King's dream and the thorny reality in long-term care

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Staff Writer Tim Mullaney
Staff Writer Tim Mullaney

I got together with a few friends last weekend, and one of them mentioned she had volunteered in a nursing home during high school. She shared one of her vivid memories, of a certain resident who was sweet as pie with the white volunteers, but who scowled and cursed — in Spanish (her native language) — at a volunteer from India.

We all laughed, in large part because of my friend's storytelling skill. And also, I think, because this type of racism seemed forgivable. Perhaps the woman had some cognitive deficits and this was a symptom, or perhaps she really was racist — but even if that was the case, the volunteers and care workers took her ranting with a grain of salt, my friend implied. The subtext seemed to be: This woman is from another generation, and at this stage in her life, certain allowances can be made.

Still, the anecdote was in my head all weekend, as stories about the 50th anniversary of the March on Washington saturated the news.

One aspect of this coverage that has stood out to me is the focus on young people.

When he speaks at the Lincoln Memorial on Wednesday — the actual anniversary of the March — President Obama will try to “strike a chord” with the country's youth, his senior advisor Valerie Jarrett told TIME. She pointed out that after his re-election, Obama said to the nation's young people, “You are all so much better than we were.”

It's a sentiment echoed by many people reflecting on the legacy of the 1963 event, including Joseph Burden, who was a rookie cop policing the March. He told NPR:

"The changes are coming about with the youngsters. They're the ones that you see are interacting with one another, you see them marrying one another, you see them doing away with all discriminatory practices, you see them opening themselves up to — everything."

While comments like these are rightly celebratory, they have an ominous flip-side for long-term care providers. The subtext here seems: Racist attitudes are still much more prevalent among the older generation. And these are the people who will soon be knocking on the doors of long-term care communities in huge numbers. Couple this with increasing numbers of immigrant direct-care workers, and the potential complications are obvious.

It's an issue addressed thoughtfully in a California Health Report/New American Media feature by Matt Perry earlier this month. John Booker, founder of the National Association for Direct Care Workers of Color, told Perry that in roughly 40% of his own experiences as a black certified nursing assistant, there is some “initial friction” over race. Booker's advice for dealing with this friction was straightforward: “You hold back your emotions and continue to give quality care.”

No doubt, Booker's no-nonsense approach is the only possible professional response in many situations. But, clearly, providing additional training and support for caregivers to help them interact with these residents and process their own responses is called for. This is especially important because the racial composition of resident and caregiver populations is soon going to be extremely diverse. Perry described the future as: “Filipinos providing care for older Latinos, African-Americans helping aging Russians, and Asian caregivers assisting Afghani elders.”

It's a situation that seems an embodiment of Martin Luther King Jr.'s dream … except, as my friend's story about the Spanish-speaking resident and Indian volunteer illustrates, this multiculturalism is forced and can lead to conflict. It also can erode the quality of care. Residents or their families might insist on certain questionable treatments due to cultural norms, and caregivers themselves have been known to withhold painkillers due to their own cultural mores and religious beliefs, Perry reported.

This state of affairs is well known to long-term care workers, but it is an issue that merits further discussion, according to the professionals Perry interviewed. It's also an issue that long-term care stakeholders might do well to raise more loudly, especially in weeks like this, when the country is reflecting on race relations and the spotlight seems to be shining more brightly on the nation's youth than its elders.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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