Hispanic Nursing Home Residents Get Poor Care
Posted by Patti on April 15th, 2009 / 
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According to this report, Hispanic nursing home residents receive poor nursing home care.
Nursing homes serving primarily Hispanic residents provided poorer quality care compared to facilities whose patients were mostly white, according to Brown University research.
Details were published recently in the Journal of the American Medical Directors Association .
Researchers reached their conclusions after looking at the rate of bed sores at nursing homes with high concentrations of Hispanic patients, compared to others with low concentrations. Hispanics at nursing homes with a high rate of Hispanic residents were more likely to have bed sores, compared to Hispanics living in nursing homes with fewer Hispanic residents.
I wish they gave more reason in this article; I fail to understand WHY this happens. Is there a difference in the way staff are trained? Are nursing standards different? What could be the reason (s) for this disparity?
April 15th, 2009 at 1:29 pm
An African American, I did not find these research results surprising. Racial-ethnic disparities in healthcare have been high historically. Overwhelming evidence indicates that these disparities negatively affect certain racial and ethnic groups. America’s long history of overt and covert racism, with all its stereotypes and discrimination, continues to pervade its institutions in ways underestimated by many people, including those who are victimized by it.
There is a tendency among some healthcare workers to assume that the solution to this problem rests with leaders of the healthcare “institution” when, in fact, it belongs to each person making up the institution. The question “Do you treat patients differently based on race?” is one that every healthcare worker must explore at a personal level with honesty. In spite of overwhelming research to the contrary, most responders still say, ”Oh, I’m colorblind. I treat everybody the same.” Recognition of the problem is the first step toward improvement. Racial and ethnic disparities must be eliminated before America will ever realize true equality in healthcare among its diverse populations.
This video “Does Your Patient’s Race Affect the Care That You Deliver?” can help get that personal conversation started.
Frances Shani Parker, Author
“Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
April 18th, 2009 at 2:12 pm
Francis,
I read the report through the AMDA magazine. I felt compelled to reply to your comment.
You’re making many assumptions, as will many who read this article without the benefit of the actual report. The article leaves open much to conjecture and this is not good.
The facilities used for this study were predominately serving either white people or, Hispanics and Blacks. The communities these facilities were located were also the home to most of the staff who were employed at the nursing homes. The vast majority of staff who worked in the homes were of the same ethnic as the residents: Hispanic staff took care of Hispanic residents; black staff took care of black residents, and so on.
So, you’re assumption about racial bias is simply not true and is unfounded. I find myself getting quite annoyed at these race baiting games that many appear to be playing.
I don’t know of your facts to back up your statement of these so called high disparities, but I would certainly take a look at the actual studies and their design before making jugdement. We cannot ask people to start having conversations with themselves, when we’re going on information that is at best biased and designed to provoke racism, to keep it alive and well; vs making people feel bad for things they don’t DO, have never DONE and would not think of doing.
I see this study as evidence that education of health care workers, particulary CNA’s, needs to improve. There is a disparity, but it’s not the fault of hands on care givers. Rather, it lays in WHO educates them and WHO supervises them. Where are these CNA’s getting certified? Who is teaching them? What is their education level prior to becoming certified? Are these care givers being pushed through a CNA course that lacks in the very basic modules that are required (such as skin care, pressure sore prevention) with blinders on, literally, just to have high “success” rates? I think so.
You paint this picture as one of individual CNA’s being racists. Knowingly or not. THAT is not right. Please open your mind a little and stop being so racist yourself. I’m sorry to be so harsh, but this stuff really bothers me.
April 18th, 2009 at 5:40 pm
As always, Kim speaks some hard truths to things. Sometimes a little too hard though
I don’t think she was being racist. I think she was trying to tell us we’re racist. BTW: I am a 39 year old white woman from W Virginia; grew up dirt poor and didn’t get my HS Diploma until I moved out of home; got married and had three children. By virtue of the work I do for a living, I am still poor.
My Grandmother resided in a nice nursing home in Florida for many years before she died. She died of an infected bed sore. Most of the staff at that nursing home were as white as I am.
Color matters little when it comes to care.
Education, training, skills and supervison matter the most. The other part missing to all this is COMMUNICATION. CNA’s need to know which residents are at risk for breakdown; they don’t automatically know this. Some say we should…but not all of us do. We learn the skills in our training; our education helps us understand those skills; supervision helps us stay on the right track with care.
In agreement with Kim overall: I think we should step back and look at the hard facts and decide where to go from there. Assuming these problems were present because of racism is a cop out and, more dangerously, it doesn’t do a thing to truly solve the problem.
April 18th, 2009 at 9:54 pm
In addition to being an African American, I read healthcare research daily. I don’t need to make assumptions about racial-ethnic healthcare disparities. The Centers for Disease Control and Prevention confirm that wide racial and ethnic disparities persist in healthcare. Even when factors such as gender, condition, age, and socio-economic status are controlled, the inferior care is consistent across a range of illnesses and services. The American Medical Association (AMA) also substantiates that racial and ethnic minorities still receive a lower quality of healthcare, resulting in higher death rates. Are these agencies simply “playing race baiting games” that annoy you?
You say, “I don’t know of your facts to back up your statement of these so called high disparities.” Perhaps it’s time for you to do more research to get the facts. Knowledgeable people in healthcare do not refer to racial-ethnic disparities as “so-called.” The U.S. government thinks the disparities are so widespread that it created the Department of Health and Human Services Council on Health Disparities to focus on racial-ethic groups that are victimized by more deaths and diseases than the general population.
If you go back and read my initial comment, you will notice I do not refer to the Hispanic study, which I read, at all. I only refer to my own reasons for not being surprised with the results. Michael Gerardo, the Brown University professor who led the research, states in his own conclusions that more research is needed to determine the implications of their findings. Your statement, “I see this study as evidence that education of health care workers, particularly CNA’s, needs to improve” is pure speculation and an opinion you are entitled to have.
The statement, “Color matters little when it comes to care’” goes against the overwhelming research findings that the Centers for Disease Control and Prevention, the American Medical Association, and many other highly respected healthcare-related institutions recognize. Statements like “Please open your mind a little and stop being so racist yourself” and “I think she was trying to tell us we’re racist” (which I never thought or tried to tell you) are the very reasons more discussions (without name-calling) on race are needed.
It will be interesting to read the results of future research by Brown University on the reasons Hispanic nursing home residents get poor care. By the way, this research by Brown University comes less than two years after a landmark 2007 study, published in “Health Affairs,” that concluded that blacks are more likely than whites to live in poor-quality nursing homes. That study found that the problem was worst in the Midwest, and that inequalities in care are closely correlated to racial segregation.
April 19th, 2009 at 6:47 am
The states in question where the nursing homes were studied are:
California, New Mexico, Texas, Arizona and Colorado.
Fact: These states have a high proportion of Hispanic people.
http://www.censusscope.org/us/map_hispanicpop.html
The info in this web site is from the year 2000; we know the population of Hispanics has grown a lot since then. Where there are large numbers of people of any race, they prefer to reside in communities of their “own”- to be near people of similar ethnic background, culture and language. That’s a good and normal thing. In MA they just opened up a nursing home for older people who are gay. It was created so that residents can be with others of similar background and sexual orientation. Is this segregation, when it’s owners are OLD GAY people who saw a need?
If you read what I wrote you would see that I do agree there are disparities. I take offense to your using some sort of “unrealized” racism as a reason for these disparities. I take offense to your hypothesis that CNA’s and other health care providers are blatantly or unknowingly bias when, from all indications, the nursing homes in this study were staffed by people of similar ethnic backgrounds. How do you respond to that? Who is to blame now? Let’s keep that mentality alive- the blame game.
A nursing home, with mostly black residents, is staffed with mostly black aides (and nurses, and everyone else). The facility delivers poor care. Where’s the bias here? A nursing home with mostly white residents, is staffed with mostly white aides and others…the facility delivers poor care. Whose to blame now?
I stand by my statement: Racism is NOT the reason. Lack of education, lack of skill and supervision is the reason for this. No matter what color skin is.
April 19th, 2009 at 2:29 pm
In many cases, large numbers of people live together in communities because they are discriminated against or barred from communities where they would like to live if they were allowed. Separated communities are often not treated equally due to racism, classism, and various other factors. That’s not “a good and normal thing.”
Using your example of gay and lesbian elders, you state they just wanted to be “with their own.” But you left out some very important facts. These people came together primarily due to misunderstandings and intolerance by others. Elders of the lesbian, gay, bisexual, and transgender (LGBT) community are often made to feel uncomfortable about their sexual orientations and lifestyles. In some nursing home environments, they are criticized or ostracized for doing what heterosexuals consider normal for themselves during everyday living. This includes such practices as spending time with their partners, reading LGBT materials, and freely sharing personal opinions. This nursing home was created as a safe haven for them in response to discrimination in regular nursing homes.
Racism in nursing homes is not so simple as a white resident with a white CNA or a black resident with a black CNA, so “Who is to blame now?” A study from the Buehler Center on Aging at Northwestern University’s Feinberg School of Medicine states that nearly 75 percent of nursing assistants (CNA’s) working in nursing homes experience racism on the job. This research showed that nursing home residents as well as residents’ families and nursing home coworkers express racism. Racism is complex, operating systemically in nursing homes and throughout the healthcare system.
Regarding your comment, “I take offense to your hypothesis that CNA’s and other health care providers are blatantly or unknowingly bias,” I rest on my record of years of supportive praise for CNA’s and my efforts to improve their work conditions. That hypothesis has never been mine. As a hospice volunteer in Detroit nursing homes, I have had a great deal of contact with CNA’s and other healthcare providers. My book, which is posted on this website, speaks highly of CNA’s and so does my blog. I mention them often during my speaking engagements. I celebrate anyone who is doing a fine job working in nursing homes.
Frances Shani Parker, Author
“Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
April 19th, 2009 at 8:39 pm
Francis, I don’t mean to offend you or anyone else. I do mean to stick up for CNA’s and others who are being falsely accused of things that are simply not true.
I know of your book, Patti has shared it with me and I appreciate all you have done for the Hospice movement. End-of-Life care is improving every day and it is thanks to people like you.
We have written about discrimination here, several times. Usually it is from families and aimed at aides.
As for the Nursing Home for Gays, in MA, the need for it was there based upon resident need. People felt they wanted to be around others with similar sexual orientation- these people had never lived in a nursing home but were preparing for the future. The facilities owners had good intentions…I have been made aware now that this home has shut down do to a lack of enough residents.
I still believe most people are not overtly or covertly racist these days. Sure, there are some, mostly down south I suspect. But for the most part, people do look beyond color. This article about poor care tells me that we have a problem with the way we select and educate and then supervise our aides. Poor care almost always is about lack of knowledge, lack of skill. And lack of teaching and coaching. It’s rarely about much else. I honestly cannot imagine ANY nurse, or aide, purposely or non-purposely ignoring the nursing needs of their assigned residents. I CAN imagine aides not providing good care because they don’t understand the reasons behind standards; because they were never educated/trained on the skills and cause no one bothers to provide oversight to their work. Time and time again it’s been shown that lack of knowledge leads to problems. No where is this more apparent than in nursing.
April 20th, 2009 at 12:30 am
Whoa ladies…come on, we’re on the same side here.
We all agree there’s a disparity. What we don’t agree on is WHY.
I’d like to join this debate with my opinion: I think it is the lack of knowledge that causes this. In areas where there are high populations of Hispanics- CA, AZ, CO and so on- perhaps the nursing homes also have staff who are Hispanic, who took CNA courses they didn’t understand well cause English isn’t their first language. That’s a theory. Not a fact…so don’t quote me.
I do find it hard to believe nursing staff discriminate against people of their own ethnic origin, and I am going further with my theory here. If this is a cause, then we need to fix the problem.
Francis, I really doubt this is about racism. For many reasons. First off, we’re talking about nursing care- which is standardized and pretty much set in stone. We’re not talking about hotel cleaners and trash collectors- industries that have no standards and where anyone can do the work.
Which brings me to another thought: Are we training just “anyone” to do this work? Out of desperation? I bet we do. I also bet we push students thru assembly line style CNA classes designed for fast turnover…Fast Food CNA’s. If this part of the problem, we need to get on top of these Fast Food Mills and bring into line. We can’t have aides out there working who are not properly trained. That’s dangerous. I’ve seen a lot of evidence to this up here- aides who go through these one week courses are NOT at all prepared for this work. They lack basic skills and they resent being re-trained. People who have no business or desire to do this work should not be allowed to do it! There are ways to vet folks who show an interest.
The original article just begs for claims of racism and a lot of people fall into this trap where they believe THAT is what IT is. But I am skeptical and question it. I really think there is a lot more to this than meets the eye. I agree with Francis that there is a disparity and that there has been for many years. I agree with Kim in her thoughts that this is not the result of racism though. I think it’s a lack of good old fashioned training and expectation.
April 20th, 2009 at 10:54 am
When I first became a CNA, the head nurse of the unit I trained on told me something I have never forgotten:
If you accuse others of being racist, you are racist yourself.
Mind you, this was back in the 80′s, and down in the deep South. The nurse was black as were most of the staff. The residents were a mix. I was one of the few white aides working there. I admitted that I felt alittle out of place- I didn’t feel like I belonged. I went out of my way to prove that color didn’t matter to me- my job depended upon it.
I was outcasted and ignored; the other aides didn’t help me and they never took breaks with me. The nurse had a meeting about this- she was wise in her ability to SEE what was happening and to DO something about it. She told her aides THEY were being racist and that they were the problem, not me. After that, we all got along just fine and I eventually ended up being (and still am) best friends with many of these fine ladies. We killed the race card and it’s been dead eversince. When new aides come, we treat them with respect and wrap our wings around them irregardless of their color, nationality, religion, sexual orientation and all that.
The residents didn’t suffer because of my discomfort. As I said, I went OUT of my way to make sure I did my job as good as I could. Back then there were no OBRA rules to worry about; standards weren’t in place. We had very few bed sores and all the other problems. If people could just focus on the job at hand, and not all the other nonsense, we wouldn’t need to have any conversations.
April 20th, 2009 at 11:51 am
As stated in my second post, I have never referred to specific causes of the Hispanic study results. I only referred to my own general reasons for not being surprised with the results. I started my first post by saying that I was not surprised by the findings because of the existence of so many racial-ethnic disparities. Period. I proceeded to speak about racial-ethnic disparities in general and also mentioned in general the importance of healthcare workers evaluating their own racial-ethnic motivations.
I never said that nursing staff in the study discriminated against people of their own ethnic origin (although that is not an impossibility). To keep attributing specifics about this study to me is as absurd as Kim calling me a racist and referring to my non-existent “hypothesis” about all CNA’s and health care providers being biased.
I’ll conclude by saying, I did not “fall into this trap” of believing racism is the cause of the study results. Scientifically speaking, the jury is still out. My comments on racism in these posts have mainly attempted to respond, with research-based evidence, to comments that were made such as “so-called disparities,” “Color matters little when it comes to care” and the dynamics of many groups living “with their own.” I have tried to explain the systemic complexities of racism in general. I wish you all the best.
Frances with an “e”
April 20th, 2009 at 1:28 pm
Now you know why people don’t have conversations about this topic. It leads to all sorts of personal feelings being hurt, heftly opinions and general disrespect. If we could take out the feelings, the fear and put some honesty into this debate, we would all come to a conclusion that satifies us. The problem with that is this conclusion most likely isn’t the root cause of the problem. IOW, overanalyzing these things often causes us to miss the real issue.
I am sure the study authors can find hundreds, if not thousands, of nursing homes that deliver poor care to ALL it’s residents, regardless of their race. We already have proof of this: Just read some survey results.
Patti is correct when she says: We’re all in this together. Let’s stop the petty arguments and look beyond this stuff. Let’s work together to get the care improved for ALL people who reside in nursing homes.
April 21st, 2009 at 10:54 am
Well Frances I believe my “speculation” is more appropriate given the fact that I do this work for a living and that I don’t sit on the outside making assumptions and judgments based upon what I “see”. I work with plenty of people of different ethnic backgrounds, and I can assure you from their point of view as well, racism is not a factor in their willingness to care for their residents. In spite of all the research and studies. Like David said, they could easily locate thousands of nursing homes, where only Caucasian residents live, and find lots of bed sores, poor care and the like. What causes THAT? Racism? I don’t think so.
April 21st, 2009 at 5:28 pm
Like I said I suspect you’re both correct to a certain degree. I also think a lot depends upon what part of the country you’re in. Sadly racism is still alive down South, according to a lot of people I know who live and work down there.
The lack of skills is the number one reason, I believe. And I see a total lack of decent work ethic these days from aides. Hate to mention it: But many of the younger ones just don’t care. They want to make a quick paycheck and thought this work would help them do so. The work is hard, they find out soon enough, and don’t put in the same effort. I guess this is a form of age discrimination coming from me- the attitude for it anyway.