The Quiet Discrimination
Posted by Patti on May 1st, 2008 / 
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I read an article over at Long Term Living/Nursing Home Magazine and it brought to light some issues CNA’s have with this work.
At first the article didn’t seem to say much new or different; the issues of low pay and poor benefit packages are discussed as being barriers to attracting good staff. We all know this is the number one problem nursing homes and assisted living facilities face- high turnover.
What disturbed me and caused me to write this post:
The study, which was funded by the National Institute on Aging, also revealed that assisted living workers, who are primarily black, often face racial discrimination from residents, who are primarily white. Nearly half of black employees reported experiencing racism, Ball says, with many of those situations arising from comments made by residents suffering from dementia. Overall, she says, facilities need to make sure their employees feel valued and appreciated.
This is in Georgia. But it happens in every state.
Of all the careers one can chose to work in, nursing is one of the most rewarding. To help another person in need is a good feeling. In no other profession, though, do we see management allowing discrimination to happen, daily, as a matter of routine course. Under the guise of resident/patient rights, aides of color are constantly victims of resident harassment and disrespect. Management bars these aides from caring for said residents- and this leads to resentment and bad morale among all the aides.
No where in any Resident Rights document is the right to ask for or turn down care from nursing staff based on their the race, sex, religion or sexual orientation. Period. Not only is this illegal, it’s immoral. It’s also just poor management when the leaders promise residents and their families only female aides will work with their loved ones. What happens when only male aides show up for work? Don’t say it won’t happen. It has and it will.
In most businesses the customer is always right, no matter what. Business owners and their agents will do most anything to satisfy those who purchase their products or goods. This is, after all, customer service. But what do we do when it’s a patient/resident, demented or not, who overtly displays racism against a nurse or an aide of color?
I’ve seen it at my work. Most of my residents (patients actually) cannot speak for themselves and they are not of age anyway. Some of our best aides, who happen to be black, have been singled out as not being good enough to work with some of our residents, by their families. They insist upon “white aides” for caregivers and that their child never have to have a permanent aide of any other color…and management cowards right down to them. They send out announcements to the nurses (via emails) stating “only so and so CNA’s are allowed to be assigned to Mrs. Smith, per family wish”…and the only names listed are of Caucasian aides. The nurses keep this all quiet of course but we hear them talking about it when they’re making out the assignments. How does it make one feel if you’re an aide of color?
Oftentimes families cite a language barrier as the problem. This is a legitimate concern. We’ve had aides from Haiti, Mexico and other nations, who barely speak any English. How they passed a CNA course and state test baffles us, because they often cannot read and comprehend care plans, assignments and other written directives. Concepts of math are not well understood either- so weights and percentages of meals consumed are huge problems for these aides. I can understand and justify a request for non- English speaking staff not be assigned to certain residents/patients. These staff CAN take charge of this problem themselves and learn to speak English fluently; as well as learn to truly understand this language and work with it. They have a choice here.
But we cannot choose the color of our skin.
In any kind of work the management should never stand for this quasi-discrimination that they excuse or write off as resident rights. While we want our customers to be happy and content, we have to take a stand that’s morally right as well as legal. Discrimination is wrong on every level and for any reason.
How can facilities make sure their staff feel valued and appreciated?
Simple. Tale a stand to this nonsense right from the get-go.
Nursing home administrators and DON’s need to tell residents and their families upon admission that they never ever have a choice or say in which CNA is going to care for their loved one. It doesn’t hurt to mention aides (and all staff) of color, or certain religions or sexual orientations are protected by labor laws. Administrators and DON’s need to make it clear they will not tolerate any form of discrimination.
Demented residents will make comments and sometimes these will be very nasty. Some demented residents will always react poorly to having certain aides care for them, and be fine with other aides. I don’t have an answer for this dilemma. I can say it certainly burdens everyone when this happens. One of the good things about dementia is it causes people to FORGET…usually within minutes of any event or problem or escalation. Sadly this memory deficit can be of help in situations where derogatory remarks are made. Usually these residents are able to become very tolerant of their aide, regardless of race, sex, religion- when the resident realizes on some level that the aide is not out to harm them. This can only happen over time, through consistent assignment.
May 1st, 2008 at 8:43 pm
Well I have experinced the opposite. I am white and we have residents of color, who refuse my care. Or my co workers who are white. Thankfully we have aides who are of the same race as these residents, but they are not always on the schedule to work. It’s an issue and you are right Patti, management caves in everytime. One day not to long ago they actually called in one of the black aides (who had worked 18 days straight) to do am cares, and then later, pm cares for these residents. Thats bad. Right now they schedule certain agency staff who are black to work on the days the others have off.
One time a couple winters ago all the lady aides didn’t make it in to work but the male aides did. What a day that was we all heard, since we have many residents who demand female aides.
It’s not that we are discriminating, it’s the residents who are.
May 1st, 2008 at 9:28 pm
We do have to remember we are dealing with people who have biases and strong opinions of others who are not like them. It’s sad and perhaps wrong, but I can see why nursing home leaders give in to these requests.
If they don’t, the family or resident will find SOME reason or ways to make the working life of the aides miserable. They will even go so far as to mock up charges of abuse or neglect. I’ve seen it happen. Is this what we want?
On the other hand, serious charges like that must be proved before the aide can be terminated. But we all know what happens to those aides who have been charged- they’re targets for future disciplinary action, forever on the watch list.
One way or another, racism always comes back to haunt one party or the other. In our work, it is the staff who have little in the ways for protection against such mean spirited things.
The other issue here is the language barrier. I too have seen detrimental problems occur when a foreign aide is allowed to work without proper screening. The trouble is, we can’t expect or ask them to go through any special testing we wouldn’t ask American aides to do. It’s expensive. The life of residents is at stake though, and lawsuits and other problems do happen when bad things happen. I once had a resident who was on strict fluid restrictions. A co worker from Mexico also worked with this resident. She didn’t understand how to measure drinks properly; in the course of one 8 hour shift she allowed him to consume more than two days worth of liquids. He died of the heart problem we were supposed to be guarding him from. The facility was sued and the family won that case.
The price to pay isn’t always clear at first.
Patti brings up the excellent point that foreign aides do have a choice when it comes to the English language and learning it very well. Skin color is not a choice, but the skills we must have are. Nursing home leaders would be smart to test ALL potential aides for these seemingly minor skills- measuring, reading a care plan and demonstrating an understanding of expectations.
May 2nd, 2008 at 9:38 am
Since your article specifically mentions Georgia and I am in Georgia can I just point out that the racism that some aides experience can be explained (not excused) by looking at the average age of the residents that are in LTC in the southern states. Most residents are over 70, some reach very advanced age (90’s and older). If you take into consideration the fact that those older people lived in a very different world when it came to seperation of the races, you can be more understanding. Most of our elders have alzheimer’s or dementia…political correctness just doesn’t apply. When they see someone of color coming into their room, where they are alone, insecure and most of the time disoriented…they react with fear and sometimes anger…give them the benefit of the doubt…we are trained to be caregivers…give care, remember that our residents have issues and reassure them that you are “here to help”. A soft and reassuring tone of voice and a compassionate heart has only one color.
May 4th, 2008 at 8:37 am
I have to disagree with this.
They are paying to be in the facility. They are the customer’s. If they were at the grocery store, they could choose who would wait on them. They have the right to refuse anything they like. They also have the right to leave the facility if they don’t like it there.
As a rule, these people have lost almost everything else: their homes, their families, their pets, their health and their ability to take care of themselves. All they have left is the right to accept or refuse the care we offer.
May 4th, 2008 at 7:31 pm
I agree with Tracy D. If a resident truly does not want someone as their caregiver, they have a right to have someone else. If I was a resident I would refuse cares from an aide I didn’t want touching my body. Some residents may have been raped or abused by men in their past, and they shouldn’t have to be cared for by a male aide if it agitates them. Dementia residents can be unpredictable…one day they like you, the next day they don’t, and having another aide do their cares might be better for them that day. I know I would prefer female aides instead of male aides. Doesn’t mean I am prejudiced or mean…
May 5th, 2008 at 9:09 am
I am in home care and we acomomdate our client’s preferences ; in part because we are providing care in their homes and they have a right to refuse admittance to their home of anyone. We are almost always ablem to find a suitable case for our African-American aides and thus not put them in this uncomfortable situation. ON occasion we will say to a client I have so and so available but she is African -American and if they refuse then they may have to wait for service to begin. One lady waited 2mos for service to start.
May 6th, 2008 at 2:31 am
People who think they have the right to refuse service to or from anybody based on race, ethnicity, religion, etc. had better start reading civil rights laws, before they learn the hard way through lawsuits they will lose.
Also, while racist comments do come from patients with dementia, a study from the Buehler Center on Aging at Northwestern University’s Feinberg School of Medicine in Chicago, IL states that nearly 75 percent of nursing assistants (CNA’s) working in nursing homes experience racism on the job. This research showed that racism is expressed by nursing home residents as well as residents’ families and nursing home co-workers.
May 6th, 2008 at 9:03 am
Yes they are customers. Which is the point: They can go elsewhere if they’re not happy with the service. Although, in reality, most nursing home residents do not get a choice as to what nursing home they will reside in. They go where the bed is.
There is no legal **right** to cherry picking the staff who will be assigned to care for residents (or patients, clients…) Under federal laws and state laws, allowing this stuff to happen can land a facility in big legal trouble. It is, make no mistake, discrimination. It is sanctioned by management and **rights** are often cited as an excuse. It’s wrong. It’s illegal. And unethical. Refusing care from a person of color, or of a certain sexual orientation, or sex, or from someone of a certain religion, should cause all of us to be concerned. Of course it is a normal routine thing we see all the time so it doesn’t stand out, to us. It should. We need to wake up to see how we add to the perception of racism.
Many people have lost things. We all grow old and most of us will need some care at some point in our lives. This doesn’t mean we can discriminate.
May 6th, 2008 at 9:06 am
I understand what you’re saying. I really do.
But this is why racism is alive and well in America today.
We keep it alive with attitudes like this.
Not that you’re attitude is wrong, it’s just part of the culture of (yes) making excuses for people.
May 7th, 2008 at 12:32 pm
I agree with the comment that non-english speaking aides should be screened before being allowed to work for a company. Many of my co-workers cannot read the instructions or medical sheets and often I am called over to pass medications for them. In the course of training new employees, I pass out instruction sheets for some tasks and 99% of the time they are left blank and I am told that by the new employee that it is a “cultural difference” and that they needed to be shown or demonstrated instead of reading the instructions. In response, I asked the employee to read the first line aloud for me and he refused. Another time the employee just admitted that he could not read the paper. I am baffled as to how they got hired in the first place. Perhaps it maybe true that what some of my co-workers said is true. Most companies have a “warm body” approach to filling the roster and skills are not high up on the priority list..