Bigotry/Racism in SNF's

[CapeCodMermaid, RN]

OKAY---here's the problem. We have a lot of demented residents, as do you all, I'm sure. Many of them hate black people, Haitians, Portugese people...they are always saying things like "she hurt me...you know those kind stick together"...or, "she's mean to me, you know how blacks are". Do you have these problems? and do you investigate every allegation?I know I need to protect my residents, but I also need to protect my staff from crazy allegations based on color. On my 11-7 shift, there is only one white CNA in the building so it would be impossible for me to assign someone else to these bigots....

[KrisV27]

Where I work, we have many nurses and aides (mostly men) from other countries, mostly in Africa. I find that the families of the residents and the residents that are cognitively intact are the worst when it comes to racism. As it is impossible to assign workloads according to certain clients' "racial needs", I find I must be firm with them. I tell them, "you are hateful, we will not tolerate this in this building, if you don't like it then go to another nursing home." This might sound unprofessional or very straight-forward, but it certainly shuts everyone up. "When they say I don't want that (man, black, etc) in here", tell them "too bad!"

[SueNYC]

Funny how this was an issue in our LTC today. Our place as predominantly haitian cna's and nurses. One of our patients has a husband on another floor who would come to visit her daily. Whenever something didnt go exactly how and when the husband would like it, he'd start the yelling,cussing and racial slurs. As of yesterday, our supervisor has refused him to come and visit her on our floor, primarily for the aforementioned reason as well as reasons pertaining to our patient, for instance when he does visit his wife, she gets very down, refuses to eat etc. Our patients sister came in today stating how we all must forgive his outbursts but hes a sick old man. Though im not haitian , just hearing the nonsense sickens me. We are all professionals, whatever position or race and should be treated as such. The patients sister would not accept all of our reasons for doing what we did. But it gets to a point that having this man continue on would end up with someones job on the line if a situation occured and someone couldnt control themselves in front of him. Granted, this is not every situation, nor can we just ban the ignorant bastards, but we still need to stick up for ourselves and others whenever possible

[MDSlady]

We also have encountered this problem. We just had a problem yesterday with this. A resident rang her call bell while she was in the bathroom. As all CNA's and other staff must do, a male African-American aide went in there and this resident was EXTREMELY upset. Screaming, yelling out racial slurs, etc.

First intervention for us, was no male CNA's. We then had Social Services call the daughter and explain the whole situation to her. We have a very good social services director who explains the whole situation and then says that we will try no male caregivers and take it from there. It is very difficult when this filters down to females too.

Tough call....but I think it ultimately comes down to Social Services and family. If it continues to be a problem, the issue of finding another home or live-in home care comes up.

Last resort.......psych consult......

[rn/writer, RN]

Whoa, Nellie! While you are absolutely right that you can't accommodate racism, telling people that they are hateful or referring to them (even in your head) as ignorant bastards, is not likely to make things less ugly. In a way, you are behaving in a similar way because you see only their exterior and have lost your awareness that there is a person behind the bad behavior.

Let me tell you what happened with my 94-year old grandmother.

She lived on her own, despite having many health problems, until she grew too weak to care for herself. Then my aunt moved her into a large nursing home with a staff that is probably 75 % black or hispanic. My grandmother grew up in a little town in Wisconsin and did not even see a black person (no TV back then) until she was well into adulthood. Fast forward to the late '90s and here she is, weak and dependent on people she has never felt comfortable with her entire life.

My aunt spent many hours at the nursing home, trying to keep tabs on the staff. The very folks who could have taken offense, didn't. Instead, they took the distrust and negative comments in stride and responded with compassion, excellent care, explanations for what they were doing, and gentle humor. They asked my gma about her family and started sharing bits and pieces about theirs. Both my gma and my aunt began to see "those black girls" as individuals and even started requesting the ones they had gotten to know.

The real turning point came when my gma was in a lot of pain and transferring her to a wheelchair or sometimes even turning her was something she dreaded. There was a large black MALE CNA who, in my gma's previous life outside the nursing home was probably her worst nightmare. Though she was terrified at the sight of him, she let him pick her up and place her in the wheelchair and his strength became her salvation. She learned to trust him and thanked him for his gentle ways.

After a year and a half in the nursing home, my gma died a fairly peaceable death of pneumonia. By this time, she and the various staff members had grown close. She left little trinkets for her regulars and some of them came to her funeral.

They defused a potentially contentious situation (my aunt was sometimes horrendously blunt and insensitive) by understanding that fear was a big component in the situation and by demonstrating genuine caring along with the nursing cares. In a perfect world, no one would have to win someone over in that manner. But in this imperfect world we live in, their patience, good humor, and refusal to take things personally and respond defensively made an old woman's life bearable and helped her to set aside years of ignorance and prejudice.

I'm not suggesting that you have to put up with outright abuse. But if you do encounter someone (resident or family member) who is openly bigoted, instead of saying, "You are hateful," try saying, "I'm so sorry you are upset. I'm sure this is a challenge for you." Meet them where they are even if you think they are terrible for being there. Sometimes, that alone lets some of the steam out of the balloon. In no way does this excuse or endorse their bigotry. It only tells them that you are trying to connect. If they are at all receptive, you can ask them to be specific about their complaints.

If they object to the staff being people of color, you can suggest they might feel more comfortable at another facility (though staffing is similar in many places). If they say they have no choice about moving, here is your opportunity to say, "Then we should probably look at how to help you (or your loved one) adjust to being here." You can introduce a CNA by name and turn her into a person. "This is Charmaine. She has worked here for six years and she is one of our most capable people. Would you rather have her help you get ready for bed at seven or at eight?"

You don't have to get drawn into a power struggle or be pulled down to the level of an angry (and probably fearful) person. Set your boundaries (which absolutely draw the line at physical or verbal abuse) and remain professional. Encourage your staff to see past the "mouth" to the resident who has lost so much control over life and the family members who are often struggling with guilt.

William Bennett (quoting someone else whose name escapes me) said, "The only way to be comfortable is to make others comfortable. And the only way to make others comfortable is to act as if you love them. And the only way to act as if you love them is to really love them."

A tall order, and, while it doesn't always work (people can still make lousy choices), it is the only thing that stands a chance.

I wish you well.

[SueNYC]

RN/writer said:

Whoa, Nellie! While you are absolutely right that you can't accommodate racism, telling people that they are hateful or referring to them (even in your head) as ignorant bastards, is not likely to make things less ugly. In a way, you are behaving in a similar way because you see only their exterior and have lost your awareness that there is a person behind the bad behavior.

....

I'm not suggesting that you have to put up with outright abuse. But if you do encounter someone (resident or family member) who is openly bigoted, instead of saying, "You are hateful," try saying, "I'm so sorry you are upset. I'm sure this is a challenge for you." Meet them where they are even if you think they are terrible for being there. Sometimes, that alone lets some of the steam out of the balloon. In no way does this excuse or endorse their bigotry. It only tells them that you are trying to connect. If they are at all receptive, you can ask them to be specific about their complaints.

To readdress this..

in the situation I spoke on....This is a resident who has been with us for several years. Obviously then the nurses at our place have also dealt with her husband for that long. Have dealt with his outbursts and reacted with patience and kindness. And yes, they have tried consulting with him as well as other family members on how to resolve the issue at hand to no avail. What it came down to was the nurses received a sorry but we cant do anything it, deal with it. Our resident, his wife, loves our home and all the people who give her care so shes not going anywhere, neither would we want her too however in short if we are told to simply deal with it from her husbands family, then we did by not allowing him to come and see her on our floor, even if for a short time. I hear what your saying about your gm, but eventually she came to accept her care from whom ever as long as they showed her respect, and care, this man does not. Nor, as this man lived around people, or not interacted with people who were not white... we live in nyc, predominatly a multi racial population, his and his wife has had care givers for the past ten years who were not white... etc.

So though I may have offended when referring to such people as ignorant bastards... im sorry but its how I feel and no one deserves to be abused when all they do is tend to anothers need as if this person was their own family.

[BamaBound2bRN]

I know this is kind of off the subject, but.........I was on the UA campus in Tuscaloosa, Al. today heading to the library to study for a Chem exam. The library wasn't open yet, so I parked and decided to walk around campus. There is a home football game tonight (which I plan on watching in my Lazyboy with a cold one), and there were several folks out on each corner selling tickets. At each corner I politely said "Not interested" and one gentleman called me a "Racist Bast**d"- I said excuse me, and he said "Fine whitey just walk on by like you better than me".......I politely told him where he could go :angryfire

[chadash]

It is so sad that racism prevails. How do you change someones heart? I have been really impressed with my fellow aides who have taken this in stride. I have spoken to a couple patients when it has come up, and flatly have told them they were wrong. Believe it or not, the most prejudice persons I have met in the south here have been educated atheist. Go figure. I hate it!

[jkaee]

I'm sorry, and I'm prepared to get flamed for this, but why does anyone think that they can change a demented, confused, elderly persons mind, or "educate" them on racism and it's implications? I spent 10 years in LTC, and of course I've seen instances that are described here. And I have to say that none of the CNA's or nurses that were of color took offense to the behaviors of the confused or demented residents. All staff caring for these confused residents must realize that the disease processes associated with Dementia, Alzheimers, OBS, etc...not to mention psychiatric disorders, break down peoples inhibitions, distort reality, and changes these once kind, caring, religous individuals into ranting, raving, cursing, socially inapprorpriate residents. We've all seen it.....the quaint Sunday school farmer's daughter that screams the "F" word every 10 minutes.....plays with her feces, screams, bites and kicks.

Besides the disease processes that these residents are dealing with, you must understand the time and place that they come from as well. It was a different time back then. People didn't have TVs or talk shows to make them more aware of socially prevelant issues. People weren't taught from childhood back then to take the time to get to know someone, rather than looking at their color. You can't judge yesterday's people by today's standards. And quite frankly, looking a confused resident in the eye and giving them hell for acting out the way they are is totally inappropriate. You are NOT going to change them!

None of this applies, of course, to family members or alert and oriented residents. In this situation, compassion and education is certainly in order. But, the staff is then responsible for rising above the comments and showing them how caring and competent they are, and not showing them anger or hositility. If they do that, then they are only reinforcing the familiy or residents warped views.

I think that the staff that RN/writer encountered did an admirable job of gaining her grandmother's trust.

[chadash]

I agree that racism is a form of dementia.

[CapeCodMermaid, RN]

My tiny (4'6") Irish grandmother hated black people...she had been beaten up in the subway in Boston 4 or 5 times when someone stole her purse. When my grandmother became ill, she moved into a nursing home where, of course, there were black people working. She called me up one night and said "I've been wrong"...wrong about what I asked. "Not all black people are bad she said. The ones here are nice. I wished I'd found this out sooner in life." If my 87+year old grandmother can change, then anyone can.

[DusktilDawn]

I think RN/Writer made a lot of good points in her posts.

There are a lot of people who have very limited experience with those of another race and/or culture. People often fear that which they do not know.

There may be underlying factors that have nothing to do with racism but are expressed in that form. Communication and understanding can go a long way. So often what is directed towards us as caregivers is really not about us, it is usually about something else.

There are some for whatever reason have an unreasonable hatred/distrust of those of another race and that can stem from many factors including upbringing. As Chadash stated "How do you change someone's heart?", my only response can be "Is by showing them yours."