Norris Cunningham

The country is changing, and fast.

Studies show that racial and ethnic minorities account for most, if not all, of the country’s population growth as of late. 

“Nationally, the U.S. grew by 19.5 million people between 2010 and 2019 — a growth rate of 6.3%. While the white population declined by a fraction of a percent, Latino or Hispanic, Asian American, and Black populations grew by rates of 20%, 29%, and 8.5%, respectively,” according to the Brookings Institution. “The relatively small population of residents identifying as two or more races grew by a healthy 30%, and the smaller Native American population grew by 7.6%.”

In addition, the country has been heavily impacted by social movements, such as Black Lives Matter and LGBTQ movements, among others. With this change comes both expected and unexpected impacts. These changes in population and cultural shifts are also reflected in nursing homes.

Implicit bias

Implicit biases are unconscious attitudes, perspectives and stereotypes that we all hold.  This is also sometimes referred to as unconscious bias. Implicit biases include attitudes or perspectives on race, gender and sexuality.  For example, studies have shown that both sexes favor men over women when it comes to career-related stereotypes. Both sexes favor women over men  when it comes to questions of child rearing. And lower socioeconomic status is generally associated with a lack of motivation.

There are many reasons we have implicit biases, many of which have to do with our upbringing and culture, but working to remove these biases is necessary as they can be harmful. Implicit bias can lead to discrimination in the form of ageism, sexism, homophobia and more.

Implicit biases also can negatively impact the care of our residents in nursing homes. Certainly, we can all agree that age, race and gender should not play a role in how residents are treated. Yet, implicit bias can unconsciously affect care and treatment.

This can lead to adverse outcomes and patient dissatisfaction. For example, one study found that providers with higher implicit biases dominated conversations with black patients, causing those patients to have less trust in their provider and feel as though they received less-than-optimal care. With the growing change in patient and staff populations, the risk increases that implicit biases will lead to missed care opportunities and safety events. 

Angela Rinehart

What do we do about it?

To provide the highest quality of care, thereby reducing the risk of claims, operators and managers of nursing homes should ensure that they and their staff take a culturally responsive approach to care.  Culturally competent care means delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and behaviors.  

How can caregivers provide culturally competent care?

First, caregivers should be aware and understand the need for cultural sensitivity.  As a caregiver, avoid making assumptions about what a resident would prefer or what you think you know about them. If you do not know, ask. In addition, be open to new information and educate yourself about other cultures.  

Lastly, build trust and rapport with your residents. For example, be conscious of your body language, which can convey as much or more than the words you are saying.  Most importantly, listen to your residents.

What can operators do?

Organizations should conduct research and collect data about performance. Issue surveys to gauge what employees’ and residents’ concerns are relative to cultural barriers. Training is key. Conduct in-services on implicit bias and cultural competence in health care and provide staff with outside resources and materials. Budget specifically for these resources.

Language barriers are inevitable as well. As such, options for on-site language classes, translation cards for staff and interpreters should be explored. Work to attract and recruit staff of various backgrounds so that residents feel more comfortable in their new home. Organize cultural activities to celebrate different cultural events. Additionally, allow staff time off to celebrate their own holidays and keep tabs on staff morale, always looking for opportunities to improve. 

After all, this can only lead to increased quality of care, better patient safety and fewer claims. 

Norris Cunningham is a founding shareholder and leads the Health Care Practice Group at Katz Korin Cunningham PC (KKC) in Indianapolis. Contact him at [email protected]Angela Rinehart is an associate attorney in the Health Care Practice Group  at KKC and focuses her practice on the defense of long-term care providers. Contact her at [email protected].