Review of work produced by Peter Rousmaniere, with support from Concentra and Broadspire.
Of the 15 occupations that are expected to see the largest numerical growth between now and 2020, foreign-born workers, immigrants, are currently over-represented in eight of them. And of those eight, six are classified as "low-skilled" for which a high school diploma is not required. The Bureau of Labor Statistics projects that these occupations will grow by 42% between 2010 and 2020. Odds are that they will continue to be over-represented by foreign-born workers.
- Forty-nine percent of private household employees are immigrants;
• Within the Construction industry, 65% of all "reinforcing iron and rebar" workers are immigrants, and they total 27% of all construction laborers;
- Forty percent of maids and housekeepers in the Accommodation industry are immigrants; and,
- While immigrants comprise 24% of all the workers in the Agricultural industry, they make up 61% of the field workers.
As of 2010, 29% of immigrants between the ages of 25 and 64 lacked a high school degree, as opposed to 7.4% of the U.S.-born population. And, although immigrants make up 15.8% of all U.S. workers (something a bit hard to believe when you consider their ridiculous over-representation in those fast growing industries), they account for 20% of all reported injuries.
These facts, alone, make Peter Rousmaniere's Work Safe: An Employer's Guide to Safety and Health in a Diversified Workforce (PDF), published with support from Concentra and Broadspire, a timely and compelling read. Moreover, it's free and is available as a pdf download at Broadspire.
Rousmaniere, publisher of the Working Immigrants blog since January 2006, and, until November 2013, a columnist for Risk and Insurance Magazine, has, until now, been a "voice crying in the wilderness." He's been banging the drum and sounding the alarm, saying that we, as a nation, and particularly as employers, are unprepared--indeed, are refusing to prepare--to deal with the needs and cultural differences presented by immigrant workers. A Harvard MBA, Rousmaniere believes that, although there is a moral imperative for doing so, making the effort to become sensitive to the language and cultural differences in our immigrant workforce just makes good business sense. And in this 57-page, 6x9 inch, handsomely produced Employer's Guide he skillfully makes the point.
Although immigrants are also over-represented in high-skilled jobs, this book is really aimed at the vast underbelly, immigrant workers who lack the education and skill set to navigate through the thorny thicket of work rules and health care issues, immigrants who may speak wonderful Spanish, or any number of other languages, but nary a word of English. The theme running through the entire book is one that urges us not to assume that English-challenged immigrant workers understand what we say, even when we say it in their language. Rousmaniere makes this point over and over again, so much so that I thought the book could have been somewhat shorter without losing a thing.
To me, this sentence is the big pitch:
"...moderately or low-skilled immigrants working in jobs of average or above-average injury risk are likely to face greater safety issues even if they work alongside U.S.-born workers."
The book has an excellent chapter on safety training in which Rousmaniere doesn't so much suggest what to say, but rather how to say it. He writes about teaching through stories, role-playing, body mapping and pictures. He's big on pictures, recommending that employers go so far as to hire cartoonists, because cartoonists have "a knack for telling a story in one or many panels." He even describes how cartoonists get paid and offers "Tips for working with artists."
In the Workers' Compensation chapter, Rousmaniere offers a novel idea -- the prepaid indemnity card. He points out that about a third of the people who earn less than $30,000 a year don't have bank accounts and, consequently pay hundreds of dollars a year in check cashing charges. To help them, he suggests that claims payers contract with debit card vendors to pay indemnity benefits directly to injured workers via the card, which the vendor would arrange to have honored at ATMs. Interestingly, this isn't a new concept. Rousmaniere says, "An increasing number of employees receive their wages via a payroll debit card." Left unsaid is what that "increasing number" actually is, but if you think about it, his idea might have more than a little merit because of the inexorable gravitational movement of technology.
The book has an extensive chapter on "Medical Care Across Cultures," and here Rousmaniere is writing about all medical care, not just work injury care. Again, it's all about translation and culture. He gives an illustration: "In some societies, it's believed that coughs are always fatal." I found myself wishing he'd enlighten us as to which ones.
He writes about "Job-Specific Challenges in Cross-Cultural Care" and says that "Medical Case Managers are likely to have to confront a patient's steep learning curve when it comes to understanding the American health care system." I found that one a bit rich, as in - does any patient understand the American health care system, if you can call it that.
In fact, I found that much of the chapter on health care really applied, not only to immigrants, but also to many native-born Americans who are unskilled at navigating the health care maze and have what Rousmaniere calls "low health literacy." For example, he offers a bullet list of "side effects" for this affliction: failure to seek preventive care, leading to more ER visits and hospital admissions; no written agenda for medical visits; missed appointments; lack of follow-through with imaging tests; misuse of medications; and so on.
Rousmaniere suggests an "Rx for Hospitals: Professional Interpreters." Moreover, he points out, "The Civil Rights Act obligates medical providers to arrange for patient communication in the most suitable language for the patient." I did not know that. He offers health care providers another bullet list of tips for overcoming language differences. In today's health care world the first tip, "Slow down. Plan double the normal time," might be hard to achieve. Trouble is, the tips all make good sense. They're thoughtfully done, and, were it not for our health care assembly line process, they'd be the norm. My bottom line takeaway to Rousmaniere's health care recommendations: they will take nearly dictatorial leadership to implement.
Then for good measure, in case we've missed the point, Rousmaniere throws in an entire chapter on translation and interpreting, entitled "Translate This!" But just when you know to the soles of your boots that this translation thing has gone way too far, he throws in this Case Study zinger that makes you think he might be right to concentrate so much on this:
"An English-speaking hospital staff once misinterpreted a patient's complaint of "intoxicado" as an admission of being intoxicated, not that the patient felt nauseous. The mistake resulted in permanent paralysis and a multi-million dollar financial settlement."
The translation and interpreting chapter lists a number of resources of which health care and insurance pros will likely be unaware. He compliments California for Senate Bill 853, which "requires that health insurance organizations provide free and timely translation and interpretation services for patients with limited English proficiency." And Rousmaniere's "10 Planning Steps for Translation and Interpreting" is spot on.
But for my money, the little jewel in this book is the last chapter - "Free Online Resources." I loved it. He has hunted down a wonderful library of resources that every professional in the field should have at his or her fingertips. They come as General Resources, such as a number of truly excellent offerings from the State Compensation Fund of California, Spanish to English and English to Spanish dictionaries published by OSHA, and resources aimed at a number of industries, the ones with all those low-skilled, fairly uneducated immigrants. Excellent, indeed!
All this may be a bit much for middle and small market employers, who may not think they have the resources or time to invest in this level of acculturation. I suspect that this book may not be a big seller for them. Health care professionals, on the other hand, would be well-advised to study it closely.
But, here's an idea: if insurance companies and insurance agencies were to distribute the book to their customers, that would go a long way toward educating employers and getting Peter Rousmaniere out of the "wilderness." For, in the immortal words of that great American philosopher and discount retailer, Sy Syms, "An educated consumer is our best customer."
The official launch of the Guide will take place at the National Workers' Compensation Conference in Las Vegas, NV, November 20-22.