Majority of nursing home aides experience racism from residents and staff

November 20, 2002

Nearly 75 percent of nurse's aides working in nursing homes experience racism on the job, according to a study from the Buehler Center on Aging at Northwestern University.

This research showed that racism is expressed by nursing home residents as well as residents' family and nursing home co-workers. "Remedial attention is called for, and strategies for dealing with diversity in nursing homes are needed," said Celia Berdes, assistant professor of medicine at the Feinberg School of Medicine and associate director of the Buehler Center, who was the author of the study.

Berdes found that foreign-born rather than African-American aides were more likely to experience on-the-job racism. Foreign-born aides also reported experiencing prejudice against immigrants; they interpreted it as such because these responses often came from people of their own race. In her article published in a recent issue of Research on Aging, Berdes reported that for the majority of nursing home residents, the race of the nurse's aides was not an issue.

However, one-third of the nursing home residents in the study exhibited race-related attitudes, which took two forms: "anachronistic racism," language not acceptable today, used in a context not intended to be offensive, and its opposite form, "malignant racism," language meant to be derogatory or offensive.

The aides who had experienced racism on the job distinguished the two forms of racism and discounted racist comments by residents they judged to be mentally incompetent but held others - competent residents, family members and fellow staff - to a higher standard. In this way, they were able to maintain a caring attitude in their work, the authors said.

It is hardly a revelation that the two largest groups of people in nursing homes, residents and nurse's aides, are often racially and ethnically disparate. Nursing home residents are predominantly white, and research shows that nursing homes are not significantly integrated. In addition, minorities are over-represented in the nurse's aide population, particularly in urban areas. Some of the under-representation of African-Americans in nursing homes is attributable to the fact that African-Americans use nursing homes at a rate between one-half and three-quarters that of whites and that part of this disparity is due to a cultural preference for home care, Berdes said.

The predominance of whites in the resident populations of many nursing homes is often explained by the fact that they were founded and are still operated by European immigrant societies or religious organizations for the benefit of members of those groups.

The maldistribution of African-American residents in nursing facilities has to do with financial and geographic barriers, as well as discrimination.

"Financial barriers are created when facilities refuse to accept Medicaid reimbursement or limit the proportion of Medicaid-paid residents they accept," Berdes said. "Geographic barriers exist because when neighborhoods are segregated, the nursing homes in them are likely to be segregated also," she said. De facto discrimination is also at work when the ethnic or religious sponsorship of long-term care facilities discourages admissions of people who are not members of that group, Berdes said.

Over-representation of minorities in the nurse's aide population is less well understood. Studies have shown that about 30 percent of nursing home aides are non-white; however, this figure is believed to be higher in urban areas and lower in rural areas and to vary regionally.

Berdes pointed out that the market for nurse's aides is a secondary labor market characterized by low occupational status, low wages, few or no benefits, low opportunity for advancement and job instability. Historically, this labor market has been occupied by part-time workers, immigrants and racial groups that suffer from discrimination, she said.

"Racism persists in nursing homes - among people who came to maturity in a more racist time and may have forgotten what they learned since - as it may persist in few other workplaces," she said.
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KEYWORDS: racism, nursing homes, nurse's aides

Northwestern University

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