My Father’s Daughter: One Daughter’s Experience with Diversity and Inclusion in Assisted Living

by

Sydney Thomas
November 29, 2021
Sydney Thomas is a Certified Professional Life Coach and a writer.

Sydney Thomas is a Certified Professional Life Coach and a writer. Formerly Director of Member Services & Operations for a senior living trade association, Sydney spends her time coaching female solopreneurs as Founder & Chief Vision Officer of Retirement Divas and is enrolled in The Bank of America Institute for Women’s Entrepreneurship at Cornell University.

I am my father’s daughter, even though he doesn’t know who I am.

Three years ago my father’s live-in caregiver who’d been caring for him in another state showed up on my doorstep with my father in tow. Given that his Alzheimer’s had progressed significantly and she was having personal and financial difficulties, she could no longer care for him.

To say that I was stunned would’ve been an understatement. My father and I weren’t close, my parents divorced when I was in college, and I’m an only child, which meant that my world had suddenly changed in a big way. I worked full-time and he couldn’t be left alone.

Did I mention that I’m also an African-American? That may not seem relevant here, but it is.

 

Lack of diversity is about more than what meets the eye

After calling at least a dozen communities, I visited a handful of them. The first thing I noticed was that if I saw any people of color at all, they were either CNAs or dining room, housekeeping, or maintenance staff. I didn’t meet any leadership team members of color and I didn’t see any residents of color either. In nearly every instance, my father would have been one of very few residents of color, and definitely the only male.

One visit to a beautiful, shiny new community brought tears to my eyes. The residents were sitting in a big room around tables working on simple puzzles or playing card games listening to old show tunes. I don’t think my father played a game or worked a puzzle in his entire life. That was so not him.

Gardening, old jazz and R&B music, cooking, helping others, caring for dogs, eating good food . . . that was my dad.

Each of the communities ran through a long list of activities they schedule for their residents, but of all the communities I visited, only one asked who my father was… what were his hobbies and his passions? What did he enjoy doing? What things made him happy? And most importantly, what could they do to make this strange new place feel like home for him?

 

Why diversity matters

Whether we want to acknowledge them or not, cultural differences are real and they do matter.

Ironically, I’d argue that they may matter more among elders living with dementia because maintaining as much familiarity and consistency as possible is so important. I once met a woman living with advanced dementia who didn’t know her own name, but when you played an old hymn, she could sing all of the verses, in perfect pitch.

Even though my father’s memory was fading, his sense of who he’d been was still there. How could that sense of familiarity, of belonging, of maintaining connections to things he’d known and loved be preserved when he moved into an all-white retirement community?

My father served proudly in the U.S. Army and has worked for, supervised, mentored, and befriended people of all races and backgrounds. He is not a racist, but he’s been mistreated countless times by people who were.

The most poignant story of racial discrimination my father shared with me happened when he was a young teenager. His mother died when he was six. His father worked their tobacco farm from sunup to sundown every day, leaving my father to raise his two younger brothers, ages four and two when their mother died.

Although he wasn’t old enough to drive at the time, thankfully my father knew how. When my grandfather was stung by a black widow spider, my father and his brothers put their father in the back of their pick-up truck and drove to the nearest hospital, which happened to be the all-white hospital serving the county where they lived.

My grandfather had very fair skin, wavy hair, and blue-gray eyes. When they arrived at the hospital, my father told the admissions person that his boss was stung by a black widow spider and was very sick. Thinking he was white, they admitted my grandfather and treated him. When it was time to take my grandfather home, a doctor patted my father on the shoulder and said Boy, it’s a good thing this man was your boss and not your father, because if you’d had to drive him all the way to the black hospital he wouldn’t have survived.

Fast forward 75+ years and I had to make the difficult choice of placing my father in a community in which he could easily be triggered by memories of invisible insults and injustices. From the outside looking in, the scene was simply a black man in a sea of white people. For my father, however, it meant being reminded of the churches he was not welcome to attend, the neighborhoods we weren’t supposed to live in, the countless times he was called the n word, the promotions he’d earned but were denied because of the color of his skin, and so much more that he never discussed.

To make things even more complicated, my father’s memories weren’t the only triggers I was concerned about. What if seeing a black man brought back memories for a white resident of another time when racism was more overt and he or she reacted as they would have years ago?

Whether another resident had an overt reaction to my father or not, social rejection or isolation is another potential cause for concern. The Centers for Disease Control and Prevention (CDC) reports that based on a 2020 study by the National Academies of Sciences, Engineering, and Medicine, social isolation significantly increases the risk of premature death from all causes, as well as a 50% increased risk of dementia, a 29% increased risk of heart disease, and a 32% increased rate of stroke. Further, loneliness is also associated with higher rates of depression, anxiety, agitation, and suicide.

 

Pervasive stereotypes

I’ve heard so many times that black people won’t move into retirement communities simply because they can’t afford it. What a dismissive and insulting stereotype. I’m one of several African-Americans who were stunned to realize how much wealth their parents had accumulated until much later in life. Our parents simply didn’t talk about money.

Increases in the numbers of middle- and upper-income African-Americans have also made additional financial resources available to support the care of their parents.

For those who buy into the assumption that the lack of finances is the only impediment to diversity in senior living, consider that a significant number of older African-Americans are military veterans eligible for very generous additional monthly benefits to help cover their health-related expenses, including assisted living expenses, through the VA’s Aid & Attendance Program.

While I’m thankful to have learned of this best-kept secret and was able to secure benefits for my father, I find it troubling that only one of the communities I visited bothered to mention it as a potential source of financial assistance if we needed it, even though for some communities, it could make the difference between whether or not a prospective resident could afford to live there.

 

3 ways you can start to make a difference

Yes, financial challenges are a significant barrier when it comes to choosing to live in a retirement community, and not just for people of color. However, if as a society we have any hope of diversifying the face of senior living in this country, we need to ask ourselves some tough questions, listen to the responses we get, and then act accordingly to implement change.

What are we doing to make African-American elders feel welcome in our retirement communities? How are we reaching out to them and their adult children to let them know that we stand ready to offer them care and dignity as they age? Are our marketing and community outreach efforts targeting and effectively reaching senior communities of color? How are we expanding our activities and other programming efforts to embrace the cultural nuances that have been such important parts of the lives of African-Americans?

Does the music we play, the styles of worship we offer, the variety in dining menu options, and even the TV programming in common spaces reflect the diversity the long-term care industry says it wants?

The lack of racial diversity in senior living is a challenge that has been generations in the making and it won’t be solved overnight, but change is long overdue.

Here are three ways you can start to make a difference.

  1. Start talking: Hold focus groups, reach out to African-American churches in your community, and enlist engaged African-Americans in your community to be champions for your organization. Ask tough questions. Be open to hearing the answers. Then demonstrate your commitment to change by acting on what you heard.
  2. Ensure board and leadership diversity within your organization: Make sure that decision makers in your organization reflect the diversity of current and future residents.
  3. Diversify your own personal and professional network: Often, we hire and recruit other professionals based on pre-existing relationships. One way to grow diversity in your organization is to ensure that your own personal and professional networks are diverse. 

Here are a few articles I found discussing diversity and inclusivity in healthcare and senior living.

Cultural Competence and Ethnic Diversity in Healthcare

Creating Inclusivity in Aging Services

Embracing Cultural Diversity at Your Assisted Living Community

If you would like to learn more or be part of the on-going conversation, contact Joy Skovira, RN at jskovira@wematchwell.com or Bree Becker, MSN, FNP-C, RN at bbecker@wematchwell.com

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