Historically, African Americans have faced discrimination in almost every aspect of their lives, including education, employment and health care. That discrimination even extends to nursing homes, where African Americans may receive lower-quality care than white residents. Some nursing home employees have personal biases that cause them to treat residents of color poorly, resulting in worse health outcomes and reduced quality of life.
As a result of this legacy of discrimination, it can be difficult to find an assisted living community that provides culturally responsive care. African American caregivers may even feel guilty if they can no longer provide the level of care their loved ones need, making them hesitant to explore other senior living options.
This guide provides insight into why it’s so difficult for many African Americans to access high-quality senior care. It also explains why Black Americans tend to distrust the health care system and offers tips to help you find the right assisted living community for your older loved one.
For African American seniors, finding an assisted living community isn’t as simple as looking through a directory and choosing a facility based on reviews or amenities. Discrimination, financial challenges and cultural distrust all make it more difficult to find a safe, comfortable environment that offers the right level of care.
Although the Fair Housing Act prohibits discrimination on the basis of race or ethnicity, not all leasing agents and community managers follow the law. As a result, African American seniors and their family members must be aware of the potential for discrimination when searching for an assisted living community. This discrimination is well-documented in public health research.
According to researchers from the University of Wisconsin-Madison, African American seniors are overrepresented in nursing homes and underrepresented in assisted living communities. In other words, they’re less likely to move to assisted living facilities when they decide that living at home is no longer an option.
It’s not entirely clear why this is the case, but it may be due to the effects of racial discrimination on a senior’s knowledge of long-term care options. Racial disparities in health care may push African American seniors toward nursing homes, rather than making them aware of assisted living and other forms of long-term care.
In long-term care settings, African American seniors are also more likely than white, non-Hispanic seniors to experience racial disparities. This includes poor quality of health care and lower levels of social engagement. For example, African American residents are less likely to feel comfortable interacting with others during structured group activities, which can lead to social segregation and isolation.
When discussing the issue of racial discrimination in long-term care facilities, a focus group of ombudsmen revealed that they had personally witnessed residents of color refuse to file complaints regarding abuse and violations of their financial rights. When asked why, the residents reported that they were concerned about retaliation or didn’t want to be labeled as “problem” community members.
Structural racism in the health care system also contributes to the difficulty African American seniors face in getting appropriate care. Although some discriminatory policies have been eliminated, many African American adults continue to experience the effects of those early policies. For example, the Hill-Burton Act was supposed to help Americans by financing the construction of hospitals in underserved communities. The law contained a separate-but-equal provision, allowing facilities to discriminate against patients of color under certain circumstances.
While the Hill-Burton Act did improve access to health care, many African Americans hesitated to support this “accommodation to segregation.” Some of them stopped seeking preventive care, causing them to develop serious health conditions as they aged. Those health conditions make it more difficult to qualify for assisted living instead of nursing home care.
Structural racism isn’t the only form of discrimination in the U.S. health care system. Many physicians, despite their promise to “do no harm,” have some level of implicit bias against African American patients. This type of bias causes health care professionals to stereotype patients of color and treat them differently from white patients without even realizing it. In the early 20th century, medical school professors taught some of these stereotypes to their students, perpetuating racism and making African American patients more likely to avoid seeking health care.
One common stereotype is that African Americans have less sensitive nerve endings than their white counterparts. As a result, they’re less likely to receive appropriate treatment for pain. In fact, one study showed that Black patients are 22% less likely than white patients to receive pain medication in a hospital setting.
Generations of racism and mistreatment have left many African American adults hesitant to seek care, even when they have symptoms of a potentially serious condition. When these adults are ready to move out of their homes and into some type of senior care, they may not qualify for assisted living due to the cumulative effects of avoiding medical care for so long.
In 2021, assisted living had a median monthly cost of $4,500, according to the Genworth Financial Cost of Care Survey. Median costs are much higher in cities such as Los Angeles, New York and Seattle, as they all have higher-than-average costs of living. Many seniors struggle to afford this type of care, but the financial challenges faced by African Americans make it even more difficult to access assisted living services.
In many areas of the country, occupational segregation makes it more difficult for African Americans to land stable jobs with high pay rates and comprehensive benefits. Some hiring managers also engage in discriminatory behavior, such as refusing to hire African American applicants. As a result, Black Americans have higher rates of unemployment than white Americans.
When the economy slows down, African American workers are often the first to lose their jobs, making it difficult to save money for emergencies and maintain continued access to health insurance and other benefits. Additionally, once an African American worker loses a job, it takes them longer than a white worker to find new employment.
The United States has many programs designed to promote innovation, but African Americans are often excluded, leaving them unable to access research funding. This makes it more difficult to invent new products or start successful businesses. As a result, many African Americans struggle to build wealth. Lower levels of wealth affect an African American senior’s ability to pay for senior care.
The Equal Credit Opportunity Act prohibits creditors from taking these actions based on race, color or national origin:
Unfortunately, the ECOA didn’t go into effect until 1974, more than a century after the Civil War ended. During that century, African Americans faced intense racism. For example, Jim Crow laws excluded Black men and women from serving on juries, using public transportation and accessing high-paying jobs. When the FICO scoring system debuted in 1989, more than 100 years of discrimination made it difficult for African Americans to qualify for credit cards, loans and other forms of credit.
Discrimination has also made it difficult for African Americans to create generational wealth, leaving their children and grandchildren at a disadvantage. Generational wealth refers to the transfer of assets from one generation of a family to the next. The transfer of valuable assets makes it easier for heirs to build a strong financial future. For example, someone who inherits a piece of real estate can borrow against the value of the property or sell the property and use the proceeds to start a business, pay for college or purchase a vehicle.
Segregation, employment discrimination and other discriminatory practices have made it difficult for African Americans to purchase assets and pass them on to their children. As a result, many African American seniors lack the funds needed to pay for assisted living and other forms of care.
African Americans haven’t always been treated fairly by government agencies and health care organizations. In 1932, researchers at the Tuskegee Institute began following a group of African American men with syphilis. They never offered any treatment, allowing the disease to progress. During the 20th century, thousands of Black women were also sterilized against their will as part of a widespread eugenics program.
Although things have improved, African Americans continue to face discrimination in the health care system, causing some of them to avoid seeking medical care. What makes the situation even worse is that patients who avoid preventive care due to their high level of mistrust are often called “noncompliant” and blamed for their worsening health problems.
In 2020, 55% of African Americans reported that they distrust the health care system. For some people, their mistrust runs so deep that they refuse to fill prescriptions, attend medical appointments or accept medical advice. As a result, they may have to move out of their homes earlier than expected. African American seniors with advanced health problems may need too much care to qualify for assisted living, forcing them to move into skilled nursing facilities.
Ethnic minority caregivers, including African Americans, provide more care to their older loved ones than white caregivers do, often with fewer resources and more demands on their time. This may be due to the cultural expectation that family members and neighbors look out for each other. As a result of this expectation, many African American caregivers feel guilty when they can no longer provide the amount of care an older adult needs. If you’re struggling with this type of guilt, here’s what you can do to overcome it:
Caregiving comes with a variety of challenges, but you don’t have to tackle them on your own. Consult one of these resources if you need more information about providing culturally responsive care to an older adult.
SGECEP educates health care professionals on how to provide better care to members of diverse populations. The organization’s website also has helpful articles on geriatric health care.
(202) 289-6976 [email protected]
Justice in Aging advocates on behalf of older adults and their caregivers. They focus exclusively on health care equity and economic security.
The ASA has several initiatives designed to address inequality. It also has a diverse board of directors, which helps ensure that all ASA educational materials are appropriate for diverse audiences.
NCCBA has several programs to help minority citizens access affordable housing and improve their well-being. The health and wellness program aims to eliminate health disparities for older minority adults and their caregivers.
AAWP aims to help African Americans learn how to advocate for better health care. Its partners provide funds to help address inequities related to diabetes, heart disease and obesity in African American individuals.