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Nathan Adelson Hospice PHOTO 1: The aviary at the Nathan Adelson Hospice.

Elizabet Romero PHOTO 2: Elisabet Romero, Hispanic Outreach Coordinator for the Nathan Adelson Hospice holds a Spanish-language newspaper article about her meeting to start reaching uninsured Hispanics in Nevada. Nation-wide, Hispanics lack insurance at a rate 10 percent higher than any other group.

One out of every six Nevadans doesn't have health insurance according to a recent U.S. census Bureau report - ranking Nevada with the fifth highest number of uninsured. Not only that, the rate of uninsured here is growing at the second fastest in the nation. Among the uninsured, the largest group in the United States is Latinos. Efforts to help the uninsured however are fledgling at best.

PLASKON: The birds at this aviary mostly perch, but time-to-time they swoop down from every corner of this aviary and join mid-air to fly around the coop in unison. These are the birds of the dead. When an owner dies here at the Nathan Adelson Hospice near UNLV the bird is often donated to this aviary. The Nathan Adelson Hospice is the second oldest end of life service in the nation - and it's the only free service in Las Vegas. So naturally the uninsured should be attracted here. But Gary Gardia, Vice President for the Center for Compassionate Care at Nathan Adelson says they aren't and describes a common fate of the uninsured.

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GARDIA: How many stories do you want? There are people daily all over the country that are not getting the care that they need. One of the things that hospice provides is pain control, that people don't die in pain, so how many people do you want to know about that are dying in pain . . . it is a horrible way to die wherever you live on this planet and so if people aren't accessing the care then how are people dieing and where without support. That is what was happening 100 years ago, people were dieing in horrible pain. There is no excuse for that to be happening today.

PLASKON: There are some 42 million uninsured in the United States who are eligible but aren't accessing services like this. And the number's rising. Last week Senator John Ensign held a round-table discussion at the federal courthouse in Las Vegas to discuss why. They blamed overly complicated health insurance plans, high deductibles, re-allocation of funding for public health programs. Bill Bible of the Nevada Resort Association attended the meeting and said the result is that the uninsured cost the state a lot of money.

BIBLE: I am here because these costs get distributed to everyone in the community, the uninsured is kind of a misnomer, it is just a question of who pays, if someone who does not have health insurance coverage gets sick in southern Nevada they go to a public hospital, they are treated at public expense which is typically charged back to everybody in the system.

PLASKON: There's another reason to be concerned about the uninsured besides money and pain according to Carl Heard of the Nevada Health Centers. He says sick people who don't get treatment because they don't have insurance pose a danger to the whole population.

HEARD: So there is this herd dynamic, where you have to look at one sick member of a herd is likely to affect a larger portion of that herd where as if that one sick member of that herd is removed, managed adequately and put back into that herd.

PLASKON: The meeting went for an hour and a half. Heard admits that the traditional health experts here mostly came up with mostly traditional solutions. But that didn't keep them from trying. On his way out, he says good-bye to John Alden Health Insurance Marketing Representative Deon Dorsey who also attended.

HEARD: I hope we really get to keep working together, because I think we need to continue to build bridges.

PLASKON: Hurd and Dorsey say that the cost of insurance is not the problem. There are very cheap insurance plans.

DORSEY: Definitely there are plans that are out there, it is just getting the word out to the public and educating them on the plans that will work for them, educating them on how the plans work.

PLASKON: He says that education is key, not just among the uninsured, but even among insurance agents. Identifying who needs to be educated was what Senator Ensign got out of the meeting.

ENSIGN: The most important comment that was made was that there are really segments of the uninsured and not one solution is really going to take care of the whole uninsured and we are going to have to break down the population, for instance the young person that feels that they are invincible. That is completely different than a single mom.

PLASKON: And then he rushed off to a meeting upstairs. Ensign's staff says the information gathered here will be filed away, maybe for some legislation someday. Meanwhile, back at the hospice, experts who weren't at the round-table have identified such a population and are actually getting started on educating them and preparing legislation.

ROMERO: This is actually the second hospice built nation-wide, back in 1978.

PLASKON: Elizabet Romero is Hispanic Outreach Coordinator at Nathan Adelson. She was recently elected Chairperson for the Nevada Center for Ethics and Health Policy and chair of the subcommittee on Hispanic Outreach. The highest rate of uninsured in the United States is among Latinos - 30 percent - that's ten percent higher than any other group in the U-S. Romero already knows that traditional education efforts don't work. She's seen lots of Spanish-language newspaper ads for free services.

ROMERO: You can't just sit here and wait for them to come to your doors, no you literally have to go to them and the number one fear is the immigration and if they don't have insurance usually its that, I don't want to say it goes hand in hand, they are afraid to get any kind of service it is not just health care. But it is still in it's baby stages, that is what it looks like.

PLASKON: Today she's holding the first State Ethics and Health Policy subcommittee meeting on Hispanic Outreach. She says they've borrowed some new Latino education ideas: For instance attend churches to talk about services and recruit Hispanic neighborhood volunteers too talk about the services they provide and insurance. She reads from a Spanish-language newspaper outlining some goals for the meeting.

ROMERO: The first is to educate Hispanics about the services, bring in bilingual employees and volunteers and fifth, change political policies.

PLASKON: Since this is their first meeting, they haven't developed the policy changes they'd like to effect. But she does say some suspect that Hispanics are discriminated against at hospitals and don't receive translation services to understand the care they need. Gary Gardia of Adelson who has worked in health care for 25 years explains how the unwelcoming and hard to understand healthcare system comes across to Hispanics.

GARDIA: I think there are some cultural issues that we take care of our own, that we find in some of the underserved population . . . we don't need you, we can do this ourselves, some of that is cultural based some of that is sort of a pride issue, if you are going to exclude us from the culture then we will show you that we don't need you and I understand that. I understand that kind of thinking.

PLASKON: Meanwhile he says people continue to die in pain and don't get the services they need. A local attorney and health care worker are monitoring the level of care uninsured Hispanics receive. The hope is to use the information they gather will also be used to recommend new Nevada legislation related to care for the uninsured.

Ky Plaskon, News 88-9 KNPR TAG: For more information and photos, go to our web site,

Nathan Adelson Hospice
Elisabet Romero, Hispanic Outreach Coordinator: 702-296-1659

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Wednesday, January 21, 2004