Q&A: Considerations for case managers caring for immigrants

Q: Are there any extra considerations case managers should take into account when helping care for a patient who is an immigrant?

A: The circumstances faced by these immigrants and their families can be complex. Although a majority of immigrants are healthy, others endure tremendous hardship due to the conditions that prompted their journey. A large number of persons suffer extreme trauma as a result of physical and mental abuse they endure. Consider the challenges faced by those persons forced to exit their homeland courtesy of poverty, natural or manmade disasters, or gang violence. These intense social and occupational factors affect the emotional reserve of immigrants and ultimately influence their health and health outcomes. Many of the issues are guided by a person’s legal status in the country where care is being rendered, and case managers need to be aware of the following terms and definitions.

• Alien: Any person who is not a U.S. citizen.
• Amnesty: A pardon, or legal forgiveness, granted for an offense such as entering a country illegally.
• Anchor baby: A child born in the U.S. to undocumented immigrants or other noncitizens.
• Asylum: The protection that countries grant to refugees.
• Asylum seeker: A person who files an application for asylum in a country other than his or her country of nationality.
• Citizenship: The rights and responsibilities that a person has as a result of being born or naturalized in a country.
• Deportation: Formal removal of an alien from the U.S. for violating the immigration laws; an immigration judge must find the alien removable and order deportation.
• Emigration: The act of departing or exiting from one state with a view to settling in another.
• Green card holder: See lawfully permanent resident.
• Illegal alien: A foreigner who has either entered a country illegally (i.e., without inspection or proper documents) or violated the terms of legal admission to the country (e.g., by overstaying the duration of a tourist or student visa).
• Immigrant: Permanent resident aliens and those who have been naturalized as U.S. citizens.
• Immigration: The process of entering one country from another to take up permanent or semipermanent residence.
• Lawfully permanent resident: A person who is not a U.S. citizen or national, but is permanently residing in the U.S. legally, as a lawfully recorded permanent immigrant (aka immigrant, permanent resident, permanent resident alien, resident alien permit holder, green card holder).
• Migrant: Any person who is moving or has moved across an international border or within a state away from his or her habitual place of residence, regardless of his or her legal status, whether the movement is voluntary or involuntary, what the causes for the movement are, or what the length of the stay is.
• Migration: The process of moving across a boundary to take up permanent or semipermanent residence; categorized into international migration (from one country to another) or domestic migration (within one country but across a subdividing boundary).
• Naturalized citizen: An immigrant sworn in as a U.S. citizen.
• Native: People residing in the U.S. who are U.S. citizens. Natives of the U.S. fall into three categories: people born in one of the 50 states or the District of Columbia, people born in U.S. insular areas (such as Puerto Rico or Guam), or people born abroad but have at least one parent who is a U.S. citizen.
• Refugee: A person with a well-founded fear of persecution for reasons of race, religion, nationality, membership of a particular social group or political opinions who is outside the country of his nationality and is unable—or because of such fear—unwilling to avail him or herself of the protection of that country.
• Resident alien: Any person who is not a U.S. citizen or national but is residing in the U.S. legally.
• Safe haven: Temporary refuge given to migrants who left their countries of origin due to persecution or well-founded fear of persecution.
• Unaccompanied alien minor: An unaccompanied minor (younger than age 18 without legal guardians in the U.S.) who is an alien.
• Visa Waiver Program: A program allowing citizens of certain countries on a reciprocal basis who wish to enter the U.S. under the nonimmigrant class of visitor to do so without a visa, provided that their stay does not exceed 90 days.

For more information see The Social Determinants of Health: Case Management’s Next Frontier.