manual, which is distributed by Provider
   Relations Representatives during site visits. Below is a chart listing training topics which
   cover culturally and linguistically appropriate service delivery. Information will be
   delivered via the provider manual, newsletters and online.

    Provider Training
                 TOPIC                                        FOCUS                      MEDIA
Cultural Competency Plan                     Information on the Organization’s         Provider
                                             efforts                                   Manual
Ethnicity and Race                           Introduction to the Nature of Social      Newsletter
                                             Group Differentiation and Inequality
What is Cultural Competency?                 Everyone is uniquely multicultural        Newsletter
Cultural Competency – Basic Concepts         Awareness and appreciation of             Newsletter
and Definitions                              differences
Conceptual Frameworks/Models, Guiding        How workplace behavior contributes        Newsletter
Values and Principles                        to or detracts from compliance
Culture Crossing – Guide to Cross-           Self-awareness of one’s own beliefs,      Newsletter
Cultural Etiquette and Understanding         stereotypes, biases
Language Line™                               General knowledge of resource             Newsletter


   Cultural competency awareness/education is provided to P/GLTC members through the
   member handbook, member newsletters and at Member/Provider Council meetings.
   The member handbook contains a section identified as Cultural Competency Program
   which includes information related to bilingual staff, translators and translation services,
   as well as Spanish translated documents, and culturally sensitive service delivery.

   An article titled “Cultural Competency” was printed in the Winter 2008 member
   newsletter, The material covered was specific to the member survey which measured
   how well physicians communicated/related to their patients. The Fall 2009 member
   newsletter information about translation services. The article was printed in both English
   and Spanish.

   The Member/Provider Council meeting agendas for both counties included cultural
   competency throughout the year. The specific topics covered were; a demonstration of
   the Language Line™ (including a video), a discussion of the current year’s Plan,
   diversity in the workplace and the ongoing online staff training, in relation to cultural

   These efforts will continue in the same three formats through Contract Year 2010.
                                                                                    Page 18 of 32
Section 8 – Strengthening Community Ties

As a result of the 2008 Community Involvement, Input and Support Survey a position
was created to address the areas of concern. The resounding theme throughout the
survey responses was that P/GLTC needed to be more visible in the community. Areas
of concern that ran a thread through the responses were for P/GLTC to be more
proactive in the community to support a positive resolution to issues for which they are
not programmatically responsible, but may have an impact on the lives of our members
and future program participants. For community organizations who took the time to
participate in this survey and identify the needs for the communities they serve, it was
important for P/GLTC to extend an offer of partnership. Suggestions primarily focused
on community presence and outreach in a variety of venues, including the internet.

In July 2009, a Community Relations and Outreach Coordinator position was filled. This
new position is responsible for attending agency and community meetings to provide
information regarding the ALTCS program including eligibility and benefits,
representation as a vendor at appropriate health fairs in both counties, and participation
at key community events that directly impact P/GLTC’s member base.

P/GLTC now has consistent representation at the following meetings:
    Casa Grande Mayor’s Task Force on Disabilities
    Pinal County Networking Group
    Southern Gila Networking Group
    Pinal County Triads
    Pinal County Domestic Violence Coalition
    Sizzling Seniors
    Elder Abuse Task Force
    Pinal County Diabetes Coalition
    Payson Inter-Agency/Continuum of Care Group
    Pinal County CARE Team Group
    Pinal Hispanic Council

In addition to representation and information dissemination at community health fairs,
the Community Relations and Outreach Coordinator played a key role in the event
planning for:
    2009 Halloween Dance and Costume Event for Casa Grande Citizen’s with
    2009 Pinal County “A Day For Diabetes and Wellness Fair”
    2009 Pinal County Domestic Violence Conference
    2010 Elder Abuse Conference

                                                                               Page 19 of 32
    Section 9 – Annual Self Assessment and Evaluation

2009 Member Survey Case Management Questions (first seven questions on survey)
                                                                  5) When      6) When
                                                                  I leave a    my CM is
                                                        4) I      routine      not there, I
                    1) My                  3) When      have a message am able to
                    CM         2) My CM    I talk with say in     for my       speak with
                    Listens to answers     my CM, I the           CM, I get or given a         7) I know
                    me and     questions   am           help      a call       chance to       how to
                    helps me in a way I    treated      my CM back by          speak with      get a
                    with what can          with         sets up the next       another         hold of
                    I need     understand respect.      for me. workday. CM.                   my CM.         Overall Total
1 Agree Very Much          451         460        479        453         410            400           455     3108
2 Agree A Little            44          37          23        36          56             50                   246
3 Don't Agree               19          15           9        16          26             19           30      134
   Total                   514         512        511        505         492            469          485      3488
   % Agree             96.30%      97.07%     98.24% 96.83%          94.72%         95.95%       93.81%       96.16%
   % Don't Agree        3.70%       2.93%      1.76%      3.17%       5.28%          4.05%        6.19%       3.84%

    This is the evaluation and self assessment portion of the plan. The three main
    components considered in the self-audit are staff diversity, cultural and linguistic
    competence, and goals. In addition, a member survey was conducted.

    Overall 96.16% of the initial seven questions asked of members were given a positive
    answer. This indicates that member needs are being met in a favorable manner by their
    case manager. The 3.84% of negative answers to questions asked will be addressed in
    upcoming trainings.

    Five additional questions were asked of members during the survey that pertained
    specifically to cultural competency and two more questions pertained to transportation.
    All but one of the cultural competency questions received an overwhelmingly positive
    response. With more than 95% of positive responses to the answers, this is a strong
    indicator that P/GLTC is appropriately addressing member concerns and issues as they
    relate to cultural competency. P/GLTC will continue these efforts to ensure that member
    needs are met. The one exception was question number four “There is an interpreter at
    the doctor’s office that can help me.” While 47.54% of respondents agreed positively,
    52.46% responded negatively. This area of concern will be addressed in upcoming
    provider trainings which will also include more information and instruction for use of the
    Language Line™.

    The two questions pertaining to transportation received unusually high positive
    responses with 90.22% agreeing that they do not have a problem when they call to
    schedule a ride. While 91.73% felt that the transportation company gets them to their
    appointments on time. This is a dramatic improvement over last year's results which are
    due in large part to a vendor change from MTBS to AAA. P/GLTC has been very hands
    on and proactive in working with AAA to ensure that member complaints and issues are
    heard and immediately addressed. These efforts will continue throughout the year.

                                                                                              Page 20 of 32
Staff Diversity
A comparison of current and past staff demographics on pages 10-11 of this plan show
the following changes from 2008 to September 2009:

      Decrease in Caucasian staff, a reduction of 4.4%
      An increase in Hispanic staff, increase of 4.1%
      Consistent staffing of African-Americans
      No change in Native American staffing
      Slight increase in Asian staffing, up 1%

Cultural and Linguistic Competence
The Practical Guide and CLAS standards continue to be the two main components
driving P/GLTC’s Conceptual Framework. While P/GLTC continues to make progress
toward cultural competence excellence, much work remains to be done in this area.
Over the next 12 months, P/GLTC will continue its efforts to accurately measure
member and providers through ongoing survey efforts. Staff and provider education in
dealing with diverse populations will also continue through various educational offerings.
Emphasizing diversity and making cultural competence a part of the organizational
culture and in day-to-day operations will also be an important role of the diversity
committee, its members and designated staff. The continued commitment,
reinforcement and support of executive management and county administration
demonstrate to staff and the community that P/GLTC is dedicated to cultural
awareness, embracing diversity and ensuring that services are provided in a culturally
competent manner.

P/GLTC continues to view this initiative enthusiastically and accepts it as a long-term,
ongoing commitment to further the development and progression of cultural and
linguistic competence within the organization.

                                                                               Page 21 of 32
Past Goals
There were ten goals in last self audit:

   1.     Identification of member’s cultural needs.
   2.     Partial implementation of the cultural competency curriculum.
   3.     Continue system-wide interventions to heighten cultural and linguistic
          awareness and sensitivity.
   4.     Acquisition of new skills, strategies and knowledge to include easy-to-access
          cultural reference material for staff and providers.
   5.     Continuous staff and provider training on how to effectively utilize medical
   6.     Consistent support and reinforcement from senior leaders.
   7.     Allocation of resources for translation.
   8.     Incorporate findings obtained from surveys to effect change.
   9.     Increase level of community involvement.
   10.    Recruiting, hiring, and retaining minority staff who can demonstrate necessary
          skills to achieve the standards.

The self-assessment revealed successful accomplishment of the goals. Overall all but
one of the prior year goals were achieved. One exception was the allocation of
resources for translation which was not possible due to budget constraints.

Future Goals
P/GLTC’s leadership assessment lists the following measures that the organization is
taking to demonstrate its commitment to cultural competency:

   1.     Identification of cultural needs of members through data collection and
          member consults with case management staff.
   2.     Full implementation of the cultural competency curriculum.
   3.     Staff and provider trainings to heighten cultural and linguistic awareness as
          well as sensitivities.
   4.     Acquisition of new materials, knowledge, and resources to include easy-to-
          access cultural reference material for staff.
   5.     Continuous staff, provider, and community training on how to effectively utilize
          medical interpreters for our members.
   6.     Consistent support and reinforcement from senior leaders.
   7.     Allocation of resources for translation with staff and outside vendors.
   8.     Incorporate findings obtained from surveys to effect change.
   9.     Continue recruiting, hiring and retaining staff who demonstrate the necessary
          skills to achieve the standards.

                                                                               Page 22 of 32
                                      Survey Instruments

Member Satisfaction Survey 2009

Case Management Questions (Agree Very Much, Agree A Little, Don’t Agree Responses)
  1. My case manager listens to me and helps me with what I need
  2. My case manager answers questions in a way I can understand
  3. When I interact with my case manager, I am treated with respect
  4. I have a say in the help my case manager sets up for me
  5. When I leave a routine message for my CM, I get a call back by the next workday
  6. When my case manager is not there, I am able to speak with, or given a chance to speak
     with another CM
  7. I know how to get a hold of my CM. (Yes or No Responses)

Cultural Competency Questions (Agree Very Much, Agree A Little, Don’t Agree Responses)
   8. I can talk with my doctor and other service providers to that they understand my medical
   9. I experience problems in getting health care because of the language my doctors or
       caregivers speak.
   10. I use a family member to interpret.
   11. There is an interpreter at the doctor’s office that can help me.
   12. I am seen by my doctor within 45 minutes of my appointment time.

Transportation Questions (Agree Very Much, Agree A Little, Don’t Agree Responses)
   13. I do not have a problem when I call to schedule a ride.
   14. The transportation company gets me to my appointments on time.

                                                                                     Page 23 of 32
 Provider Cultural Competency Survey 2009

 All 190 surveys were conducted via telephone by a Provider Services Representative. The following
 questions were asked and then loaded into a database.

 1.     I have brochures available in the languages my patients speak.
  Strongly Agree    Agree  Neither Agree nor Disagree      Disagree             Strongly Disagree

 2.     My staff represents the same racial or ethnic groups of my patients.
  Strongly Agree    Agree  Neither Agree nor Disagree       Disagree      Strongly Disagree

 3.     I include culture in planning my patients’ treatment/services.
  Strongly Agree     Agree  Neither Agree nor Disagree       Disagree           Strongly Disagree

 4.     I have interpreter services for my patients who require them.
  Strongly Agree     Agree  Neither Agree nor Disagree       Disagree           Strongly Disagree

 5.    Are you aware that interpreter services are available to your practice?
  Yes        No

 6.      When you have a patient who requires interpretation services, how is this accomplished?

                  Your answers to the following questions are will be kept confidential.

 Please tell us about the composition of your staff:

Would you describe yourselves as:                           Please indicate language(s) spoken by
 □ American Indian, Native American or Alaskan Native       staff___________________________________
 □ Asian or Pacific Islander                                _______________________________________
 □ African-American/ Black                                  _______________________________________
 □ Hispanic (of any origin)                                 _______________________________________
 □ White or European American (non Hispanic)                _______________________________________
 □ Other (Please Specify):______________________            _______________________________________
 If you would like to speak to someone about this survey or cultural competency and diversity training
 opportunities, please complete the following:

 Name:                                               Telephone number:

 Other Comments:

                                                                                                  Page 24 of 32
Page 25 of 32
    Cultural Competency Staff Survey 2009

    Name:                                                  Position Title:

    Hire Date:                                            Section Name:

    What is your Ethnic Background?
            White (Not Hispanic or Latino)
            Black/African American
            Native Hawaiian/ or Other Pacific Islander
            American Indian or Alaskan Native

    What is the ethnicity of the most recent immigrant in your family?

    What is your highest educational level?
             High School Diploma
             Associate’s Degree
             Bachelor’s Degree
             Graduate Degree
             Other (specify)
    If you have a degree, what is it in?


1. Language(s) Fluency (other than English) including sign language:
   Specify Language                                      Speak                 Write          Read
   Specify Language                                      Speak                 Write          Read
   Specify Language                                      Speak                 Write          Read

2. Specify Language(s)
      Medical (highest level of proficiency – very good to excellent in language and medical terminology)

3. Certified? For example, Spanish Bilingual Assistant (SBA) or other language certification?
            Yes               No

4. Qualified Translator? For example, are you able to translate written communication from one language to another?
           Yes                 No

If you were contacted for assistance with translation, how and when would you be willing to translate?

    On the job/in person                        Over the phone
Specify days/hours you are able to translate:

                                     THANK YOU FOR YOUR PARTICIPATION

                                                                                                         Page 26 of 32
Page 27 of 32
 Staff Satisfaction Survey Results Cultural Competency 2009

*"No Response" means nothing checked on form left Null and is not included in totals or in % Negative Responses
** Total includes On the job, phone on the job, on the job only, not interested, not applicable and no response
*** Negative Responses include Not interested, not applicable and no response
*** Positive Responses include On the job (in person), Phone on the job, and on the job only.

                                                                                                                  Page 28 of 32
                  Language Directory

                     October 2009

Revised 10/2009

                                       Page 29 of 32


This is a directory of internal bilingual staff. They have indicated their willingness to help as an interpreter to appropriately
communicate with our members, their family members and the community.

The Language Directory will be updated and published periodically, and will be available to anyone that needs it.

Interpretation is the conversion of oral communication from one language to another.

Translation is the conversion of written communication from one language to another.


The directory is sorted by Language, and within the language by Location.

Description of the headings:

LANGUAGE:              Language spoken. A “T” next to the language indicates this person is also a translator.
LEVEL:                 Medical is the highest level of proficiency, meaning that the person has indicated a Very Good to Excellent
                       proficiency in the language and in medical terminology in the language listed.
LNAME:                 Last Name
FNAME:                 First Name
LOCATION:              Where the person indicated is assigned.
CLASS:                 Title or a more specific location
PHONE:                 Work phone number
NOTE:                  Information on the form of contact. It also indicates that person is willing to assist on an interpretation. If “on the
                       job only” is indicated, the person is willing to interpret at their workstation only.

                                                                                                                                    Page 30 of 32
   LANGUAGE       LEVEL    LAST NAME   FIRST NAME      LOCATION         CLASS         PHONE             NOTE

Spanish         Social    Castro       Margie       Florence      Case Mgmt.          866-6704   Phone & and the job

Spanish         Social    Grijalva     Cecilia      Florence      Case Mgmt.          866-6762   Phone and on the job

Spanish         Social    Hoyos        Lupe         Florence      Case Mgmt.          866-6741   Phone and on the job

Spanish         Social    Mejia        Rosa         Florence      Case Mgmt.          866-6781   On the job only
Spanish         Social    Stegner      Carla        Florence      Case Mgmt.          866-6778   On the job only

Spanish         Social    Mendoza      Rayna        Florence      Case Mgmt.          866-6727   Phone and on the job
Spanish         Social    Wood         Yolanda      Florence      Programs            866-6715   On the job only

Spanish         Social    Huerta       Gerardo      Florence      Provider Services   866-4419   Phone and on the job

Japanese        Social    Hughes       Paula        Florence      Case Mgmt.          866-4422   Phone and on the job

German          Social    Ross         Wally        Florence      AIS                 866-6770   On the job

Vietnamese      Social    Rocker       Vinh         Florence      Provider Services   866-6794   Phone and on the job

American Sign   Social    Montgomery   Rhonda       Florence      Provider Services   866-6761   On the job

                                                                                                          Page 31 of 32

Pinal/Gila Long Term Care provides comprehensive healthcare in an efficient and
innovative manner by a skilled, motivated and trans-cultural workforce to enhance the
quality of life for our consumers.


Pinal/Gila Long Term Care provides member-centered, high quality services to our
consumers and communities through progressive, proactive leadership, state of the art
technologies and prevention programs that enhance individual quality of life while
maintaining cost effectiveness.


Dedication      We are dedicated to providing member-centered, consistent, high
                quality services through collaboration with consumers, providers and
                our communities.

Innovation      We strive to be creative and adapt to new and changing environments
                while remaining in the vanguard.

Diversity       We recognize, respect and embrace a variety of cultures and value the
                diversity of all people.

Integrity       We serve our community and one another with honesty, pride and
                accountability in a responsive and ethical manner.

Respect         We treat the community, our consumers and each other with
                consideration, compassion and dignity.

Responsibility We take ownership of our actions and results and empower our
               consumers to do the same.

Stewardship:    We judiciously manage the resources entrusted to us so consumers,
                and those for whom we are responsible, receive quality health care.

Service         We proudly serve our customers with courtesy and excellence while
                promoting maximum independence and choice for our consumers.


                          “Quality Through Commitment”

                                                                          Page 32 of 32

Shared By: