When language becomes a barrier to survival

By Alexandra Nguyen

(This story is made possible with the support of AARP)

The Takeaways

• AAPI elders often struggle with language barriers in U.S. health care, leaving family members like Tracey Nguyen to translate and advocate during medical visits.
• NAPCA and similar organizations help bridge these gaps through multilingual support, education, and advocacy, though access to bilingual providers remains uneven.
• Funding cuts and new federal policies threaten essential services

The Details

At her mother’s doctor’s appointment, Tracey Nguyen sits beside her, listening closely as the physician speaks, translating questions and answers along the way. 

“I started helping with doctor’s appointments with my father when he started getting sick,” Nguyen said. “And then it just gradually became my mother’s too.”

In the United States, aging Asian American and Pacific Islander (AAPI) elders often face barriers navigating an English-first health care system. Limited English proficiency can make scheduling appointments, understanding diagnoses, and communicating with providers difficult. As policy uncertainty and potential funding cuts threaten access to care, the need for advocacy has grown. Some community organizations have stepped in to help bridge these gaps. 

NAPCA’s Mission to Bridge the Gap

One of these organizations is the National Asian Pacific Center on Aging (NAPCA), a non-profit that has helped close these gaps through education and advocacy since 1979.

Between vaccine events and career programs NAPCA’s main goal is to support AAPI elders in overcoming language and cultural barriers to ensure access to all services and opportunities. “A big part of what we do is make sure that elders are empowered,” NAPCA president Clayton Fong said. 

Language, in particular, is a central barrier that NAPCA works to address. AAPI elders are uniquely vulnerable to this challenge because, for many, English is not their first language. Fong said, “Eighty percent of our elders speak a language other than English at home, and about half don’t speak English well.”

Language Access in Hospitals

In the hospital, this language barrier often manifests as confusion, miscommunication, and stress for both elders and their families. Whether discussing paperwork, health insurance, or ordering prescriptions, issues such as missed letters, automatic disenrollment, and delayed care may arise. 

Some hospitals in certain areas have expanded their services to respond to these challenges. Resources often include language assistance and bilingual staff, though they are usually limited to large urban hospitals. 

In California, state law mandates these resources, making it a bit easier for Nguyen and others like her to care for their mother, Hoang. “With Kaiser, it got easier when they went online because you could pick doctors who spoke Vietnamese,” Nguyen said. “Those doctors usually have Vietnamese nurses too, so I don’t always need to translate.”

Nguyen also recalled a time when her mother’s provider used a remote interpreter, revealing the potential limits of language access systems. While technology allows hospitals to provide interpretation when in-person translators are unavailable, it can introduce new barriers for older patients. 

Organizations have also responded to these needs for AAPI seniors nationwide, those located in areas with language resources and those without. 

NAPCA’s Multilingual Helpline

In 2004, NAPCA implemented its multilingual helpline to provide a forum for AAPI elders to ask questions and receive support. Fong said, “What we really try to do is give high-touch, hands-on assistance to answer just about any question.” Callers across the country inquire about Medicare, Medicaid, Social Security, SSI, and the Affordable Care Act.

The helpline helps users navigate health care decisions, enroll in programs, and complete eligibility screenings. Currently, it offers guidance in Mandarin, Cantonese, Korean, Vietnamese, and English, and is expanding its offerings. 

Navigating the healthcare system becomes increasingly complex with age, making these organizations and resources all the more valuable. For most AAPI elders, America is their second home, and English is not their native language. Later in life, retaining the language becomes more difficult. “If you grew up in another country or if your education is in another language, it’s a lot harder than if you were educated here,” Fong said. 

For Nguyen, this is a lived reality. She and her family ultimately decided to move from Union City to be closer to her parents, to help with medical-related challenges, and manage appointments. Acting as both a translator and advocate for her parents’ health carries emotional responsibility, a role Nguyen has willingly taken on even as her own life has gotten busier with work and children. 

Consequences of Language Barriers in Clinical Care

In an unpredictable health care landscape with ever-evolving policies and legislation, organizations and caregivers play a crucial role in helping elders receive the appropriate care. Language gaps create additional challenges that complicate access and understanding. 

Stereotypes, delayed care, and the loss of preventative care are all potential outcomes of language barriers in clinical practice. Providers sometimes perceive AAPI as having few urgent health concerns, which can influence how symptoms are evaluated and addressed. As a result, care may be delayed, and patients may not fully understand their symptoms or feel able to ask necessary questions. Without adequate language access, preventive care, such as routine screenings and early interventions, is often lost.  

A Family’s Immigration Journey

Hoang and her family came to the United States in 1975, sponsored by a Baptist church in Panama City, Florida. In Vietnam, she was a stay-at-home, but after immigrating, she began working to support her family. As she has grown older, both her language skills and health have presented new challenges. 

“The first generation comes so the next generation can have a better life, and often their life is a little harder,” Fong said. “So, NAPCA is here to try to make it a little easier, give some dignity and independence.”

However, looming funding cuts may limit the resources that states and hospitals can provide. 

Threats From Federal Funding Cuts

This July, President Donald Trump passed the One Big Beautiful Bill. This piece of legislation increases costs and reduces access to Medicare or Medicaid, targeting seniors, immigrants, and low-income individuals. 

The bill’s implementation has been gradual and is expected to continue throughout 2026. How states respond to the proposed federal funding cuts will play a critical role in their potential impact. 

The New York Times reports that the bill could have a ripple effect on hospitals, putting their care and their resources at stake. The sweeping cuts could strain health care facilities that serve low-income and Medicaid-covered patients. 

Some hospitals’ expanded programs, such as language access services, could also be threatened. Advocates emphasize the need for these resources. 

“If you want to treat people and provide health care without language, it’s no different than veterinary medicine,” Fong said. “And I think we can do better than that.