Posted by Positive Aging SourceBook on 11/23/2020

Inclusive Senior Living

Inclusive Senior Living

The generation that fought for the rights of people of color and lesbian, gay, bi-sexual, transgender, and queer (LGBTQ) individuals is aging. While the world has undoubtedly become more inclusive since their youth, there is still work to be done.

To serve all older adults, senior living communities and service providers need to be cognizant of and dedicated to promoting diversity and inclusion. Increasingly, senior living providers are acknowledging the diversity of their staff and clients. These forward thinking providers are working to make sure that everyone is comfortable and respected. Our seniors and senior living providers— all of them—deserve no less.

Positive Aging Sourcebook is dedicated to helping senior living providers promote diversity and inclusion. We have held numerous digital discussions on equity, inclusion and diversity in senior living to advance acceptance and expand understanding. View past conversations or join future discussions at retirementlivingsourcebook.com/ digital-discussions.

LGBTQ Seniors

Many of the LGBTQ seniors who are seeking senior living services today are the same individuals who struggled to come out to friends, families, and employers for decades because of fear of discrimination. Now, as they face retirement living decisions, they are again fearful that their lifestyle will lead to discrimination or the outright refusal of services.

Unlike other seniors, LGBTQ older adults are less likely to have children to help them in their later years. They may also be estranged from their families. This demographic is far more likely to rely solely on a partner or close friend for their care as they age.

In 2010, a groundbreaking documentary film addressed the dilemmas of LGBTQ seniors. Gen Silent profiles six LGBTQ seniors in the Boston area. Many of them are struggling with the decision to hide their sexuality to survive the long-term health care system.

Unfortunately, the seniors profiled in Gen Silent are not isolated examples. A 2018 analysis by University of Washington professor Karen Fredriksen-Goldsen concluded that unique prevention and intervention strategies needed to be developed to address the needs of queer seniors. The study noted that the number of LGBTQ seniors is expected to double to more than four million by 2030.

During a recent Positive Aging digital discussion, Jennifer Marie Brown, the community relations manager at Seabury Resources for Aging, explained the historical context that drives distrust among LGBTQ seniors. “During McCarthyism, people lost their jobs, people were hounded out of a lot of federal government positions here in the DMV, because they were gay and lesbians. And it made them even more closeted, more guarded, more suspect of being out or public about who they were,” she said.

Brown continued, “As we provide services for 80-year-olds, 85-year-olds, they are very leery of the consequences of being out in a retirement community or with home health care providers. They lived a life in which it was not okay to be queer in the workplace, was not okay to be queer in a house of worship, was not okay to be queer in the PTA, was not okay to be queer anywhere.”

Brown encouraged local senior care providers to seek out training and enrichment opportunities to better serve LGBTQ seniors. Some communities, including Seabury and Iona, have custom programs to serve this population. Additionally, SAGECare is an independent organization that provides training and consultation on LGBTQ aging issues to service providers.

Racism in Senior Living

When thinking of senior living challenges, most people focus on eliminating ageism. However, racism is a significant issue in senior living— just as it is throughout our society. Equity, inclusion and diversity are important topics that senior living providers must confront directly.

Historically, people of color have underutilized senior living services. Many senior living communities have completely homogenous populations—often all white. For senior living service providers, systemic racism and its corresponding economic disparities may prevent people of color from accessing services. There are also cultural barriers to access. Even for hospice services, which are primarily covered by Medicare and Medicaid, a recent study of utilization by race revealed that 83 percent of hospice patients in the United States are Caucasians, while African Americans represent only 8 percent, followed by Hispanics at 6.4 percent, Asians at 2 percent and Native Americans at .05 percent. People of color do not use senior living services like they could— or should.

Hiring Practices

Beyond utilization, one of the biggest challenges facing senior living providers seeking to promote diversity and inclusion is diversity in hiring. In senior living communities and home care agencies, frontline caregivers are disproportionately people of color, while clients are disproportionately white.

Companies that are not already doing so need to actively recruit and promote people of color. Frontline caregivers should be made aware of opportunities and paths for promotion. They should be encouraged to recruit other people like them to work in the organization. They should also see themselves reflected in the management.

To improve hiring practices, senior living providers can turn to local colleges. “You’ve all heard of Howard University. You’ve all heard of Morgan State. You’ve all heard of UMBC. So if you’re not doing active recruiting in those locations, then you’re not looking hard enough,” explained Cordell Martin, community relations coordinator at Tribute at Melford, an assisted living and memory care community in Bowie, Md, during a digital discussion. “I’m talking about bringing in talented people. I’m not talking about bringing in someone just so you can say you’ve fulfilled a quota, because that’s often how it’s presented.”

Discrimination by Clients

During Positive Aging’s digital discussion, many of the panel members and the participants highlighted discrimination by clients, especially in the home care sector. Many caregivers, particularly those who are from foreign countries, face discrimination from clients.

Caregivers may be mistreated or misjudged simply based on racist ideas. Home care workers and owners alike reported clients asking for caregivers who “didn’t have accents” or who “looked like them.”

Sambal Johnson, a caregiver with HomeCare.com, relayed her personal experience. “I’ve been discriminated against because of my name. They assume that there will be a language barrier or that I don’t know what I’m doing. But once you get in and you understand them and explain yourself to them, the majority of the people are understanding and it works out.”

Companies have to support and defend their workers—to the point of removing them from uncomfortable or unsafe situations. Todd Walrath, the CEO of HomeCare.com, spoke of how he supports his frontline workers by ensuring that they know they can always refuse a client if they feel they are in danger or being discriminated against. With clients, Walrath tries to keep the focus on the qualifications of the caregiver, instead of their race or ethnicity.

Industry Actions

To truly change the make-up of senior living, diversity and inclusion must become a way of life for companies. Dr. Jeffrey Ash the associate dean for diversity and inclusion at the University of Maryland School of Nursing explained that the single best way to encourage diversity in hiring practices and inclusion in employee experiences is to attach them to metrics. Dr. Ash encourages companies to add questions about diversity and discrimination to their employee and client reviews and to track the responses.

To help the health care industry as a whole better address these issues, HomeCare.com established a coalition called Nurses Against Racism. The mission of the group is to unite healthcare providers to make meaningful change towards racial equity in the nursing industry. For more information or to get involved, visit NursesAgainstRacism.com.

Capital Caring Health, a nonprofit provider of advanced illness, home and hospice care services throughout the Washington metropolitan area, recently established The Center for Equity, Inclusion, and Diversity to serve more minority elders who need hospice care, as well as those who need traditional medical care to remain independent in their homes.

Finally, Broadmead, a senior living community near Baltimore, is engaging in a coordinated effort to recruit a more diverse resident population. Led by Jennifer Jimenez Maraña, the community’s director of diversity and inclusion, the effort focuses on promoting social justice by ensuring that the population of residents is as diverse as the caregivers.

While none of these efforts can eliminate systemic racism or homophobia in the senior living sector, they are small and important steps in the right direction. They can also serve as a model for larger efforts to ensure that senior living services truly serve all seniors and that the industry presents real opportunities for care professionals. If we advance a system that serves all, we will all be better served.

An Enriching Community

A native Floridian, Gilbert enjoyed an extraordinary academic and teaching career, earning two Ph.D.s and gaining teaching assignments across the globe. Even though he had traveled widely, he was happy to settle in Florida. That is, until the effects of climate change made Florida increasingly dangerous.

As hurricane seasons became more intense, Gilbert and his wife faced power outages, property damage and repeated evacuations. While Gilbert enjoys good health, his wife is experiencing difficult health challenges. Every new storm brought a new threat of evacuation and new complications. It was time for something different.

The couple decided to move closer to their daughter Janice, who lives in Virginia. When Janice toured Seabury at Friendship Terrace in Washington, D.C., she was thrilled. Janice found the Seabury team to be “kind, good people.” She further noted, “The community is in a great neighborhood. We also had to take into account the cost of my parents living in DC. Friendship Terrace is an affordable community.”

Once settled in at Friendship Terrace, Gilbert began to share his many talents with his fellow residents. He made presentations on his work with Operation Crossroads Africa, helped organize discussions with residents who served in the Peace Corps, and launched lunch discussion groups. Gilbert is doing what he enjoys most: meeting new people, sharing his experiences, and NOT worrying about hurricanes.

Resources for Inclusion

Positive Aging Digital Discussions
retirementlivingsourcebook.com/digital-discussions

SAGECare
sageusa.care

Nurses Against Racism
NursesAgainstRacism.com

The Center for Equity, Inclusion, and Diversity
www.capitalcaring.org/america-must-do-better

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