In a sunlit community room in the Banning Villa Apartments, a senior living center in Wilmington, a predominantly Latino neighborhood in Los Angeles, Sandra Himenez, 72, recounts a cooking lesson she just learned in health class.
“In Mexico, you are used to cooking with greasy food and lard sometimes, and now I have learned to use olive oil or grapeseed oil, so that helps with my cholesterol,” said Himenez, speaking in Spanish. “My medical exams have been more positive. I feel good.”
A community health worker, known as a promatora, has been leading the classes so that Himenez and her Mexican-born elderly neighbors can become masters of their own health. As California’s Latino population ages, promatoras are increasingly seen as a way to boost seniors’ health in a way that honors their culture.
A promotora typically receives specialized training to provide information to residents in the Latino communities in which they live. Promotoras make house calls, go to PTA meetings and offer informal presentations in school classrooms.
In L.A., as the aging Latino population booms, promotoras are encountering more seniors on their rounds. The city is home to 1.8 million seniors 60 and older, according to Laura Trejo, general manager of the City of Los Angeles Department of Aging, which provides community health services to seniors and their caregivers. By 2030, more than 740,000 Angelenos of Latino descent will be age 65 and older.
Trejo is part of a new coalition of organizations just beginning to explore how to nurture the work of promotoras serving aging residents in underserved communities.
Promatora Rosario Moreno, who earns $30 per class through L.A Care Health Plan, has helped Himenez and her neighbors learn how to monitor their health conditions, manage their medications and talk to their doctors. Classes, taught all in Spanish, have also focused on nutrition, dementia, Alzheimer’s and diabetes.
“As we look to improve health of elderly in our community, we are looking for non-traditional models that have a history of being effective,” Trejo said. “One of my sayings is, ‘I can teach you to be bilingual in a few years, but I can’t teach you how to understand someone’s culture in a few years.’ That takes some of us our whole lives.”
June Simmons, president and CEO of Partners in Care Foundation, said half of the people her organization serves are Latino and the kind of cultural fitness that promotoras have can literally be a lifesaver for seniors.
“Words count. Nuance counts,” she said. “To understand people is never easy and to communicate about sensitive and private, and often complex matters—it’s great if it’s in a language someone is most comfortable with.”
A Network of 4,000
For Maria Lemus, the Executive Director of Visión y Compromiso, building knowledge and understanding is her daily commitment. The L.A.-based nonprofit organization’s mission is to promote the well-being of Latino communities by supporting promotoras through leadership and training.
The organization, founded in 2001, has a network of 4,000 promotoras working in 13 regions across California. The promatoras are in cities—including San Diego, Santa Barbara, San Francisco, Riverside, and Fresno—but also in rural parts of Coachella and Kern counties.
Whether and how the work of promotoras is funded varies, according to Bob Thurman, Health Program Specialist with the California Department of Public Health.
A 2016 California Primary Care Association Health Center survey conducted by the CDPH, reported that 93 percent of the agencies pay their community health workers or promotoras a salary from a combination of health center general funds, clinic revenue, grants, or a share of Medicare or Medi-Cal reimbursements. Approximately one quarter of the health centers reporting did not have a sustainable funding source for the workers and another quarter reported that their promotoras were volunteers.
Lemus is investigating how to pair promotoras with health insurance programs that focus on older adults. One pitch? Improving culturally competent care reduces expenditures in health spending, according to a study by the National Center for Farmworker Health, which reviewed the return on investment of community health worker programs in several states.
Practical Tools for Wellbeing
Maria Isabel Nuno, an experienced promotora, has been a bridge to the health care system for more than 2,000 people in her Wilmington neighborhood, takes that prevention mission wherever she goes. One topic—depression—invariably comes up.
“People say (they’re depressed) because they are divorced and feel like they don’t have anyone, so they’d rather not be here,” Nuno said. “I tell them it’s OK to be down sometimes,” and she gives them resources and phone numbers of psychologists. She has even called 911 for patients that are suicidal.
Moreno, the promotora who taught the class at the Banning Villa Apartments, agrees that giving seniors practical tools to take care of themselves is critical to their sense of wellbeing. She uses games to teach seniors about prevention and nutrition.
In one game, she asks them to match a photo to a category and guess which scenario represents an urgent situation, an emergency or an opportunity for prevention. For example, she asks: “Is a heart attack in the emergency category? How about someone who has an ear infection? How about someone kicking it on the couch?”
Another popular lesson is prepping for doctor visits. “They say they have conditions or situations bothering them,” she said, “but when they’re at the doctor they forget about it.”
She advises them to write their questions in a notepad along with a list of medications and to remember to find a Spanish speaker in advance who can translate for them.
Himenez’s friend Catalina Garcia, 67, said before she took the class, her typical breakfast was a Mexican sweet bread called pan dulce with a coffee.
“Not very nutritious!” said Garcia, smiling. Because she is pre-diabetic, she said now her mornings meals are egg-white omelets with veggies.
“It was very interesting and important to learn about this because we didn’t know much about these topics,” Himenez added. “We learned how to really take care of ourselves.”